Circumcision of children

Children Circumcision, Aliskamp by Dr Rizwan Khan, Pune, Mumbai, India, (September 2018).

Circumcision - what is it exactly?

Circumcision is generally understood to mean the circular removal of both foreskin sheets of the penis. The surgical removal can be done, for example, with the Gomco clamp or with the plastic-bell method. If it is an intervention from a medical point of view, it is usually not circumcision but circumcision.

Apart from the treatment of a phimosis (narrowing of the penis foreskin) circumcision is not common in Germany. In addition, there are also cultural or religious motives to have the intervention carried out. There is often an increased need for discussion in so-called ""mixed"" partnerships, for example, in a German-Arab or Christian-Jewish relationship in which for one parent the circumcision of the common son is self-evident and absolutely foreign to the other parent.

Circumcision and circumcision are usually performed in the hospital under light anesthesia or on an outpatient basis by a physician under at least local anesthesia. If the medical indication is missing, it is an achievement that can not be settled by the health insurance.

Circumcision, which has no ritual motive, is in Germany also made on infants only under anesthesia. The intervention in babies is usually made only after half a year, if a general anesthetic can be better tolerated by the child.

Circumcision from a Medical Point of View

A medical indication for circumcision in Germany is phimosis, which is usually eliminated with the Plastic-bell method. In a short anesthetic, a plastic bell (English plastic bell) is pushed under the spread foreskin over the glans penis (glans penis). Subsequently, the foreskin is tied off at the bell ring. This necroses the foreskin and falls off. The procedure is mainly done on an outpatient basis in infancy.

After circumcision of male infants has been routinely recommended for a while, especially in the US, paediatricians are now taking a neutral stance. There is some controversy as to whether circumcision can prevent certain infectious diseases later in life. This is triggered by research results from Africa.

Pruning as protection against infection?

In a study of more than 5,000 uncircumcised adult men in Uganda, researchers found that after circumcision, the rate of infection with the herpes-causing virus has decreased by 28 percent and the transmission of human papillomavirus (HPV ) - the virus that can cause cervical cancer and warts in the genital area - has been reduced by 35 percent.

In a previous study, the same researchers found that circumcision reduced HIV infection by 60 percent. Two other research teams - one working in Kenya and the other in South Africa - have produced similar results.

Head of Studies in Uganda is dr. Thomas Quinn of the National Institute for Allergy and Infectious Diseases (NIAID) and Professor of Medicine at the Johns Hopkins School of Medicine in Baltimore. He says that there are several reasons why removing the foreskin of the penis may help to reduce the transmission of certain infections. The foreskin, he explains, has two distinct sides. The outside is very similar to regular skin cells. The inside is very similar to the mucous membranes of the female vagina. During sexual intercourse, the skin side is pulled back and the slimy side is open and unprotected. And, he says, it is likely that there are virus receptors on the mucosal side that make it easier for a virus to enter the cells.

In addition, once the woman has passed on virus cells, they are now trapped in the foreskin, in a humid environment conducive to virus proliferation.

After Quinn's team found that pruning so dramatically reduced the transmission of HIV, they rehearsed the blood samples to see if pruning also reduced the rates of other common viruses that are sexually transmitted , They examined the blood samples for HPV, herpes (especially HSV-2) and syphilis.

Two years after circumcision, 7.8 percent of those who were circumcised were infected with the herpes virus, while 10.3 percent of the men in the control group were infected. For high-risk genotypes of HSV, transmission was 18 percent in the circumcised group and slightly less than 28 percent in the control group. There were no statistically significant differences in the transmission of syphilis.

Quinn believes that the benefits found in this study would be similar for circumcised babies.

Dr. Matthew Golden, director of Public Health's Seattle and King County Sexually Transmitted Diseases Control Program and a professor of medicine at the University of Washington Center for AIDS and STD in Seattle, said that ""circumcisions should be routinely offered and accessible to those who you want to. I believe circumcision is in the interest of the child, but not everyone will come to that conclusion. It is important that parents get the right information and that they know that there are real health benefits. ""

Risks of Circumcision

"" Parents need to talk to their doctors about circumcision. You need to know where the risks of this intervention lie.For newborns, this is a lighter procedure, it's cheaper and there are fewer complications, ""said Quinn, who added that there are some minimally unfavorable events in the adult world that is pruned.

By contrast, a study from Australia suggests that there is no evidence that pruning babies reduces the risk of sexually transmitted disease later in life. It is even warned that circumcision can cause significant psychological damage.

In general, ""there is still a lot of uncertainty about the risks and benefits of circumcision,"" Dr. Douglas S. Diekema, a pediatrician at the University of Washington, who knows both studies. ""There are some clear advantages of circumcision,"" said the physician. ""There are also some risks of circumcision, although they seem to be rarer."" The Archives of Pediatrics and Adolescent Medicine, which examined three studies, took a different course It says that risks of complication in circumcision are less than one percent, and long-term complications are extremely rare. ""Caryn Perera, of the Royal Australasian College of Surgeons and chief investigator for the Australian study, opposes and says the risk of serious complications Between 2 and 10 percent, parents who believe that circumcision brings medical benefits should know that there is no consensus and robust evidence on this issue, ""she adds, adding that circumcision poses problems in mental health Which mainly causes things such as ""big trouble or feeling, incomplete."" being hurt, frustrated, abnormal or hurt / raped. Perera adds that there is no evidence that circumcision affects sexual sensitivity when performed on an adult male. There is no information on whether circumcision in babies has an effect on the feeling.

Circumcision as a Ritual

It is customary in various cultures and religious communities to circumcise the male offspring, which is to be understood as an initiation rite, an act by which the affiliation or the confession of a community is accomplished. Relevant in Germany are primarily circumcisions from an Islamic and Jewish perspective. The religious identity emanates from the father in Islam, in Judaism from the mother. In Judaism, the removal of the foreskin of the male member is called Brit Mila. It is founded in Genesis and is seen as entering the covenant with God. Circumcision is a religious ritual performed on the eighth day of life of the infant after a very specific ceremony by a mohel (a trained professional).

In the case of Muslims circumcision does not decide on belonging.It is rather a Sunna of the Prophet Ibrahim and belongs to the natural hygiene. There are different currents. After some imams circumcision is recommended, after others it is compulsory.

According to the Sunna, parents are advised to perform circumcision on the seventh day after birth (including birth). But it can also be done sooner or later, but from a medical point of view not before the 4th day after birth. Whoever undertakes the procedure remains free for the parents.

Pruning yes or no?

The decision to have your son trimmed or not can only be made by you alone. There are studies that point to possible harm to the child, while others only speak of minimal risk and unlikely complications. Benefits from a medical point of view, which have been identified in some studies, are refuted by others. There is also no consensus within the denominations on the compelling need for circumcision.

Please also note that circumcision in Germany is increasingly controversial in law and that the interference of courts may not be classified as an exercise of religious freedom, but as a personal injury and a violation of the general right to privacy.

Dr. Hans-Ulrich Neumann from the Babycenter team of experts believes that there are few medical reasons for circumcision. In our culture, he would advise against circumcision without medical or ritual reasons.

Concern should be given that the procedure will be performed on a child who has not given his consent and may not endorse your decision later. On the other hand, you should also consider that as your child grows older, your child will be very scared of the procedure and may find it humiliating. An infant usually puts the pruning away quickly and well.

If you decide to have a circumcision, always have it done by a doctor who has the technical and hygienic conditions. If you have the slightest doubt about either, look for another doctor or hospital.

Circumcision of Girls

Unfortunately, it is still common in some - mostly African - populations to prune girls and young women. This so-called clitoridectomy is the ritual removal of the clitoris. In many countries this has now been criminalized, as it involves genital mutilation, which for the affected women is associated throughout life with great health and psychological damage. The Central Council of Muslims in Germany e. V. (ZMD) expressly distances itself from this pre-Islamic custom and expressly calls all faith communities to stand up against female circumcision: ""Circumcision is not mentioned directly or indirectly in the Koran.Circumcision of women is completely unknown in most of the Islamic world and is not practiced there, with the exception of a few countries in Africa. Where there is the circumcision of girls, it also occurs among non-Muslims, because it is a pre-Islamic custom. In contrast to the recently published opinion of the Egyptian sheikh Yusuf Al Badri, there is no such requirement from an Islamic point of view. The mangled genital mutilation of girls' sexual organs clearly contradicts the teachings of Islam, also because it makes a grave and health risky change to GOD'S creation. ""

Among the most prominent victims and opponents of female genital mutilation is the Somali-born top model Waris Dirie, who was circumcised at the age of five and published her autobiography under the title"" Desert Flower ""(Droemer / Knaur).

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