Circumcision Techniques: Types, Healing, And Complications

Circumcision techniques vary in their approach and incision type. One method, circumcision, involves removing the entire foreskin. Circumferential incision creates a circular cut around the base of the penis, while dorsal slit makes a single cut on the top of the penis. Excisional circumcision removes a section of the foreskin, and foreskinectomy removes the entire foreskin. Each technique has its own advantages and disadvantages in terms of healing time, cosmetic appearance, and potential complications.

Explain the various medical procedures involved in circumcision, such as circumcision, circumferential incision, dorsal slit, excisional circumcision, and foreskinectomy.

Medical Procedures for Circumcision

Circumcision, a surgical procedure involving the removal of the foreskin—the skin covering the tip of the penis—has been practiced for centuries for various cultural, religious, and medical reasons. Several medical procedures are employed to perform circumcision.

• Circumcision: The traditional method, where the foreskin is cut and removed using a scalpel or scissors.

• Circumferential Incision: A circular cut is made around the base of the foreskin, which is then removed.

• Dorsal Slit: A single incision is made along the top of the foreskin, which is then stretched and cut away.

• Excisional Circumcision: A V-shaped incision is made, and the foreskin is removed in a single piece.

• Foreskinectomy: The entire foreskin is removed, resulting in a thin band of skin around the base of the glans (tip of the penis).

Circumcision: The Cut That Stirs the Pot

Circumcision, the surgical removal of the foreskin from the penis, is a procedure that has sparked heated debates for centuries. While some extol its virtues, others condemn its risks. Let’s dive into the potential health benefits and risks to help you make an informed decision about this controversial practice.

Benefits: Swords and Shields

• HIV Prevention: Studies have shown a significant reduction in HIV transmission among circumcised men. The foreskin can harbor HIV-infected cells, and its removal reduces the target for the virus.
• Urinary Tract Infections (UTIs): Circumcision can lower the risk of UTIs in children. The foreskin can trap bacteria, leading to these infections.
• Other Benefits: Some claim that circumcision may reduce the risk of other conditions, such as penile cancer, sexually transmitted infections (STIs), and cervical cancer in female partners. However, more rigorous research is needed to confirm these benefits.

Risks: The Double-Edged Blade

• Bleeding: Circumcision can cause painful bleeding, especially if not performed correctly. In rare cases, excessive bleeding may require medical intervention.
• Infection: Like any surgical procedure, circumcision carries a risk of infection. Poor hygiene or an underlying medical condition can increase this risk.
• Complications: Circumcision can lead to complications such as scarring, sensitivity loss, and in extreme cases, amputation. These risks are rare, but they should be considered before making a decision.
• Pain: The procedure can be painful, both during and after surgery. Pain management techniques, such as local anesthesia, can help minimize discomfort.
• Long-Term Effects: Some claim that circumcision can have lasting effects on sexual pleasure and sensitivity. However, scientific evidence on this issue is inconclusive.

Circumcision is a complex procedure with both potential benefits and risks. Weighing the risks against the potential benefits is crucial for parents and individuals considering circumcision. Informed consent is essential, and consulting with a healthcare professional is highly recommended to make a decision that fits your individual circumstances.

Circumcision: A Tale of Cultures and Beliefs

In the realm of circumcision, cultural and religious influences dance a mesmerizing waltz, shaping the practice in ways both unique and universal. Let’s embark on a journey through these vibrant societal tapestries to unravel the profound significance of this ancient ritual.

Across the tapestry of human history, circumcision has woven itself into the fabric of countless cultures. In ancient Egypt, it marked the transition from childhood to manhood, a sacred symbol of virility. In Africa, it held deep spiritual significance, connected to tribal identity and ancestral lineage. From the ancient Romans to the Vikings, circumcision served as a rite of passage, a testament to strength and courage.

But it’s not just in the past that circumcision remains a cultural touchstone. In present-day Australia, for example, it’s widely practiced among Aboriginal and Torres Strait Islander communities, symbolizing spiritual cleanliness and cultural continuity. In some parts of the Middle East, circumcision is an essential part of manhood and a religious obligation, while in the United States and Europe, it’s often seen as a hygienic or medical procedure.

Religious Perspectives

Religion also plays a pivotal role in shaping circumcision’s significance. In Judaism, it’s known as Brit Milah, a covenant between God and the Jewish people, performed on male infants at eight days old. In Islam, circumcision is considered a “sunnah,” a practice recommended by the Prophet Muhammad but not mandatory. The Seventh-day Adventist Church, too, encourages circumcision as a health measure and a symbol of Christian discipleship.

No matter the cultural or religious context, circumcision remains a practice steeped in tradition, symbolism, and deep-seated beliefs. By delving into its diverse meanings, we gain a profound appreciation for the rich tapestry of human experiences and the enduring power of ancient rituals.

Describe the practices of Brit milah (Jewish circumcision), religious circumcision, and traditional circumcision.

Cultural and Religious Factors: Practices of Circumcision

When it comes to circumcision, religion and culture play a profound role. Let’s dive into some of the most common practices:

Brit Milah: A Jewish Tradition

For Jewish families, circumcision is a sacred ritual known as Brit Milah. Performed on the eighth day of a baby boy’s life, it represents the covenant between God and the Jewish people. The procedure is typically carried out by a mohel, a specially trained religious practitioner.

Religious Circumcision: A Ritual of Faith

Circumcision holds significance in many religions. In *Islam*, it’s a practice derived from the teachings of the Prophet Muhammad. In *Christianity*, some denominations consider it a sign of religious obedience. These circumcisions are usually performed during infancy or childhood.

Traditional Circumcision: A Cultural Practice

In certain parts of Africa, Asia, and Australia, circumcision is performed as a traditional coming-of-age ritual. It symbolizes the transition from boyhood to manhood and is often accompanied by ceremonies and celebrations. The techniques and age at which it’s performed can vary greatly depending on the specific culture.

These diverse practices reflect the deep cultural and religious significance that circumcision carries in different societies around the world. Whether it’s a spiritual covenant, a sign of faith, or a cultural milestone, circumcision remains a complex and multifaceted practice with historical and societal implications.

A Journey Through Time: Circumcision’s Historic Voyage

Buckle up, folks! We’re about to hop on a time-traveling rollercoaster and explore the fascinating history of circumcision. From the sun-baked sands of ancient Egypt to the buttoned-up Victorian era, this practice has been making its mark on humanity for centuries.

Ancient Roots: The Dawn of Circumcision

The earliest whispers of circumcision echo back to the sands of ancient Egypt around 3000 BCE. Archaeologists have discovered mummies adorned with images of circumcised men, suggesting it was a ritual of passage associated with cleanliness and maturity.

Religious Symbolism: The Covenant with God

Around 1800 BCE, circumcision took on a new significance for the Israelites. Abraham was commanded by God to circumcise himself and his descendants as a sign of their covenant with him. This religious practice spread throughout Jewish communities and has remained a central ritual to this day.

Greek Influence: A Matter of Health and Hygiene

Centuries later, in ancient Greece, philosophers and physicians promoted circumcision as a measure of hygiene and health. Hippocrates himself extolled its benefits in preventing urinary tract infections and other ailments.

The Victorian Era: A Shift in Perspective

In the 19th century, the Victorian era witnessed a wave of medical enthusiasm for circumcision. Surgeons began to advocate for its use in treating a variety of ailments, including epilepsy and masturbation. However, questions and debates about its necessity arose, setting the stage for the ongoing scientific and ethical discussions about this practice that continue today.

Circumcision: A Journey Through Time

In the tapestry of human history, circumcision has left an indelible mark. From the ancient sands of Egypt to the Victorian era and beyond, attitudes and practices surrounding this enigmatic procedure have undergone a captivating transformation.

Pharaonic Practices

The earliest known evidence of circumcision dates back to ancient Egypt, where it was practiced as a religious rite of passage. Mummified remains reveal that Egyptian priests and rulers underwent circumcision as a symbol of purity and cleanliness.

Abrahamic Roots

Circumcision became deeply intertwined with religion during the rise of Abrahamic faiths. In Judaism, the covenant of circumcision was established by God as a sacred bond between Himself and His chosen people, the Israelites. For Muslims, circumcision is a sunnah, a recommended but not obligatory practice believed to have been performed by the Prophet Muhammad.

The Victorian Era: A Time of Debate

The Victorian era marked a pivotal point in the history of circumcision. With the advent of modern medicine, the procedure gained popularity as a way to prevent childhood diseases like phimosis and balanitis. However, heated debates raged about its necessity and medical benefits.

A Modern Dilemma

In the 20th century, the pendulum of opinion swung back toward skepticism. As medical science advanced, the need for circumcision as a preventive measure came into question. Today, the practice is widespread in some parts of the world, such as the United States, while in others it is rarely performed.

The Role of Culture, Religion, and Ethics

Throughout history, cultural, religious, and ethical factors have played a crucial role in shaping attitudes toward circumcision. In some cultures, it is seen as a necessary and beneficial procedure, while in others it is considered a violation of bodily autonomy. The ongoing debate about the ethics of circumcision highlights the complexities of balancing personal beliefs with the well-being of children.

The Future of Circumcision

As the world continues to evolve, so too will attitudes toward circumcision. Medical research, cultural shifts, and ethical considerations will continue to shape the practice in the years to come. Only time will tell what the future holds for this ancient and controversial procedure.

Examine the ethical implications of circumcision, including parental consent, informed decision-making, and the right to bodily autonomy.

Ethical Implications of Circumcision: A Balancing Act

When it comes to circumcision, the ethical considerations are as complex as the procedure itself. At the heart of the debate lies parental consent, informed decision-making, and the fundamental right to bodily autonomy.

Parental consent is a non-negotiable aspect of any medical procedure involving a minor. However, in the case of circumcision, the grey area kicks in since the procedure is often performed on newborns who cannot provide their own consent.

This raises the question: at what age does a child gain the capacity to decide what happens to their body? And who gets to determine that age?

Informed decision-making is another critical aspect. Parents must be fully informed about the potential benefits and risks of circumcision before making a decision. This includes understanding the short- and long-term health implications, the cultural and religious significance, and the ethical concerns surrounding the procedure.

But here’s the kicker: how do we ensure informed decision-making when the decision-makers aren’t directly affected by the procedure? Striking a balance between parental autonomy and the child’s future autonomy is a delicate dance.

And finally, there’s the elephant in the room: bodily autonomy. Circumcision is a permanent alteration to a person’s body. While it may be argued that parents have the right to make this decision for their newborn, it can raise questions about the child’s own right to control their body as they mature.

The ethical implications of circumcision are a tangled web that requires careful consideration and ongoing dialogue. It’s a balancing act that weighs the rights of parents, children, and the complex tapestry of medical, cultural, and ethical factors involved.

The Great Circumcision Debate: Ethics Under the Knife

Picture this: a tiny human, just arrived on Earth, facing a momentous decision that’s got folks in a tizzy—circumcision. Whether to snip or not to snip, that is the question. And like any topic that touches on personal choices and bodily rights, it’s a debate that’s as heated as a sauna.

On one side, pro-circumcision peeps point to studies suggesting that ditching the foreskin might lower the risk of certain health issues, like HIV and UTIs. They argue that since these infections can be nasty and even life-threatening, it’s worth considering the snip to protect against them.

Meanwhile, anti-circumcision advocates cry foul. They maintain that circumcision is an unnecessary procedure that may put newborns through pain and discomfort. Plus, they argue that removing a perfectly healthy part of the body without the individual’s consent raises serious ethical concerns.

The debate rages on, and the lines aren’t always clear-cut. Some argue that cultural and religious traditions should take precedence, while others stand firm on the importance of individual autonomy. Parents are left trying to balance potential health benefits with the ethical implications of making a choice for their child.

It’s an emotional topic, and passions run high on both sides. But remember, it’s important to approach the discussion with respect and open-mindedness. After all, it’s not just a matter of snipping skin; it’s about the rights of individuals and the complexities of our bodies and beliefs. So, let’s continue the conversation, but let’s do it with a healthy dose of empathy and a willingness to listen to all perspectives.

Circumcision: A Closer Look

Circumcision is an ancient practice that has been around for centuries. But what exactly is it, and what are the potential health benefits?

Circumcision involves the surgical removal of all or part of the foreskin from the penis. It can be performed for medical reasons, religious reasons, or cultural reasons.

Health Benefits of Circumcision

Reduced Risk of HIV Transmission

Studies have shown that circumcision can significantly reduce the risk of HIV transmission from an infected female to a male. This is because the foreskin is a common site of infection for HIV.

Reduced Risk of Urinary Tract Infections (UTIs)

Boys who are circumcised have a lower risk of developing UTIs, which are infections of the urethra, bladder, or kidneys. This is because the foreskin can trap bacteria, which can lead to infection.

Other Potential Benefits

Circumcision may also be associated with a reduced risk of:

• Penile cancer
• Syphilis
• Chlamydia
• Cervical cancer in female partners

It’s important to note that circumcision is not a 100% guarantee against these infections. However, it can provide significant protection.

Considerations Before Circumcision

Before deciding whether or not to circumcise your son, it’s important to weigh the potential benefits and risks. Talk to your doctor about your concerns and make an informed decision that’s right for you and your family.

Potential Risks and Complications of Circumcision

Ouch, that’s not a pleasant thought!

While circumcision is generally a safe procedure, there are a few potential risks and complications that you should be aware of before making a decision.

• Infection: Infection is the most common complication of circumcision. It can occur if the surgical site is not properly cleaned and cared for. Symptoms of infection include redness, swelling, pain, and drainage.
• Bleeding: Bleeding is another potential risk of circumcision. It can occur during the procedure or in the days following. In most cases, bleeding is minor and stops on its own. However, in rare cases, bleeding can be severe and require medical attention.
• Scarring: Scarring is a common side effect of circumcision. The scar is usually small and fades over time. However, in some cases, the scar can be large and noticeable.
• Urethral damage: Urethral damage is a rare but serious complication of circumcision. It can occur if the surgeon accidentally cuts the urethra, the tube that carries urine from the bladder to the outside of the body. Urethral damage can lead to incontinence and other problems.
• Penile deformity: Penile deformity is another rare but serious complication of circumcision. It can occur if the surgeon removes too much skin from the penis. Penile deformity can lead to pain, difficulty with urination, and sexual dysfunction.

These are the primary potential risks and complications of circumcision. While these risks are rare, it is important to be aware of them before making a decision about whether or not to circumcise your son.

Religious Perspectives: Where Do They Stand?

Hey there, curious minds! Let’s dive into the world of circumcision and take a closer look at what different religions have to say about it.

First up, we’ve got the Catholic Church. They believe that circumcision is a personal choice and not a religious requirement. They respect the decision of parents who choose to circumcise their sons.

Next in line is Islam. Circumcision is considered a sunnah (recommended practice) in Islam. According to Islamic teachings, circumcision is a sign of cleanliness and purity.

Now, let’s turn to the Jewish faith. Circumcision, known as Brit milah, is a crucial covenant between God and the Jewish people. It’s a significant religious ceremony that symbolizes the child’s entry into the Jewish community.

Finally, we have the Seventh-day Adventist Church. They believe that circumcision is a violation of the human body and should not be practiced. They hold that God created us in a perfect state, and we should not alter our bodies.

So, there you have it! Different religions have varying perspectives on circumcision. Whether it’s a religious obligation, a personal choice, or a practice to be avoided, the decision ultimately lies with the parents and the child when they grow up.

Religious Perspectives on Circumcision

The Catholic Church

The Catholic Church has traditionally supported circumcision for religious reasons, considering it a sign of the covenant between God and Abraham. However, the Church does not consider circumcision a necessary sacrament and does not require it for its followers.

Islam

In Islam, circumcision is considered a “Sunnah” or recommended practice, but it is not mandatory for all Muslims. Circumcision is usually performed on male infants or children and is often seen as a symbol of purity and cleanliness.

The Jewish faith

In Judaism, circumcision is considered a mitzvah or commandment, and it is one of the central rituals of the Jewish religion. Circumcision is performed on male infants on the eighth day after birth and is known as “Brit Milah.”

The Seventh-day Adventist Church

The Seventh-day Adventist Church discourages circumcision as they believe that it is unnecessary and potentially harmful. They interpret the Bible to indicate that circumcision was a temporary measure for the Israelites and does not apply to Christians today.

Introduce anti-circumcision advocacy groups and their arguments.

Anti-Circumcision Advocacy: Unlocking the Truth

In this exploration of the complex and controversial practice of circumcision, we’ve stumbled upon a group of passionate advocates who passionately oppose the routine cutting of the foreskin. These rebels, known as anti-circumcision advocacy groups, are on a mission to shed light on the potential risks and ethical concerns surrounding this procedure.

One such advocate is Dr. Brian Morris, a renowned pediatrician who has dedicated his career to educating parents about circumcision. Morris argues that the supposed health benefits of circumcision are often exaggerated, while the potential risks, including pain, infection, and reduced sexual sensitivity, are often downplayed.

Another prominent advocate, Intact America, is a non-profit organization that provides comprehensive information and resources on circumcision. They believe that circumcision violates the human rights of boys and that it should be a personal choice made by the individual when they are old enough to fully understand the implications.

Anti-circumcision advocates use various tactics to raise awareness and promote their cause. They organize rallies, distribute educational materials, and engage in online campaigns. Their message is simple: circumcision is a serious medical procedure that should be approached with caution and only performed when absolutely medically necessary.

By giving a platform to these anti-circumcision advocacy groups, we aim to foster an open and informed dialogue on a topic that has long been shrouded in misinformation and controversy. Together, we can ensure that every boy has the right to make choices about their own body, and that the practice of circumcision is based on sound medical evidence and ethical principles.

Circumcision Support Groups: Empowering Families with Information and Comfort

When it comes to circumcision, parents often find themselves overwhelmed by a sea of questions and uncertainties. Circumcision information and support groups serve as a lifeline, providing families with the resources and reassurance they need to make informed decisions.

These groups are staffed by experienced professionals and knowledgeable volunteers who can answer questions, share their insights, and dispel common myths. They offer a safe space where parents can connect with others who are going through the same experience, sharing stories, tips, and encouragement.

Support groups empower families by:

• Providing up-to-date medical information: They present evidence-based research on the potential benefits and risks of circumcision, helping parents understand the pros and cons.

• Addressing ethical and cultural concerns: Groups foster discussions on the ethical implications of circumcision, exploring parental consent, informed decision-making, and cultural traditions.

• Offering emotional support: Parents can share their worries, doubts, and anxieties in a non-judgmental environment, gaining comfort and reassurance from others.

These groups are a valuable resource for parents of all backgrounds, whether they are considering circumcision, have already made a decision, or are simply seeking more information. They provide a sense of community and support, empowering families to make the best choice for their child.

Surgical Techniques in Circumcision

When it comes to circumcision, there’s more than one way to skin a cat, or rather, a foreskin. Let’s dive into the different surgical techniques that can be used:

Gomco Clamp: Picture a futuristic spaceship with a giant clamp. That’s the Gomco clamp. It’s like the RoboCop of circumcision devices, using a combination of suction and crushing to remove the foreskin. It’s quick and efficient, like a well-oiled machine.

Plastibell Device: This one’s a bit more playful. It’s a plastic ring with a tiny scalpel blade that cuts around the foreskin like a pizza cutter. It’s like playing a miniature game of “Operation,” except with a little less stress.

Vanjimalavadath Circumcision Device (VCD): Now, let’s get a little fancy. The VCD is a reusable, adjustable device that’s like a Swiss Army knife for circumcision. It can perform several different techniques, making it the ultimate circumcision chameleon.

Mogen Clamp: This one’s a classic, like a reliable old pickup truck. It’s a metal clamp with a sharp blade that cuts through the foreskin with precision. It’s a tried-and-true method, like a timeless recipe that’s always a crowd-pleaser.

Each technique has its own advantages and disadvantages, like choosing between a sports car and a family sedan. Your healthcare provider will recommend the best option based on your needs and preferences. Just remember, knowledge is power, and understanding the different surgical techniques will help you make an informed decision about the procedure.

Explain the advantages and disadvantages of each technique.

Surgical Techniques for Circumcision: Pros and Cons

When it comes to circumcision, there’s a whole toolbox of techniques to choose from. Each one has its own set of strengths and quirks, so let’s dive in and uncover them together!

Gomco Clamp: A Surgical Star

Picture this: a sleek silver clamp that looks like a tiny pair of pliers. Meet the Gomco clamp, a surgical virtuoso that can swiftly remove the foreskin. Pro: It’s quick, precise, and can handle larger circumcisions with ease. Con: It’s not always as gentle as other techniques, and a little pain can tag along.

Plastibell Device: The Kid-Friendly Option

Think of the Plastibell device as a plastic ring that gently squeezes the foreskin into submission. Over a few days, it works its magic and the foreskin falls off naturally. Pro: It’s non-invasive and relatively painless for little tykes. Con: It can take longer than other methods and doesn’t suit every circumcision.

Vanjimalavadath Circumcision Device: A One-Cut Wonder

This nifty device is a game-changer in the circumcision world. It’s like a surgical paperclip that swiftly and painlessly snips the foreskin in one swift motion. Pro: Quick, comfortable, and leaves a clean, even cut. Con: Not as widely available as other techniques.

Mogen Clamp: A Versatile Champ

The Mogen clamp is a versatile tool that combines elements of the Gomco and Plastibell devices. It clamps the foreskin and detaches it with a scalpel, giving surgeons great control. Pro: Can handle a variety of circumcisions effectively. Con: May require more sutures compared to other techniques.

So, what’s the bottom line? Every technique has its own pros and cons, and the best choice will depend on the individual and their situation. Chat with a healthcare professional to explore the options and find the one that suits you or your loved one best!

Who’s Who in the Circumcision World?

When it comes to circumcision, a whole squad of healthcare professionals is on the scene, each with their own specialties and expertise. Let’s meet the team!

Mohels: The Circumcision Specialists

These trained professionals perform circumcisions as part of Jewish religious tradition. They’re like the Jedi Knights of circumcision, with specialized knowledge and finesse.

Urologists: The Urinary Tract Experts

Urologists are the doctors who handle all things urinary system, including circumcisions. They’re like the mechanics of the plumbing world, keeping your “pipes” in tip-top shape.

Obstetrician-Gynecologists: The Women’s Health Experts

These doctors focus on women’s health, including pregnancy, childbirth, and yep, you guessed it, circumcisions. They’re like the Swiss Army knives of healthcare, ready to tackle any challenge.

Pediatricians: The Kids’ Docs

Pediatricians are the go-to docs for all things baby and child health. They’re the ones who usually perform circumcisions in the hospital after your little one arrives.

_Specialists with Specialty Tools

Each of these healthcare professionals has their own tool belt filled with specialized instruments to perform circumcisions safely and effectively. From the Gomco clamp, Plastibell device, and Vanjimalavadath circumcision device, they’ve got the gadgets to make the procedure as smooth as a baby’s bottom.

Circumcision: A Comprehensive Guide

From ancient rituals to modern medical procedures, circumcision has been a topic of fascination for centuries. Let’s dive into the world of circumcision, exploring its medical aspects, cultural significance, ethical implications, and much more.

Medical Aspects

Circumcision is a surgical procedure to remove the skin covering the tip of the penis. It can be performed for a variety of medical reasons, such as reducing the risk of HIV transmission and urinary tract infections. However, it’s important to note that circumcision is not essential for good health.

Cultural and Religious Factors

Circumcision is steeped in cultural and religious traditions. In some cultures, it’s a rite of passage, while in others, it’s a religious obligation. From Brit milah in Judaism to religious circumcision in Islam, each practice carries its own unique significance.

Historical Context

The history of circumcision dates back to ancient Egypt, where it was a symbol of cleanliness and hygiene. Over time, it became a practice in various cultures worldwide, from the Greeks to the Victorian era.

Ethical Considerations

The ethics of circumcision have been debated for centuries. Some argue that it’s a violation of a child’s bodily autonomy, while others believe it’s a necessary medical procedure.

Health Implications

While circumcision has potential health benefits, such as reduced risk of STIs, it’s crucial to weigh these against the potential risks, such as bleeding, infection, and pain.

Religious Perspectives

Circumcision holds different meanings in various religions. The Catholic Church, for example, does not require circumcision, while Islam considers it a religious obligation.

Advocacy and Support

Anti-circumcision advocacy groups raise awareness about the potential risks and support organizations provide information and support to families considering circumcision.

Surgical Techniques

Circumcision can be performed using various surgical techniques, from the Gomco clamp to the Vanjimalavadath device. Each technique has unique advantages and disadvantages.

Healthcare Professionals

Mohels, urologists, obstetrician-gynecologists, and pediatricians play vital roles in performing and providing circumcision services. They ensure the safety and well-being of patients undergoing the procedure.

So, there you have it, a comprehensive guide to circumcision that covers everything from its medical aspects to its cultural and ethical implications. Ultimately, the decision of whether or not to circumcise a child is a personal one that should be made after careful consideration of all the factors discussed here.