Urine

A Doctor Examining Urine,  Trophime Bigot.[5]

In humans, soluble wastes are excreted primarily by the urinary system.[5][12]

1. Human urinary system: 2. Kidney, 3. Renal pelvis, 4.Ureter, 5. Urinary bladder, 6. Urethra. 
7. Adrenal gland
8. Renal artery and vein, 9. Inferior vena cava, 10. Abdominal aorta, 11. Common iliac artery and vein
12. Liver, 13. Large intestine, 14.Pelvis [10]

The urinary system is regulated by the endocrine system via hormones such as antidiuretic hormone, aldosterone, and parathyroid hormone.[10][11]

Urine is an aqueous solution of greater than 95% water, with the remaining constituents, in order of decreasing concentration:[5][13]

• urea 9.3 g/L
• chloride 1.87 g/L
• sodium 1.17 g/L
• potassium 0.750 g/L
• creatinine 0.670 g/L 
• and other dissolved ions, inorganic and organic compounds.

It is a myth that holding your urine too long can make your bladder burst (provided you are healthy, have not just had surgery in your nether regions, and are without certain pre-existing medical conditions). 

There also isn't evidence that holding it for excessive lengths of time increases the risk of UTIs.[2][36][37]

A healthy adult bladder can hold up to 16 ounces of urine comfortably, according to the National Institutes of Health.[3]

Eating asparagus can cause a strong odor in urine. This may be caused by the body's breakdown of asparagusic acid, an organosulfur.[5][6][7] 

Particularly spicy foods can have a similar effect, as their compounds pass through the kidneys without being fully broken down before exiting the body.[4][5][8][9]

SciShow via YouTube

The Color of Urine & What it May or May Not Indicate:

• Severe dehydration can produce urine the color of amber.[14]

• Dark brown urine— particularly if accompanied by pale stools and yellow skin and eyes — may be a sign that the liver is malfunctioning.[14]

• Factors that can cause urinary blood (hematuria) include urinary tract infections, enlarged prostate, cancerous and noncancerous tumors, kidney cysts, long-distance running, and kidney or bladder stones.[14]

• Consuming beets can result in beeturia (pink/red urine containing betanin) for some 10–14% of the population.[5][15]

• Blackberries and rhubarb can also turn urine red or pink.[14]

• Rifampin (Rifadin, Rimactane), an antibiotic often used to treat tuberculosis, can turn urine red — as can phenazopyridine (Pyridium), a drug that numbs urinary tract discomfort, and laxatives containing senna.[14]

• Chronic lead or mercury poisoning can cause urine to turn red.[14]

• Medications that can turn urine orange include rifampin; the anti-inflammatory drug sulfasalazine (Azulfidine); phenazopyridine (Pyridium), a drug that numbs urinary tract discomfort; some laxatives; and certain chemotherapy drugs.[14]

• In some cases, orange urine can indicate a problem with your liver or bile duct, especially if you also have light-colored stools. Orange urine may also be caused by dehydration, which can concentrate your urine and make it much deeper in color.[14]

• Some brightly colored food dyes can cause green urine. Dyes used for some tests of kidney and bladder function can turn urine blue.[14]

• A number of medications produce blue or green urine, including amitriptyline, indomethacin (Indocin) and propofol (Diprivan).[14]

Green urine during long term
infusion of the sedative propofol[5]

• Familial hypercalcemia, a rare inherited disorder, is sometimes called blue diaper syndrome because children with the disorder have blue urine.[14]

• Green urine sometimes occurs during urinary tract infections caused by pseudomonas bacteria.[14]

• Eating large amounts of fava beans, rhubarb or aloe can cause dark brown urine.[14]

• A number of drugs can darken urine, including the antimalarial drugs chloroquine and primaquine, the antibiotics metronidazole and nitrofurantoin, laxatives containing cascara or senna, and methocarbamol — a muscle relaxant.[14]

• Some liver and kidney disorders can turn urine dark brown, as can some urinary tract infections.[14]

• Urinary tract infections and kidney stones can cause urine to appear cloudy or murky.[14]

The pH of urine can vary between 4.6 and 8, with neutral (7) being normal. 

• In persons with hyperuricosuria, acidic urine (low pH) can contribute to the formation of stones of uric acid in the kidneys, ureters, or bladder.[5][16]

• A diet high in citrus, vegetables, or dairy can increase urine pH (more basic).[5][17]

• Drugs that can decrease urine pH (more acidic) include ammonium chloride, chlorothiazide diuretics, and methenamine mandelate.[5][18][19]

***

• When diluted with water in specific ratios, urine can be applied directly to soil as a fertilizer.[5][23][24]

• The fertilization effect of urine has been found to be comparable to that of commercial fertilizers with an equivalent nitrogen, phosphorous and potassium rating.[5][25]

• General limitations to using urine as fertilizer depend mainly on the potential for buildup of excess nitrogen,[5][23] and inorganic salts such as sodium chloride, which are also part of the wastes excreted by the renal system.

• Urine can also be used safely as a source of complementary nitrogen in carbon-rich compost.[5][24]

• Since about 2011, the Bill and Melinda Gates Foundation has been providing research funding sanitation systems that recover the nutrients in urine.[5][26][27] 

***

• Some research has shown that more environmental problems are created when urine is treated (as part of sewage in waste water treatment plants) versus when it is used as a resource (waterless urinals, urine diversion toilets).[5][28][29][30]

• Pregnant mare urine is the source of estrogens for hormone replacement therapy (ex. Premarin).[5][20][21]

• Urine also contains antibodies, which can be used in diagnostic antibody tests for a range of pathogens, including HIV-1.[5][22]

• Ancient Chinese medicine used ants for the evaluation of urine of patients to detect whether the urine contained high levels of glucose.[38]  

• In the Middle Ages, urine charts were used to link the colours, tastes and smells of urine to various medical conditions.[39]

• Due to the fact that urea in urine breaks down into ammonia, urine has historically been used as a cleaning agent.[5][31]

• Urine was also historically used in the manufacture of gunpowder. Applied to straw or other organic material, the salts resulting from the rotting material were evaporated to allow collection of the crude saltpeter crystals used in making gunpowder.[5][32]

• It is an urban myth that urine works well against jellyfish stings. At best it is ineffective, and in some cases this treatment may make the injury worse.[5][33][34][35] 

On the question of whether or not cranberry juice can cure urinary tract Infections:[1]

"In general, the preventive efficacy of cranberry has been variable and modest at best. …The findings of the Cochrane Collaboration support the potential use of cranberry products in the prophylaxis of recurrent UTIs in young and middle-aged women. However, in light of the heterogeneity of clinical study designs and the lack of consensus regarding the dosage regimen and formulation to use, cranberry products cannot be recommended for the prophylaxis of recurrent UTIs at this time."

***

Fin

UPDATES & RELATED

Bladder Control Is All Thanks To Your Brain; What The Link Can Do To Treat Chronic Pelvic Pain / Medical Daily / October 15, 2014

REFERENCES

[1] Cranberry and urinary tract infections.

Guay DR Drugs. 2009;69(7):775-807. doi: 10.2165/00003495-200969070-00002. Review.

PMID:19441868 [PubMed - indexed for MEDLINE]

[2] http://www.vox.com/2014/9/23/6538083/pee-urine-bladder

[3] http://www.livescience.com/32330-how-much-urine-can-a-healthy-bladder-hold.html

[4] http://www.webmd.com/food-recipes/features/why-pee-smells-funny-eat-asparagus

[5] http://en.wikipedia.org/wiki/Urine

[6] Lison M, Blondheim SH, Melmed RN (1980). "A polymorphism of the ability to smell urinary metabolites of asparagus". Br Med J 281 (6256): 1676–8.doi:10.1136/bmj.281.6256.1676. PMC 1715705. PMID 7448566.

[7]  Michael T. Madigan; Thomas D. Brock (2009). Brock biology of microorganisms. Pearson/Benjamin Cummings. ISBN 978-0-13-232460-1. Retrieved 10 September 2011.

[8]  Stefan Gates; Max La Riviere-Hedrick (15 March 2006). Gastronaut: adventures in food for the romantic, the foolhardy, and the brave. Houghton Mifflin Harcourt. pp. 87–.ISBN 978-0-15-603097-7. Retrieved 27 April 2011.

[9] Foods that Affect the Odor of Urine. livestrong.com. December 27, 2010.

[10] http://en.wikipedia.org/wiki/Urinary_system

[11] Maton, Anthea; Jean Hopkins; Charles William McLaughlin; Susan Johnson; Maryanna Quon Warner; David LaHart; Jill D. Wright (1993). Human Biology and Health. Englewood Cliffs, New Jersey, USA: Prentice Hall. ISBN 0-13-981176-1.

[12]  Arthur C. Guyton; John Edward Hall (2006). "25". Textbook of medical physiology (11 ed.). Elsevier Saunders. ISBN 978-0-8089-2317-6. 

[13] David F. Putnam Composition and Concentrative Properties of Human Urine. NASA Contractor Report. July 1971

[14] http://www.mayoclinic.org/diseases-conditions/urine-color/basics/symptoms/con-20032831

[15] Watts AR, Lennard MS, Mason SL, Tucker GT, Woods HF (December 1993). "Beeturia and the biological fate of beetroot pigments". Pharmacogenetics 3 (6): 302–11.doi:10.1097/00008571-199312000-00004. PMID 8148871.

[16] Martín Hernández E, Aparicio López C, Alvarez Calatayud G, García Herrera MA (2001)."[Vesical uric acid lithiasis in a child with renal hypouricemia]". An. Esp. Pediatr. (in Spanish; Castilian) 55 (3): 273–6. PMID 11676906.

[17] Welch AA, Mulligan A, Bingham SA, Khaw KT (2007). "Urine pH is an indicator of dietary acid–base load, fruit and vegetables and meat intakes: Results from the European Prospective Investigation into Cancer and Nutrition (EPIC)-Norfolk population study".British Journal of Nutrition 99 (6): 1335–1343. doi:10.1017/S0007114507862350.PMID 18042305.

[18]  Urine pH: MedlinePlus Medical Encyclopedia. Nlm.nih.gov (2011-03-28). Retrieved on 2011-04-27.

[19]  Discovery Health "Urine PH – Medical Dictionary". Healthguide.howstuffworks.com (2007-05-16). Retrieved on 2011-04-27.

[20] Carrell, D.T., & Peterson, C. M. eds. (2010). Chapter 31, Artificial insemination: intrauterine insemination. 31.3.1.2 Gonadotrophins, Reproductive endocrinology and infertility.(Excerpt, p. 489), New York, New York: Springer. DOI 10.1007/978-1-4419-1436-1. 

[21]  Adelson, Andrea. Wall Street; A Fertility Drug Grows Scarce.http://www.nytimes.com/1995/02/26/business/wall-street-a-fertility-drug-grows-scarce.html New York Times 1995-02-26

[22] Urine Antibody Tests: New Insights into the Dynamics of HIV-1 Infection – Urnovitz et al. 45 (9): 1602 – Clinical Chemistry. Clinchem.org.

[23] Morgan, Peter (2004). "10. The Usefulness of urine". An Ecological Approach to Sanitation in Africa: A Compilation of Experiences (CD release ed.). Aquamor, Harare, Zimbabwe. Retrieved 6 December 2011.

[24] Steinfeld, Carol (2004). Liquid Gold: The Lore and Logic of Using Urine to Grow Plants. Ecowaters Books. ISBN 978-0-9666783-1-4.

[25] M. Johansson; Jönsson, H.; Höglund, C.; Richert Stintzing, A.; Rodhe, L. (2001)."Urine Separation – Closing the Nitrogen Cycle" (PDF). Stockholm Water Company.

[26] South African city looks to turn urine into fertilizer, UN Office for the Coordination of Humanitarian Affairs, November 2010. Sanitationfinance.org (2010-11-13). 

[27] Ganrot, Zsofia (2005). Ph.D. Thesis: Urine processing for efficient nutrient recovery and reuse in agriculture. Goteborg, Sweden: Goteborg University. p. 170.

[28] UDD-Toilets and urine management. (PDF). ecosanservices.org. 

[29] von Münch, E., Winker, M. (2011). Technology review of urine diversion components - Overview on urine diversion components such as waterless urinals, urine diversion toilets, urine storage and reuse systems. Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH

[30] Mara Grunbaum Human urine is shown to be an effective agricultural fertilizer, Scientific American, July 2010.

[31] Sueton, Vespasian 23 English, Latin. Cf. Dio Cassius, Roman History, Book 65, chapter 14,5 English, Greek/French (66, 14)

[32] Joseph LeConte (1862). Instructions for the Manufacture of Saltpeter. Columbia, S.C.: South Carolina Military Department; printer: Charles P. Pelham. p. 14.

[33]  Old Wives' Tale? Urine as Jellyfish Sting Remedy. ABC News (2006-08-08). Retrieved on 2011-04-27.

[34]  Fact or Fiction?: Urinating on a Jellyfish Sting is an Effective Treatment. Scientific American. 4 January 2007. 

[35] Jellyfish Sting Treatment – How to Treat a Jellyfish Sting. Firstaid.about.com. 22 August 2010.

[36] http://www.popsci.com/science/article/2012-05/fyi-can-bladder-actually-burst
[37]http://www.ncbi.nlm.nih.gov/pubmed/21095409
[38] Van der greef and Smilde, J Chemomet, (2005) 19:376-386
[39] Nicholson JK, Lindon JC (October 2008). "Systems biology: Metabonomics". Nature 455 (7216): 1054–6.Bibcode:2008Natur.455.1054N. doi:10.1038/4551054a.PMID 18948945.

ADDITIONAL RESOURCES

http://womenshealth.gov/publications/our-publications/fact-sheet/urinary-tract-infection.html

http://www.hopkinsmedicine.org/healthlibrary/conditions/kidney_and_urinary_system_disorders/bladder_and_bowel_dysfunction_134,113/

IMAGE CREDITS

"Bigot, Trophime - A Doctor Examining Urine" by Trophime Bigot - Web Gallery of Art:   Image  Info about artwork. Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Bigot,_Trophime_-_A_Doctor_Examining_Urine.jpg#mediaviewer/File:Bigot,_Trophime_-_A_Doctor_Examining_Urine.jpg

"IMAG0466" by Rmosler2100 - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:IMAG0466.jpg#mediaviewer/File:IMAG0466.jpg

"216 pH Scale-01" by OpenStax College - Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.. Licensed under CC BY 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:216_pH_Scale-01.jpg#mediaviewer/File:216_pH_Scale-01.jpg

"Urinary system" by Jordi March i Nogué [1] - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Urinary_system.svg#mediaviewer/File:Urinary_system.svg

Circumcision

  

Circumcision knife from the Congo;
wood, iron; late 19th/early 20th century[1]

Male circumcision is the surgical removal of the foreskin from the human penis.[1][2][3][4]

The oldest documented evidence for circumcision comes from ancient Egypt.[1][5] The Egyptian Book of the Dead describes the sun god Ra as having circumcised himself.[1][6][7]

British and American doctors began recommending circumcision in the late 19th century, primarily as a deterrent to masturbation.[1][8][9] 

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, feeble-mindedness, and insanity.[1][10][11]

Approximately one-third of males worldwide are circumcised, most often for non-medical reasons.[1][5][13] 

Prevalence of circumcision by country.[1]

A 2010 review of literature worldwide found circumcisions performed by medical practitioners to have a median complication rate of 1.5% for newborns and 6% for older children, with few cases of severe complications.[1][13][14][15]

A 2013 systematic review found that circumcision did not appear to affect sexual desire, pain with intercourse, premature ejaculation, time to ejaculation, erectile dysfunction or difficulties with orgasm.[1][16]

Circumcision surgery with hemostats and scissors.[1]

The procedure is most often elected for religious or cultural reasons,[1][5] but may be indicated as a treatment option for pathological phimosis (inability to retract the foreskin over the glans penis)  and chronic urinary tract infections (UTIs).[1][2][12][13][30][32][33] 

Circumcision is associated with a reduced prevalence of oncogenic types of Human papillomavirus (HPV) infection.[35]

• The procedure is associated with increased clearance of the papillomavirus by the body,[26][27] which may account for the finding of reduced prevalence.[27] 

• There is no statistically significant relationship between being circumcised and the presence of genital warts.[1][19][19][20][21]

Important risk factors for penile cancer include phimosis and HPV infection, both of which are mitigated by circumcision.[1][13][25][34][35][36]

Yeast infections are the most common penile infection and are rarely identified in samples taken from circumcised males.[1][31]

***

The World Health Organization (WHO) and the Joint United Nations Program 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.[1][5][17][18][21]

• The joint WHO/UNAIDS recommendation also notes that circumcision only provides partial protection from HIV and should not replace known methods of HIV prevention (ex: condoms).[1][5][17]  

• 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.[1][22] 

• In Rwanda, circumcision has been found to be cost-effective across a wide range of age groups from newborn to adult,[1][19] with the greatest savings achieved when the procedure is performed in the newborn period due to the lower cost per procedure and greater time-frame for HIV infection protection.[1][20] 

• 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.[1][22][23] 

***

In 2014, the Centers for Disease Control and Prevention released, "Draft CDC Recommendations for Providers Counseling Male Patients and Parents Regarding Male Circumcision and the Prevention of HIV Infection, STIs, and Other Health Outcomes." 

These draft guidelines suggested that the benefits of male circumcision outweigh the risks. 
The following is their summary of beneficial versus adverse effects:[24]

Health benefits of elective male circumcision in adults and adolescents:

• Male circumcision reduces the risk of acquiring HIV infection through penile-vaginal sex by 50-60%, as demonstrated in three well-conducted clinical trials among adult men living in sub-Saharan Africa.
• In clinical trials involving heterosexual males living in sub-Saharan Africa, male circumcision reduces the risk of some sexually transmitted infections.
• HSV-2 (herpes simplex virus type 2): circumcised men were approximately 30%-45% less likely to acquire HSV-2 infection than were uncircumcised men.
• HPV (human papillomavirus): circumcised men were approximately 30% less likely to be infected with high-risk strains of HPV associated with cancers than were uncircumcised men.

Adverse events and risks associated with elective male circumcision of adults: 

• For adult male circumcision performed by clinicians, the rate of adverse events is between 2% and 4%, with pain, bleeding, infection and unsatisfactory post-surgical appearance most commonly reported. While severe and/or long-term complications have been reported, they are so rare that they have not been precisely established.
• Adult men who undergo circumcision generally report minimal or no change in sexual satisfaction or function. 

Health benefits of neonatal male circumcision:

• The estimated annual rate of urinary tract infections (UTIs) in uncircumcised male infants is 0.70%. Male circumcision reduces the risk for infant UTIs by about 80%.
• In the U.S., the estimated lifetime risk of penile cancer for males is about 1 in 1,400 (0.07%) and that of prostate cancer is about 15%. Neonatal male circumcision reduces the risk of penile carcinoma by about 90% and may reduce the risk of prostate cancer by 15% compared to men who are uncircumcised. 

Adverse events and risks associated with neonatal male circumcision:

• Adverse events: For male circumcision performed by clinicians, the rate of reported adverse events is as follows:
• 0.4% in infants (age through 12 mo.)
• 9.1% in children (age 1-9 years)

***
Fin

References:

[1] http://en.wikipedia.org/wiki/Circumcision

[2] Lissauer T, Clayden G (October 2011). Illustrated Textbook of Paediatrics, Fourth edition. Elsevier. pp. 352–353. ISBN 978-0-7234-3565-5.

[3] Rudolph C, Rudolph A, Lister G, First L, Gershon A (18 March 2011). Rudolph's Pediatrics, 22nd Edition. McGraw-Hill Companies, Incorporated. p. 188. ISBN 978-0-07-149723-7.

[4] Sawyer S (November 2011). Pediatric Physical Examination & Health Assessment. Jones & Bartlett Publishers. pp. 555–556. ISBN 978-1-4496-7600-1.

[5] "Male circumcision: Global trends and determinants of prevalence, safety and acceptability" (PDF). World Health Organization. 2007.

[6] Alanis MC, Lucidi RS (May 2004). "Neonatal circumcision: a review of the world's oldest and most controversial operation". Obstet Gynecol Surv 59 (5): 379–95.doi:10.1097/00006254-200405000-00026. PMID 15097799.

[7] Gollaher (2001), ch. 1, The Jewish Tradition, pp. 1-30

[8] Matthew, H. C. G. (2004). 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. ISBN 978-0-19-861411-1.

[9] Siegfried N, Muller M, Volmink J et al. (2003). Siegfried, Nandi, ed. "Male circumcision for prevention of heterosexual acquisition of HIV in men". Cochrane Database of Systematic Reviews (3): CD003362. doi:10.1002/14651858.CD003362.PMID 12917962.

[10] Boyle GJ, Hill G (2011). "Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: methodological, ethical and legal concerns". J Law Med19 (2): 316–34. PMID 22320006.

[11] Dowsett GW, Couch M (May 2007). "Male circumcision and HIV prevention: is there really enough of the right kind of evidence?". Reproductive Health Matters 15 (29): 33–44.doi:10.1016/S0968-8080(07)29302-4. PMID 17512372.

 [12] Hay W, Levin M (25 June 2012). Current Diagnosis and Treatment Pediatrics 21/E. McGraw Hill Professional. pp. 18–19. ISBN 978-0-07-177971-5.

[13] Weiss HA, Larke N, Halperin D, Schenker I; Larke; Halperin; Schenker (2010). "Complications of circumcision in male neonates, infants and children: a systematic review". BMC Urol 10: 2. doi:10.1186/1471-2490-10-2. PMC 2835667.PMID 20158883.

[14] American Academy of Pediatrics Task Force on Circumcision (2012). "Technical Report". Pediatrics 130 (3): e756–e785.doi:10.1542/peds.2012-1990. ISSN 0031-4005. PMID 22926175.

[15] "Circumcision: Position Paper on Neonatal Circumcision". American Academy of Family Physicians. 2007. 

[16]Ko MC, Liu CK, Lee WK, Jeng HS, Chiang HS, Li CY (April 2007). "Age-specific prevalence rates of phimosis and circumcision in Taiwanese boys". Journal of the Formosan Medical Association=Taiwan Yi Zhi 106 (4): 302–7. doi:10.1016/S0929-6646(09)60256-4. PMID 17475607.

[17]  "WHO and UNAIDS announce recommendations from expert consultation on male circumcision for HIV prevention". World Health Organization. March 2007.

[18] "New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications" (PDF). World Health Organization. March 28, 2007.

[19] Albero G, Castellsagué X, Giuliano AR, Bosch FX (February 2012). "Male Circumcision and Genital Human Papillomavirus: A Systematic Review and Meta-Analysis".Sex Transm Dis 39 (2): 104–113. doi:10.1097/OLQ.0b013e3182387abd.PMID 22249298.

[20] Kim H, Li PS, Goldstein M, Howard H; Li, Philip S; Goldstein, Marc (November 2010). "Male circumcision: Africa and beyond?". Current Opinion in Urology 20 (6): 515–9.doi:10.1097/MOU.0b013e32833f1b21. PMID 20844437.

[21] Siegfried N, Muller M, Deeks JJ, Volmink J; Muller; Deeks; Volmink (2009). Siegfried, Nandi, ed. "Male circumcision for prevention of heterosexual acquisition of HIV in men". Cochrane Database of Systematic Reviews (2): CD003362.doi:10.1002/14651858.CD003362.pub2. PMID 19370585.

[22] Doyle S, Kahn J, Hosang N, Carroll P (2010). "The Impact of Male Circumcision on HIV Transmission". Journal of Urology 183 (1): 21–26. doi:10.1016/j.juro.2009.09.030.PMID 19913816.

[23]  Hankins C, Forsythe S, Njeuhmeli E (Mar 2012). Sansom, Stephanie L, ed. "Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up". Arch Pediatr Adolesc Med 8 (11): e1001127.doi:10.1371/journal.pmed.1001127. PMC 3226452. PMID 22140362
[24] http://www.regulations.gov/#!documentDetail;D=CDC-2014-0012-0003

[25] Larke et al. "Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis" (2011), Albero et al. "Male Circumcision and Genital Human Papillomavirus: A Systematic Review and Meta-Analysis" (2012), Rehmeyer "Male Circumcision and Human Papillomavirus Studies Reviewed by Infection Stage and Virus Type" (2011).

[26] Larke N, Thomas SL, Dos Santos Silva I, Weiss HA (November 2011). "Male circumcision and human papillomavirus infection in men: a systematic review and meta-analysis". J. Infect. Dis. 204 (9): 1375–90. doi:10.1093/infdis/jir523. PMID 21965090.

[27] Rehmeyer C, CJ (2011). "Male Circumcision and Human Papillomavirus Studies Reviewed by Infection Stage and Virus Type". J Am Osteopath Assoc 111 (3 suppl 2): S11–S18. PMID 21415373.

[28]Templeton DJ, Millett GA, Grulich AE; Millett; Grulich (February 2010). "Male circumcision to reduce the risk of HIV and sexually transmitted infections among men who have sex with men". Current Opinion in Infectious Diseases 23 (1): 45–52.doi:10.1097/QCO.0b013e328334e54d. PMID 19935420.

[29] Millett GA, Flores SA, Marks G, Reed JB, Herbst JH (October 2008). "Circumcision status and risk of HIV and sexually transmitted infections among men who have sex with men: a meta-analysis". JAMA 300 (14): 1674–84. doi:10.1001/jama.300.14.1674.PMID 18840841.

[30] Becker K (January 2011). "Lichen sclerosus in boys". Dtsch Arztebl Int 108 (4): 53–8.doi:10.3238/arztebl.2011.053. PMC 3036008. PMID 21307992.

[31] Aridogan IA, Izol V, Ilkit M (August 2011). "Superficial fungal infections of the male genitalia: a review". Crit. Rev. Microbiol. 37 (3): 237–44.

[32] Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S (2012). Fedorowicz, Zbys, ed. "Routine neonatal circumcision for the prevention of urinary tract infections in infancy". Cochrane Database of Systematic Reviews 11: CD009129.doi:10.1002/14651858.CD009129.pub2. PMID 23152269.

[33] Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S (2011). Fedorowicz, Zbys, ed. "Routine neonatal circumcision for the prevention of urinary tract infections in infancy (Protocol)". Cochrane Database of Systematic Reviews (5): CD009129.doi:10.1002/14651858.CD009129.

[34] Hayashi Y, Kojima Y, Mizuno K, Kohri K (2011). "Prepuce: phimosis, paraphimosis, and circumcision". ScientificWorldJournal 11: 289–301. doi:10.1100/tsw.2011.31.PMID 21298220.

[35] Larke NL, Thomas SL, Dos Santos Silva I, Weiss HA (August 2011). "Male circumcision and penile cancer: a systematic review and meta-analysis". Cancer Causes Control 22 (8): 1097–110. doi:10.1007/s10552-011-9785-9. PMC 3139859.PMID 21695385.

[36] "Can penile cancer be prevented?". Learn About Cancer: Penile Cancer: Detailed Guide. American Cancer Society. 

Additional Resources:

http://www.webmd.com/sexual-conditions/guide/circumcision

http://www.scientificamerican.com/article/male-circumcision-benefits-outweigh-risks-cdc-says/?WT.mc_id=SA_HLTH_20141209

http://www.theguardian.com/us-news/2014/dec/02/guidelines-male-circumcision
American Academy of Pediatrics Task Force on Circumcision (2012). "Technical Report". Pediatrics 130 (3): e756–e785.doi:10.1542/peds.2012-1990. ISSN 0031-4005. PMID 22926175.

Image Credits:

"Mangbetu Beschneidungsmesser Museum Rietberg RAC 15" by Photograph: Andreas Praefcke - Own work (own photograph). Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Mangbetu_Beschneidungsmesser_Museum_Rietberg_RAC_15.jpg#mediaviewer/File:Mangbetu_Beschneidungsmesser_Museum_Rietberg_RAC_15.jpg

"Global Map of Male Circumcision Prevalence at Country Level" by Emilfaro - The World Health Organization report of 14 December 2007. Male circumcision: global trends and determinants of prevalence, safety and acceptability. This report is the result of collaborative work between the London School of Hygiene and Tropical Medicine, the World Health Organization and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Based on:13. Demographic and health surveys. MEASURE DHS, 2006 (http://www.measuredhs.com, accessed 21 September 2006).53. Drain PK et al. Male circumcision, religion and infectious diseases: an ecologic analysis of 118 developing countries. BMC Infect Dis, 2006, 6(1):172.54. Williams BG et al. The potential impact of male circumcision on HIV in sub-Saharan Africa. PLoS Med, 2006, 3(7):262.55. International religious freedom report for 2004. U.S. Department of State (http://www.state.gov/g/drl/rls/irf/2004/index.htm, accessed 21 September 2006).. Licensed under Public Domain via Wikimedia Commons - http://commons.wikimedia.org/wiki/File:Global_Map_of_Male_Circumcision_Prevalence_at_Country_Level.png#mediaviewer/File:Global_Map_of_Male_Circumcision_Prevalence_at_Country_Level.png

"Circumcision illustration" by MrArifnajafov - File:Sünnət_circumcision_əməliyyatı.gif. Licensed under CC BY-SA 1.0 via Wikipedia - http://en.wikipedia.org/wiki/File:Circumcision_illustration.jpg#mediaviewer/File:Circumcision_illustration.jpg