Male circumcision & Female circumcision (genital mutilation)

Male circumcision & Female circumcision (genital mutilation)

Circumcision

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This article is about male circumcision. For female circumcision, see Female genital mutilation.

Circumcision

Circumcision central Asia2.jpg

A circumcision performed in Central Asia, c. 1865–1872

ICD-10-PCS 0VBT

ICD-9-CM V50.2

MeSH D002944

OPS-301 code 5–640.2

MedlinePlus 002998

eMedicine 1015820

[edit on Wikidata]

Circumcision is the removal of the foreskin from the human penis.[1][2] In the most common procedure, the foreskin is opened, adhesions are removed, and the foreskin is separated from the glans. After that, a circumcision device may be placed, and then the foreskin is cut off. Topical or locally injected anesthesia is sometimes used to reduce pain and physiologic stress.[3] For adults and children, general anesthesia is an option, and the procedure may be performed without a specialized circumcision device. The procedure is most often an elective surgery performed on babies and children, for religious or cultural reasons.[4] In other cases it may be done as a treatment for certain medical conditions or for preventative reasons. Medically it is a treatment option for problematic cases of phimosis, balanoposthitis that does not resolve with other treatments, and chronic urinary tract infections (UTIs).[5][6] It is contraindicated in cases of certain genital structure abnormalities or poor general health.[1][6]

The positions of the world's major medical organizations range from considering elective circumcision of babies and children as having no benefit and significant risks, to its having a modest health benefit that outweighs small risks.[7] No major medical organization recommends either universal circumcision of all males or banning the procedure.[7] Ethical and legal questions regarding informed consent and human rights have been raised over the circumcision of babies and children for non-medical reasons; for these reasons the procedure is controversial.[8][9]

Male circumcision reduces the risk of HIV infection among heterosexual men in sub-Saharan Africa.[10][11] Consequently, the WHO recommends considering circumcision as part of a comprehensive HIV prevention program in areas with high rates of HIV such as sub-Saharan Africa.[12] The effectiveness of using circumcision to prevent HIV in the developed world is unclear,[13] however there is some evidence that circumcision reduces HIV infection risk for men who have sex with men.[14] Circumcision is also associated with reduced rates of cancer-causing forms of human papillomavirus (HPV),[15][16] UTIs, and cancer of the penis.[3] Prevention of these conditions is not a justification for routine circumcision of infants in the Western world.[5] Studies of other sexually transmitted infections also suggest that circumcision is protective, including for men who have sex with men.[17] A 2010 review found circumcisions performed by medical providers to have a typical complication rate of 1.5% for babies and 6% for older children, with few cases of severe complications.[18] Bleeding, infection, and the removal of either too much or too little foreskin are the most common complications cited.[18] Complication rates are higher when the procedure is performed by an inexperienced operator, in unsterile conditions, or in older children.[18] Circumcision does not appear to have a negative impact on sexual function.[19][20]

An estimated one-third of males worldwide are circumcised.[4][18][21] The procedure is most common among Muslims and Jews (among whom it is near-universal for religious reasons), and in parts of Southeast Asia, and Africa.[4] It is relatively rare for non-religious reasons in Europe, Latin America, parts of Southern Africa, and most of Asia.[4] In the United States rates of circumcision decreased from 64% in 1979 to 58% in 2010.[22] The origin of circumcision is not known with certainty; the oldest documented evidence for it comes from ancient Egypt.[4][23] Various theories have been proposed as to its origin including as a religious sacrifice and as a rite of passage marking a boy's entrance into adulthood.[24] It is part of religious law in Judaism[25] and is an established practice in Islam, Coptic Christianity, and the Ethiopian Orthodox Church.[4][26][27] The word circumcision is from Latin circumcidere, meaning "to cut around".[4]

Female genital mutilation

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"FGM" redirects here. For other uses, see FGM (disambiguation).

Billboard with surgical tools covered by a red X. Sign reads: STOP FEMALE CIRCUMCISION. IT IS DANGEROUS TO WOMEN'S HEALTH. FAMILY PLANNING ASSOCIATION OF UGANDA

Road sign near Kapchorwa, Uganda, 2004

Definition "Partial or total removal of the external female genitalia or other injury to the female genital organs for non-medical reasons" (WHO, UNICEF, and UNFPA, 1997).[1]

Areas Africa, Southeast Asia, Middle East, and within communities from these areas[2]

Numbers Over 200 million women and girls in 27 African countries; Indonesia; Iraqi Kurdistan; and Yemen (as of 2016)[3]

Age Days after birth to puberty[4]

Prevalence

Ages 15–49

Ages 0–14

Female genital mutilation (FGM), also known as female genital cutting and female circumcision,[a] is the ritual cutting or removal of some or all of the external female genitalia. The practice is found in Africa, Asia and the Middle East, and within communities from countries in which FGM is common. UNICEF estimated in 2016 that 200 million women living today in 30 countries—27 African countries, Indonesia, Iraqi Kurdistan and Yemen—have undergone the procedures.[3]

Typically carried out by a traditional circumciser using a blade, FGM is conducted from days after birth to puberty and beyond. In half the countries for which national figures are available, most girls are cut before the age of five.[6] Procedures differ according to the country or ethnic group. They include removal of the clitoral hood and clitoral glans; removal of the inner labia; and removal of the inner and outer labia and closure of the vulva. In this last procedure, known as infibulation, a small hole is left for the passage of urine and menstrual fluid; the vagina is opened for intercourse and opened further for childbirth.[7]

The practice is rooted in gender inequality, attempts to control women's sexuality, and ideas about purity, modesty and beauty. It is usually initiated and carried out by women, who see it as a source of honour and fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion.[8] Adverse health effects depend on the type of procedure; they can include recurrent infections, difficulty urinating and passing menstrual flow, chronic pain, the development of cysts, an inability to get pregnant, complications during childbirth, and fatal bleeding.[7] There are no known health benefits.[9]

There have been international efforts since the 1970s to persuade practitioners to abandon FGM, and it has been outlawed or restricted in most of the countries in which it occurs, although the laws are poorly enforced. Since 2010 the United Nations has called upon healthcare providers to stop performing all forms of the procedure, including reinfibulation after childbirth and symbolic "nicking" of the clitoral hood.[10] The opposition to the practice is not without its critics, particularly among anthropologists, who have raised difficult questions about cultural relativism and the universality of human rights.[11]