A cura di MGMbill.org:
Male Genital Mutilation
The
traditional custom of ritual cutting and alteration of the genitalia of male
infants, boys, and adolescents, referred to as male genital mutilation (MGM),
persists primarily in the United States, Canada, Australia, South Korea, the
Philippines, Africa and among certain communities in the Middle East and Asia.
Families from all regions in the United States may have sons who have undergone
a ritual genital procedure or may request that such a procedure be performed by
a physician
TYPES OF MALE GENITAL
MUTILATION
MGM is most often performed between the ages of
infancy and 14 years, although in some communities it may be postponed until 20
years of age.11 In developing countries, typically a local village practitioner
or lay person is engaged for a fee to perform the procedure, which is done
without anesthesia using a variety of instruments, such as knives, razor blades,
broken glass, or scissors. In developed countries physicians or mohels may be
sought to perform MGM under clean or sterile conditions with or without the use
of anesthesia. Figure 1 shows the normal genital anatomy of a prepubertal male.
The various ritual genital practices are classified into four types based on the
severity of structural disfigurement.12
Fig. 1. Normal male genital
anatomy.
Click to View
Larger: http://mgmbill.org/images/aapintactpenislarge2.jpg
Type I MGM, often termed circumcision, involves
excision or injury of part or all of the skin and specialized mucosal tissues of
the penis including the prepuce and ridged band (Fig 2). When this procedure is
performed in infants and young boys, a portion of or all of the frenulum may be
removed. If only the tip of the foreskin is removed, or if the foreskin has only
been prematurely and forcibly retracted, the physical manifestation of Type I
MGM may be subtle, necessitating a careful examination of the glans, foreskin,
and adjacent structures for recognition.
Fig. 2. Type I male
genital mutilation.
Click to View
Larger: http://mgmbill.org/images/aaptypeImgmlarge.jpg
Type II MGM, referred to as glandectomy or
penectomy, is excision or injury to the glans and/or penis shaft, along with
Type I MGM. (Fig 3). Crude stitches may be used to control bleeding from the
penile artery and raw tissue surfaces, and patients with Type II MGM have a
shortened urethra resulting from the absence of the glans and/or penile shaft
that may cause problems urinating and/or ejaculating
Fig. 3. Type
II male genital mutilation.
Click to View
Larger: http://mgmbill.org/images/aaptypeIImgmlarge.jpg
Type III MGM, known as castration, is the most
severe form in which the testicles are excised with or without some or all of
the foreskin and/or penile shaft (Fig 4). The raw surfaces are stitched together
and the patient may no longer be able to maintain an erection or father
children.
Fig. 4. Type III male genital
mutilation.
Click to View
Larger: http://mgmbill.org/images/aaptypeIIImgmlarge.jpg
Type
IV includes different practices of variable severity including pricking,
piercing or incision of the prepuce, glans, scrotum or other genital tissue;
cutting and suturing of the prepuce over the glans (infibulation); slitting open
the urethra along the ventral surface of the penis (subincision); slitting open
the foreskin along its dorsal surface (superincision); severing the frenulum;
stripping the skin from the shaft of the penis; introducing corrosive or
scalding substances onto the genital area; and any other procedure which falls
under the definition of MGM given above.
The physical complications
associated with MGM may be acute or chronic. Early, life-threatening risks
include hemorrhage, infection, excessive skin loss, skin bridges, glans
deformation, bowing, meatal stenosis, loss of penis, and death.13,14
Circumcision (Type I) is often associated with long-term sexual function
difficulties. Common problems involve chafing and dryness during intercourse,
reduced sexual feeling, and a buildup of desensitizing keratin on the exposed
glans and remaining inner foreskin.
Less well-understood are the
psychological, sexual, and social consequences of MGM, because little research
has been conducted in countries where the practice is endemic.15 However,
personal accounts by men who have had a medicalized genital procedure recount
anxiety before the event, terror at being seized and forcibly held during the
event, and lack of sexual pleasure during intercourse.16 Some men have no
recollection of the event, particularly if it was performed in infancy, while
others deny that the procedure has had any negative effect on their health or
sexual life.
FONTE: http://mgmbill.org/aap.htm
REFERENCES
National Organization
to Halt the Abuse and Routine Mutilation of Males. Genital Mutilations. http://noharmm.org/geography.htm.
National Organization
to Halt the Abuse and Routine Mutilation of Males. Statistics on Human Genital
Mutilation. http://noharmm.org/HGMstats.htm.
National Organization
of Circumcision Information Resource Centers. About NOCIRC. www.nocirc.org/about.php.
International Coalition for
Genital Integrity. About Us. www.icgi.org/about/.
Doctors Opposing Circumcision.
Foreskin Curriculum. www.doctorsopposingcircumcision.org/info/foreskin.html.
Nurses
for the Rights of the Child. Position Statement on Infant Circumcision. www.nurses.cirp.org.
Proceedings of the First
International Symposium on Circumcision. Declaration of the First International
Symposium on Circumcision. www.nocirc.org/declare.php.
Sections 664 and 665 of the
Illegal Immigration Reform and Immigrant Responsibility Act of 1996, Division C,
Omnibus Consolidated Appropriations Act for Fiscal Year 1997. Pub L No. 104-208;
Sept 30, 1996. http://frwebgate.access.gpo.gov/
cgi-bin/useftp.cgi?IPaddress=162.140.64.45
&filename=h4278cph.txt&directory=/disk3/wais/data/104_cong_bills.
Attorneys
for the Rights of the Child. Who We Are. www.arclaw.org/arc_about/arc_about.php.
MGMbill.org.
About Us. www.mgmbill.org/aboutus.htm.
National Organization to
Halt the Abuse and Routine Mutilation of Males. Genital Cutting Customs by Age
and Region/Ethnic Group. http://noharmm.org/age-region.htm.
International
Coalition for Genital Integrity. Human Genital Mutilation (HGM) Classifications.
www.icgi.org/information/hgm-classification/.
Williams
N. and Kapila L. Complications of Circumcision. www.cirp.org/library/complications/williams-kapila/.
Circumcision
Information and Resource Pages. Complications of Circumcision. www.cirp.org/library/complications/.
Circumcision
Information and Resource Pages. Psychological impacts of male circumcision. www.cirp.org/library/psych/.
Menage J. Circumcision and
Psychological Harm. www.norm-uk.org/circumcision_psychological_effects.html.
Aldeeb
Abu-Sahlieh S. To Mutilate in the Name of Jehovah or Allah. www.quran.org/CIRCUMCISION.HTM.
Jewish Circumcision
Resource Center. Information Summary. www.jewishcircumcision.org/info.htm.
Goldman R.
Circumcision to Look Like Others. www.circumcision.org/others.htm.
Winkel R. Male
Circumcision in the USA: A Human Rights Primer. www.ratical.org/ratville/MGMprimer.html.
Young H. The
role of money in the continuation of circumcision. www.circumstitions.com/$$$.html.
Kennard J.
Complications following Male Circumcision. http://menshealth.about.com/od/genitalsexu...ms=circumcision.
Pollack
B. A Delicate Ritual. www.boystoo.com/religion/religion2.htm#A%20delicate%20ritual.
Smith
J. Male Circumcision and the Rights of the Child. www.cirp.org/library/legal/smith/.
Abd el Salam S. Male
Genital Mutilation (Circumcision) A Feminist Study of a Muted Gender Issue. www.noharmm.org/muted2.htm.
Goodenough P. Activists
Want UN to Declare Circumcision a Human Rights Crime. www.cnsnews.com/public/content/article.aspx?RsrcID=6722.
MGM is most often performed between the ages of infancy and 14 years, although in some communities it may be postponed until 20 years of age.11 In developing countries, typically a local village practitioner or lay person is engaged for a fee to perform the procedure, which is done without anesthesia using a variety of instruments, such as knives, razor blades, broken glass, or scissors. In developed countries physicians or mohels may be sought to perform MGM under clean or sterile conditions with or without the use of anesthesia. Figure 1 shows the normal genital anatomy of a prepubertal male. The various ritual genital practices are classified into four types based on the severity of structural disfigurement.12
Fig. 1. Normal male genital anatomy.
Click to View Larger: http://mgmbill.org/images/aapintactpenislarge2.jpg
Type I MGM, often termed circumcision, involves excision or injury of part or all of the skin and specialized mucosal tissues of the penis including the prepuce and ridged band (Fig 2). When this procedure is performed in infants and young boys, a portion of or all of the frenulum may be removed. If only the tip of the foreskin is removed, or if the foreskin has only been prematurely and forcibly retracted, the physical manifestation of Type I MGM may be subtle, necessitating a careful examination of the glans, foreskin, and adjacent structures for recognition.
Fig. 2. Type I male genital mutilation.
Click to View Larger: http://mgmbill.org/images/aaptypeImgmlarge.jpg
Type II MGM, referred to as glandectomy or penectomy, is excision or injury to the glans and/or penis shaft, along with Type I MGM. (Fig 3). Crude stitches may be used to control bleeding from the penile artery and raw tissue surfaces, and patients with Type II MGM have a shortened urethra resulting from the absence of the glans and/or penile shaft that may cause problems urinating and/or ejaculating
Fig. 3. Type II male genital mutilation.
Click to View Larger: http://mgmbill.org/images/aaptypeIImgmlarge.jpg
Type III MGM, known as castration, is the most severe form in which the testicles are excised with or without some or all of the foreskin and/or penile shaft (Fig 4). The raw surfaces are stitched together and the patient may no longer be able to maintain an erection or father children.
Fig. 4. Type III male genital mutilation.
Click to View Larger: http://mgmbill.org/images/aaptypeIIImgmlarge.jpg
Type IV includes different practices of variable severity including pricking, piercing or incision of the prepuce, glans, scrotum or other genital tissue; cutting and suturing of the prepuce over the glans (infibulation); slitting open the urethra along the ventral surface of the penis (subincision); slitting open the foreskin along its dorsal surface (superincision); severing the frenulum; stripping the skin from the shaft of the penis; introducing corrosive or scalding substances onto the genital area; and any other procedure which falls under the definition of MGM given above.
The physical complications associated with MGM may be acute or chronic. Early, life-threatening risks include hemorrhage, infection, excessive skin loss, skin bridges, glans deformation, bowing, meatal stenosis, loss of penis, and death.13,14 Circumcision (Type I) is often associated with long-term sexual function difficulties. Common problems involve chafing and dryness during intercourse, reduced sexual feeling, and a buildup of desensitizing keratin on the exposed glans and remaining inner foreskin.
Less well-understood are the psychological, sexual, and social consequences of MGM, because little research has been conducted in countries where the practice is endemic.15 However, personal accounts by men who have had a medicalized genital procedure recount anxiety before the event, terror at being seized and forcibly held during the event, and lack of sexual pleasure during intercourse.16 Some men have no recollection of the event, particularly if it was performed in infancy, while others deny that the procedure has had any negative effect on their health or sexual life.
