Circumcision Fiction

For many decades of the twentieth century, American physicians both recommended and presumed consent for routine infant circumcision. The American Academy of Pediatrics sharply revised its policy position (1999) to hold that circumcision was strictly a cultural and/or religious consideration with no medical consideration. A decade later, the AAP again revised its policy position (2012) citing two medical benefits—reduced risk of UTI for the first year of life and reduced risk of STI/STD later in adulthood. (There might also be an indirect risk reduction of penile cancer due to reduced risk of HPV (as an STI), but the HPV vaccine is now approved for males). However, the 2012 policy revision acknowledged that the data only showed that the statistical benefit was greater than the statistical risk of the procedure. Infant circumcision was therefore categorized as an acceptable medical procedure only; the data dud not establish infant circumcision as a necessary medical procedure. In other words, infant circumcision did not achieve the level of a medical recommendation.

I would add that circumcision significantly reduces (but not completely eliminates) the risk of balanitis (yeast infection of foreskin). Still, yeast is easily avoided by daily washing. Athlete’s foot is also caused by yeast and hygiene is the correct preventative practice, not surgery. Circumcision does eliminate the risk of phimosis and paraphimosis, but both of these rare conditions are easily treated by preputioplasty which is a small incision made into the foreskin to make the opening larger.

On the other hand, circumcision carries its own risks. Too much skin might be removed causing a buried penis, and circumcision scars sometimes require surgical revision to correct issues with achieving a full erection. Very rarely, a physician performing the circumcision catastrophically damages the infant’s penis through negligence or defective instrument (clamp, plastibel, etc).

Proponents of circumcision often advocate the practice as a hygienic aid and a means of improving an adult man’s coital stamina, but both of these arguments are strained. The same hygiene logic could (but never would) be applied to females so it is unclear why it is so necessary for males. Regular washing adds less than thirty seconds to a full shower. The argument of delayed ejaculation plainly admits that circumcision desensitizes the penis.

As for UTI and STI/STD reduction, this argument is an equally difficult justification—the prevention is disproportionate to the risk. By way of comparison, every person carries a risk of developing tonsillitis and appendicitis, but no one would perform infant tonsillectomies and appendectomies just to avoid that statistically low risk later in life. And, of course, STI/STD rates have much more to do with risky behaviors than with circumcision.

The American obsession with circumcision probably has a great deal to do with the legacy of puritan prudishness. Starting in the mid- to late-1800s (and lasting about a century), physicians prescribed male circumcision as a treatment for excessive masturbation. This shows the dark side of circumcision as reducing the quality of a man’s sexual experience.

The penile foreskin consists of two parts—epidermis and mucosa—which is the same at one’s oral labia (face lips). The point at which the skin color and texture change from epidermis to mucosa is the mucocutaneous juncture. .ucocutaneous junctures also exist at the eyelids, vaginal labia, and anus. The glans (or penis head) is covered by mucosa, not epidermis. Removing the foreskin exposes this mucosa to chaffing and drying which keratinizes the glans mucosa making it tougher and less sensitive. Opponents of circumcision argue that this reduces nerve sensitivity (which explains how circumcision is said to delay ejaculation). The circumcised penis also looses its mobike skin sheath and thus makes masturbation less functional (in other words, the uncircumcised penis is free to move about in its skin sheath and does not require lubricant for masturbation).

Infant circumcision is very different from adult circumcision. Just as females are born with hymens, the foreskin of the male infant is adhered to the glans by a hymen-like membrane. This membrane, however, naturally dissolves on its own at puberty. Infant circumcision requires forcible tearing. Prior to the AAP’s 1999 policy statement, nearly all infant circumcisions were performed without anesthesia (many physicians still do not use anesthesia to this day). As is narrated and demonstrated in the video links below, infant circumcision begins by strapping the infant’s arms and legs into a special cradle. A local anesthesia might (or might not) be injected into the penis. Scissors then forcibly stretch the hole to enable inserted of a probe to tear the membrane. An incision is made into the foreskin so that a clamp can be applied to “crush” the skin. The crushing action fuses the skin together and usually prevents bleeding. The foreskin is then trimmed with a scalpel and the clamp is removed. Post-procedure care calls for massive application of petroleum jelly for several weeks to protect the penis from feces and urine as it heals.

Since the size of the adolescent/adult penis cannot be foreknown, how much foreskin to remove during Infant circumcision is something of a guess. If too much skin is removed, the adolescent/adult male will develop a “buried penis” meaning that his erections cannot achieve full extension because the remaining shaft skin is too short. This is not a concern if too little skin is removed, but the adolescent/adult male may be displeased with the appearance and might choose to have it surgically revised. Infant circumcision also does not generally remove the ventral frenulum which is a narrow band of tissue that attaches just below the urethral meatus (pee hole). Since the frenulum is not removed, both the circumcised and uncircumcised male may turn out to have frenulum breve (short frenulum) which causes the penis head to curve downward. This is easily corrected by an in-office frenulotomy which involves placing a few dissolvable sutures that will cause the frenulum to detach within two to three weeks.

Circumcision opponents focus on the anatomical structures of the penis. They point out that the preputial skin is different than other skin and is very densely populated with specialized nerve endings. The prepuce also contains lightly contractile Dartos fascia which is what naturally causes the foreskin to return to its forward position to protect the glans mucosa from friction and irritation. Protection from chaffing, the glans mucosa will retain its natural color, texture, and sensitivity throughout the male’s life. Also, since the penis is free to move longitudinally within its skin sheath, lubrication is unnecessary for enjoyable masturbation. Furthermore, the skin sheath keeps more vaginal lubrication within the vaginal canal during intercourse.

Male circumcision is not unique to Western civilization. Several Amerindian cultures, for example, were documented by the Spanish explorers to engage in various forms of foreskin modification like piercing and gauging. Judeo-Christian cultures largely cite Abraham’s circumcision of himself, his son(s), and his servants (see Genesis 17:9-14). However, another instructive passage is found in Joshua 5:2-12 where a population-wide adult circumcision occurred. What is interesting about the Joshua passage is that it speaks of “roll[ing] away” their shame, perhaps suggesting a very different practice than is done today by amputating the foreskin.

Modern adult circumcision is performed quite differently from infant circumcision. Adults can be circumcised at the foreskin or a the base of the penis (the latter pulls the foreskin back along the penile shaft but leaves it and all of its nerve endings intact). For adults, however, either way requires considerable and careful suturing because unlike infants, adult males get raging nocturnal erections that can tear sutures and rip the wound open. Simply bandaging the adult penis without sutures would not heal well and would produce massive scarring. For these reasons, I think that the “roll[ing] away” describes cutting the ventral frenulum which would allow the foreskin and the sheath to actually roll behind the coronal sulcus (the ridge) and remain there. Medically, this would treat any genetic predispositions for frenulum breve; hygienically, it would avoid balanitis as the Israelites roamed the wilderness without regular bathing. But even then, in the Jewish tradition Mohels do not remove nearly as much skin during a brit milah as is removed in a modern medical circumcision.

The Catholic church has long advocated circumcision—particularly in the Americas—as a means of bringing sanctity to the “sinful” member. This doctrine draws a parallel between the Jewish covenant of circumcision and the Christian rite of baptism as if circumcision is a rite that brings special redemption to the penis. The Apostle Paul, however, wrote in 1 Corinthians 7:17-20 that circumcision was irrelevant to salvation: ‘Circumcision is nothing and uncircumcision is nothing. Keeping God’s commands is what counts. Each person should remain in the situation they were in when God called them.’ (However, Paul did previously advise Timothy to be circumcised in Acts 16:3 due to the hostility of area Jews who might otherwise reject Timothy’s preaching). Today, however, some of the Catholic clergy is coming around and speaking against modern circumcision!

Superstition is probably the biggest driver of infant circumcision in the USA, but economics would be a close second. Physicians get paid for performing the procedure, insurers pay for the procedure. A surprising amount of foreskin tissue is collected in hospitals and is sold for medical research and/or use in cosmetics. But outside of the USA, some jurisdictions have even passed legislation banning hospital circumcision to disrupt the economic incentives (as 60-Minutes Australia (below) explains).

Circumcision is a one-way street and as more than 99% of all circumcisions are performed in infancy, circumcised adults have no frame of reference to qualify their sexual satisfaction with the procedure. There are, however, various internet accounts of men who underwent elective circumcision in adolescence or adulthood such as this article on four men who underwent adult circumcision.

As one who was never circumcised, I can say that I am extremely happy to have 100% of my anatomy. I twice considered circumcision, once when I was eight or nine years old and again at eighteen or nineteen. Both contemplations were entirely about fitting in with the American majority. The first time I declined the procedure because of pain; the second time I decided against it because I found a certain pride in remaining in my natural state…the way God created me. Much later I came to fully understand the deeper sexual enjoyment of my foreskin. I am thankful that no one forced circumcision upon me and that I did not elect circumcision. I also would not have it any other way. I am proud of my minority standing. As an adult, I once asked my mother why I had not been circumcised and I was very surprised by the answer. She said that she wanted to circumcise so that I would be like the other boys but my father undertook a tireless fight/battle/war against it (and I’m thankful that he did). I knew my father was not circumcised but I also asked my paternal grandfather about it and found out that not only was my grandfather not circumcised, but neither his father nor his grandfather. That meant that I could trace the non-circumcision at least five generations and I was all the more proud to continue the tradition. When I see the opportunity, I advocate against infant circumcision by explaining my happiness and pride in being fully intact. For those mothers who want their boys to be like other boys in appearance, I suggest explaining to their sons that they should be proud to have 100% of their anatomy and that the other boys should be embarrassed to have had theirs amputated. And for the fathers who want their sons to be like other boys I would point out that not being circumcised has actually led to sexual encounters on various occasions simply because my partner had never been with an intact man before.

As I mused in another post, it would be interesting to know what percentage of “pro-choice” individuals apply that same freedom of choice when it comes to infant circumcision. The problem as I see it is that parents are ignorant of the facts of circumcision. These videos will help educate the willing reader on the topic of circumcision.

One Mother’s Deliberation on Circumcising Her Son

Canadian Ladies of TwentySomething TV Discussing Uncircumcised Partners

60-Minutes (Australia)

The Doctors (TV Show) Discussing Circumcision

Samuel Kunin (M.D. & Mohel) Performing Infant Circumcision (with anesthesia)

Unknown Practitioner Performing Infant Circumcision (without anesthesia)

Ryan McAllister, Ph.D. – Child Circumcision: An Elephant In the Hospital

Anatomy & Physiology of the Foreskin

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