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Circumcision

Why?

Featuring

Intact

by Meryn Callander

and

A Physician’s Perspective

By George L. Williams MD


(Originally published in Byron Child Magazine Courtesy of the fabulous Kali - http://www.byronchild.com)

Mutilate - mu • ti • late (mew-till-ate) vb -lating, -lated 1. to injure by tearing or cutting off a limb or essential part; maim.
2. to spoil or damage severely. mutilated adj mutilation n. mutilator

While statistics show its popularity is rapidly declining, a surprising number of babies still undergo a radical procedure which threatens to break the essential continuum of bonding and safety that is each child’s birthright — and humanity’s future. In spite of near universal medical opinion clearly stating that there is no significant health related reason to traumatise our baby boys in this way, a multitude of myths and misunderstandings perpetuate its ritual/routine re-enactment. Routine is still mistaken for rightness.


Intact

By Meryn Callander


Circumcision — ten years ago I had trouble spelling the word. I would stumble over the pronunciation of it, had I cause to use it, which I rarely did. Then Marilyn Milos entered my life through our founding meeting of the Alliance for Transforming the Lives of Children (aTLC).1 It was her eyes, large and bright and gentle, that first engaged me. Then her generous and ready smile, resonant and contagious laugh, her deep voice. The word circumcision rolled off her tongue with the ease borne of speaking it many, many times each day.

Marilyn’s own sons are circumcised. Her doctor had told her that the surgery was a necessary health measure, it didn’t hurt, and only took a moment to perform. It wasn’t until several years later, in 1979, that Marilyn, as a nursing student, saw the surgery herself.

She recalls filing into the newborn nursery with the other students, to find a baby strapped spread-eagle to a plastic board on a counter top. He was struggling against his restraints — tugging, whimpering, and then crying helplessly. No one was tending him. When she asked her instructor if she could comfort him, she was told to wait till the doctor arrived. When he arrived, Marilyn immediately asked him if she could help the baby. On putting her finger into the baby’s mouth, as the doctor suggested, she found the baby sucked. As she stroked his head and spoke softly to him, he began to quiet.

The silence was broken by a piercing scream — the baby’s reaction to having his foreskin pinched and crushed as the doctor attached the clamps to his penis. The shrieks intensified as the procedure continued. The baby started shaking his head — the only part of his body free to move — back and forth. He began to gasp and choke, breathless from shrill continuous screams. In the final stage of the surgery, the doctor crushed the foreskin against the circumcision instrument and then, finally amputated it. The baby was limp, exhausted.

While the doctor remained passive, ‘professional’, Marilyn was devastated. Even more so when she heard his comment: ‘There’s no medical reason for doing this.’ Eyes filled with tears, sick to her stomach, she questioned how it could be that medical professionals, dedicated to helping and healing, could inflict such pain and anguish on innocent babies unnecessarily. Marilyn made the decision to dedicate her life to bringing an end to this horrendous practice.

As a nurse, believing every parent had a right and an obligation to be fully informed, she told parents what she wished she had been told before her sons were circumcised. Told to keep her mouth shut, she made a video of a circumcision for parents. She was told it was too much for parents to see. ‘Perhaps, then,’ Marilyn responded, ‘it’s too much for a baby to endure!’ The video was censored and, in 1985, Marilyn was fired. Fired from the nursing profession and fired to advocate for the genital integrity of all children. That same year, she co-founded the National Organisation of Circumcision Information Resource Centres (NOCIRC); the first national clearinghouse in the United States for information about circumcision.

Today, my frustration is no longer fuelled by an inability to readily spell or even pronounce the word circumcision fluently, but rather by the fact that this practice continues in the face of an abundance of research revealing, beyond any shadow of doubt, the damage inflicted. For example, while many circumcisers claim that babies do not experience pain, a mountain of published scientific studies prove that they do. In fact, babies feel pain more sharply than adults. Pain is serious. It is not something to be dismissed, ignored, or laughed at. It does not ‘toughen’ little boys. In fact, baby boys who have been circumcised suffer from an abnormally and artificially lowered pain threshold, and their heightened response to pain is consistent with post-traumatic stress disorder.

... No one is aware of the deep implications and life-lasting effect (of circumcision). The torture is experienced in a state of total helplessness, which makes it even more frightening and unbearable. — Frederick Leboyer

Unbearable Trauma

Circumcision is painful and traumatising. In the course of every circumcision, all babies scream, tremble, and/or cry. Many hold their breath, defecate, or vomit. Breathing difficulties can induce choking and apnea. Some infants are so severely traumatised by the experience that they fall into a semi-comatose state. (Some circumcisers pretend or presume these babies are falling asleep.) Going into a coma-like state is one way for a baby to distance himself from his agony, but it has dangerous consequences for the brain. Some infants cry for hours afterwards, and remain irritable for days. Post-circumcision stresses increase adrenal corticosteroids (stress hormones), decrease arterial oxygen perfusion, and disturb the sleep-awake cycles.1

It is difficult to reconcile the awareness that so many people bring to a birth today — that a newborn, in the course of delivery, must be well oxygenated, not sedated, tenderly cared for, and welcomed with love; and the practice of strapping him to a restraining board within a day or two after delivery, if the infant is a male, exposing him to bright lights and cold instruments and, without benefit of anesthesia (which, unfortunately creates additional risks and potential complications for newborns), amputating his foreskin. There is something terribly bizarre and irrational in this, even more so in a climate where current ethical guidelines state that surgical procedures cannot be performed on research animals without using anesthesia.

When they brought him back to me, I could see that he had been crying and had a glassy, wild look in his eyes. I think it was terror… I’ll never forget that look. They probably shattered every bit of trust he had. — C. Miller

What we know from infant neurological development, trauma theory, clinical experience, and research all support the conclusion that circumcision is a trauma. Like other traumas, the experience of circumcision is repressed, but may be remembered or relived under special circumstances. Long-term psychological effects can be difficult to establish because the consequences of early trauma are very rarely recognisable to the person who experienced the trauma. However, it is well established that adults, abused as young children, suffer adverse behavioural responses connected with their early trauma. Clinical experience, child development theory, and infant behaviour all suggest that circumcision can impair bonding. At the most immediate level, the separation of newborn from the mother, on whom the infant’s world centres, is in itself a traumatic experience.

Circumcision is an enormous obstacle to the development of basic trust between mother and child. — Rima Laibow

Some infants withdraw because of the trauma of circumcision. They may be less responsive and more irritable. Some mothers, feeling guilty, become overprotective; or withdraw to protect themselves from feeling their own pain. Some circumcised infants cry for extended periods and seem inconsolable. While this helps the infant resolve the trauma, the crying may exceed the mother’s tolerance level. She may think of the infant as having a ‘difficult’ temperament and use that belief as a reason not to respond. Or, she may feel incompetent and withdraw because she feels unable to relieve the infant’s distress. Clearly, it is not only the infant who suffers post-traumatic stress disorder (PTSD). Witnessing circumcision, or becoming aware of the harm or injury inflicted on her child, leaves the mother, too, liable to PTSD. The mother–infant relationship depends on the responsiveness of both. If either mother or infant is unresponsive, the relationship will suffer.

Jesse was shrieking and I had tears streaming down my face. Jesse screamed so loud that all of a sudden there was no sound! He was screaming and it went up and then there was no sound and his mouth was just open and his face was full of pain! I remember something happened inside of me… the intensity of it was like blowing a fuse! I don’t think I can ever recover from it. It was too intense. When he was first born, there was a tie with my newborn. And when the circumcision happened, in order to allow it I had cut off the bond. I had to cut off my natural instincts, and in doing so I cut off a lot of feelings towards Jesse. I cut it off to repress the pain and to repress the natural instinct to stop the circumcision. (emphasis added) — Elizabeth Pickard-Ginsburg

Complications

Circumcision creates a disturbingly long list of unnecessary surgical risks and complications ranging from lacerations, haemorrhage, infections, penile amputation, and urethral damage to an inordinately large number of badly performed circumcisions with resultant deformed penises. There is no trustworthy data on the true rate of complications. Hospitals are free of any obligation to report circumcision accidents.

The risks of newborn circumcision are an underreported and ignored factor…. Most often a poor surgical result is not recognised until years after the event. — James Snyder

… the true incidence of complications associated with circumcision is at best an estimate. These complications are often overlooked or under-reported… most complications were discovered only by carefully examining the nurses’ notes. — John Gearhart

One study estimates that a realistic complication rate for newborn circumcision ranges from 2 to 10%. There is simply no way of knowing which circumcised newborn will become a victim of these statistics. The only way of ensuring that an infant will not is to say ‘No!’ to circumcision. To many of the circumcised men today, the very fact that the foreskin was destroyed is itself a complication, putting the actual complication rate at 100%. The long-term consequences of neonatal circumcision only now are beginning to be documented.

Accurate reporting of deaths attributed to circumcision is suspect. Many deaths from circumcision are signed out as due to sepsis (blood poisoning). Other deaths are hidden as due to ‘complications of anesthesia’ with no mention of the fact the baby had been anesthetised for no reason other than an unnecessary routine circumcision. It would take great courage on the part of physicians to report a death attributable to circumcision knowing that the procedure had been deemed unnecessary by every pediatric and obstetrical society in the Western world, and that they may be sued for malpractice.

General anesthesia is very dangerous for a baby and local anesthesia is largely ineffective. Even if local anesthesia is used — and the death and complication rate from local anesthesia is itself a disincentive for using it — the effect lasts but an hour or two. Then, the pain of the amputation returns. It is now impossible to avoid contact between the unprotected, raw, reddened, exquisitely sensitive glans penis and the inevitable faeces or urine-soaked diapers. The throbbing pain of the wound is aggravated every time the baby urinates and hot acidic urine burns the raw flesh. Even holding the infant to comfort him inflicts pain. It takes ten to fourteen days until the wound heals and the initial pain of circumcision subsides.

What is Normal?

A physician’s entire training is geared to distinguish what is normal and what is abnormal. Disease is a deviation from the normal, which one hopes to correct. The normal needs no correction. The foreskin — or prepuce — is normal and natural. It is the flexible, double-layered sheath of specialised skin that covers and protects the glans — or head — of the penis. The foreskin is a uniquely specialised, sensitive and functional organ of touch, and an integral and important part of the skin system of the penis. Nature designed the glans to be an internal organ. In many ways, the foreskin is like the eyelid. It covers, protects, and preserves the sensitivity of the glans by maintaining optimal levels of moisture, warmth, pH balance, and cleanliness. Genitally intact males know from experience that the foreskin is one of the most sensitive parts of the body. Circumcised males have no idea what was taken from them. Most are surprised to learn that the glans penis is one of the least sensitive parts of the entire body. Circumcision is a disservice to both males and females, especially in later life. A circumcised male can never reach his full birth potential of genital pleasure. The woman can never be a recipient of her lover’s full sexual response.

Intact males can be more tender, gentle, relaxed, and loving during sex because the lightest and subtlest gesture or motion evokes deeply satisfying sensations. — Paul M. Fleiss and Frederick M. Hodges

Contrary to popular myth, the penis or foreskin is not ‘dirty’. The immunological functions of the foreskin and the self-cleansing functions of the penis actually protect the body from harm. No extra care is needed for an intact infant or young boy. Hygienic care of the normal intact penis is simple. One washes it as one washes any other part of the body. The prepuce is a normal structure with a definite function. Like a shoe, or glove, it protects the underlying structure — in this case the glans — from the environment. The glans is appropriately and advantageously exposed upon only three occasions: when urinating, washing, and engorgement/erection.

The myth that circumcision protects babies from urinary tract infections — which are a relatively rare and minor problem — evaporates in the light of current scientific data. Breastfeeding is a more effective and appropriate way to prevent urinary tract infections. Circumcision does not prevent premature ejaculation (a common sexual complaint of Australian and American men — most of whom are circumcised) — it likely causes it. Preventing penile and cervical cancer are not valid reasons for infant circumcision any more than amputating young girls’ breasts to prevent breast cancer. It would make just as much sense to amputate the breasts from all young girls to prevent breast cancer. The incidence of cancer of the penis in Europe, where circumcision is rare, is no higher than in the US or Australia. More US and Australian men develop and die of breast cancer than penile cancer. Cigarette smoking contributes to penile, prostate and breast cancer in males, and ‘blame’ should more aptly be placed there.

One unique argument for circumcision — now rejected in all English-speaking countries except the US — is the notion circumcision has prophylactic value, that is, it ‘prevents’ certain problems from developing. As a surgery, the concept is a bizarre one, now applied solely to the genitals. No other body part is subject to ‘routine’ removal as a ‘preventive’ measure especially when measured against the pain and risks of surgery. — Marilyn Milos

The intact penis is not more likely to spread sexually transmitted diseases, including AIDS. The fact is that the US has one of the world’s highest AIDS rates as well as the most circumcised sexually active males. It is not the foreskin that causes these diseases, and circumcision will not prevent them. Rigorously controlled studies have demonstrated that the foreskin plays a protective role in shielding the rest of the penis and thus the rest of the body from AIDS.

There are no valid medical reasons for performing circumcision. The risks and disadvantages far outweigh any possible protective benefits. Any doctor who says otherwise is misinformed about relative risk. While the principles of medical ethics require that babies be protected from pain and trauma, laboratory animals are provided greater protection from painful experiences than are our infants. Any doctor who performs a circumcision is violating a major tenet of medicine: ‘First, do no harm.’

Faith and Culture

Aside from medical persuasion, religious, cultural, and social pressures perpetuate circumcision. Doctors performing circumcision today usually remove far more tissue from the penis than was removed during the period of both the Old Testament and New Testament. During Biblical times, only the tip of the foreskin was removed.

Circumcision has suffered an escalation from the original Biblical injunction, with tragic consequences.
When most people think of religious circumcision, they think of Muslims and Jews, for whom this is a deeply sensitive topic. Despite their being subject to tremendous emotional stresses and cultural pressures when considering the issue, a courageous reexamination of circumcision is occurring within both the Muslim and Jewish communities.

Traditional Jewish circumcision is performed by a ritual circumciser on the eighth day after the baby’s birth, at home, in public (females are often excluded from observing the actual cutting). For many Jews, the bris milah is a joyous occasion when friends and family celebrate and welcome the new member of the family. It is difficult for some Jews to consider any information that could appear as criticism of Judaism. For others, freeing Judaism from circumcision is not about criticism; it is about spiritual renewal and affirmation.

No matter how much religious sentiment may have clung to it in the past, today it is perpetuated only by custom and fear, to which we surely do not want to erect temples. — Abraham Geiger

During the nineteenth century, the founders of Reform Judaism in Germany and the United States sought to abolish circumcision as part of their task to modernise Judaism. Many prominent Jews disapprove of circumcision: Sigmund Freud and Theodor Herzl, the founder of Zionism and spiritual father of the state of Israel, protected their own sons from it.

Many Jews defend ritual circumcision because of the deep meaning they see in the bris milah, the ceremony during which the baby is circumcised. In recent years, though, observant Jews in the United States have developed new traditions to replace the circumcision part of the ceremony. Instead of bris milah at eight days, they celebrate bris shalom. Here, the joyous, beautiful and deeply moving religious and spiritual aspects of the ceremony are retained and enhanced, but no-one gets hurt. The boy is named and presented to the community and his penis remains intact. These gentle ceremonies are increasing in popularity. Jews are able to retain the best parts of their traditions, follow their conscience and their hearts in protecting their baby from unnecessary surgery while still affirming the spiritual ties to their community and history. — Paul M. Fleiss and Frederick M. Hodges

A growing number of Muslim organisations have taken a firm stand against circumcision, proclaiming:

God with his infinite grace did not and would not condone such cruel ritual. This act is not found anywhere in the Qur’an. It is only in such man-made innovations such as ‘hadith and Sunnah’ that one can find such cruel laws and rituals. — Edip Yuksel

The parental decision to circumcise an infant — regardless of religious faith — is based mainly on emotion and peer pressure, with little comprehension of the disservice done to the newborn. The decision is frequently made with the tacit consent of a doctor.

In all cases where parents request a circumcision for their child the medical attendant is obliged to provide accurate information on the risks and benefits of the procedure. Up-to-date, unbiased written material summarising the evidence should be widely available to parents. — Pediatric and Child Health Care Division, Royal Australasian College of Physicians.

Despite this policy statement, few doctors inform parents of what is actually done to a baby when he is circumcised, and parents remain unaware of the realities of the procedure, the pain inflicted, and the potential complications and repercussions. Most who have witnessed a circumcision or seen a videotape have been shocked:

It’s absolutely horrible. I didn’t know how horrific it was going to be. It was the most gruesome thing I have ever seen in my life. I told the doctor as soon as he was done, if I had had a gun I would have killed him. — Melissa Morrison

Observing their son’s pain leaves many with deep feelings of regret:

His screams tore at my heart… Too late… I knew that this was a terrible mistake and that it was something no one… should ever have to endure… my body feeling nauseatingly sick with guilt and shame. All I could think of was holding and consoling my child, but his pain felt inconsolable — his body rigid with fear and anger — his eyes filled with tears of betrayal. — B. Raisbeck

A big issue for many parents, fathers especially, is that of their baby looking like his dad.

…circumcising a baby cannot make him look like his circumcised father, nor does it create a ‘bond’ between father and son. Bonds are created by the expression of love rather than by cutting the penis... What if the father were missing a finger? Would it be right to amputate a finger from the baby so that he matches his father? — Paul M. Fleiss and Frederick M. Hodges

Surely no one of us would claim it reasonable to perpetuate any form of bodily mutilation — be it binding of the feet, burning or excising the clitoris, or circumcision — on the sway of emotions or peer pressure. Just as boys do not need to be circumcised because their father has been circumcised, boys do not need to be circumcised just because their neighbour or even their parents’ best friend’s infant son has been, and with the decline in circumcision rates, this excuse is less valid than ever. The chances are approaching 50-50 that the boy next door is intact, and the locker rooms are reflecting that.

The ‘I’m circumcised and I’m fine’ syndrome is prevalent throughout our culture, and completely ignores the fact that the typical circumcised male has no means of comparing his experience with what may have been. All of his sexual experience has been with his circumcised penis. Then, too, he is in all likelihood woefully lacking in knowledge of the functions of foreskin, glans sensitivity, and the pleasure dynamics of the normal intact penis. To admit that a penis is not all it could be takes a great deal of soul searching, courage, and honesty.

The danger in knowing about circumcision is that one is then vulnerable to feeling the associated emotional pain of what has been done. The greater danger is that without this knowledge we will continue to circumcise and cause more pain. — Ronald Goldman, PhD

We live in a society shaped by Puritan ethics and views on sexuality. Sexual pleasures are held to be immoral or dangerous, and celibacy and virginity held to be virtues. Generally, we are uncomfortable talking seriously about sex. The subject — which includes, of course, anything to do with the penis, and hence circumcision — is avoided or joked about.

It is hardly surprising that denial persists, despite the data, as a common defence mechanism. Few people want accurate information: dealing with the facts is too confronting. The trauma of circumcision is gruesome and upsetting. And so, on an individual, familial, and social level, we silently collude in agreeing not to ask or tell about circumcision. However, the facts remain, and with our silence, we perpetuate the pain.

Our materialistic view of the body gives rise to medical materialism and reflects our cultural materialism. The foreskin, we tell ourselves, is ‘just a little piece of skin’. But we are more than our material body, and the impact of circumcision is not just material. It is also psychological and social. When the bond between child and mother is disrupted, the bond between child and humanity is disrupted. Consequently, it is not only the child who is wounded during circumcision. We are all wounded: the parents, the physicians, the community, and the society. — Ronald Goldman

Awareness, inquiry, and disclosure are vital to a healthy society. Healing involves taking responsibility.

…to hold the medical community (or any other group) solely responsible for the practice of circumcision would be a serious mistake. A person, group, or institution has only as much power as other people give it. Circumcision is a social problem in which the whole society is complicit. — Ronald Goldman

Most of the world rejects circumcision: Over 80% of the world’s males are intact. Most circumcised men are Muslim, Jewish, or North American. The United States is the only country in the world that circumcises most of its male infants for nonreligious reasons. The rise of circumcision in the first half of the 20th century to prevent masturbation and for other purported health benefits, or simply as a fashion, was confined to the English-speaking countries. It never gained acceptance in any of the Continental European countries. In Sweden and Finland, male circumcision is closely regulated and their governments are giving serious consideration to prohibiting it altogether, just as female genital mutilation is banned.

Since the 1950s and 1960s male circumcision has been in decline in the English-speaking world, and medical associations in the UK, Canada, and Australia have taken strong stands against routine circumcision. The introduction of the National Health Scheme in the UK brought about a precipitous reduction in the circumcision rate there, so that by the 1970s fewer than 1% of baby boys were being circumcised. By about the same time, the circumcision rate in Australia had fallen below 50% and it continued to fall so that in the 1990s only about 10% of baby boys were circumcised.

Professional Influence

Physicians influence circumcision rates by their attitude towards circumcision and their willingness or unwillingness to educate parents. Most of our male physicians are unaware of how they themselves have been genitally compromised. Additionally, they were likely given little or no accurate information about circumcision in medical school.

Nearly every illustration of male sexual anatomy in medical textbooks, popular medical books, and American-produced pornography portrays the penis as being circumcised, without comment, as if it were naturally so. — Paul M. Fleiss and Frederick M. Hodges

Many physicians purport it to be a stress-free surgery without any negative consequences. Most are uncomfortable discussing sexual matters, not only with their patients but also with other physicians. Many have not made peace with their own sexual feelings or have not been honest in their evaluation of their sexual prejudices. Our culture’s deeply imprinted bias toward the appearance of the intact penis remains largely unchallenged and unrecognised by the medical profession as well as the culture at large.

Then too, circumcision is big business. Neonatal circumcision is the most frequently performed routine operation in the US. In Australia, several GPs and other practitioners have exploited the publics fears as a business strategy.

In the US, doctors are collecting as much as $240 million yearly to perform 1.2 million needless operations on 1.2 million normal penises.

Most parents want the operation. I can make an extra $200. Why should I try to dissuade them? — Anonymous obstetrician

Then too, there are hidden factors that raise the cost of circumcision to the healthcare industry. For example, the additional cost of the hospital stay for circumcised infants in the US — an annual cost estimated between 1990 and 1991 to be between $234 million and $527 million beyond the charges for the procedure itself. The total cost of all neonatal circumcisions performed in hospitals in the US in 1999 was reported to be $2.1 billion, surely difficult to justify in a time of increasingly scarce healthcare dollars.

Circumcision is profitable, and not only for the medical-industrial complex. Human foreskins are in great demand for a number of commercial enterprises, and the marketing of purloined baby foreskins is a billion-dollar-a-year industry. Some examples: pharmaceutical companies use foreskin in the manufacture of interferon and other drugs, and international biotech corporations are procuring cells from amputated foreskins and experimenting with artificial skin. According to a report in Forbes magazine, the annual market for baby-penis-derived products could be $1 to $2 billion. And all of this without the permission of the ‘donor’. Biotechnology firms like Organogenesis have received fast-lane approval from the Food and Drug Administration for its foreskin-based Graftskin. American doctors, medico-legal experts, and bioethicists were denied the opportunity to request a full hearing and voice their concerns over the ethics of trafficking in and marketing these foreskins.

The heartening news is that, despite pressures to continue circumcision, the rate of circumcision has declined overall. Many people are beginning to question the moral or legal right of a parent (or doctor) to remove a valuable and normal part of another human’s body. Would it be moral or legal to remove the tip of every male’s left little finger? While many doctors who do not really believe in circumcision still perform it under pressure from colleagues, hospitals, and parents, many noted physicians have spoken out against circumcision, including Benjamin Spock. Enlightened doctors, nurses, and parents are saying ‘No’.

My feeling is that it is a traumatic experience and I am opposed to traumatising the baby… and to inflicting an operation on an individual without his permission. My feelings became more concrete when I talked to Leboyer and saw his birth film. It seemed so incongruous to have a nonviolent birth and then do violence to the baby by circumcising him. — Howard Marchbanks

In the US, the average rate of circumcision was close to 90% during the 1970s, but today it is just about 50% nationally. An improvement, yes, but that still leaves 3,500 infants being subjected to a traumatic and entirely unnecessary surgical procedure in that country every day, one every twenty-five seconds. Estimates for Australia are around 10%, most of which are now performed under a general aneasthetic in boys older than six months, or approximately 16,000 circumcisions per year, 35 every day.

Only by denying the existence of excruciating pain, perinatal encoding of the brain with violence, interruption of maternal–infant bonding, betrayal of infant trust, the risks and effects of permanently altering normal genitalia, the right of human beings to sexually intact and functional bodies, and the right of individual religious freedoms, can human beings continue this practice. — Marilyn Fayre Milos and Donna Macris

Language is important in shaping our reality and experience — when we change the language, we’ll change society. Marilyn continues to challenge my thinking and my language. Rather than being an anti-circumcision movement, NOCIRC today recognises itself as a genital integrity organisation. Most recently, on another aTLC board conference call, a member was sharing her excitement at a recent birth she had attended: ‘…he weighs eight pounds and is uncircumcised’.

Marilyn’s voice boomed along the telephone wires from her home in Marin County, California, across the Pacific Ocean, and into my living room in East Gippsland, Australia: ‘Oh, my dear, do not say he is uncircumcised. Women are not called “unclitoridectomised”. He is natural, normal, whole, intact!’

Meryn G. Callander is editor of the Wellspring Guide (www.thewellspring.com/TWO), co-author of A Change of Heart: The Global Wellness Inventory, and Wellness for Helping Professionals and co-founder of the Alliance for Transforming the Lives of Children (www.aTLC.org) with husband, John W. Travis, MD. They are parents to Juniper, 11, and live in Metung, Victoria, Australia.

This article is excerpted from Meryn’s forthcoming book, Myth Busting: Dispelling Misconceptions about Pregancy, Birth and the Early Years.

Sources:
What Your Doctor May Not Tell You About Circumcision: Untold Facts on America’s Most Widely Performed — and Most Unnecessary — Surgery, Paul M Fleiss and Frederick M Hodges

Doctors Re-examine Circumcision, Thomas J Ritter and George C Denniston

Circumcision: The Hidden Trauma: How An American Cultural Practice Affects Infants and Ultimately Us All, Ronald Goldman - Questioning Circumcision: A Jewish Perspective, Ronald Goldman

Invaluable websites include:
www.NOCIRC.org
www.circinfo.org
www.circumstitions.com

Footnotes:
1: See: www.aTLC.org



Current Australian Statistics

Eight years to the month after reaching perhaps its lowest point in over 100 years, the infant circumcision rate in Australia reached its highest level for well over a decade in March 2004.

The national rate was driven up by rises in New South Wales (up by 42% in less than eight years to a new high in March). Rises are also evident in Victoria (up by 36% in three and a half years also to a new high) and Western Australia (up by 10% in seven months). These rises swamped large percentage falls in the last year in states with small populations — Tasmania (down by 55% in one year and by 72% in less than seven years to a new low), Australian Capital Territory and Northern Territory. (Note that the increasing percentages may show the picture to be worse than it actually is. For example, the recent increase in Victoria is from a very low base. The rate has risen by less than 2% from its lowest point, so that slightly more than 6 out of every one hundred babies is being circumcised, compared with less than 5 out of every one hundred at the low point.)

Standing back to survey the bigger picture, what was actually phenomenal was the decline in the circumcision rate from perhaps 90% in the 1950s and 1960s to close to 10% in the 1990s. In the 90s, the issue suddenly became controversial, primarily due to the efforts of a few die-hard circumcision enthusiasts making strident, implausible claims for the protective effects of circumcision against a number of diseases that have defied normal control strategies, such as HIV/AIDS, and as a means of preventing trivial penis problems in infancy.

Circumcision advocates exploit the public’s fear of AIDS and most recently HPV (human papillomavirus — the wart virus implicated in cancer of the penis and cervix) by demanding universal circumcision of male infants as a public health measure. They offer the misleading analogy that preputial amputation is just like vaccinations, and thus a harmless and effective medical intervention that should be made compulsory.

While some intactivists want this upward trend in circumcision rates publicised in the hope that it may spur people into action to fight it, others believe that Western circumcision is first and foremost a fashion, not unlike the current mania for body piercings, and publicising an increase in its popularity may encourage people to jump on the bandwagon. To the extent this may be, educating parents and communities on the costs of circumcision could significantly alter this trend. Studies in Australia have shown that circumcision remains far more common in rural areas than in the cities and is significantly more common in the more disadvantaged and less educated socioeconomic groups. The more well educated, more well-to-do in Australia have been quicker to abandon circumcision.

Whatever the underlying reasons for the upward trend, it surely, in time, will be seen as but a tiny upbeat in the overall trend towards declining rates. This belief is strengthened by policy statements of medical bodies that would truly make any sustainable rise completely unconscionable.

The Australasian Association of Paediatric Surgeon’s official position reads: ‘It is considered to be inappropriate and unnecessary as a routine to remove the prepuce, based on the current evidence available.’ The Australian College of Paediatrics states: ‘Routine male circumcision should not be performed prior to six months of age.’ In addition, it considers that ‘neonatal male circumcision has no medical indication. It is a traumatic procedure, performed without anaesthesia, to remove a normal functional and protective prepuce’.

The most recent policy statement by the Pediatric and Child Health Division of the Royal Australasian College of Physicians, after a thorough review of the medical literature, including recent claims that circumcision is protective against STDs, AIDS, urinary tract infection, and cervical cancer in female partners, concludes that there is ‘no evidence of benefits outweighing harm for circumcision as a routine procedure’. It also warns more strongly than in previous statements against the risks and complications, and raises serious legal and ethical issues. This new statement, one of the most authoritative statements ever issued by a medical organisation, has been endorsed by six Australian and New Zealand medical bodies.


About the Foreskin

The foreskin — also known as the prepuce — is the flexible, doublelayered sheath of specialised skin that covers and protects the glans (or head) of the normal penis. The foreskin is a uniquely specialised, sensitive and functional organ of touch. No other part of the body serves the same purpose.

Drs. Cold and McGrath conclude that, over the last 65 million years, the foreskin has offered reproductive advantages. It must also be remembered that the sexual selection has refined the external genitalia of every creature, including man. The human foreskin is the product of millions of years of evolutionary refinement, and, as such, the human foreskin represents the epitome of design perfection.

How big is the foreskin?

The foreskin is the largest part of the skin system of the penis. It covers and usually extends far beyond the glans before folding under itself to its circumferential point of attachment just behind the corona (the rim of the glans). The foreskin is, therefore, a double- layered organ. Its true length is twice the length of its external fold and comprises as much as 80 percent or more of the penile skin covering. In children, the foreskin often runs to impressive lengths, frequently representing over three quarters of length of the penis.

If the average adult foreskin were unfolded and laid flat and unstretched, it would be approximately the size of a 3 x 5 index card. Moderately stretched, it would entirely cover a man’s forehead or the back of his hand and fingers. That’s a lot of skin!

Isn’t the foreskin a vestigial (functionless) organ like the appendix?

No. First of all, the appendix is hardly a vestigial organ. This myth was created back in the nineteenth century when medical science was too primitive to figure out the purpose of the appendix. We now know the appendix to be an important part of the immune system. Similarly the foreskin cannot be vestigial. Studies conclude that the human foreskin is an evolutionary advancement over the foreskins of other primates. In monkeys and apes, the glans is more sensitive than the foreskin. In humans, this is reversed, so that the foreskin is more sensitive than the glans. If the foreskin were ‘vestigial’, this advancement would never have taken place and the human foreskin would be either equally or less sensitive than the ape foreskin.

Erogenous sensitivity

The foreskin is more sensitive than the fingertips or the lips of the mouth. It contains a richer variety and greater concentration of specialised nerve receptors than any other part of the penis. These specialised nerve endings can discern motion, subtle changes in temperature, and fine gradations of texture. This function enables genitally intact males to experience a superior dimension of sexual pleasure, compared to males who were circumcised. Intact males can be more tender, gentle, relaxed, and loving during sex because the slightest and subtlest gesture or motion evokes deeply satisfying sensations. Circumcised males have to work harder just to feel sensations. This is an unhealthy situation for both the male and his female partner.

Excerpted with permission from What Your Doctor May Not Tell You About Circumcision by Paul M. Fleiss, M.D. and Frederick M. Hodges, D. Phil



A Physician’ s Perspective

By Dr George L. Williams

 

Circumcision has puzzled me since my childhood. I was born in a country town, Worcester, in South Africa in 1947. Our family midwife at my homebirth slapped me to life as I was blue with breathing difficulties. My mother recounted that I needed to be spared circumcision as I had enough difficulty adjusting to my birth. My three brothers were circumcised in the newborn period. I would guess that circumcision was a prevalent practice in our community. We had no Jewish or Islamic affiliation and I am told my father was circumcised. During my childhood as I gazed with wonder at my brothers’ exposed penises, I felt different and defective. This ‘strangeness of the intact penis’ was also noted by Romberg, mother of three circumcised sons, childbirth educator and author of the pioneering book Circumcision: The Painful Dilemma.

As a medical intern I learned the surgical skills of circumcision in 1970. The procedure filled me with great concern and fortunately I did not have to perform further operations. I noted serious complications during my paediatric residency in South Africa and Australia.

In 1978 to 1980 whilst doing my postgraduate fellowship in Perinatal Medicine at The McMaster University (Canada), I learned the epidemiological discernment of clinical trials. In the ensuing years I explored the scientific validity of newborn circumcision.

Despite the Medical Colleges of Paediatrics and Obstetrics discouraging the routine practice on medical grounds, the operation continues to be done for its alleged benefits.

These benefits have not been proven by cohort analytic study or randomised controlled trials — the best tests for scientific validity. The long-term effects of infant circumcision have not been evaluated.

I have come to the conclusion that newborn circumcision does harm and offers no medical or surgical benefit. Circumcision is a surgical procedure with its inherent risks. These may include medical complications associated with infection, bleeding, disfigurement and stress-related sequelae.

The Cassell Pocket English Dictionary issued 1991 defines mutilate as ‘to cut off a limb or an essential part of; to maim; to mangle; to disfigure; to injure by excision’. Circumcision of the male newborn can be aptly described as penile mutilation. Boyd stated that the term is not only scientifically accurate but also honours the feelings of those who feel they are victims of circumcision.

The subject of circumcision in our society is plagued by bias and ignorance. I do not believe adequate education is given in the antenatal period/infancy about the care and value of the foreskin. There appears to be a misguided notion that the foreskin is a dangerous, troublesome and useless appendage.

The United Nations Convention on the Rights of the Child recently ratified by Australia, guarantees the right of the children of ethnic, religious or linguistic minorities to enjoy their own culture. However, the Convention also calls upon all parties to ‘take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children’. Circumcision is prejudicial to the health of children so its practice is to be condemned.

Newborn circumcision raises serious ethical and legal questions. Do parents have the right to choose medically unnecessary and harmful cosmetic surgery for their children?

I do not believe so. Female circumcision is culturally abhorrent but male circumcision is acceptable in the USA, Canada and Australia. Is circumcision battery, child sexual assault or false imprisonment? asked Boyd. Demetrakopoulos states that circumcision ‘is an invasion of the rights of new and unprotected citizens whom we reward after their elaborate entry into our world with hostility and pain’. Erickson collected this quote:

‘Fear, pain, crippling, disfigurement and humiliation are the classic ways to break the human spirit. Circumcision includes them all’.

The First International Symposium on Circumcision of 1989 adopted these declarations which I endorse:

• We recognise the inherent right of all human beings to an intact body. Without religious or racial prejudice we affirm this basic right.

• We recognise the foreskin, clitoris and labia are normal, functional body parts.

• Parents and/or guardians do not have the right to consent to surgical removal or modification of their children’s normal genitalia.

• Physicians and other health-care providers have a responsibility to refuse to remove or mutilate normal body parts.

• The only persons who may consent to medically unnecessary procedures upon themselves are individuals who have reached the age of consent (adulthood), and then only after having been fully informed about the risks and benefits of the procedure.

• We categorically state that circumcision has unrecognised victims.

• In view of the serious physical and psychological consequences that we have witnessed in victims of circumcision, we hereby oppose the performance of a single additional unnecessary foreskin, clitoral or labial amputation procedure.

• We oppose any further studies which involve the performance of the circumcision procedure upon unconsenting minors. We support any further studies which involve identification of the effects of circumcision.

• Physicians and other health-care providers have a responsibility to teach hygiene and the care of normal body parts and to explain their normal anatomical and physiological development and function through
out life.

• We place the medical community on notice that it is being held accountable for misconstruing the scientific database available on human circumcision in the world today.

• Physicians who practise routine circumcisions are violating the first maxim of medical practice, ‘Primum Non Nocere’, ‘First Do No Harm’, and anyone practising genital mutilation is violating Article V of the United Nations Universal Declaration of Human Rights: ‘No-one shall be subjected to torture or to cruel, inhuman or degrading treatment.’

In the USA, Australia, Britain and France, female genital mutilation is expressively prohibited by law. In Sweden, male circumcision on healthy children is not allowed and enshrined in legislation. The Law Reform Association (Australia) opined that ‘for a parent’s consent on a child’s behalf to the procedure to be lawful, it would have to be shown that it is therapeutic. A parent may validly authorise a non-therapeutic operation only if it is not actively against the child’s interest’.

While circumcision is likely to continue in our society, Boyd urges us to clear-headed thinking and analysis. A poignant quote from Ritter: ‘the operation of routine, neonatal circumcision involves a paradox of absurdities completely at variance with sound medical- surgical-legal practice’. We harm the honour and integrity of our profession if we continue with this neolithic practice.

George Williams, paediatrician, has been an activist against all circumcision since 1982. He co-founded NOCIRC of Australia in 1993 and received the Award of Merit in 1996 from Australia’s Parent’s Magazine for recognition of his efforts to make the world a better place for children.

This is an excerpt from a paper which was first presented at the Second International Homebirth Conference, 4-7 October 1992, University of Sydney, Australia and updated January 2004. References are available on request.

Articles Courtesy of Kali and Byron Child Magazine - http://www.byronchild.com