The foreskin: Why is it such a secret in North America?
comments and emails in response to a blog post, much less rumors that
I'm a man who has or has not been circumcised. I'll keep that in mind
for any follow-up posts I write.
` And for the record, it wasn't until
2014 that I finally had the opportunity to put a man's intact penis in
my very much female vagina. This frictionless appendage made me realize
that sex doesn't have to be painful or cause yeast infections. And with
that image in your mind, we will switch over to... cocks! Thank you.
I was nineteen or twenty years old when a male friend of mine, we'll
call him Bill, let me in on a most shocking fact: He was missing part of
his penis, and so were almost all boys and men that I had ever seen in
my entire life, as well as all the anatomical diagrams that I had ever
seen. Ever.
Sure, I had heard of circumcision as a Jewish religious practice, but
thought myself unlikely to ever see its results. Little did I know, all
the male genitalia I had seen both in real life and as depicted in
American anatomy books, had been edited in exactly the same way.
` The shock from this revelation overwhelmed me for weeks, especially
since I considered myself to be fairly knowledgeable about anatomy. (My
interests included biology and drawing biological structures.)
Why would anyone selectively remove foreskins, not just from real people
but from scientific anatomical texts, which I had thought were meant to
represent the natural human form?
` And why did no one ever tell me about this? It was as though a basic
feature that males (of all mammals) are normally born with was not to be
understood or even acknowledged.
I spent the next few weeks at the local library, immersing myself in
primary and secondary source materials on the relevant anatomy, medicine
and history, before I was satisfied that I had an accurate
understanding of what was going on. To summarize what I had found:
` The foreskin (or prepuce) is a man's most sensitive erogenous zone,
more well-developed in humans than in other species of mammal. It has
unique sexual functions (more on that later), which circumcision
effectively destroys -- and this is intentional:
` Although foreskin-chopping was once a purely religious or cultural
practice, it was introduced to American medicine in the late 1800s, as a
'cure-all', thanks to the trend of pathologizing (treating as illness)
normal human sexuality and healthy genitalia.
At the time, many doctors believed that sexual stimulation and
ejaculation literally drained men of their vitality and caused all
manner of illnesses and mental problems. Semen was thought to take a lot
of blood to make, and losing one ounce was considered the equivalent of losing a quart of blood.
` Painfully severing the man or boy's most erogenous zone was
recommended, and in orphanages, it was more common to sever the penile
nerve as well. This was meant to traumatize and discourage him from
masturbating, lest his health deteriorate from excessive ejaculations
(which was diagnosed as "spermatorrhea").
` Yes, really.
` There were many quack remedies in the 1800s to improve men's virility
and erections, and to keep them from losing semen via masturbating and
nocturnal emissions. This was not considered a contradiction because a
man's purpose was thought to be saving his sperm for making babies.
This may be a shock to some, although my readers may be more familiar
with the ancient belief that women suffered from a vague illness called
"hysteria", especially if they experienced such "symptoms" as sexual
desire and vaginal lubrication.
` Typically, this was a "disorder" of women who didn't have husbands, or
whose husbands left them wanting in bed, and it was thought that the
buildup of sexual fluids such as "female sperm" (ejaculate) were
poisoning them.
` In order to relieve "hysteria" symptoms, the two-thousand year old wisdom of treating it involved "massage" techniques of the "womb" (vulva), in order to induce a "hysterical paroxysm" (orgasm).
` For doctors in the 1800s, this was hard work, so often they
recommended a midwife to do this, and later on invented a number of vibrators and water jets that were much more effective.
` The fact that vibrators were the fifth household appliance to become
electrified is a testament
to the pathologization of women's sexuality, not to their sexual freedom, as is popularly imagined. (That part happened later.)
Importantly, this treatment was not openly considered to be sexual because it did not involve penetration, thanks to the male-centered view of sex.
` This is how masturbation (that is, without a medically-sanctioned device) could be thought of as causing illness in females.
` However, there was another, less popular "treatment" to discourage
"irritation" and "over-stimulation" in females -- excision of the
external clitoris. In other words, medicalized 'female circumcision'.
` Various forms of this practice appeared sporadically until the 1970s,
and were even funded by Medicaid and promoted for the same reasons as
male circumcision (appearance, cleanliness, health, etc).
It may come as a shock to find that in the U.S., many widespread popular
beliefs about the penis today are actually based on the same Victorian
Era quackery rather than medical science.
` Indeed
,the non-therapeutic circumcision of infant boys has continued to be
medicalized in the U.S., and to a lesser extent in Canada, due to such
persistent beliefs.
` One example, thanks to Lewis Sayre, surgeon and pro-circumcision quack
of the 1870's, is the pathologization of completely normal infant
foreskins:
` This continues today in hospitals, thanks to continued ignorance about
penile gross anatomy: Attempts to 'fix' the child's normal foreskin
often result in severe injury and pain. More about this shortly.
Non-therapeutic circumcision of boys by medical professionals did spread
to a few other countries -- most of which have long rejected it on the
grounds that it is extremely harmful, with no significant medical
benefit.
` As for the few cultures that continue to give routine infant
penis-reductions a veil of medical validation, the justifications for it
depend on the culture and era. In other words, it is based on local
beliefs, not science.
` The scientific literature reveals the
physical, neurological, and psychological harms of this tradition, but
these are creatively ignored or glossed-over in much of the U.S. medical
community.
This past April 28th, the Seattle Atheists invited John Geisheker to correct some of these myths. He is Executive Director and General
Counsel for Doctors Opposing Circumcision (DOC), an organization which
opposes the unnecessary genital surgery of any child.
His presentation was video-recorded and uploaded on YouTube, so if
you're interested, you can open the link in a new tab before reading on:
Circumcision: At the intersection of Religion, Medicine, and Human Rights
` I have handily rehashed most of what he says in the rest of my
article, partly thanks to the notes I took -- which you can see me doing
in the center of the frame.
So, how did an anti-sexuality practice of the Victorian Era ever become
normalized and progressive? And, what was missing from all those anatomy
books, anyway?
` Even anatomy books I've seen that include the foreskin do not have a
detailed visual representation of it, nor do they have much description
beyond saying that's skin that 'covers the tip of the penis'.
` But it isn't:
An anatomy lesson that a medical professional should not need:
The male prepuce, or foreskin, is a highly mobile and extraordinarily
sensitive double fold of tissue that is the end of the penis. During an erection, it rolls back and inside-out, unfolding until it covers much of the penile shaft.
` The rest of the time, its specialized mechanisms cause it to spring
back into place over the delicate mucus membrane of the glans (head),
where it serves a protective function, much like your eyelids. Even in
this position, it can easily be retracted simply by pulling the skin of
the shaft toward the body:
While Europeans, Chinese, Japanese, and most other people may wonder why
anyone would need to explain this most mundane fact, the truth is that
the foreskin is not well-understood in U.S. culture and medicine:
` One of Geisheker's jobs is tracking cases of American doctors who are so outrageously ignorant of intact penile anatomy that they cause serious pain and injury, usually to infants.
` They don't even know the following basic facts, so read carefully:
At birth, a boy's foreskin is fused to his glans via a membrane
called the balano-preputial lamina (BPL). Much like the membrane that
fuses the fingernail to the finger, it acts as a living 'glue'.
` (The same is true of the prepuce and glans of the clitoris: The female foreskin is also called the 'clitoral hood'.)
`
Over the years, little 'pearls' of the membrane die off, thus gradually
separating the foreskin and glans, creating the preputial space. (This
is also true of the clitoris.)
Important to this process is a compilation of sebum and other protective
secretions that mix with these dead cells, thus creating the same stuff
that coats the squishy bits of females.
` This anti-bacterial, anti-viral and anti-fungal substance works its
way toward the tip of the penis so that these 'pearls' can be ejected.
It is still known by the Latin word for 'soap' -- smegma.
In U.S. popular culture, smegma is contradictorily regarded as
completely benign in females, yet as a volatile disease agent of the
male foreskin. (More accurately, I should say, it is not recognized as smegma in females.)
` By around 10 to 15 years of age, the boy is able to fully retract his
foreskin. This is an everyday fact in most people's experience, except
in cultures where infant circumcision is so common that doctors exist
who have lost almost all knowledge of the foreskin.
Such is the case in the U.S., where there really are doctors who think
an infant's healthy foreskin is abnormally tight. Thus, they may
forcibly retract it, tearing the membrane and causing lots of bleeding,
excruciating pain, and further problems -- much as tearing off a
fingernail would.
` This injury can leave scar tissue, causing the foreskin to actually
become abnormally tight. Such problems, as well as its natural
non-retractibility, can be enough for the doctor to decide this part
must be be defective and needs to be removed.
Another supposed abnormality of the infant foreskin is the free-moving tip, which can extend well beyond
the glans. It contains muscle fibers which allow it to close itself
like a drawstring over the urethra (urinary opening).
` These fibers relax when the baby urinates, keeping the foreskin wide open and pulled back, away from the
urethra. At other times, they draw the end of the foreskin together to prevent contaminants
(such as those found in his diaper) from getting inside.
` This normal contraction of the foreskin's muscle gives it a long and
narrow appearance and can be misinterpreted as being "too tight" or
"redundant". Smegma also creates an oily, waxy barrier which protects
the infant's glans from the irritation of urine.
` Without these layers shielding the urethra from E. coli and other nasties, the infant is more predisposed to urinary tract infections.
Buildup of smegma is completely harmless, yet it has been demonized
in the anti-masturbation craze as causing illness. Thus, frequent
cleaning of smegma is recommended by doctors who still believe the B.S.
-- yet, the foreskin gets in the way.
` Both the normal fusion and muscular contraction of the infant foreskin
is considered a disorder in American medical literature, called
'phimosis'. This false diagnosis must be corrected repeatedly in the literature by doctors from abroad, as well as such organizations as DOC.
Premature forced retraction, a colossal failure of some medical
professionals (an estimated 100,000 cases in the U.S. per year), is what Geishsheker calls 'the gateway drug' to circumcision.
` Near the end of his presentation, he also reads a recent and
heartbreaking letter he received from a woman whose pediatrician did
this to her son, without even asking her first.
` The boy was traumatized by this, screamed in pain every time he
urinated or was washed, and woke up screaming for five nights in a row.
On top of this, she was billed $100 for 'penile surgery'.
According
to his sources, the foreskin is not part of American medical training,
and according to his sources, 67% of medical books do not depict a
foreskin at all. Not surprisingly, that seems to be consistent with my
own observations of various medical and anatomy books over the years.
In 2005, Avery's Neonatology said that circumcision is so common
in the U.S. that observations of the foreskin must be made in countries
where it is not usually practiced. Even so, the U.S. medical community
isn't paying enough attention to these observations:
A survey
taken at a 2009 meeting of the American Academy of Family Practice
found that only 3 of 113 participants understood how to care for an
intact penis. (Of course, this also suggests they didn't have their own
point of reference.)
` An American Academy of Pediatrics survey in 1981 showed that 78% of
pediatricians gave obsolete or dangerous advice concerning an intact
penis. That wasn't the last time they gave such advice:
` In 2012, the AAP's recommendation for cleaning babies' foreskins is to
retract them -- thus tearing the foreskin and glans apart -- and to
wash the bleeding wound with soap and water.
` The soap, of course, causes inflammation and can lead to infections
and other serious problems. Yes, this is an erroneous example of
"medical advice" for infants in the U.S., although in most of the world,
the advice is, basically, "leave it alone, it takes care of itself".
` In fact, a male should not use soap beneath his foreskin for the same
reason that a female should not wash her own internal bits with it: It
changes the pH of those areas and causes inflammation, which can lead to
imbalances of microflora and infection.
The AAP also says that "adhesions" (the natural fused condition of the
foreskin) will "resolve" by 2 to 4 months of age. As I've mentioned, the
foreskin doesn't fully retract until around puberty, when the boy is
most ready to use it.
` "I just find this astonishing," says Geisheker, of the fact that there
are still medical professionals who don't understand this ordinary,
basic bit of anatomy.
So, how did all this ignorance start, anyway?
Circumcision, as I mentioned, has been a tradition of some religions and
cultures going back thousands of years, including the priests of
Ancient Egypt.
` Geisheker explains a bit of the history centered around the Jewish
blood sacrifice of penile bits, and how it changed in Ancient Greece
from removing the tip of foreskin to removing the whole thing.
` During the middle ages, Jews were discriminated against for this practice, which includes the mohel (ritual circumciser) sucking blood out of the wound
with his mouth. Anti-semitic Christians invented superstitions about
how this was how Jews drained babies of blood and ate their flesh.
` However, none of this explains the complete lack of foreskins from so
much of the U.S. culture and population -- which is only 2% Jewish.
This modern-day phenomenon has its roots in the 1800's, when sexual
pleasure was considered immoral. It was also when doctors had all sorts
of strange beliefs about 'vital energy', and weren't quite sure what
caused diseases.
` You know, the good ol' days, when homeopathy was a better bet than
some of the treatments of medical doctors. One outmoded belief was that
people start with a certain amount of energy and inevitably run out.
` A pre-scientific model of disease based on this idea was called 'Reflex Neurosis', which pathologized genital stimulation.
It literally meant 'self-nerve overstimulation': If you touched your
highly-innervated genitalia (whether sexually or not), you would drain
yourself of energy, and a disease would occur in your lungs, eyes,
heart, etc.
` It was also believed that men would eventually run out of sperm, and
that ejaculation was injurious to the health -- and moral constitution!
Many people not only shunned masturbation, but were terrified of losing
"life force" through nocturnal emissions.
In order to prevent boys from having emissions, as well as erections
that are part of a normal sleep cycle, some parents were conned into
buying all manner of horrific devices designed to associate pain with the genitalia.
` There were penis-cooling devices, contraptions with spikes on the inside, and even one that activated a phonograph player.
` Chastity belts were a product of this era, rather than medieval times,
as is commonly believed. They were invented, along with armored
night-wear, to sell to parents as a way to keep their kids from causing
themselves "harm".
In Battle Creek Michigan, anti-masturbation big shots such as surgeon
John Harvey Kellogg, recommended punishing both girls and boys for
"self-abuse" by holding them down, kicking and screaming, and excising
their most "abuse"-prone parts.
` The trauma of genital mutilation, as well as the resulting loss of
sensitivity, were meant to keep these adolescents from wanting to do it
again, lest they make themselves sick. (This is clearly stated in
Kellogg's Treatment of Self Abuse and its Effects.)
` A bland vegetarian diet was believed by many to curb sexual feelings,
and so Kellogg also invented Corn Flakes, and provided them at his
sanitorium in Battle Creek Michigan -- along with yogurt enemas and
electrifying baths. (Yes, very much like in The Road to Wellville.)
Kellogg believed that all sex was harmful, claimed to have never had sex
himself, and adopted 42 foster children -- who I don't envy. He would
travel around the country, paying various medical societies to have a
Chair of Circumcision for promoting genital mutilation as a health
measure.
` In girls, he preferred using carbolic acid to burn off the external clitoris. (Later forms of medicalized 'female circumcision' were not usually as extensively harmful, or even done for the same reasons.)
` When this was being promoted in the U.S. and some other countries,
even the female circumcision rituals of foreign cultures were
interpreted as being done to get rid of 'foul-smelling' smegma in females, thus ignoring their religious significance.
` This eventually came to an end in the twentieth century, partly
because it was so widely believed that women had no sexual needs unless
they were mentally deranged. As for male circumcision, the fact that we
know sex is healthy is a great reason to stop doing it:
A Unique Erogenous Zone
Although the technical details are known today, the foreskin was already well-understood by Renaissance anatomists as to be the most erogenous part of the penis, while the glans was known to be the dullest.
` This knowledge carried on into the 1800s, which is why the Americans
(and later, other Anglophones) targeted it in their anti-masturbation
crusade. Let's take a look at its role in sexual function, as understood
by modern medical science:
The Semmes-Weinstein esthiometer
is used to test skin sensitivity for patients with burns or
neuropathy. The readings from a man's foreskin, particularly the mucus
membrane of the 'lip' and inner surface, go off the high end of the
scale.
` A 2007 study,
published in BJU international, mapped the fine-touch sensitivity
regions on circumcised versus intact penises, concluding that:
"The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from theThe authors' fine-touch maps can be seen below, but first a bit of explanation about what is pictured in their illustration:
external to the internal prepuce is the most sensitive region of the
uncircumcised penis and more sensitive than the most sensitive region of
the circumcised penis. Circumcision ablates the most sensitive parts of
the penis." (Emphasis mine.)
The foreskin is packed with fine-touch nerve endings called Meisner's
corpuscles. You can sort coins by feeling the edges using the front of
your hands, which are dense with Meisner's corpuscles, whereas this is
not true for the backs of your hands.
part of the penis, but in fact it is dominated by free nerve endings,
which primarily sense pain. It has about the same fine-touch sensitivity
as your
earlobe, and wouldn't be of much use for penile coin-sorting. (If you're
into that.)
` The glans is less of an erogenous zone and more of a device to hold
the foreskin in its proper shape and to keep the inner surface moist:
Its presence only makes functional sense when one considers it is meant
to work with the foreskin.
Since most people of the world know this next part, I feel as though I'm
trying to reach folks of some remote, uneducated village when I explain
this:
` As the penis becomes erect, the foreskin is pulled back, rolling
inside-out, everting its most sensitive areas, and (usually) exposing
the glans. It can also be retracted simply by pulling the skin of the
shaft toward the body. (You can view an animation and videos here.)
` When fully retracted, the foreskin is just about sufficient to cover the
entire shaft: Although the length varies, it makes up approximately one
half of the skin on the penis.
` What is removed by circumcision
is about
three inches long and five inches in circumference -- think of a 3x5
index card. That's the actual size. Although it is sometimes described
as a 'tiny little piece of skin', this is only true of tiny little infants, not sexually active men.
It seems almost a joke to think that so many adults in such developed Western regions as the entirety of North America are completely unaware of this. Sadly, it's not:
` I was once inspired to show a few such people two pictures of the same
intact member -- one hanging and one standing tall -- and most of them
thought that the erect one was missing its foreskin. They didn't realize
that it retracts!
` This relates to misconceptions I've heard that the glans is most
sensitive, that the foreskin impedes sexual function by covering the
glans during intercourse, and even that circumcised men have more
sensation and a richer sex life because of this.
` This is maddeningly contrary to the facts, as we shall see, with a
detailed understanding of what this sexual structure is and does:
The human foreskin contains up to 20,000 nerve endings, which is
significant, since they make up about half the nerve endings of the
entire penis. In fact, the human penis has a more innervated and well-developed foreskin when compared to other mammals -- including our close cousins, the sex-crazed bonobos.
` So, we must ask ourselves, why would millions of years of natural --
and sexual -- selection, result in humans having an unusually large and
highly-developed foreskin (and a larger glans to work with it), if it
were somehow harmful, disadvantageous, or "vestigial" as is popularly
believed?
True to its retractile nature, the foreskin is made to be pushed back
and inside-out as it slides into the vagina, so that its more sensitive
inner surface is exposed to the vaginal wall.
` As the penis is withdrawn, the foreskin is pulled forward again, so
that it squeezes against the sensitive ridge at the base of the glans,
and perhaps farther.
` This inside-out motion, partly aided by the foreskins' own muscular
action, is unique in human physiology: It allows the man to roll the
skin of his penis against itself, either during sex or just by grasping
his shaft with two fingers and thumb.
` This creates a gliding sensation that is not abrasive or drying to the
partner. Indeed, the foreskin adds its own lubrication and erotic scent
from smegma, which is laced with pheremones.
` This scent is revealed only when the man gets an erection, so it's not
as though he always smells, as my friend Bill had imagined. It is
important in chemical signaling for the female, just as female smegma is
an important signal for the male.
` In most cultures, the smell of smegma is widely considered a turn-on
in both females and males. It is unclear exactly how important this is
to human sexuality, but it is interesting to note that circumcised male
lab rats have trouble finding a mate.
Without the foreskin's action and natural lubrication, the glans may
tend to 'squeegee' away the vagina's own fluids, often requiring the
repeated addition of artificial lubricant. [This is no joke: It's a huge
problem for me.]
` Another common complaint is that the non-moving skin of the
circumcised penis (even with a condom) creates friction and even
microtears in the vagina or anus of the partner. This, as you may guess,
can precipitate the transmission of HIV and STDs in general. [This can
hurt a lot.]
` However, the movement of the foreskin (with or without a condom)
prevents any friction at all. This is generally preferred by sexual
partners who have had experience with both, although this varies
somewhat by culture.
At least since the Taylor study in 1996,
the specialized structures of the foreskin have been known -- although I
have yet to see an anatomy book that mentions them at all. Two are
rather important for this discussion:
` The most erogenous tissue of the foreskin is to be found in the
frenulum and ridged band. A frenulum is a cord-like fusion of flesh
which holds a moving structure to a fixed structure, like the one found
under your tongue.
` The penile frenulum
anchors the foreskin to the underside of the glans and is highly
sensitive to stretching (which it does a lot of during intercourse and
masturbation). It is partly or totally removed with circumcision.
Contiguous with the frenulum is the ridged band,
a ring of ridges just inside the tip of the foreskin. Each ridge has
three times the density of Meisner's corpuscles as your fingers.
` When the member is flaccid, this band serves a protective function in
sensing foreign objects around the urethra: The sensitive ridges in your
lips and anus partly serve a similar function in guarding those
orifices.
` While engaged in vaginal intercourse, the ridged band is rolled far
back on the penile shaft, facing outwards. This may be to encourage
deeper penetration, thus getting the sperm closer to the eggs.
` Much like condoms with large 'ribs', the outwardly-projecting ridges
stimulate the sexual partner. The ridged band also 'catches' on the
clitoris and inner labia of the female, suggesting that these structures
co-evolved for this purpose.
` On the out-stroke, the ridged band is pressed between the partner and
the coronal ridge of the glans. The ridged band is usually removed
entirely by circumcision.
You can see the ridged band and frenulum in red here, which indicates
the highest sensitivity level (or lowest pressure needed for the subject
to notice it) as measured using Semmes-Weinstein monofilaments. The
yellow of the glans indicates the least sensitive tissue, requiring 1.1
grams of pressure.
I have also learned of many pleasurable acts that can be done with a
foreskin that circumcised males cannot do. For example, a partner can
pull the foreskin forward over the glans and slip his/her tongue between
them, thus stimulating two surfaces at once.
` Another technique involves pulling the foreskin forward and outward
and directing a jet of water to flow underneath it. Even just pinching
the foreskin shut during urination, allowing it to 'balloon', activates
its stretch sensors in an unusual way.
` (This also can happen naturally when a boy's foreskin is partially
separated, which is harmless, but sometimes confounds parents.)
` Such inflation can also be achieved with air -- a different type of
"blow job", shall we say? It is also possible to use the muscular tip to
stimulate the nipples, clitoris, or other parts of the partner:
` In the case of male-on-male sex, there is the practice of 'docking',
which means to pull the foreskin forward so that it envelops the
partner's glans. If both partners are intact, they can do
'double-docking', with one foreskin within the other.
` In fact, stimulating only the most erogenous areas are enough to elicit an orgasm. Indeed, the foreskin is thought to play an important role in controlling and modulating male orgasm.
Geisheker challenges the audience to find a book in the University of
Washington medical library that says the foreskin is the seat of sexual
sensation. Most medical books do, but all the books at UW he has seen
have incorrectly said it is the glans.
This is also what Bill had told me, back in 2002, after revealing his
shocking news. (But who could blame him? He got that from a medical
text!) He also said that the foreskin was the least sensitive part of
the penis, which is also a common belief I have heard.
` No matter what I said, he insisted that the part's only function was
to protect the glans, and is no longer needed because humans wear
clothes. What I discovered at the library was that the glans is covered
in mucus membrane and is meant to be an internal structure which can be
exposed, like the tongue:
` When left exposed to the outside world for weeks, the glans develops a
layer of dead, dry skin -- especially when there is clothing rubbing
against it -- thus blocking the sensitivity of the underlying nerves.
` If the foreskin is restored and the glans is re-internalized, this
callus will actually dissolve within two weeks, improving sensitivity.
(BTW, this can be done via 'tugging' devices or even tape, which expand the tissue without surgery. Such techniques are becoming popular as awareness of these facts spreads.)
Bill had been right in saying that the foreskin has a protective
function, but he was wrong about the details: One aspect of this
function involves the dartos
fascia, the layer of muscle fibers that pulls the scrotum
towards the body.
` As I have hinted at already, this layer is
also
found in the foreskin, which allows it to close over the glans and pull
it inward. This is handy in cold water, and even helps to prevent
frostbite.
` The smegma of the inner surfaces also contains
chemicals and immune cells which protect the penis from microorganisms
and viruses. For more information (and citations) on foreskin functions,
you may want to start here.
To say that circumcision has no effect on sexual pleasure or function is
to be dishonest about how the penis works, or neurology, for that
matter.
` Indeed, removing half of penile nerve feedback can well cause a number of problems, from erectile dysfunction to premature ejaculation
, which are more common in circumcised men.` Although the literature shows that men who are circumcised work harder
for sexual satisfaction, and to this end must practice more types of
stimulation, this is re-interpreted by pro-circumcision advocates to
mean that circumcised men have more fun and get more oral sex.
At TAM 2012, I talked to a man from Denmark, who told me that some girls
get the idea from American porn that vigorous motion and lots of
lubricant is needed to stimulate a man.
` As they become more experienced with Danish men, who are almost all
intact, they find this not to be the case. I actually wrote about this
near the bottom of this post.
` Indeed, there are a few studies that purport to show that circumcision
has no effect on penile sensitivity or sexual function: That is because
of fatal design flaws, including that the scientists are measuring everything but the foreskin:
What they found was that the sensitivity of the glans and shaft skin are
not that much different whether or not you have a foreskin, yet they
are completely silent about the sensation that comes from the foreskin
itself.
` So, nearly half the penis' sensitivity is entirely omitted and
ignored, rendering this research worthless. To conclude that removing
the foreskin doesn't affect the penis is to pretend that the foreskin is not part of the penis.
` This page
gives a pretty good analysis of these studies in detail, as well as the
effect on sexual partners, and comparing infant versus adult
circumcision on sexual function.
As for the idea that the foreskin is not part of the penis, this is
actually a deeply-rooted cultural belief. I remember this occurring to
me in 2006 when riding in the backseat
of a friend's car one rainy night.
` The rear windows were fogged, and the
person next to me made a mark by touching the glass, saying "I think
I'll draw a penis." Because it is difficult to draw anything in a
moving vehicle, the drawing turned out a bit mishapen, so he said,
"Well, it can be an uncirumcised penis."
` Something clicked in my mind. To him, a penis was always circumcised, unless it had a foreskin "added" to it.
` Wait... what?
` That
would explain why I had heard the foreskin described as "extra" skin. If it's normal, how is it extra?
` This parallel reality was no doubt created as a way to make this
operation more palatable to people who don't want to believe they or
their loved ones were harmed by
it.Some have said that I'm against letting a man have the freedom to harm
himself in this way if he wants, but this is not so: I would, however,
insist that he understand the consequences, as he will have to live with
them.
` Many adult men who chose circumcision for themselves have regretted
it, and some who have chosen it as medical treatment were misled into
thinking that it was the only or best treatment option when it was not.
` For example, a genuinely tight foreskin can often be fixed with
stretching, steroid cream, different masturbation techniques, or even
surgery which does not remove tissue. Some guys, unfortunately, were
misled by their doctors into thinking that foreskin removal was their
only hope.
In 2005, I interviewed a guy who had at age two, bizarrely, retracted his own
foreskin. This injury to his frenulum led to pain and bleeding during
sex, and his doctor told him that it needed to be removed, along with
the rest of the foreskin. He went along with the operation, if
reluctantly.
` After the intense pain had subsided, he found that he had lost a lot
of sensation, responsiveness, intimacy, and confidence. He had to learn
how to achieve orgasm all over again. He had traded a medical condition
for an overall decrease in sexual satisfaction.
` He felt a very strong sense of loss and grief for two years before he
was able to pull himself back together and adapt, which you can read
about on my ancient blog post here. It's just one anecdote among many, but along with the scientific data, it shows that there can be a real difference.
In European, Japanese, and other cultures in which circumcision is
very rare, they have developed a substitute surgery called a 'sleeve
reduction', or removal of a section of penile skin from the shaft.
`
This permanently retracts the foreskin and gives the look of
circumcision, while exposing the most erogenous tissue on the outside.
Although this is still damaging and painful, it shows that the people of
some cultures value the foreskin too much to cut it off.
When a man voluntarily has his own genital bits cut off, it is his
choice, based on the information that he knows. But how can we justify
his doing it to another human being who has no idea of what is going on
and cannot defend himself?
` I am talking about the infant, usually screaming in pain, or the young
boy who only knows what others tell him about what is being done to
him. Most intact men would not choose this for themselves.
` Although circumcised boys are usually told what was done to them and
that it was for the best, some reach adulthood before they learn what
was done to them. If this was so shocking for me to learn, imagine how
shocked they must be at the ignorance of their own bodies!
Because Bill was a hardcore believer in the myths his parents taught
him, he was so stunned at the information I found that he refused to
believe any of it. I brought him photocopies and printouts of journal
articles and medical texts, but he rolled his eyes at them.
` "The foreskin can't have any real function," he said, "otherwise they wouldn't cut it off." ("Appeal to Consequences", anyone?)
Fraudulent Diagnoses and Questionable Ethics
As we know, the reason it is cut off is because it has a very definite
function, which was most threatening to many Americans of the Victorian
era. Even more, a tight foreskin was thought to cause all manner of
illness, from hydrocephalus to lunacy:
` In his presentation, Geisheker brings up the 1881 assassination of James A Garfield by the insane
lawyer, Charles Guiteau. Famously, Guiteau danced to the gallows, recited a poem, and shook
hands with his executioner before hanging.
` Upon autopsy, it was
discovered that his foreskin was tight, and so his insanity was blamed
on that. Such was the mentality of the people at the time.
This 'diagnosis' can largely be blamed on a medical doctor named Lewis Sayre, who claimed
to have cured a boy of Polio by circumcising him. Like many others of his ilk, he had no proof of
this, he just assumed so because the patient never returned.
` I wouldn't have, either.
` In 1870, Sayre gave a
speech about the harms of normal foreskins, which he called
'congenital phimosis' (cannot be retracted) and 'Adhered Prepuce' -- in
other words, the normal fusion found in boys until at least ten years of
age.
` Today, there are still some doctors who apparently think that a
normal, healthy foreskin is 'adhered' in 'congenital phimosis', or even 'redundant' for its long, tapered look.
` In the billing book for medical
procedures, a Code 605 refers to "redundant prepuce and phimosis, adherent prepuce,
phimosis congenital."
` Many healthy children are fraudulently diagnosed and subsequently circumcised under this billing code -- because there is nothing wrong! Wait, what?
The process of circumcising infants has been brutal, especially since it was once assumed (also thanks to 1870's pseudoscience) that infants do not feel pain. That's right -- even open-heart surgery has been performed on infants with zero pain control.
` In reality, the younger a child is, the more pain he or she
experiences, and it is especially acute in newborns. These facts, and
their relation to infant surgery, did not begin to be explored until the
1980's.
In 1934, the Gomco clamp was invented to minimize the likelihood that
the infant would bleed to death if someone other than a surgeon did the
operation, and without any type of pain control.
` The erogenous tissue is torn from the infant's glans and crushed,
excruciatingly, into goo. When the clamp is removed ten minutes later,
the wound doesn't bleed.
` The shallow bell
is actually meant to maximize the amount of erogenous tissue that is
lost. And yes, it is commonly used today in U.S. hospitals, with little
pain relief, if any: This is because anesthetics are dangerous and not
fully effective in infants, including nerve block techniques.
Another circumcision device is the Plastibell clamp, which strangles
the erogenous tissue over an entire week. The pain and discomfort from
this process commonly interferes with breastfeeding, sleep cycles, and
parental bonding.
` Whatever the method used, the glans is afterward revealed as a raw, open
sore, and the infant is almost never prescribed pain relievers. When he urinates, the ammonia burns the open sore.
` This wound takes weeks to heal, and
complications (besides the intended damage) are not as uncommon as is widely believed:
` Meatal stenosis isn't counted as a 'complication' because it doesn't
occur until three months after the procedure, and sexual problems of
course do not count because they become evident much later on. And there
are more problems which are not mentioned:
Ironically, the study of anesthetics on infants during circumcision has
had to stop because it is considered to be grossly unethical: The
intense pain (measured in infants' stress responses) is far too high to
justify further study.
` Typical pain responses include an extremely fast heart rate, very high
levels of cortisol (stress hormone), and high-pitched screaming,
sometimes until the infant turns blue from lack of oxygen. The fragile
newborn's heart, lungs, and other organs can be damaged or ruptured from
being overworked.
` Although some parents may believe that their own son "slept through"
his circumcision, this is what they are told when their baby goes into
shock and doesn't respond to any stimulus.
` These are exactly the type of responses that we would expect in an
adult whose genitals are being torn apart, yet this may be framed as
'discomfort'. Wouldn't 'torture' be more appropriate?
This extreme trauma is known to cause a sort of PTSD in infants, similar
to the effects of other types of surgery or a traumatic birth, and can
lead to a variety of psychological and emotional problems later on in
life.
` It doesn't matter whether the individual has any conscious
("explicit") memory of this because most types of memory are stored
outside of conscious awareness in the involuntary ("implicit") systems
of the brain and body.
` Similarly, circumcised infants, as with preemies given a heel
stick or scalp IV, show neurological changes that cause a permanent increase in sensitivity to
pain. In other words, intense pain in an infant re-wires the brain for life.
` I should also note that compared to intact boys, the circumcised ones
tend to be more irritable, have trouble eating, sleeping and thriving,
and demonstrate a significant increase in 'colic' (crying for no
apparent reason) for up to a year after this 'procedure'.
` A whole spectrum of emotional reactions to being put through this in
one's infancy become evident later on, and they (naturally) include a
sense of loss and grief.
` Although foreskin reconstruction is becoming more popular today, with its own market, it was only in 1990 that desiring one's lost foreskin was suggested to be a form of "body dysmorphia".
For more information, and citations, you may want to start here.
As though that wasn't bad enough, what about unintended injuries and
trauma? Surgical mistakes and infections can result in more problems,
from an inability to urinate, to even more tissue being excruciatingly
cut away from the infant, sometimes his entire penis and more.
` Infections can also, more rarely, cause brain damage and death. Even
if this procedure goes 'right', the penile skin often attempts to
re-fuse itself together, resulting in abnormal adhesions, which require
further tearing apart.
` In the long-term, the boy's penis may grow too large to fit within the
skin that is left, and may bend or even tear open when he gets an
erection. This may require further surgery to add skin to his penis.
` Indeed, a seemingly long prepuce in infancy can turn out to be quite
short in the adult. This cannot be predicted in infants, which is
another good reason to wait on this question, and leave the decision to
the person who is affected by it.
More popular myths that Bill told me was that the foreskin is prone to
disease and is too hard to clean under to be worth the bother. In
reality, the easily-retracted adult foreskin only needs to be briefly
rinsed in the shower; therefore, it is easier to clean than behind one's
ears.
` As we shall see, this misunderstood and vilified body part has not
been shown to be a vector for disease. If it was, our ancestors wouldn't
have evolved it in the first place, much less a particularly extensive
one.
` Indeed, you don't see other species scrubbing their penises -- not even bonobos.
The cleanliness myths began in the late 1800s, with the idea of 'moral
cleanliness' in the eye of God as he watches you masturbate. By the
early twentieth century, the meme had changed to physical cleanliness
and preventing STDs.
` However, when all the literature over the years is taken together (including many reviews),
it shows that circumcision slightly increases one's chances of getting
certain STDs, while slightly decreasing the chances for others, and there
are different statistics between cultures. All in all, it's a wash.
` Child circumcision was not common in the early 20th century, but
because of the STD-prevention belief around World War I, the militaries
of English-speaking countries were all but forcing sailors and soldiers to be circumcised -- as most of them refused to go along with it.
` (In Geisheker's audience, one guy said his uncle was an aircraft mechanic, but at 45 years
old he wasn't allowed on a Naval aircraft carrier to do work unless he was circumcised for some health and safety code. So, he
was, and regretted it. Scary stuff.)
In the 1930's, childbirth had become medicalized, and those doctors who were
experts in female health (yet knew little about male health), were
enthusiastic in promoting and performing circumcision on the newborn
males. Their inexpertise was what the Gomco clamp was invented for.
` By the start of World War II (during which we find the sand myth),
newborn circumcision was beginning to become popular in the U.S., and
almost as popular in Britain, although this changed when the U.K. was
devastated by the war.
` With so few resources, U.K. doctors didn't see any point in continuing
unnecessary and dangerous surgery, so they put an end to it. At the
same, the practice took off in the U.S., because it was funded by most health insurance
packages, and fueled by advice from the popular press.` This includes the influential child expert, Dr. Benjamin Spock,
although to his credit he later recanted his position. By the end of the
1950's, almost all newborn boys in the U.S. were subjected to this
procedure, whereas almost none were in the U.K.
` Although child circumcision had spread to a number of English-speaking
countries during the early 20th century, nowadays this practice is
long-gone from most of them. And then there's South Korea.
During the Korean War, MASH doctors imposed circumcision on the South
Koreans, claiming that it improved cleanliness. Now South Korea has one
of the highest penile abridgement rates in the world, and it is
typically done to ten-year olds, just as their foreskin begins to reach
its adult potential.
` At the library way back when, I remember reading a very detailed
report about the history and cultural beliefs about this South Korean
phenomenon.
` Most of the South Koreans who were surveyed believed that people from
all developed countries practiced routine circumcision -- which is a
popular belief in the U.S. as well.
` These South Koreans also believed that if it wasn't done, they had a
very high chance of developing 'phimosis' and needing to be circumcised
anyway. So popular was this misconception that they called it 'the
phimosis operation'.
` I also recall that many adults in South Korea had this done to
themselves, partly due to a combination of collectivist culture and
public baths -- everyone must do the same or else be looked down upon!
` Interestingly, those men who said that they experienced sexual
problems after this operation were able to describe what was wrong,
whereas those (fewer) men who said it helped their sex life did not
explain how. Were they just saying what was expected of them?
And then there is the medicalized circumcision of the Philippines, which
is partly influenced by Americans. Slitting the foreskin of eight-year
olds (without removing tissue) has morphed into outright
foreskin-severing as a rite of passage.
` The Filipinos have their own unique cultural myths
about medicalized routine circumcision, such as that it stimulates
growth in the boy, and that it will increase his virility as an adult.
` When you think about it, this is just as silly as the myth that a
normal infant's penis has a medical problem, that females don't produce
smegma, or that the foreskin gets in the way of sexual pleasure -- and I
am surrounded by people who believe these things!
Culture versus medicine
Besides cultural beliefs and customs, the only thing which supports circumcision
is religious rituals. This is why the second-largest group of people to
practice circumcision, after Americans, are the Muslims of the world.
` It is worth mentioning that most Jews in South America and
parts of Europe don't bother with this ritual anymore. As for the handful of Jews in N.Z., they fly
mohels in from Australia for $5,000.
` And, if you're tempted to accuse Doctors Opposing Circumcision of being anti-semitic, it
should be noted that the VP is an observant Jew who has restored his
foreskin.
I do think that people should be allowed to express
their own religious beliefs on their own bodies, but they should not be
allowed to impose their beliefs on other people's bodies, especially
children, who cannot consent or understand.` The practice of withholding
medical treatment from children, especially when they have cancer,
diabetes, infections, etc. is widely looked down upon as religious
abuse. So are 'female circumcision' rituals.
In many cultures outside of the U.S., male circumcision is viewed in the
same way. Most industrialized cultures do not give routine circumcision
on minors the legitimacy of medicalization.
` During my first library endeavors, this became clear to me when I
noticed a very interesting difference between relevant entries in an
American medical encyclopedia and a very similar-looking British medical
encyclopedia:
` Both contained nearly the same information -- basically, highlights of
what I'm covering in this post -- but the American version was written
with a completely neutral tone whereas the British one had a distinct
note of relief at the news that Americans are finally starting to learn
not to chop at their infants.
` As for today, infant circumcision rates in the U.S. are continuing to drop, and are now around 50% or lower.
Even so, the
Americans who have not learned have instead been inventing and recycling ideas each decade in
order to justify continuing it. This includes the continuation of the old idea that it
prevents sexually transmitted diseases.
` It is worth pointing out that New Zealand, where Geisheker is from, they stopped routine infant
circumcision 40 years ago and have lower rates of STDs than the U.S..
Clearly, there are scientifically valid ways of prevention, such as sex education and
condom use, which is often lacking in the U.S..
More importantly, I feel that I should point out the obvious -- that
infants don't have sex. Would it not be more appropriate to wait until
the individual is old enough to make a judgment about his own sex life?
The same could be said in the case of sexually transmitted HIV
prevention, which is re-gaining popularity in the U.S. as an argument
for circumcising infants.
` This connection was first proposed in a 1986 letter, by Canadian
urologist Aaron Fink, who had self-published a book advocating
circumcision. He promoted the unsupported claim that the callus that
forms over the glans of circumcised males creates a barrier to HIV.
` In February 1996, Scientific American printed an article about
the Caldwell retrospective analysis of HIV and its prevalence in those
African populations who circumcise versus those who do not.
` They concluded that HIV is more prevalent among those who are intact,
although they did not examine any of the patients. Vincenzi and Mertens
(1994) pointed out serious flaws in the design of this study.
` This was pointed out in two letters to Scientific American, but they
were heavily edited for publication, and the criticisms went unaddressed
by the Caldwells in their rebuttal.
Even since then, most similar studies have a small sample size and
contain many flaws, including guessing whether or not a subject is
circumcised, based on which culture he is from.
` Due to publication bias, studies which are purported to show a
connection between HIV and circumcision are more likely to be published
than studies which show no correlation at all.
` Dozens of such studies did not take into account other confounding
factors such as the practice of 'dry sex', which creates lots of
friction and tears in the vagina, nor genital ulcer disease, viral load,
or female circumcision, which is also done in cultures which practice
male circumcision.
` A 2003 Cochrane review points out all these flaws, and "found
insufficient evidence to support an interventional effect of
male circumcision on HIV acquisition in heterosexual
men."
` Also, it is worth pointing out that researchers who are white males of
nations that have had a history of circumcision are the main proponents
of this correlation.
The resurgence of this meme is based on three recent and incomplete
studies, which were done in Africa partly because the ethics committees
in other parts of the world would not approve. Only one of these studies
(Auverts, 2006) was actually published in a peer-reviewed journal.
` The clock for the experiment started when
half of the volunteers were circumcised at random. While the intact men went off to have sex,
the circumcised group had to wait four to six weeks, as they were in too
much pain for intercourse.
` Also, they had to come back to the
clinic twice more to make sure they were healing properly, where they
got additional safe sex counseling and condoms. Not only that, but this
study also did not control for blood
exposure or homosexual intercourse.
` On top of this, the researchers used an HIV antibody test, which only
gives results from three months since the last exposure. However, they
did not wait three months after the duration of the study to administer
the test.
` Based on this dubious data, the conclusion is that heterosexual men
are 60% less likely to catch HIV from infected females with each
exposure. And how was this determined?
As Geisheker explains it, this study showed a very low incidence of HIV
in the
intact subjects, and a slightly lower incidence in circumcised subjects.
It's like comparing 1.5% versus 1%, and declaring that there's a huge
difference between the two.
` So, the 60% rate is relative, not absolute. If this were a vaccine, it
wouldn't be considered very effective. And the Gates Foundation is
funding this.
There has long been plenty of evidence against this connection, even for
adult men who might want to protect themselves from HIV in Africa. Even
worse, some of these men believe they are protected from HIV and don't
necessarily need a condom at all.
` On top of that, this newest wave is inspiring some journalists and
even doctors to spin fanciful tales that these African studies justify
doing circumcision to infants living in quite different conditions in
the U.S..
` There is also some evidence in industrialized cultures that
circumcision does not decrease HIV transmission, simply because the U.S.
has both the highest circumcision rate and highest HIV incidence of any
industrialized nation.
Another popular justification for slicing infant dicks which is
trumpeted to this day is the claim that it protects against penile
cancer.
` This idea started in the early 20th century from the
circumcision-promoting Dr. Wolbarst, who proposed that smegma is
carcinogenic (which was disproven), and that circumcision stops
"epileptic fits" (actually orgasms) in boys.
` Of course cutting off a body part will prevent it from getting cancer
-- you can't get cancer on what isn't there! However, penile cancer is
extremely rare, even more rare than earlobe cancer.
` If we think that the risk of penile cancer is worth cutting the
foreskin off, then why don't we cut off our earlobes if that is even
more likely to help? Also, why don't the folks at the American Cancer Society agree that this is a reason to circumcise infants?
` According to them, "it would take over 900 circumcisions to prevent
one case of penile cancer in this country." That's a pretty extreme
health measure, don't you think?
An oncology nurse in Geisheker's audience said that there isn't any association at all between
penile cancer and foreskins. It's just a meme, but if you're a lazy journalist, you'll
pad your article with these types of dubious claims and statistics.
` She said that when debating this issue with a urologist, she brought
up breast cancer, which 1 in 12 women will eventually develop. "Would
you remove breast buds off a girl?" she asked.
` The urologist said, "You're right, we
shouldn't do it." Besides, at this rate, infants are more likely to die of the circumcision itself than
to die of penile cancer as adults.
Indeed, infants don't get penile cancer at all, men do, so again, it
would make more sense to let him judge this matter for himself.
A similar argument has been made that circumcision prevents transmission
of HPV, and thus cervical cancer, in women. This is also completely
untrue and based on fatally-flawed studies, which you can read more about here.
` What is most outrageous with this claim is the idea of causing
significant and irreversible harm to an unconsenting infant, in
anticipation that it may have some effect on a hypothetical female
sexual partner in the future.
` It's not meant to help the unconsenting infant who's being operated
on, but rather, someone he may never meet. He may, for all we know, turn
out to be gay. Also, such a concern of HPV should be outmoded, since
there is now an effective vaccine against it.
Then, of course, there is the the tired old argument that it prevents
urinary tract infections. This began with the Wiswell study (yes, really), which
compared the rate of UTIs between circumcised with intact babies.
`
There were a few fatal flaws, including instructing the
parents of the intact boys to repeatedly retract the foreskin and wash
under it. Which, as we know, is a known cause of infection -- this
includes UTIs.
The larger picture here, of course, is that UTIs are generally no big
deal -- they are easily treated with antibiotics. In fact, young girls are
four times more likely to get UTIs than intact boys, and no surgery is
recommended for them.
` There is also no evidence that foreskinless prevents UTIs in adults, even though it is sometimes
recommended for chronic ones. It shouldn't be, because chronic UTIs are
caused by internal problems, not external ones.
` In any case, it is ludicrous to put weight on foreskin-chopping in
infancy as a treatment for such a minor and treatable problem, even if
the literature did show a benefit. The treatment is far worse than the
sickness!
Interestingly, in the United States, the highest rate of circumcision
centers around Michigan, home of Kellogg -- coincidence? Of course, the
Midwest also has more Medicaid subsidies that pay for it.
` Out
here in Seattle, and other U.S. locales where circumcision is not nearly as common,
the children are no sicker than the ones in the Midwest.
In New Zealand, Geisheker's home country, they completely gave up
routine circumcision 40 years ago, and NZ children are healthier
than U.S. children today.
` Also, the rate of circumcision in Australia has plummeted in recent decades, while at the same time, health among children has improved, due to better healthcare.
` Geisheker also works with European and Australian doctors, who think
that Americans are a bit backwards when it comes to chopping babies'
perfectly healthy genitals. According to most doctors of the world, it's
a bad idea:
After reviewing the currently available evidence, the RACP-- The Royal Australasian College of Physicians, 2010.
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.
Circumcision of newborns should not be routinely performed.-- The Canadian Paediatric Society, 1996.
There is no convincing evidence that circumcision is useful or-- The Royal Dutch Medical Association, 2010.
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.
While most doctors of the world discourage this practice, doctors in the
U.S. frame the situation differently. Their arguments for child
circumcision center around motivating parents to feel comfortable with
choosing this for their unconsenting children.
` The parents don't want to hear that they, or loved ones, have been
harmed, and so are more willing to believe that it's for the best.
Extraordinary claims sometimes require extraordinary justifications, and
we can see some level of parallel with female genital mutilation.
` In one African culture that I have heard of, it is believed that when a
woman gives birth and the baby's head touches her clitoris, both will
die. We know this is ridiculous, since we see that it doesn't happen.
` In the same way, outsiders ridicule the "disadvantages of a foreskin"
that I hear all around me, particularly if they never occur in real
life.
In college, I wrote a paper on child genital mutilation (yes, really)
and I remember reading an article about immigrants to the U.S. from
someplace in Africa. They believed that the clitoris causes women to
like sex "too much" and engage in excessive sexual behavior.
` When they saw a pregnant teenage girl, they would say, "See? Americans
need to circumcise their daughters. I would not let my daughter keep
her clitoris!"
` If this is shocking to you, then good: This is basically how most
people of the world regard parents who say their son needs to have his
most erogenous zone cut off.
` Many of the immigrant women did not know what a clitoris is, nor what
they were missing. This may seem dismaying to you, and it is equally so
to me when I am asked by a full-grown man what a foreskin is.
` Even worse is the ones who don't know, but they don't realize they don't know.
Only a few years ago I heard of a controversy in Egypt, where 90% of
women are circumcised, over whether the female practice should be
medicalized.
` As per Egyptian culture, some doctors recommended removing the prepuce
of the clitoris, with the belief that there was medical evidence that
this protects against HIV.
` They called this procedure 'female circumcision', but they called
removing the entire clitoris 'genital mutilation'. Other doctors said
that was an unfair characterization and that all of this is female
genital mutilation.
Since the bias against some genital parts over others is based on
cultural beliefs, I wondered about other body parts that might be
discriminated against. One example is to be found in a book by Carol
Tavris and Elliot Aronson.
` The title should give you a clue -- Mistakes Were Made (But Not By Me): Why We Justify Foolish Beliefs, Bad Decisions, and Hurtful Acts.
` It's about how people solve their cognitive dissonance between their
image of themselves as a generally good person, and facts which seem to
contradict this.
` The book opens with the Nuer and Dinka tribes, and a much stranger
coming-of-age ritual: Surgically extracting the front teeth with fishing
hooks -- two on the top, and up to six on the bottom.
This is extremely painful, somewhat risky, and in the long-term, causes a
gradual atrophy of the jawbone, especially a caved-in chin. What could
possibly possess anyone to do this to their own children?
` It is thought to have been their solution to an outbreak of tetanus,
in order to keep children from starving to death through clenched jaws.
Over the years, it became a coming-of-age rite, 'normal' for everyone in
the tribe.
` Now the general opinion amongst tribe members is that people who have
all their teeth look frightening like cannibals, or silly like donkeys.
They also say they prefer the whistling sounds they make when they talk.
These post-hoc justifications are a way to resolve the cognitive
dissonance between causing harm to children, and having had harm caused
to them. Besides, it's just normal to them!
` This very same point is repeatedly made by researchers concerning the
U.S. bias against foreskins, and the billion-and-a-half dollar industry
based on cutting them off.
` Indeed, there are a million infant circumcisions done in U.S.
hospitals each year -- it is the most common surgery in the United
States.
Instead of allowing the individual to enjoy his own erogenous zone, it
is tossed in the incinerator, or sold to companies such as Invitrogen for other people's profit and benefit.
` That's right -- genital parts ripped from uncomprehending infants are made into Apligraf Magic Skin Treatment, and even Oprah has been criticized for pushing a skin cream made from baby penile cells.
` It seems that in the U.S., the male prepuce is valued more as a
commodity than as a rightful part of a person's own body. (Yet, the
reverse is true for the female prepuce.)
` There's a difference between donating an organ and stealing an organ. Which is this? Whose body is it, anyway?
I once made this point to a former housemate of mine who was pregnant with a boy.
` Although I had previously talked with her about this subject, twice,
it evidently had no effect. She personally didn't like the look of a
normal, intact penis, and wanted her boy to match his friends.
` I explained to her that only 30% of newborn boys are circumcised in the Seattle area, so he would actually be unlike most of his friends.
` She replied, "So?"
` Then I told her why most other societies in the world look down upon chopping off the most sensitive part of the penis.
` She said, "Who cares what they do in other countries? I want to do what Americans do!"
` I switched tactics and asked her, "Whose penis is it? Is it yours?
What if your dad had part of your genitals cut off because he didn't
like the way they looked? How would that make you feel?"
` Unable to answer in a rational manner, she started screaming about how
it was her right as a parent to make this decision and how dare I tell
her what to do, or even care about it at all, as it was none of my
business.
` "It's my child, it's my choice!" she shouted, and stormed out of the
room, slamming the door. Although her emotional reaction was quite
strong, it is not that different from more typical incidents I have
heard of.
Indeed, instead of centering this surgery around the person who is
affected by it, and letting him make this decision about his own body, I
have noticed that pro-circumcision websites are all about having the
parent choose.
` Displayed on their front pages are comments from parents along the
lines of "I have never regretted my choice," and "I agree, parents
should be the ones to decide."
` What about his choice? Can it wait until he is old enough to
fill out a consent form? He will probably prefer to keep what he was
born with, thanks. Most do.
In response to making this very point, I've heard, "Of course he will
want to keep his foreskin, that's why I shouldn't leave the choice to
him!"
` Sound familiar?
This is why most male circumcision rituals of various cultures are done
on young boys -- they are not large enough to fight back or leave the
tribe. They also don't usually have lawyers to protect them, although
those are employed in North America:
`
Geisheker mentions the 14 year old boy by name of Bolt, whose father
had converted to Judaism and wanted his son's penis to match his. Bolt's
case was turned down by the Supreme Court, but by then, he was old
enough to testify in court. He escaped unharmed and went to live with
his mom.
` Defending male children from circumcision is tough in the U.S. because
no medical license is required -- it can be done by mohels, midwives,
nurses, or parents.
That's partly because it's not medicine.
` In New Male Studies, Geisheker published an article about this, called The Completely Unregulated Practice of Circumcision.
Indeed, in the U.S., most doctors, midwives, and OBGYNs bring up the
question, and frame it as though it is a decision to be made by the
parents. Although I've heard of doctors in Seattle questioning parents
who want to do this to their children, they could do better:
` In
the 1960's, doctors in New Zealand ended the practice by not bringing
it up to parents, and if anyone asked about it, they said that it was an
obsolete procedure that came from England. That was usually enough to
dissuade them.
American medical culture is still full of bias on this topic, as many
European doctors pointed out in response to a 2012 American Academy of
Pediatrics pro-circumcision technical report. Plus, out of eight people
on the AAP committee, four of them had vested interests:
` One had circumcised
his own son on his kitchen table; one was a doctor in Seattle at the
children's hospital who promoted female circumcision; one was an expert in medical financing; and one refused to
reign in a mohel for giving babies herpes via sucking their penis wounds.
Near the end of his presentation, Geisheker demonstrates what Bioethics
101 means. There are a few points to consider when you focus on the
patient's immediate needs, from the point of view of the patient.
Beneficence -- Is the procedure necessary/beneficial?
Nonmaleficense -- Does it avoid harm/suffering
Justice -- Would we choose this for ourselves?
Autonomy -- Is the patient being treated as a separate person or as a member of a community? Can it wait for patient assent?
Proportionality -- Is the risk and pain worth the gain?
As I hope to have demonstrated in this post, non-therapeutic child circumcision fails every one of those requirements.
` He comes to the same conclusion that I grasped many years ago: It is plastic surgery, a phrase that means 'adult'.
This is so obvious to people outside of this sort of culture that they
could easily assume that Americans don't do this, just as Americans
commonly assume that the rest of the industrialized
world does.
` The first time I
discussed this with a non-U.S. person, a man from Ireland, he said he
had no clue of this practice until he saw a variety of American
pornography. He reported feeling repulsed by the strange, vigorous way
that mutilated genitals had to be stimulated.
` The people from Europe that I have talked to on this issue have all
told me that in their countries, male and female circumcision are both
regarded as pointless and culturally backwards.
Indeed, it is a bizarre double standard in North America and some other
places that people can think that hacking at boys' genitals is good, but
that hacking at girls' genitals is bad.
` I think that much of this is related to the deeply-embedded cultural
attitude that the foreskin is not part of the penis. As I've mentioned,
I've seen this phenomenon in person, as well as on TV and in movies.
` Another example is Robin Williams' comedy routine about how
wonderful the male member is, yet his only allusion to the hyper-developed erogenous zone was "an
optional covering". That is like saying that your lips are an optional covering, rather than a functional part of your mouth.
` I once even saw the episode of Penn &
Teller: Bullshit on this topic, and laughed hysterically when the doctor
actually said they use a clamp so as not to "hurt the baby's penis",
while he screams in agony (or "tolerates extremely well").
` It would
be quite a feat to be able to amputate a huge section of any appendage
without harming it, yet that is essentially the claim here.
"Cutting off part of the penis is not injuring it in this
reality, only cutting off more than what you intended to leave," says physical oncologist Ryan McAllister in his presentation The Elephant In The Hospital, which I've linked to below.
` In 2011, someone I'll call 'L' posted this video on Facebook in
response to his brother and wife's adopting what was about to become
most-of-a boy.
` The wife claimed that this is a religious practice
required in Catholicism, which is anything but true, yet is a common belief.
`
The brother, who admitted to knowing nothing at all about foreskins,
said that he was satisfied in the amount of research he had done that he
was making the right choice.
` Instead of clicking on the video, they simply raised a fuss, calling
it a 'family crisis', and forbid L from ever meeting the boy.
In the hopes that someone would learn from this video, I posted it on Facebook (where else?):
Ryan McAllister, PhD What is infant circumcision? Why is the practice
common in U.S. hospitals and not in other countries? What does it
remove...
common in U.S. hospitals and not in other countries? What does it
remove...
He brings up most of the same things that I have brought up already, and
takes a closer look at some of the phallic logical fallacies of this
culture:
Poisoning the well: "It's cleaner, looks better."
Appeal to Majority: "Everyone does it."
Minimizing words: "Little snip", "useless", "flap of skin."
Special Pleading: "Babies don't feel pain or remember."
Appeal to Ignorance: "I can't imagine how it could be harmful."
He examines the cyclic view of a social surgery, that is, one that
removes a healthy unique organ part. Doctors know it's a social surgery,
not a treatment, yet they take advantage of the parents' trust.
` They trivialize complications and don't tell the parents that the
foreskin is a sexual part. They don't bring up ethical questions or
conflicts of interest, such as profit and tissue uses.
` Losing one's job is one possible punishment for doctors and nurses who don't want to do it, or who tell parents not to.
` Not only does it harm children and their parents, it hurts the health practitioners because they are learning to harm people.The AAP ethics committee says that it is inappropriate to allow the
individual to make his own decision, and obstetricians claim that it's
the mother's choice because she is the patient, not her child.
Ferguson's talk show. She said it really is a social and cultural
procedure, and that any health benefits from circumcision can be
achieved through washing.
` Then she says, "You have to choose as a parent."
` "That's a tough choice," Craig jokes.
` Do you have to choose giving your baby a nose job?
` Do you have to choose giving your baby a nose job?
Because of the circumcision craze, David Gibbins, Pediatric Urologist said that in a two year period he was
referred over 275 newborns and toddlers with complications from this social surgery, and almost half needed corrective surgery.
referred over 275 newborns and toddlers with complications from this social surgery, and almost half needed corrective surgery.
There is also the unspoken assumption that this surgery is
inevitable. I have long noticed this, as in "My parents waited until I was six before
they finally had me circumcised."
` Also, Americans tend to use the word 'uncircumcised', which implies
that you're in line to do it eventually. I would not say that I am
'uncircumcised', or 'unmastectomized' for that matter. Women aren't
viewed that way, so why are men?
To my surprise, I didn't get any dissenting comments on the video --
instead, it attracted the attention of an Australian man, who I was able
to relate a few of my bizarre anecdotes to, some of which I have
related in this post.
` I'd display those comments here, but I'm saving them for a future post.
instead, it attracted the attention of an Australian man, who I was able
to relate a few of my bizarre anecdotes to, some of which I have
related in this post.
` I'd display those comments here, but I'm saving them for a future post.
I hope I have made thus far a fairly convincing argument that there is a
clear cultural bias in this matter, based on ignorance, misinformation,
and a desire to justify the damage that has been done.
clear cultural bias in this matter, based on ignorance, misinformation,
and a desire to justify the damage that has been done.
` Pointing out the double standard of 'male circumcision is good' and
'female circumcision is bad', has earned me accusations that I'm discriminating
against females:
` The truth is, I want
everyone to be protected from having chunks of them cut off for other
people's benefits, male, female, and otherwise.
There's a difference
between donating body parts and having body parts stolen from you as a child:
'female circumcision is bad', has earned me accusations that I'm discriminating
against females:
` The truth is, I want
everyone to be protected from having chunks of them cut off for other
people's benefits, male, female, and otherwise.
There's a difference
between donating body parts and having body parts stolen from you as a child:
` A friend of mine is a
man who was born intersex,
and whose penis and testicles were removed when he was an infant. His medical records were destroyed and the truth
was kept hidden from him by his family and all his doctors until he finally solved the mystery himself in middle age.
` I know
something of the anguish and impairment that social surgery can have on a person, and it goes beyond men with normal anatomy.
man who was born intersex,
and whose penis and testicles were removed when he was an infant. His medical records were destroyed and the truth
was kept hidden from him by his family and all his doctors until he finally solved the mystery himself in middle age.
` I know
something of the anguish and impairment that social surgery can have on a person, and it goes beyond men with normal anatomy.
By the way, it's taken me until 2015 to finally publish this draft, and this was part of what motivated me to get going:
` I saw one of my skepticy friends had posted a quote from a Victorian
Era doctor about how masturbation makes you ill. I tried to explain how
the backwardsness of this is still with us in medicine, but it didn't
work, as you can see.
` If I'd completed this article by then, and thus was able to link to it, this wouldn't have happened:
Era doctor about how masturbation makes you ill. I tried to explain how
the backwardsness of this is still with us in medicine, but it didn't
work, as you can see.
` If I'd completed this article by then, and thus was able to link to it, this wouldn't have happened:
Circumcision existed long before America. It was done for religious
reasons representing a covalent between God and Abraham. Here: "the
procedure is most often elected for religious reasons or personal
preferences,but may be indicated for both therapeutic and prophylactic
reasons. It is a treatment option for pathological phimosis, refractory
balanoposthitis and chronic urinary tract infection. " And "The WHO
recommends considering circumcision as part of a comprehensive HIV
program in areas with high endemic rates of HIV, such as sub-Saharan
Africa,"...Nothing to do with masturbation.
I am snickering, thinking of God and Abraham sharing electrons. I will
abbreviate my own responses, which threatened to become their own blog
post.
abbreviate my own responses, which threatened to become their own blog
post.
First of all, the religious tradition is
partly for desensitizing the penis and getting the man's focus on
heaven.... It was promoted by the co-founder of the American Medical
Association and his followers....
Various myths about circumcision and
medical benefits arose, which persist to this day and are not generally
believed in most countries, where it is not practiced or recommended.......It also unnecessarily maims the penis
by cutting off the most sensitive part. The foreskin is as sensitive as
your lips, and the glans is as sensitive as your arm. That is because
it serves several purposes, including controlling orgasm. Circumcised
men have the most sexual dysfunctions.
...it's an unbearably painful thing to do to an infant's fused
penis, and can lead to long term trauma reactions. It is outlawed in
many parts of the world for this and the sexual repercussions.
I could go on, but you get the idea. It
is a practice to suppress sexual pleasure. It is not done in Europe,
other than for religious reasons....
He responded:
Proof. Where is the proof it is an American thing? Where is the proof
there is higher sexual dysfunction? Where is the proof it was/is used to
deter masturbation? It is not recommended nor is advised against...
Unable to do much of an internet search, or even paste links, thanks to my malfunctioning smartphone at the time, I replied:
...Last I checked the internet and online medical journals I found pretty much the same thing.Why not do a few keyword searches and see what you find?...I often talk about it with men in other parts of the world and they all
think it's nutty and wtf is wrong with Americans. One guy said he broke
up with his girlfriend from South Africa because she said if they had a
son she would have him circumcised because she likes having sex with
circumcised cocks. This is a common attitude I have found in the U.S..
What if a man said he prefers sex with circumcised women so he does that
to his daughter? Is he planning to have sex with her? Is he seeing her
as a sex object?...
He didn't respond to that well.
Proof. Where is your proof? If you are going to assert that male
circumcision is an American phenomenon to deter masturbation you are
making one hell of a claim. The original post had nothing to do with
circumcision but about masturbation. I have seen not heard of no study
that shows even correlation between circumcision and the desire or
pleasure derived from masturbation
They exist. A few of them are even quoted here. I couldn't paste any such links, however, so I replied:
It's not based on science.Also I did not say it's an American phenomenon, I'm saying that the
medicalization of it started in Victorian America, as part of their
cultural beliefs.In the late 1800 it became a Christian-anti masturbation medical practice....It won't let me paste the link, just [do a search] and the proof will
magically appear, don't tell me I didn't give you any evidence!!And to repeat myself, I often talk about how nutty it is with people
from parts of the globe where it is not practiced as a medicalized
phenomenon.They count it as one more reason Americans are nutty.Also in parts of Africa, some doctors are fighting to medicalize female circumcision. Does it make that legit, too?
This hardly had the effect I had hoped:
As I said in an early post, there are religions that practice it and
there are medical benefits in some cases. Googling as you recommended,
yes there were some who thought it would stop masturbation in addition
to health reasons. About one-third of males WORLDWiDE are circumcised
(http://whqlibdoc.who.int/publications/2007/9789241596169_eng.pdf)Male circumcision is not the same as female genital mutilation.I grow bored of this
Evidently, he was more interested in dismissing me than understanding my argument. I replied:
I didn't say it was . I pointed that out because it is fashionable in
those cultures to believe that female genital mutilation is good.You are good at putting words in my mouth.And where do those males worldwide live? In cultures where people have
traditionally done so and come up with beliefs about why they do it --
mostly Muslims.My point is, where it is done depends on the culture. Do you not see that?Also, you should check out what Maimonides said about it, he was after all an ancient Jewish scholar. ;-)
[Maimonides says that circumcision is good because it decreases sexual
pleasure for the man and the woman, so that they will keep their minds
on God rather than the unclean flesh.]
At that moment, he deleted the thread, and I had thought it was because of me, although he says otherwise.
` Later on, I was able to send him a link to a relevant article, one of a series. I don't know if he ever read it.
` By coincidence, Geisheker wrote two of the articles in this series, and suggests some further reading:
There's Robert Darby's account of circumcision as a fad in Britain, A surgical temptation: The demonization of the Foreskin and the Rise of Circumcision in Britain.
` Also, there's his commentary on the continued practice in America The Sorceror's Apprentice: Why Can't We Stop Circumcising Boys?
Also, there's an interesting book by David Gollaher, Circumcision: A History of the World's Most Controversial Surgery.
Anthropologist Leonard Glick wrote Marked In Your Flesh.
If this post already hasn't been too much for you, these might be worth
checking out. And of course I still must post a follow-up article, with
more anatomy facts, biased anatomy books, and Facebook comments which
show that indeed, it is just a cultural thing.
