I was nineteen or twenty years old when a male friend of mind, 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 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 it's a 'flap of skin', or that it 'covers the tip of the penis'.
` Both of these statements are inaccurate:
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 67% of medical books do not depict a foreskin at all. 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. Recently, the organization has continued giving 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 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. 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, although later forms of medicalized 'female circumcision' were not as extensively harmful.
` 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:
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 the 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 authors' fine-touch maps can be seen below, but first a bit of explanation about what is pictured in their illustration:
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.
` In the U.S., the glans is popularly imagined to be the most sensitive 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 that makes 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 tends to 'squeegee' away the vagina's own fluids, often requiring the repeated addition of artificial lubricant.
` 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.
` 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 causes 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 misinterpreted in popular culture 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, 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 often heard the foreskin described as "extra" skin, or that it was unusual for "the penis itself" to be harmed by circumcision.
` 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 be fixed with stretching, 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 pain had finally subsided for good, 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?)
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 severely burns the glans and he screams in distress.
` This wound takes weeks to heal, and complications (besides the intended damage) are not as uncommon as widely assumed.
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'. 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 the relatively few 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!
Besides cultural beliefs, 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, before you start accusing Doctors Opposing Circumcision of being anti-semitic, it should be noted that the VP is an observant Jew who has restored his foreskin.
I 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 children's bodies, who cannot consent, and who don't 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.
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.
` 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.
` 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."
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 researchers used an HIV antibody test, which only gives results from three months since the last exposure. However, they did not wait long enough to administer the test, so that many of the HIV cases they detected had been contracted before the study had started.
` Also, the duration of 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.
` 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 journalists and even some 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 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, 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, which compared the rate of UTIs between circumcised with intact babies.
` There were a few fatal flaws in this study, 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