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Tento článek je o mužské obřízce. O obřízce žen pojednává článek ženská obřízka.

Male circumcision is the removal of the foreskin from the human penis.[1][2][3] In the most common procedure, the foreskin is opened, adhesions are removed, and the foreskin is separated from the glans. After that, the circumcision device (if used) is placed, and then the foreskin is cut off. Topical or locally injected anesthesia is occasionally used to reduce pain and physiologic stress.[4] 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 and cultural reasons.[5] In other cases it may be done as a treatment for a condition 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).[1][6] It is contraindicated in cases of certain genital structure abnormalities or poor general health.[2][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 having a modest health benefit that outweighs small risks. No major medical organization recommends either universal circumcision for all males (aside from the recommendations of the World Health Organization (WHO) for areas with high rates of HIV), 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, and for that reason the procedure is controversial.[8][9]

Evidence supports that male circumcision reduces the risk of HIV infection among heterosexual men in sub-Saharan Africa.[10][11] Therefore, 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] Evidence for a health benefit against HIV for men who have sex with men is less clear.[13][14] Additionally, the effectiveness of using circumcision to prevent HIV in the developed world is also unclear.[15] Circumcision in general is associated with reduced rates of cancer causing forms of HPV[16][17] and risk of both UTIs and cancer of the penis.[4] Prevention of those conditions is not a justification for routine circumcision of infants.[1][18] Studies of its potential protective effects against other sexually transmitted infections have been unclear. A 2010 review of literature 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.[19] Bleeding, infection and the removal of either too much or too little foreskin are the most common complications cited.[19] Complication rates are higher when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age.[19] Circumcision does not appear to have a negative impact on sexual function.[20][21]

An estimated one-third of males worldwide are circumcised.[5][19][22] The procedure is most common in the Muslim world and Israel (where it is near-universal for religious reasons), the United States, and parts of Southeast Asia and Africa.[5] It is relatively rare in Europe, Latin America, parts of Southern Africa, and most of Asia.[5] The origin of circumcision is not known with certainty; the oldest documented evidence for it comes from ancient Egypt.[5] 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.[23] It is part of religious law in Judaism[24] and is an established practice in Islam, Coptic Christianity, and the Ethiopian Orthodox Church.[5][25][26] The word circumcision is from Latin circumcidere, meaning "to cut around".[5]

Indikace a kontraindikace editovat

Routine or elective editovat

Neonatal circumcision is usually elected by the parents for non-medical reasons, such as religious beliefs or personal preferences, possibly driven by societal norms.[6] Outside the parts of Africa with high prevalence of HIV/AIDS, the positions of the world's major medical organizations on non-therapeutic neonatal circumcision range from considering it as having a modest net health benefit that outweighs small risks to viewing it as having no benefit with significant risks for harm. No major medical organization recommends universal neonatal circumcision, and no major medical organization calls for banning it either. The Royal Dutch Medical Association, which expresses some of the strongest opposition to routine neonatal circumcision, does not call for the practice to be made illegal out of their concern that parents who insist on the procedure would turn to poorly trained practitioners instead of medical professionals. This argument to keep the procedure within the purview of medical professionals is found across all major medical organizations. In addition, the organizations advise medical professionals to yield to some degree to parental preferences, which are commonly based upon cultural or religious views, in their decision to agree to circumcise.[7] The Danish College of General Practitioners states that circumcision should "only [be done] when medically needed, otherwise it is a case of mutilation."[27]

Owing to the HIV/AIDS epidemic there, sub-Saharan Africa is a special case. The finding that circumcision significantly reduces female-to-male HIV transmission has prompted medical organizations serving the affected communities to promote circumcision as an additional method of controlling the spread of HIV.[7] The World Health Organization (WHO) and UNAIDS (2007) recommend circumcision as part of a comprehensive program for prevention of HIV transmission in areas with high endemic rates of HIV, as long as the program includes "informed consent, confidentiality, and absence of coercion".[12]

Zdravotní indikace editovat

Obřízka může být použita k léčbě patologické fimózy, chronické balanopostitidy a chronických a recidivujících infekcí močových cest.[1][6] Světová zdravotnická organizace podporuje obřízku jako preventivní zákrok u sexuálně aktivních mužů v oblastech s vysokým výskytem HIV.[12] International Antiviral Society-USA obřízku doporučuje u všech sexuálně aktivních heterosexuálních mužů a diskusi o ní navrhuje s gayi, kteří provozují anální sex, a to zejména v oblastech s vysokým výskytem HIV.[28]

Kontraindikace editovat

Obřízka je kontraindikována u kojenců s abnormalitou genitálií, jako je atypické vyústění močové trubice (například hypospadie nebo epispadie), deformace penisu (chordea) nebo nejednoznačnost genitálií, jelikož předkožka může být potřeba pro případnou rekonstruktivní operaci. Dále je kontraindikována u předčasně narozených dětí, jejichž zdravotní stav není dostatečně stabilní.[2][6][29] Pokud jedinec, dítě nebo dospělý, má v rodinné anamnéze poruchu srážení krve (hemofilie), doporučuje se u něj provést vyšetření na toto onemocnění.[6][29]

Techniky editovat

 
Circumcision surgery with hemostats and scissors
 
Before (left) and after (right) an adult circumcision, undertaken to treat phimosis. The glans is exposed even when the penis is flaccid.

The foreskin extends out from the base of the glans and covers the glans when the penis is flaccid. Proposed theories for the purpose of the foreskin are that it serves to protect the penis as the fetus develops in the mother's womb, that it helps to preserve moisture in the glans, and that it improves sexual pleasure. The foreskin may also be a pathway of infection for certain diseases. Circumcision removes the foreskin at its attachment to the base of the glans.[5]

Odstranění předkožky editovat

For infant circumcision, devices such as the Gomco clamp, Plastibell and Mogen clamp are commonly used in the USA.[4] These follow the same basic procedure. First, the amount of foreskin to be removed is estimated. The practitioner opens the foreskin via the preputial orifice to reveal the glans underneath and ensures it is normal before bluntly separating the inner lining of the foreskin (preputial epithelium) from its attachment to the glans. The practitioner then places the circumcision device (this sometimes requires a dorsal slit), which remains until blood flow has stopped. Finally, the foreskin is amputated.[4] For adults, circumcision is often performed without clamps,[30] and non-surgical alternatives such as the elastic ring controlled radial compression device or the Shang ring are available.[31]

Zvládání bolesti editovat

The circumcision procedure causes pain, and for neonates this pain may interfere with mother-infant interaction or cause other behavioral changes,[32] so the use of analgesia is advocated.[4][33] Ordinary procedural pain may be managed in pharmacological and non-pharmacological ways. Pharmacological methods, such as localized or regional pain-blocking injections and topical analgesic creams, are safe and effective.[4][34][35] The ring block and dorsal penile nerve block (DPNB) are the most effective at reducing pain, and the ring block may be more effective than the DPNB. They are more effective than EMLA (eutectic mixture of local anesthetics) cream, which is more effective than a placebo.[34][35] Topical creams have been found to irritate the skin of low birth weight infants, so penile nerve block techniques are recommended in this group.[4]

For infants, non-pharmacological methods such as the use of a comfortable, padded chair and a sucrose or non-sucrose pacifier are more effective at reducing pain than a placebo,[35] but the American Academy of Pediatrics (AAP) states that such methods are insufficient alone and should be used to supplement more effective techniques.[4] A quicker procedure reduces duration of pain; use of the Mogen clamp was found to result in a shorter procedure time and less pain-induced stress than the use of the Gomco clamp or the Plastibell.[35] The available evidence does not indicate that post-procedure pain management is needed.[4] For adults, general anesthesia is an option,[36] and the procedure requires four to six weeks of abstinence from masturbation or intercourse to allow the wound to heal.[29]

Efekt editovat

Sexuálně přenosné nemoci editovat

HIV editovat

Existují přesvědčivé důkazy, že obřízka snižuje riziko infekce HIV u heterosexuálních mužů v rizikové populaci.[10][11] Důkazy v mužské heterosexuální populaci v subsaharské Africe ukazují absolutní pokles rizika o 1,8 %, což je v průběhu dvou let relativní pokles o 38–66 %.[11]

There are plausible explanations based on human biology for how circumcision can decrease the likelihood of female-to-male HIV transmission. The superficial skin layers of the penis contain Langerhans cells, which are targeted by HIV; removing the foreskin reduces the number of these cells. When an uncircumcised penis is erect during intercourse, any small tears on the inner surface of the foreskin come into direct contact with the vaginal walls, providing a pathway for transmission. When an uncircumcised penis is flaccid, the pocket between the inside of the foreskin and the head of the penis provides an environment conducive to pathogen survival; circumcision eliminates this pocket. Some experimental evidence has been provided to support these theories.[37]

The WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) state that male circumcision is an efficacious intervention for HIV prevention, but should be carried out by well-trained medical professionals and under conditions of informed consent (parents' consent for their infant boys).[5][12][38] The WHO has judged circumcision to be a cost-effective public health intervention against the spread of HIV in Africa, although not necessarily more cost-effective than condoms.[5] The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should not replace known methods of HIV prevention.[12]

The available evidence does not indicate that circumcision provides HIV protection for heterosexual women.[4][39][40] Data is lacking regarding the effect circumcision may have on the transmission rate of men who engage in anal sex with a female partner.[38][41] It is undetermined whether circumcision benefits men who have sex with men.[14][42]

Lidský papilomavirus editovat

Lidský papilomavirus (HPV) je nejčastěji přenášenou sexuálně přenosnou nemocí, která postihuje muže i ženy. Zatímco většina infekcí je asymptomatických a odezní bez léčení, některé typy viru způsobují genitální bradavice a jiné, v případě neléčení, mohou vést k rakovině – například cervikální nebo penilní. Genitální bradavice a cervikální rakovina jsou dva nejčastější problémy způsobené HPV.[43]

Obřízka je spojována se sníženou prevalencí onkogenetických typů infekce HPV, což znamená, že u náhodně vybraného obřezaného muže je menší pravděpodobnost infekce rakovinu-způsobujícího typu HPV, než u neobřezaného muže.[44][45] Snižuje rovněž pravděpodobnost vícenásobné infekce.[17] Neexistují přesvědčivé důkazy o tom, že by obřízka snižovala míru infekce HPV,[16][17][46] but the procedure is associated with increased clearance of the virus by the body,[16][17] which can account for the finding of reduced prevalence.[17]

Ačkoliv jsou genitální bradavice způsobeny určitým typem HPV, neexistuje statisticky významný vztah mezi obřízkou a výskytem genitálních bradavic.[16][45][46]

Další infekce editovat

Studie vyhodnocující vliv obřízky na incidenci jiných sexuálně přenosných nemocí dospěly k protichůdným výsledkům. Metaanalýza z roku 2006 zjistila, že obřízka je spojovaná s nižší mírou výskytu syfilis, měkkých vředů a zřejmě i genitálního herpesu.[47] Výzkum Wetmora a kolektivu z roku 2010 zjistil, že obřízka snižuje incidenci infekce HSV-2 (herpes simplex virus, typ 2) o 28 %.[48] Vědci zároveň získali neurčité výsledky, pokud jde o ochranu před prvokem bičenkou poševní (způsobuje vaginitidu, uretritidu a trichomoniázu) a bakterií Chlamydia trachomatis (způsobuje chlamydiózu), a žádné výsledky, pokud jde o ochranu před kapavkou a syfilis.[48] Výzkumy zaměřené na homosexuálně orientované muže nenašly dostatečné důkazy o tom, že obřízka ochraňuje před sexuálně přenosnými nemocemi (kromě HIV a s možnou výjimkou u syfilis).[13][42]

Fimóza, balanitida, balanopostitida editovat

Soubor:Phimosis.jpg

Phimosis is the inability to retract the foreskin over the glans penis.[49] At birth, the foreskin cannot be retracted due to adhesions between the foreskin and glans, and this is considered normal (physiological phimosis).[49] Over time the foreskin naturally separates from the glans, and a majority of boys are able to retract the foreskin by age three.[49] Less than one percent are still having problems at age 18.[49] If the inability to do so becomes problematic (pathological phimosis) circumcision is a treatment option.[1][50] This pathological phimosis may be due to scarring from the skin disease balanitis xerotica obliterans (BXO), repeated episodes of balanoposthitis or forced retraction of the foreskin.[51] Steroid creams are also a reasonable option and may prevent the need for surgery including in those with mild BXO.[51][52] The procedure may also be used to prevent the development of phimosis.[6] Phimosis is also a complication that can result from circumcision.[53]

An inflammation of the glans penis and foreskin is called balanoposthitis, and the condition affecting the glans alone is called balanitis.[54][55] Most cases of these conditions occur in uncircumcised males,[56] affecting 4–11% of that group.[57] The moist, warm space underneath the foreskin is thought to facilitate the growth of pathogens, particularly when hygiene is poor. Yeasts, especially Candida albicans, are the most common penile infection and are rarely identified in samples taken from circumcised males.[56] Both conditions are usually treated with topical antibiotics (metronidazole cream) and antifungals (clotrimazole cream) or low-potency steroid creams.[54][55] Circumcision is a treatment option for refractory or recurrent balanoposthitis, but in recent years the availability of the other treatments have made it less necessary.[54][55]

Infekce močových cest editovat

A UTI affects parts of the urinary system including the urethra, bladder, and kidneys. There is about a one percent risk of UTIs in boys under two years of age, and the majority of incidents occur in the first year of life. There is good but not ideal evidence that circumcision reduces the incidence of UTIs in boys under two years of age, and there is fair evidence that the reduction in incidence is by a factor of 3–10 times.[4][58][59] Prevention of UTIs does not justify routine use of the procedure, however.[1] Circumcision is most likely to benefit boys who have a high risk of UTIs due to anatomical defects,[4] and may be used to treat recurrent UTIs.[1]

There is a plausible biological explanation for the reduction in UTI risk after circumcision. The orifice through which urine passes at the tip of the penis (the urinary meatus) hosts more urinary system disease-causing bacteria in uncircumcised boys than in circumcised boys, especially in those under six months of age. As these bacteria are a risk factor for UTIs, circumcision may reduce the risk of UTIs through a decrease in the bacteria population.[4][60]

Rakovina editovat

Circumcision has a protective effect against the risks of penile cancer in men, and cervical cancer in the female sexual partners of heterosexual men. Penile cancer is rare, with about 1 new case per 100,000 people per year in developed countries, and higher incidence rates per 100,000 in sub-Saharan Africa (for example, 1.6 in Zimbabwe, 2.7 in Uganda and 3.2 in Swaziland).[61] Penile cancer development can be detected in the carcinoma in situ (CIS) cancerous precursor stage and at the more advanced invasive squamous cell carcinoma stage.[4] Childhood or adolescent circumcision is associated with a reduced risk of invasive squamous cell carcinoma in particular.[4][61] There is an association between adult circumcision and an increased risk of invasive penile cancer; this is believed to be from men being circumcised as a treatment for penile cancer or a condition that is a precursor to cancer rather than a consequence of circumcision itself.[61] Penile cancer has been observed to be nearly eliminated in populations of males circumcised neonatally.[57]

Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision.[61] The mitigating effect circumcision has on the risk factor introduced by the possibility of phimosis is secondary, in that the removal of the foreskin eliminates the possibility of phimosis. This can be inferred from study results that show uncircumcised men with no history of phimosis are equally likely to have penile cancer as circumcised men.[4][61] Circumcision is also associated with a reduced prevalence of cancer-causing types of HPV in men[17] and a reduced risk of cervical cancer (which is caused by a type of HPV) in female partners of men.[6] Because penile cancer is rare (and may get more rare with increasing HPV vaccination rates), and circumcision has risks, the practice is not considered to be valuable solely as a prophylactic measure against penile cancer in the United States.[4][18][57]

A 2015 meta-analysis found a non-statistically significant reduced risk of prostate cancer associated with circumcision, but that this reduction was significant among blacks and in studies looking at post-PSA and -testing groups.[62]

Adverse effects editovat

Neonatal circumcision is generally safe when done by an experienced practitioner.[63][64] The most common acute complications are bleeding, infection and the removal of either too much or too little foreskin.[4][65] These complications occur in approximately 0.12% of procedures, and constitute the vast majority of all acute circumcision complications in the United States.[65] Minor complications are reported to occur in three percent of procedures.[63] Severe complications are rare.[66] A specific complication rate is difficult to determine due to scant data on complications and inconsistencies in their classification.[4] Complication rates are greater when the procedure is performed by an inexperienced operator, in unsterile conditions, or when the child is at an older age.[19] Significant acute complications happen rarely,[4][19] occurring in about 1 in 500 newborn procedures in the United States.[4] Severe to catastrophic complications, including death, are so rare that they are reported only as individual case reports.[4][64] Other possible complications include buried penis, chordee, phimosis, skin bridges, urethral fistulas, and meatal stenosis.[64] These complications may be avoided with proper technique, and are most often treatable without requiring a hospital visit.[64]

Bolest editovat

The circumcision procedure may carry the risks of heightened pain response for newborns and dissatisfaction with the result.[32] Newborns that experience pain due to being circumcised have different responses to vaccines given afterwards, with higher pain scores observed.[67]

Sexuální efekt editovat

The highest quality evidence indicates that circumcision does not decrease the sensitivity of the penis, harm sexual function or reduce sexual satisfaction.[20][68][69] A 2013 systematic review found that circumcision did not appear to adversely affect sexual desire, pain with intercourse, premature ejaculation, time until ejaculation, erectile dysfunction or difficulties with orgasm. However, the study found that the existing evidence is not very good.[70] Another 2013 systematic review found that the highest-quality studies reported no adverse effects of circumcision on sexual function, sensitivity, sensation or satisfaction.[21]

Psychologický efekt editovat

Behavioral effects have been observed following infant circumcision including changes in sleep patterns, irritability, changes in feeding, and parental bonding.[71] Some men who were circumcised as an infant involuntary, described their feelings about the procedure using the terms "violation, torture, mutilation and sexual assault".[72]

Prevalence editovat

 
Rozšíření obřízky na světě[5]
     prevalence > 80 %
     prevalence 20–80 %
     prevalence < 20 %
     informace není dostupná

Obřízka patří mezi nejčastější chirurgické zákroky na světě.[73] Přibližně 37 až 39 % všech mužů na světě je obřezaných, z toho polovina z náboženských a kulturních důvodů.[74] Zákrok se nejčastěji provádí od narození do dvacátého roku života.[5] Světová zdravotnická organizace v roce 2007 odhadla, že ve věkové kategorii starší 15 let je obřezáno 664 500 000 mužů (globální prevalence 30–33 %), z nichž je téměř 70 % muslimů.[5] Obřízka je nejčastěji rozšířená v muslimské světě, Izraeli, Jižní Koreji, Spojených státech amerických a částech jihovýchodní Asie a Afriky. Je relativně vzácná v Evropě, latinské Americe, částech jižní Afriky, Oceánii a většině Asie. V oblastí blízkého východu a střední Asie je prevalence téměř 100%.[5][75] Obřízka z nenáboženských důvodů je v Asii, s výjimkou Jižní Koreje a Filipín, poměrně vzácná,[5] a v Evropě je prevalence tohoto zákroku obecně nízká (méně než 20 %).[5][76] Prevalence ve Spojených státech amerických a Kanadě je odhadována na 75 %, respektive 30 %,[5] zatímco odhady v Austrálii hovoří o 58,7 %.[77] Prevalence v Africe se pohybuje od méně než 20 % v některých jihoafrických zemích, po téměř 100% v oblastech severní a západní Afriky.[75]

The rates of routine neonatal circumcision over time have varied significantly by country. In the United States, hospital discharge surveys estimated rates at 64.7% in the year 1980, 59.0% in the year 1990, 62.4% in the year 2000, and 58.3% in the year 2010.[78] These estimates are lower than the overall circumcision rates, as they do not account for non-hospital circumcisions,[78] or for procedures performed for medical or cosmetic reasons later in life;[5][78] community surveys have reported higher neonatal circumcision.[5] Canada has seen a slow decline since the early 1970s, possibly influenced by statements from the AAP and the Canadian Pediatric Society issued in the 1970s saying that the procedure was not medically indicated.[5] In Australia, the rate declined in the 1970s and 80s, but has been increasing slowly as of 2004.[5] In the United Kingdom, rates are likely to have been 20–30% in the 1940s but declined in the late 40s. One possible reason may have been a 1949 British Medical Journal article which stated that there was no medical reason for the general circumcision of babies.[5] The overall prevalence of circumcision in South Korea has increased markedly in the second half of the 20th century, rising from near zero around 1950 to about 60% in 2000, with the most significant jumps in the last two decades of that time period.[5] This is probably due to the influence of the United States, which established a trusteeship for the country following World War II.[5]

Medical organizations can affect the neonatal circumcision rate of a country by influencing whether the costs of the procedure are borne by the parents or are covered by insurance or a national health care system. Policies that require the costs to be paid by the parents yield lower neonatal circumcision rates. The decline in the rates in the UK is one example; another is that in the United States, the individual states where insurance or Medicaid covers the costs have higher rates. Changes to policy are driven by the results of new research, and moderated by the politics, demographics, and culture of the communities.[7]

Historie editovat

 
Circumcision knife from the Congo; wood, iron; late 19th/early 20th century

Circumcision is the world's oldest planned surgical procedure, suggested by anatomist and hyperdiffusionist historian Grafton Elliot Smith to be over 15,000 years old, pre-dating recorded history. There is no firm consensus as to how it came to be practiced worldwide. One theory is that it began in one geographic area and spread from there; another is that several different cultural groups began its practice independently. In his 1891 work History of Circumcision, physician Peter Charles Remondino suggested that it began as a less severe form of emasculating a captured enemy: penectomy or castration would likely have been fatal, while some form of circumcision would permanently mark the defeated yet leave him alive to serve as a slave.[23][79]

The history of the migration and evolution of the practice of circumcision is followed mainly through the cultures and peoples in two separate regions. In the lands south and east of the Mediterranean, starting with Sudan and Ethiopia, the procedure was practiced by the ancient Egyptians and the Semites, and then by the Jews and Muslims, with whom the practice travelled to and was adopted by the Bantu Africans. In Oceania, circumcision is practiced by the Australian Aborigines and Polynesians.[79] There is also evidence that circumcision was practiced among the Aztec and Mayan civilizations in the Americas,[5] but little detail is available about its history.[23][73]

Blízký východ, Afrika a Evropa editovat

 
Köçeks dancing at the circumcision celebration of Sultan Ahmed III's sons (1720); miniature from the Surname-i Vehbi, Topkapı Palace, Istanbul

Evidence suggests that circumcision was practiced in the Arabian Peninsula by the 4th millennium BCE, when the Sumerians and the Semites moved into the area that is modern-day Iraq.[73] The earliest historical record of circumcision comes from Egypt, in the form of an image of the circumcision of an adult carved into the tomb of Ankh-Mahor at Saqqara, dating to about 2400–2300 BCE. Circumcision was done by the Egyptians possibly for hygienic reasons, but also was part of their obsession with purity and was associated with spiritual and intellectual development. No well-accepted theory explains the significance of circumcision to the Egyptians, but it appears to have been endowed with great honor and importance as a rite of passage into adulthood, performed in a public ceremony emphasizing the continuation of family generations and fertility. It may have been a mark of distinction for the elite: the Egyptian Book of the Dead describes the sun god Ra as having circumcised himself.[23][79]

Though secular scholars consider the story to be literary and not historical,[80] circumcision features prominently in the Hebrew Bible. The narrative in Genesis chapter 17 describes the circumcision of Abraham and his relatives and slaves. In the same chapter, Abraham's descendants are commanded to circumcise their sons on the eighth day of life as part of a covenant with God.

In addition to proposing that circumcision was taken up by the Israelites purely as a religious mandate, scholars have suggested that Judaism's patriarchs and their followers adopted circumcision to make penile hygiene easier in hot, sandy climates; as a rite of passage into adulthood; or as a form of blood sacrifice.[73][79][81]

Alexander the Great conquered the Middle East in the 4th century BCE, and in the following centuries ancient Greek cultures and values came to the Middle East. The Greeks abhorred circumcision, making a life for circumcised Jews living among the Greeks (and later the Romans) very difficult. Antiochus Epiphanes outlawed circumcision, as did Hadrian, which helped cause the Bar Kokhba revolt. During this period in history, Jewish circumcision called for the removal of only a part of the prepuce, and some Hellenized Jews attempted to look uncircumcised by stretching the extant parts of their foreskins. This was considered by the Jewish leaders to be a serious problem, and during the 2nd century CE they changed the requirements of Jewish circumcision to call for the complete removal of the foreskin, emphasizing the Jewish view of circumcision as intended to be not just the fulfillment of a Biblical commandment but also an essential and permanent mark of membership in a people.[79][81]

 
The Circumcision of Jesus Christ, by Ludovico Mazzolino

A narrative in the Christian Gospel of Luke makes a brief mention of the circumcision of Jesus, but the subject of physical circumcision itself is not part of the received teachings of Jesus. Paul the Apostle reinterpreted circumcision as a spiritual concept, arguing the physical one to be no longer necessary. The teaching that physical circumcision was unnecessary for membership in a divine covenant was instrumental in the separation of Christianity from Judaism. Although it is not explicitly mentioned in the Quran (early 7th century CE), circumcision is considered essential to Islam, and it is nearly universally performed among Muslims. The practice of circumcision spread across the Middle East, North Africa, and Southern Europe with Islam.[82]

Genghis Khan, and the following Yuan Emperors in China forbade Islamic practices such as halal butchering and circumcision.[83][84] This led Chinese Muslims to eventually take an active part in rebelling against the Mongols and installing the more tolerant Ming Dynasty.

The practice of circumcision is thought to have been brought to the Bantu-speaking tribes of Africa by either the Jews after one of their many expulsions from European countries, or by Muslim Moors escaping after the 1492 conquest of Spain. In the second half of the 1st millennium CE, inhabitants from the North East of Africa moved south and encountered groups from Arabia, the Middle East, and West Africa. These people moved south and formed what is known today as the Bantu. Bantu tribes were observed to be upholding what was described as Jewish law, including circumcision, in the 16th century. Circumcision and elements of Jewish dietary restrictions are still found among Bantu tribes.[73]

Domorodé kmeny editovat

Circumcision is practiced by some groups amongst Australian Aboriginal peoples, Polynesians, and Native Americans. Little information is available about the origins and history of circumcision among these peoples, compared to circumcision in the Middle East.

For Aboriginal Australians and Polynesians, circumcision likely started as a blood sacrifice and a test of bravery and became an initiation rite with attendant instruction in manhood in more recent centuries. Often seashells were used to remove the foreskin, and the bleeding was stopped with eucalyptus smoke.[73][85]

Christopher Columbus reported circumcision being practiced by Native Americans.[23] It was also practiced by the Incas, Aztecs, and Mayans. It probably started among South American tribes as a blood sacrifice or ritual mutilation to test bravery and endurance, and its use later evolved into a rite of initiation.[73]

Moderní dějiny editovat

Circumcision did not become a common medical procedure in the Anglophone world until the late 19th century.[86] At that time, British and American doctors began recommending it primarily as a deterrent to masturbation.[86][87] Prior to the 20th century, masturbation was believed to be the cause of a wide range of physical and mental illnesses including epilepsy, paralysis, impotence, gonorrhea, tuberculosis, feeblemindedness, and insanity.[88][89] In 1855, motivated in part by an interest in promoting circumcision to reduce masturbation, English physician Jonathan Hutchinson published his findings that Jews had a lower prevalence of certain venereal diseases.[90] While pursuing a successful career as a general practitioner, Hutchinson went on to advocate circumcision for health reasons for the next fifty years,[90] and eventually earned a knighthood for his overall contributions to medicine.[91] In America, one of the first modern physicians to advocate the procedure was Lewis Sayre, a founder of the American Medical Association. In 1870, Sayre began using circumcision as a purported cure for several cases of young boys diagnosed with paralysis or significant motor problems. He thought the procedure ameliorated such problems based on a "reflex neurosis" theory of disease, which held that excessive stimulation of the genitals was a disturbance to the equilibrium of the nervous system and a cause of systemic problems.[86] The use of circumcision to promote good health also fit in with the germ theory of disease during that time, which saw the foreskin as being filled with infection-causing smegma (a mixture of shed skin cells and oils). Sayre published works on the subject and promoted it energetically in speeches. Contemporary physicians picked up on Sayre's new treatment, which they believed could prevent or cure a wide-ranging array of medical problems and social ills. Its popularity spread with publications such as Peter Charles Remondino's History of Circumcision. By the turn of the century, in both America and Great Britain, infant circumcision was near universally recommended.[23][87]

After the end of World War II, Britain moved to a nationalized health care system, and so looked to ensure that each medical procedure covered by the new system was cost-effective and the procedure for non-medical reasons was not covered by the national healthcare system. Douglas Gairdner's 1949 article "The Fate of the Foreskin" argued that the evidence available at that time showed that the risks outweighed the known benefits.[92] Circumcision rates dropped in Britain and in the rest of Europe. In the 1970s, national medical associations in Australia and Canada issued recommendations against routine infant circumcision, leading to drops in the rates of both of those countries. The United States made similar statements in the 1970s, but stopped short of recommending against it — simply stating that it has no medical benefit. Since then they have amended their policy statements several times with the current recommendation being that the benefits outweigh the risks, but they do not recommend it routinely.[23][87]

An association between circumcision and reduced heterosexual HIV infection rates was suggested in 1986.[23] Experimental evidence was needed to establish a causal relationship, so three randomized controlled trials were commissioned as a means to reduce the effect of any confounding factors.[93] Trials took place in South Africa, Kenya and Uganda.[11] All three trials were stopped early by their monitoring boards on ethical grounds because those in the circumcised group had a lower rate of HIV contraction than the control group.[11] Subsequently, the World Health Organization promoted circumcision in high-risk populations as part of an overall program to reduce the spread of HIV,[12] although some have challenged the validity of the African randomized controlled trials, prompting a number of researchers to question the effectiveness of circumcision as an HIV prevention strategy.[94][95][96][97] The Male Circumcision Clearinghouse website was formed in 2009 by WHO, UNAIDS, FHI and AVAC to provide current evidence-based guidance, information, and resources to support the delivery of safe male circumcision services in countries that choose to scale up the procedure as one component of comprehensive HIV prevention services.[98][99]

Společnost a kultura editovat

Kultury a náboženství editovat

In some cultures, males are generally required to be circumcised shortly after birth, during childhood or around puberty as part of a rite of passage. Circumcision is commonly practiced in the Jewish and Islamic faiths.

Judaismus editovat

Podrobnější informace naleznete na stránce Brit mila.
 
Preparing for a Jewish ritual circumcision with a Mogen shield (on the table, next to the scalpel)

Circumcision is very important to most branches of Judaism, with over 90% of adherents having the procedure performed as a religious obligation. The basis for its observance is found in the Torah of the Hebrew Bible, in Genesis chapter 17, in which a covenant of circumcision is made with Abraham and his descendants. Jewish circumcision is part of the brit milah ritual, to be performed by a specialist ritual circumciser (a mohel) on the eighth day of a newborn son's life (with certain exceptions for poor health). Jewish law requires that the circumcision leaves the glans bare when the penis is flaccid. Converts to Conservative and Orthodox Judaism must also be circumcised; those who are already circumcised undergo a symbolic circumcision ritual. Circumcision is not required by Judaism for one to be considered Jewish, but some adherents foresee serious negative spiritual consequences if it is neglected.[24][100]

According to traditional Jewish law, in the absence of a grown free Jewish male expert, a woman, a slave, or a child, that has the required skills, is also authorized to perform the circumcision, provided that she or he is Jewish.[101] However, most streams of non-Orthodox Judaism allow female mohels, called mohalot (מוֹהֲלוֹת‎, the plural of מוֹהֶלֶת‎ mohelet, feminine of mohel), without restriction. In 1984, Deborah Cohen became the first certified Reform mohelet; she was certified by the Berit Mila program of Reform Judaism.[102]

Some contemporary Jews in the United States choose not to circumcise their sons.[103] They are assisted by a small number of Reform and Reconstructionist rabbis, and have developed a welcoming ceremony that they call the brit shalom ("Covenant [of] Peace") for such children, also accepted by Humanistic Judaism.[104][105]

This ceremony of brit shalom is not officially approved of by the Reform or Reconstructionist rabbinical organizations, who make the recommendation that male infants should be circumcised, though the issue of converts remains controversial[106][107] and circumcision of converts is not mandatory in either movement.[108]

Islám editovat

Although there is some debate within Islam over whether it is a religious requirement, circumcision (called khitan) is practiced nearly universally by Muslim males. Islam bases its practice of circumcision on the Genesis 17 narrative, the same Biblical chapter referred to by Jews. The procedure is not explicitly mentioned in the Quran, however, it is a tradition established by Islam's prophet Muhammad directly (following Abraham), and so its practice is considered a sunnah (prophet's tradition) and is very important in Islam. For Muslims, circumcision is also a matter of cleanliness, purification and control over one's baser self (nafs). There is no agreement across the many Islamic communities about the age at which circumcision should be performed. It may be done from soon after birth up to about age 15; most often it is performed at around six to seven years of age. The timing can correspond with the boy's completion of his recitation of the whole Quran, with a coming-of-age event such as taking on the responsibility of daily prayer or betrothal. Circumcision may be celebrated with an associated family or community event. Circumcision is recommended for, but is not required of, converts to Islam.[26][109][110]

Křesťanství editovat

 
Detail fresky v kostele sv. Martina v Sieně od Guido Reni znázorňující obřezání Páně

Postoj k obřízce se v křesťanství různí. Evangelium podle Lukáše uvádí, že Ježíš ji podstoupil podle židovských náboženských zákonů: „Když uplynulo osm dní a nastal čas k jeho obřízce, dali mu jméno Ježíš, které dostal od anděla dříve, než jej matka počala“.[111] Tato událost je v řeckokatolické a pravoslavné církvi připomínána svátkem Obřezání Páně. Ten byl slaven i v římskokatolické církvi, kde byl v roce 1960 druhým vatikánským koncilem nahrazen Oktávem Narození Páně. Obřízce je dále v Novém zákoně věnována kapitola 15 knihy Skutky apoštolů, podle níž apoštolové a starší rozhodli, že obřízku křesťanství nevyžaduje.[112] Zároveň ji však ale nezakazuje. Katolická církev zastává neutrální pohled na obřízku prováděnou z jiných, než náboženských důvodů,[113] ačkoliv v roce 1442 zakázala provádění obřízky z náboženských důvodů na Basilejsko-ferrarsko-florentském koncilu.[114] Koptští křesťané provádí obřízku jako přechodový rituál.[5][25][115][116] Etiopská pravoslavná církev k obřízce vyzývá, a téměř všichni její mužští přívrženci tak jsou obřezáni.[5] V Jihoafrické republice některé kongregace s praktikou nesouhlasí, zatímco jiné ji po svých členech vyžadují.[5]

Africká kultura editovat

Certain African cultural groups, such as the Yoruba and Igbo of Nigeria, customarily circumcise their infant sons. The procedure is also practiced by some cultural groups or individual family lines in the Sudan, Zaire, Uganda and in southern Africa. For some of these groups, circumcision appears to be purely cultural, done with no particular religious significance or intention to distinguish members of a group. For others, circumcision might be done for purification, or it may be interpreted as a mark of subjugation. Among these groups, even when circumcision is done for reasons of tradition, it is often done in hospitals.[117] It is not clear how many deaths and injuries result from traditional circumcisions which occur outside of hospitals.[118]

Australská kultura editovat

Some Australian Aborigines use circumcision as a test of bravery and self-control as a part of a rite of passage into manhood, which results in full societal and ceremonial membership. It may be accompanied by body scarification and the removal of teeth, and may be followed later by penile subincision. Circumcision is one of many trials and ceremonies required before a youth is considered to have become knowledgeable enough to maintain and pass on the cultural traditions. During these trials, the maturing youth bonds in solidarity with the men. Circumcision is also strongly associated with a man's family, and it is part of the process required to prepare a man to take a wife and produce his own family.[117]

Filipínská kultura editovat

In the Philippines, circumcision known as "tuli" is sometimes viewed as a rite of passage.[119] About 93% of Filipino men are circumcised.[119]

Etické a právní otázky editovat

There is a long-running and vigorous debate over ethical concerns regarding circumcision, particularly neonatal circumcision for reasons other than intended direct medical benefit. There are three parties involved in the decision to circumcise a minor: the minor as the patient, the parents (or other guardians) and the physician. The physician is bound under the ethical principles of beneficence (promoting well-being) and non-maleficence ("first, do no harm"), and so is charged with the responsibility to promote the best interests of the patient while minimizing unnecessary harms. Those involved must weigh the factors of what is in the best interest of the minor against the potential harms of the procedure.[9]

With a newborn involved, the decision is made more complex due to the principles of respect for autonomy and consent, as a newborn cannot understand or engage in a logical discussion of his own values and best interests.[8][9] A mentally more mature child can understand the issues involved to some degree, and the physician and parents may elicit input from the child and weigh it appropriately in the decision-making process, although the law may not treat such input as legally informative. Ethicists and legal theorists also state that it is questionable for parents to make a decision for the child that precludes the child from making a different decision for himself later. Such a question can be raised for the decision by the parents either to circumcise or not to circumcise the child.[9]

Generally, circumcision on a minor is not ethically controversial or legally questionable when there is a clear and pressing medical indication for which it is the accepted best practice to resolve. Where circumcision is the chosen intervention, the physician has an ethical responsibility to ensure the procedure is performed competently and safely to minimize potential harms.[8][9] Worldwide, most legal jurisdictions do not have specific laws concerning the circumcision of males,[5] but infant circumcision is considered legal under the existing laws in countries such as Australia, Canada, New Zealand, the United Kingdom, and the United States.[120] A few countries have passed legislation on the procedure: Germany allows non-therapeutic circumcision,[121] while non-religious routine circumcision is illegal in South Africa and Sweden.[5][120]

Throughout society, circumcision is often considered for reasons other than medical need. Public health advocates of circumcision consider it to have a net benefit, and therefore feel that increasing the circumcision rate is an ethical imperative. They recommend performing the procedure during the neonatal period when it is less expensive and has a lower risk of complications.[8] While studies show there is a modest epidemiological benefit to circumcision, critics argue that the number of circumcisions that would have to be performed would yield an overall negative public health outcome due to the resulting number of complications or other negative effects (such as pain). Pinto (2012) writes "sober proponents and detractors of circumcision agree that there is no overwhelming medical evidence to support either side."[8] This type of cost-benefit analysis is highly dependent on the kinds and frequencies of health problems in the population under discussion and how circumcision affects those health problems.[9]

Parents are assumed to have the child's best interests in mind. Ethically, it is imperative that the medical practitioner informs the parents about the benefits and risks of the procedure and obtain informed consent before performing it. Practically, however, many parents come to a decision about circumcising the child before he is born, and a discussion of the benefits and risks of the procedure with a physician has not been shown to have a significant effect on the decision. Some parents request to have their newborn or older child circumcised for non-therapeutic reasons, such as the parents' desires to adhere to family tradition, cultural norms or religious beliefs. In considering such a request, the physician may consider (in addition to any potential medical benefits and harms) such non-medical factors in determining the child's best interests and may ethically perform the procedure. Equally, without a clear medical benefit relative to the potential harms, a physician may take the ethical position that non-medical factors do not contribute enough as benefits to outweigh the potential harms and refuse to perform the procedure. Medical organization such as the British Medical Association state that their member physicians are not obliged to perform the procedure in such situations.[8][9]

The German Academy for Pediatric and Adolescent Medicine (Deutsche Akademie für Kinder- und Jugendmedizin e.V., DAKJ) recommend against routine non-medical infant circumcision.[122]

Ekonomické souvislosti editovat

The cost-effectiveness of circumcision has been studied to determine whether a policy of circumcising all newborns or a policy of promoting and providing inexpensive or free access to circumcision for all adult men who choose it would result in lower overall societal healthcare costs. As HIV/AIDS is an incurable disease that is expensive to manage, significant effort has been spent studying the cost-effectiveness of circumcision to reduce its spread in parts of Africa that have a relatively high infection rate and low circumcision prevalence.[123] Several analyses have concluded that circumcision programs for adult men in Africa are cost-effective and in some cases are cost-saving.[124][125] In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult,[46][126] with the greatest savings achieved when the procedure is performed in the newborn period due to the lower cost per procedure and greater timeframe for HIV infection protection.[15][126] Circumcision for the prevention of HIV transmission in adults has also been found to be cost-effective in South Africa, Kenya, and Uganda, with cost savings estimated in the billions of US dollars over 20 years.[123] Hankins et al. (2011) estimated that a $1.5 billion investment in circumcision for adults in 13 high-priority African countries would yield $16.5 billion in savings.[127]

The overall cost-effectiveness of neonatal circumcision has also been studied in the United States, which has a different cost setting from Africa in areas such as public health infrastructure, availability of medications, and medical technology and the willingness to use it.[128] A study by the CDC suggests that newborn circumcision would be societally cost-effective in the United States based on circumcision's efficacy against the heterosexual transmission of HIV alone, without considering any other cost benefits.[4] The American Academy of Pediatrics (2012) recommends that neonatal circumcision in the United States be covered by third-party payers such as Medicaid and insurance.[4] A 2014 review that considered reported benefits of circumcision such as reduced risks from HIV, HPV, and HSV-2 stated that circumcision is cost-effective in both the United States and Africa and may result in health care savings.[129] However, A 2014 literature review found that there are significant gaps in the current literature on male and female sexual health that need to be addressed for the literature to be applicable to North American populations.[130]

Odkazy editovat

Reference editovat

V tomto článku byl použit překlad textu z článku Circumcision na anglické Wikipedii.

  1. ↑ a b c d e f g Lissauer T, Clayden G. Illustrated Textbook of Paediatrics, Fourth edition. [s.l.]: Elsevier, October 2011. ISBN 978-0-7234-3565-5. S. 352–353. 
  2. ↑ a b c Rudolph C, Rudolph A, Lister G, First L, Gershon A. Rudolph's Pediatrics, 22nd Edition. [s.l.]: McGraw-Hill Companies, Incorporated, 18 March 2011. Dostupné online. ISBN 978-0-07-149723-7. S. 188. 
  3. ↑ Sawyer S. Pediatric Physical Examination & Health Assessment. [s.l.]: Jones & Bartlett Publishers, November 2011. Dostupné online. ISBN 978-1-4496-7600-1. S. 555–556. 
  4. ↑ a b c d e f g h i j k l m n o p q r s t u v w x American Academy of Pediatrics Task Force on Circumcision. Technical Report. Pediatrics. 2012, s. e756–e785. Dostupné online. ISSN 0031-4005. DOI 10.1542/peds.2012-1990. PMID 22926175. 
  5. ↑ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad Male circumcision: Global trends and determinants of prevalence, safety and acceptability [online]. Světová zdravotnická organizace, 2007 [cit. 2017-01-30]. Dostupné online. (anglicky) 
  6. ↑ a b c d e f g h Hay W, Levin M. Current Diagnosis and Treatment Pediatrics 21/E. [s.l.]: McGraw Hill Professional, 25 June 2012. Dostupné online. ISBN 978-0-07-177971-5. S. 18–19. 
  7. ↑ a b c d JACOBS, Micah; GRADY, Richard; BOLNICK, David A. Surgical Guide to Circumcision. Redakce Bolnick David A.. London: Springer, 2012. Dostupné online. ISBN 978-1-4471-2857-1. DOI 10.1007/978-1-4471-2858-8_1. Kapitola Current Circumcision Trends and Guidelines, s. 3–8. 
  8. ↑ a b c d e f Pinto K. Circumcision controversies. Pediatric clinics of North America. August 2012, s. 977–986. DOI 10.1016/j.pcl.2012.05.015. PMID 22857844. 
  9. ↑ a b c d e f g Caga-anan EC, Thomas AJ, Diekema DS, Mercurio MR, Adam MR. Clinical Ethics in Pediatrics: A Case-Based Textbook. [s.l.]: Cambridge University Press, 8 September 2011. Dostupné online. ISBN 978-0-521-17361-2. S. 43. 
  10. ↑ a b Krieger JN. Male circumcision and HIV infection risk. World Journal of Urology. May 2011, s. 3–13. DOI 10.1007/s00345-011-0696-x. PMID 21590467. 
  11. ↑ a b c d e Siegfried N, Muller M, Deeks JJ, Volmink J; MULLER; DEEKS; VOLMINK. Male circumcision for prevention of heterosexual acquisition of HIV in men. Redakce Siegfried Nandi. Cochrane Database of Systematic Reviews. 2009, s. CD003362. DOI 10.1002/14651858.CD003362.pub2. PMID 19370585. 
  12. ↑ a b c d e f WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention [online]. World Health Organization, March 2007. Dostupné online. 
  13. ↑ a b Millett GA, Flores SA, Marks G, Reed JB, Herbst JH. Circumcision status and risk of HIV and sexually transmitted infections among men who have sex with men: a meta-analysis. JAMA. October 2008, s. 1674–84. DOI 10.1001/jama.300.14.1674. PMID 18840841. 
  14. ↑ a b Wiysonge CS, Kongnyuy EJ, Shey M; AND OTHERS; SHEY; MUULA; NAVTI; AKL; LO. Male circumcision for prevention of homosexual acquisition of HIV in men. Redakce Wiysonge Charles Shey. Cochrane Database of Systematic Reviews. 2011, s. CD007496. DOI 10.1002/14651858.CD007496.pub2. PMID 21678366. 
  15. ↑ a b KIM H, LI PS, GOLDSTEIN M, Howard H; LI, Philip S; GOLDSTEIN, Marc. Male circumcision: Africa and beyond?. Current Opinion in Urology. November 2010, s. 515–9. DOI 10.1097/MOU.0b013e32833f1b21. PMID 20844437. 
  16. ↑ a b c d Larke N, Thomas SL, Dos Santos Silva I, Weiss HA. Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis. J. Infect. Dis.. November 2011, s. 1375–90. DOI 10.1093/infdis/jir523. PMID 21965090. 
  17. ↑ a b c d e f REHMEYER C, CJ. Male Circumcision and Human Papillomavirus Studies Reviewed by Infection Stage and Virus Type. J Am Osteopath Assoc. 2011, s. S11–S18. Dostupné online. PMID 21415373. 
  18. ↑ a b Can penile cancer be prevented? [online]. American Cancer Society [cit. 2012-10-25]. Dostupné online. 
  19. ↑ a b c d e f Weiss HA, Larke N, Halperin D, Schenker I; LARKE; HALPERIN; SCHENKER. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urol. 2010, s. 2. DOI 10.1186/1471-2490-10-2. PMID 20158883. 
  20. ↑ a b The American Academy of Pediatrics Task Force on Circumcision "Technical Report" (2012) addresses sexual function, sensitivity and satisfaction without qualification by age of circumcision. Sadeghi-Nejad et al. "Sexually transmitted diseases and sexual function" (2010) addresses adult circumcision and sexual function. Doyle et al. "The Impact of Male Circumcision on HIV Transmission" (2010) addresses adult circumcision and sexual function. Perera et al. "Safety and efficacy of nontherapeutic male circumcision: a systematic review" (2010) addresses adult circumcision and sexual function and satisfaction.
  21. ↑ a b MORRIS, BJ; KRIEGER, JN. Does male circumcision affect sexual function, sensitivity, or satisfaction?--a systematic review.. The Journal of Sexual Medicine. November 2013, s. 2644–57. DOI 10.1111/jsm.12293. PMID 23937309. 
  22. ↑ Neonatal and child male circumcision: a global review [online]. World Health Organization, 2010 [cit. 2015-04-12]. Dostupné online. 
  23. ↑ a b c d e f g h Alanis MC, Lucidi RS. Neonatal circumcision: a review of the world's oldest and most controversial operation. Obstet Gynecol Surv. May 2004, s. 379–95. DOI 10.1097/00006254-200405000-00026. PMID 15097799. 
  24. ↑ a b Glass JM. Religious circumcision: a Jewish view. BJUI. January 1999, s. 17–21. DOI 10.1046/j.1464-410x.1999.0830s1017.x. PMID 10349410. 
  25. ↑ a b Columbia Encyclopedia. Circumcision. [s.l.]: Columbia University Press, 2011. Dostupné online. 
  26. ↑ a b Clark M. Islam For Dummies. [s.l.]: John Wiley & Sons, 10 March 2011. Dostupné online. ISBN 978-1-118-05396-6. S. 170. 
  27. ↑ Referat bestyrelsesmøde den 16. december 2013 [online]. [cit. 2016-09-04]. Dostupné online. 
  28. ↑ MARRAZZO, JM; DEL RIO, C; HOLTGRAVE, DR; COHEN, MS; KALICHMAN, SC; MAYER, KH; MONTANER, JS. HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel. JAMA: The Journal of the American Medical Association. Jul 23–30, 2014, s. 390–409. DOI 10.1001/jama.2014.7999. PMID 25038358. 
  29. ↑ a b c Manual for male circumcision under local anaesthesia [online]. Světová zdravotnická organizace, 2009-12 [cit. 2017-02-04]. Dostupné online. (anglicky) 
  30. ↑ MCCLUNG, Chris; VOELZKE, Bryan. Surgical Guide to Circumcision. Redakce Bolnick David A.. London: Springer, 2012. Dostupné online. ISBN 978-1-4471-2857-1. DOI 10.1007/978-1-4471-2858-8_14. Kapitola Adult Circumcision, s. 165–175. 
  31. ↑ Use of devices for adult male circumcision in public health HIV prevention programmes: Conclusions of the Technical Advisory Group on Innovations in Male Circumcision. whqlibdoc.who.int. World Health Organization, 2012. Dostupné online. 
  32. ↑ a b Perera CL, Bridgewater FH, Thavaneswaran P, Maddern GJ; BRIDGEWATER; THAVANESWARAN; MADDERN. Safety and efficacy of nontherapeutic male circumcision: a systematic review. Annals of Family Medicine. 2010, s. 64–72. DOI 10.1370/afm.1073. PMID 20065281. 
  33. ↑ Professional Standards and Guidelines – Circumcision (Infant Male).Chybí název periodika! College of Physicians and Surgeons of British Columbia, September 2009. 
  34. ↑ a b Lonnqvist P. Regional anaesthesia and analgesia in the neonate. Best Pract Res Clin Anaesthesiol. Sep 2010, s. 309–21. DOI 10.1016/j.bpa.2010.02.012. PMID 21033009. 
  35. ↑ a b c d Shockley RA, Rickett K; RICKETT. Clinical inquiries. What's the best way to control circumcision pain in newborns?. J Fam Pract. April 2011, s. 233a–b. PMID 21472156. 
  36. ↑ Wolter C, Dmochowski R. Handbook of Office Urological Procedures. [s.l.]: Springer, 2008. Dostupné online. ISBN 978-1-84628-523-3. Kapitola Circumcision, s. 88–. 
  37. ↑ Weiss HA, Dickson KE, Agot K, Hankins CA; DICKSON; AGOT; HANKINS. Male circumcision for HIV prevention: current research and programmatic issues. AIDS. 2010, s. S61–9. Dostupné online. DOI 10.1097/01.aids.0000390708.66136.f4. PMID 21042054. 
  38. ↑ a b New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications [online]. World Health Organization, March 28, 2007. Dostupné online. 
  39. ↑ Dinh MH; FAHRBACH KM; HOPE TJ. The role of the foreskin in male circumcision: an evidence-based review. Am J Reprod Immunol. March 2011, s. 279–83. DOI 10.1111/j.1600-0897.2010.00934.x. PMID 21114567. 
  40. ↑ LEI, JH; LIU, LR; WEI, Q; YAN, SB; YANG, L; SONG, TR; YUAN, HC. Circumcision Status and Risk of HIV Acquisition during Heterosexual Intercourse for Both Males and Females: A Meta-Analysis.. PLOS ONE. 5 May 2015, s. e0125436. DOI 10.1371/journal.pone.0125436. PMID 25942703. 
  41. ↑ Male Circumcision and Risk for HIV Transmission and Other Health Conditions: Implications for the United States [online]. Centers for Disease Control and Prevention, 7 February 2008 [cit. 2011-07-15]. Dostupné online. 
  42. ↑ a b Templeton DJ, Millett GA, Grulich AE; MILLETT; GRULICH. Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men. Current Opinion in Infectious Diseases. February 2010, s. 45–52. DOI 10.1097/QCO.0b013e328334e54d. PMID 19935420. 
  43. ↑ STD facts – Human papillomavirus (HPV) [online]. CDC [cit. 2012-09-12]. Dostupné online. 
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  67. ↑ Canadian Paediatric Society. Newborn male circumcision Position statements and practice points. Paediatr Child Health. Sep 8, 2015, s. 311–15. Dostupné online. 
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  71. ↑ GOLDMAN, R. The psychological impact of circumcision. BJU International. Jan 1999, s. 93–102. Dostupné online. DOI 10.1046/j.1464-410x.1999.0830s1093.x. 
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  82. ↑ Gollaher (2001), ch. 2, Christians and Muslims, pp. 31–52
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  84. ↑ Johan Elverskog. Buddhism and Islam on the Silk Road. illustrated. vyd. [s.l.]: University of Pennsylvania Press, 2010. Dostupné online. ISBN 0-8122-4237-8. S. 228. 
  85. ↑ Gollaher (2001), ch. 3, Symbolic Wounds, pp. 53–72
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  87. ↑ a b c Gollaher (2001), ch. 4, From Ritual to Science, pp. 73–108
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  89. ↑ CONRAD, Peter; JOSEPH W. SCHNEIDER. Deviance and Medicalization: From Badness to Sickness. Philadelphia: Temple University Press, 1992. ISBN 0877229996. S. 212. 
  90. ↑ a b DARBY, Robert. A surgical temptation : the demonization of the foreskin and the rise of circumcision in Britain. Chicago: University of Chicago Press, 2005. ISBN 978-0-226-13645-5. S. 262-. 
  91. ↑ MATTHEW, H. C. G. Oxford dictionary of national biography : in association with the British Academy : from the earliest times to the year 2000. Oxford New York: Oxford University Press, 2004. ISBN 978-0-19-861411-1. 
  92. ↑ Gairdner D. The fate of the foreskin: a study of circumcision.. Br Med J. 1949, s. 1433–7. Dostupné online. DOI 10.1136/bmj.2.4642.1433. PMID 15408299. 
  93. ↑ Siegfried N, Muller M, Volmink J; AND OTHERS; VOLMINK; DEEKS; EGGER; LOW; WEISS. Male circumcision for prevention of heterosexual acquisition of HIV in men. Redakce Siegfried Nandi. Cochrane Database of Systematic Reviews. 2003, s. CD003362. DOI 10.1002/14651858.CD003362. PMID 12917962. 
  94. ↑ Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: methodological, ethical and legal concerns. J Law Med. 2011, s. 316–34. PMID 22320006. 
  95. ↑ Dowsett GW, Couch M. Male circumcision and HIV prevention: is there really enough of the right kind of evidence?. Reproductive Health Matters. May 2007, s. 33–44. DOI 10.1016/S0968-8080(07)29302-4. PMID 17512372. 
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  97. ↑ Frisch M; AIGRAIN Y; BARAUSKAS V; BJARNASON R; BODDY S-A; CZAUDERNA P; DE GIER RPE. Cultural Bias in the AAP's 2012 Technical Report and Policy Statement on Male Circumcision. Pediatrics. 2013, s. 796–800. DOI 10.1542/peds.2012-2896. PMID 23509170. 
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  99. ↑ AVAC: Global Advocacy for HIV Prevention. About male circumcision [online]. [cit. 2012-12-01]. Dostupné online. 
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  101. ↑ Talmud Avodah Zarah 26b; Menachot 42a; Maimonides' Mishneh Torah, Milah, ii. 1; Shulkhan Arukh, Yoreh De'ah, l.c.
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Literatura editovat

  • Bolnick DA, Koyle M, Yosha A. Surgical Guide to Circumcision. [s.l.]: Springer, September 2012. Dostupné online. ISBN 978-1-4471-2857-1. 
  • GOLLAHER D. Circumcision: A History Of The World's Most Controversial Surgery. [s.l.]: Basic Books, February 2001. Dostupné online. ISBN 978-0-465-02653-1. 

Externí odkazy editovat

Genitální chirurgické a jiné procedury (ICD-9-CM, 3. díl, 60–71)
Mužská
rozmnožovací soustava
prostata
chámovody
penis
varlata
Ženská
rozmnožovací soustava
vaječníky
vejcovody
děloha
pochva
vulva
Sex
Historie
Identita a orientace
Fyziologie
Zákon
Sexuální praktiky
Zdraví a výchova
Vztahy a společnost
Sexuální průmysl
Věda
lidská sexualita • lidské sexuální chování • zvířecí sexuální chování • sexuální slang
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