CIRCUMCISION DECISION PACK
A little birdie told us you were expecting!
Congratulations from
www.TheWholeNetwork.org
The WHOLE Network (TWN) is a grassroots, not-for-profit organization
dedicated to providing accurate information about circumcision and proper
intact care. We supply information to both medical professionals and the general
public, both in the United States and abroad.
We know many parents struggle with the decision of whether they should
circumcise their baby boys or keep them intact. That’s why we have gathered the
most up-to-date and factual information currently available to help you with your
decision.
If at any time you have questions regarding circumcision or care of the intact
child don’t hesitate to contact us. We are here to help!
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TheWholeNetwork@gmail.com
Please note: the following pages contain several illustrations of penises.
What’s included in your
Circumcision Decision Pack
Printed Materials Table of Contents
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The Circumcision Decision…………………………………………………………………..1
What is the male foreskin?.............................................................................5
What is circumcision?....................................................................................6
Anatomical features removed by circumcision…………………………….….……..7
Difference between circumcised and intact infant care……………..…………...8
Circumcision risks and complications………………….……………………..….…….9
Circumcision and erectile dysfunction………………………..….…………...10
Major medical organization statements………………………………..………………11
Circumcision and religion
Christian and Jewish perspectives………………………………………………12
Open Letter to Mohel Michael Henecsh……………………………………...13
Psychology Today Circumcision articles…………………………….……….14
Suggested links……………………………………………………………………..…
Circumcision Decision DVD
Hear perspectives from doctors, nurses, professionals, and parents.
1.
2. Doctor Discusses Circumcision Complications
3. Urologist Discusses Circumcision Controversy
4. A Nurse Shares Her Circumcision Experience
5. A Nurse Discusses the Foreskin and Functions
6. Confessions of a Circumcised American Dad
7. Lawyer Discusses Ethics of Circumcision
8. A Nurse Shares Her Circumcision Experience
9. A Nurse Discusses The Foreskin and Functions
10. Confessions of a Circumcised American Dad
11. Doctor Discusses Circumcision and AIDS
12. Child Circumcision: An Elephant in the Hospital
13. A Scientist Discusses Penile and Foreskin Neurology
14. Watch a Circumcision (Graphic)
The Circumcision Decision:
A Personal Message from Lauren Jenks, Founder of The WHOLE Network
During my first pregnancy, I was overwhelmed with
joy when I found out that there was a little boy in
my belly. Like many ‘mamas-to-be’, I instantly fell
in love and spent my days (and nights) dreaming
about him. As the months passed by, I began to plan
for his arrival: washing and hanging all of his tiny
clothes, picking out the softest blankets I could
find, figuring out what breast pump would be best. I
wanted to be prepared for every little detail. When
I began to make plans for the birth itself, I thought
about what would happen on the day of his birth,
and circumcision crossed my mind.
At the time, I did not think there was even a
choice about circumcision. Every male I knew- my
husband, dad, brothers, friends – were all
circumcised. The thought of a penis with a foreskin
wasn’t appealing to me (even though I never saw
one in real life), and I had always heard of women
saying it was “dirty” or “gross”. I also advocated
the benefits of circumcision (even though I never
truly looked at the research articles.)
My heart sank in my chest, because I didn’t
want to put my newfound love through any pain
whatsoever. However, after talking to various
family members and my OB/GYN, it seemed that
circumcision was the best option for my son and his
future. “It’s cleaner” and “he’ll have fewer
problems” were the most common responses. I had
yet to hear a single response that was in favor of
not circumcising.
I didn’t think about it much after that, until about 2 months before his due date. By that time, my
love for him had grown immensely, and the thought of any painful procedure made my head spin. So one
day, I decided to sit down and search on Google to see what came up about circumcision. I was very
surprised when the vast majority of the information was against it! My curiosity was perked, and I found
myself on YouTube, watching a video of the procedure. After all, my baby boy would have to go through itso I should see it, right?
My jaw dropped to the floor when I saw the video. I couldn’t stop crying. From that day forward, I
poured everything I could into researching this topic. I wanted to know the truth. Using various sites and
forums, I started to network with as many people as I could. To my surprise, I found that there were
thousands of parents who had healthy boys who were not circumcised. This intrigued me, because I had
always been told that foreskins would cause many problems in boys/men. I needed to know more.
As I dug further into the topic, I found out that the majority of the males in the world are not
circumcised. In fact, the United States is the only country to perform this procedure routinely for nonreligious purposes. Another interesting fact is there is not a single medical organization in the world who
recommends circumcision- not even the American Academy of Pediatrics!
So why was I under the impression that circumcision was best? Why do parents continue to choose it?
Why do some doctors advise us to do so? I decided to create a list of the apparent benefits and researched
them one by one. I had heard various reasons, such as better hygiene, less chance for UTIs, less chance for
HIV/STDs, needing to look like father/brother(s), less chance of penile cancer/HPV, better to be done as an
infant and needing to fit in with his peers. Here’s what I found.
Page 1
Better Hygiene
It’s been said that much more care is needed when boys have a foreskin. That more cleaning time is
required, because it is dirty and the foreskin needs to be retracted and cleaned from an early age. However,
there is nothing unclean about a foreskin, especially in infancy. In fact, both boys and girls have foreskins,
which serve the same purposes. The male foreskin is actually fused to the head (glans) of the penis in
infancy and through much of childhood (much like a fingernail is fused to a finger.) This is the body’s way of
protecting the genitals against urine and feces. Because it is fused shut, bacteria and other foreign particles
cannot invade. There’s no need to retract the foreskin to clean under it. You simply wipe the outside only,
like cleaning a finger- it’s easy!
The foreskin will naturally start to separate at an average of age 10. Once he can retract it on his
own, he can just simply rinse with warm water in the shower. It’s just as easy as teaching a girl how to
bathe and there’s nothing difficult about it.
Information over the internet can only go so far, so I wanted to personally network with people that
had intact sons (or were intact themselves). I asked all about hygiene and care, and I never ran into a
person or parent that had any issues with it. The parents all agreed that it was easy to care for an intact boy
and all of the intact men said it was just a simple rinse in the shower- no extra time or effort. There’s even
a video on YouTube that shows how simple it is! You can also listen to a pediatrician on intact care vs.
circumcision care.
Less Chance of UTIs
Urinary tract infections are very rare in boys. But the prevalence of UTI in girls up to 2 years is more
than twice the prevalence in boys of the same age. The rate in girls up to one year of age is 6.5%, while it is
3.3% in boys. From age one to two, it is 8.1% in girls and only 1.9% in boys. This being said, we can easily
treat urinary tract infections in girls with a simple antibiotic, without the need to perform any surgery. In
the rare case that a boy might get a UTI, an antibiotic would solve the problem.
There have been some claims of an increased risk of UTI during the first year of life for boys who are
not circumcised. According to Psychology Today, “This claim is based on one study that looked at charts of
babies born in one hospital (Wiswell 1985). The study had many problems, including that it didn’t accurately
count whether or not the babies were circumcised, whether they were premature and thus more susceptible
to infection in general, whether they were breastfed (breastfeeding protects against UTI), and if their
foreskins had been forcibly retracted (which can introduce harmful bacteria and cause UTI) (Pisacane 1990).
There have been many studies since which show either no decrease in UTI with circumcision, or else an
increase in UTI from circumcision. Thus circumcision is not recommended to prevent UTI (Thompson 1990).”
Less Chance of HIV/STDs
A few select studies show a prevalence of HIV transmission in uncircumcised men, but real world
empirical data shows that circumcision hasn’t stopped HIV in countries where there is already a prevalence
of the practice of circumcision. Take the United States for example: we are a country with a very high rate
of circumcision (70% of the current male population, compared to 10-15% worldwide), yet we have one of
the highest rates of children/adults living with HIV & AIDS out of the post-industrial nations.
Greg Millett of the U.S. Centers for Disease Control and Prevention even said the following: “overall,
we found no association between circumcision status and HIV infection status” when he presented his
findings to the CDC’s National HIV Prevention Conference.
While circumcision is very common in the United States, it is uncommon in Europe. This would lead
one to assume that HIV/AIDS and sexually transmitted diseases would be much higher in Europe, where
circumcision is rare. However, this publication clearly shows that HIV and sexually transmitted diseases are
much higher in the United States:
“The percentage of the United States’ adult population that has been diagnosed with HIV or AIDS is
six times greater than in Germany, three times greater than in the Netherlands, and one-and-a-half
times greater than in France.(Fig. 5)[5]”
“…data from the Netherlands found that rates of reported incidence [of sexually transmitted
diseases] are considerably higher in the United States.[6,7] Further, comparisons of prevalence
(the proportion of a given population which is infected) find that the Chlamydia prevalence
Page 2
among young adults in the United States is twice that among young adults in the
Netherlands.[8,9]*”
Less Chance of Penile Cancer/HPV
Penile cancer is among the diseases circumcision claims to prevent. However, it is important to
remember that penile cancer is incredibly rare. Did you know that more men are diagnosed and more deaths
occur from male breast cancer than penile cancer? The chance of dying from penile cancer is so low that it
is not even presented separately by http://www.cancer.gov/ – it is lumped in with all male genital cancers
(including testicular cancer and the much more common prostate cancer) at a total of 310 estimated deaths
in 2010. Compare this to the annual circumcision death rate of approximately 117 neonates (first month of
life). That’s more than SIDS (115 annually) and more than suffocation (44) and auto accidents (8) combined.
(via Saving Babies)
The Journal of Infectious Diseases from the Oxford Journals did a study on the baseline prevalence of
penile, scrotal, and perineal/perianal human papillomavirus (HPV) in heterosexual men on 5 continents.
They found that “Neither condom usage nor circumcision was associated with HPV DNA prevalence.”
One of the most compelling items I found on the subject of penile and cervical cancer was a letter
written from the American Cancer Society to the American Academy of Pediatrics:
“As representatives of the American Cancer Society, we would like to
discourage the American
Academy of Pediatrics from promoting routine
circumcision as preventative measure for penile or
cervical cancer.
The American Cancer Society does not consider routine circumcision
to be a valid or
effective measure to prevent such cancers.
Research suggesting a pattern in the circumcision status of partners
of women with cervical cancer is
methodologically flawed, outdated and
has not been taken seriously in the medical community for
decades.
Likewise, research claiming a relationship between circumcision and
penile cancer is inconclusive.
Penile cancer is an extremely rare
condition, effecting one in 200,000 men in the United States.
Penile
cancer rates in countries which do not practice circumcision are lower
than those found in
the United States. Fatalities caused by
circumcision accidents may approximate the mortality rate
from penile
cancer.
Portraying routine circumcision as an effective means of prevention
distracts the public from the
task of avoiding the behaviors proven to
contribute to penile and cervical cancer: especially
cigarette smoking
and unprotected sexual relations with multiple partners. Perpetuating
the
mistaken belief that circumcision prevents cancer is inappropriate.”
Better to be Done as an Infant
It has often been said that circumcision is better to be performed on an infant for various reasons,
but it is important to look at the subject logically. If a man is left intact, he can always choose to be
circumcised later. However, once a circumcision is performed, it cannot be undone. There are many cases
of men who are unhappy with their circumcision, and wish that they had the choice.
Even if he opted for circumcision later, not only would he have the choice, but he would also get
adequate pain medication for the surgery and understand what is happening to his body. A large majority of
routine infant circumcisions are not performed with any anesthetic. In fact, up to 96 percent of the babies
in the United States and Canada receive no anesthesia when they are circumcised, according to a report
from the University of Alberta in Edmonton.
This has many parents (and medical professionals) concerned about the pain associated with
circumcision, but is a local anesthetic even enough? In a recent research study, 11 male newborns were
circumcised with a local dorsal penile nerve block, and 13 controls were circumcised without anesthetic.
When the adrenal cortisol levels were compared, response to surgery was not significantly reduced by the
administration of lidocaine. Some doctors use EMLA cream as an anesthetic. Not only is EMLA cream less
effective than a lidocaine injection, but the manufacturer’s insert warns against its use on infants and on
the genitals of children.
The truth of the matter is, infants cannot get the adequate pain treatment, including post-op pain
medication, like an adult would. They don’t understand what is happening to their bodies, and
most of all, they don’t have a choice.
Page 3
Needing to Look Like Father/Brothers
This was a very important issue for me. My husband is circumcised, and so is his oldest son. I was
worried that there would be issues with the new baby being different than his dad and brother. I didn’t
want him to feel different or alone.
I found out that a distant family member was kept intact, even though his older brother and dad
were circumcised. Although it seemed like it would be an awkward conversation, I just had to have my
husband ask him about it. So he did. It turned out that he really didn’t care and it was never a big deal.
I connected with other men who grew up intact with circumcised dads, and they laughed saying, “I
don’t even remember what my dad’s penis looked like…. and quite frankly, I wouldn’t want to remember!”
It all made sense even though I never thought of it that way. To my surprise, it just wasn’t an issue
for these men. There were even online groups dedicated to keeping future sons intact, and I spoke with
hundreds of parents who had made this same decision. Many of them now had grown children, and were
happy to share their experience with me. I asked many questions, and it came down to this: as parents, we
can only do what we think is best for our children. But, we also need to be able to grow and learn, so we
can always make the best decisions possible. Sometimes, we learn that a past decision wasn’t necessarily
the best, and that is OK. We adapt and move on, and our children will understand that. “I did then what I
knew how to do. Now that I know better, I do better.” – Maya Angelou
Needing to Fit in with His Peers
“Getting made fun of in the locker room” was a very common response for potential issues for boys
who were not circumcised. This was also an important issue for me, much like the issue for my son to look
like his father and brother. While this may have been an issue for men in previous generations, it is just not
the same for boys growing up today.
In 2010, a slide presented by a CDC researcher at the International Aids Conference in Vienna
claimed that circumcision rates in the US had dropped to 32.5% in 2009. While this number was not actually
endorsed by the CDC, their 2010 reports still show circumcision rates have dropped over the years (54.7% in
2010). No matter which number you choose to use, the results are the same: circumcision rates are falling in
the United States, and continue to do so. With at least half of American parents saying no to circumcision,
intact boys will no longer be in the minority. Boys growing up in today’s generation will have the same
amount of peers who are intact vs. circumcised.
Some regions in the US have a higher percentage of intact males, while other regions have a lower
percentage, so it will vary depending on your location. However, it is important to remember that no matter
what, children are going to be different than each other in a variety of ways. Some will be considered too
smart, not smart enough, too fat, too thin, too tall, too short… the list goes on and on. The main thing is to
be sure to teach our children to understand that they are unique and that they should love themselves for
who they are. After all, they are special in their own ways, and that will never change.
Conclusions
Fast forward to now, and my son is happy, healthy and has never had a single problem whatsoever
with being intact. As I’ve continued to research the subject, I’ve learned so much more than I could have
imagined, such as the many important functions of the foreskin and how specialized it is. It is truly so much
more than a “flap of skin”.
I’ve been so moved by the plethora of information I have discovered, that I even founded a grassroots nonprofit organization called The WHOLE Network. I wanted to be able to reach other parents who were in the
same shoes as I, and make sure they had a place for accurate information and support. As more and more
parents seek out information, we continue to grow and help others. We have locations in each US state, as
well as various countries worldwide. If anyone ever has any questions or needs information, we would love
to help them and get them the accurate information they need.
We know that parents want what is best for their children. We understand that many moms and dads are
simply trusting in the advice of their doctors or family. We aren’t here to condemn parents, or to make
them feel guilty for past decisions. We are here to empower parents with information, and help inform them
so that they can make educated decisions for the ones that they love most.
Page 4
What is the foreskin?
The foreskin- also known as the prepuce- is the flexible, double layered sheath of specialized skin that covers and
protects the glans (or head) of the normal penis. The foreskin is a uniquely specialized, sensitive, and functional organ of
touch. No other part of the body serves the same purpose.
The foreskin is an integral and important part of the skin system of the penis. It is a complex and sophisticated structure
with many interesting and unique properties. No other part of the body's skin covering duplicates the amazing design and
functional possibilities of the foreskin. Among the many interesting features of the foreskin is the fact that it is highly
elastic, entirely devoid of any subcutaneous fat, and lined with a sheet of smooth muscle.
The foreskin is more than just skin;
it is a complex, highly mobile, and
beautifully engineered organ
composed of an intricate web of
blood vessels, muscle, and nerves.
In fact, the foreskin contains about
240 feet of nerve fibers and tens of
thousands of specialized
erotogenic nerve endings of
various types, which can feel the
slightest pressure, the lightest
touch, the smallest motion, the
subtlest changes in temperature,
and the finest gradations in
texture.
Nature has designed the delicate
glans (commonly called the head
of the penis) to be an internal
organ. In the normal, intact penis,
the glans is a glistening, rich red or
purple color. The foreskin protects
the glans and keeps it in excellent
condition. In many ways, the foreskin is just like the eyelid. It covers, cleans, and protects the glans just as the eyelid
covers, cleans, and protects the eye. Also, just as the eyelid can open and close to uncover the eye, so the foreskin can
open to reveal the delicate glans. The foreskin's inside fold is lined with a smooth red tissue called mucous membrane.
This type of tissue is also found lining the lips, the inside of the mouth, and the inner fold of the eyelid. The foreskin's
soothing inner fold gently keeps the surface of the glans healthy, clean, shiny, warm, soft, moist, and sensitive.
(Diagram from Fine-Touch Pressure Thresholds in the Adult Penis: http://www.nocirc.org/tuch-test/bju_6685.pdf)
Page 5
What is Circumcision?
There are several different techniques used in the circumcision of
infants. The most common procedures include the Plastibell,
Gomco, and Mogen clamps. All techniques include the same basic
elements- forcibly breaking the tissue that attaches the foreskin to
the glans, followed by the gripping, crushing, cutting, and
removal of the prepucial organ.
The following diagram exhibits the step-by-step process of a baby
boy being circumcised with a Gomco clamp.
Page 6
What Anatomical Features Are Removed by
Circumcision?
Frenar Band/Ridged Band: The frenar band is a group of soft ridges near the junction of the inner and outer
foreskin. This region is the primary erogenous zone of the intact male body. Loss of this delicate belt of densely
innervated, sexually responsive tissue reduces the fullness and intensity of sexual response.
Gliding Action: The foreskin's gliding action is a hallmark feature of the normal, natural, intact penis. This
non-abrasive gliding of the penis in and out of its own shaft skin facilitates smooth, comfortable, pleasurable
intercourse for both partners. Without this gliding action, the corona of the circumcised penis can function as a
one-way valve, making artificial lubricants necessary for comfortable intercourse.
Meissner’s Corpuscles: Circumcision removes the most important sensory component of the foreskin thousands of coiled fine-touch receptors called Meissner's corpuscles. Also lost are branches of the dorsal nerve,
and between 10,000 and 20,000 specialized erotogenic nerve endings of several types. Together these detect
subtle changes in motion and temperature, as well as fine gradations in texture.
Frenulum: The frenulum is a highly erogenous V-shaped structure on the underside of the glans that tethers the
foreskin. During circumcision it is frequently either amputated with the foreskin or severed, which destroys or
diminishes its sexual and physiological functions.
Dartos Fascia: Circumcision removes approximately half of this temperature-sensitive smooth muscle sheath
which lies between the outer layer of skin and the corpus cavernosa.
Immunological System: The soft mucosa (inner foreskin) contains its own immunological defense system
which produces plasma cells. These cells secrete immunoglobulin antibodies as well as antibacterial and
antiviral proteins, including the pathogen killing enzyme lysozyme.
Lymphatic Vessels: The loss of these vessels due to circumcision reduces the lymph flow within that part of
the body's immune system.
Estrogen Receptors: The presence of estrogen receptors within the foreskin has only recently been discovered.
Their purpose is not yet understood and needs further study.
Apocrine Glands: These glands of the inner foreskin produce pheromones - nature's powerful, silent, invisible
behavioral signals to potential sexual partners. The effect of their absence on human sexuality has never been
studied.
Length and Circumference: Circumcision removes some of the length and girth of the penis - its doublelayered wrapping of loose and usually overhanging foreskin is removed. A circumcised penis is truncated and
thinner than it would have been if left intact. One study found that circumcised penises were an average eight
millimeters shorter than their intact counterparts, with a reduction in girth of the penis by an average of two
millimeters behind the coronal ridge and four millimeters at the glans in the circumcised penis.
From NORM: The Lost List http://www.norm.org/lost.htm
Page 7
Which is easier to care for?
Circumcised
Intact
After circumcision, the entire glans of the baby’s penis and the
site of the incision are raw, open wounds. You should watch your
baby carefully the first few days for possible complications.
Post-operative complications to watch for:
Bleeding: After your baby is circumcised, bleeding should stop.
If your baby’s penis keeps bleeding, the doctor should be notified
immediately.
Infection: Infections can be in the wound, deeper tissues and or
the blood stream. Increasing redness, swelling, oozing, and fever
are all signs of infection. Infections can quickly invade a newborn
baby’s body. If you see any sign of infection, the doctor should
be notified immediately.
Complications from anesthetics: The penile dorsal nerve block
requires injections at the base of the penis. Needles puncturing
tissue in this area can cause bruising and can damage the dorsal
penile nerve. Accidental puncture of the dorsal artery or vein can
lead to hematoma or gangrene.
Pain: After circumcision – with or without an anesthetic – your
baby will be in pain. Urine and feces in the wound add to his
discomfort and distress. Some doctors prescribe post-operative
pain medication, but it is not always effective and is never 100%
effective. You can comfort your baby by holding him, nursing
him frequently, sleeping with him, and being especially careful
when changing his diapers.
Feeding: Some babies feed readily right after they are
circumcised. Many do not. The pain and trauma of circumcision
often interfere with initiation of breastfeeding.
Sleep patterns: Having part of the penis cut off is a painful,
stressful, and exhausting experience for a newborn baby. Sleep
helps your baby recover. He may sleep more than usual.
Circumcision wound care:
Dressing changes: With Plastibell circumcision the plastic ring
should be in place with no dressing on his penis. If your baby was
circumcised with a Gomco Clamp, his penis may be bandaged
with a gauze dressing to keep the wound on his remaining
foreskin and the open wound on his glans from sticking to each
other or a diaper. Some doctors recommend gently replacing this
dressing when it is soiled. Others recommend removing it after an
hour or two. Some doctors recommend applying Vaseline to the
wound with every diaper change to keep the wound from sticking
to the diaper. A yellowish crust on your baby’s glans form as part
of the healing process. It will fall off by itself as the glans heals.
Bathing: After your baby has a bowel movement, the
circumcision area should be gently rinsed with warm running
water. It’s best to wait until the wound has healed (seven to ten
days) before touching it or using a washcloth or “baby-wipes.”
Preventing adhesions: Adhesions form when raw surfaces of the
glans and remaining penile skin fuse together. This can be
prevented by pulling the penile shaft skin behind the line of
incision gently away from the glans once a day after the initial
healing of the wound (seven to ten days). This should be done
for at least one year to ensure that the deeper layers of the
wound heal without fusing to adjacent tissue.
Page 8
The intact penis requires no special care.
The foreskin is fused to the head of the penis at birth. This is the body's
way of protecting the genitals against urine and feces. Because it is fused
shut, bacteria and other foreign particles cannot invade.
It is absolutely unnecessary to forcibly retract (pull back) the foreskin to
clean under it, and in fact to do so will cause bleeding, scarring, and
damage to the penis. Pulling it back before it is ready can also introduce
foreign bacteria, which can lead to infection.
The first person to retract a boy's foreskin should be the boy himself.
Everyone else- hands off. The average age for this to happen is about 10
years old. About that time, the foreskin will start to become detached
(sometimes sooner, sometimes later). Until about puberty, the body isn't
producing anything that needs to be 'rinsed'. So if he gets especially
dirty, sitting in a warm water bath (without soap) should take care of the
cleaning. Once he can comfortably retract his own foreskin, he just needs
to pull it back during a shower, rinse with warm water, and return it to
the original position. No soap and no scrubbing under the foreskin.
It is important to have a doctor that is knowledgeable about the foreskin
understands the importance of not forcibly retracting it. Never assume
that a doctor, nurse, or medical professional knows not to push back the
foreskin and cause injury. You may consider selecting your son’s doctor
from our list of intact-friendly doctors that you can view on our website.
List of Intact-Friendly Doctors:
http://www.thewholenetwork.org/intact-friendly-doctors.html
Here is more information on normal development of the foreskin and its
natural separation process:
Percentage of boys with fused foreskin by age
http://www.thewholenetwork.org/14/post/2011/08/thedevelopment-of-foreskin-retraction.html
Information provided by the NOCIRC pamphlet “Answers to your questions about your young son’s
circumcised penis” at http://www.nocirc.org/publish and “Proper care of the intact penis”
http://www.thewholenetwork.org/14/post/2011/09/proper-care-of-the-intact-penis-from-baby-to-teenager.html
Circumcision Complications and Risks
Keratinization of the glans: (See picture on previous page.) The glans is
normally an internal organ protected by the moist mucosal tissue of the foreskin.
Without the foreskin the glans is exposed to the outer environment (air, soap, clothing,
etc.) This causes the glans to dry out and become calloused (keratinized.)
Adhesions/skin bridges: Adhesions (or skin bridges) are the result of two raw
tissues healing together. With circumcision, the cut skin will try to heal back and can
possibly attach itself to the penis, creating a skin bridge. This may necessitate
additional reparative surgery at a later date.
Excessive skin removal/scar tissue: This results in painful erections,
curvature of the penis, and scrotal skin and pubic hair being drawn onto the shaft of the
penis.
Death: A baby only needs to lose 1 ounce of blood to hemorrhage, and just 2.3 ounces
to die as a result of this blood loss. It can, and does, occur at a frighteningly quick pace.
A study published in Thymos: Journal of Boyhood Studies estimates that more than
100 baby boys die from circumcision complications each year, including from
anesthesia reaction, stroke, hemorrhage, and infection. Because infant circumcision is
elective, all of these deaths are avoidable.
Additional complications include: Aesthetic damage, wound dehiscence,
emotional sense of loss or feelings of helplessness, haemorrhage, meatal stenosis,
meatal ulcer, meatitis, urethrocutaneous fistula, infection, prepucial stenosis, blockage
of the urethra, buried penis, penoscrotal webbing, necrotising fasciitis, loss of the
glans, loss of the entire penis, and more.
For additional information about circumcision risks and
complications check visit the following websites:
Adult males with permanent circumcision complications:
http://www.circumstitions.com/Complic.html
http://www.circumcisionharm.org/gallery.htm
Infant males with permanent circumcision complications:
http://www.circumcisionquotes.com/complications.html
Page 9
Does Circumcision Cause
Erectile Dysfunction?
The United States, a nation with 4.5% of the
world's population, consumes 47% of the
world's Viagra (Pfizer's own figures). Turns
out the same nation has been circumcising
the majority of its male infants for
generations.
A new study in the International Journal of Men’s Health shows that circumcised men have a 4.5
times greater chance of suffering from erectile dysfunction (ED) than intact men, revealing what
appears to be a significant acquisition vector. Other studies have previously observed that
circumcision’s damage results in worsened erectile functioning, inability to maintain an erection, and
reducing the glans sensitivity, including an overall penis sensitivity reduction by 75%. A recent study
discovered that premature ejaculation is five times more likely when adjusted for erectile dysfunction
and circumcision. A new Danish study also found that circumcised men are three times more likely to
have ED.
Moreover, Israel- a country that routinely circumcises their baby boys for religious reasons- was the
NUMBER ONE country for U.S. imported Viagra in 2010. It imported $172.4 million (28.2% of total
sales, up 24.2% from same period in 2009). In fact, Viagra is so common there that the Pfizer
pharmaceutical company asked for permission to market Viagra without a doctor's prescriptionmaking it an over-the-counter medication.
The truth is you simply cannot change form without altering function. While there are immediate
dangers and harm caused by circumcision, there are also other problems that may not arise until
much later in life. One of these dangers is erectile dysfunction (more commonly known as ED).
One of the major reasons that circumcision can lead to ED is because of keratinization. The glans (or
head) of the penis is intended to be an internal organ, protected by the prepuce (foreskin). When the
foreskin is removed, the head is completely exposed to the elements, including a constant rubbing
against clothing. Over time, the skin thickens to protect the glans (much like a callous forms in areas
of excessive friction). The head becomes dry and thick and is no longer supple and moist.
As men grow older, the thickened skin of the glans becomes less and less sensitive, which can cause
men to have issues with erections. Sensitivity loss is also contributed to the circumcision itself, which
removes the majority of the specialized nerve endings in the penis (over 20,000) .
Page 10
http://www.thewholenetwork.org/14/post/2011/08/does-circumcision-cause-erectile-dysfunction.html
What do the world’s major medical organizations have to
say about circumcision?
College of Physicians and Surgeons of British Columbia – 2009: “Current understanding of the benefits, risks and potential harm
of this procedure no longer supports this practice for prophylactic health benefit. Routine infant male circumcision
performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention.”
British Medical Association – 2006: “The medical benefits previously claimed have not been convincingly proven… The British
Medical Association considers that the evidence concerning health benefits from non-therapeutic circumcision is insufficient for this
alone to be a justification for doing it.”
Royal Australian College of Physicians – 2002: “There is no medical indication for routine male circumcision.”
American Academy of Family Physicians – 2002: “Evidence from the literature is often conflicting or inconclusive… A physician
performing a procedure for other than medical reasons on a nonconsenting patient raises ethical concerns.”
American Medical Association (AMA) – 2000: “Virtually all current policy statements from specialty societies and medical
organizations do not recommend routine infant circumcision…The AMA supports the general principles of the 1999 Circumcision
Policy Statement of the American Academy of Pediatrics.”
Australian Medical Association – 1996: “The Australian College of Paediatrics should continue to discourage the practice of
circumcision in newborns.”
Canadian Paediatric Society – 1996: “Circumcision of newborns should not be routinely performed.”
British Medical Association – 1996: “To circumcise for therapeutic reasons where medical research has shown other techniques to
be at least as effective and less invasive would be unethical and inappropriate.”
Australasian Association of Paediatric Surgeons – 1996: “The Australasian Association of Paediatric Surgeons does not support
the routine circumcision of male neonates, infants, or children in Australia. It is considered to be inappropriate and unnecessary as a
routine to remove the prepuce [foreskin], based on the current evidence available… We do not support the removal of a normal part of
the body, unless there are definite indications to justify the complications and risks which may arise. In particular, we are opposed to
male children being subjected to a procedure, which had they been old enough to consider the advantages and disadvantages, may well
have opted to reject the operation and retain their prepuce.”
The Royal Dutch Medical Association (KNMG) – 2010: “The official viewpoint of KNMG and other related medical/scientific
organizations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical
integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks
are particularly common. KNMG is therefore urging a strong policy of deterrence.”
Royal Australasian College of Physicians – 2010: “Ethical and human rights concerns have been raised regarding elective infant
male circumcision because it is recognized that the foreskin has a functional role, the operation is non-therapeutic and the infant is
unable to consent. After reviewing the currently available evidence, the RACP believes that the frequency of disease modifiable by
circumcision, the level of protection offered by circumcision, and the complication rates of circumcision do not warrant routine infant
circumcision in Australia and New Zealand."
Page 11
Circumcision in the Christian Perspective
Christians are forbidden from practicing routine infant circumcision by the New Testament.
Behold, I, Paul, tell you that if you be circumcised, Christ will be of no advantage to you. – Galatians 5:2
And even those who advocate circumcision don’t really keep the whole law. They only want you to be circumcised so they can brag about it
and claim you as their disciples. – Galatians 6:13
For there are many who rebel against right teaching; they engage in useless talk and deceive people. This is especially true of those who insist on circumcision for
salvation. They must be silenced. By their wrong teaching, they have already turned whole families away from the truth. Such teachers only want your money. – Titus
1:10-11
Watch out for those wicked men – dangerous dogs, I call them – who say you must be circumcised. Beware of the evil doers. Beware of the mutilation. For it isn’t the
cutting of our bodies that makes us children of God; it is worshiping him with our spirits. – Philippians 3:2-3
And I testify again to every male who receives circumcision that he is in debt to keep the whole Law. You who do so have been severed from Christ...you have fallen
from grace. - Galatians 5:3
As God has called each man, in this manner let him walk. And thus I command in all the churches. Was any man called in the circumcision [Old Covenant]? Let him
not try to become uncircumcised. Has anyone been called in the uncircumcision [New Covenant in Christ]? Let him not be circumcised! Circumcision is nothing. And
uncircumcision is nothing but the keeping of the commandments of God. Let each man remain in that condition in which he was called. - 1 Corinthians 7:17
And some men came and were teaching the brethren, 'Unless you are circumcised according to the custom of Moses, you cannot be saved.' But Paul and Barnabas
together had great dissension and disputing with these men. . . Then Peter stood up and said to them 'Why do you put God to the test by placing upon the neck of the
disciples a yoke which neither our fathers nor we have been able to bear?’
- Acts 15:1-2, 7, 10
But if I still proclaim circumcision. . . then the stumbling block of the cross has been abolished.- Galatians 5:11
I wish that those who are pushing you to do so would mutilate themselves! - Galatians 5:12
Now, therefore, why are you putting God to the test by placing a yoke on the neck of the disciples that neither our fathers nor we have been able to bear? But we believe
that we will be saved through the grace of the Lord Jesus, just as they will. - Acts 15:10
Learn more at http://www.thewholenetwork.org/religion--circumcision.html
Circumcision in the Jewish Perspective
Over the last 170 years, a Jewish and Israeli movement to stop circumcision has emerged. The movement is
inspired by modern notions of an individual’s right to their own body, new historical information about the
non-Judaic origin of circumcisions in Africa and Egypt, scientific discoveries about the damage caused by
circumcision, and a desire to live a higher level of spiritual ethics. They include Jewish mothers, fathers,
families, scholars, intellectuals, educators, and Jews around the world. More and more Jewish parents in
Israel, America, and the rest of the world are choosing to bypass circumcision, and to keep their new sons
intact. Alternative rituals called the Brit B’lee Milah or Bris Shalom are serving as covenant ceremonies rather
than surgical circumcision. More Jews are beginning to live their spiritual values and ethics by respecting their
son's bodies and refining their rituals accordingly.
Suggested Links:
http://www.thewholenetwork.org/14/post/2011/8/the-many-jews-who-oppose-circumcision.html
http://www.jewsfortherightsofthechild.org/
http://www.jewsagainstcircumcision.org/
http://www.jewishcircumcision.org/
http://www.beyondthebris.com/
Page 12
Suggested Reading:
QUESTIONING CIRCUMCISION: A Jewish Perspective
by Ronald Goldman, Ph.D.
An Open Letter to Mohel Michael Henesch by Shea Levy
This is an email I just sent to the mohel who performed my circumcision 21 years ago today. My goal in
sending this was to show him the perspective of someone who wished he hadn’t been circumcised, so that he
would understand what his profession could do and maybe so he would question his continued participation in
the field. I’ve chosen to publish this openly for two reasons: So that my friends and family can understand how
I feel personally about my circumcision (rather than just my intellectual position on circumcision in the
abstract), and so that anyone out there who is considering performing a circumcision or having one performed
might change their minds.
Before I get to the email, a few notes:
• The account includes personal descriptions involving my genitalia. While there is nothing graphically sexual
and no pictures or anything, this may make some uncomfortable.
• I’m well aware that my parents had a significant role to play in my circumcision as well. I do not mean this
letter to be construed as faulting only Rabbi Henesch. I am still not sure how to discuss this topic with
my parents, or even if I should considering that they will not be in the position to circumcise another boy
in the future.
• In the email, I used some transliterated Hebrew phrases that I can be sure Rabbi Henesch knows and that
some of my readership doesn’t. Such phrases will be explained in square brackets; these brackets
were not included in the original email.
Dear Rabbi Henesch,
You wouldn’t remember me, but 21 years ago you changed my life. Like most of your clients, I was eight days
old at the time, so I doubt I was able to articulate my thoughts on the procedure. But now I’ve had a fair amount
of time living with the effects of your work, and I’d like to share with you my perspective on what you did to me.
If you haven’t guessed by my tone, I wish I hadn’t been circumcised. I could show you studies that I believe
demonstrate the deleterious effects of the procedure on infants, the costs to the adults that had the procedure
done earlier in life, and the falsity of the supposed health benefits of circumcision, but I won’t. There are
dedicated organizations that can convey that information far better than I could. What I have to offer you is my
personal experience, the costs I believe your action has lead me to bear, in the hope that you might
understand on a personal level the potential for harm that comes with your profession, and perhaps even
consider leaving it. This account will be both physically and spiritually personal, but as someone who has had a
permanent impact on my genitals I think we’re past those types of boundaries.
Almost every single day, for as long as I can remember, I have at one point or another felt discomfort in the tip
of my penis. It doesn’t matter what type of undergarments I wear, if I wear pants or shorts, or whether I’m
sedentary at a desk all day or out playing a sport: eventually, my penis will brush against something in an
unpleasant way. It’s not a major discomfort or pain, but it’s there and it’s noticeable, and it doesn’t feel natural.
It makes me feel like something is wrong, like something is somewhere it doesn’t belong, and there’s nothing
at all like it for any other parts of my body that are covered in clothing all day. I can’t verify this personally, but
apparently this is a problem that only happens to some circumcised men, and not to any intact ones. In fact, it
is my understanding that intact men experience significantly less genital chafing in any circumstances.
Regardless of the cause, the fact remains that most days I get a physical reminder of a fact of my biology that I
strongly wish wasn’t so.
The permanently uncovered portions of my glans are calloused. They aren’t big callouses like might form on
your hands, but the skin is thicker, tougher, and less sensitive than the skin of the glans still partially covered.
I have a scar around my penis, a visual reminder of what used to be there that I never knew. It’s not nearly as
bad as some of the extreme examples of circumcisions gone wrong that I’ve seen, but it’s there and
noticeable. It certainly doesn’t make me look more attractive than I otherwise would.
The area underneath the folded shaft skin that remains regularly collects dust, lint, and other foreign particles.
Though I wash daily, it is fairly sticky and catches occasionally on my pubic hair or the cloth of my
Page 13
underwear, resulting in an unpleasant sensation when it becomes uncaught.
Sex and masturbation are less enjoyable than they could have been. I have good reason to
believe, given the callouses I can feel and the physical sensitivity studies that I’ve read, that I am not capable
of the same level and variety of physical pleasure that would have been available to me had I been left intact. I
lose out on the sensation of loose skin sliding up and down my penis during intercourse or masturbation. My
penis has less natural lubrication than it should. Sexual activity causes more friction than it should. Sexual
activity is more likely to leave my penis feeling raw and sensitive for some time after the fact than it should. I
am more likely to require supplemental lubrication for intercourse than I should. In particular, masturbation is
more abrasive, less pleasurable, and overall more difficult than it should be (which, not incidentally, was one of
the leading arguments that led to the rise in circumcision rates among non-Jewish Americans).
These physical problems are not insignificant, and I think they alone would be enough for me to regret what
happened to me, but they pale in comparison to the spiritual problems. You see, Rabbi Henesch, I do not
consider myself a religious Jew. Culturally, I still maintain some of the familial values and some practices,
especially those that bring me closer to my family, but I do not believe in God and do not find spiritual or moral
guidance from the Tanach [The Old Testament, including the Torah] or the Rabbis. I grew up going to shul
[synagogue], celebrating the holidays, going to Sunday School, having a Bar Mitzvah [the Jewish coming-ofage, at 13 for boys], and even going to a Jewish Day School, yet today I am in almost complete control over
the extent to which Jewish culture and Jewish religion play a role in my daily life. The exception is circumcision:
For the rest of my life, I will have to live with a penis that was cut in the name of a covenant I did not agree to
with a being I do not believe exists. I expect you are a civilized man and that you would balk at the idea of
adults being forced to express belief in a system they have not personally chosen, whether that expression
comes in the form of a requirement to wear a cross around your neck or even a requirement that all who were
born Jewish wear the tallit katan [a four-cornered garment with long fringes that is worn under everyday
clothing]. Yet that is what the circumcision ritual does: it forces one participant, someone who has just barely
opened his eyes to see the world, to bear a permanent, irreversible mark of the religion of the other participant.
The Jewish cultural practices I’ve chosen to keep remind me of the goodness and greatness that comes from
some aspects of Judaism. The physical modification I cannot change reminds me of all of the bad that helped
lead me to reject it as a whole.
At one point, not too long ago, I hated you. I wanted to rage at you, to extract justice from you, to make you
explain yourself. But I understand now. I understand how you could have chosen your profession, how you
could have chosen to do this to me. Circumcision is viewed as a badge of honor in Judaism, is seen as
fundamental to many aspects of the religion, and has a history of being a symbol for the autonomy that the
Jews have held on to in the face of tyrannical governments and cultures that have conquered them in the past.
I do not condone it, but I can understand why someone raised in that culture might view your job as holy and
celebrated, and never even question the possible downsides. But now, you don’t have that luxury. You’ve seen
the other side of the issue and now you have a choice to make.
Out of the hundreds or thousands of circumcisions you’ve done, it’s possible I’m the only one who regrets it.
But next time you stand over a baby boy, ready to cut, ask yourself: Can I be sure that this boy won’t be the
same? Can I be sure that I’m not dooming this child to a life of physical discomfort and inconvenience? Can I
be sure that this child will embrace my faith and this symbol of it for the rest of his life? Can I be sure that I
have the right to make this decision for him?
You might respond: what about the majority, those who never have any physical problems and remain religious
Jews their whole life? Well, my question to you would be: What would they lose? Do Jewish daughters have a
less joyous start to their life due to the simchat bat [the female celebration of birth ceremony, with no analogue
to circumcision] not including any permanent physical modification? Do Jewish women who retain their faith
into adulthood have any less of a role in God’s covenant with Abraham as a result of their lack of a bodily
symbol of the contract? And could not a Jewish man who was left intact, upon reaching adulthood, decide that
he would like to be circumcised? Given that half of the Jewish population manage to be celebrated members of
the community without circumcision and that the other half could choose circumcision when they are more
aware of what Judaism means to them, can you justify your next cut?
Page 14
Regards, Shea Levy
http://www.thewholenetwork.org/14/post/2011/08/an-open-letter-to-mohel-michael-henesch.html
Copyright 2011 Darcia Narvaez, PhD and Lillian Dell'Aquila Cannon
The following is a series of circumcision and
intact care articles from the Psychology Today
Moral Landscapes Blog. You can view these
articles at http://www.psychologytoday.com/.
Myths about Circumcision You Likely Believe
CIrcumcision does great harm to babies
Published on September 11, 2011 by Darcia Narvaez, Ph.D. in Moral Landscapes
*First author is Lillian Dell'Aquila Cannon. Read more from Lillian at Moralogous.com.
When I was pregnant with my first child, I just thought that circumcision was what you
did, no big deal, and that every man was circumcised. Then one day I saw a picture of a baby being
circumcised, and everything changed. Just one tiny, grainy photo was enough to make me want to know
more, and the more I knew, the worse it got. It turns out circumcision really is a big deal.
Part 1 - Circumcision Surgery Myths
Myth 1: They just cut off a flap of skin. Reality check: Not true.
The foreskin is half of the penis's skin, not just a flap. In an adult man, the foreskin is 15 square inches of
skin. In babies and children, the foreskin is adhered to the head of the penis with the same type of tissue that
adheres fingernails to their nail beds. Removing it requires shoving a blunt probe between the foreskin and the
head of the penis and then cutting down and around the whole penis.
Myth 2: It doesn't hurt the baby.
Reality check: Wrong. In 1997, doctors in Canada did a study to see what
type of anesthesia was most effective in relieving the pain of circumcision. As with any study, they needed a
control group that received no anesthesia. The doctors quickly realized that the babies who were not
anesthetized were in so much pain that it would be unethical to continue with the study. Even the best
commonly available method of pain relief studied, the dorsal penile nerve block, did not block all the babies'
pain. Some of the babies in the study were in such pain that they began choking and one even had a seizure
(Lander 1997).
Myth 3: My doctor uses anesthesia.
Reality check: Not necessarily. Most newborns do not receive
adequate anesthesia. Only 45% of doctors who do circumcisions use any anesthesia at all. Obstetricians
perform 70% of circumcisions and are least likely to use anesthesia - only 25% do. The most common
reasons why they don't? They didn't think the procedure warranted it, and it takes too long (Stang 1998). A
circumcision with adequate anesthesia takes a half-hour - if they brought your baby back sooner, he was in
severe pain during the surgery.
Myth 4: Even if it is painful, the baby won't remember it.
Reality check: The body is a historical repository
and remembers everything. The pain of circumcision causes a rewiring of the baby's brain so that he is more
sensitive to pain later (Taddio 1997, Anand 2000). Circumcision also can cause post-traumatic stress disorder
(PTSD), depression, anger, low self-esteem and problems with intimacy (Boyle 2002, Hammond 1999,
Goldman 1999). Even with a lack of explicit memory and the inability to protest - does that make it right to
inflict pain? Law requires anesthesia for animal experimentation - do babies deserve any less?
Myth 5: My baby slept right through it.
Reality check: Not possible without total anesthesia, which is not
available. Even the dorsal penile nerve block leaves the underside of the penis receptive to pain. Babies go
into shock, which though it looks like a quiet state, is actually the body's reaction to profound pain and distress.
Nurses often tell the parents "He slept right through it" so as not to upset them. Who would want to hear that
his or her baby was screaming in agony?
Myth 6: It doesn't cause the baby long-term harm.
Reality check: Incorrect. Removal of
healthy tissue from a non-consenting patient is, in itself, harm (more on this point later).
Circumcision has an array of risks and side effects. There is a 1-3% complication rate during the
Page 15
newborn period alone (Schwartz 1990). Here is a short list potential complications:
Meatal Stenosis: Many circumcised boys and men suffer from meatal stenosis. This is a narrowing of the
urethra which can interfere with urination and require surgery to fix.
Adhesions. Circumcised babies can suffer from adhesions, where the foreskin remnants try to heal to the head
of the penis in an area they are not supposed to grow on. Doctors treat these by ripping them open with no
anesthesia.
Buried penis. Circumcision can lead to trapped or buried penis - too much skin is removed, and so the penis is
forced inside the body. This can lead to problems in adulthood when the man does not have enough skin to
have a comfortable erection. Some men even have their skin split open when they have an erection. There
are even more sexual consequences, which we will address in a future post.
Infection. The circumcision wound can become infected. This is especially dangerous now with the prevalence
of hospital-acquired multi-drug resistant bacteria.
Death. Babies can even die of circumcision. Over 100 newborns die each year in the USA, mostly from loss of
blood and infection (Van Howe 1997 & 2004, Bollinger 2010).
Isn't it time to think more carefully about whether we should be circumcising our boys?
But, you say, aren't there important health benefits? See the next post.
References for Part 1
Anand et al., "Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior? Biol
Neonate 77 (2000): 69-82.
Bollinger, D. "Lost Boys: An Estimate of U.S. Circumcision-Related Infant Deaths," Thymos: Journal of
Boyhood Studies Volume 4, Number 1 (2010).
Boyle, G.,et al., "Male Circumcision: Pain, Trauma, and Psychosexual Sequelae," Journal of Health
Psychology 7 (2002): 329-343.
Hammond, T., "A Preliminary Poll of Men Circumcised in Infancy or Childhood," BJU 83 (1999): suppl. 1: 8592.
Goldman, R., "The Psychological Impact of Circumcision," BJU 83 (1999): suppl. 1: 93-102.
Lander, J. et al., "Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal
Circumcision," JAMA 278 (1997): 2157-2162.
Schwartz, William M., MD et al., PEDIATRIC PRIMARY CARE: A Problem-solving Approach, 2nd Edition, Year
Book Medical Publishers, Inc., 1990, pp. 861-862.
Stang, H. et al., "Circumcision Practice Patterns in the United States," Pediatrics Vol. 101 No. 6 (1998): e5.
Taddio A, et al., "Effect of neonatal circumcision on pain response during subsequent routine vaccination."
Lancet 1997;349(9052):599-603.
Van Howe, R., "Variability in Penile Appearance and Penile Findings: A Prospective Study," BJU 80 (1997):
776-782.
Van Howe, R., "A Cost-Utility Analysis of Neonatal Circumcision," Med Decis Making, December 1, 2004;
24(6): 584 - 601.
Page 16
More Circumcision Myths You May Believe:
Hygiene and STDs
Is circumcision cleaner and healthier?
Published on September 13, 2011 by Darcia Narvaez, Ph.D. in Moral Landscapes
There's a lot of hype about how circumcision is better for a man's health. But is it really?
Here is Part 2 of our series on myths about circumcision. First author is Lillian Dell'Aquila Cannon*
Myth: You have to get the baby circumcised because it is really hard to keep a baby's penis clean. Reality
check: In babies, the foreskin is completely fused to the head of the penis. You cannot and should not retract
it to clean it, as this would cause the child pain, and is akin to trying to clean the inside of a baby girl's vagina.
The infant foreskin is perfectly designed to protect the head of the penis and keep feces out. All you have to
do is wipe the outside of the penis like a finger. It is harder to keep circumcised baby's penis clean because
you have to carefully clean around the wound, make sure no feces got into the wound, and apply ointment.
Myth: Little boys won't clean under their foreskins and will get infections. Reality check: The foreskin
separates and retracts on its own sometime between age 3 and puberty. Before it retracts on its own, you
wipe the outside off like a finger. After it retracts on its own, it will get clean during the boy's shower or bath.
Once a boy discovers this cool, new feature of his penis, he will often retract the foreskin himself during his
bath or shower, and you can encourage him to rinse it off. But he should not use soap as this upsets the
natural balance and is very irritating. There is nothing special that the parents need to do. Most little boys
have absolutely no problem playing with their penises in the shower or anywhere else! It was harder to teach
my boys to wash their hair than it was to care for their penises. (Camille 2002)
Myth: Uncircumcised penises get smelly smegma. Reality check: Actually, smegma is produced by the
genitals of both women and men during the reproductive years. Smegma is made of sebum and skin cells and
lubricates the foreskin and glans in men, and the clitoral hood and inner labia in women. It is rinsed off during
normal bathing and does not cause cancer or any other health problems.
Myth: "My uncle wasn't circumcised and he kept getting infections and had to be circumcised as an adult."
Reality check: Medical advice may have promoted infection in uncircumcised males. A shocking number of
doctors are uneducated about the normal development of the foreskin, and they (incorrectly) tell parents that
they have to retract the baby's foreskin and wash inside it at every diaper change. Doing this tears the foreskin
and the tissue (called synechia) that connects it to the head of the penis, leading to scarring and infection.
Misinformation was especially prevalent during the 1950s and 60s, when most babies were circumcised and
we didn't know as much about the care of the intact penis, which is why the story is always about someone's
uncle. Doing this to a baby boy would be like trying to clean the inside of a baby girl's vagina with Q-tips at
every diaper change. Rather than preventing problems, such practices would cause problems by introducing
harmful bacteria. Remember that humans evolved from animals, so no body part that required special care
would survive evolutionary pressures. The human genitals are wonderfully self-cleaning and require no
special care.
Myth: My son was diagnosed with phimosis and so he had to be circumcised. Reality check: Phimosis
means that the foreskin will not retract. Since children's foreskins are naturally not retractable, it is impossible
to diagnose phimosis in a child. Any such diagnoses in infants are based on misinformation, and are often
made in order to secure insurance coverage of circumcision in states in which routine infant circumcision is no
longer covered. Even some adult men have foreskins that do not retract, but as long as it doesn't interfere with
sexual intercourse, it is no problem at all, as urination itself cleans the inside of the foreskin (note that urine is
sterile when leaving the body.) Phimosis can also be treated conservatively with a steroid cream and gentle
stretching done by the man himself, should he so desire it, or, at worst, a slit on the foreskin, rather than total
circumcision. (Ashfield 2003) These treatment decisions can and should be made by the adult man.
Page 17
Myth: Uncircumcised boys get more urinary tract infections (UTIs.) Reality check: This claim is based on one
study that looked at charts of babies born in one hospital (Wiswell 1985). The study had many problems,
including that it didn't accurately count whether or not the babies were circumcised, whether they were
premature and thus more susceptible to infection in general, whether they were breastfed (breastfeeding
protects against UTI), and if their foreskins had been forcibly retracted (which can introduce harmful bacteria
and cause UTI) (Pisacane 1990). There have been many studies since which show either no decrease in UTI
with circumcision, or else an increase in UTI from circumcision. Thus circumcision is not recommended to
prevent UTI (Thompson 1990). Girls have higher rates of UTI than boys, and yet when a girl gets a UTI, she
is simply prescribed antibiotics. The same treatment works for boys.
Myth: Circumcision prevents HIV/AIDS. Reality check: Three studies in Africa several years ago that claimed
that circumcision prevented AIDS and that circumcision was as effective as a 60% effective vaccine (Auvert
2005, 2006). These studies had many flaws, including that they were stopped before all the results came in.
There have also been several studies that show that circumcision does not prevent HIV (Connolly 2008). There
are many issues at play in the spread of STDs which make it very hard to generalize results from one
population to another. In Africa, where the recent studies have been done, most HIV transmission is through
male-female sex, but in the USA, it is mainly transmitted through blood exposure (like needle sharing) and
male-male sex. Male circumcision does not protect women from acquiring HIV, nor does it protect men who
have sex with men (Wawer 2009, Jameson 2009). What's worse, because of the publicity surrounding the
African studies, men in Africa are now starting to believe that if they are circumcised, they do not need to wear
condoms, which will increase the spread of HIV (Westercamp 2010). Even in the study with the most favorable
effects of circumcision, the protective effect was only 60% - men would still have to wear condoms to protect
themselves and their partners from HIV. In the USA, during the AIDS epidemic of the 1980s and 90s, about
85% of adult men were circumcised (much higher rates of circumcision than in Africa), and yet HIV still
spread. It is important to understand, too, that the men in the African studies were adults and they volunteered
for circumcision. Babies undergoing circumcision were not given the choice to decide for themselves.
Myth: Circumcision is worth it because it can save lives. Reality check: Consider breast cancer: There is a
12% chance that a woman will get breast cancer in her lifetime. Removal of the breast buds at birth
would prevent this, and yet no one would advocate doing this to a baby. It is still considered somewhat
shocking when an adult woman chooses to have a prophylactic mastectomy because she has the breast
cancer gene, yet this was a personal choice done based upon a higher risk of cancer. The lifetime risk of
acquiring HIV is less than 2% for men, and can be lowered to near 0% through condom-wearing (Hall
2008). How, then, can we advocate prophylactic circumcision for baby boys?
Science and data do not support the practice of infant circumcision. Circumcision does not preclude the use of
the condom. The adult male should have the right to make the decision for himself and not have his body
permanently damaged as a baby. What's the damage, you ask? See the next post.
References for Part 2
Ashfield, J., et al., Treatment of phimosis with topical steroids in 194 children, JOURNAL OF UROLOGY,
Volume 169, Number 3: Pages 1106-1108, March 2003.
Auvert, B. et al., Randomized, controlled intervention trial of male circumcision for reduction of HIV infection
risk: the ANRS 1265 Trial, PLoS Med. 2005 Nov;2(11):e298. Epub 2005 Oct 25.
Camille CJ, Kuo RL, Wiener JS. Caring for the uncircumcised penis: What parents (and you) need to know.
Contemp Pediatr 2002;11:61.
Connolly, C. et al., Male circumcision and its relationship to HIV infection in South Africa: Results of a national
survey in 2002, South African Medical Journal, October 2008, Vol. 98, No. 10.
Hall, H. et al., Estimating the lifetime risk of a diagnosis of the HIV infection in 33 states, 2005-2005; J Acquir Immune
Page 18
Defic Syndr. 2008;49(3):294-297.
Jameson, D. et al., The Association Between Lack of Circumcision and HIV, HSV-2, and Other Sexually
Transmitted Infections Among Men Who Have Sex With Men, Sex Transm Dis. 2009 Nov 6.
Pisacane A, et al. Breastfeeding and urinary tract infection. The Lancet, July 7, 1990, p50.
Thompson RS: Does circumcision prevent urinary tract infection? An opposing view. J Fam Pract 1990; 31:
189-96.
Wawer, M. et al., Circumcision in HIV-infected men and its effect on HIV transmission to female partners in
Rakai, Uganda: a randomised controlled trial, The Lancet, Volume 374, Issue 9685, Pages 229 - 237, 18 July
2009.
Westercamp, W., et al., Male Circumcision in the General Population of Kisumu, Kenya: Beliefs about
Protection, Risk Behaviors, HIV, and STIs, PLoS ONE 5(12): e15552. doi:10.1371/journal.pone.0015552
Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants.
Pediatrics 1985, 75: 901-903.
________________________________________________________________________________________
Circumcision: Social, Sexual, Psychological Realities
Should circumcision tradition trump ethics and empirical evidence?
Published on September 18, 2011 by Darcia Narvaez, Ph.D. in Moral Landscapes
We continue examining myths about circumcision, including traditions, social and
sexual relations. NOTE: Primary author is Lillian Dell'Aquila Cannon, with assistance from Dan Bollinger
Part 3
Myth: You have to circumcise the baby so that he will match his dad. Reality check: The major difference
that boys notice is that dad's penis has hair, and is larger. When a boy notices the difference between his
foreskin and his father's lack of one, just tell him, "When your father was born, they thought that you had to cut
off the foreskin, but now we know better." Since when does parent/child bonding require a matching set of
genitals? If it did, could mothers and sons bond, or fathers and daughters? The real issue at play here is
protecting the father: if it is okay for his son to not be circumcised, then he did not have to be circumcised, and
so he is missing something from his penis. It is not right to harm the child's body to spare the father's
emotions.
Myth: My first son is circumcised, so I have to circumcise my second son.
Reality check: You can explain
this to your children the same way as with the circumcised father. There are plenty of families who changed
their minds after one or more sons were circumcised, and didn't circumcise any more. See here. As with the
"matching dad" myth, what is really at issue here are the parents' feelings: if they don't circumcise the second
son, then that means that they didn't have to circumcise the first child, and so they harmed their first child.
This can be unbearably painful, but it is not right to continue to harm future children to avoid dealing with pain
and regret. As they say, two wrongs do not make a right.
Myth: My husband is the one with the penis, so it is his choice. Reality check: If your husband is circumcised,
he has no idea what having a foreskin is like, and he is likely operating from a psychological position of
needing to believe that what was done to him was beneficial and important. (See here for an extended
discussion of pre and post circumcised adult men and much more by Marilyn Milos, director of NOCIRC.) The
baby is the one who is going to have to live with the decision for the rest of his life, not your husband. The
baby will be the one who has to use the penis for urination and sex -- it should be his decision.
Page 19
Myth: Everyone is circumcised.
Reality check: Actually, world-wide, only 30% of men are circumcised,
and most of these men are Muslim (WHO 2007). Most modern Westernized countries have rates well below
20%. In the United States about 25 years ago, around 85% of babies were circumcised. The rates have
dropped substantially to 32% in 2009, according to a report by the Centers for Disease Control (El Becheraoui
2010).
Myth: Circumcision is an important tradition that has been going on forever. Reality check: In the United
States, circumcision wasn't popularized until Victorian times, when a few doctors began to recommend it to
prevent children from masturbating. Dr. Kellogg (of Corn Flakes fame) advocated circumcision for pubescent
boys and girls to stop masturbation: "A remedy which is almost always successful in small boys is
circumcision, especially when there is any degree of phimosis. The operation should be performed by a
surgeon without administering an anæsthetic, as the brief pain attending the operation will have a salutary
effect upon the mind, especially if it be connected with the idea of punishment... In females, the author has
found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal
excitement" (Kellogg 1877). Circumcision caught on among the sex-negative Victorians, but only wealthy
parents could afford it. In 1932, only 31% of men were circumcised; this peaked around 85% in 1980, and has
been dropping ever since (Laumann 1997, Wallerstein 1980). Far from an ancient tradition, it was only popular
in post-war America; think of it as "your parent's body mod."
Myth: The other boys will make fun of him. Reality check: What other cosmetic surgeries will we perform on
our children to prevent them from being teased? Should a "flat" girl get implants? What about the boy with a
small penis? What surgery would be recommended for him? Circumcised babies are the minority now, and so
intact will not be mocked. Plus, as our husbands say, "You just don't look at or comment on another man's
penis in the locker room."
Myth: Circumcision makes sex better for the woman.
Reality check: The function of the foreskin for
women in intercourse is to seal the natural lubrication inside the vagina and provide a gentle internal
massaging action. The intact penis moves in and out of its foreskin, which provides a frictionless, rolling,
gliding sensation. Intact men tend to make shorter strokes that keep their bodies in contact with the clitoris
more, thus aiding female orgasm (O'Hara 1999). On the other hand, the circumcised penis functions like a
piston during intercourse - the head of the penis actually scrapes the lubrication out of the vagina with each
stroke. As the man thrusts, his skin rubs against the vaginal entrance, causing discomfort, and sometimes
pain (O'Hara 1999, Bensley 2001). Far from making sex better for women, circumcision decreases female
satisfaction.
Myth: Women don't want to have sex with uncircumcised men.
Reality check: In a landmark study of US
women, 85% who had experienced both circumcised and intact men preferred sex with intact men. Sex with a
circumcised man was associated with pain, dryness and difficulty reaching orgasm (O'Hara 1999). In another
study, women were twice as likely to reach orgasm with an intact man (Bensley 2003). Even when a woman
said she preferred a circumcised partner, she had less dryness and discomfort with intact men (O'Hara 1999).
Myth: "Being circumcised doesn't affect my sex life."
Reality check: Men who are circumcised are 60%
more likely to have difficulty identifying and expressing their feelings, which can cause marital difficulties
(Bollinger 2010). Circumcised men are 4.5 times more likely to be diagnosed with erectile dysfunction, use
drugs like Viagra, and to suffer from premature ejaculation (Bollinger 2010, Tang 2011). Men who were
circumcised as adults experienced decreased sensation and decreased quality of erection, and both they and
their partners experienced generally less satisfaction with sex (Kim 2007, Solinis 2007).
Myth: "If I were any more sensitive, it would be a problem."
Reality check: The foreskin contains several
special structures that increase sexual pleasure, including the frenulum and ridged band (the end of the
foreskin where it becomes internal), both of which are removed in circumcision. The LEAST sensitive parts of
the foreskin are more sensitive than the MOST sensitive parts of the circumcised penis (Sorrells 2007). In
other words, if you wanted to decrease a penis' sensitivity the most, circumcision would be the ideal surgery.
The foreskin has nerves called fine-touch receptors, which are clustered in the ridged band (Cold 1999). This
type of nerve is also found in the lips and fingertips. To get an idea of the sensation these nerves provide, try
this experiment: first lightly stroke your fingertip over the back of the other hand. Now stroke your fingertip over
Page 20
the palm of your hand. Feel the difference? That is the kind of sensation the foreskin provides, and the
circumcised man is missing.
It may feel like the penis is overly sensitive to a circumcised man because there is little sensation left to
indicate excitement, leading to unexpected premature ejaculation (a common problem with circumcised young
men). However, as circumcised penises age they become calloused and much less sensitive.
References
Male circumcision: Global trends and determinants of prevalence, safety and acceptability. (PDF). World
Health Organization. 2007. http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf. Retrieved
Sept. 14, 2011.
Bensley GA, Boyle GJ. Physical, sexual, and psychological effects of male infant
circumcision: an exploratory survey. In: Denniston GC, Hodges FM, Milos MF, editors. Understanding
circumcision: a multi-disciplinary approach to a multi-dimensional problem. New York: Kluwer
Academic/Plenum Publishers; 2001. p. 207-39.
Bensley, G. et al., Effects of male circumcision on female
arousal and orgasm, NEW ZEALAND MEDICAL JOURNAL, Volume 116, Number 1181: Pages 595-596,
12
September 2003.
Bollinger, D., Van Howe, R. S. (2010). Alexithymia and Circumcision Trauma: A Preliminary Investigation (in
press).
Cold CJ, Taylor JR. The prepuce. BJU International 1999; 83, Suppl. 1: 34-44.
El Becheraoui C, Greenspan
J, Kretsinger K, Chen R. Rates of selected neonatal male circumcision-associated severe adverse events in
the United States, 2007-2009 (CDC). Proceedings, AIDS 2010, Vienna, Austria. 5 Aug 2010.
Kellogg, J.
Plain facts for old and young: embracing the natural history and hygiene of organic life, 1877.
Kim D, Pang
M. The effect of male circumcision on sexuality. BJU Int 2007;99(3):619-22.
Laumann, EO, Masi CM,
Zuckerman EW. Circumcision in the United States. JAMA 1997;277(13):1052-7.
O'Hara K, O'Hara J. The effect of male circumcision on the sexual enjoyment of the female partner. BJU Int
1999;83 Suppl 1:79-84.
Solinis I, Yiannaki A. Does circumcision improve couple's sex life? J Mens Health
Gend 2007;4(3):361.
Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int
2007;99:864-9.
Tang WS, Khoo EM. Prevalence and correlates of premature ejaculation in a primary care setting: A
preliminary cross-sectional study. J Sex Med, 14 Apr 2011, Available online at:
http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2011.02280.x/abstract
Wallerstein E. Circumcision: An American health fallacy. New York: Springer Publishing Company; 1980:217.
________________________________________________________________________________________
Circumcision Ethics and Economics
Let’s face reality and abandon the harmful practice
Published on September 25, 2011 by Darcia Narvaez, Ph.D. in Moral Landscapes
Infant circumcision is an ethical issue that has lifelong effects on
the child and societal costs.
No medical association in the world recommends routine infant circumcision. None.
The American Academy of Pediatrics Policy Statement on Circumcision says: "Existing scientific evidence
demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient
Page 21
to recommend routine neonatal circumcision." (AAP 1999)
The British Medical Association says: "[P]arental preference alone is not sufficient justification for performing a
surgical procedure on a child." (BMA 2006)
The Royal Australasian College of Physicians says: "After reviewing the currently available evidence, the
RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by
circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia
and New Zealand." (RACP 2010)
The Canadian Paediatric Society says: "Circumcision of newborns should not be routinely performed." (CPS
1996)
The Royal Dutch Medical Association (KNMG - Netherlands) policy statement is wonderfully clear: "There is no
convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene... circumcision
entails the risk of medical and psychological complications... Non-therapeutic circumcision of male minors
conflicts with the child's right to autonomy and physical integrity." (KNMG 2010)
Circumcision wastes money. Medicaid spends $198 million each year on routine infant circumcision in the
33 states that still pay for it, a procedure its own guidelines consider to be medically unnecessary. Private
insurance programs are reimbursing an additional $677 million, raising prices for us all (Craig 2006.) In
addition to the cost of circumcision itself, correcting its complications are said to double the cost, bringing the
total bill to $1.75 billion each year. Is this what we should be spending money on during a recession and at a
time when healthcare costs are skyrocketing?
Circumcision violates the Hippocratic Oath to "First, do no harm." Doctors have an ethical duty to treat
the patient by the most conservative means possible, but removing healthy tissue in the absence of any
medical need absolutely harms the patient. In the case of routine infant circumcision, nothing was diseased,
and thus nothing justifies its removal. Medical personnel who support infant circumcision in any way should
reexamine their ethical duties to the child.
Everyone has a right to bodily autonomy and self-determination. This is a fundamental tenet of
international human rights law (UNESCO 2005). As babies cannot speak for themselves, they need special
protection. Balancing the potential benefits of circumcision with the definite risks can be difficult decision, but
the only person qualified to make this decision is the owner of the penis, as he is the one who is going to have
to live with the results, not his parents.
Parents' aesthetic preferences are not valid reasons for circumcision. If a mother thinks her daughter's
nose is too big, should she force her to get a nose job? If a father prefers large breasts, can he force his
daughter to get breast implants? If a woman prefers circumcised men, can she force her son to be
circumcised?
Even if you are fine with being circumcised, your son may not be. If you have never had a foreskin, you
cannot possibly know what having one would feel like. You only know what it feels like to not have a foreskin.
You cannot know now how your son will feel in 20 or 30 years. If you have your son circumcised, he may grow
up to regret the decision you made for him, but circumcision is irreversible. (Yes, men can partially restore
their foreskins, but it is difficult and the sensitive nerve endings are gone forever.) Leave the decision to your
son. It is his penis. He deserves to decide for himself.
Parents have a duty to educate themselves on circumcision rather than do it just because it was done
to them. As parents, we are entrusted by God or the universe or by nature with the care of our babies. They
truly are a gift, but one that we do not get to keep. We have a responsibility to care for them as best as we
can, because they cannot speak nor care for themselves. Though they are babies now, and we have to make
decisions for them, they will be adults, with minds and feelings of their own. We need to make decisions for
them that we will be proud to stand behind now and in the future. If your son asks you why you had him
Page 22
circumcised, how will you answer? "Because I am circumcised and I needed your penis to match mine?"
"Because I didn't trust you to be able to make your own decisions?" When making this decision for your son,
be brutally honest with yourself. What does your decision serve: the child's rights, or your ego?
For clear, easy and plain-language help making the circumcision decision, try the Circumcision
Decision Maker at http://circumcisiondecisionmaker.com/.
Just because it has been a "tradition" does not make it right. Slavery and child labor were traditions
sanctioned by religions and other authorities. But we abandoned those practices because they were unjust and
harmful. Infant circumcision, similarly supported by authorities, should be abandoned by the people who care
for children because it is unjust and harmful.
It's time to face our discomfort and admit that circumcision was a mistake. Routine infant circumcision is
a 90-year aberration in the more than 150,000 years that Homo sapiens has existed on this planet. It's a
remnant of times when people thought it was okay to beat your wife and children, that babies couldn't feel pain
and so could be operated on without any anesthesia, and that it was bad to enjoy your sexuality. We've
discarded all these other ideas, and now we're discarding circumcision, too.
It is time to face reality. If you are a circumcised man, or a parent who circumcised his child because you
thought it was good for him, you have a painful task in front of you. It's time to face reality:
You were circumcised because your dad was circumcised because everyone else was circumcised because
140 years ago, some perverted doctors wanted to stop boys from masturbating. Being circumcised isn't better,
and it isn't popular anymore. The 70% of the world's men who have foreskins almost never choose to have
them cut off and consider them to be the best part of the penis. You don't have this part of your penis, and
that's really terrible, but it would be even more terrible to make the same mistake with your own child.
The future Circumcision is ending with the generation being born now - only 32% of babies born in 2009 in the
USA were circumcised. Boys born today who keep their foreskins are not going to be mocked, because
they're in the majority, and because people now are more informed. Uncircumcised boys are not going to be
scarred because their penises do not match their fathers'. The myths are dying - more and more people are
realizing that leaving children's penises intact is better.
References:
American Academy of Pediatrics. Circumcision Policy Statement (1999) Pediatrics 1999;103(3):686-93.
Circumcision of Male Infants. Sydney: Royal Australasian College of Physicians, 2010.
Craig A, Bollinger D. Of waste and want: A nationwide survey of Medicaid funding for medically unnecessary,
non-therapeutic circumcision. In: Denniston GC, Gallo PG, Hodges FM, Milos MF, eds. Bodily Integrity and the
Politics of Circumcision: Culture, Controversy, and Change. New York: Springer; 2006:233-46.
Fetus and Newborn Committee, Canadian Paediatric Society. Neonatal circumcision revisited. (CPS)
Canadian Medical Association Journal 1996;154(6):769-80.
Intergovernmental Bioethics Committee. Universal Declaration on Bioethics and Human Rights. Adopted by
the General Conference of the United Nations Educational, Scientific and Cultural Organization on 19 October
2005.
Medical Ethics Committee. The law & ethics of male circumcision - guidance for doctors. London: British
Medical Association, 2003, 2006.
Non-therapeutic circumcision of male minors. Utrecht, Royal Dutch Medical Association (KNMG),
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Copyright 2011 John Geisheker, JD, LLM
2010.
What Is the Greatest Danger for an
Uncircumcised Boy?
A doctor’s visit can harm your boy.
Published on October 23, 2011 by Darcia Narvaez, Ph.D. in Moral Landscapes
*Written by John Geisheker, J.D., LL.M.
WHAT IS THE MOST DANGEROUS EVENT FACING AN 'INTACT' (NOT CIRCUMCISED) BOY?
Aside from circumcision? ... a well-baby visit. Our physicians' international non-profit intervenes in
over 100 cases each year of intact boys who were injured by a primary care provider. The injury is
called 'PFFR,' or Premature Forcible Foreskin Retraction. We conservatively estimate the annual
incidence in the U.S. at more than 100,000 cases. Ironically, many occur when a parent takes the
child to a well-baby visit, at 6, 12, or 24 months; but this injury might occur at any age. The children
we have helped range in age from one week to 12 years.
Here is a typical email we receive: Dear Doctors: At a well-baby visit yesterday for my uncircumcised
son Jonah, 18-months, the doctor pushed his foreskin back so hard I could see my boy's entire glans,
which was oozing blood. The Dr. told me I must do this at every bath or my child "will need to be
circumcised for sure." Jonah now screams when we change him, is restless, and seems to be in pain.
Is this really necessary? It does not seem reasonable to hurt a boy in order to clean him. Please help
us. Signed -G.W., Puzzled in Peoria.
HOW COULD THIS INJURY POSSIBLY HAPPEN? At birth the penis is under-developed. The
foreskin is fused to the glans (head) by a normal connective membrane, the balano-preputial lamina,
(translation: glans-foreskin layer). The two are functionally an undifferentiated single structure. It
takes many years for this membrane to naturally dissipate, a few cells at a time. The average age for
full foreskin retraction without trauma is ten years, with half of all boys at age ten fully retractable, and
half not yet so. At age 6, for instance, only 20% of boys are fully retractable (Øster et al., 1968-2005).
Typically this injury occurs when a poorly-trained physician or nurse tells the parent that the child has
'adhesions' (an unnatural tissue connection) which must be separated "for hygiene." He or she will
then tear the foreskin from the glans by forcing it towards the abdomen, exposing the entire glans and
destroying the boy's protective membrane. Some doctors insert a blunt metal probe or closed
hemostat to "lyse the adhesions." Either way, this is intensely painful and traumatic for the child, as
well as exposing him to infection, scarring, and even adult sexual problems.
WHAT HAPPENS TO BOYS WHO HAVE BEEN FORCIBLY RETRACTED? The trauma of tearing
the glans and foreskin apart before they separate naturally will cause intense pain, bleeding, swelling,
and expose what was formerly a sterile, internal site to infection. The trauma and subsequent
infection may create scarring all the way around the foreskin that will make the it inelastic and thus
difficult to retract in later life, when adult hygiene will actually be needed. This condition is called
phimosis. In older children and adolescents, true phimosis is almost invariably due to forced retraction
in childhood with its resultant infection and scarring. (False diagnoses of phimosis are, sadly,
commonplace, the clinician mistaking the natural membrane for claimed 'adhesions.')
Pediatrics, a reference text for doctors by Rudolph and Hoffman, warns: "The prepuce, foreskin, is
normally not retractile at birth. The ventral surface of the foreskin is naturally fused to the glans of the
penis. At age 6 years, 80 percent of boys still do not have a fully retractile foreskin. By age 17 years,
Page 24
however, 97 to 99 percent of uncircumcised males have a fully retractile foreskin... in particular,
there is no indication ever for forceful retraction of the foreskin from the glans. Especially in the
newborn and infant, this produces small lacerations in addition to a severe abrasion of the glans. The
result is scarring and a resultant secondary phimosis. Thus it is incorrect to teach mothers to
retract the foreskin." (Emphasis ours)
WHERE DID THE NOTION OF FORCIBLE RETRACTION ORIGINATE? The complete answer is a
book-length story of medical ignorance, 'hygiene hysteria,' prudery, even outright cruelty—but a short
synopsis is possible.
In the mid-19th-century, before doctors discovered germs, they devised a disease theory called 'reflex
neurosis.' This theory held that stimulation, (then called 'irritation' or 'neurosis') of sensitive tissue,
would cause disease to appear in a distant part of the body (the reflex). As the genitals are intensely
sensitive tissue, doctors blamed disease even on innocent touching 'down there.' A refinement of this
theory claimed that children touched themselves because smegma, the natural substance that both
sexes produce, would sour, become itchy, and draw the child's attention to his (or her) genitalia.
Thus if a boy in 1870 contracted tuberculosis, he was accused of 'irritating' his penis. The solution?
Aggressive, regular, internal cleaning -or circumcision. This medical theory was a perfect fit with the
sexual mores of the Victorian era. Thus began a hundred-year tradition in English-language medicine
of vilifying the genitals, both male and female, as the source not only of disease, but also a potential
temptation to offend 'moral hygiene.' Doctors reasoned that rigorous cleaning, drying-up,
desensitizing (with acid), or even amputation of genital mucosal tissue (i.e., circumcision) was both a
medical and a moral imperative.
Reflex neurosis survived in English language medicine until well after germs were discovered in
1879. Even in the 1930s some doctors were still advising parents to tie scratchy muslin bags on
children's fists to discourage even inadvertent genital contact during sleep. An entire industry of 'antimasturbation' devices for children developed. (Hoag Levins, 1996).
In an influential article in 1949, a British pediatrician conceded the BPL membrane was normal
anatomy, but suggested, erroneously, it should disappear by age three years (Gairdner, 1949). This
abbreviated and inflexible timetable -to be fair, an incremental improvement on a theory that this
membrane was a 'birth-defect'- thrives today, even though modern, evidence-based medicine has
shown otherwise, numerous times since 1968: (Øster, 1968; Kayaba, 1996; Cold & Taylor, 1999;
Concepción-Morales, 2002; Ishikawa, 2004; Agawal, 2005; Thorvaldsen and Meyhoff, 2005, Agawal,
Mohta, and Anand, 2005.) To reiterate: we have known for over 40 years that it is normal for the
foreskin to not retract in children.
It was once standard English-language medical practice (1870-1980) to forcibly separate the glans
from the foreskin, either by the doctor or by the parents on doctor's orders, "a little at each bath."
Mothers reported disliking this chore as they knew it was painful. (cite available) This pernicious
practice is not yet dead, and many grandmothers (and doctors) still cling to it. The American
Academy of Pediatrics' has issued a stern (if tardy) prohibition in recent years:
"Until separation occurs, do NOT try to pull the foreskin back - especially an infant's. Forcing the
foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding, and tears
in the skin.”
...but this warning is widely flouted by many practicing clinicians.
Reflex neurosis lives on today in locker room jokes about blindness, insanity, and unusual hair growth caused by touching
the genitals. But it also lingers as PFFR, premature, forcible, foreskin retraction.
Page 25
John V. Geisheker, J.D., LL.M., George C. Denniston, M.D.,
M.P.H., Mark D. Reiss, M.D., Morris R. Sorrels, M.D. of
Doctors Opposing Circumcision, Seattle Pediatric consultant:
Robert S. Van Howe, M.D., M.S
Copyright 2011 John Geisheker, JD, LLM
Why Continue to Harm Boys from
Ignorance of Male Anatomy?
What you can do to protect boys
Published on October 30, 2011 by Darcia Narvaez, Ph.D. in Moral Landscapes
*Written by John Geisheker, J.D., LL.M.
WHY DO FORCED RETRACTION INJURIES CONTINUE TODAY? Simplest answer: Folklore -as
well as a recognized failure of U.S. medical schools to teach fundamental gross anatomy of male
infants. One medical text, Avery's Neonatology (2005), candidly suggests a feeble excuse: "Because
circumcision is so common in the United States, the natural history of the preputial development has
been lost, and one must depend on observations made in countries in which circumcision is usually
not practiced."
There are, indeed, excellent foreign resources which describe the correct infant anatomy:
(Øster, 1968; Kayaba, 1996; Cold & Taylor, 1999; Concepción-Morales, 2002; Ishikawa, 2004;
Agawal, 2005; Thorvaldsen and Meyhoff, 2005; Agawal, Mohta, and Anand, 2005.)
...but U.S. medical providers continue to cling to and circulate Victorian myths among themselves.
A recent survey of U.S. medical books, for instance, revealed that only two out of 42 pediatric,
nursing, neonatology, and urology texts as well as family health encyclopedias, detailed the correct
(minimal) hygiene needs for male infants. The rest featured obsolete, misleading, and potentially
injurious advice directly traceable to 19th-century sources.
Many medical texts even depict males as naturally circumcised, thus eliminating a normal body
part as if it never existed, and quashing any need to discuss the slow timetable for natural, unaided,
foreskin-glans detachment. (Harryman, 2004).
At a national convention of family practice doctors in 2009, for example, only two out of 113
doctors and med students we polled understood the proper, minimal, hygiene needs of a male infant.
This is very likely due to the fact that the doctors themselves are circumcised and so inherently see
the foreskin as abnormal.
WHAT DOES FORCED RETRACTION HAVE TO DO WITH CIRCUMCISION? The claimed
necessity for foreskin retraction and cleaning is used to 'market' circumcision. Circumcision is touted
as a one-time method for parents to avoid the (imaginary) chore of regular genital cleaning. Leaving
the genitals of both boys and girls to develop naturally, as is the case in Europe, has not yet fully
arrived in American medical training or clinical practice.
Many U.S. families have an anecdote of their Uncle Charlie's distressing circumcision as a
young boy. Very likely, though, his circumcision was claimed to 'cure' a normal condition -the natural
fusion of glans and foreskin. Or possibly, Uncle Charlie was forcibly retracted as an infant and
developed true secondary phimosis due to inelastic scarring. For over a century such cases were
used as a scare tactic to convince parents to choose infant circumcision. Doctors claimed, "He'll only
need it later when it is more painful." In truth, phimosis is both over-diagnosed and easily treated
without circumcision, with topical steroids and stretching exercises. And in any case, a boy, even one
with the rare true but mild phimosis, does not need to see his glans, nor does his penis need internal
cleaning, until adolescence.
WHAT ABOUT THE CONCERN FOR UTI, URINARY TRACT INFECTIONS? Proponents of
circumcision claim that intact boys have a higher incidence of UTI, (Wiswell, 1985-86) but even the
absolute incidence is only 1%, one infant in 100, if that. And that 1% can be easily explained by
'septic genital tampering' of which forcible foreskin retraction is a glaring example. In several years of
investigating parent complaints of forcible retraction, we have not found even a single case involving
a physician wearing surgical gloves -not one. Many parents claimed that the practitioner was not
even seen to wash his or her hands beforehand.
Such failures of simple antisepsis, -100,000 or more times each year- easily explain the
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entire claimed higher incidence of UTI in intact boys.
WHAT IF MY SON'S FORESKIN 'BALLOONS' WHEN HE PEES? While the errant
sprinkles might be annoying, ballooning is harmless and easily explained. Unfortunately, it often leads
to poor medical advice to either circumcise or forcibly retract the boy. The inflation of the foreskin by
urine is due to a simple fact of flow dynamics -if it is easier for the urine to inflate the partially
detached but elastic foreskin than to flow outward, it will flow sideways. Intact boys sometimes pinch
their outer opening closed so the urine inflates their foreskin. Because the sensitive nerve receptors
of the erogenous foreskin like being stretched, boys no doubt enjoy the sensation, (as well as the
reaction they get out of their parents.) This ballooning phase is transient, as eventually the outer
opening will be wide enough to allow unimpeded flow, or the boy can be taught to pull his foreskin
back gently to encourage the stream outward.
WHY NOT JUST LEAVE THE BOY'S PENIS TO DEVELOP ON ITS OWN? Why not, indeed!
Evolution has apparently provided a useful protection for boys, at a time when they are still
developing. Penises, like vulvas, do not need internal cleaning in childhood. The balano-preputial
lamina is very much like the female hymen, protecting the child's genitals from feces and other
infection or injury at a time when the child does not need to procreate.
It cannot be the case that our primate ancestors bothered to scrub their offspring's genitalia
when their time was better spent foraging for food. We are the evolutionary survivors who needed no
such intrusive care -or none of us would be here.
A medical historian notes the following about the erroneous and invented English-language
urge to scrub the genitals of young males:
"To appreciate the scale of the error, consider its equivalent in women: it would be as if doctors had
decided that the intact hymen in infant girls was a congenital defect known as 'imperforate hymen'
arising from 'arrested development' and hence needed to be artificially broken in order to allow the
interior of the vagina to be washed out regularly to ensure hygiene." (Dr. Robert Darby, A Surgical
Temptation, The Demonization of the Foreskin and the Rise of Circumcision in Britain, Univ. of
Chicago Press, 2005:235.)
WHAT CAN BE DONE TO DISCOURAGE THIS INJURY? Our child-hygiene advice to parents is
amazingly simple: "Only Clean What is Seen!" The first person to ever retract the boy's foreskin
should be the boy himself, as he will stop when it hurts. Our simple advice to medical practitioners
may be found on a diaper/nappy sticker we supply parents. It warns, "I'm Intact! Don't Retract!" This
prompts an exam-table discussion well worth having in advance of any injury.
The developing penis of a child, like his sister's vulva, is self-cleaning and self-defending, as it
has been for tens of thousands of years. In evolutionary terms, it could hardly be otherwise. The most
sensible parents are those who instinctively practice 'benign neglect,' largely ignoring their child's
penis (and antique medical advice) and who insist that their son's medical providers observe a
'hands-off' policy.
Unfortunately, until this injury is fully abandoned, forever banished by reform from within U.S.
medical education, parents will need to be on constant guard. They should NEVER leave their intact
child's side during any medical exam. They should simply forbid, in advance, any retraction in
unequivocal terms, and compose a signed letter to be inserted in the child's medical chart explaining
their wish to protect their son. Parents must remain on guard to any medical professional's request
or insistence to "just see the urethra" or any other manipulation of the foreskin.
It may be a pity to admit it -but until today's generation of intact boys grows up to be doctors,
the education of medical practitioners must now come from observant parents with good natural
instincts.
John V. Geisheker, J.D., LL.M., George C. Denniston, M.D., M.P.H., Mark D. Reiss, M.D., Morris R. Sorrels,
M.D.of Doctors Opposing Circumcision, Seattle. Pediatric consultant: Robert S. Van Howe, M.D., M.S.
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Suggested websites to continue your research
The WHOLE Network
http://www.thewholenetwork.org/
DOCTORS OPPOSING CIRCUMCISION (D.O.C.) Physicians
for Genital Integrity
http://www.doctorsopposingcircumcision.org/
Moralogous
http://www.moralogous.com/
National Organization of Circumcision Information Resource Centers
http://www.nocirc.org
Circumcision Information and Resource Pages
http://www.cirp.org
Sex As Nature Intended It
http://www.sexasnatureintendedit.com
Intact America
http://www.intactamerica.org
The National Organization of Restoring Men
http://www.norm.org/
Global Survey of Circumcision Harm (GSCH)
http://www.circumcisionharm.org/
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We hope you found this Circumcision Decision Pack helpful. When you are ready please consider passing
it on so that another family can benefit from its use.