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THE FORESKIN IS
NECESSARY
Part two
by Paul M. Fleiss, MD, MPH
"Routine
circumcision of babies in the United States did not begin until the
Cold War era. Circumcision is almost unheard of in Europe, Southern
America, and non-Muslim Asia. In fact, only 10 to 15 percent of men
throughout the world are circumcised."
"The natural penis requires no special care. A child's foreskin,
like his eyelids, is self-cleansing. Forcibly retracting a baby's
foreskin can lead to irritation and infection. The best way to care
for a child's intact penis is to leave it alone."
How Does Circumcision Harm?
The "medical" debate about the "potential health benefits" of
circumcision rarely addresses its real effects.
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Circumcision denudes: Depending on the amount of skin cut off,
circumcision robs a male of as much as 80 percent or more of his
penile skin. Depending on the foreskin's length, cutting it off
makes the penis as much as 25 percent or more shorter. Careful
anatomical investigations have shown that circumcision cuts off more
than 3 feet of veins, arteries, and capillaries, 240 feet of nerves,
and more than 20,000 nerve endings.31 The foreskin's muscles,
glands, mucous membrane, and epithelial tissue are destroyed, as
well. |
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Circumcision desensitizes: Circumcision desensitizes the penis
radically. Foreskin amputation means severing the rich nerve network
and all the nerve receptors in the foreskin itself. Circumcision
almost always damages or destroys the frenulum. The loss of the
protective foreskin desensitizes the glans. Because the membrane
covering the permanently externalized glans is now subjected to
constant abrasion and irritation, it keratinizes, becoming dry and
tough. The nerve endings in the glans, which in the intact penis are
just beneath the surface of the mucous membrane, are now buried by
successive layers of keratinization. The denuded glans takes on a
dull, grayish, sclerotic appearance. |
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Circumcision disables: The amputation of so much penile skin
permanently immobilizes whatever skin remains, preventing it from
gliding freely over the shaft and glans. This loss of mobility
destroys the mechanism by which the glans is normally stimulated.
When the circumcised penis becomes erect, the immobilized remaining
skin is stretched, sometimes so tightly that not enough skin is left
to cover the erect shaft. Hair-bearing skin from the groin and
scrotum is often pulled onto the shaft, where hair is not normally
found. The surgically externalized mucous membrane of the glans has
no sebaceous glands. Without the protection and emollients of the
foreskin, it dries out, making it susceptible to cracking and
bleeding. |
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Circumcision disfigures: Circumcision alters the appearance of the
penis drastically. It permanently externalizes the glans, normally
an internal organ. Circumcision leaves a large circumferential
surgical scar on the penile shaft. Because circumcision usually
necessitates tearing the foreskin from the glans, pieces of the
glans may be torn off, too, leaving it pitted and scarred. Shreds of
foreskin may adhere to the raw glans, forming tags and bridges of
dangling, displaced skin.32
Depending on the amount of skin cut off and how the scar forms, the
circumcised penis may be permanently twisted, or curve or bow during
erection.33 The contraction of the scar tissue may pull the shaft
into the abdomen, in effect shortening the penis or burying it
completely.34 |
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Circumcision disrupts circulation: Circumcision interrupts the
normal circulation of blood throughout the penile skin system and glans. The blood flowing into major penile arteries is obstructed by
the line of scar tissue at the point of incision, creating backflow
instead of feeding the branches and capillary networks beyond the
scar. Deprived of blood, the meatus may contract and scarify,
obstructing the flow of urine.35 This condition, known as meatal
stenosis, often requires corrective surgery. Meatal stenosis is
found almost exclusively among boys who have been circumcised.
Circumcision also severs the lymph vessels, interrupting the
circulation of lymph and sometimes causing lymphedema, a painful,
disfiguring condition in which the remaining skin of the penis
swells with trapped lymph fluid. |
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Circumcision harms the developing brain: Recent studies published in
leading medical journals have reported that circumcision has
long-lasting detrimental effects on the developing brain,36
adversely altering the brain's perception centers. Circumcised boys
have a lower pain threshold than girls or intact boys.37
Developmental neuropsychologist Dr. James Prescott suggests that
circumcision can cause deeper and more disturbing levels of
neurological damage, as well.38, 39 |
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Circumcision is unhygienic and unhealthy: One of the most common
myths about circumcision is that it makes the penis cleaner and
easier to take care of. This is not true. Eyes without eyelids would
not be cleaner; neither would a penis without its foreskin. The
artificially externalized glans and meatus of the circumcised penis
are constantly exposed to abrasion and dirt, making the circumcised
penis, in fact, more unclean. The loss of the protective foreskin
leaves the urinary tract vulnerable to invasion by bacterial and
viral pathogens.
The circumcision wound is larger than most people imagine. It is not
just the circular point of union between the outer and inner layers
of the remaining skin. Before a baby is circumcised, his foreskin
must be torn from his glans, literally skinning it alive. This
creates a large open area of raw, bleeding flesh, covered at best
with a layer of undeveloped proto-mucosa. Germs can easily enter the
damaged tissue and bloodstream through the raw glans and, even more
easily, through the incision itself.
Even after the wound has healed, the externalized glans and meatus
are still forced into constant unnatural contact with urine, feces,
chemically treated diapers, and other contaminants.
Female partners of circumcised men do not report a lower rate of
cervical cancer,40 nor does circumcision prevent penile cancer.41 A
recent study shows that the penile cancer rate is higher in the US
than in Denmark, where circumcision, except among Middle-Eastern
immigrant workers, is almost unheard of.42 Indeed, researchers
should investigate the possibility that circumcision has actually
increased the rate of these diseases.
Circumcision does not prevent acquisition or transmission of
sexually transmitted diseases (STDs). In fact, the US has both
the highest percentage of sexually active circumcised males in
the Western world and the highest rates of sexually transmitted
diseases, including AIDS. Rigorously controlled prospective
studies show that circumcised American men are at a greater risk
for bacterial and viral STDs, especially gonorrhea,43
nongonoccal urethritis,44 human papilloma virus,45 herpes simplex virus type
2,46 and chlamydia.47 |
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Circumcision is always risky: Circumcision always carries the risk
of serious, even tragic, consequences. Its surgical complication
rate is one in 500.48 These complications include uncontrollable
bleeding and fatal infections.49 There are many published case
reports of gangrene following circumcision.50 Pathogenic bacteria
such as staphylococcus, Proteus, Pseudomonas, other coliforms, and
even tuberculosis can cause infections leading to death.51, 52 These
organisms enter the wound because it provides easy entry, not
because the child is predisposed to infection.
Medical journals have published numerous accounts of babies who have
had part or all of their glans cut off while they were being
circumcised.53,54,55 Other fully conscious, unanesthetized babies
have had their entire penis burned off with an electrocautery
gun.56,57, 58 The September 1989 Journal of Urology published an
account of four such cases.59 The article described the sex-change
operation as "feminizing genitoplasty," performed on these babies in
an attempt to change them into girls. The March 1997 Archives of
Pediatrics and Adolescent Medicine described one young person's
horror on learning that "she" had been born a normal male, but that
a circumciser had burned his penis off when he was a baby.60 Many
other similar cases have been documented.61,62 Infant circumcision
has a reported death rate of one in 500,000.63,64 |
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Circumcision harms mothers: Scientific studies have consistently
shown that circumcision disrupts a child's behavioral development.
Studies performed at the University of Colorado School of Medicine
showed that circumcision is followed by prolonged, unrestful non-REM
(rapid-eye-movement) sleep.65 In response to the lengthy bombardment
of their neural pathways with unbearable pain, the circumcised
babies withdrew into a kind of semicoma that lasted days or even
weeks.
Numerous other studies have proven that circumcision disrupts the
mother-infant bond during the crucial period after birth. Research
has also shown that circumcision disrupts feeding patterns. In a
study at the Washington University School of Medicine, most babies
would not nurse right after they were circumcised, and those who did
would not look into their mothers' eyes.66 |
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Circumcision violates patients' and human rights: No one has the
right to cut off any part of someone else's genitals without that
person's competent, fully informed consent. Since it is the infant
who must bear the consequences, circumcision violates his legal
rights both to refuse treatment and to seek alternative treatment.
In 1995, the American Academy of Pediatrics Committee on Bioethics
stated that only a competent patient can give patient consent or
informed consent.67 An infant is obviously too young to consent to
anything. He must be protected from anyone who would take advantage
of his defenselessness. The concept of informed parental permission
allows for medical interventions in situations of clear and
immediate medical necessity only, such as disease, trauma, or
deformity. The human penis in its normal, uncircumcised state
satisfies none of these requirements.
Physicians have a duty to refuse to perform circumcision. They also
must educate parents who, out of ignorance or misguidance, request
this surgery for their sons. The healthcare professional's
obligation is to protect the interests of the child. It is unethical
in the extreme to force upon a child an amputation he almost
certainly would never have chosen for himself. |
Common Sense
To be intact, as nature intended, is best. The vast majority of
males who are given the choice value their wholeness and keep their
foreskins, for the same reason they keep their other organs of
perception. Parents in Europe and non-Muslim Asia never have forced
their boys to be circumcised. It would no more occur to them to cut
off part of their boys' penises than it would to cut off part of
their ears. Respecting a child's right to keep his genitals intact
is normal and natural. It is conservative in the best sense of the
word.
A circumcised father who has mixed feelings about his intact newborn
son may require gentle, compassionate psychological counseling to
help him come to terms with his loss and to overcome his anxieties
about normal male genitalia. In such cases, the mother should
steadfastly protect her child, inviting her husband to share this
protective role and helping him diffuse his negative feelings. Most
parents want what is best for their baby. Wise parents listen to
their hearts and trust their instinct to protect their baby from
harm. The experience of the ages has shown that babies thrive best
in a trusting atmosphere of love, gentleness, respect, acceptance,
nurturing, and intimacy. Cutting off a baby's foreskin shatters this
trust. Circumcision wounds and harms the baby and the person the
baby will become. Parents who respect their son's wholeness are
bequeathing to him his birthright-his body, perfect and beautiful in
its entirety.
For More Information
Organizations
Doctors Opposing Circumcision (DOC), 2442 N.W. Market Street, Suite
42 Seattle, WA 98107 206-368-8358 weber.u.washington.edu/~gcd/DOC/
The National Organization of Circumcision Information Resource
Centers (NOCIRC), PO Box 2512 San Anselmo, CA 94979-2512
415-488-9883 www.nocirc.org
The National Organization to Halt the Abuse and Routine Mutilation
of Males (NOHARMM), PO Box 460795 San Francisco, CA 94146-0795
415-826-9351 www.noharmm.org
Nurses for the Rights of the Child, 369 Montezuma, Suite 354 Santa
Fe, NM 87501 505-989-7377 http://nurses.cirp.org/
Books
Available from bookstores, from the publishers, or from NOCIRC.
Bigelow, Jim, PhD. The Joy of Uncircumcising! Exploring
Circumcision: History, Myths, Psychology, Restoration, Sexual
Pleasure and Human Rights. 2nd ed. Aptos, CA: Hourglass, 1995.
Denniston, George C., MD, MPH, and Marilyn Fayre Milos, RN, eds.
Sexual Mutilations: A Human Tragedy. (Proceedings of the Fourth
International Symposium on Sexual Mutilations, Lausanne,
Switzerland, 1996). New York: Plenum Press, 1997.
Goldman, Ronald, PhD. Circumcision: The Hidden Trauma: How an
American Cultural Practice Affects Infants and Ultimately Us All.
Boston: Vanguard Publications, 1997.
Goldman, Ronald, PhD. Questioning Circumcision: A Jewish
Perspective. 2nd ed. Boston: Vanguard Publications, 1997.
O'Mara, Peggy, ed. Circumcision: The Rest of the Story-A Selection
of Articles, Letters, and Resources 1979- 1993. Santa Fe, NM:
Mothering, 1993.
Ritter, Thomas J., MD, and George C. Denniston, MD. Say No to
Circumcision! 40 Compelling Reasons Why You Should Respect His
Birthright and Keep Your Son Whole, 2nd ed. Aptos, CA: Hourglass,
1996.
Video
Whose Body, Whose Rights? Examining the Ethics and the Human Rights
Issue of Infant Male Circumcision. Award-winning documentary. 56
min. VHS. Personal use: VideoFinders, 1-800-343-4727
Educational facilities
UC Center for Media and Independent Learning 2000 Center Street, 4th
Floor Berkeley, CA 94704 510-642-0460.
For World Wide Web ordering and preview: www.cirp.org/pages/reviews/whosebody/
Notes
1. T. J. Ritter and G. C. Denniston, Say No to Circumcision: 40
Compelling Reasons, 2nd ed. (Aptos, CA: Hourglass, 1996),6-20.
2. "Incipit Libellus De Ecclesiasticis Disciplinis et Religione
Christiana Collectus. Liber II.XC, XCI" in Patrologiæ Cursus
Completus , vol. 132 (Paris: Apud Garnier Fratres, Editores et J. P.
Migne Successores, 1880), 301-302.
3. S. Grayzel, The Church and the Jews in the XIIth Century, vol. 2,
ed. K. R. Stow (Detroit, MI: Wayne State University Press, 1989),
246-247.
4. See Note 10, 17-40.
5. M. F. Campbell, "The Male Genital Tract and the Female Urethra,"
in Urology, eds. M. F. Campbell and J. H. Harrison, vol. 2, 3rd ed.
(Philadelphia: W. B. Saunders, 1970), 1836.
6. See photographic series: J. A. Erickson, "Three Zones of Penile
Skin." In M. M. Lander, "The Human Prepuce," in G. C. Denniston and
M. F. Milos, eds., Sexual Mutilations: A Human Tragedy (New York:
Plenum Press, 1997), 79-81.
7. M. Davenport, "Problems with the Penis and Prepuce: Natural
History of the Foreskin" (photograph 1), British Medical Journal 312
(1996): 299-301.
8. J. Øster, "Further Fate of the Foreskin," Archives of Disease in
Childhood 43 (1968): 200-203.
9. H. L. Tan, "Foreskin Fallacies and Phimosis," Annals of the
Academy of Medicine, Singapore 14 (1985): 626-630.
10. F. A. Hodges, "Short History of the Institutionalization of
Involuntary Sexual Mutilation in the United States," in G. C.
Denniston and M. F. Milos, eds., Sexual Mutilations: A Human Tragedy
(New York: Plenum Press, 1997), 35.
11. A. B. Hyman and M. H. Brownstein, "Tyson's 'Glands': Ectopic
Sebaceous Glands and Papillomatosis Penis," Archives of Dermatology
99 (1969): 31-37.
12. A. Ahmed and A. W. Jones, "Apocrine Cystadenoma: A Report of Two
Cases Occurring on the Prepuce," British Journal of Dermatology 81
(1969): 899-901.
13. G. N. Weiss et al., "The Distribution and Density of Langerhans
Cells in the Human Prepuce: Site of a Diminished Immune Response?"
Israel Journal of Medical Sciences 29 (1993): 42-43.
14. P. J. Flower et al., "An Immunopathologic Study of the Bovine
Prepuce," Veterinary Pathology 20 (1983):189-202.
15. Z. Halata and B. L. Munger, "The Neuroanatomical Basis for the
Protopathic Sensibility of the Human Glans Penis," Brain Research
371 (1986): 205-230.
16. J. R. Taylor et al., "The Prepuce: Specialized Mucosa of the
Penis and Its Loss to Circumcision," British Journal of Urology 77
(1996): 291-295.
17. H. C. Bazett et al., "Depth, Distribution and Probable
Identification in the Prepuce of Sensory End-Organs Concerned in
Sensations of Temperature and Touch; Thermometric Conductivity,"
Archives of Neurology and Psychiatry 27 (1932): 489-517.
18. D. Ohmori, "Über die Entwicklung der Innervation der
Genitalapparate als Peripheren Aufnahmeapparat der Genitalen Reflexe,"
Zeitschrift für Anatomie und Entwicklungsgeschichte 70 (1924):
347-410.
19. A. De Girolamo and A. Cecio, "Contributo alla Conoscenza
dell'innervazione Sensitiva del Prepuzio Nell'uomo," Bollettino
della Societá Italiana de Biologia Sperimentale 44 (1968):
1521-1522.
20. A. S. Dogiel, "Die Nervenendigungen in der Haut der äusseren
Genitalorgane des Menschen," Archiv für Mikroskopische Anatomie 41
(1893): 585-612.
21. A. Bourlond and R. K. Winkelmann, "L'innervation du Prépuce chez
le Nouveau-né," Archives Belges de Dermatologie et de Syphiligraphie
21 (1965): 139-153.
22. R. K. Winkelmann, "The Erogenous Zones: Their Nerve Supply and
Its Significance," Proceedings of the Staff Meetings of the Mayo
Clinic 34 (1959): 39-47.
23. R. K. Winkelmann, "The Cutaneous Innervation of Human Newborn
Prepuce," Journal of Investigative Dermatology 26 (1956): 53-67.
24. R. Hausmann et al., "The Forensic Value of the
Immunohistochemical Detection of Oestrogen Receptors in Vaginal
Epithelium," International Journal of Legal Medicine 109 (1996):
10-30.
25. See Note 12.
26. American Academy of Pediatrics, Newborns: Care of the
Uncircumcised Penis: Guidelines for Parents (Elk Grove Village, IL:
American Academy of Pediatrics, 1994).
27. See Note 1.
28. See Note 1.
29. S. A. Aldeeb Abu-Sahlieh, "Jehovah, His Cousin Allah, and Sexual
Mutilations," In: Sexual Mutilations: A Human Tragedy, eds. G. C.
Denniston and M. F. Milos (New York: Plenum Press, 1997), 41-62.
30. National Center for Health Statistics of the United States
Department of Health and Human Services, 1994.
31. See Note 17.
32. G. T. Klauber and J. Boyle, "Preputial Skin-Bridging:
Complication of Circumcision," Urology 3 (1974): 722-723.
33. J. P. Gearhart, "Complications of Pediatric Circumcision," in
Urologic Complications, Medical and Surgical, Adult and Pediatric,
ed. F. F. Marshall (Chicago: Year Book Medical Publishers, 1986),
387-396.
34. R. D. Talarico and J. E. Jasaitis, "Concealed Penis: A
Complication of Neonatal Circumcision," Journal of Urology 110
(1973): 732-733.
35. R. Persad et al., "Clinical Presentation and Pathophysiology of
Meatal Stenosis Following Circumcision," British Journal of Urology
75 (1995): 90-91.
36. A. Taddio et al., "Effect of Neonatal Circumcision on Pain
Responses during Vaccination in Boys," Lancet 345 (1995): 291-292.
37. A. Taddio et al., "Effect of Neonatal Circumcision on Pain
Response during Subsequent Routine Vaccination," Lancet 349 (1997):
599-603.
38. J. W. Prescott, "Genital Pain vs. Genital Pleasure: Why the One
and Not the Other?" Truth Seeker 1 (1989): 14-21.
39. R. Goldman, Circumcision: The Hidden Trauma (Boston: Vanguard
Publications, (1997), 139-175.
40. M. Terris et al., "Relation of Circumcision to Cancer of the
Cervix," American Journal of Obstetrics and Gynecology 117 (1973):
1056-1065.
41. C. J. Cold et al., "Carcinoma in Situ of the Penis in a
76-Year-Old Circumcised Man," Journal of Family Practice 44 (1997):
407-410.
42. M. Frisch et al., "Falling Incidence of Penis Cancer in an
Uncircumcised Population (Denmark 1943-90)," British Medical Journal
311 (1995): 1471.
43. B. Donovan et al., "Male Circumcision and Common Sexually
Transmissible Diseases in a Developed Nation Setting," Genitourinary
Medicine 70 (1994): 317-320.
44. G. L. Smith et al., "Circumcision as a Risk Factor for
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(1987): 452-454.
45. L. S. Cook et al., "Clinical Presentation of Genital Warts among
Circumcised and Uncircumcised Heterosexual Men Attending an Urban
STD Clinic," Genitourinary Medicine 69 (1993): 262-264.
46. I. Bassett et al., "Herpes Simplex Virus Type 2 Infection of
Heterosexual Men Attending a Sexual Health Centre," Medical Journal
of Australia 160 (1994): 697-700.
47. E. O. Laumann et al., "Circumcision in the United States:
Prevalence, Prophylactic Effects, and Sexual Practice," Journal of
the American Medical Association 277 (1997): 1052-1057.
48. W. F. Gee and J. S. Ansell, "Neonatal Circumcision: A Ten-Year
Overview: With Comparison of the Gomco Clamp and the Plastibell
Device," Pediatrics 58 (1976): 824-827.
49. G. W. Kaplan, "Complications of Circumcision," Urologic Clinics
of North America 10 (1983): 543-549.
50. S. J. Sussman et al., "Fournier's Syndrome: Report of Three
Cases and Review of the Literature," American Journal of Diseases of
Children 132 (1978): 1189-1191.
51. B. V. Kirkpatrick and D. V. Eitzman, "Neonatal Septicemia after
Circumcision," Clinical Pediatrics 13 (1974): 767-768.
52. J. M. Scurlock and P. J. Pemberton, "Neonatal Meningitis and
Circumcision," Medical Journal of Australia 1 (1977): 332-334.
53. G. R. Gluckman et al., "Newborn Penile Glans Amputation during
Circumcision and Successful Reattachment," Journal of Urology 153
(1995): 778-779.
54. B. S. Strimling, "Partial Amputation of Glans Penis during Mogen
Clamp Circumcision," Pediatrics 87 (1996): 906-907.
55. J. Sherman et al., "Circumcision: Successful Glandular
Reconstruction and Survival Following Traumatic Amputation," Journal
of Urology 156 (1996): 842-844.
56. J. R. Sharpe and R. P. Finney, "Electrocautery Circumcision,"
Urology 19 (1982): 228.
57. C. K. Pearlman, "Caution Advised on Electrocautery
Circumcisions," Urology 19 (1982): 453.
58. C. K. Pearlman, "Reconstruction Following Iatrogenic Burn of the
Penis," Journal of Pediatric Surgery 11 (1976):121-122.
59. J. P. Gearhart and J. A. Rock, "Total Ablation of the Penis
after Circumcision with Electrocautery: A Method of Management and
Long-Term Followup," Journal of Urology 142 (1989):799-801.
60. M. Diamond and H. K. Sigmundson, "Sex Reassignment at Birth:
Long-Term Review and Clinical Implications," Archives of Pediatrics
and Adolescent Medicine 151 (1997): 298-304.
61. J. Money, "Ablatio Penis: Normal Male Infant Sex-Reassigned as a
Girl," Archives of Sexual Behavior 4 (1975): 65-71.
62. D. A. Gilbert et al., "Phallic Construction in Prepubertal and
Adolescent Boys," Journal of Urology 149 (1993): 1521-1526.
63. R. S. Thompson, "Routine Circumcision in the Newborn: An
Opposing View," Journal of Family Practice 31 (1990): 189-196.
64. T. E. Wiswell, "Circumcision Circumspection," New England
Journal of Medicine 336 (1997): 1244-1245.
65. R. N. Emde et al., "Stress and Neonatal Sleep," Psychosomatic
Medicine 33 (1971): 491-497.
66. R. E. Marshall et al., "Circumcision: II. Effects upon
Mother-Infant Interaction," Early Human Development 7 (1982):
367-374.
67. Committee on Bioethics, "Informed Consent, Parental Permission,
and Assent in Pediatric Practice," Pediatrics 95 (1995): 314-317.
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Citation:
Fleiss, P. The case against circumcision. Mothering Magazine (Santa
Fe). Winter 1997.
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Copyright 1999 Philip
Cook, all rights reserved
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