| The penile foreskin defined
- The foreskin (or prepuce) is a natural, retractile, protective
covering for the glans (head) of the penis, and is the most erotogenic area of
the penis in terms of the quantity, concentration, and quality of
specialized nerve receptors and stretch receptors that it is endowed with,
especially on its inner mucosal lining (which gets redeployed behind the glans
during erection).
- The average adult foreskin consists of 1½ inches of outer skin,
1½ inches of inner mucosal lining – totaling a length of 3 inches
– and is 5 inches in circumference when erect. This amounts to a surface
area of 15 square inches, or a surface area equivalent to that of a 3"
by 5" inch index card!
- The foreskin contains over 240 feet of nerves and over 1,000 nerve
endings, as well as being a highly vascularized structure.
- The foreskin contains “junctional mucosa that appear to be an
important component of the overall sensory mechanism of the human penis”
–J. R. Taylor et al. The prepuce: specialized mucosa of the penis and its
loss to circumcision. British Journal of Urology (1996) 77, pp. 291-295.
- The foreskin is not vestigial or redundant tissue, in that no other
part of the male body does what the foreskin does, or feels what the
foreskin feels.
- The foreskin serves to protect the glans, thereby maintaining the
glans-surface’s naturally-intended thinness, texture, and
sensitivity.
- The foreskin has rich sensations in and of itself. The foreskin
also plays a mechanical-lubrication role. It serves as a gliding sheath during
masturbation or sexual activity, rendering the quality of the friction
between the man and his partner more gentle, less abrasive. This is useful to
the woman, especially with prolonged intercourse and especially with age, when
she provides less liquid lubrication. With circumcision, this natural
gliding mechanism is lost.
- The fact that the foreskin in infancy is usually non-retractile serves to
protect the baby’s glans penis from urine and feces during the period that
he is incontinent.
- Women have a foreskin as well, which covers and protects their clitoris.
It is alternatively referred to as the clitoral foreskin,
clitoral prepuce, or clitoral hood.
Penile development
- Development of the foreskin is incomplete in the newborn male child,
and separation from the glans, making it retractable, does not usually occur
until some time between 9 months and 3 years.
- Tight non-rectractile foreskin (normal developmental
non-retractability, or physiological phimosis) resolves by age 6
in 92% of boys, 94% by their teens. 1% of late adolescents will still have a
non-retractile foreskin. (Gentle, systematic stretching is indicated to resolve
this. Moreover, steroid creams are successful in resolving this in the vast
majority of cases when this is a problem.)
- Infant circumcision interrupts natural penile development.
Hygiene easy
- The American Academy of Pediatrics (AAP) states: “The uncircumcised
penis is easy to keep clean. No special care is required. No attempt
should be made to forcefully retract the foreskin [of a child whose foreskin is
as yet unretractable].”
- Simple overall hygiene can offer all the potential benefits of
circumcision, without the sacrifice of the health benefits
of the foreskin and of physical and functional integrity.
- Intact genital hygiene for a male is easy and takes very little time,
certainly less time than shaving or brushing the teeth.
The basis of the (non-religious) circumcision
decision
- Research has consistently shown that parents who decide to circumcise do so
mainly for non-medical reasons. Social concerns are more important than medical
ones according to one recent study. Reasons given for the procedure included
perceived ease of hygiene, ease of infant circumcision compared with adult
circumcision, father circumcised, to be like other boys, appearance, culture,
and family pressure.
–Tiemstra JD. Factors affecting the circumcision decision. J Am Board
Fam Pract 1999;12:16-20 [Full
Text]
Immediate risks and possible surgical
complications
- No accurate statistical records are kept of infant circumcision
complications.
- According to the American Academy of Pediatrics, the exact incidence of
post-operative complications is unknown.
- Complications are often overlooked or un(der)reported. They include:
Lacerations, skin bridges, chordee, meatitis, meatal stenosis, urinary
retention, glans necrosis, hemorrhage, meningitis, sepsis, gangrene, and penile
loss requiring sex re-assignment. The literature abounds with reports of
morbidity, and even death, from infant circumcision.
- A realistic complication figure is 2%-10%.
–Williams, N. Complications of Circumcision. British Journal of
Surgery, vol. 80, October 1993, pp. 1231-1236.
- Infant circumcision excises normal, healthy, healthful,
functioning erogenous tissue that belongs to someone else (i.e., to
someone other than the one making the circumcision decision, and other
than the one who will be affected by the decision), and leaves a scar.
Pain, trauma, and memory
- According to a comprehensive recent study, infant responses to pain
are “similar to but greater than those observed in adult subjects.”
- Infant circumcision causes severe, persistent pain.
- Some infants do not cry because they go into shock from the
overwhelming pain of the surgery.
- Infants rarely receive anaesthesia or post-operative pain management.
- No anesthetic has been found to be safe and totally effective in
preventing circumcision pain in infants. [A man circumcised in adulthood will
be given the benefit of general anaesthetic, post-operative pain management,
choice and informed consent over the fate of his own genital integrity.]
- The persistence of specific behavioural changes after circumcision
in neonates implies the presence of memory for the incident.
–Taddio A, Katz J, Ilersich AL, et al. Effect of neonatal circumcision on
pain response during subsequent routine vaccination. Lancet
1997;349(9052):599-603. [Full text]
Maternal-infant interaction and breastfeeding
affected
- A stressful, painful event such as circumcision affects feeding
patterns. Infants feed less frequently and are less available for
interaction after circumcision. Observed deterioration of breastfeeding after
circumcision may potentially contribute to breast-feeding failure and changes
in mother-infant interaction.
–Howard CR, Howard FM, Weitzman ML. Acetominophen Analgesia in Neonatal
Circumcision: The Effect on Pain. Pediatrics, 1994; 93:641-646. [Full text]
–Dixon S. Snyder J. Holve R. Bromberger P. Behavioral effects of
circumcision with and without anesthesia. J Dev Behav Peds 1984; 5:
246-250. [Full
Text]
–Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon
mother-infant interaction. Early Hum Dev 1982; 7:367-374 [Full
text]
- Breastfeeding has a protective effect against urinary tract
infection (UTI) and other infant infections. There is a three-fold
reduction in urinary tract infections during the first year of life in
breast-fed infants according to the AAP. According to a recent study by Teresa
To et al., 195 boys would have to be circumcised to prevent one hospitalization
for UTI in the first year of life. By contrast, breast-feeding provides a
three-fold reduction of the risk.
–Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary
tract infection. J Pediatr 1992;120:87-89. [Full
text]
–AAP Workgroup on Breastfeeding. Breastfeeding and the use of human milk.
Pediatrics 1997;100: 1035-39. [Full text]
–To T, Agha M, Dick PT, et al. Cohort study on circumcision of newborn
boys and subsequent risk of urinary-tract infection. Lancet
1998;352:1813-16. [Full text]
Long-term adverse outcomes
- An estimated minimum of 1.3 to 6.6 million males born in the U.S. between
1940 and 1990 carry some degree of physical complication from infant
circumcision. Unknown numbers carry some form of sexual or psychological
complication.
- Circumcision constitutes a subtraction, removing one- to two-thirds of the
penile skin system.
- Long-term possible adverse outcomes (physical) include: skin
tags; skin bridges; prominent scarring (keloid scar formation); tight, painful
erections; bleeding of the circumcision scar during prolonged intercouse
(constituting an efficient portal of entry for HIV among other viruses); penile
curvature due to uneven skin loss; skin tone variance; progressive sensitivity
loss (progressive keratinization of the glans-surface); excessive/painful
stimulation or prolonged exaggerated thrusting needed to achieve orgasm;
beveling deformities of the glans.
- Adverse outcomes of a psychological nature that have been reported
and documented include: sexual dysfunction of various forms and degrees,
including impotence; awareness of a loss of normal protective, sensory, and
mechanical functioning; anger, resentment; feelings of parental petrayal;
feeling (awareness) of being mutilated; feelings (awareness) of one’s
right to a normal intact body having been violated and removed; feelings
(awareness) of being unwhole and unnatural; addictions or dependencies; sense
of anatomical and sexual inferiority to genitally intact (non-circumcised) men;
foreskin (or intact penis) envy.
- The quality and quantity of long-term negative impacts on men from infant
circumcision have never been investigated.
Involvement of Obstetricians/Gynecologists
- Ob/Gyn’s, specialists in female genitalia and practicing out of
their field, perform most newborn male circumcisions.
- Ob/Gyn fees for circumcision range to $400, averaging $137 nationwide
[U.S.]
- Circumcising 10 infants weekly for only 10 months of the year at $125 each
(1987 U.S. rate), circumcisers earn at least an additional $50,000 annually.
- 74% of the Ob/Gyns surveyed perform circumcision.
- Ob/Gyns are generally not aware of preputial (foreskin) structure and
function, or of the growing numbers of men undertaking foreskin restoration.
The questionable medical value of non-therapeutic (i.e.
routine) male infant circumcision
Urinary tract infection (UTI)
- Worldwide, infant UTI is treated antibiotically, not amputatively.
- In the 1980s, retrospective studies by Wiswell et al. suggested that
98-99% of intact (non-circumcised) male infants will not
develop UTI (compared with his finding of 99.9% in circumcised male infants).
In 1989, the AAP (American Academy of Pediatrics) cautioned that Wiswell’s
studies comparing the two groups may be methodologically flawed, and that the
percentage of intact male infants who will not develop UTI may be
even higher. Research in the 90s has since confirmed that Wiswell’s
studies are flawed, as the AAP cautioned, and that the incidence of UTIs in
intact male infants is significantly lower than the 1-2% he reported.
- Females have higher rates of UTI in childhood and throughout life
than either intact or circumcised boys.
- European doctors cite American birthing practices, not the foreskin,
as the cause of the U.S.’s allegedly higher rate of UTI in intact
boys.
- UTI in males often results from a congenital abnormality which
predisposes the child to bacterial infection. Such congenital abnormalities
have nothing to do with the foreskin.
- Antimicrobial management of UTI in infants is routine, and the outcome
generally good.
Penile Cancer
- Among intact (i.e., non-circumcised) males, 99.999% will not
develop penile cancer [The rate of penile cancer is 1 in 100,000. It is one
of the rarest cancers, rarer even than male breast cancer.]
- Testicular cancer strikes 1 in 300 males, prostate cancer 1 in 11.
(Source: American Cancer Society)
- It has been suggested that performing 100,000 infant circumcisions –
thus removing in 100% of those circumcisions 100% of the foreskin’s
irreplaceable health benefits – in order to possibly prevent an otherwise
preventable cancer in one elderly man is absurd.
- Annually, there are more infant deaths from infant circumcisions
than deaths from cancer of the penis.
- It has been erroneously claimed that penile cancer virtually never
occurs in men who have been circumcised in infancy.
- In a recent study on penile cancer, a full 20% of the study-group
had been circumcised at birth.
Cervical cancer
- Scandinavian society (virtually non-circumcised) has a lower rate of
cervical cancer than the U.S (a majoritarily circumcised society).
- Both cervical and penile cancer are now understood to be caused not
by genital smegma (which both sexes produce), but by HPV (Human
Papilloma Virus), a sexually transmitted virus.
Sexually Transmitted Diseases (STDs)
(coming soon): A major medical study by Lauman and colleagues find slightly
lower risks of STD's in uncircumcised men, confirming other previous
studies.
The following categories will be added soon:
Ethical, bioethical, and human rights issues raised by non-therapeutic
infant/child circumcision
Medico-legal issues raised by non-therapeutic infant/child circumcision
Men’s emerging voices
Non-surgical foreskin restoration (glans re-covering)
Comparisons and contrasts with FGM (female genital mutilation)
Non-surgical treatments of foreskin problems
Conservative surgical (i.e., non-excisional) treatments
The circumcision procedure itself and what it involves
Adult circumcision
Religious circumcision and the debate surfacing
within the Jewish community
(See “Religious Aspects” in main menu, or visit
www.circumcision.org)
Why infant circumcision continues
|
