Circumcision
Circumcision (from Latin circumcisio 'circumcision' ), also male circumcision , is the partial or complete removal of the male foreskin . It is one of the most frequently performed physical interventions in the world and is usually performed for religious and cultural reasons , rarely with a medical indication .
It is estimated that between 25% and 33% of the world's male population is currently circumcised. The circumcision of healthy children on the eighth day of life is considered a command of God in Judaism . The Koran does not specifically mention them. Nevertheless, it is widespread in Islamic countries as Sunna and is carried out in childhood or adolescence. In some societies, circumcision is an initiation ritual ; this ritual symbolizes the adolescent's acceptance into the community of adult men.
Circumcision is one of several treatment options (e.g. triple incision ) that is indicated, for example, in severe forms of pathological phimosis , if treatment alternatives are not promising or previously did not bring healing success.
Circumcision as a routine operation is particularly controversial among minors, even if not nearly to the extent that it would be comparable to the universal outlawing of female genital mutilation . Non-medically justified circumcision is rejected by child protection associations and medical organizations because it irreversibly changes the body and, in the case of boys who are unable to consent, is not in line with health protection and child welfare. In the Anglo-Saxon area there has been a social debate for some time between groups who oppose it (“intactivist” movement) and groups who support circumcision. In particular, the medical benefits and risks are controversial, and in the case of children also ethical and legal aspects, as well as the assessment with regard to human rights , especially the right to physical integrity .
Circumcision in Cultural History and Religion
Origin and ritual meaning of circumcision
The origins of the custom of circumcision are largely unclear. Presumably, tribal patriarchal societies introduced circumcision of both sexes. The oldest traditions of the ritual point to ethnic groups that lived in arid , desert-like regions. Nomads in particular from North and East Africa as well as Australia and their successor religions still practice the religiously motivated circumcision of boys, of girls (see Geographical Distribution of Female Circumcision ) or of both sexes.
Finds of the traditionally used tool point to an origin in the Stone Age . It is assumed here that the procedure initially served to mark tribal affiliation.
Archaeological finds suggest that as early as 7500 BC Chr. The castration as an act of devotion essential part of the ancient Cybele cult was. According to a theory of urologists Mordeniz and Verit, this developed into the custom of foreskin circumcision as a less invasive and bloody procedure. Contact with the cult at the beginning of the 1st millennium BC led to the adoption of the custom in Judaism. Another, more popular argument is that the foreskin is basically the only part of the (male) body whose “sacrifice” does not cause any damage. This reform was a pars-pro-toto sacrifice, which in the biblical tradition - and for the outlined connection between human sacrifice (here the sacrifice of the son Isaac ), circumcision and fertility exemplarily - Abraham undertook the first ( Gen 17.12 EU ).
The ritual or religious circumcision during puberty is considered an initiation rite for both sexes . The growing person is accepted into the community by being consciously brought into a crisis situation in which he should “ show courage ”, “prove himself” and prove to be a “full member”. He often has to endure painful or humiliating procedures. The circumcision of the Bambara and Dogon in the West African Mali represents a rite of manliness, which is supposed to cancel the original androgyny , symbolized by the foreskin as “bewitched femininity”.
In addition to the circumcision of the man's foreskin, there are various forms of surgical interventions on the penis that are still practiced today in primitive peoples as part of such initiation rites . Among the Aborigines (the Australian natives) and on several islands in the West Pacific Ocean , it is a custom to slit open the penis of young men a few weeks after removing the foreskin, which causes a complete or partial split of the urethra , the so-called subincision . In Indonesia , some boys have bamboo or metal balls, so-called implants , placed in the penis shaft or glans at the beginning of puberty .
Circumcision in Ancient Egypt
The oldest known representation of circumcision carried out by priests is an Egyptian relief in the mastaba of Ankhmahor, vizier of Pharaoh Teti II , in Saqqara (around 2300 BC). The origins of circumcision in Egypt are associated with the serpent cult there, which is expressed in the worship of the gods Mehen , Wadjet and Apophis . The ancient Egyptians regarded the snake as immortal because it shed its skin and was able to renew itself again and again. Some cultural historians suspect that the circumcision of a man was supposed to symbolically trace the skin of the snake and make the human soul immortal.
Judaism
According to the Torah , circumcision was introduced among the Israelites through a divine commandment to their ancestor Abraham :
“But this is my covenant, which you are to keep between me and you and your generation after you: everything that is male among you is to be circumcised; you shall circumcise your foreskin. That should be the sign of the covenant between you and me. When it is eight days old, you are to circumcise every child of your offspring. [...] But if a male is not circumcised on his foreskin, he will be cut off from his people because he has broken my covenant. "
As mentioned here, circumcision should take place on the eighth day after the birth. It is performed by a Jewish circumciser ( Mohel , plural Mohalim ) who was trained in it. There are different opinions as to whether the Brit Mila should take place without or with anesthesia.
In Judaism, circumcision is viewed as entering into the covenant with God. According to Jewish tradition, God entered into this covenant with Abraham (and his family); therefore the circumcision covenant is also known as the “Abrahamic covenant”.
Just like the Jewish-Hellenistic philosopher Philon of Alexandria in De Circumcisione in the 1st century AD, the Jewish doctor and Rabbi Moses Maimonides also advocated circumcision in the 12th century because of its allegedly moderating effect on the sex drive : the sexual organs were supposed to be injured and are weakened so that they still work, but no longer allow "excess" pleasure . According to Maimonides, the ability to give the wife sexual pleasure is a prerequisite for marriage.
While, according to the (Christian) historical-critical biblical research, most of the history of Abraham was created around 950 BC. . AD are assigned to this form of the Abrahamic covenant until 400 years later with the Priestly in the wake of a comprehensive review of the Pentateuch have been inserted. The same applies to the repeated prescription of the circumcision of boys on the eighth day of life by God in the Torah ( Lev 12: 1-8 LUT ), which is mentioned there in the context of the mother's temporary uncleanness. The original version of the covenant is Genesis 15 ( Gen 15: 1–21 EU ), which Abraham concluded there by means of animal sacrifice.
According to Israeli anthropologist Nissan Rubin, Jewish circumcision did not include the periah for the first two millennia . This was only prescribed by the rabbis in the time of the Bar Kochba uprising (132–135 AD) in order to a. Meshikhat orlah ( repairing the foreskin by stretching) mentioned in the Talmud and the Maccabees ( 1 Makk 1,11-15 EU ) impossible. This had spread under Hellenistic influence, since in Greek society a bared acorn was considered obscene and ridiculous.
Books 1 and 2 Maccabees - which are regarded as Apocrypha according to the Jewish and Protestant understanding - are the oldest known source for the suppression of the Brit Mila . According to the Maccabees, Antiochus IV Epiphanes tried to Hellenize Jews in his empire at the beginning of the second century BC : “[…] He also forbade circumcision and ordered people to get used to all impurities and pagan customs… The women who their sons had circumcised and were killed as Antiochus had commanded; the boys were hung around their necks in their houses and they were also killed who had circumcised them. "( 1 Makk 1,51-64 EU )" Two women were brought before because they had circumcised their sons. The children were tied to their chests and led around the whole city in public and finally thrown over the wall. "( 2 Makk 6,10 EU )
In ( 1 Sam 18,25-27 EU ) King Saul demands a bride price of 100 foreskins of killed Philistines from King David for his daughter, in the hope that he will perish in the process, but the latter then hands over double the amount. In ( Gen 34,14-25 EU ) the brothers Dinas, a daughter of Jacob who was raped by the son of the local Hiwiter prince, demand the circumcision of his tribe as a prerequisite for a compensatory marriage. Here, too, the demand turns out to be a ruse, because two of the brothers use the wound fever of the circumcised to kill everything male in the city without hindrance.
Within the reform Judaism that emerged in Germany in the 19th century , there were voices who wanted to abolish or at least modify the old ritual. In 1844, Rabbi Samuel Holdheim , in his book About Circumcision, took the position that circumcision was not a sacrament and therefore not a necessity for belonging to Judaism. Abraham Geiger , one of the founders of Reform Judaism, which in Germany is referred to as Liberal Judaism , decided to keep circumcision, which continues to apply to Reform Judaism today. In the 19th and early 20th centuries, some assimilated Jewish families did not have their sons circumcised. For example, Theodor Herzl did not have his son Hans circumcised in 1891. Theodor Herzl did not identify with Judaism until 1891; Before he began to found modern political Zionism , he recommended a mass baptism of Jews in St. Stephen's Cathedral in Vienna as a solution to the “Jewish question” .
Currently, most Jewish families - including most non-religious ones - have their sons circumcised shortly after they are born. In the countries of the former Eastern Bloc - it disintegrated in 1990 - according to a mohel working there, only a very small minority of Jewish men is circumcised, which is due to the former communist regime in these countries; According to the mohel, however, the willingness to circumcise is now increasing significantly. In Israel , where, according to Rabbi Moshe Morsenau, head of the Circumcision Unit (Brit Mila) in the office of the Israeli Chief Rabbinate, around 60,000 circumcisions took place in 2011, the proportion of uncircumcised Jewish sons is estimated at 2% and the number of Families who have renounced a Brit Mila, a few thousand. Israeli opponents of circumcision say new polls show that 3% of Jewish Israelis either did not or do not want to circumcise their sons.
Christianity
In early Christianity , Paul of Tarsus spoke out against a duty of circumcision for the newly converted Gentile Christians . Paul himself was a circumcised Jewish Christian . Decisive for him was not the physical circumcision, but - also underlined already in Judaism - "circumcision of the heart" as they already know the fifth book of Moses: "You shall circumcise the foreskin of your heart, and be no more stiff-necked." ( Dtn 10.16 EU ). Anyone who believes, according to Paul, to be pleasing to God and to become holy through physical circumcision alone, is on the wrong track: “Circumcision is useful if you keep the law; but if you do not keep the law, you have already become uncircumcised from being circumcised ” ( Rom. 2.25 EU ). The decisive factor is humble faith : "For in Christ Jesus it is not a matter of being circumcised or uncircumcised, but of having faith that is effective in love." ( Gal 5,6 EU )
He condemned the relapse into a mere law attitude in Philippians in a clear exaggeration: (Phil 3,2-4a: 2) "Beware of the dogs, beware of the evil workers, beware of the intersection." (3) " Because circumcision, that is us, who serve in the spirit of God and boast in Christ Jesus and do not trust in flesh ” - (4) “ although I could also trust in flesh. ”
If one had adhered to the obligation to circumcise male converts, this would have meant a very considerable obstacle for the missionary work of non-Jews and the ascent to a world religion .
With the end of ancient Jewish Christianity as a separate trend, circumcision almost completely disappeared in Christianity. Some Christian churches such as the Coptic Orthodox Church , Ethiopian Orthodox Church and the Eritrean Orthodox Tewahedo Church continue to practice circumcision. In Christianity, the ritual of the circumcision of newborn males, which is also a ritual of the name or its assignment, has largely been replaced by that of baptism .
The Visigoth King Wamba put in a 673 circumcision as punishment for members of his own troops, the Spanish during a campaign women had raped. Those affected were marked as Jews in accordance with the anti-Jewish legislation of the Toledan Empire and expelled from the Christian community.
In 1962 the Second Vatican Council abolished the feast of the circumcision of the Lord (in circumcisione domini) , with which the circumcision of Jesus ( Lk 2.21 EU ) was commemorated eight days after Christmas Eve .
Islam
Circumcision ( Arabic ختان chitān , DMG ḫitān andختن, DMG hatn , Persian andختنه chotne , DMG ḫotne ) is nowregardedby most Muslims as an integral part of Islam . Tradition has it that theProphet Mohammed was born with no or a very short foreskin. Circumcision is now performed among Muslims as a sign of religious affiliation in childhood - up to the age of 13. A large family festival is often celebrated on this occasion. In most cases, the circumcision is done so that the entire foreskin is removed so that the glans is always exposed. The “low & tight” circumcision style is widely used here.
In some countries (e.g. Turkey) boys are circumcised in later childhood. At the family celebration , the Sünnet , organized on this occasion, Islamic elements can mix with traditional elements.
Circumcision is not explicitly mentioned in the Koran and can only be derived from the instruction to follow the religion of Abraham:
“Say, 'What God says is the truth.' Follow the way of Abraham the Hanif ! He believed deeply in God, to whom he did not associate any other deities. "
However, circumcision is mentioned in the hadiths . The following tradition is of fundamental importance:
“ Abū Huraira , may Allah be pleased with him, reported: The Prophet, may Allah bless him, said: Fitra (natural disposition) includes five things: circumcision (of men / boys), shaving off pubic hair, cutting (Finger and toe) nails, plucking (or shaving) the armpit hair and trimming the mustache. "
There is also a hadith according to which Mohammed circumcised his two grandsons al-Hasan ibn ʿAlī and al-Husain ibn ʿAlī , but it is not considered trustworthy because it is not mentioned in either the six books or the Musnad of Ahmad ibn Hanbal .
Nonetheless, the circumcision of the male genitals is a duty for most Muslims and is usually commissioned by the parents for male Muslim children at an early age - often as babies. In the case of Muslims who later convert, circumcision can be carried out through an operation with local anesthesia. It is considered one of the signs of prophethood that the prophets are already circumcised - that is, born without a foreskin. To be circumcised can be interpreted as "following the example of the prophets".
The circumcision costume (Sünnet Kıyafetleri) worn on this occasion is a traditional, religious costume that is mainly used in Turkey , is elaborately made and usually consists of trousers, a shirt, an embroidered vest, a tie or a bow tie, a long one Cape and a striking headgear. The basic color is often white, but it can also be a different color. Shoes and a scepter or dagger are worn for this. Sometimes a sash with the inscription "Masallah" is worn around the shoulder, which in Arabic means "May God protect you".
Yezidism
Also in Jesidentum , which although a monotheistic religion is not on the revelations of Scripture based, circumcision is of boys aged 14 years part of the traditional rites of passage , the Sinet or Sunet is called.
Modern times
In 1712 the pamphlet Onania, probably written by the enterprising quack and writer John Marten and published anonymously, appeared in England : or, the Heinous Sin of Self-Pollution ("Onanism or the hideous sin of self-pollution "), which gradually spread to everyone has been translated and widely used in European languages. It claimed that excessive masturbation could cause a variety of diseases such as smallpox and tuberculosis . Even the great enlighteners of the time believed the anonymously published work. Denis Diderot even included the questionable theses in his encyclopédie . In the 18th and 19th centuries a “campaign against masturbation” took place all over Europe. Countless scientific and popular science publications have appeared denouncing the alleged dangers of masturbation and offering methods of preventing it. The font L'Onanisme. Dissertation sur les maladies produits par la masturbation ("Onanism. Treatise on illnesses through masturbation") by the Lausanne doctor Simon-Auguste Tissot apply. Many doctors of the time believed that masturbation was the cause of “youthful rebellion” and of diseases such as epilepsy , “softening of the body and mind”, hysteria and neuroses .
In Victorian England , circumcision was particularly popular among the upper classes. Via the British colonization (→ British Empire ), circumcision also spread to India (a British colony until 1947), North America, Australia , New Zealand and South Africa. From around 1860 publications appeared that propagated circumcision as “prevention against masturbation” - at that time pejoratively referred to as “self-abuse” - or as a “punishment” for it. Examples:
“ In cases of masturbation, I believe we need to break the habit by bringing the affected parts of the body into such a state that it is too difficult to continue the practice. To this end, if the foreskin is long, we can circumcise the patient with present and likely future benefit. Also, the operation should not be performed under chloroform, so that the pain suffered can be related to the habit we wish to eradicate. "
" A remedy for masturbation, which is almost always successful in young boys, is circumcision [...] The operation should be performed by a surgeon without anesthesia, as the pain associated with it has a beneficial effect on the mind, especially when interacting with the Notion of punishment. "
“ Clarence B. surrendered to the secret vice that is common among boys. I performed a circumcision on him [...] He deserved the just punishment by the pain of the operation after his illicit sensations. "
The number of circumcisions increased. The anti-masturbation motivation can still be found in Campbell's Urology, an English-language standard textbook on urology, in the 1970 edition:
“ Parents readily recognize the importance of local cleanliness and genital hygiene in their children, and are usually willing to take measures that can prevent masturbation. For these reasons, circumcision is usually advised. "
Medically unnecessary circumcision of the penis was removed from the list of paid health insurance benefits in Great Britain after 1949 (the National Health Service was established in 1948 ), and in Canada in the 1990s. In Australia , levels dropped from 90% to 10-20% in the 1970s. In the United States, values fell from around the 1980s (not as sharply and partly indexed by immigration). For more information, see the section " Situation in individual countries ".
present
In the United States, 56% of newborn males nationwide were circumcised before discharge from hospital in 2005 , according to a report by the Agency for Healthcare Research and Quality (AHRQ). In the Midwest , the proportion was significantly higher at 75% than in the West at 31%. The sources differ about the development. While the AHRQ report shows a largely stable rate over the past ten years, other surveys indicate a decrease or an increase.
The number of cases is increasing in Germany. The Scientific Institute of the AOK determined for the outpatient and clinical cases of foreskin operations in boys up to five years of age in 2006 still 5472 operations, in 2011 it was 7,103 cases, although the number of insured boys fell by 5% in the same period. The National Association of Statutory Health Insurance Physicians also recorded an increase of 34% between 2008 and 2011 in the outpatient area alone.
Circumcision is also widespread in English-speaking countries in Africa as well as in the Arab world. There the proportion is over 80% of the population. In Europe the quota is generally rather low, in some countries of Western Europe it has increased or is increasing (as of 2006).
With the exception of the Islamic states, South Korea has the second highest proportion of circumcisions in Asia after the Philippines . For young men this is almost 80%. The circumcision of newborns is uncommon; South Korea is the country with the highest rates of teenage and adult circumcision. The circumcision rate rose sharply in the 1980s and 1990s (in 1945 it was around 0.1%). Circumcision is generally not carried out in South Korea for religious or cultural reasons and is to be seen more as an ideal of beauty shaped by Anglo-Saxon or US-American influences. Since the 2010s, the percentage of circumcisions in South Korea has declined moderately.
In the Philippines , circumcision is largely an obligatory component of the local cultures and is known there as Tulì . It is carried out less for religious and much more for cultural reasons, the origins of which are not fully understood. However, it is largely believed that the rite stems from Islamic influences in the 14th and 16th centuries. Circumcision is usually performed on boys between the ages of 10 and 14 by a local circumciser without any anesthesia with a sharpened knife blade. Due to increasing medical and ethical concerns, the number of medically accurate circumcisions shortly after birth is increasing; other parts of the population, however, still swear by the traditional implementation. Approximately 92% of the male population in the Philippines are circumcised, but contrary to popular belief outside of the Philippines, circumcision is not legally mandatory. However, uncircumcised boys or men are often subjected to humiliation and are socially labeled and vilified as "Supót". Especially in school and puberty age, uncircumcised boys are often seen as a target for bullying by their peers regardless of gender and often have to reckon with severe torture.
Circumcision is used as part of a package of measures under the United Nations Program for HIV Prevention. It is intended to reduce the risk of infection for men during heterosexual intercourse. To this end, campaigns have been started in countries with a high HIV prevalence calling on men to be circumcised. These actions, sponsored by the World Health Organization (WHO) and national governments, have led to a sharp rise in circumcision rates locally. For example, circumcision has established itself among the Luo , a people in Kenya who are traditionally uncircumcised - the Kenyan Prime Minister Raila Odinga had himself circumcised with publicity.
Performing the circumcision
There are several surgical methods for performing a circumcision. In the most common method, the surgeon cuts the foreskin circularly with a scalpel . The surgical technique typically used for medical indications goes back to the founder of plastic surgery, Johann Friedrich Dieffenbach .
In the USA in particular, various methods with different clamps and so-called circumcision kits are in use, which are intended to replace freehand circumcision and, above all, make the suture superfluous (the clamp remains in place until the wound has healed under it).
Various techniques for reducing stress levels have been developed for neonatal circumcision. In 1978, Kirya and Werthman presented the Dorsal Penile Nerve Block (DPNB). For this purpose, a locally effective anesthetic is injected subcutaneously on both sides of the penis base. Lidocaine and bupivacaine can be used as local anesthetics for the DPNB . In a comparative study from 2005, bupivacaine was found to be superior. In 1990 Masciello examined local anesthesia by injecting lidocaine into the penile shaft and found this method to be superior to DPNB in comparison. Stang u. a. recommended in 1997 to reduce stress and pain in addition to the DPNB, the use of a pacifier that was previously dipped in a sucrose solution, as well as the use of a specially designed operating chair. In a traditional Brit Mila, the Sandek has the task of holding the child and calming it down with sweet wine. The systematic review with meta-analysis of the data of several randomized, controlled studies showed in 2001 that the DPNB was the most widely studied method of pain relief in neonatal circumcision, and most effective against the pain of the procedure. Compared to a placebo , the superficial lidocaine application ( EMLA ) was also effective, but less so than a DPNB. Both interventions appeared to the review authors to be safe for use in neonates. None of the investigated methods could completely eliminate the pain-related reactions.
In Germany, non-ritual circumcisions are always carried out with local anesthesia , even for babies . According to the guidelines of the German Society for Pediatric Surgery , anesthesia is required for the surgical treatment of phimosis , supplemented by conduction anesthesia .
General
In Europe, it is common to first grasp the protruding foreskin, which is protruding over the glans, with a clamp and then to cut off this layer that protects the glans. Often the skin ring (inner foreskin sheet) remaining between this incision and the glans rim is also shortened. Depending on the wishes of the patient or his parents or depending on the recommendation of the doctor, a different result can be determined with regard to the amount of skin remaining (see section “ Circumcision styles ”). Another method consists of free-hand circular cutting of the skin at two previously marked areas. This marking is also used to determine how much skin is to be removed and how far away from the glans the healed scar should be. Then the skin lying between the two ring-shaped cuts is removed; the flanking edges are brought together. This type is indicated for a short prepuce that cannot be pulled so far in front of the glans that it protrudes in front of it.
The procedure takes about 15 minutes, after which the wound edges are sewn together with self-dissolving material. The wound usually heals within two weeks. After this time, the threads dissolve on their own. However, sexual intercourse should be avoided for a period of three weeks after the procedure.
Gomco clamp
Gomco Clamp , in German Gomco clamp, is a brand name of the Go ldstein M edical Co mpany and is mainly used in the USA for infant circumcision. The clamp is pushed between the glans and the foreskin and then closed. The foreskin is carefully clamped off. Advantages are relatively low blood loss and relatively quick implementation.
Plastibell
Here a two-part plastic ring is created. One part lies between the glans and the foreskin, the other part outside, at the base of the foreskin. The skin lying between the two applied parts is tied off with a thread. The foreskin falls off by itself after a few days when it is tied. The procedure can be regarded as minimally invasive and relatively painless, but does not take place entirely under medical supervision, so that the doctor cannot intervene in the event of any swelling. If the ring is removed too early, the wound, which has not yet healed sufficiently, can burst open at its edges, which usually requires further intervention in the form of a suture; if this is not done, inflammation often occurs with subsequent bulging scarring.
Extension of the circumcision to the foreskin ligament
Often the foreskin ligament (frenulum praeputii, see " Foreskin "), an individually very different, more or less tight skin bridge on the underside of the penis, stretched between the urethral opening and shaft skin, is also the subject of circumcision. Irrespective of the prescribed amount of removal of the inner and outer foreskin sheet, the ribbon is either only cut through and then mostly sutured again across the wound edges or it is completely cut out. In particular, a short frenulum ( frenulum breve ) can pull the glans down on the erect limb, making the erection crooked and painful. This effect is decisively reinforced by circumcision, especially a radical one. Therefore, especially with "tight" circumcisions, it is usually advisable to at least cut the frenulum ( frenulotomy ), as a rule it should - or must - be cut out completely ( frenulectomy )
Traditional circumcision
In the ritual Jewish circumcision, the Brit Mila , the procedure is performed by a specially trained person, the so-called mohel . The ritual Muslim circumcision (Sünnet) is carried out by the Sünnetci . The usual age for the rite is eight days for Jews and up to about twelve years for Muslims. The blood loss is usually so low that the wound edges are not sewn.
The Jewish circumcision consists of three separate processes: First, the foreskin in front of the glans is gripped with a sickle-shaped clamp and severed with a knife; then the remaining inner foreskin sheet is torn away; and finally the mohel sucks the blood out of the wound by means of a glass tube or with his mouth and wets it with a little wine to clean it. Some Mohalim are doctors these days. According to the orthodox understanding, a process symbolizing the religious act of Brit Mila must be carried out on men and boys who have already been circumcised and convert to Judaism , because a secular circumcision that has already been carried out does not do justice to this claim; In this symbolic act, at least a drop of blood (Tippat Dam) is to be produced through a small opening in the skin as a literal translation and at the same time the name of the ceremony. According to the liberal understanding, this action can be dispensed with when converting .
Clipping styles and shapes
In men, circumcision removes part or all of the foreskin . The circumcision variants therefore vary in terms of tightness and placement of the scar: In everyday language, the different circumcision styles are described using English terms. A distinction is made between low , with the scar close to the glans , and high, with the scar on the shaft, further away from the glans. With a low circumcision , the inner foreskin is almost completely removed. According to the tightness of the shaft skin, a distinction is made between loose , whereby the glans can still be partially covered when not erect, and tight , whereby the glans is always exposed and the shaft skin has very little or no freedom of movement during an erection . This results in the circumcision styles high & tight , high & loose , low & tight and low & loose . If both the inner and outer foreskin sheets are removed so far that the glans is always exposed, even in the non-erect state, and only a few - up to ten - millimeters of inner foreskin remains, this is generally referred to as "radical circumcision"; this also as an indication, provided that the complete removal of the foreskin is medically indicated. While the fact that the limb has been trimmed in the high styles is usually clearly recognizable by the different color tones of the skin above and below the circumcision seam, this is only indicated in a narrow strip in the low versions due to the lack of a lighter inner layer of the foreskin the glans furrow or not at all; when the scar is directly behind the glans, the penis looks as if it has always been without a foreskin. In addition, the color of the circumcision scar itself often differs from the surrounding skin, which is also more evident in the high styles.
High & loose; outer foreskin layer worn away, inner foreskin layer in folds
Low & loose; inner foreskin sheet removed, outer foreskin sheet turned inside out in two layers
Low & tight; inner and outer foreskin layer removed (radical circumcision)
High & tight; Outer foreskin removed, inner foreskin partially preserved
While high & tight cuts are mainly used in the USA , the low styles are more common in Europe.
If only part of the foreskin is removed so that the glans is still partially covered when the limb is at rest, “scar phimosis” can occur. In particular, if the circumcision was "high & loose", the circumcision scar sometimes even lies at the level of the glans tip when at rest, but often at least in front of the wider glans rim. If the scar tissue then grows together in bulges or contracts during healing, a circular ring is created in the scar area, which acts like a phimosis, constricting the glans. These cases inevitably require a second circumcision, which will or must be more radical, so that any new scar constriction caused by the condition can no longer affect the glans.
There are other types of foreskin circumcision besides those mentioned. As a rule, these are only to be found regionally and play a subordinate role. An example of this would be the back incision or plastic enlargement, in which the foreskin is not separated, but only partially incised.
→ Prepuceoplasty for phimosis
Indications
A medical indication for circumcision is according to an updated European guideline for chronic inflammatory diseases such as Crohn Zoon (= balanitis Plasmacellularis), lichen sclerosus et Atrophicus (chronic inflammatory disease of the foreskin) in therapy- Lichen Planus in recurrent bowenoid Papulose in Carcinomas and a non-repositionable paraphimosis . Also for scarred phimoses , for example after extensive balanopostitis .
A study carried out between 1996 and 1999 at the Dermatological Clinic and Polyclinic of the LMU Munich showed a clear superiority of circumcision (possibly with additional conservative follow-up treatment) of chronic inflammatory diseases and precancerous diseases such as lichen sclerosus et atrophicans, secondary phimosis, balanitis / balanoposthitis, Condyloma acuminata, Queirat erythroplasia, Bowen's disease, and paraphimosis versus conservative treatment alone.
Colonization with condylomata acuminata (genital warts), on the other hand, is primarily treated with a laser or “icing” with deep-frozen liquid nitrogen .
An indication can be seen in individual cases in a foreskin constriction that is not caused by scarring or lichen sclerosus, the so-called phimosis , which, however, occurs relatively rarely in adults. A narrowed foreskin is normal in infants and children ("physiological phimosis"). Phimoses that have not been healed can also be treated conservatively (ointment treatment with a corticoid) or with enlargement plastic.
Contraindications
Circumcision in childhood should not be performed if there is hypospadias or penile hypoplasia , as the foreskin may be required for later reconstructive surgical measures.
Hygienic and health-preventive motives
Beyond medical indications, circumcision advocates put forward some health-preventive motives. The following physiological relationships are relevant for disease prevention :
- The germ colonization of the acorn is made more difficult. Physiologically , the preputial space (the space between the foreskin and glans) of an uncircumcised penis behaves like an intertriginous space. Also pathogenic bacteria such as coagulase positive staphylococci , Escherichia coli , Proteus mirabilis or Pseudomonas aeruginosa are not rare. There are also yeasts , especially Malassezia species (however, these are part of the normal human skin flora ). The circumcision creates “dry conditions” on the glans, which is considered to be a “more favorable basic situation” with regard to the risk of infection in this area. When the glans is exposed, the germ colonization is quantitatively significantly lower.
- The development of smegma is prevented. The male smegma preputii consists of the sebum of the foreskin glands mixed with the cell detritus of the glans epithelium and bacteria . It collects on the uncircumcised penis between the foreskin and glans. If the genital hygiene is inadequate , the deposits become visible and an intense odor develops. The accumulation of smegma is considered to be the source of inflammation (→ balanitis, balanoposthitis ) and can also promote the development of local carcinomas (→ penile carcinoma ). Most experts currently assume that the smegma does not have a direct causal effect ( i.e. it contains carcinogens ), but can increase the risk of penile cancer by promoting irritation and inflammation.
- The transmission of viruses is made more difficult. The Langerhans cells and CD4 receptor cells, which are present in high concentrations in the foreskin itself and close to the skin surface, are jointly responsible for the transmission of viruses during sexual intercourse.
Whether and in which cases the foreskin removal should be recommended as a routine operation remains controversial. The possible hygienic and health benefits ascribed to circumcision, on the one hand, should be weighed against the possible risk of complications of the operation and alternative prevention options on the other, taking into account the respective basic frequencies of the diseases under consideration. Removal of the foreskin is in no way a substitute for adequate genital hygiene and safe sex measures.
The routine circumcision of children and newborns is viewed by many professional organizations as a purely cosmetic or cultural matter; arguments relating to health and prevention are rejected. Bremen health insurance doctors refuse to settle such circumcisions at the expense of health insurance companies.
Urinary tract infections
The risk of a urinary tract infection is reduced after circumcision. In a meta-analysis of 12 studies, for example, the likelihood of urinary tract infections in circumcised people is roughly 8 times lower; the general risk of girls compared to boys is higher by this factor. However, the risk of a urinary tract infection in otherwise healthy boys was only about 1%: In the first year of life, 1 to 2 of 1000 circumcised boys develop such infections, of uncircumcised boys 7 to 14; Premature babies and children with urinary catheters are particularly affected by the latter . In boys with frequent urinary tract infections or vesicorenal reflux , the preventive effect of circumcision was more relevant. The authors of the meta-analysis therefore see a net benefit of circumcision only in boys with frequent urinary tract infections.
Penis inflammation
A balanitis (including balanitis called) is a purulent inflammation of the glans, which usually starts in the ring groove. The foreskin can also be affected, in which case it is called balanoposthitis . It is characterized by burning and itching and a rash. Fergusson et al. a. In 1988, when 500 New Zealand boys aged 8 years were examined, found 7.6 cases of penile inflammation among the circumcised and 14.4 cases of inflammation among the uncircumcised per 100 boys. In a study from 1990, balanitis was observed much less frequently in men who were being treated for skin diseases (“dermatology patients”) if the patients were circumcised. The inflammation rate in diabetic uncircumcised was again considerably increased. In contrast, Van Howe observed in 2007 when boys under 3 years of age were examined in rural northern Wisconsin that penile inflammation was approximately eight times more common in the circumcised in this age group than in the uncircumcised.
Risk of infection from HIV
Studies suggest that the risk of HIV infection during unprotected, heterosexual intercourse with HIV-infected partners may be lower for circumcised men than for uncircumcised men. The meta-analysis of the Cochrane Collaboration from 2009 showed a reduction in the relative risk of infection for heterosexual men by up to 66% after medically performed circumcision . For this purpose, data from three large, randomized and controlled studies that were carried out in Kenya , Uganda and South Africa between 2002 and 2006 were evaluated. As the authors emphasized, the studies evaluated did not assess the effects of circumcision on the female partners of HIV-infected men. After evaluating the results of the three randomized, controlled studies from Kenya, Uganda and South Africa as well as numerous observational studies, a panel of experts convened by the WHO recommended in a press release in March 2007 that its member states include circumcision as an additional means in their national anti-AIDS strategy.
The World Health Organization, UNAIDS and various non-governmental organizations in 14 selected African countries with many HIV-infected people and a low circumcision rate - including Kenya , Uganda , Zambia , Zimbabwe , Malawi and South Africa - want to achieve that by 2016 around 80% of men and boys there between 15 and 49 years of age are circumcised and there are sustained offers to circumcise all newborn male babies (up to two months old) and at least 80% of male adolescents.
Circumcision for HIV prevention has been criticized from several sides, because on the one hand the risk of HIV infection only decreases (but remains greater than zero) through circumcision and on the other hand the perceived (= subjective) security of circumcised men to reckless behavior Abstaining from condoms , loyalty or abstinence ). In addition, circumcision itself poses a significant health risk, especially in third world countries, as in many places sterile conditions are lacking and circumcision itself can become a source of an infectious disease (or several - for example HIV). The consensus is that the risk of infection by no means falls to zero, so that circumcision cannot act as a substitute for safer sex behaviors.
A South African study from 2008 also came to the conclusion that circumcision had no influence on the transmission of HIV; she thus questions the WHO recommendation. According to the 2011/2012 Zimbabwe Health Demographic Survey, there was a higher HIV infection rate among circumcised people, which Blessing Mutede from the National Aids Council attributes to a false sense of security and the resulting risky behavior. A 2009 USAID report found no clear link between male circumcision and the spread of HIV. For this purpose, data from 15 African countries, Cambodia , Haiti and India were evaluated. While those who were circumcised were relatively less likely to be infected with HIV in eight countries, the remaining ten countries had a higher prevalence of HIV among those who were circumcised.
The pediatrician Robert S. Van Howe and the family physician Michelle R. Storms criticized the "Zirkumzisionslösung" as "wasteful madness", more effective, less expensive and less invasive alternatives withdrawing resources. They believe that circumcision programs are likely to increase the number of HIV infections. Brian J. Morris et al. again, Van Howes rejected this prognosis as misleading. According to the board and management of Deutsche Aids-Hilfe (2008), intensive clarification is necessary in order to counteract the false assumption that one is protected after a circumcision. In the case of men who have sex with men (MSM), no significant difference has been found in previous studies (as of 2010). A meta-analysis of 15 observational studies on MSM found “insufficient evidence that male circumcision protects against HIV infection or other sexually transmitted diseases”.
Men who have sex with men make up the majority of new HIV infections in the West: 61% in the USA in 2009 (from 48,100 for 307 million inhabitants), in 2012 in Germany 73.5% (from 3,400 at 81.9 million). Residents). Men in the USA contributed 7.5% (3,590) to new infections through heterosexual contact, women again 18.3% (8,800); German statistics do not differentiate between the roughly 630 people here by gender. In contrast, the ratio is reversed, especially in HIV high-risk areas: In 2011, heterosexual contacts in Kenya accounted for 77% of new infections (of 104,137 in 39.5 million inhabitants); The same applies to South Africa's new infections (400,000 in 2009 with 49.3 million inhabitants).
Transmission of other sexually transmitted diseases
Studies have also shown that circumcised men have a lower risk of developing genital herpes , ulcus molle and gonorrhea .
With regard to syphilis , the results are contradicting: while some studies found a reduced risk through circumcision, other studies showed no difference to the uncircumcised.
HPV infections
The cervical cancer , also called cervical cancer is the world's second most common malignant tumor in women. It is believed that a large proportion of cervical cancers is caused by the human papillomavirus (HPV). In addition, this group of viruses is suspected of being able to cause genital warts (e.g. genital warts ), vaginal , penile and anal cancers , basal cell cancer and oral tumors. At the same time, the Langerhans cells and CD4 receptor cells found in the penis foreskin are made responsible for the transmission of viruses during sexual intercourse. However, in addition to the foreskin, the penile shaft (corpus penis), the glans ( glans penis ), the scrotum (scrotum) and urine are also involved in HPV transmission.
For the first time in the 1950s, a study compared the incidence ( prevalence ) of cervical cancer in the wives of Jewish circumcised men with that of the wives of non-Jewish uncircumcised men. The wives of the Jewish circumcised men were statistically significantly less likely to have cervical cancer than those of the non-Jewish uncircumcised men. A follow-up study from September 1962 found, however, that cervical cancer is equally common in non-Jewish women regardless of the circumcision status of their husbands. On the other hand, the comparatively lower cancer rate among Jewish women was confirmed:
“The discovery rate for cancer of the cervix among non-Jewish women whose marital partners were circumcised was no different from the rate among non-Jewish women with non-circumcised husbands. Further, the use of a sheath contraceptive by the marital partner, which has an effect equivalent to circumcision in that the cervix is protected from contact with smegma, was found not to be associated with rate differences for cancer of the cervix. In this population, among religious groups, there was no difference between Catholic and Protestant women; for Jewish women this study confirmed the finding of the low rate of cancer of the cervix in this group. "
“The incidence rate of cervical cancer in non-Jewish women with a circumcised partner was not different from that of non-Jewish women with an uncircumcised partner. The use of condoms, which, similar to circumcision, prevents contact between the smegma and the cervix, was also not associated with lower cancer rates. In this sample of religious women there was no statistically significant difference between Protestants and Catholics, whereas the Jews showed a low rate. "
Van Howe's 2006 meta-analysis of three selected studies found no support for the thesis that circumcision reduced the risk of HPV infection. This analysis was carried out in 2007 by Castellsagué et al. a. criticized as "distorted", "inaccurate" and "misleading". The critics' reanalysis of the same data showed a protective effect of circumcision.
Larke et al. found in their systematic review and meta-analysis from 2011 that circumcised men had a lower frequency of genital HPV infections than uncircumcised men. For this purpose, the results of 19 studies were taken into account. In the data from three studies, the authors also found weak statistical evidence that circumcision is associated with a lower HPV incidence and increased HPV clearance .
Albero et al. found a statistically “robust”, inverse relationship between male circumcision and the prevalence of genital HPV infections in men in the 2012 meta-analysis of 21 studies published between February 1971 and August 2010. Further studies are needed to assess the effect of circumcision on the acquisition and elimination of HPV infections. According to the authors, male circumcision could be considered as a one-time preventive intervention to reduce the burden of HPV-dependent diseases in both men and women. This is especially true in those countries where HPV vaccination programs and cervical checkups are not available.
Penile cancer
The penile cancer in the Western world a rare tumor that occurs in men at an advanced age (usually 50 years). In Central Europe and the United States, the incidence was 0.9 per 100,000 men in the 1990s and 1 per 250,000 men in Australia. Carcinoma is responsible for less than 0.5% of cancer cases in men worldwide.
According to a systematic review and meta-analysis from 2011, phimosis is one of the strongest risk factors for the occurrence of penile cancer. Phimosis is likely to lead to smegma buildup and recurrent inflammation, which in turn increases the risk of penile cancer. According to the meta-analysis, men who were circumcised in childhood or adulthood had a significantly lower risk of invasive penile cancer. The results suggest that circumcision protects against this carcinoma in childhood or adulthood. A circumcision eliminates the risk of phimosis; the authors attribute the protective effect in part to the effect of circumcision with regard to the risk of phimosis.
After improperly performed ritual circumcision in Saudi Arabia , the development of a carcinoma based on the circumcision scar was observed in some cases.
Prostate cancer
A Canadian study published in 2014 that examined the correlation between prostate cancer and circumcision on the basis of surveys came to the conclusion that this was below the statistical limits of significance. The authors found a statistically significant correlation for circumcisions carried out at the age of 36 years or older and for blacks, from which the authors concluded that they had a protective effect.
Aesthetic and cosmetic motifs
Some men decide to circumcision for reasons of personal aesthetics and / or their own body image. In an Australian study of the effects of circumcision, circumcised men were less concerned about making their bodies look unattractive during sex.
Female preference
A systematic review article published in 2019 , which summarizes the results of 29 studies from the USA, Australia and various countries in Europe and Africa, came to the conclusion that women prefer a circumcised over an uncircumcised penis: in the vast majority of studies, women expressed a preference for the circumcised penis. The main reasons for this preference were appearance, hygiene, reduced risk of infection and sensation during vaginal intercourse, manual stimulation and fellatio.
In 1988, 269 young mothers in Iowa, USA, who had just given birth to sons, were asked about their attitudes towards male circumcision. 145 participants gave usable answers. Of these, 78% only had sexual experiences with circumcised sexual partner (s), 5.5% again only with one uncircumcised man (or several). 16.5% of the participants - i.e. one sixth - had experiences with both circumcised and uncircumcised sexual partners.
89% of the mothers who answered had had their newborn sons circumcised. The majority (71 to 83%) of the women preferred circumcised male sexual partners for various sexual activities. The reasons given for preferring circumcised sexual partners were hygienic, visual and / and haptic sensations with regard to the penis. The majority stated that they found a circumcised penis to be more aesthetic and / or erotic than an uncircumcised one. About three quarters said the circumcised penis was more natural. The authors also found a strong correlation between the circumcision status of the newborn son and the woman's ideal of the status of her sexual partner during intercourse. Overall, the authors interpret the study results as support for the hypothesis that American women prefer circumcision for sexual reasons. While many women would not consciously view their sons as sexual beings, they may choose to have circumcision based on their own feelings and belief that the son will be more sexually attractive to future sexual partners. However, due to the small number of mothers with mutual experience, the study was later criticized for its informative value.
In another study from 2008 that looked at adult circumcision in men with benign foreskin disease, 38% of partners (and 44% of those who were circumcised) stated that the appearance of the penis had improved significantly.
Women who are looking for arguments to persuade their male sexual partners to circumcise also ask the organization EURO CIRC, which is in favor of circumcision, according to the organization's own information from 2008. The interest in it was justified with personal-aesthetic and hygienic preferences.
Hirsuties papillaris penis
As hirsuties papillaris penis whitish flesh-colored or reddish wart-like formations are called, which the glans edge up to the frenulum of the human penis occur. This harmless anatomical atavism affects around 10 to 20% of the male population . The papillae form in the course of sexual development, predominantly during puberty. From a medical point of view, they do not require treatment, but those affected can perceive them as an aesthetic problem. In addition, there are fears that it may be a venereal disease and the partner might react negatively.
Hirsuties papillaris penis is more commonly seen in uncircumcised men. The mechanism underlying this finding is unclear. The foreskin lying on the edge of the glans with accompanying smegma formation could be an explanation . In a 2009 study, hirsuties papillaris penis was less common in circumcised men. A decrease in the papillae after performing the circumcision was also observed in later life.
Effects on Sexuality
Due to the removal of the heavily innervated foreskin and the keratinization of the glans, the circumcision leads to a reduced sensitivity of the penis. Furthermore, the friction mechanics are influenced during vaginal intercourse . However, the extent to which these changes contribute to restrictions on sexuality or can have a positive influence on it is the subject of controversial scientific debates.
Influence on the sensitivity of the penis
The foreskin contains numerous Meissner tactile bodies , which are stimulated by stretching. In this way, the foreskin plays a role in man's sexuality. By removing the foreskin, the glans is no longer permanently covered; it can become less sensitive through constant contact with the air and rubbing against clothing. Sensitivity can also be reduced by removing the foreskin and frenulum themselves, as both have numerous nerve endings.
Damage or removal of the frenulum in the course of circumcision can also be viewed critically. In many men this part of the penis is more sensitive than the glans itself. This certainly also applies to the highly sensitive area of the foreskin, where the outer skin merges into the inner mucous membrane , which, like many mucous membrane boundaries, is a highly aerogenic zone .
A study by the American sex researchers Masters and Johnson from 1966 is sometimes incorrectly cited as evidence that a circumcised penis is more sensitive than an uncircumcised one.
masturbation
Masturbation is still possible even after circumcision. However, depending on the type and extent of circumcision, restrictions on masturbation may be experienced. In their prospective survey of 373 sexually active men, Kim and Pang found that 48% of the respondents found masturbation to be less pleasurable after circumcision, 8% as more pleasurable and 44% no change. After the procedure, 63% of the respondents had difficulty masturbating, 37% found it easier afterwards. Willcourt criticized the study design as bad and distorting: Among other things, all details about the recruitment of study participants were missing and only 138 of the 373 men were selected for the survey. The American Academy of Pediatrics (AAP) referred to the study in 2012 to determine that there was "fair evidence" of reduced masturbation pleasure after circumcision in adulthood. The level of evidence “fair” in the AAP evaluation system stands for the methodologically second-lowest quality in 4 quality levels of the work considered. Tian et al. a. ignored the publication by Kim and Pang with reference to the numerous shortcomings previously identified for their meta-analysis published in 2013 on "Effects of Circumcision on Male Sexuality".
Sexual intercourse
Sexual satisfaction and ability to orgasm
Some recent research suggests that the sensitivity of the glans decreases after circumcision. In contrast, Krieger u. a. In 2008, 64% of the adult Kenyans surveyed as part of an HIV prevention project reported increased penis sensitivity after circumcision and 54.5% reported improved ability to orgasm. Circumcision was not associated with sexual dysfunction in this study.
In 1983 Money et al. a. the loss of stretch receptors in the foreskin and frenulum and a consequent decrease in sexual response, which limits the circumcised man's ability to achieve erections and consequently erectile dysfunction as a possible complication of male circumcision.
For men, the foreskin plays an important role in their sex life due to its erogenous nature (so an orgasm is sometimes possible through its sole stimulation ). In one of Morten Frisch u. a. A comprehensive cross-sectional study , published in 2011 in the International Journal of Epidemiology (IJE) and carried out in Denmark , in which 1893 uncircumcised and 203 circumcised men were surveyed, showed that circumcised men were at greater risk of anorgasmia . Since the influence of psychological factors was excluded using robust estimation methods , the authors attribute the effect to the reduced sensitivity of the penis of circumcised people. In a letter to the editor , Brian Morris, Jake Waskett, and Ronald Gray criticized this study in terms of its methodology and the author's conclusion. The low participation (5395 men were invited and only 2096 ultimately interviewed) could lead to self-selection . Some of the statistical methods used also require precise examination. The von Frisch u. a. The assumed reduced sensitivity of the circumcised penis is without evidence and also questionable because the foreskin is not completely removed for medical circumcisions in Denmark. The tenor of the article agrees with Frisch's commitment as an opponent of circumcision, which was declared under “ Conflicts of Interest ”. In the answer, which was also published, Frisch expressly rejected this criticism. The study was carried out using the common epidemiological and statistical methods that had withstood the peer review process of the internationally recognized and high-ranking IJE. In addition, due to the loss of tissue, full circumcision would lead to an even greater loss of sensitivity than partial circumcision. The Morris et al. a. The criticism made can rather be explained by the fact that the results of the study by Frisch et al. a. did not fit on the agenda of circumcision advocates and activists Morris and Waskett. Morris initially tried to prevent the study from being published by breaking the rules of the peer review process and putting pressure on the editors of the IJE, but failed.
In the study by Solinis and Yiannaki (2007), 65% of the 123 circumcised men surveyed answered that they now need longer to ejaculate, but only 10% of them felt this was an actual improvement. A multinational study in 2005 found an average of 6.7 minutes to ejaculation during vaginal intercourse for circumcised men versus 6.0 minutes for uncircumcised men, but this difference was not statistically significant.
In a two-year study of adults in Uganda, the proportion of circumcised people who were satisfied with their sex life was 98.4%, almost the same as before circumcision (98.5%), while it increased in the intact control groups the satisfaction on the other hand from 98.0% to 99.9%. In the control group, only 0.1% reported erectile dysfunction or ejaculation difficulties; the proportion was three times as high in the circumcised. In their survey of 138 men who were sexually active before circumcision, Kim and Pang found that 6% of the respondents had an improvement in their sexual life, and 20% said it had deteriorated. In the study by Solinis and Yiannaki (2007) of 123 circumcised men, 16% reported an improvement and 35% a worsening.
In a study published in 2013, in which more than 1,300 men in Belgium were interviewed anonymously, the participants reported lower orgasm intensity and reduced pleasure from the circumcised penis and that it was more strenuous to reach orgasm at all. The problems affected both the glans and the penile shaft.
Ejaculation control
The assumption that circumcision is effective against premature ejaculation was partially empirically confirmed in a Turkish study in which 42 men were examined. The circumcision took place in adulthood (the men were between 19 and 28 years old), 39 men were circumcised for religious reasons, 3 for cosmetic reasons. The men were examined and questioned before the circumcision and at least 12 weeks after the circumcision. There were no significant differences in function, but on average the time to ejaculation was significantly increased.
In a British study on 84 men who had already been circumcised for medical reasons (mostly phimosis or genital lichen sclerosus ) before the study was carried out , 64% of the participants found no change in premature ejaculation after circumcision, 13% an improvement and 33 % deterioration.
Another study in the field of HIV prevention in high-risk heterosexual populations of 2,684 randomly selected men in Kenya on the subject of sexual function and sexual pleasure found that circumcised men seem more able to control the timing of ejaculation themselves or to delay. At the same time, most of the circumcised men reported that they had a much more sensitive penis or that they were able to reach orgasm much more easily.
Effect on the female sexual partner
In 1999, O'Hara's postal survey of women recruited through magazine ads and an anti-circumcision newsletter on the premise that they had experience with both circumcised and uncircumcised sexual partners found that the majority of respondents preferred vaginal intercourse with an intact penis . In 2008, Cortés-González et al. a survey of 19 women showed a significantly reduced vaginal lubrication after the circumcision of the partner. In contrast, the authors found no statistically significant differences with regard to general sexual satisfaction, pain during vaginal penetration, sexual desire and vaginal orgasm. In 2011, Morten Frisch et al. a higher incidence of orgasm problems and dyspareunia if the man was circumcised.
In contrast, in a 2009 study, the overwhelming majority of Ugandan women surveyed (97.1%) reported that they either experienced no change or an improvement in sexual satisfaction after their male partner was circumcised. The authors concluded that male circumcision did not have a deleterious effect on female sexual satisfaction. A study in 2002 of Luo women in Kenya, whose men were circumcised as an adult for the purpose of HIV prevention, found that the women surveyed found sexual intercourse more fulfilling after circumcision. In 2007, Williamson showed a greater preference for US women to perform fellatio and / or manual stimulation when the man was circumcised.
Indirect effects seem to play a decisive role: hygienic attitudes as well as preconceived opinions through socialization influence the partner's judgment regarding circumcision and can have a greater influence on her perception of pleasure than the mechanical-physiological changes, as surveys in Kenya and Malawi have shown.
Possible problems and complications from circumcision
Circumcisions imply a significant complication rate . Depending on the definition, it is given between 0.06% and 55% or estimated between 2% and 10%. There are also deaths, especially after the circumcision of newborns, in which even a small amount of blood loss is at risk of life.
Medical complications
Pain and post-operative discomfort
The procedure causes pain; these can last for a few days. For pain treatment, there are surface anesthetics such as lidocaine (EMLA) and benzocaine , which are applied to the skin as a cream or ointment, and a conduction anesthesia of the dorsal nerve penis by injection . Numerous clinical studies and systematic reviews by the Cochrane Collaboration have shown that surface anesthesia does bring about pain relief, but that effective and effective pain treatment can only be achieved with conduction anesthesia. The Federal Institute for Drugs and Medical Devices has revoked the indication of the numbing ointment EMLA for newborn circumcision.
Other acute complications that can occur with any surgical procedure are bleeding and infections caused by unsterile wound care. Postoperative wound pain is also possible, as is pain when urinating . After the operation, you may notice irritating rubbing against clothing; after a few days or weeks this sensation diminishes in the majority of those operated on.
Meatal stenosis
Meat stenosis refers to the pathological narrowing of the urethral opening , which occurs predominantly in babies and small children. It is one of the most common complications resulting from infant circumcision. A 2006 study found meat stenosis only in previously circumcised boys. The incidence rates after circumcision are around 10%. A urodynamic examination should be carried out as a follow-up examination, far from circumcision. If left untreated, meat stenosis can lead to secondary diseases of the urinary organs such as hydronephrosis and vesicorenal reflux due to increased flow resistance and urinary retention .
Nodulation of the veins
The dorsal vein (vena dorsalis penis superficialis), which begins at the tip of the foreskin in men, is usually, but not necessarily, severed during circumcision and branches out again over time. This can create knots. Experienced surgeons therefore clamp this vein separately in the course of the circumcision and sew up its stump to prevent such a knot.
Adhesions
Furthermore, there may be an adhesion between the skin of the glans and the surrounding skin of the penis, creating a skin bridge, which, if necessary, requires an outpatient surgical correction.
Such a correction is also urgently advised if the remaining shaft skin is sewn close to or even onto the glans rim in the course of circumcision after removing the inner foreskin, which occasionally happens, especially when circumcising small children by inexperienced surgeons. The resulting skin pockets can lead to inflammation and, above all, to disabilities during sexual intercourse. In addition, the result, even after surgical correction, is damage to the glans, which has an irreversible negative effect both in terms of sensitivity and in the cosmetic result.
Herpes risk
The Jewish Orthodox Metzitzah B'peh ritual (sucking blood from the baby's penis with the mouth) is controversial in the United States because it has resulted in multiple herpes simplex type 1 (HSV-1) infections , brain damage, and death Has.
The Centers for Disease Control and Prevention estimates that around 3,600 newborns per year in the 250,000-strong community of ultra-Orthodox Jews in New York undergo the traditional procedure. The 2005 appeal by New York City Mayor Michael Bloomberg to distance oneself from this practice was rejected on the grounds that oral-genital circumcision was safe.
The last known case of herpes from Metzitzah B'peh became known in 2019. Between 2000 and 2015, more than a dozen babies fell ill and 2 died in the United States.
necrosis
Glans necrosis can occur as a result of a cauterization injury in the Gomco technique or because of a distal displacement of an incorrectly sized Plastibell ring. Mild cases of necrosis can be treated with local wound care and topical antibiotics, more severe cases surgically. Individual reports of complete necrosis of the glans and penis, where a sex reassignment was performed after several repair attempts, are rare . In the case of David Reimer , the penis was irreparably injured by electrocautery during a medically indicated circumcision in 1966 . His parents therefore decided, on the advice of sexologist John Money , to have sex-changing surgery and to raise the child as a girl. Gearhart and Rock reported in 1989 on four cases of circumcision by means of electrocautery, in which the penis was first amputated after the initial injury and then a feminizing genitoplasty was performed. The authors rated the early feminizing genitoplasty as an “excellent method for the reconstruction of an external genitalia” in such cases. This practice was criticized early sex reassignment after injury of the male genitals in 1997 by Diamond and Sigmundson.
Accidental amputations
Accidental glans amputations are extremely rare, but are a devastating complication of attempting circumcision with the Mogen clamp. The Mogen clamp obstructs the surgeon's direct view of the glans prior to incising the foreskin. Ben Chaim et al. found one case of accidental partial amputation of the glans penis among 19,478 newborn circumcisions carried out and documented in Israel in 2001. The circumcision was done by a mohel. Gluckman et al. reported in 1995 the successful reattachment of an accidentally amputated glans. The injury occurred during neonatal circumcision with a Sheldon clamp.
Yilmaz et al. reported in 1993 the case of an accidental penile amputation that occurred during the ritual circumcision of a 10-year-old boy. The penis was successfully reattached.
Deaths
Douglas Gairdner reported 16 to 19 deaths in England and Wales from neonatal circumcision in the 1940s. Sydney Gellis noted in 1978 that, in his view, there were more deaths from complications from circumcision than cases of penile cancer.
Publicly recorded deaths directly related to circumcision include:
- in June 2008 in Italy
- on April 16, 2010 in Manchester
- in June 2012 in New York
In Africa there are sometimes drastic numbers of fatalities due to ritual circumcision celebrations:
- up to 23 in May 2012 in northeastern Mpumalanga Province, South Africa
- 30 dead in June 2012 in the Eastern Cape Province, South Africa
Other risks and complications
The medical literature contains documentation of various diseases and malformations, mostly in the form of case reports , which can occur with different incidence as a result of circumcision. Most of these are rare problems that are often caused by improper implementation.
Circumcision can lead to urinary retention with acute kidney failure , glomerulonephritis (inflammation of the kidney corpuscles), granuloma or even staphylogenic Lyell's syndrome .
Possible malformations as a result of circumcision are penile hypoplasia (a shrinking penis ) or induratio penis plastica (penile misalignment).
Subsequent psychological problems
According to Goldman (1999), circumcision of a child carries the risk of conscious and / or unconscious psychological trauma . The pain, stress and loss of control associated with circumcision could have a negative impact on his psychological development . Behavioral abnormalities became apparent six months after the operation, and the relationship between mother and child could also be impaired, especially if circumcision takes place in infancy, which from a developmental point of view falls into the highly sensitive phase of the formation of the mother-child bond (see also attachment theory ).
Timm Hammond, human rights activist and founder of the circumcision-critical organization NOHARMM, published in 1999 in the British Journal of Urology the results of a survey of circumcised male US Americans organized by NOHARMM as part of a documentation project between 1993 and 1996. 94% of the 546 participants were circumcised in childhood. Among other things, the survey showed that 50% of the participants had a low self-esteem or a feeling of inferiority compared to “intact” men.
According to Lerman and Liao (2001), there is currently a lack of solid scientific data to prove negative psychological and sexual effects of neonatal circumcision.
Controversies about the circumcision of minors
Criticism of circumcision in earlier times
Even in antiquity there was opposition to circumcision, which at that time was practiced exclusively by the Hebrews . In the course of the Hellenization , the foreskin was seen as an integral and desirable part of the human anatomy, the Hebrew tradition of circumcision contradicted it. While circumcision was initially regarded with astonishment as a cultural peculiarity of a minority, but was tolerated, circumcision was banned in 132 AD under the Emperor Hadrian . This law was modified around 140 in the Pandects under Antoninus Pius to the effect that Hebrews had exceptions that allowed legal circumcision.
In the 19th century there was increased criticism of circumcision. The practice was increasingly viewed as an archaic, backward tradition, which would no longer have a place in the modern age shaped by science and enlightenment. The British anthropologist John Lubbock, 1st Baron Avebury described the circumcision of the Jews as a sign of the "barbarism inherent in this people". The physician and chancellor of the University of Tübingen , Johann Heinrich Ferdinand Autenrieth , saw circumcision as a primitive act, which he believed to be practiced by culturally inferior peoples such as Jews and black Africans . In the debate about the meaning of circumcision, like others, he formulated the thesis of a surrogate (substitute) for a human sacrifice . The Italian doctor Paolo Mantegazza , who in the late 19th century was regarded as a "standard source" on the nature of human sexuality, commented on the "mutilation of the genitals" among "wild peoples", which included the Jews. Circumcision “among educated peoples” is “an infamy and a shame”. He appealed to the Jews:
“Do not mutilate yourselves, do not put a mark on your flesh that distinguishes you from other people, as long as you do that, as long as you cannot be our equal. From the very first days of life you pass yourself off with the iron for another race that neither wants nor can mix with ours. "
The Finnish sociologist Edvard Westermarck also regarded circumcision as "mutilation of the genital organ". Together with Auguste Forel , he took the point of view that "the intention of stimulating sexual appetite" combined with the "hygienic advantage" played a part in converting circumcision into a rite.
Criticism of circumcision in the present
While circumcision in adults (to a limited extent also in adolescents) with informed consent does not pose an ethical problem, the procedure in children is the subject of numerous controversies. The main points of dispute are ethical aspects such as the right to physical integrity (“genital integrity”) under the condition of the child's inability to consent, the weighting of medical advantages over risks and complications and the resulting costs for the health system as well as the potential consequences and effects on the Sexuality of the man as well as his partner. These debates are carried out in the specialist literature of various disciplines, mainly medicine and physiology , medical ethics and legal ethics, and cultural anthropology .
Since, in contrast to Central Europe, a high proportion of men are circumcised in the USA, the most violent controversies between supporters and opponents of circumcision can be found there. There are various organizations that have made it their business to abolish the indications-free circumcision of minors. The National Organization of Circumcision Information Resource Centers (NOCIRC) was founded in 1985 as the first group critical of circumcision . In 2008, a joint international campaign by the circumcision-critical groups NORM-UK (National Organization of Restoring Men) and FORWARD (Foundation for Women's Health, Research and Development) was launched under the title “Genital Autonomy”, which oppose any form of circumcision of boys or Girls judge unless this is medically necessary. The campaign particularly criticizes the WHO recommendation on circumcision in the context of HIV prevention ( see above ).
The German circumcision debate that was initiated in 2012 by a ruling by the Cologne Regional Court goes back to the legal scholar Holm Putzke . He sees the circumcision of children as a significant physical intervention that is being played down too much. The law already prohibits light corporal punishment . Then circumcision as an irreversible encroachment on physical self-determination would have to be forbidden.
In a joint appeal, more than 700 doctors and lawyers, including university professors Matthias Franz , Holm Putzke, Maximilian Stehr and Hans-Georg Dietz, called on the federal government and members of the Bundestag to focus on what they believe is the best interests of the child: “There is a remarkable attitude of denial and a refusal to empathize with the little boys, who suffer considerable suffering from genital circumcision”.
The German Academy for Child and Adolescent Medicine e. V. (DAKJ) spoke out on July 25, 2012 against circumcision of minors for religious and ritual reasons. The German Society for Pediatric Surgery (DGKCH) did the same . The professional association of paediatricians expressed itself on August 23, 2012 after the meeting of the National Ethics Council with “incomprehension and horror” (“a child's right to physical integrity obviously does not count!”).
On September 9, 2012, a demonstration of 250 to 500 members of religious communities took place in Berlin, who campaign for the preservation of the impunity of ritual circumcision of boys. According to some Jewish representatives, the German circumcision debate expresses a new anti-Semitism and should be viewed against the background of National Socialism . For the European Rabbinical Conference, the Cologne judgment is “the worst attack on Jewish life since the Holocaust”. She accused circumcision critics of "abusing the language of human rights" as "the new language of anti-Semitism". The social scientist Samuel Salzborn also confirmed that the circumcision controversy in particular demonstrated "how dense and at the same time deeply anchored anti-Semitic resentments are in the psychological structures" of anti-Semites.
On September 12, 2012, Deutsche Kinderhilfe , the professional association of paediatricians and Terre des Femmes demanded a two-year moratorium from the federal government and the Bundestag and the establishment of a round table on the subject of ritual circumcision before a change in the law. The German Association of Judges , however, welcomed the Bundestag resolution on the legislative project.
Inadequate consent of those affected
Since children themselves cannot consent to medical interventions, parents in Germany are entitled to consent to medically indicated interventions within the framework of parental custody as legal representatives .
This parental consent is largely undisputed in the case of medically necessary interventions, but is rejected by critics of circumcision as an interference with the physical integrity and permanent physical change in the case of circumcisions that are not medically indicated.
In Germany in 2012, the medically unnecessary circumcision of male children was explicitly permitted by supplementing family law. According to the lawyer Claudia Holzner, this contradicts the Basic Law and the prevailing opinion on the effectiveness of consent to bodily harm.
Possible health benefits of circumcision only become relevant for the most part at the onset of sexual maturity ; Critics consider prior surgery to be superfluous unless there is an acute medical need. They refer to the pain associated with circumcision and the (possible) restrictions on sexual life.
Proponents of early circumcision, on the other hand, citing the WHO, refer to a less painful implementation and lower complication rates at this point in time. They also argue that the psychological burden of circumcision is significantly greater during puberty. Circumcision in adulthood disturbs the life of the person concerned more and causes a greater loss of privacy than circumcision in infancy. The person concerned must let himself be released from work and temporarily refrain from various sexual and other activities. Circumcision in adulthood is expensive because it has to be performed in an operating room under anesthesia.
However, the view that babies and toddlers have little or no pain sensitivity has been scientifically refuted and the German Pain Society points out that the procedure should only be carried out with adequate pain treatment.
A bioethics committee convened by the American Academy of Pediatrics , the American Association of Pediatric Doctors , regards proxy consent from parents as mandatory if there is a medical need for the procedure. On the other hand, interventions, the omission of which is not associated with health risks, should be postponed to a later age capable of giving consent.
Religion and culture as a justification for circumcision
The question of to what extent ritual circumcision (based on religion and tradition) is justified in the interests of the child is also controversially discussed. Proponents of ritual circumcision are legitimized by the freedom of religion and the right of parents to bring up parents: education in the sense of the parents' religion is in the interests of the child. The objection is made that freedom of religion also includes freedom from religion. Minors are circumcised before they have reached religious maturity; it remains uncertain whether the children later share the religion and the views of their parents. The right of parents to exercise their religion freely must be put on hold where the child's rights to physical integrity are restricted. This argument does not take into account the fact that Article 14 II of the UN Convention on the Rights of the Child (CRC) guarantees the right of parents to guide their child in the exercise of his or her religious freedom. Insofar as circumcision is a sign of belonging to a religious-cultural minority, it is also expressly protected by Art. 30 CRC (protection of cultural identity).
Sirkku K. Hellsten, a philosopher at the University of Birmingham , does not see religious and cultural reasons for circumcision (regardless of gender) as a sufficient justification for restricting physical integrity. The philosopher David M. Shaw, who teaches at the University of Glasgow , draws a comparison with other religiously motivated forms of body modification . These are rightly forbidden in children, although their consequences are often less profound, and special treatment of circumcision about religion is not justifiable from a legal philosophical point of view. The non-Jewish German legal scholar Rolf Dietrich Herzberg questions the alleged necessity of ritual circumcision for religious affiliation in Islam and Judaism: numerous Jewish parents would forego circumcision of their children without losing their identity, and many communities do not consider circumcision as a prerequisite for " benevolent acceptance ”into the community.
Herzberg also argues that a religiously motivated change in the law would make the question unavoidable why similarly religiously motivated interventions should remain prohibited in girls, provided that they are restricted to the clitoral hood , as is the case with the Shafi'ites . The Swiss lawyer Sami Aldeeb sees no valid justification in Islamic law for a different approach to male and female circumcision. Against this background, he criticizes the differing assessment in western countries and by international and non-governmental organizations. (See also: Demarcation for the circumcision of female genitals )
Stefan Trapp, a specialist in pediatric and adolescent medicine in Bremen, estimates that a third of families have their children circumcised not for religious reasons but because of peer pressure: “If the operation were illegal, a lot of pressure would be relieved from these families. So far, however, this has not been mentioned in the discussion. "
Health consequences
The argument in favor of circumcision is the lower prevalence of various diseases in circumcised men. Circumcision is recommended by advocates as a preventive measure against these diseases; their arguments are questioned by circumcision critics.
There are lower transmission rates for some sexually transmitted diseases (HIV, HPV), along with the recommendation to use circumcision as a measure of disease prevention . This is countered by the fact that possible positive consequences could only occur from the first sexual intercourse , so that they do not justify circumcision in childhood, and that safer sex is a much safer - and side-effect-free - preventive measure. The circumcision creates an illusion of security in the circumcised, which leads him to take no precautionary measures against sexually transmitted diseases or to practice. For example, a study in 2000 found that circumcised men were less likely to be willing to use condoms.
With regard to the reduced risk of penile cancer, the objection is that the likelihood of disease is very low (0.5% of all cancer cases), penile cancer almost without exception affects men over 50 years of age and thus does not justify circumcision in childhood without any indication. According to Gellis, more people die each year from complications associated with circumcision than from penile cancer.
Proponents of a legal clarification in favor of circumcision (for example Volker Beck , parliamentary director of the GRÜNEN in the German Bundestag), pointed out that the infants or boys face even higher risks if they are circumcised other than doctors. They prophesied a "circumcision tourism" in the event that circumcision would be banned in Germany.
Opponents of circumcision point to numerous deaths after circumcision.
Critics argue: the foreskin is not a useless piece of skin, but on the contrary one of the most sensitive areas of the penis. In addition, the foreskin is there to protect the glans from drying out and keratinization and to keep it sensitive. Amputation of the foreskin leads to a significant loss of sensitivity in several ways.
Differentiation from the circumcision of female genitals
The term female genital mutilation (more rarely: 'vaginal mutilation ') subsumes interventions in which structures of the vulva are permanently changed. These interventions are usually motivated by traditional rituals (e.g. initiation rite ); they are criticized by numerous international organizations such as the United Nations , UNICEF , the United Nations Development Fund for Women and the WHO as a violation of the human right to physical integrity. Many of these organizations support projects that aim to ensure that this circumcision is banned or no longer carried out. In many Western countries, female genital mutilation of any kind is a criminal offense. In both sexes, circumcisions are performed for ritual reasons (and / or less often to make a genital "more beautiful" in the sense of an ideal of beauty). The harmful effects of vaginal circumcision on health and sexuality are seen in many countries as a determining factor in moral and legal condemnation; but not that of circumcision. Several authors criticize this general unequal treatment in the evaluation of male and female circumcision.
The very negative health and sexual function consequences of severe forms of female genital mutilation (such as infibulation and clitoridectomy ) are not in question; some authors consider male circumcision to be quite comparable to less extensive types of vaginal circumcision. With the clitoral hood, women have an anatomically analogous structure to the male foreskin.
The removal of the clitoral hood in minors, which (also in Western countries) adult women have for cosmetic reasons, is considered a case of genital mutilation according to the WHO definition criterion Type Ia. Accordingly, there is the demand that the circumcision of the man as "male genital mutilation" (English. Male genital mutilation ) to be considered. When classifying female circumcision as a human rights violation, no distinction is made according to severity and extent. A general legal and ethical inequality of treatment of circumcision of men and women regardless of the extent and severity of the intervention is critically questioned by various authors and criticized as a violation of the principle of equality and an expression of double standards.
An initiative launched by the American Academy of Pediatrics in 2010 , which provided for a small notch in the clitoral hood (“ritual nick”) as a culturally sensitive compromise solution, was stopped after public protests, so the procedure remains illegal in the USA. According to Raj Bhopal, Professor of Health Sciences at the University of Edinburgh , the decision would set unequal standards for both sexes: the reasons for withdrawing the “ritual nick” would apply equally to male circumcision. In 2005, the anthropologist Kirsten Bell criticized the unbalanced discourse on circumcision in both sexes as a form of gender bias : the uncritical acceptance of male circumcision is opposed to an unquestioned condemnation of female circumcision. Likewise (2009) the anthropologist Carlos D. Londoño Sulkin argues that circumcision can also be viewed as genital mutilation and that many people in the West accept male circumcision as unproblematic, but find it difficult to see female circumcision in this way. In 2003, the cultural psychologist Richard Shweder saw no reason to evaluate circumcision in girls and women (provided it is limited to the removal of the clitoral hood and inner labia) differently from circumcision.
Irmingard Schewe-Gerigk , chairman of the board of the Terre des Femmes association , said in November 2012 that a change in the law in favor of male circumcision would remove the basis for the general ban on vaginal circumcision. The so-called “mild forms” of female circumcision, which are comparable to circumcision, would be legitimized.
As part of the German legislative process for the introduction of a § 226a StGB (genital mutilation), at the hearing in the legal committee, the expert Bernhard Hardtung, professor of criminal law at the University of Rostock, stated that a special offense for bodily harm that only applies to female victims is due to a violation against the principle of equality and the prohibition of discrimination in Art. 3 GG is unconstitutional, since the light forms of female circumcision are comparable in their degree of injustice to the (still permitted) male circumcision. The Bundestag did not agree with this view and passed Section 226a of the Criminal Code, as planned, in a version that only refers to female genitals. Tonio Walter , Professor of Criminal Law at the University of Regensburg, sees this newly created paragraph as a violation of the constitutional principle “that no one may be disadvantaged or preferred because of their gender”, and predicts: “The Federal Constitutional Court will concede him [§226a StGB] ".
Regulation of the circumcision of minors in individual states
Europe
Germany
Criminal and civil law
Up until December 12, 2012, there was no special legal regulation in Germany for the circumcision of underage boys. Based on the standard commentary on the criminal code by Thomas Fischer , 59th edition. In 2012, the offense of bodily harm was affirmed and the question of whether the consent of the custodian removes the illegality was described as controversial with regard to Section 228 .
- In 2004 the Frankenthal regional court passed a judgment on circumcision by non-medical professionals; This denied a legally effective consent of the parents: "The consent of the parents in the medically not indicated procedure carried out by a non-medical practitioner under non-sterile conditions represents abuse of custody and therefore has no justifying effect."
- In August 2007, the higher regional court in Frankfurt / M. Legal aid , as a circumcision of a child who is not yet capable of giving consent, which is arranged by a Muslim father who is not custodial without the consent of the custodial mother, constitutes a violation of the child's right to self-determination . (see right of self-determination )
- The Cologne Regional Court gave judgment that circumcision as a second instance 7 May 2012 assault classifies represented by a religious motivation and the desire of the parents would not be justified and are not in the interests of the child was.
The judgment of the Cologne Regional Court led to a broad public debate (“circumcision debate”) about the legitimacy and legality of the circumcision of minors.
On July 19, 2012, the German Bundestag approved with a large majority a joint motion for a resolution by the CDU / CSU , SPD and FDP , which called on the federal government to submit “a draft law in autumn 2012 that ensures that a medically professional circumcision of boys without unnecessary Pain is generally permissible ”.
On August 23, 2012, the German Ethics Council held a public plenary meeting on the subject with the participation of Leo Latasch , Ilhan Ilkilic , Reinhard Merkel , Wolfram Höfling and Peter Dabrock . Christiane Woopen chaired the meeting . Despite “profound differences”, four minimum requirements were agreed for a legal regulation: comprehensive information and consent of custodians, qualified pain treatment, professional implementation of the intervention and recognition of a development-dependent veto right of the boy concerned.
On September 28, 2012, a paper drawn up by the Federal Ministry of Justice was presented for an expert hearing on " Circumcision of boys - key points in a regulation ". It proposed to insert a section 1631d, circumcision of the male child , into the civil code :
- "(1) Personal care also includes the right to consent to a medically unnecessary circumcision of a male child who is incapable of understanding and judgment, if this is to be carried out according to the rules of medical science. This does not apply if the circumcision also takes into account the best interests of the child are at risk for their purpose.
- (2) In the first six months after the birth of the child, persons designated by a religious community may also perform circumcision in accordance with paragraph 1 if they are specially trained for this and, without being a doctor, have comparable skills to perform the circumcision. "
The child policy spokesman for the SPD , the Greens and the Left Party in the Bundestag jointly opposed the draft. Wolfram Hartmann , President of the Association of Pediatricians , criticized this draft law for the fact that, according to the rules of medical art, such an intervention could not be carried out by a non-doctor.
The draft was passed by the Federal Cabinet on October 10, 2012 as a draft law on the scope of personal care in the event of a male circumcision and submitted to the Federal Council in accordance with Article 76, Paragraph 2, Clause 1 of the Basic Law , which on November 2, 2012 had no objections he lifted. The members of the Bundestag M. Rupprecht, D. Golze, K. Dörner u. a. submitted a counter-draft on November 8, 2012, which provided for an age of consent of 14 years. Both drafts were discussed for the first time in the Bundestag on November 22, 2012 and then referred to the Legal Committee of the German Bundestag , which held a public hearing of experts on this on November 26.
On December 12, 2012, the Bundestag adopted the federal government's bill in its third reading with 434: 100 votes and 46 abstentions . The Federal Council approved on December 14, 2012. The announcement was made in the Federal Law Gazette on December 27, 2012; the law has been in force since December 28, 2012 as Section 1631d BGB.
In December 2012, a survey carried out by Infratest dimap on behalf of the Mogis association (victims of abuse against Internet blocking) showed that 24% of those questioned supported this law and 70% opposed it.
On August 30, 2013, the Hamm Higher Regional Court (3 UF 133/13) confirmed a first-instance decision by the District Court - Family Court - Dortmund . The divorced child parents argued in the preliminary injunction procedure about whether the child mother from Kenya (now married elsewhere) may have her six-year-old son circumcised. The son lives in the mother's household, who also has sole custody. The OLG decided that the prerequisites for the consent of the mother with custody to a circumcision did not exist in the negotiated case. Even if a six-year-old is not yet in a position to decide on the circumcision of his penis himself, the statutory provision obliges the parents with custody and also the doctor to discuss the circumcision with the child in a manner appropriate to his age and level of development to take into account the wishes of the child in the parental decision. The child did not participate in the present case in accordance with these requirements. By the custodial outspoken parent or sole custody parent consent for circumcision is also only effective when (r) through the engagement previously properly and comprehensively informed physician was (s) (see informed consent ). The OLG also considered other circumstances of the individual case in its weighing .
One year after §1631d BGB came into force, the professional association of paediatricians , the German Academy for Child and Adolescent Medicine , Terre des Femmes u. a. the repeal of the rule. Wolfram Hartmann pointed out that according to internal surveys, the number of complications as a result of circumcisions remained high. The criminal lawyer Reinhard Merkel called for an obligation to report severe health consequences after circumcision. Although these are rare, they still occur. Putzke criticized the law as "inconsistent" and "obviously unconstitutional" and took the view that the medical qualifications of the Mohalim and the pain treatment during the operation were inadequate.
Social law
The statutory health insurance companies only cover the costs of a circumcision if this is medically necessary. Costs for a circumcision carried out for aesthetic or religious reasons will not be borne by them.
In October 2013, the National Association of Statutory Health Insurance Physicians announced to the Frankfurter Allgemeine Sonntagszeitung (FAS) that the number of outpatient circumcisions of boys under the age of five had increased by 34% between 2008 and 2011. The children's surgeons in Germany say they perform around 21,000 circumcisions a year. At around 300 euros per procedure, this costs around six million euros. Maximilian Stehr, chairman of the 'Working Group on Pediatric Surgery ' in the German Society for Pediatric Surgery (DGKCH), told the FAS that it would become clear “why the outcry from the resident colleagues […] after the Cologne circumcision judgment was so violent”. The FAS suspects that doctors are “tricking the billing”, since in the outpatient area the more expensive foreskin plastic surgery, in which the foreskin is retained, is billed up to 20 times more often than the complete removal of the foreskin. A spokeswoman for the AOK said that the health insurance companies cannot understand which operation was actually carried out. Oliver Hakenberg, General Secretary of the German Society for Urology, contradicted a similar report by NDR Radio from January 15, 2015: Urologists are required to provide comprehensive documentation, with the statutory health insurance associations requiring either photo documentation or a pathological finding of the removed foreskin. It is both absurd and embarrassing for patients and doctors to have to take genital photos just to please the clearing house inspectors. The pathological examination of a removed foreskin is only useful in exceptional cases. If it was just too tight, a tissue examination would be useless. The DGU therefore protested against the fraud allegation and demanded that the statutory health insurance associations put an end to absurd and cost-driving administrative bureaucracy.
The Lüneburg Higher Administrative Court ruled in 2002 that the social welfare institution is obliged to assume the costs of a religiously motivated, medically professional circumcision.
Appeals to the Federal Constitutional Court
On February 8, 2013, the Federal Constitutional Court did not even accept the constitutional complaint of a man who was circumcised in 1991 at the age of six against Section 1631 d of the German Civil Code (BGB), because the man is not affected by the law as he was already circumcised. On February 13, 2013, it rejected a father's application for a temporary injunction against the transfer of sole custody of his son to the child's mother who is presumably intending to circumcise, as Section 1631d of the German Civil Code allows other courts to be brought before the court.
Austria
In Austria, as in Germany, bodily harm is punishable without a special regulation for circumcision. In contrast to Germany, the Austrian constitutional laws do not contain an express basic right to physical integrity . However, Section 137 (2) ABGB declares “the use of any form of violence and the infliction of physical or mental suffering” by the parents to be inadmissible. According to Section 90, Paragraph 3 of the Criminal Code, “a mutilation or other injury to the genitals that is likely to cause lasting impairment of sexual perception” cannot be consented to even by adults. The "Israelite Law" of 1890 entitles the Israelite Religious Society and its members to "lead children and young people outside of school through all traditional customs and educate them according to religious commandments" (Section 9, Paragraph 4).
The Austrian Ministry of Justice does not consider the circumcision of boys for religious reasons to be a criminal offense (as of 2012), this was justified by parental rights . Health Minister Alois Stöger said in July 2012 that the debate about religious circumcision in Austria was an “artificial discussion”. A topic from Germany was taken over, "that is not important".
Great Britain
Due to Douglas Gairdner's paper The Fate of the Foreskin , published in the British Medical Journal in 1949 , in which the functions of the foreskin was described and routine circumcision was rejected as unnecessary and disadvantageous, the British health insurance companies stopped assuming the costs of the procedure. As a result, circumcision rates in Great Britain fell dramatically from 30% in 1950 to below 0.5% today. Until 1945 (or longer) the circumcision rate in the Anglican and Catholic upper and middle classes was over 95%.
The British Medical Association issued guidelines on male circumcision in 2004. In it, she outlined the different opinions as to whether non-therapeutic circumcision is beneficial, neutral or harmful. The harm or benefit of the operation has not been clearly proven. The BMA does not give any special guidelines on “ritual circumcision” and considers parents to be fundamentally entitled to make the decision about the intervention instead of their children.
France
The French government justifies the permissibility of circumcision with the religious freedom guaranteed in the constitution . However, there are only explicit regulations in Alsace-Lorraine , where an imperial decree of 1862 regulates the certification of Mohalim.
Sweden
In Sweden , circumcision without medical indication for boys under 18 has been regulated since 2001 by the “Lag (2001: 499) om omskärelse av pojkar” (Law on the Circumcision of Boys). According to this, such circumcisions are to be carried out as a surgical intervention by a licensed doctor and under anesthesia. For a boy up to two months old, another qualified person with state approval can perform the circumcision. This applies in particular to persons suggested by denominations in which circumcision is part of the religious tradition. Persons who perform circumcision without the necessary qualification or authorization are threatened by the law with a fine or imprisonment for up to six months. Circumcision requires the consent of the guardian. It may not be made against the child's will, provided that the child is of the age and maturity to make such a declaration.
North America
United States
In the US , the infant circumcision rate fell from 83% in the 1960s to 77% in 2010. The rate of neonatal circumcision in US hospitals is 64.7 , according to the Centers for Disease Control and Prevention (CDC) % decreased in 1980 to 58.3% in 2010. The downward trend is partly explained by the increasing proportion of Hispanics who do not have their children circumcised as often as the rest of the population. The situation in the USA is particularly uneven regionally (e.g. because of the different population groups); This means that opposing currents and higher percentages can also be localized. Medicaid reimbursement is a key factor . In 2012, there were 18 states that no longer covered the cost of infant circumcision under Medicaid. The professional association of American paediatricians, the American Academy of Pediatrics (AAP), however, advocates reimbursement by third parties. While the health benefits of circumcision are not great enough to recommend routine circumcision of male newborns, they are great enough to justify access to it for families who want it.
Although, with very few exceptions, practically no Christian church elevates circumcision to a doctrinal principle of belief, most religiously based circumcisions today take place in the United States among Christians, especially evangelicals. Reasons for this include, among others, wanting to follow the example of Jesus or to follow the Word of God itself where this is not expressly required. The 1963 book None of These Diseases by the Christian physician S. I. McMillen contributed greatly to the spread of this attitude among Christians .
After a local referendum in San Francisco in 2011 on a ban on routine circumcision was declared inadmissible, a law came into force in California in October 2011 that bans circumcision bans at the local or regional level.
Canada
In Canada , too , the health insurances no longer pay for the procedure that is deemed superfluous. The circumcision rate has fallen sharply.
Asia
Israel
The circumcision rate is very high in Israel. According to an online survey by the parent portal Mamy in 2006, it is 95%. Ben Shalem, an organization dedicated to the abolition of circumcision, petitioned the Supreme Court in 1999 on the grounds that circumcision violated human dignity, children's rights and criminal law. The petition was rejected.
Representation in art
- In his four-volume novel Joseph und seine Brüder (published between 1933 and 1943) Thomas Mann describes a possibility of the emergence of the custom as a gesture of appeasement and submission to the archaic, warlike and originally nomadic deity "Yahu", whom he allegedly preceded the Old Testament YHWH depicted.
- Orazio Gentileschi (1563-1639): Circumcision. Panel painting, oil on canvas, 390 × 252 cm, around 1606 (Church of Gesù, Ancona , dep. Pinacoteca Communale).
- Rembrandt van Rijn (1606–1669): The circumcision of Christ (or The circumcision in the stable ). Etching, 1654.
Interpretations in psychoanalysis
The psychoanalysis by Sigmund Freud (1856-1939) looked in the circumcision and characterized fed castration anxiety one of the essential causes of the unconscious antisemitism. According to Freud, circumcision is equated with castration and the Jews are hated for it. For example, the Stürmer- editor Julius Streicher was so fixated on the topic that he mentioned circumcision just as often in private conversations as "the Jews" itself. In 1913, Freud declared in his work Totem and Tabu that circumcision was a castration equivalent that supported the prohibition of incest in the most effective way. It would be stimulated or motivated by the unconscious fear of retribution by the man who has become a father. The unconscious memory of his own incestuous and hostile emotions from childhood, which were directed at his parents, is still alive in him. The father is afraid that his child will realize these wishes and that it could itself be their damaged object. The circumcision should prevent incest.
Theodor Reik (1888-1969, an Austrian-American psychoanalyst of the Jewish denomination and a well-known student of Freud) wrote in 1915 in his work The Puberty Rites of the Wild: About some similarities in the psychological life of the wild and the neurotics:
“ Strehlow should be mentioned as one of the few notable exceptions among ethnologists who did not subscribe to the popular view of the purpose of circumcision [that it is supposed to increase the young man's fertility] . This missionary contends that through the painful operation, the young who are not used to obedience are brought under the authority of the elderly; they should obey the ancients [...] In this respect, circumcision, as cruel as it is in and of itself, has a beneficial influence on unbound indigenous peoples who are not accustomed to any order, since it prevents the exuberance and insubordination of the youth entering their boozy years controls and makes them aware of the authority of the elderly, whose will is now decisive for them [...] Circumcision is intended to put a dam on the sexual excesses of adult youth. The operation is carried out at a time when the sex drive awakens in the boys concerned, which naturally occurs to a greater extent in these primitive peoples'. "
“One can probably express one's astonishment that none of the numerous anthropologists, ethnic psychologists and religious researchers who have dealt with the problem of circumcision has recognized the hostile nature of this operation [...] Most researchers even agree with that of the savages themselves given hypothesis [see above]. This kind of intellectual blindness can be explained psychologically if one considers that similar psychological obstacles as those which keep the consciousness of the primitive from the real motivation of circumcision are also operative in the learned. "
Anna Freud sees circumcision as a possible source of neurosis and trauma.
According to the psychoanalyst Matthias Franz , circumcision at the age of around five can be experienced by the affected boys as a “threat of castration”, as it takes place in developmental psychology in the consolidation phase of their sexual identity . In the experience of many boys, the threat is: “If you don't do what God and your father like, you could be circumcised again.” In terms of cultural history, sexuality is subordinated to the “primacy of patriarchy ”.
Circumcision as an object of anti-Semitic propaganda
The neo-Nazi band Skalinger uses circumcision in the refrain of the song "You are ...!" ("You are ...!"), Which is punishable for sedition (§130 StGB) ("Because you are Jews and we are not! You are crooked noses and we are not! You are circumcised and we are not!" we are Aryan and you are not! ”) as a main criterion for the demarcation of the Jews as a negatively viewed foreign group from the national community.
See also
- Body Integrity Identity Disorder
- Body modification (various changes in the human body)
- Labioplasty
- Self-mutilation
- Restoring the penile foreskin
literature
- Hermann Ferdinand Hitzig : Circumcisio . In: Paulys Realencyclopadie der classischen Antiquity Science (RE). Volume III, 2, Stuttgart 1899, Col. 2570 f.
- Julius Rosenbaum : History of the lust epidemic in antiquity together with detailed studies of the Venus and phallic cults, brothels, Νούσος ϑήλεια of the Scythians, paederasty and other sexual excesses of the ancients as contributions to the correct explanation of their writings . 7th edition, H. Barsdorf, Berlin 1904, pp. 283 f., 336–343 ( circumcision ) and 424.
- Werner Pieper (Ed.): From the foreskin files. Green Force, 1988, ISBN 978-3-925817-28-1 .
- David L. Gollaher: CIRCUMCISION - a history of the world's most controversial surgery. Basic Books (AZ), New York 2001, ISBN 0-465-04397-6 .
- German translation: The hurt sex. Structure, 2002, ISBN 3-351-02540-8 .
- Başar Alabay: Cultural Aspects of Socialization: Young Turkish Men in the Federal Republic of Germany. Dissertation. Springer VS, Wiesbaden 2012, ISBN 978-3-531-19609-1 ( reading sample in the Google book search).
- Matthias Küntzel : Contaminated Terrain. at: Perlentaucher . August 8, 2012.
- Nicole Steiner: The religiously motivated circumcision of boys in the light of criminal law: At the same time a contribution to the possibilities and limits of parental consent. Dissertation. Duncker & Humblot, Berlin 2013, ISBN 978-3-428-14154-8 .
- Matthias Franz (ed.): The circumcision of boys. A sad legacy. Vandenhoeck & Ruprecht, Göttingen 2014, ISBN 978-3-525-40455-3 .
- Clemens Berger (Ed.): Revealed! The circumcision of boys - just a small cut? Sufferers grapple with loss, pain and shame. Hamburg 2015, ISBN 978-3-7323-4012-5 .
- Melanie Klinger: Intimate injuries. Female and male genital cutting. (Not) an inadmissible comparison ?! Tredition, Hamburg 2019, ISBN 978-3-7497-3199-2 ( review [accessed June 25, 2020]).
Web links
Wikinews: Genital Mutilation - In The News- Karin Janke, Claudia Krallmann: Patient information: circumcision in men (circumcision). In: Urologenportal.de. April 21, 2020, published by the Professional Association of German Urologists and the German Society for Urology .
- The Cologne circumcision judgment. In: City of Münster. August 26, 2012 (extensive collection with numerous links to texts and interviews on the topic, for example by Holm Putzke, Rolf Dietrich Herzberg, Heribert Prantl ).
- Scientific services of the German Bundestag : circumcision and criminal law. June 29, 2012 (PDF; 73 kB, 2 pages on bundestag.de).
Individual evidence
- ^ German Society for International Cooperation : Male Circumcision (PDF) Eschborn, January 2011.
- ^ A b S. Moses, RC Bailey, AR Ronald: Male circumcision: assessment of health benefits and risks. In: Sexually transmitted infections. Volume 74, Number 5, October 1998, ISSN 1368-4973 , pp. 368-373, PMID 10195035 , PMC 1758146 (free full text) (review).
- ↑ World Health Organization and Joint United Nations Program on HIV / AIDS (Ed.): Male circumcision: global trends and determinants of prevalence, safety and acceptability . Geneva 2007, ISBN 978-92-4159616-9 , pp. 7 ( unaids.org [PDF; 2.1 MB ; Retrieved October 24, 2011] UNAIDS, ISBN 978-92-9173-633-1 ).
- ^ Bijan Fateh-Moghadam (2010): Religious Justification? The circumcision of boys between criminal law, religious freedom and parental custody. In: Journal for legal research. Issue 2, pp. 115–142, full text (PDF; 200 kB).
- ↑ a b c d e f Guidelines of the German Society for Pediatric Surgery: Phimosis and Paraphimosis ( Memento from December 11, 2017 in the Internet Archive ) (PDF; 210 kB).
- ↑ Five years after the Bundestag resolution: Doctors criticize the circumcision law - health. In: Spiegel Online . December 11, 2017. Retrieved June 9, 2018 .
- ↑ Ulrich Zimmermann: Article circumcision (AT) in the Lexicon Biblical Science
- ↑ C. Mordeniz, A. Verit: Is circumcision a modified ritual of castration? In: Urologia internationalis. Volume 82, number 4, 2009, ISSN 1423-0399 , pp. 399-403, doi: 10.1159 / 000218527 , PMID 19506405 (review).
- ↑ The circumcision stands here at the beginning of a six-stage initiation cycle, at the end of which stands the restoration of androgyny as the integration of "spiritual femininity", according to Mircea Eliade , Ioan Petru Culianu : Handbuch der Religionen. Frankfurt am Main 1995, pp. 37-38; Quote: “Circumcision deprives the androgynous being of its feminine component. Freed from his femininity, the man goes in search of a woman, and that is how common ground emerges again. "
- ↑ Doris Schwarzmann-Schafhauser: Under the primacy of the cult of the dead? Surgery in Ancient Egypt. Würzburger medical history reports 24, 2005, pp. 73–81; here p. 76 f.
- ↑ a b Peter Bollag: Sleek type. In: Jüdische Allgemeine . November 17, 2011, (accessed August 14, 2012).
- ↑ “[the baby] does not even receive a local anesthetic, because the covenant with God has to be carried out with full consciousness, so to speak. Of course the baby cries, of course the procedure hurts. ”In: Paul Spiegel : What is kosher? Jewish faith, Jewish life. Munich 2003, p. 40.
- ↑ Rabbi Antje Yael Deusel , senior physician at the Clinic for Urology and Pediatric Urology in Bamberg: "Concerns about the Brit Mila for medical reasons can be countered by performing the circumcision according to the latest surgical standard, using a suitable anesthesia." Ark. de / britmila So she speaks neither for nor against anesthesia.
- ^ Daniel Boyarin: Sparks of the Logos: Essays in Rabbinic Hermeneutics. Koninklijke Brill, Leiden 2003, ISBN 90-04-12628-7 , p. 37 (English; page preview in the Google book search).
- ↑ Shaye JD Cohen: Why Aren't Jewish Women Circumcised? Gender and Covenant in Judaism. University of California Press, Berkeley / Los Angeles 2005, ISBN 0-520-21250-9 , p. 147 (English; page preview in Google Book Search).
- ^ A b Leonard B. Glick: Marked in Your Flesh: Circumcision from Ancient Judea to Modern America. Oxford University Press, New York 2005, ISBN 0-19-517674-X , pp. 14–15 (English; page preview in Google Book Search).
- ^ Nissan Rubin: Brit Milah: A Study of Change in Custom. In: The same: The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite. University Press of New England, Lebanon 2003, ISBN 1-58465-307-8 , pp. 87 ff. (English; page preview in the Google book search).
- ^ Klaus Hödl: The German-language circumcision debate in the 19th century. In: Ashkenaz. Volume 13 (2007), Issue 1, pp. 189-209, doi: 10.1515 / ASCH.2003.189 .
- ↑ Why do Muslims and Jews circumcise their sons? Die Welt , June 28, 2012, (accessed August 13, 2012).
- ↑ Fact 6 Myths in the Circumcision Debate, AJC Berlin Lawrence & Lee Ramer Institute for German Jewish Relations, November 15, 2012.
- ↑ a b Thorsten Schmitz : The Scream. In: Süddeutsche Zeitung . August 7, 2012, p. 3.
- ^ Jewish ceremonies - circumstitions.com.
- ↑ Ernst Lautenbach: Lexicon Bible Quotes: Selection for the 21st Century. with prefaces by Robert Zollitsch and Ulrich Fischer . Munich 2006, ISBN 3-89129-789-0 , p. 94.
- ↑ Herwig Wolfram : The Goths and their history. CH Beck, Munich 2010, p. 113.
- ↑ Michael Sintzel, (confessor of the mother house of the merciful sisters in Munich): Life and deeds of the saints - a collection of legends for the Christian Catholic people. In: The Feast of the Circumcision of our Lord Jesus Christ. 1839 (heiligenlegende.de - Josef Dirschl)
- ^ H. Wehr: Arabic dictionary , Wiesbaden 1968, p. 205.
- ↑ Junker / Alavi: Persian-German Dictionary , Leipzig 1970, p. 266.
- ↑ The Book of Purification (Kitab Al-Taharah). ( Memento from May 11, 2013 in the Internet Archive ) Center for Muslim-Jewish Engagement, University of Southern California (English).
- ↑ See Sami Aldeeb : Male & Female Circumcision among Jews, Christians and Muslims. Religious, Medical, Social and Legal Debate. Warren Center, Pennsylvania 2001, p. 109.
- ↑ Gülnaz Beyaz: My life in the shadow of blood revenge. DTV, Munich 2008, ISBN 978-3-423-34480-7 , p. 146.
- ↑ Simon-Auguste Tissot: The onanism, or treatise on the diseases that result from self-defilement. , Facsimile of a translation from French from 1774, first edition 1758.
- ^ R. Darby: The Masturbation Taboo and the Rise of Routine Male Circumcision: A Review of the Historiography. In: Journal of Social History. Volume 36, Number 3, 2003, pp. 737-757, doi: 10.1353 / jsh.2003.0047 (full text)
- ^ Athol AW Johnson: On An Injurious Habit Occasionally Met with in Infancy and Early Childhood. In: The Lancet . Volume 1, April 7, 1860, pp. 344–345, here p. 345, right (English; page preview in the Google book search; quote: “In such cases we must, I believe, break the habit by inducing such a condition of the parts as will cause too much local suffering to allow of the practice being continued. For this purpose, if the prepuce is long, we may circumcise the male patient with present and probably future advantage; the operation, too, should not be performed under chloroform, so that the pain experienced may be associated with the habit we wish to eradicate. In the female, Dr. Gros has advocated, in like manner, complete or partial amputation of the clitoris [...] ".
- ^ John Harvey Kellogg: Plain Facts for Young and Old. F. Segner & Co., Burlington, Iowa 1888, Chapter 11: Treatment for Self-Abuse and Its Effects, p. 295: "A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. "
- ^ N. Bergman: Report of a Few Cases of Circumcision. In: Journal of Orificial Surgery. Volume 7, 1898, pp. 249-251.
- ^ MF Campbell: The male genital tract and the female urethra. In: MF Campbell, JH Harrison (Eds.): Urology. 3. Edition. WB Saunders, Philadelphia 1970, Volume 2, p. 1836: “Parents readily recognize the importance of local cleanliness and genital hygiene in their children and are usually ready to adopt measures which may avert masturbation. Circumcision is usually advised on these grounds. "
- ^ BBC - Ethics - Male circumcision: Cultural and health aspects to circumcision. In: bbc.co.uk. Retrieved February 9, 2015 .
- ↑ Statistical Brief # 45: Circumcisions Performed in US Community Hospitals, 2005. (English).
- ^ A b Health News: Circumcision rates vary by region. (accessed September 12, 2008).
- ↑ Normal versus Circumcised: US Neonatal Male Genital Ratio 2001 (accessed September 12, 2008).
- ↑ CP Nelson, R. Dunn, J. Wan, JT Wei: The increasing incidence of newborn circumcision: data from the nationwide inpatient sample. In: The Journal of urology. Volume 173, Number 3, March 2005, pp. 978-981. doi: 10.1097 / 01.ju.0000145758.80937.7d . PMID 15711354 . (English).
- ↑ a b More and more boys of preschool age are being circumcised. In: FAZ.net . October 19, 2013, accessed February 9, 2015 .
- ↑ a b Good cut. In: Frankfurter Allgemeine Sonntagszeitung . 19th October 2013.
- ↑ a b Natalie Wiesmann: Small cuts are becoming fashionable. In: taz.de . November 29, 2006, accessed on May 2, 2020 (“'When a foreskin is too tight, you can argue about it,' says the operating doctor”).
- ^ A b Gregor Tholl: Male circumcision: Operation foreskin. In: stern.de . April 28, 2007.
- ^ JH Ku, ME Kim, NK Lee, YH Park: Circumcision practice patterns in South Korea: community based survey . In: Sex Transm Inf . Vol. 79, 2003, pp. 65-67 , doi : 10.1136 / sti.79.1.65 .
- ^ MG Pang, DS Kim: Extraordinarily high rates of male circumcision in South Korea: history and underlying causes. In: BJU international. Volume 89, Number 1, January 2002, pp. 48-54, ISSN 1464-4096 . PMID 11849160 .
- ↑ DaiSik Kim, Sung-Ae Koo, Myung-Geol Pang: Decline in male circumcision in South Korea In: BMC Public Health. Volume 12, article no. 1067, December 11, 2012 (English; full text: doi: 10.1186 / 1471-2458-12-1067 ).
- ↑ http://www.gmanews.tv/story/219779/nation/tuli-a-rite-of-passage-for-filipino-boys
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772313/table/Tab1/?report=objectonly
- ↑ https://www.channelnewsasia.com/news/asia/-circumcision-season---philippine-rite-puts-boys-under-pressure--11640442
- ^ WHO: Voluntary medical male circumcision for HIV prevention. July 2012, accessed September 18, 2016 .
- ↑ WHO: WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention. March 28, 2007, accessed September 18, 2016 .
- ↑ BBC News: Kenyan MPs admit to circumcision. September 23, 2008, accessed September 18, 2016 .
- ↑ Schumpelick u. a .: Circumcision according to Dieffenbach. P. 434 ff. ( Page previews in Google book search).
- ↑ C. Kirya, MW Werthmann Jr .: Neonatal circumcision and penile dorsal nerve block - a painless procedure. In: J Pediatr. 1978 Jun; 92 (6): 998-1000. PMID 660375 . Full text .
- ↑ OC Stolik-Dollenberg, p Dollenberg: Bupivacaine versus lidocaine analgesia for neonatal circumcision. In: BMC Pediatr. 2005 May 22; 5 (1): 12. PMID 15907216 . PMC 1164419 (free full text).
- ↑ AL Masciello: Anesthesia for neonatal circumcision: local anesthesia is better than dorsal penile nerve block. In: Obstet Gynecol. 1990 May; 75 (5), pp. 834-838, PMID 2183111 . Full text .
- ^ HJ Stang, LW Snellman, LM Condon, MM Conroy, R. Liebo, L. Brodersen, MR Gunnar: Beyond dorsal penile nerve block: a more humane circumcision. In: Pediatrics. 1997 Aug; 100 (2): E3. PMID 9233974 . Full text (PDF)
- ^ B. Brady-Fryer, N. Wiebe, JA Lander: Pain relief for neonatal circumcision. In: Cochrane Database Syst Rev. 2004 Oct 18; (4): CD004217. PMID 15495086 .
- ↑ Karin Janke: Circumcision in men (circumcision). urologenportal.de, November 23, 2006, accessed on September 18, 2016 .
- ↑ For more details, see also the English Wikipedia .
- ↑ Gallo, L., Perdonà, S., & Gallo, A. (2010). EJACULATORY DISORDERS: The Role of Short Frenulum and the Effects of Frenulectomy on Premature Ejaculation. The journal of sexual medicine, 7 (3), 1269-1276 doi: 10.1111 / j.1743-6109.2009.01661.x
- ↑ a b City Urges Requiring Consent for Jewish Rite nytimes.com, June 12, 2012 (accessed July 24, 2012).
- ↑ Circumcision Styles ( Memento from December 16, 2011 in the Internet Archive ) (English).
- ↑ Dorsal-slit history (English).
- ↑ 2012 European guideline for the management of balanoposthitis
- ↑ Peter Altmeyer: Bowenoide Papulosis In: Dermatological differential diagnosis: The way to clinical diagnosis. Springer, 2011, ISBN 978-3-540-39001-5 , p. 551.
- ↑ B. Wörle; MJ Flaig, B. Konz: Indication for operation and importance of circumcision in the treatment of chronic inflammatory diseases and precancerous diseases. In: G. Sebastian, A. Stein, I. Hackert (ed.): Standards and trends in operative and oncological dermatology, phlebology and proctology. Volume 17, Congress Compact, Berlin 2001, ISBN 3-9806898-5-9 , pp. 101-106.
- ↑ Jakob Øster: Further Fate of the Foreskin - Incidence of Preputial Adhesions, Phimosis, and Smegma among Danish Schoolboys (English).
- ↑ E. Stark, J. Steffens: Errors and dangers in outpatient operations: circumcision. In: The Urologist. A, 42 (8) 2003, pp. 1035-1038 PMID 1451322 .
- ^ A b Otto Braun-Falco, Helmut Heinrich Wolff: Dermatology and Venerology. 5th edition. Springer, 2005, ISBN 3-540-40525-9 , pp. 1034-1035 ( page previews in the Google book search).
- ^ Peter Fritsch: Dermatology, Venereology: Basics, Clinic, Atlas. 2nd Edition. Springer, 2004, ISBN 3-540-00332-0 , p. 752 ( page previews in the Google book search).
- ↑ Peter Reuter: Smegma In: Springer Lexicon Medicine. Springer, Berlin a. a. 2004, ISBN 3-540-20412-1 , p. 1989.
- ↑ a b Christian Jung: Urology in Questions and Answers: Questions and case histories to prepare for oral exams during the semester and in the exam. 2nd Edition. Elsevier, Urban & Fischer, 2007, ISBN 978-3-437-43101-2 , p. 10 ( page previews in the Google book search).
- ^ American Cancer Society: What are the risk factors for penile cancer?
- ^ HA Weiss, SL Thomas, SK Munab2, RJ Hayes: Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. In: Sexually Transmitted Infections. Volume 86, 2006, pp. 101-110. PMID 16581731 . PMC 2653870 (free full text).
- ↑ How does male circumcision protect against HIV infection? In: British Medical Journal. PMC 1127372 (free full text) (English).
- ↑ Circumcision Policy Statements .
- ↑ Doctors don't want health insurance to be cut , Ärztezeitung online, May 11, 2010, accessed on August 15, 2012.
- ↑ Circumcision for the prevention of urinary tract infection in boys: a systematic review of randomized trials and observational studies (English).
- ↑ Wing-Yee Kwok1, Marjolein CE de Kwaadsteniet, Mirjam Harmsen, Lisette WA van Suijlekom-Smit, François G Schellevis, Johannes C. van der Wouden1: Incidence rates and management of urinary tract infections among children in Dutch general practice: results from a nation -wide registration study In: BMC Pediatrics. April 2006, full text .
- ^ A b American Academy of Pediatrics - Task Force on Circumcision: Male Circumcision. In: Pediatrics. Volume 130, No. 3, September 1, 2012, pp. E756–785 (English; doi: 10.1542 / peds.2012-1990 ).
- ↑ Donough J O'Donovan: Urinary tract infections in newborns . In: UpToDate. August 2012.
- ↑ Kimberly G Lee: Urinary catheter - infants . University of Maryland Medical Center, December 2009.
- ^ Children's Hospital of The King's Daughters: Catheter-Associated Urinary Tract Infections, Frequently Asked Questions . April 2009.
- ^ DM Fergusson, JM Lawton, FT Shannon: Neonatal circumcision and penile problems: an 8-year longitudinal study. In: Pediatrics. 1988 Apr; 81 (4): 537-41. PMID 3353186 . Full text .
- ↑ N. Fakjian, S. Hunter, GW Cole, J. Miller: An argument for circumcision. Prevention of balanitis in the adult , Volume 126, No. 8, August 1990 (English).
- ^ Robert S. Van Howe: Neonatal Circumcision and Penile Inflammation in Young Boys. In: Clin Pediatr (Phila). 2007 May; 46 (4): 329-33. doi: 10.1177 / 0009922806295708 . PMID 1747599 .
- ^ N. Siegfried, M. Muller, JJ Deeks, J. Volmink: Male circumcision for prevention of heterosexual acquisition of HIV in men. In: Cochrane Database Syst Rev. 2009 Apr 15; (2): CD003362. doi: 10.1002 / 14651858.CD003362.pub2 . PMID 19370585 . Full text (PDF) Commented by E. Pisani ( PMID 20824909 ) and RH Gray u. a. ( PMID 20624821 ). HTML full text . Full text (PDF)
- ↑ WHO: WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention (English).
- ↑ AIDS: WHO recommends circumcision for men ( memento from August 1, 2012 in the web archive archive.today )
- ↑ Joint Strategic Action Framework to Accelerate the Scale-Up of Voluntary Medical Male Circumcision for HIV Prevention in Eastern and Southern Africa ( Memento of July 5, 2012 in the Internet Archive ) (PDF) 2012–2016 UNAIDS (PDF; 276 kB).
- ↑ One man, one knife . In: Der Spiegel . No. 34 , 2008, p. 79 ( online ).
- ↑ The Circumcised Nation . In: Welt Online.
- ↑ B. Auvert, D. Taljaard, E. Lagarde, J. Sobngwi-Tambekou, R. Sitta, A. Puren: Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. In: PLoS Med. 2005 Nov; 2 (11): e298. Epub 2005 Oct 25. PMID 16231970 . PMC 1262556 (free full text).
- ↑ CDC HIV / AIDS Science Facts: Male Circumcision and Risk for HIV Transmission: Implications for the United States; August 2006 ( Memento of October 28, 2006 in the Internet Archive ) (English).
- ↑ C. Connolly, LC Simbayi, R. Shanmugam, A. Nqeketo: Male circumcision and its relationship to HIV infection in South Africa: Results of a national survey in 2002. In: South African Medical Journal. 2008 (English). PMID 19115756 . Full text. (PDF)
- ↑ Shamiso Yikoniko: Circumcised men not spared from HIV infection. In: The Sunday Mail. Zimbabwe, July 7, 2012; Retrieved July 25, 2012.
- ↑ USAid: Levels and Spread of HIV Seroprevalence and Associated Factors: Evidence from National Household Surveys. USAID DHS Comparative Reports No. February 22, 2009; S. Xii. measuredhs.com (PDF) accessed on August 25, 2012
- ^ Robert S. Van Howe, Michelle R. Storms: How the circumcision solution in Africa will increase HIV infections In: Journal of Public Health in Africa. 2011; 2: e4, doi: 10.4081 / jphia.2011.e4 full text ( Memento from June 20, 2012 in the Internet Archive )
- ↑ Brian J. Morris, Jake H. Waskett, Ronald H. Gray, Daniel T. Halperin, Richard Wamai, Bertran Auvert, Jeffrey D. Klausner: Exposé of misleading claims that male circumcision will increase HIV infections In: Journal of Public Health in Africa. 2011; volume 2: e28, doi: 10.4081 / jphia.2011.e28 PDF .
- ↑ Everything will be different and everything will stay the same! - The importance of the HIV viral load for prevention , July 4, 2008, ondamaris.de.
- ↑ Circumcision: Not a Good Protection Strategy for Gay Men? ondamaris.de, December 15, 2010.
- ↑ GA Millett, SA Flores, G. Marks, JB Reed, JH Herbst: Circumcision status and risk of HIV and sexually transmitted infections among men who have sex with men: a meta-analysis In: JAMA 300 (14). 2008, pp. 1674-1684, doi: 10.1001 / jphia.300.14.1674 . PMID 18840841 .
- ↑ CDC Fact Sheet: Estimates of New HIV Infections in the United States, 2006–2009 (PDF; 754 kB), cdc.gov
- ↑ HIV / AIDS in Germany - key data of the estimate ( Memento from November 17, 2016 in the Internet Archive ) (PDF) Brief epidemiological information from the Robert Koch Institute, as of the end of 2012.
- ↑ The Kenya AIDS epidemic UPDATE 2011 (PDF; 6.6 MB), unaids.org
- ↑ Country Progress Report on the Declaration of Commitment on HIV / AIDS, 2010 Report (PDF; 1.7 MB), unaids.org
- ^ A b H. A. Weiss, SL Thomas, SK Munabi, RJ Hayes: Male circumcision and risk of syphilis, chancroid, and genital herpes: a systematic review and meta-analysis. In: Sexually Transmitted Infections. Volume 82, 2006, pp. 101-110, PMID 16581731 (English).
- ↑ Circumcision: Protection against sex diseases. focus.de, March 26, 2009.
- ^ Brian J. Morris: Why circumcision is a biomedical imperative for the 21 (st) century. In: Bioessays. 2007 Nov; 29 (11): 1147-58. PMID 17935209 . Full text. (PDF)
- ↑ Elizabeth Stern, Peter M. Neely: Cancer of the Cervix in Reference to Circumcision and Marital History. In: J Am Med Womens Assoc. 1962 Sep; 17: 739-40. PMID 13916981 . Full text .
- ^ RS Van Howe: Human papillomavirus and circumcision: a meta-analysis. In: J Infect. 54 (2007), pp. 490-496, doi: 10.1016 / j.jinf.2006.08.005 , PMID 16997378 . Full text.
- ↑ Xavier Castellsagué, Ginesa Albero, Ramon Cleries, F. Xavier Bosch: HPV and circumcision: a biased, inaccurate and misleading meta-analysis. In: J Infect. 55 (2007), pp. 91-93. doi: 10.1016 / j.jinf.2007.02.009 , PMID 17433445 . http://www.circs.org/index.php/Library/Castellsague (link not available)
- ↑ Natasha Larke, Sara L. Thomas, Isabel dos Santos Silva, Helen A. Weiss: Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis. In: J Infect Dis. 2011 Nov; 204 (9), pp. 1375-1390, doi: 10.1093 / infdis / jir523 , PMID 21965090 .
- ^ G. Albero, X. Castellsagué, AR Giuliano, FX Bosch: Male circumcision and genital human papillomavirus: a systematic review and meta-analysis. In: Sex Transm Dis. 2012 Feb; 39 (2), pp. 104-113, doi: 10.1097 / OLQ.0b013e3182387abd , PMID 22249298 .
- ↑ G. Schoeneich, D. Heimbach, SC Müller: Peniskarcinoma. In: Journal of Urology and Urogynaecology. Volume 6 (1) (edition for Austria), 1999, pp. 16-27. Full text. (PDF)
- ^ The Royal Australasian College of Physicians: Circumcision of Infant Males. 2010, p. 13. Full text. (PDF)
- ^ A b N. L. Larke, SL Thomas, Silva I. dos Santos, HA Weiss: Male circumcision and penile cancer: a systematic review and meta-analysis. In: Cancer Causes Control. 2011 Aug; 22 (8), pp. 1097-1110. Epub 2011 Jun 22. PMID 21695385 . PMC 3139859 (free full text).
- ↑ NK Bissada, RR Morcos, M. el-Senoussi: Post-circumcision carcinoma of the penis. I. Clinical aspects. In: Journal of Urology. 1986, pp. 135, pp. 283-285, PMID 3944860 .
- ↑ RM Seyam, NK Bissada, A. Mokhtar, W. Mourad, M. Aslam, N. Elkum: Outcome of penile cancer in circumcised men. In: Journal of Urology. 2006, p. 175 (2), p. 557-561, doi: 10.1016 / S0022-5347 (05) 00234-X , PMID 16406995 .
- ^ Andrea Spence, Marie-Élise Parent, Pierre I. Karakiewicz, Marie-Claude Rousseau: Circumcision and prostate cancer: a population-based case-control study in Montreal, Canada. 2014, PMID 24655933 , doi: 10.1111 / bju.12741 .
- ↑ JA Ferris, J. Richters, MK Pitts, JM Shelley, JM Simpson, R. Ryall et al. a .: Circumcision in Australia: further evidence on its effects on sexual health and wellbeing. In: Australian and New Zealand journal of public health. 34 (2), (2010), pp. 160-164, doi: 10.1111 / j.1753-6405.2010.00501.x .
- ^ Morris, BJ, Hankins, CA, Lumbers, ER, Mindel, A., Klausner, JD, Krieger, JN, & Cox, G. (2019): Sex and Male Circumcision: Women's Preferences Across Different Cultures and Countries: A Systematic Review. Sexual medicine, 7 (2), 145-161 doi: 10.1016 / j.esxm.2019.03.003
- ^ A b M. L. Williamson, PS Williamson: Women's preferences for penile circumcision in sexual partners. In: J Sex Educ Ther. Volume 14; 1988. (English). doi: 10.1080 / 01614576.1988.11074930 . Full text on circlist.com
- ↑ a b K. O'Hara, J. O'Hara: The effect of male circumcision on the sexual enjoyment of the female partner. In: BJU Int. 1999 Jan; 83 Suppl 1, pp. 79-84. PMID 10349418 . Full text (English).
- ↑ a b Masood: Penile Sensitivity and Sexual Satisfaction after Circumcision: Are We Informing Men Correctly? In: Urol Int. 75, (2005), pp. 62-66, doi: 10.1159 / 000085930 .
- ^ F. van Dijk, HB Thio, HAM Neumann: Non-Oncological and Non-Infectious Diseases of the Penis (Penile Lesions). (English).
- ↑ Professional association of paediatricians : That goes below the belt! (PDF; 0.6 MB) Information brochure for boys and their parents, p. 11.
- ↑ Clarence William Brown Jr .: Pearly Penile Papules. In: Medscape Reference - Drugs, Diseases & Procedures. (English).
- ↑ K. Agha, S. Alderson, S. Samraj, A. Cottam, C. Merry, V. Lee, R. Patel: Pearly penile papules regress in older patients and with circumcision. In: Int J STD AIDS. 2009 Nov; 20 (11), pp. 768-770. PMID 19833692 .
- ↑ a b c J. R. Taylor, A. Lockwood, A. Taylor: The prepuce: specialized mucosa of the penis and its loss to circumcision. In: British journal of urology. February 1996, p. 77 (2), p. 291-295, doi: 10.1046 / j.1464-410X.1996.85023.x , PMID 8800902 full text .
- ^ CJ Cold, JR Taylor: The prepuce In: British Journal of Urology. January 1999, Volume 83, Suppl. 1, pp. 34-44. PMID 10349413 full text .
- ↑ ML Sorrells, JL Snyder, MD Reiss, C. Eden, MF Milos, N. Wilcox, Van Howe RS: Fine-touch pressure thresholds in the adult penis. In: BJU Int. Volume 99, Issue 4, April 2007, PMID 17378847 , pp. 864–869 full text (PDF; 144 kB).
- ^ R. Crooks, K. Baur: Our Sexuality. 5th edition. The Benjamin / Cummings Publishing, Redwood City 1993, p. 129.
- ↑ Why Masters & Johnson's 1966 Circumcision Study is Flawed (1998) .
- ↑ a b DaiSik Kim, Myung-Geol Pang: The effect of male circumcision on sexuality. In: BJU international. Volume 99, Issue 3, March 2007, pp. 619-622. doi: 10.1111 / j.1464-410X.2006.06646.x , PMID 17155977 .
- ↑ Robin Willencourt: The effect of male circumcision on sexuality. In: BJU International. Volume 99, No. 5, pp. 1169-1170, May 2007. doi : 10.1111 / j.1464-410X.2007.06895_3.x , PMID 17437447 .
- ↑ Tian Y., Liu W. u. a .: Effects of circumcision on male sexual functions: a systematic review and meta-analysis. In: Asian J Androl. No. 5, September 2013, pp 662-666. (English; doi: 10.1038 / aja.2013.47 ; PMID 23,749,001 . PMC 3881635 (free full text)).
- ↑ EO Laumann, CM Masi, EW Zuckerman: Circumcision in the United States: Prevalence, prophylactic effects, and sexual practice. In: JAMA. Volume 277, No. 13, 1997, pp. 1052-1057 (English; full text on cirp.org; PMID 9091693 ).
- ↑ KS Fink, CC Carson, RF DeVellis: Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction. In: J Urology Volume 167, No. 5, May 2002 May, pp. 2113-2116 (English; full text on cirp.org; PMID 11956453 ).
- ↑ JN Krieger, SD Mehta, RC Bailey, K. Agot, JO Ndinya-Achola, C. Parker, S. Moses: Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya. In: J Sex Med. 2008 Nov; 5 (11), pp. 2610-2622. doi: 10.1111 / j.1743-6109.2008.00979.x PMID 18761593 PMC 3042320 (free full text)
- ^ J. Money, J. Davison: Adult penile circumcision: Erotosexual and cosmetic sequelae. In: Journal of Sex Research. 19: 289-292 (1983). cirp.org .
- ↑ What Intact Men Say ( Memento from November 30, 2014 in the web archive archive.today ) (English).
- ↑ a b Morten Frisch, Morten Lindholm, Morten Grønbæk: Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. In: International Journal of Epidemiology. October 2011, p. 40 (5), p. 1367-1381, doi: 10.1093 / ije / dyr104 , PMID 21672947 .
- ^ Brian J. Morris, Jake H. Waskett, Ronald H. Gray: Does sexual function survey in Denmark offer any support for male circumcision having an adverse effect? In: International Journal of Epidemiology. February 2012, p. 41 (1), p. 310-326, doi: 10.1093 / ije / dyr180 , PMID 22422464 .
- ↑ Morten Frisch: Author's Response to: Does sexual function survey in Denmark offer any support for male circumcision having an adverse effect? In: International Journal of Epidemiology. February 2012, p. 41 (1), p. 312-314, doi: 10.1093 / ije / dyr181
- ↑ a b I. Solinis, A. Yiannaki: "Does circumcision improve couple's sex life?" In: J Mens Health Gend. 2007; 4 (3), p. 361. Full text .
- ↑ MD Waldinger, P. Quinn, M. Dilleen, R. Mundayat, DH Schweitzer, M. Boolell: A multinational population survey of intravaginal ejaculation latency time. In: The journal of sexual medicine. Volume 2, Number 4, July 2005, pp. 492-497, ISSN 1743-6095 . doi: 10.1111 / j.1743-6109.2005.00070.x . PMID 16422843 .
- ↑ G. Kigozi, S. Watya, CB Polis, D. Buwembo, V. Kiggundu, MJ Wawer, D. Serwadda, F. Nalugoda, N. Kiwanuka, MC Bacon, V. Ssempijja, F. Makumbi, RH Gray: The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention, Rakai, Uganda. In: BJU Int. 2008 Jan; 101 (1), pp. 65-70, doi: 10.1111 / j.1464-410X.2007.07369.x , PMID 18086100 . Commented by Jelto J. Drenth ( full text ) and Marwan Daar (full text)
- ↑ Guy A. Bronselaer, Justine M. Schober, Heino FL Meyer-Bahlburg, Guy T'Sjoen, Robert Vlietinck, Piet B. Hoebeke: Male circumcision decreases penile sensitivity as measured in a large cohort. In: BJU Int. On-line. February 4, 2013, doi: 10.1111 / j.1464-410X.2012.11761.x , PMID 23374102 .
- ↑ Robert Bublak: circumcision costs sex fun , Medical Journal online February 19, 2013, accessed on March 3, 2013.
- ↑ T. İ. Şenkul, C. İşeri, K. Karademir, F. Saraçoğlu, D. Erden: Circumcision in adults: effect on sexual function. Urology, 63 (1), (2004), pp. 155-158, doi: 10.1016 / j.urology.2003.08.035 .
- ↑ JN Krieger, SD Mehta, RC Bailey, K. Agot, JO Ndinya-Achola, C. Parker, S. Moses: Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya. In: J Sex Med. 2008 Nov; 5 (11), Epub 2008 Aug 28, pp. 2610-2622, PMID 18761593 .
- ^ J. Cortés-González, J. Arratia-Maqueo, L. Gómez-Guerra: Does circumcision has an effect on female's perception of sexual satisfaction? In: Rev Invest Clin. 60 (3), 2008, p. 227. PMID 18807735 .
- ↑ Kigozi, G., Lukabwe, I., Kagaayi, J., Wawer, MJ, Nantume, B., Kigozi, G., ... & Ridzon, R. (2009): Sexual satisfaction of women partners of circumcised men in a randomized trial of male circumcision in Rakai, Uganda. In: BJU international , 104 (11), 1698-1701 doi: 10.1111 / j.1464-410X.2009.08683.x
- ↑ Bailey, Muga, Poulussen, Abich: The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya. In: AIDS Care. Volume 14, No. 1, February 2002, pp. 27-40. Full text (English).
- ^ C. Hankins: Male circumcision: implications for women as sexual partners and parents. In: Reproductive Health Matters. 15 (29), (2007), pp. 62-67. PMID 17512377 full text (PDF)
- ^ Canadian Pediatric Society: Neonatal circumcision revisited. ( Memento of October 23, 2007 in the Internet Archive ) In: CMAJ. 1996; 154 (6), pp. 769-780.
- ^ N. Williams, L. Kapila: Complications of circumcision. In: The British Journal of Surgery . Volume 80, Number 10, October 1993, ISSN 0007-1323 , pp. 1231-1236, PMID 8242285 (review).
- ^ Circumcision and Information Resource Pages: Circumcision Deaths , accessed July 9, 2012.
- ^ Baby's Death Renews Debate Over a Circumcision Ritual. In: New York Times . March 7, 2012, Retrieved July 9, 2012.
- ↑ a b Queen’s Park baby bled to death two days after being circumcised. In: kilburntimes.co.uk. June 22, 2012, accessed February 9, 2015 .
- ↑ Cynthia R. Fagen: Tot's shock hosp death. In: nypost.com. May 5, 2011, accessed February 9, 2015 .
- ↑ a b Circumcised baby 'bled to death'. In: bbc.co.uk. November 27, 2012, accessed February 9, 2015 .
- ^ B. Brady-Fryer, N. Wiebe, JA Lander: Pain relief for neonatal circumcision. In: Cochrane Database Syst Rev. 18, 2004, (4), S. CD004217, doi: 10.1002 / 14651858.CD004217.pub2
- ↑ MJ O'Sullivan, B. Mislovic, E. Alexander: Dorsal penile nerve block for male pediatric circumcision - randomized comparison of ultrasound-guided vs anatomical landmark technique. In: Pediatr Anaesth. 21 (12), (2011), pp. 1214-1218. doi: 10.1111 / j.1460-9592.2011.03722.x
- ↑ M. Butler-O'Hara, C. LeMoine, R. Guillet: Analgesia for neonatal circumcision: a randomized controlled trial of EMLA cream versus dorsal penile nerve block. In: Pediatrics. 101 (4), (1998), p. E5, PMID 9521971 .
- ↑ J. Lander, B. Brady-Fryer, JB Metcalfe, S. Nazarali, S. Muttitt: Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial. In: JAMA. 24-31; 278 (24), (1997), pp. 2157-2162, PMID 9417009
- ↑ A. Taddio, K. Ohlsson, A. Ohlsson: Lidocaine-prilocaine cream for analgesia during circumcision in newborn boys. In: Cochrane Database Syst Rev. (2), (2000), S. CD000496. Review. PMID 10796371
- ↑ Pharmaceutical information of the federal government and the federal states - Changes to the instructions for use and specialist information from July 22, 2013 - Available at pharmnet-bund.de
- ↑ Markus C. Schulte von Drach: Circumcision of newborns - questionable anesthesia. In: sueddeutsche.de . August 19, 2013, accessed February 9, 2015 .
- ^ A b R. S. Van Howe: Incidence of meatal stenosis following neonatal circumcision in a primary care setting. In: Clinical Pediatrics. 45 (1), (2006), pp. 49-54. PMID 16429216 .
- ↑ a b Meatal Stenosis - Medscape Reference.
- ↑ A. Stenram, G. Malmfors, L. Okmian: Circumcision for phimosis: a follow-up study. In: Scandinavian journal of urology and nephrology. 20 (2), (1986), p. 89. PMID 3749823 .
- ↑ M. Joudi, M. Fathi, M. Hiradfar: Incidence of asymptomatic meatal stenosis in children following neonatal circumcision. In: Journal of Pediatric Urology. 7 (5), (2010), pp. 526-528. PMID 20851685 .
- ↑ SA Naimer, R. Peleg u. a .: Office management of penile skin bridges with electrocautery. In: The Journal of the American Board of Family Practice. Volume 15, Number 6, 2002 Nov-Dec, ISSN 0893-8652 , pp. 485-488, PMID 12463295 .
- ^ RS van Howe: Variability in penile appearance and penile findings: a prospective study. In: British Journal of Urology. Volume 80, Number 5, pp. 776-782 (English).
- ^ New York City Department of Health and Mental Hygiene: Circumcision. Before the Bris: How to Protect Your Baby Against Infection. (online) ( Memento from May 13, 2012 in the Internet Archive )
- ↑ Martin Gehlen: It's routine in the USA. In: tagesspiegel.de . June 28, 2012, accessed February 9, 2015 .
- ↑ nyc.gov (PDF)
- ↑ nytimes.com
- ^ A b A. J. Krill, LS Palmer, JS Palmer: Complications of circumcision In: Scientific World Journal. Number 11, pp. 2458–2468, doi: 10.1100 / 2011/373829 PMID 22235177 PMC 3253617 (free full text)
- ↑ J. Money: Ablatio Penis: Normal Male Infant Sex-Reassigned as a Girl. In: Archives of Sexual Behavior. 4 (1), 1975, pp. 65-71.
- ^ JP Gearhart, JA Rock: Total ablation of the penis after circumcision with electrocautery: a method of management and long-term followup. In: J Urol. 1989 Sep; 142 (3), pp. 799-801, PMID 2769863 .
- ↑ Milton Diamond, H. Keith Sigmundson: Sex Reassignment at Birth: A Long Term Review and Clinical Implications. In: Arch Pediatr Adolesc Med 1997; 151 (3), pp. 289-304, PMID 9080940 full text .
- ↑ J. Ben Chaim, PM Livne, J. Binyamini, B. Hardak, D. Ben-Meir, Y. Mor: Complications of Circumcision in Israel: A One Year Multicentric Survey. In: Isr Med Assoc J. 2005 Jun; 7 (6), S. 368-70, PMID 15984378 full text (PDF)
- ↑ GR Gluckman, ML Stoller, MM Jacobs, BA Kogan: Newborn penile glans amputation during circumcision and successful reattachment. In: J Urol. 1995 Mar; 153 (3 Pt 1), pp. 778-9, PMID 7861536 .
- ^ AF Yilmaz, S. Sarikaya, S. Yildiz, R. Büyükalpelli: Rare complication of circumcision: penile amputation and reattachment. In: Eur Urol. 1993; 23 (3), pp. 423-4, PMID 8508901 .
- ↑ a b Quoted from Canadian Pediatric Society: Position Statement: Neonatal circumcision revisited. March 15, 1996.
- ↑ Bimbo morto dissanguato, fermata nigeriana In: la tribuna di Treviso of June 5, 2008
- ↑ Murder investigations in South Africa: Up to 23 dead in circumcisions. In: Spiegel Online . May 17, 2013, accessed February 9, 2015 .
- ↑ 30 deaths: Failed traditional circumcisions in South Africa. In: nzz.ch. July 7, 2013, accessed February 9, 2015 .
- ↑ JD Eason, M. McDonnell, G. Clark: Lesson of the Week: Male ritual circumcision resulting in acute renal failure. In: BMJ: British medical journal. 309 (6955), (1994), pp. 660-661, doi: 10.1136 / bmj.309.6955.660 .
- ↑ V. Tasic, M. Polenakovic: Acute glomerulonephritis poststreptococcal Following circumcision. In: Pediatric Nephrology. 15 (3), 2000, pp. 274-275, doi: 10.1007 / s004670000451 .
- ↑ E. Kocakoc, A. Kazez, AF Dagli, M. Koc: Postcircumcision Granuloma. In: Journal of ultrasound in medicine. 25 (12), (2006), pp. 1611-1613, PMID 17121960 .
- ↑ a b R. A. Yegane, AR Kheirollahi, NA Salehi, M. Bashashati, JA Khoshdel, M. Ahmadi: Late complications of circumcision in Iran. In: Pediatric surgery international. Volume 22, number 5, (2006), pp. 442-445, doi: 10.1007 / s00383-006-1672-1 .
- ↑ SA Naimer, A. Cohen, D. Vardy: Pyogenic granuloma of the penile shaft following circumcision. In: Pediatric dermatology. 19 (1), 2002, pp. 39-41, PMID 11860569 .
- ^ D. Annunziato, LM Goldblum: Staphylococcal scalded skin syndrome: A complication of circumcision. In: Archives of Pediatrics and Adolescent Medicine. 132 (12), 1978, p. 1187 PMID 717333 .
- ^ AA Esen, G. Aslan, H. Kazımoğlu, D. Arslan, I. Celebi: Concealed penis: rare complication of circumcision. In: Urologia internationalis. 66 (2), (2001), pp. 117-118 PMID 11223758 .
- ↑ S. Yildirim, T. Aköz, M. Akan: A rare complication of circumcision: concealed penis. In: Plastic and reconstructive surgery. 106 (7), (2000), p. 1662. PMID 1112920 .
- ↑ JB Chaim, PM Livne, J. Binyamini, B. Hardak, D. Ben-Meir, Y. Mor: Complications of circumcision in Israel: a one year multicenter survey. In: Isr. Med. Assoc. J. 7, (2005), pp. 368-370 PMID 15984378 .
- ^ Goldman: The psychological impact of circumcision. In: BJU Int. 83 (1), (1999), pp. 93-102, doi: 10.1046 / j.1464-410x.1999.0830s1093.x .
- ^ Timm Hammond: A Preliminary Poll of Men Circumcised in Infancy or Childhood. In: British Journal of Urology International. Volume 83, Number S1, January 1999, pp. 85-92. doi: 10.1046 / j.1464-410x.1999.0830s1085.x , PMID 10349419 .
- ^ SE Lerman, JC Liao: Neonatal circumcision. In: Pediatr Clin North Am. Volume 48, Number 6, 2001, pp. 1539-1557. PMID 11732129 .
- ↑ FM Hodges: The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme. In: Bulletin of the History of Medicine. 75 (3), (2001), pp. 375-405. PMID 11568485 .
- ↑ a b c Sander L. Gilman: Readings of Circumcision In: Freud, Identity and Gender , S. Fischer, 2016, ISBN 978-3-10-561430-3 ; Pp. 80-81.
- ^ A b c Michael Benatar, David Benatar: Between Prophylaxis and Child Abuse: The Ethics of Neonatal Male Circumcision. In: The American Journal of Bioethics. 3: 2, (2003), pp. 35-48. doi: 10.1162 / 152651603766436216 . PMID 12859815 . Between prophylaxis and child abuse: the ethics of neonatal male circumcision. ( Memento of April 28, 2009 in the Internet Archive ).
- ↑ a b Y. Vawda, L. Maqutu: Neonatal circumcision-violation of children's rights or public health necessity? In: South African Journal of Bioethics and Law. 4 (1), (2011), pp. 36-42.
- ↑ a b c d e f S. K. Hellsten: Rationalizing circumcision: from tradition to fashion, from public health to individual freedom — critical notes on cultural persistence of the practice of genital mutilation. In: Journal of Medical Ethics. 30 (3), (2004), p. 248, doi: 10.1136 / jme.2004.008888 .
- ↑ a b c d M. F. Milos, D. Macris: Circumcision: A medical or a human rights issue? In: Journal of Nurse-midwifery. 37 (2), (1992), pp. S87-S96 PMID 1573462 .
- ^ Genders Unite for Genital Autonomy - It's a Personal Choice; London, September 3, 2008. genitalautonomy.org (English)
- ↑ NORM-UK: Genders Unite to promote Genital Autonomy ( Memento from November 2, 2012 in the Internet Archive ) (English).
- ↑ Holm Putzke: The criminal relevance of the circumcision of boys. At the same time, a contribution about the limits of consent in cases of personal care. (PDF; 7.5 MB), In: Festschrift for Rolf Dietrich Herzberg. Tübingen 2008, pp. 669-709.
- ↑ FAS: "Religious freedom cannot be a license for violence". In: FAZ.net . July 21, 2012, accessed February 9, 2015 .
- ↑ dakj.de ( Memento from March 16, 2016 in the Internet Archive ) or dakj.de ( Memento from December 3, 2013 in the Internet Archive ) (PDF)
- ^ Press release (July 4, 2012) on the judgment of the Cologne Regional Court (on the illegality of medically non-indicated circumcision in boys who are unable to consent) - German Society for Pediatric Surgery (DGKCH).
- ↑ A child's right to physical integrity does not seem to count! - Professional association of paediatricians
- ↑ Hundreds demonstrate for circumcision - Deutsche Welle
- ↑ Good old anti-Semitism. In: Jüdische Allgemeine .
- ↑ The new language of anti-Semitism is the language of human rights. In: Telepolis . (online), November 25, 2012.
- ^ Samuel Salzborn: Global anti-Semitism. A search for traces in the abyss of modernity. 2nd edition, Beltz Juventa, Weinheim 2020, p. 181
- ↑ Rie / aerzteblatt.de: Circumcision: Child protectors call for a moratorium. In: aerzteblatt.de . September 13, 2012, accessed February 9, 2015 .
- ↑ The Association of Judges calls for an exception in the case of circumcision for religious reasons. In: SZ-Online . July 20, 2012, accessed January 20, 2013 .
- ^ R. Cruz, LB Glick, JW Travis: Circumcision as Human-Rights Violation: Assessing Benatar and Benatar. In: The American Journal of Bioethics. 3 (2), 2002, pp. 19-20, doi: 10.1162 / 152651603766436351 .
- ↑ FM Hodges: Prophylactic interventions on children: balancing human rights with public health. In: Journal of Medical Ethics. 28 (1), 2002, pp. 10-16, doi: 10.1136 / jme.28.1.10 .
- ^ DA Canning: Informed consent for neonatal circumcision: An ethical and legal conundrum. In: Journal of Urology. 168 (4), 2002, pp. 1650-1651, PMID 12356070 .
- ^ G. Hill: Can Anyone Authorize the Nontherapeutic Permanent Alteration of a Child's Body? In: The American Journal of Bioethics. 3 (2), 2003, pp. 16-18, doi: 10.1162 / 152651603766436342 .
- ↑ C. Holzner: Overview of the discussion "Statement on the draft bill of a law of the Federal Ministry of Justice of October 1, 2012 on the extent of personal care in the event of a male circumcision". In: foerderverein-medizinrecht.de. (2012)
- ^ M. Fox, M. Thomson: A covenant with the status quo? Male circumcision and the new BMA guidance to doctors. In: Journal of Medical Ethics. 31, (2004), pp. 463-469, doi: 10.1136 / jme.2004.009340 .
- ↑ GJ Boyle, G. Hill: Circumcision-generated emotions bias medical literature. In: BJU international. 109 (4), 2012, pp. E11-E11, doi: 10.1111 / j.1464-410X.2012.10917.x .
- ^ A b R. S. Van Howe: Is neonatal circumcision clinically beneficial? Argument against. In: Nature Clinical Practice Urology . 6 (2), (2009), pp. 74-75, doi: 10.1038 / ncpuro1292 .
- ↑ G. Boyle, R. Goldman, JS Svoboda, E. Fernandez: Male Circumcision: Pain, Trauma and Psychosexual Sequelae . In: Journal of Health Psychology . tape 7 , no. 3 , 2002, p. 329-343 .
- ↑ a b c d M. Johnson (2010): Male genital mutilation: Beyond the tolerable? Ethnicities, 10 (2), pp. 181-207, doi: 10.1177 / 1468796810361654 .
- ↑ Zentralratdjuden.de
- ↑ Charlotte Knobloch: The Brit Mila stays! In: Jüdische Allgemeine . July 12, 2012.
- ^ Allan J. Jacobs: The ethics of circumcision of male infants. In: Israel Medical Association Journal , 2013 Jan; 15 (1): 60-5. PMID 23484246 .
- ↑ Anand KJ, Hickey PR: Pain and its effects in the human neonate and fetus. . In: The New England Journal of Medicine . 317, No. 21, 1987, pp. 1321-1329. doi : 10.1056 / nejm198711193172105 .
- ^ Anand KJ: Summary Proceedings From the Neonatal Pain Control Group. . In: Pediatrics . 17, No. 3, 2006, pp. 9-22. doi : 10.1542 / peds.2005-0620C .
- ↑ Press release (PDF; 182 kB) of the German Pain Society e. V.
- ^ RS Van Howe, JS Svoboda et al. a .: Involuntary circumcision: the legal issues. In: BJU international. Volume 83 Suppl 1, January 1999, ISSN 1464-4096 , pp. 63-73, PMID 10349416 (review).
- ^ A b David Shaw: Cutting through red tape: non-therapeutic circumcision and unethical guidelines. In: Clinical Ethics. Vol. 4, No. 4, 2009, pp. 181-186, doi: 10.1258 / ce.2009.009029 .
- ↑ Alexandra Jorzig: 25 years working group - 25 years medical liability . Ed .: Arbeitsgemeinschaft Rechtsanwälte im Med.Springer, 2011, ISBN 978-3-642-18433-8 , Circumcision in the field of tension between the tradition of faith and criminal law, p. 177-186 , doi : 10.1007 / 978-3-642-18434-5_14 .
- ↑ a b Rolf Dietrich Herzberg : Is there a legal prohibition against the biblical commandment of circumcision? In: Medical Law (MedR) . Volume 30, No. 3, 2012, pp. 169-175, doi: 10.1007 / s00350-012-3099-0 .
- ↑ AM Viens: Value judgment, harm, and religious liberty. In: Journal of Medical Ethics. Vol. 30, No. 3, 2004, pp. 241-247, doi: 10.1136 / jme.2003.003921 .
- ^ Rolf Dietrich Herzberg: Legal problems of ritual circumcision. In: JuristenZeitung (JZ). 7/2009, pp. 332–339, mohr.de ( Memento from August 17, 2011 in the Internet Archive ) (PDF; 2.89 MB)
- ↑ Stefanie Schmahl : Commentary on the UN Convention on the Rights of the Child with additional protocols (hand commentary). Baden-Baden 2013, ISBN 978-3-8329-7650-7 , paragraph 7f on Article 14.
- ^ SK Hellsten: Rationalizing circumcision: from tradition to fashion, from public health to individual freedom - critical notes on cultural persistence of the practice of genital mutilation. In: Journal of Medical Ethics. Volume 30, 2004, pp. 248-253, doi: 10.1136 / jme.2004.008888 .
- ↑ a b c Dietrich Herzberg: Permit circumcision legally? In: Journal for International Criminal Law Doctrine . (ZIS) 10/2012, p. 486, zis-online.com (PDF; 277 kB)
- ↑ Thomas von der Osten-Sacken : "Circumcision obligatory for women and men" ( Memento of November 3, 2012 in the Internet Archive ) In: Jungle World . July 28, 2012.
- ↑ Ab. Rahman Isa, Rashidah Shuib & M. Shukri Othman: The practice of female circumcision among Muslims in Kelantan, Malaysia. In: Reproductive Health Matters. Volume 7, Number 13, 1999, pp. 137-144, doi: 10.1016 / S0968-8080 (99) 90125-8
- ↑ Sami A. Aldeeb Abu-Sahlieh: Islamic Law and the Issue of Male and Female Circumcision In: Third World Legal Studies. Volume 13, 1995, Article 4, p. 101. Full text (PDF).
- ↑ Birgitta vom Lehn: Circumcisions: Underestimated trauma risk. In: fr-online.de . July 18, 2012, accessed February 9, 2015 .
- ^ AAR Tobian, RH Gray: The medical benefits of male circumcision. In: JAMA: The Journal of the American Medical Association. 306 (13), (2011), pp. 1479-1480, doi: 10.1001 / jama.2011.1431 .
- ↑ S. Rennie, AS Muula, D. West Empire: Male circumcision and HIV prevention: ethical, medical and public health tradeoffs in low-income countries. In: Journal of Medical Ethics. 33, (2007), pp. 357-361, doi: 10.1136 / jme.2006.019901 .
- ^ LM Carpenter, MJ Casper: A Tale of Two Technologies. HPV Vaccination, Male Circumcision, and Sexual Health. In: Gender & Society. 23 (6), (2009), pp. 790-816, doi: 10.1177 / 0891243209352490 .
- ^ GA Bensley, GJ Boyle: Physical, sexual and psychological effects of male infant circumcision: an exploratory survey. In: GC Denniston, FM Hodges, MF Milos (Eds.): Understanding circumcision: A multi-disciplinary approach to a multidimensional problem. Kluwer / Plenum, New York 2000, pp. 207-239.
- ^ CC Gellis: Circumcision. In: American Journal of Diseases of Childhood. 132 (12), (1978), pp. 1168-1169, PMID 717329 .
- ^ Circumcision Information and Resource Pages (CIRP): Circumcision Deaths
- ↑ Morayo Atoki: Should female circumcision continue to be banned? In: Feminist Legal Studies. Volume 3, Number 2, (1995), pp. 223-235, doi: 10.1007 / BF01104114 .
- ↑ a b R. Darby, JS Svoboda: A Rose by Any Other Name? Rethinking the Similarities and Differences between Male and Female Genital Cutting. In: Medical Anthropology Quarterly. 21, (2007), pp. 301-323, doi: 10.1525 / maq.2007.21.3.301 .
- ↑ a b Kirsten Bell: Genital Cutting and Western Discourses on Sexuality In: Medical Anthropology Quarterly. Volume 19, Number 2, 2005, pp. 125-148. Full text .
- ^ H. Askola: Cut-Off Point? Regulating Male Circumcision in Finland. In: Int J Law Policy Family. 25 (1), (2011), pp. 100-119, doi: 10.1093 / lawfam / ebq018 .
- ↑ a b Dena Davis: Cultural Bias in Responses to Male and Female Genital Surgeries In: The American Journal of Bioethics. 3: 2, (2003), p. 15. http://mitpress.mit.edu/journals/ajob/3/2/save_embed (link not available)
- ↑ Debra L. DeLaet: Framing Male Circumcision as a Human Rights Issue? Contributions to the Debate Over the Universality of Human Rights. In: Journal of Human Rights. Volume 8, Number 4, 2009, doi: 10.1080 / 14754830903324795 .
- ^ CJ Cold, JR Taylor: The prepuce. In: BJU International. 83, (1999), pp. 34-44, doi: 10.1046 / j.1464-410x.1999.0830s1034.x .
- ↑ Classification of female genital mutilation - WHO (accessed September 4, 2012).
- ↑ Rahman & Toubia: Female Genital Mutilation: A guide to laws and policies worldwide. Zed Books, 2000, ISBN 1-85649-773-9 . “The act of cutting itself - the cutting of healthy genital organs for nonmedical reasons - is at its essence a basic violation of girls' and women's right to physical integrity. This is true regardless of the degree of cutting or of the extent of the complications that may or may not ensue ”.
- ^ CR Horowitz, JC Jackson: Female "circumcision" - African women confront American medicine. In: Journal of general internal medicine. Volume 12, 1997, pp. 491-499, doi: 10.1046 / j.1525-1497.1997.00088.x .
- ↑ LM Solomon, RC Noll: Male versus female genital alteration: Differences in legal, medical, and socioethical responses. In: Gender medicine. Volume 4, 2007, pp. 89-96, doi: 10.1016 / S1550-8579 (07) 80023-4 .
- ^ S. Webber, T. Schonfeld: Cutting history, cutting culture: Female circumcision in the United States. In: The American Journal of Bioethics. Volume 3, 2003, pp. 65-66, doi: 10.1162 / 152651603766436324 .
- ^ A b M. Evans: Circumcision in boys and girls: why the double standard? In: BMJ: British medical journal. 342, (2011), p. D978. PMID 21325390
- ^ A. Myers, J. Myers: Male circumcision - the new hope? In: S Afr Med J. 97, (2007), pp. 338-341, ISSN 2078-5135 .
- ↑ N. MacReady: AAP retracts statement on controversial procedure. In: The Lancet. 376 (9734), (2010), p. 15, doi: 10.1016 / S0140-6736 (10) 61042-2 .
- ↑ Has a US Pediatrics Group Condoned Genital Cutting? - Time Magazine.
- ^ R. Bhopal: Circumcision. Parity for the sexes? In: BMJ: British medical journal. 21, 341, (2010), p. C3888. PMID 20659998 .
- ^ C. Sulkin: Anthropology, liberalism and female genital cutting. In: Anthropology Today. Volume 25, number 6, 2009, pp. 17-19, doi: 10.1111 / j.1467-8322.2009.00700.x .
- ^ Richard A. Shweder: When Cultures Collide: Which Rights? Whose Tradition of Values? A Critique of the Global Anti-FGM Campaign. Originally prepared for Joint Princeton University / Central European University Conference on "Universalism and Local Knowledge in Human Rights" (October 24-25, 2003), Princeton, New Jersey. Full text ( Memento of March 4, 2012 in the Internet Archive ) (PDF)
- ↑ “Equal rights for boys and girls!” ( Memento from February 10, 2013 in the web archive archive.today ) In: Cicero . (online), November 25, 2012.
- ^ Right case of the clitoral hood. Telepolis , November 25, 2012.
- ↑ BR-Drs. 867/09. (PDF; 57 kB) (No longer available online.) Federal Council, February 12, 2010, p. 7 , archived from the original on October 7, 2013 ; Retrieved May 21, 2013 .
- ↑ Bernhard Hardtung: Statement on the public hearing ( memento of June 17, 2013 in the Internet Archive ) (PDF; 410 kB) in the Legal Committee on the draft bills BT-Drucksachen 17/1217, 17/12374 and 17/4759 on April 24, 2013.
- ↑ Tonio Walter: Genital Mutilation: The inviolable sex. In: The time . No. 28/2013.
- ^ Thomas Fischer: Criminal Code and ancillary laws. 59th edition. CH Beck, Munich 2012, § 223 No. 6c.
- ^ LG Frankenthal: Consent to the ritual circumcision of a nine year old. In: MedR. 2005; 23, pp. 243-244.
- ↑ OLG Frankfurt, Az. 4 W 12/07 of August 21, 2007 .
- ↑ 151 Ns 169/11 - Cologne Regional Court full text (PDF; 68 kB)
- ↑ Chronicle of the events see also: tagesspiegel.de
- ↑ Barbara Hans: Regional Court of Cologne: Circumcision for religious reasons is punishable. on: Spiegel Online . June 26, 2012.
- ^ Maximilian Stehr: Unreasonable pain . In: Der Spiegel . No. 30 , 2012 ( online ).
- ^ Topic: Circumcision - Süddeutsche Zeitung.
- ↑ Printed matter 17/10331 (PDF; 51 kB) of the German Bundestag.
- ↑ bundestag.de plenary minutes 17/189 pages 22829–22836 + annexes 7 to 12 (pages 22851–22856) (PDF; 1.5 MB).
- ↑ Lectures and discussions on the topic of “Religious Circumcision” ( Memento from August 27, 2012 in the Internet Archive ) - documents from the plenary meeting of the German Ethics Council on August 23, 2012.
- ↑ Ethics Council recommends legal and professional standards for circumcision ( Memento of August 27, 2012 in the Internet Archive ), press release of the German Ethics Council.
- ^ Circumcision of boys - cornerstones of a regulation via bmj.de ( Memento from January 28, 2013 in the Internet Archive )
- ↑ Full throttle into the BGB. In: Ärztezeitung .
- ↑ Controversial draft law: Opposition and child protection activists criticize circumcision rules. on: Spiegel Online. September 27, 2012.
- ^ Opposition to the Ministry of Justice's bill. In: Frankfurter Allgemeine Zeitung .
- ^ Circumcision: The Skepticism of Pediatricians. In: aerztezeitung.de. October 21, 2012, accessed February 9, 2015 .
- ↑ DRadio (online)
- ^ Circumcision: Pediatricians appalled at key points. In: aerztezeitung.de. September 26, 2012, accessed February 9, 2015 .
- ↑ Bundestag DIP on BT-Drucksache 17/11295 (draft law of the federal government)
- ↑ BT printed matter 17/11430 (PDF; 219 kB)
- ↑ Press release of the Bundestag ( Memento of November 29, 2012 in the Internet Archive ); Humanistic press service
- ↑ bundestag.de
- ↑ Plenary Protocol 17/213, pp. 26073–26107, 26110–26112, 25151–26172 [dip21.bundestag.de/dip21/btp/17/17213.pdf pdf]
- ↑ Press release by the Federal Council ( Memento from October 23, 2013 in the Internet Archive )
- ↑ Infratest survey: majority of Germans against the circumcision law. In: Spiegel Online . December 22, 2012, accessed February 9, 2015 .
- ↑ dejure.org: 3 UF 133/13 , press release OLG Hamm ( Memento from October 9, 2013 in the Internet Archive ) (PDF)
- ^ Anno Fricke: Circumcision Act. Doctors demand the end. In: Ärztezeitung. December 13, 2013.
- ↑ President of the Pediatrician against the Circumcision Act. Number of complications apparently remains high. In: Focus. December 7, 2013.
- ^ Corinna Buschow: Criminal lawyer Merkel calls for amendments to the circumcision law. In: evangelisch.de. December 12th 2013.
- ^ The Circumcision Act (§ 1631d BGB) - Lazy compromise and fatal signal, letter to the editor in the monthly Pediatric Medicine October 2013, p. 950 f. (Electronic special print for H. Putzke) (PDF)
- ↑ Ursula Mirastschijski and Eugenia Remmel: Intimchirurgie , Springer, Berlin 2019, ISBN 978-3-662-57391-4 , p. 139.
- ↑ Alleged billing fraud by urologists is a false report ( memento from April 26, 2016 in the Internet Archive ), Professional Association of German Urologists e. V. of January 20, 2015
- ^ OVG Lüneburg: Decision of July 23, 2002 - 4 ME 336/02
- ↑ BVerfG, 1 BvR 102/13 , February 8, 2013
- ↑ BVerfG, 1 BvQ 2/13 , February 13, 2013
- ↑ current version of the AGBG , legal information system of the Austrian Federal Chancellery.
- ↑ current version of the StGB , legal information system of the Austrian Federal Chancellery.
- ↑ Law concerning the regulation of the external legal relationships of the Israelite religious society. Legal information system of the Austrian Federal Chancellery.
- ↑ Bodily harm with consent not punishable. In: derstandard.at . July 27, 2012, accessed February 9, 2015 .
- ↑ Henning Klingen: End of the circumcision debate required. In: Deutschlandradio . 2nd August 2012.
- ^ Oskar Deutsch about circumcision, the legal situation and religious freedom in Austria. In: Jüdische Allgemeine . 2nd August 2012.
- ↑ Debate about circumcision "put on" for Stöger. (No longer available online.) In: Kleine Zeitung . July 25, 2012, archived from the original on December 3, 2013 .
- ^ Douglas Gairdner: The Fate of the Foreskin. In: British Medical Journal. Vol. 2, December 24, 1949, pp. 1433–1437 (online)
- ^ The law and ethics of male circumcision: guidance for doctors. In: Journal of Medical Ethics. 2004; Volume 30, p. 260. ( jme.bmj.com online version).
- ↑ Interview with Interior Minister Manuel Valls : La France a une part juive incontestable In: Information juive. No. 326, October 2012, p. 8.
- ↑ Edwige Belliard, Laurence Herry, Yohann Bénard, Édouard Crépey, Julie Burguburu u. a .: Reflections sur laïcité. In: Conseil d'État, Rapport public 2004. La Documentation française, Paris 2004, ISBN 2-11-005595-2 , pp. 331-332.
- ↑ Riksdagsförvaltningen: Svensk författningssamling 2001: 499 Lag (2001: 499) om omskärelse av pojkar - riksdagen.se. In: riksdagen.se. Retrieved February 9, 2015 (Swedish).
- ↑ see also religious circumcisions In: aerzteblatt.de vol. 109, issue 31, August 6, 2012, p. 2 (PDF)
- ↑ BJ Morris, SA Bailis, TE Wiswell: Circumcision rates in the United States: rising or falling? What effect might the new affirmative pediatric policy statement have? In: Mayo Clinic proceedings. Volume 89, number 5, May 2014, pp. 677-686, doi: 10.1016 / j.mayocp.2014.01.001 , PMID 24702735 (review).
- ↑ M. Owings et al., Centers for Disease Control and Prevention: Trends in Circumcision for Male Newborns in US Hospitals: 1979–2010 , August 22, 2013.
- ^ Jared Lane Maeda, Ramya Chari & Anne Elixhauser: Statistical Brief # 126: Circumcisions Performed in US Community Hospitals, 2009. Website of the Healthcare Cost and Utilization Project. February 2012.
- ↑ Andrea K. Walker: Which states don't cover circumcision? In: The Baltimore Sun . August 21, 2012.
- ↑ American Academy of Pediatrics Task Force on Circumcision: Circumcision policy statement. In: Pediatrics. Volume 130, No. 3, September 1, 2012, pp. 585-586. (English; doi: 10.1542 / peds.2012-1989 ).
- ↑ Jim Bigelow: Evangelical Christianity in America and its Relationship to Infant Male Circumcision. In: George C. Denniston, Frederick Mansfield Hodges, Marilyn Fayre Milos (Eds.): Male and Female Circumcision: Medical, Legal, and Ethical Considerations in Pediatric Practice. Springer, 1999, ISBN 0-306-46131-5 , pp. 173-177.
- ^ Maria L. La Ganga: Judge orders San Francisco circumcision ban off ballot. In: Los Angeles Times . July 29, 2011.
- ^ Circumcision in California: But no referendum. In: the daily newspaper , July 29, 2011.
- ^ California Circumcision Ban: Governor Signs Bill To Prevent Circumcision Bans. In: The Huffington Post . October 2, 2011.
- ^ Netta Ahituv: Even in Israel, More and More Parents Choose Not to Circumcise Their Sons. Haaretz , June 14, 2012, accessed June 7, 2016 .
- ↑ cf. Thomas Mann: Joseph and his brothers 1. Frankfurt am Main 1974, p. 130 f.
- ↑ Alphons Silbermann , Herbert A. Sallen: Latent anti-Semitism in the Federal Republic. In: Cologne journal for sociology and social psychology . Volume 28, 1976, pp. 706-723, here pp. ??.
- ^ Wolfgang Benz, Werner Bergmann, Brigitte Mihok: Freud, Sigmund. In: Handbook of Antisemitism. Volume 2, Part 1: People A – K. de Gruyter, 2009, ISBN 978-3-598-44159-2 , pp. 249-251 ( page previews in the Google book search).
- ↑ Gustave M. Gilbert : Nürnberger Tagebuch: Conversations of the accused with the forensic psychologist. Frankfurt / M. 1962, ISBN 3-436-02477-5 , pp. ??.
-
↑ Theodor Reik: The puberty rites of the savages. 1915. Newly published: Ahriman, Freiburg 2006, p. 30 - quoted from Tanja Schweizer: Male genital mutilation recommended by W »H« O. In: Heretic letters 144: special issue critical medicine (XV). March / April 2008, pp. 1–5, here p. 2/3 ( PDF: 821 kB, 5 pages on bund-gegen-anituation.com ( Memento from December 3, 2013 in the Internet Archive )).
Compare the same text as a footnote in Theodor Reik: Problems of Religious Psychology. 1st part: the ritual. Internationaler Psychoanalytischer Verlag, 1919, p. 90: footnote ( Textarchiv - Internet Archive ). - ↑ Theodor Reik: The puberty rites of the savages. 1915. Newly published: Ahriman, Freiburg 2006, p. 24 - quoted from Tanja Schweizer: Male genital mutilation recommended by W »H« O. In: Heretic letters 144: special issue critical medicine (XV). March / April 2008, pp. 1–5, here p. 3 ( PDF: 821 kB, 5 pages on bund-gegen-anituation.com ( Memento from December 3, 2013 in the Internet Archive )).
- ↑ Anna Freud : The role of bodily illness in the mental life of children. In: Psychoanalytic Study of the Child. Volume 7, 1952, pp. 69-81, here p. ?? ( Full text on cirp.org).
- ↑ Matthias Franz , interviewed by Heide Oestreich: Debate about circumcision: "It's a genital trauma". In: taz.de . July 25, 2012, accessed April 13, 2020.
- ↑ Report of the independent expert group on anti-Semitism ( Memento of January 12, 2015 in the Internet Archive ) (PDF) German Bundestag - 17th electoral period, printed matter 17/7700, p. 18.
