Med Health Care Philos; 8 2 : Denniston, G. An analysis of circumcision advocacy. Dumenci, L. Measurement structure of the Turkish translation of Child Behavior Checklist using confirmatory factor analytic approaches to validation of syndromal constructs. J Abnorm Child Psych; 32 , Dumont, Y.
Neuropeptide Y pathways in anxietyrelated disorders. Biol Psychiatry; 76 11 Frisch, M.
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Pediatrics; Goodman, J. Jewish circumcision: an alternative perspective. BJU International; Suppl 82 1: Goldman, R. The psychological impact of circumcision. BJU Int; 83 1 : 93— Circumcision: The hidden trauma. Vanguard Publishers. Karadag, M. SmartClamp circumcision versus conventional dissection technique in terms of parental anxiety and outcomes: A prospective clinical study.
La circoncision rituelle
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Turkish standardization, reliability and validity of State Trait Anxiety Inventory for children. Turk J Psychol; 10 Ozturk, O. Ritual circumcision and castration anxiety. Psychiatry; 36 1 : 49—59 Price, C. Male non-theraphotic circumcision. The legal and ethical issues. Male and female Circumcision.
Medical, legal and ethical considerations in pediatric practice. Ramos, S. Ritual and medical circumcision among Filipino boys: Evidence of post-traumatic stress disorder. Circumcision was not found to be protective against gonorrhea or chlamydia. The female partners of men circumcised in the same African studies had a lower adjusted prevalence rate of 0. Although circumcision can decrease the risk of acquiring and transmitting STIs, it should be emphasized that other preventative measures, including abstinence, use of condoms and other safe sex practices, must continue to be taught and practiced.
Female partners of circumcised men have a reduced cervical cancer risk, with ORs ranging from 0. Penile cancer is rare in developed countries one in , men. Squamous cell carcinoma of the penis occurs almost exclusively in uncircumcised men, with phimosis being the strongest associated risk factor OR The benefit may also extend to penile cancer, especially as the program is broadened to include young men.
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Surgical procedures, including circumcision, are painful. Even with procedural analgesia, individuals experience postprocedural pain that must be treated.
Newborns who experience procedural pain have altered response to later vaccinations, with demonstrated higher pain scores. Acute complications of neonatal circumcision include minor bleeding, local infection and an unsatisfactory cosmetic result. Severe complications, such as partial amputation of the penis and death from hemorrhage or sepsis, are rare occurrences.
A recent meta-analysis reporting on prospective and retrospective studies investigating circumcision found a median complication rate of 1. Such adhesions often resolve spontaneously by puberty but, when they are extensive, may also benefit from treatment with a topical steroid preparation. Surgical lysis is rarely required.
The foreskin serves to cover the glans penis and has an abundance of sensory nerves,  but medical studies do not support circumcision as having a negative impact on sexual function or satisfaction in males or their partners. Health care providers should be aware of potential contraindications to neonatal circumcision. Hypospadias requires an assessment by a urologist before circumcision is considered.
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Any risk of bleeding diathesis requires further investigation and discussion with appropriate professionals and decision makers before proceeding with circumcision. Neonatal circumcision is a contentious issue in Canada.
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The procedure often raises ethical and legal considerations, in part because it has lifelong consequences and is performed on a child who cannot give consent. Infants need a substitute decision maker — usually their parents — to act in their best interests.
Yet the authority of substitute decision makers is not absolute. In most jurisdictions, authority is limited only to interventions deemed to be medically necessary. In cases in which medical necessity is not established or a proposed treatment is based on personal preference, interventions should be deferred until the individual concerned is able to make their own choices. With newborn circumcision, medical necessity has not been clearly established.
However, there are some health benefits, especially in certain populations. Furthermore, performing circumcision in older boys, who are able to provide consent, can also increase risk and costs to the individual. A complete discussion of ethical and legal issues associated with newborn male circumcision is beyond the scope of this statement. Readers are referred to the July issue of the Journal of Medical Ethics , which is devoted to the topic. Current evidence indicates that there are potential health benefits associated with male circumcision, particularly in high-risk populations.
Infant circumcision reduces the incidence of UTI in young boys and eliminates the need for medical circumcision in later childhood to treat recurrent balanoposthitis, paraphimosis and phimosis. Circumcised men have a lower risk of developing penile cancer, while the incidence of trichomonas, bacterial vaginosis and cervical cancer in the female partners of circumcised men is also reduced. Minor complications of circumcision can occur, although severe complications are rare. The risk of complications is lower in infants than in older children. The complication rate decreases significantly when the procedure is performed by experienced health care professionals, with close follow-up in the days postprocedure to ensure that bleeding does not increase.
It is important to remember that most data regarding the benefits and outcomes following circumcision come from countries other than Canada, which can make application to our population difficult.
Male and Female Circumcision
Because the medical risk:benefit ratio of routine newborn male circumcision is closely balanced when current research is reviewed Table 1 , it is challenging to make definitive recommendations for the entire male newborn population in Canada. For some boys, the likelihood of benefit is higher and circumcision could be considered for disease reduction or treatment. Health care professionals should provide parents with the most up-to-date, unbiased and personalized medical information available so that they can weigh the specific risks and benefits of circumcising their son in the context of familial, religious and cultural beliefs.
Having the right information will enable them to make the best decision for their boys. Decision aids based on current medical information can be helpful. Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.