Bro-telligence or Just Hard To Swallow?

[kong1971]

I've been accused of many things in my time here as a contributor to [words=http://www.mattersofsize.com/join-now.html]MOS[/words], from being a scam artist of some kind to a would-be cult leader and a self-deluded maniac with mental disabilities. Most of these accusations are thinly veiled personal attacks meant to distract and maybe "run me off" because of the nature of the subject matter I've tried to bring to light, a kind of aggressive self-protection mechanism from some of the other members here who cannot bring themselves to contemplate some of the issues I have brought to the table.

All this bitterness and rage have shaken me from time to time, infuriated me, frustrated me and left me wondering what I am doing, why I am doing it, and what I want to get out of it. I have responded in like kind at times, tried to psycho-analyze those who are most strident in their objections, and even resorted to mean and petty attempts to frustrate them as well.

I am concerned at the negative portrayal of myself that has been painted, and admit that I have had a hand in that painting myself at times when I succumbed to my own human desire for revenge at the unfounded aspersions often heaped upon my character. My only concern is that the drama and the ridiculous claims fired my direction serve only to cast a shadow on the message that I have been broadcasting the last year and a half here.

That message is about the tragic and unnecessary assault upon our very manhood. That message is about the violence done to our sex every minute of the day, every day of the year. It's about our gender and our lives and our identity. It's not just our cocks they cut off, our bodies they modify and our masculinity they attempt to excise, but our identity, our souls and our rights as men here in the United States of America.

Perhaps I was foolish to believe that I would never encounter such rabid opposition from my own gender with this message, but I suppose there are always a few cowards around. It may not even be psychological cowardice but a form of mental coping, like how kidnappees identify and sympathize with their kidnappers... Whatever the reason, just try, for a second, to pull the "tail" from between your legs and see the whole picture.

Over the course of this thread I am going to be reprinting some of the articles and essays that helped to form the beliefs that I hold and which serve as the backbone of the message I have been working ceaselessly to get across to you all. Some of the articles are written by doctors, accredited scholars and all sorts of high-faluting muckamucks, but it is all annotated and cross-referenced.

NOT FINISHED...PLEASE WAIT FOR THE WHOLE POST BEFORE REPLYING...

 

[kong1971]

The Sexual and Psychological Consequences of Infant Circumcision

Lawrence Barichello

Executive Director, Intact, Toronto, Ontario, Canada.



--------------------------------------------------------------------------------


Introduction

Since infant circumcision became widespread in North America for what were thought to be medical reasons, the debate over the advantages and disadvantages of the procedure has focused on surgical risks and supposed prophylactic medical benefits. With this pseudo-medical argument of the mid 1900s came the assertion that circumcision had no effect on the sex life of the adult, though there has never been any evidence to support this claim. North American medical schools often teach nothing of the foreskin—perhaps the only disregarded tissue on the human body. The evidence that circumcision causes damage has often been ignored, minimized, or ridiculed, both by the medical profession and the general public. However, even a casual glance at the literature on the subject points to a large body of evidence of significant harm.


Sexual Consequences of Circumcision

Contrary to what is popularly conceived today, circumcision had long been known to be desensitizing to the penis. In fact, in North America, one 19th century rationale for circumcising both males and females was to decrease the sexual sensitivity of the genitals and thereby reduce the incidence of masturbation, a much vilified act thought to cause a wide variety of diseases, including insanity.[1] These excerpts from medical journals and texts of the late 1800’s illustrate this point graphically.

There can be no doubt of [masturbation’s] injurious effect, and of the proneness to practice it on the part of children with defective brains. Circumcision should always be practiced. It may be necessary to make the genitals so sore by blistering fluids that pain results from attempts to rub the parts.[2]

In consequence of circumcision the epithelial covering of the glans becomes dry, hard…the sensibility of the glans is diminished, but not sufficiently to interfere with the copulative function of the organ or to constitute an objection... It is well authenticated that the foreskin...is a fruitful cause of the habit of masturbation in children... I conclude that the foreskin is detrimental to health, and that circumcision is a wise measure of hygiene.[3]

In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement, and preventing the recurrence of the practice in those whose will-power has become so weakened that the patient is unable to exercise entire self-control.[4]

The reasons why circumcision continued to be inflicted on males but not females are not clearly understood, but I suggest that existing models of femininity, which made it easier to convince little girls not to touch their genitals, and the emergence of a pseudo-medical rationale specific to male circumcision both played a part.

Recent anatomical studies by Taylor, et al now irrefutably demonstrate the existence of special nerves in, and therefore the sexual importance of, the foreskin. Primarily, these special nerves are found in what Taylor calls the ridged band of the prepuce—not a general area but rather a very strict, anatomically distinct band.[5] This specialized skin and mucous membrane, with its specialized nerves, is anatomically very similar to the clitoral prepuce, and the special nerve bundles found there are also found in the clitoris and the clitoral prepuce, but not commonly in the glans penis.[6] In the male, the distal position of this ridged band and its narrowness is such that it is always removed in circumcision, regardless of the method used.[7]

The word "specialized" for these nerve bundles is appropriate because they are not like other sensory or "free" nerve endings found generally on the skin. These nerve clusters are found only in the juncto-cutaneous areas of the body, such as the vulva, clitoris, and clitoral prepuce, the lips, and the peri-anal area. In all cases, these nerves are responsible for erotic sensation, though generally only in the genital area do they trigger orgasm.[8]

Damage to the glans caused by circumcision has been well-documented. Such damage takes two forms:

Circumcision performed in the newborn period traumatically interrupts the natural separation of the foreskin from the glans that normally occurs somewhere between birth and age 18. The raw, exposed glans penis heals in a process that measurably thickens the surface of the glans and results in desensitization of the head of the penis. When circumcision is performed after the normal separation of the foreskin from the glans, the damage done by forcible separation of these two parts of the penis is avoided, but the glans must still thicken in order to protect itself from constant chafing and abrasion by clothing.[9]

Zdenek observes that "rete ridges of the epidermis are irregular and vary in height depending on location, age, and presence or absence of a foreskin."[10]

The sexual damage caused by circumcision also affects the sexual partner of the circumcised man. Because the natural lubrication of the skin sheath is lost, abrasion and trauma to the female sexual partner is increased.[11][12] This would presumably also affect a male sexual partner.

That these differences result in altered sexual behaviour in the adult has also been documented. Laumann et al showed that circumcised men needed to resort to a wider variety of sexual practices in order to achieve orgasm.[13]

Impotence and loss of sensitivity has been linked to adult circumcision,[14] and increased sexual dysfunction after circumcision is supported by animal studies of both bulls[15] and rats.[16] Human infant circumcision would not be supposed to have a similar result if there were some mechanism by which nerves lost in infancy could regrow in childhood. Such effects are sometimes found in the case of infant brain lesion where normal function can be regained if the damage is done before a threshold age. In the case of circumcision, however, the nerves do not regrow, probably because the mucosa needed to support the specialized nerve endings has been excised. Cold has found that infant circumcision results in amputation neuromas, an indication that the sensitivity of the severed nerves is not regained.[17]


Psychological Consequences of Circumcision

There is little consensus in the field of psychology save that behaviour is mediated through the central nervous system,[18] and that early childhood trauma affects adult behaviour. By trauma we generally mean either ‘wound’ (in the field of medicine) or ‘emotional shock’ (in the field of psychology). Since a wound caused by circumcision would be presupposed to cause pain in the absence of anesthetic, and pain is a primary cause of emotional shock, we can see that circumcision results in both types of trauma.

There are still those who doubt the physical pain of circumcision, and by extension any psychological effects. This school of thought either maintains the insensitivity of the foreskin, which I have already dealt with, or the inability of the infant nervous system to perceive or process pain. While there has never been any evidence whatsoever to support either hypothesis, the myth continues. I suggest that many such people have never actually witnessed a circumcision as it is commonly performed in hospitals and clinics today, which is still, in the majority of cases, done without any anesthetic. Moreover, any discussion of North American men must take into account that anesthetic for circumcision is a relatively new idea, and that any contemporary men who were circumcised at birth were almost certainly not given any pain relief whatsoever.


A. Early Effects

Rather than there being good scientific evidence that infants do not feel pain, the contrary is the case. Neonatal infant responses to pain are "similar to but greater than those in adult subjects,"[19] and investigators have reported that the level of pain of circumcision is "among the most painful performed in neonatal medicine"[20] and "would not be tolerated by older patients."[21]

That such pain affects infant behaviour should hardly be surprising. Richards presents "both circumstantial and direct evidence that circumcision of male infants leads to behavioral changes."[22] The circumcision status of babies in American studies is rarely, if ever, corrected for as a factor in demonstrating behaviour differences between male and female infants, such as sensory thresholds or sensitivity to sensory stimuli, and preference for sweet substances. In fact, in examining studies that show gender differences between male and female infants, Richards points out that "in some American studies using circumcised infants, reported gender differences may instead be the result of the altered behavior of circumcised males."[23]

Another immediate effect of circumcision is that infants feed less frequently. In particular, circumcision led to a decrease in postoperative breastfeeding. Howard concluded that, after circumcision,

the observed deterioration in ability to breast-feed may potentially contribute to breast feeding failure. Furthermore some neonates in this study required formula supplementation because of maternal frustration with attempts at breast-feeding, or because the neonate was judged unable to breast-feed postoperatively. This finding is disconcerting because early formula supplementation is associated with decreased breast-feeding duration.[24]

Other studies which demonstrate the effects of circumcision on infant behavior point out the alteration of sleep patterns[25] and psychophysiology.[26] Citing Dobbing, Richards points out that "the human brain is particularly vulnerable to exogenous and endogenous influences during the period of its maximum growth rate, from the latter part of pregnancy until approximately 18 months postnatal."[27]


B. Long-term Effects

Those that admit that the procedure causes pain, but dismiss the long-term negative effects of circumcision often theorize that because the adult cannot remember the event, there can be little or no long-term psychological effects. This theory is in direct conflict with established psychological thought, which maintains that unremembered trauma may actually have the greater effect. If such a theory were to be applied elsewhere, we would maintain that a child sexually molested at an age so young that it can not be consciously remembered as an adult would suffer no ill effects from the experience.

On the contrary, there is considerable evidence that demonstrates that the effects of circumcision are not short-lived. Immerman proposes that circumcision not only affects localized nerves, but also causes permanent cortical reorganization in the brain. These changes in the brain not only affect the areas responsible for sensation in the (now) excised foreskin, but also the emotional centre of the brain related to adult sexuality. Such changes in the brain must be aligned with changes in behaviour, and "the earlier in the male’s life the circumcision occurs, the more impact the ablation would be expected to have on his nervous system, and hence, his behavioural tendencies." Specifically, Immerman concludes that circumcision "would be expected to affect the overall sexual behaviour of that individual…to lower excitability or raise the threshold of sexual arousal," and refers to circumcision as "low-grade neurological castration."[28]

Richards agrees that the neurological impact of circumcision is long-term, pointing out that

in view of all the evidence showing long-term behavioral, physiological, anatomical, and even neuropharmacological effects of ‘minor’ events on early animal development (e.g., Levine,1969), we would be unwise to assume without empirical demonstration that the circumcision effects are short-lived.[29]

A recent study by Taddio demonstrates that neonatal circumcision increases the perception of pain in four-month-old children during inoculation. The study found that postoperative anesthetic did not reduce this effect.[30]

In addition to changes in sexual behaviour, circumcision has been proposed to cause more disturbing changes to adult male psychology. Goldman finds that the effects of infant circumcision on the adult "appear to be consistent with the symptom pattern of post-traumatic stress disorder [PTSD]."[31] This observation is supported by Rinehart, who found that the circumcision-related symptoms of his patients were "no different from the experience of rape victims, combat veterans,… [and]…female circumcision victims."[32] The symptoms of PTSD include avoidance of the topic and emotional numbing,[33] which may explain why many men do not complain about their circumcision. Other symptoms of PTSD include recurrent thoughts and dreams about the trauma, feelings of powerlessness, inappropriate anger, and extreme forms of panic, rage, and violence.

Van der Kolk finds that victims of violence have a compulsion to repeat the trauma, either as victimizer, or again as victim, and that those victimized as children are more vulnerable to this compulsion than adults.[34] This may explain why, even in the absence of medical need and with foreknowledge of the damage of circumcision, many fathers elect to have their sons circumcised. It may also explain why North American, Australian, and, to a lesser degree, British doctors with similar foreknowledge continue to do this surgery on unconsenting minors in the absence of medical indications or benefit.* Perhaps more alarming is the effect that repetition compulsion has on society in general. Van Der Kolk notes that "re-enactment of victimization is a major cause of violence… [and that] …criminals have often been physically or sexually abused as children."[35]

[* In the countries in which circumcision is commonly performed by doctors (Australia, Britain, Canada, and the U.S.A.), it is unique in this regard-there is no other surgery performed on minors for the sole reason of parental preference. Moreover, in these countries doctors who perform circumcisions are also unique-no other practitioner (tattoo artist, body piercer, etc.) would be allowed to permanently alter the body of a minor, even if the consent of the minor was given.]


Conclusion

There is little doubt that both the adult man’s sexual sensitivity and his partner’s comfort are diminished by infant circumcision. What is less recognized by most lay people is the possibility that circumcision may lead to an increase in violent behaviour. Goldman writes that "whatever affects us psychologically also affects us socially."[36] It seems self-evident that, a baby should be as free from pain as possible for normal neurological, and, therefore, psychological, development. It also seems self-evident that in order for a man to have a normal sex life, his penis should be intact.

Currently, both the professional and the public debate surrounding the propriety of infant circumcision requires a more thorough understanding of the sexual, psychological, human rights, legal and ethical consequences of this procedure. Moreover, if the culture-wide denial of the effects of circumcision is to be overcome, public awareness of the available scientific data must be increased.


Further Reading

Alice Miller discusses the effects of early child abuse and trauma on later violent and self-destructive behaviour. Alice Miller is a Swiss psychoanalyst. Her books include The Drama of the Gifted Child: The Search for the True Self, Thou Shalt Not Be Aware: Society's Betrayal of the Child, Banished Knowledge: Facing Childhood Injuries, and For Your Own Good: Hidden Cruelty in Child-rearing and Roots of Violence, The Untouched Key: Tracing Childhood Trauma in Creativity and Destructiveness.] Anchor Books (Doubleday) New York.

Krupnick J, Horowitz M. Stress response syndromes. Arch Gen Psychiatry 1981; 38: 428-35

Visit the Circumcision Information Resource Page at http://www.cirp.org/. This the only Circumcision-related site listed in the British Medical Journal.




Endnotes

Ralph A. Goodner, MD, "The Relation of Masturbation to Insanity, with Report of Cases," Medical News 1897.
Angel Money. Treatment Of Disease In Children. Philadelphia: P. Blakiston. 1887.
Jefferson C. Crossland, MD, "The Hygiene of Circumcision," New York Medical Journal, 1891.
John Harvey Kellogg, MD. "Treatment for Self-Abuse and Its Effects," Plain Facts for Old and Young. Burlington, Iowa: F. Segner & Co. 1888.
The prepuce: specialized mucosa of the penis and its loss to circumcision. Taylor, J. R., Lockwood, and Taylor, A. J. British Journal of Urology (1996), 77, 291-295.
Anatomy and Histology of the Penile and Clitoral Prepuce in Primates. Cold, C. J. and McGrath, K. A. Male and Female Circumcision, Denniston et al, eds. Kluwer Academic/Plenum Publishers, New York, 1999.
Interview with John Taylor, Anatomic Pathologist, Department of Pathology, Health Sciences Centre, University of Manitoba, Winnipeg Manitoba, Canada on www.intact.ca/taylor.html, 1998.
Interview with Christopher Cold, Anatomic and Clinical Pathologist, Marshfield Clinic, Marshfield, Wisconsin, U.S.A.
Human Sexuality: an Encyclopedia edited by Vern L. Bullough and Bonnie Bullough New York: Garland Pub., 1994. p. 119-122.
Zdenek, H and Munger, B. L. The Neuroanatomical Basis for the Protopathic Sensibility of the Human Glans Penis. Anatomisches Intitut der Univesität Hamburg, Abteilung für Funktionelle Anatomie, Hamburg (F. R. G.) and Department of Anatomy, The Pennsylvania State University, College of Medicine, The Milton S. Hershey Medical Center, Hershey [words=http://www.mattersofsize.com/join-now.html]PA[/words] 17033 (U.S.A.) (Accepted June 18th, 1985).
Human Sexuality: an Encyclopedia edited by Vern L. Bullough and Bonnie Bullough New York: Garland Pub., 1994. p. 119-122.
O'Hara, K., and O'Hara, J. The effect of male circumcision on the sexual enjoyment of the female partner. BJU International, Volume 83, Supplement 1, Pages 79-84, January 1, 1999.
Laumann, E. O., Masi, C. M., Zuckerman, E. W. Circumcision in the United States. Journal of the American Medical Association, Vol. 277 No. 13, Pages 1052-1057. April 2, 1997.
Stinson J. Impotence and adult circumcision. J Nat Med Assoc1973; 65: 161.
Desrochers A, St. Jean G., Anderson D. E. Surgical management of preputial injuries in bulls: 51 cases (1986-1994). Can Vet J 1995;36:553-6.
Lumina A. R., Sachs B. D., Meisel R. L. Sexual reflexes in male rats: restoration by ejaculation following suppression by penile sheath removal. Physiol Behavior 1979;23:273-7.
Interview with Christopher Cold, Anatomic and Clinical Pathologist, Marshfield Clinic, Marshfield, Wisconsin, U.S.A.
Immerman, R. S. and Mackey, W. C. A Proposed Relationship Between Circumcision and Neural Reorganization. Journal of Genetic Psychology, Vol. 159, No. 3, pp. 367-378, September, 1998.
Hickey, A. K. Pain and its effects in the human neonate and fetus. New Eng J Med 1987: 317: 1321-9.
Ryan, C. and Finer, N Changing attitudes and practices regarding local anesthesia for newborn circumcision. Pediatrics 1994; 94:232.
Williamson P and Williamson M Psysiologic stress reduction by a local anesthetic during newborn circumcision. Pediatrics 1983: 71: 40.
Richards, M. P. M., Bernal. Early Behavioral Differences: Gender or Circumcision? Developmental Psychobiology, Vol. 9, No. 1, (January 1976): Pages 89-95.
Richards, M. P. M., Bernal. Early Behavioral Differences: Gender or Circumcision? Developmental Psychobiology, Vol. 9, No. 1, (January 1976): Pages 89-95.
Howard, C. R., Howard, F. M., and Weitzman, M. L. Acetaminophen Analgesia in Neonatal Circumcision: the Effect on Pain. Pediatrics, Volume 93 Number 4: Pages 641-646. April 1994.
Marshall, R. E., Stratton, W. C., Moore, J. and Boxerman, S. B. Circumcision I: Effects Upon Newborn Behavior. Infant Behavior and Development. 1980, Volume 3: Pages 1-14.
Richards, M. P. M., Bernal. Early Behavioral Differences: Gender or Circumcision? Developmental Psychobiology, Vol. 9, No. 1, (January 1976): Pages 89-95.
Marshall, R. E., Stratton, W. C., Moore, J. and Boxerman, S. B. Circumcision I: Effects Upon Newborn Behavior. Infant Behavior and Development. 1980, Volume 3: Pages 1-14.
Immerman, R. S. and Mackey, W. C. A Proposed Relationship Between Circumcision and Neural Reorganization. Journal of Genetic Psychology, Vol. 159, No. 3, pp. 367-378, September, 1998.
Richards, M. P. M., Bernal. Early Behavioral Differences: Gender or Circumcision? Developmental Psychobiology, Vol. 9, No. 1, (January 1976): Pages 89-95.
Taddio, A, Katz, J. Ilersich, A. L., Koren, G. Effect of Neonatal Circumcision on Pain Response During Subsequent Routine Vaccination. The Lancet, Vol. 349: Pages 599-603 (March 1, 1997).
Goldman R. Circumcision - The Hidden Trauma:How an American Cultural Practice Affects Infants & Ultimately Us All. Boston: Vanguard Publications, 1997:134.
Rhinehart, J. Neonatal Circumcision Reconsidered. Transactional Analysis Journal, Volume 29, Number 3, Pages 215-221, July 1999.
Goldman, R. The psychological impact of circumcision. BJU International, Volume 83 Supplement 1, Pages 93-102, January 1, 1999.
van der Kolk, B. A. The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism. Psychiatric Clinics of North America, Volume 12, Number 2, Pages 389-411, June 1989.
van der Kolk, B. A. The Compulsion to Repeat the Trauma: Re-enactment, Revictimization, and Masochism. Psychiatric Clinics of North America, Volume 12, Number 2, Pages 389-411, June 1989.
Goldman, R. The psychological impact of circumcision. BJU International, Volume 83 Supplement 1, Pages 93-102, January 1, 1999.

 

[kong1971]

The British Medical Association's ethical guidelines

These guidelines are a great step forward from anything that has come out of the US, such as the AAP guidelines. In particular, "parental preference alone is not sufficient justification for performing a surgical procedure on a child." Emphasis in red is added.

the law & ethics of male circumcision - guidance for doctors
March 2003

Aim of the guidelines
Principles of good practice
Circumcision for medical purposes
Non-therapeutic circumcision
The law
Summary: the law
Consent and refusal
Children's own consent
Parents' consent
Summary: consent and refusal
Best interests
Summary: best interests
Health issues
Standards
Facilities
Charging patients
Conscientious objection

Aim of the guidelines
One of the BathmateA's roles is to issue guidance to doctors on ethical and medico-legal issues. Accordingly, this guidance addresses the queries medical practitioners raise with the BathmateA about both therapeutic and non-therapeutic[1] male circumcision. The two procedures raise different issues. It does not cover circumcision carried out by non-medical practitioners, but we note that there may be no requirement in law for these practitioners to have proven expertise. Nor does the guidance address female genital mutilation, that is sometimes referred to as female circumcision.[2]

Circumcision of male babies and children at the request of their parents is an increasingly controversial area and strongly opposing views about circumcision are found within society and within the BathmateA's membership. The medical evidence about its health impact is equivocal.

As with any aspect of medical practice, doctors must use their skills in a way that promotes their patients' interests. They must act within the boundaries of the law and their own conscience, and weigh the benefits and harms of circumcision for the particular child. This guidance outlines good practice and safeguards which the BathmateA believes doctors should follow in the circumcision of male babies and children.

The General Medical Council has also issued advice on circumcision,[3] and advocates similar safeguards to those suggested here.

Principles of good practice
- The welfare of child patients is paramount and doctors must act in the child's best interests.
- Children who are able to be express views about circumcision should be involved in the decision-making process.
- Consent for circumcision is valid only where the people (or person) giving consent have the authority to do so and understand the implications and risks.
- Both parents[4] must give consent for non-therapeutic circumcision.
- Where people with parental responsibility for a child disagree about whether he should be circumcised, doctors should not circumcise the child without the leave of a court.
- As with all medical procedures, doctors must act in accordance with good clinical practice and provide adequate pain control and aftercare.
- Doctors must make accurate, contemporaneous notes of discussions, consent, the procedure and its aftercare.

Circumcision for medical purposes
Unnecessarily invasive procedures should not be used where alternative, less invasive techniques, are equally efficient and available. It is important that doctors keep up to date and ensure that any decisions to undertake an invasive procedure are based on the best available evidence. Therefore, to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.

Male circumcision in cases where there is a clear clinical need is not normally controversial. Nevertheless, normal anatomical and physiological characteristics of the infant foreskin have in the past been misinterpreted as being abnormal. The British Association of Paediatric Surgeons advises that there is rarely a clinical indication for circumcision.[5] Doctors should be aware of this and reassure parents accordingly.

If there is doubt about whether treatment is needed, or what is the most appropriate course of management, specialist advice should be sought. It is recommended that circumcision for medical purposes must only be performed by or under the supervision of doctors trained in children's surgery in premises suitable for surgical procedures.[6]

[Function and role of the foreskin
This section is unaccountably missing.]

Non-therapeutic circumcision
Male circumcision that is performed for any reason other than physical clinical need is termed non-therapeutic (or sometimes "ritual") circumcision. Some people ask for non-therapeutic circumcision for religious reasons, some to incorporate a child into a community, and some want their sons to be like their fathers. Circumcision is a defining feature of some faiths. [Intactness is a defining feature of others, such as Sikhism.]

There is a spectrum of views within the BathmateA's membership about whether non-therapeutic male circumcision is a beneficial, neutral or harmful procedure or whether it is superfluous, and whether it should ever be done on a child who is not capable of deciding for himself. The medical harms or benefits have not been unequivocally proven except to the extent that there are clear risks of harm if the procedure is done inexpertly. The Association has no policy on these issues. Indeed, it would be difficult to formulate a policy in the absence of unambiguously clear and consistent medical data on the implications of the intervention. As a general rule, however, the BathmateA believes that parents should be entitled to make choices about how best to promote their children's interests, and it is for society to decide what limits should be imposed on parental choices. What those limits currently are is discussed below, together with the legal and ethical considerations for doctors asked to perform non-therapeutic circumcision.

The law
It is presently generally accepted that non-therapeutic circumcision is lawful.

"Even when violence is intentionally afflicted and results in actual bodily harm, wounding or serious bodily harm the accused is entitled to be acquitted if the injury was a foreseeable incident of a lawful activity in which the person injured was participating. [It is grotesque to describe an infant - the person injured - as "participating" in being circumcised.] Surgery involves intentional violence resulting in actual or sometimes serious bodily harm but surgery is a lawful activity [when medically necessary. Doctors have been struck off for performing unnecessary surgery]. Other activities carried on with consent by or on behalf of the injured person have been accepted as lawful notwithstanding that they involve actual bodily harm or may cause serious bodily harm. Ritual circumcision, tattooing, ear-piercing and violent sports including boxing are lawful activities". [It seems the judge assumed ritual circumcision is lawful on the basis that it had never been challenged.][7]
This comment was made in passing by a judge considering a case about the extent to which a person could consent to physical interference by another and was relied on by a judge in a subsequent case considering the religious circumcision of a 5 year old boy whose parents disagreed.[8] In that case the judge concluded that "as an exercise of joint parental responsibility, male ritual circumcision is lawful". The lawfulness of the procedure is challenged by some, however, and in the mid-1990s the English Law Commission said that although in its view ritual circumcision is lawful, law reform to "put the lawfulness [or the unlawfulness] of ritual male circumcision beyond any doubt" would be useful.[9] This, however, has not been forthcoming.

These legal cases were heard before the implementation of the Human Rights Act which, in 2000, incorporated Articles of the European Convention on Human Rights [10] into UK law. Doctors must consider whether their decisions impact on a person's human rights and, if so, whether the interference can be justified. Rights that might be relevant to non-therapeutic circumcision include:
- Article 3: "No one shall be subjected to torture or to inhuman or degrading treatment or punisHydromaxent"
- Article 5(1): "Everyone has the right to liberty and security of the person"
- Article 8: "Everyone has the right to respect for his private and family life" except for the "protection of health or morals, or for the protection of the rights and freedoms of others"
- Article 9(1): "Everyone has the right to freedom of thought, conscience and religion"
- Article 9(2): "Freedom to manifest one's religion or beliefs shall be subject only to such limitations as are prescribed by law and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or for the protection of the rights and freedoms of others"

Many aspects of good practice – including careful assessment of best interests, balancing conflicting rights and consulting with patients and their families – have taken on added importance as a result of the Human Rights Act, which makes them a required part of the decision-making process. As yet, the full impact of the Act on medical decision making is not known, and the rights in the Act are used by commentators to both support and reject non-therapeutic circumcision. One reason why it is not clear where the balance of rights lies is that the medical evidence is equivocal. Some argue that circumcision is a relatively neutral procedure, that, competently performed, carries little risk but can confer important psychosocial benefits. Others argue that circumcision has, or can have, profound and long-lasting adverse effects on the person who has been circumcised. [This is where the missing section, Function and role of the foreskin, might have shed some light.] If it was shown that circumcision where there is no clinical need is prejudicial to a child's health and wellbeing, it is likely that a legal challenge on human rights grounds would be successful. Indeed, if damage to health were proven, there may be obligations on the state to proscribe it. The UN Convention on the Rights of the Child, which has been ratified by the UK, requires ratifying states to "take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children".[11] At present, however, the medical evidence is inconclusive.

Summary: the law
Male circumcision is generally assumed to be lawful provided that:
- it is performed competently;
- it is believed to be in the child's best interests; and
- there is valid consent.

The Human Rights Act may affect the way non-therapeutic circumcision is viewed by the courts. There has been no reported legal case involving circumcision since the Act came into force. If doctors are in any doubt about the legality of their actions, they should seek legal advice.

Consent and refusal
Consent for any procedure is valid only if the person or people giving consent understand the nature and implications of the procedure. To promote such an understanding of circumcision, parents and children should be provided with up-to-date written information about the risks. The BathmateA is concerned that they may not have easy access to up-to-date information, however, and has called on appropriate bodies such as the Royal College of Paediatrics and Child Health and the British Association of Paediatric Surgeons to produce an information leaflet.

Children's own consent
All children who are capable of expressing a view should be involved in decisions about whether they should be circumcised, and their wishes taken into account. The BathmateA cannot envisage a situation in which it is ethically acceptable to circumcise a competent, informed young person who consistently refuses the procedure. As with any form of medical treatment, doctors must balance the harms caused by violating a child's refusal with the harm caused by not circumcising. Often surgery for non-medical reasons is deferred until children have sufficient maturity and understanding to participate in the decision about what happens to their bodies, and those that are competent to decide are entitled in law to give consent for themselves. When assessing competence to decide, doctors should be aware that parents can exert great influence on their child's view of treatment. That is not to say that decisions made with advice from parents are necessarily in doubt, but that it is important that the decision is the child's own independent choice. [Yet the child can have no knowledge of the effect of circumcision on his future sexual functioning.]

Parents' consent
Where children cannot decide for themselves, their parents usually choose for them. Although they usually coincide, the interests of the child and those of the parents are not always synonymous. There are, therefore, limits on parents' rights to choose and parents are not entitled to demand medical procedures contrary to their child's best interests.

The BathmateA and GMC have long recommended that consent should be sought from both parents. Although parents who have parental responsibility are usually allowed to take decisions for their children alone, non-therapeutic circumcision has been described by the courts as an "important and irreversible" decision that should not be taken against the wishes of a parent.[12] It follows that where a child has two parents with parental responsibility, doctors considering circumcising a child must satisfy themselves that both have given valid consent. If a child presents with only one parent, the doctor must make every effort to contact the other parent in order to seek consent. If parents disagree about having their child circumcised, the parent seeking circumcision could seek a court order authorising the procedure which would make it lawful, although doctors are advised to consider carefully whether circumcising against the wishes of one parent would be in the child's best interests. Where a child has only one parent, obviously that person can decide.

In all cases, doctors should ask parents to confirm their consent in writing by signing a consent form.

Summary: consent and refusal
- Competent children may decide for themselves.
- The wishes that children express must be taken into account.
- If parents disagree, non-therapeutic circumcision must not be carried out without the leave of a court.
- Consent should be confirmed in writing.

Best interests
In the past, circumcision of boys has been considered to be either medically or socially beneficial or, at least, neutral. The general perception has been that no significant harm was caused to the child and therefore with appropriate consent it could be carried out. The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BathmateA, that this surgical procedure has medical and psychological risks. It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child. The responsibility to demonstrate that non-therapeutic circumcision is in a particular child's best interests falls to his parents.

It is important that doctors consider the child's social and cultural circumstances. Where a child is living in a culture in which circumcision is required for all males, the increased acceptance into a family or society that circumcision can confer is considered to be a strong social or cultural benefit. Exclusion may cause harm by, for example, complicating the individual's search for identity and sense of belonging. Clearly, assessment of such intangible risks and benefits is complex. On a more practical level, some people also argue that it is necessary to consider the effects of a decision not to circumcise. If there is a risk that a child will be circumcised in unhygienic or otherwise unsafe conditions, doctors may consider it better that they carry out the procedure, or refer to another practitioner, rather than allow the child to be put at risk.

On the other hand, very similar arguments are also used to try and justify very harmful cultural procedures, such as female genital mutilation or ritual scarification. Furthermore, the harm of denying a person the opportunity to choose not to be circumcised must also be taken into account, together with the damage that can be done to the individual's relationship with his parents and the medical profession if he feels harmed by the procedure.

The BathmateA identifies the following as relevant to an assessment of best interests in relation to non-therapeutic circumcision:
- the patient's own ascertainable wishes, feelings and values;
- the patient's ability to understand what is proposed and weigh up the alternatives;
- the patient's potential to participate in the decision, if provided with additional support or explanations;
- the patient's physical and emotional needs;
- the risk of harm or suffering for the patient;
- the views of parents and family;
- the implications for the family of performing, and not performing, the procedure;
- relevant information about the patient's religious or cultural background; and
- the prioritising of options which maximise the patient's future opportunities and choices.[13]

The BathmateA is generally very supportive of allowing parents to make choices on behalf of their children, and believes that neither society nor doctors should interfere unjustifiably in the relationship between parents and their children. It is clear from the list of factors that are relevant to a child's best interests, however, that parental preference alone is not sufficient justification for performing a surgical procedure on a child. [In other words, Routine Infant Circumcision is not ethical.]

The courts have also identified some factors that are important in a decision about circumcision. J was a 5 year old boy who lived with his mother, a non-practising Christian. His father, a non-practising Muslim, wanted him to be circumcised. Asked to decide whether J should be circumcised, the Court considered all the factors relevant to J's upbringing and concluded that J should not be circumcised because of three key facts:
- he was not, and was not likely to be, brought up in the Muslim religion;
- he was not likely to have such a degree of involvement with Muslims as to justify circumcising him for social reasons; and as a result of these factors,
- the "small but definite medical and psychological risks" of circumcision outweighed the benefits of the procedure.[14]

Summary: best interests
- Doctors must act in the best interests of the patient.
- Even where they do not decide for themselves, the views that children express are important in determining what is in their best interests.
- The BathmateA does not believe that parental preference alone constitutes sufficient grounds for performing a surgical procedure on a child unable to express his own view. Parental preference must be weighed in terms of the child's interests.
- The courts have confirmed that the child's lifestyle and likely upbringing are relevant factors to take into account. The particular situation of the case needs to be considered.
- Parents must explain and justify requests for circumcision, in terms of the child's interests.

Health issues
There is significant disagreement about whether circumcision is overall a beneficial, neutral or harmful procedure. At present, the medical literature on the health, including sexual health, implications of circumcision is contradictory, and often subject to claims of bias in research. Doctors performing circumcisions must ensure that those giving consent are aware of the issues, including the risks associated with any surgical procedure: pain, bleeding, surgical mishap and complications of anaesthesia [and the functions of the intact foreskin, including the erogenous ones]. All appropriate steps must be taken to minimise these risks. It may be appropriate to screen patients for conditions that would substantially increase the risks of circumcision, for example haemophilia.

Doctors should ensure that any parents seeking circumcision for their son in the belief that it confers health benefits are fully informed of the lack of consensus amongst the profession over such benefits, and how great any potential benefits and harms are. The BathmateA considers that the evidence concerning health benefit from non-therapeutic circumcision is insufficient for this alone to be a justification for doing it.

Standards
Doctors unfamiliar with circumcision who are asked about it should seek advice about the physical risks from doctors experienced in conducting circumcisions. Religious and cultural organisations may be able to give advice and suggest practitioners who perform circumcisions. It may be necessary to refer a family to a paediatric surgeon, urologist or other doctor experienced in performing the operation for advice and care.

Poorly performed circumcisions have legal implications for the doctor responsible. An action could be brought against the doctor responsible on the child's behalf if the circumcision was carried out negligently. Alternatively, the child could issue such proceedings in his own name on reaching the age of 18 and the normal time limit for starting legal proceedings would run from that birthday. However, unless the lawfulness of circumcision itself is successfully challenged, action cannot currently be taken against a doctor simply because a man is unhappy about having been circumcised at all. [And the judge in the case of Flatt vs. Kantak specifically disallowed any discussion of the lawfulness of circumcision itself.] A valid consent from a person authorised to give it on the patient's behalf is legally sufficient in such cases. It goes without saying that a health professional who is not currently registered must never give the impression of so being even though there is no legal requirement for non-therapeutic circumcision to be undertaken by a registered health professional.

[So no matter how carefully doctors argue the ethics, any amateur can do it instead, and ethics be hanged.]

The General Medical Council does not prohibit doctors from performing non-therapeutic circumcision, although would take action if a doctor was performing such operations incompetently. The Council explicitly advises that doctors must "have the necessary skills and experience both to perform the operation and use appropriate measures, including anaesthesia, to minimise pain and discomfort".[15]

Facilities
Doctors must ensure that the premises in which they are carrying out circumcision are suitable for the purpose. In particular, if general anaesthesia is used, full resuscitation facilities must be available.

Charging patients
Although circumcision is not a service which is provided free of charge, some doctors and hospitals have been willing to provide circumcision without charge rather than risk the procedure being carried out in unhygienic conditions. In such cases doctors must still be able to justify any decision to circumcise a child based on the considerations above.

Conscientious objection
Some doctors may refuse to perform non-therapeutic circumcisions for reasons of conscience. Doctors are under no obligation to comply with a request to circumcise a child. [Many US doctors behave as if there were.] If doctors are asked to circumcise a child but have a conscientious objection, they should explain this to the child and his parents. Doctors may also explain the background to their conscientious objection if asked.

Clearly where patients or parents request a medical procedure, doctors have an obligation to refer on promptly if they themselves object to it (for example termination of pregnancy). Where the procedure is not therapeutic but a matter of patient or parental choice, there is arguably no ethical obligation to refer on. The family is, of course, free to see another doctor and some doctors may wish to suggest an alternative practitioner.

 

[kong1971]

Journal of Health Psychology
An Interdisciplinary, International Journal
Volume 07 Issue 03 - Publication Date: 1 May 2002

Men's Health
Male Circumcision:
Pain, Trauma and
Psychosexual Sequelae


GREGORY J. BOYLE
Bond University, Australia

RONALD GOLDMAN
Circumcision Resource Center, Boston, USA

J. STEVEN SVOBODA
Attorneys for the Rights of the Child, Berkeley, USA

EPHREM FERNANDEZ
Southern Methodist University, Dallas, USA

GREGORY J. BOYLE, PhD (Melbourne & Delaware), is Professor of Psychology at Bond University. His research covers psychological, ethical and medico-legal issues pertaining to men's health issues. URL: http://www.bond.edu.au/hss/staff/gboyle.htm.
RONALD GOLDMAN, PhD Psychologist, is Executive Director, Circumcision Resource Center, PO Box 232, Boston, Massachusetts 02133 USA. His research concerns the psychological aspect of circumcision. URL:
http://www.circumcision.org/
J. STEVEN SVOBODA, MA, JD, is Executive Director, Attorneys for the Rights of the Child. His research encompasses the legal, ethical, and human rights implications of harmful procedures performed on children for non-medical reasons. URL: http://www.arclaw.org/.
EPHREM FERNANDEZ, PhD, is Associate Professor of Psychology at Southern Methodist University and special faculty in clinical psychology at the University of Texas Southwestern Medical Center. His research focuses on cognitive-behavioral approaches to the management of chronic pain with special emphasis on emotional aspects of pain. URL: http://www2.smu.edu/psychology/faculty/fernandez.html

ACKNOWLEDGEMENTS. The authors acknowledge the contribution of George Hill, Executive Honorary Secretary, Doctors Opposing Circumcision, and librarian, Circumcision Information Resource Pages URL: http://www.cirp.org.

COMPenis EnlargementTING INTERESTS: None declared.

ADDRESS: Correspondence should be directed to:
G. J. BOYLE, PhD, Department of Psychology, Bond University, Gold Coast, Queensland, 4229, Australia.



Abstract
Infant male circumcision continues despite growing questions about its medical justification. As usually performed without analgesia or anaesthetic, circumcision is observably painful. It is likely that genital cutting has physical, sexual and psychological consequences too. Some studies link involuntary male circumcision with a range of negative emotions and even post-traumatic stress disorder (PTSD). Some circumcised men have described their current feelings in the language of violation, torture, mutilation and sexual assault. In view of the acute as well as long-term risks from circumcision and the legal liabilities that might arise, it is timely for health professionals and scientists to re-examine the evidence on this issue and participate in the debate about the advisability of this surgical procedure on unconsenting minors.

Keywords
child abuse, male circumcision, pain, sexual dysfunction, trauma

Background to circumcision
"To circumcise (from the Latin, "to cut around") means to cut off part or all of the foreskin of a penis, permanently exposing the normally covered glans..." (Boyd, 1998, p. 13). Circumcision involves the amputation of both layers of the foreskin, and is often performed on baby boys a few days after birth (Ritter & Denniston, 1996). The inner layer of the foreskin comprises thousands of erogenous nerve endings (Taylor, Lockwood, & Taylor, 1996; Cold & Taylor, 1999; Cold & McGrath, 1999).

Moses Maimónides (1135-1204), known as the "Rambam," was a medieval Jewish rabbi, physician and philosopher who stated unequivocally that the real purpose of circumcision was to reduce sexual gratification. According to Maimónides (see 1963 translation, p. 609),

Similarly with regard to circumcision, one of the reasons for it is, in my opinion, the wish to bring about a decrease in sexual intercourse and a weakening of the organ in question, so that this activity be diminished and the organ be in as quiet a state as possible... In fact this commandment has not been prescribed with a view to perfecting what is defective congenitally, but to perfecting what is defective morally. The bodily pain caused to that member is the real purpose of circumcision. None of the activities necessary for the preservation of the individual is harmed thereby, nor is procreation rendered impossible, but violent concupiscence and lust that goes beyond what is needed are diminished. The fact that circumcision weakens the faculty of sexual excitement and sometimes perhaps diminishes the pleasure is indubitable. For if at birth this member has been made to bleed and has had its covering taken away from it, it must indubitably be weakened.

In the English speaking world, circumcision was introduced as a medical procedure in the late-nineteenth century (Hodges, 1997). Victorian notions about the "ills of masturbation" influenced some physicians to endorse amputation of the erotogenic foreskin as "preventative therapy" since circumcised boys could not use their foreskins for masturbation (Moscucci, 1996). Circumcision subsequently was accepted as a panacea for many conditions, including epilepsy, paralysis, malnutrition, "derangement of the digestive organs," chorea, convulsions, hysteria, and other nervous disorders (Gollaher, 2000). In the ensuing decades, as each claimed benefit of circumcision was disputed, another would come to take its place (Hodges, 1997).

Various national medical associations have evaluated studies on therapeutic rationales for infant circumcision under standard surgical conditions and management (see Denniston, Hodges, & Milos, 1999, for example). However, no national medical association anywhere in the world that has studied the issue recommends routine circumcision (American Academy of Pediatrics, 1999; Australasian Association of Paediatric Surgeons, 1996; Australian College of Paediatrics, 1996; British Medical Association, 1996; Canadian Paediatric Society, 1996). Recently, the American Medical Association (2000) has gone even further, confirming that infant circumcision is non-therapeutic. It is now generally acknowledged that any potential medical benefits of routine circumcision are outweighed by its risks and drawbacks (AAP, 1999).

Although approximately 80-85% of the world's adult males remain genitally intact (Lang, 1986; Wallerstein, 1985; Williams & Kapila, 1993), an estimated 650 million males alive today nevertheless have been circumcised (Hammond, 1999). In the United States alone, each year 1.2 million males are circumcised shortly after birth (National Center for Health Statistics, 1998). In addition, the social anthropological literature on ritual circumcision in non-western cultures (see Gollaher, 2000) indicates that circumcision of boys during late childhood also is commonplace.

Objections to circumcision have been articulated for a while (e.g., Wallerstein, 1980) with increasing concerns coming from the professional mental health community (e.g., Boyle, 2000; Goldman, 1997, 1998, 1999). There is also mounting anxiety about issues of legal liability (see Boyle, Svoboda, Price, & Turner, 2000; Richards, 1996; Smith, 1998; Somerville, 2000; Svoboda, Van Howe, & Dwyer, 2000; Van Howe, Svoboda, Dwyer, & Price, 1999). Moreover, Giannetti (2000) has pointed to psychosexual sequelae that appear to go well beyond those acknowledged in the recent American Academy of Pediatrics (1999) circumcision policy statement. The present paper recounts many of these concerns. Evidence for both short- and long-term manifestations of circumcision are reviewed. Among the sequelae considered are pain, problems in sexual functioning, and emotional distress or trauma--all factors that impact on men's psychosexual health and well-being.



Circumcision pain
One of the fundamental issues that divides opinion on the practice of circumcision regards the presence or degree of pain. To address this issue, we turn to the concept of pain and the evidence for pain sensitivity in infants. As defined by scientists, pain is an unpleasant sensory experience associated with tissue damage (IASP, 1986). There is no doubt that circumcision entails observable pain and identifiable tissue damage (see joint statement of American Academy of Pediatrics and American Pain Society (American Academy of Pediatrics, 2001). The only matter of some interpretation is the infant's behaviour during circumcision. As with adults, pain in infants is expressed in stereotypic ways involving vocalisation, facial expression, body movements, and autonomic activity. Analysing the vocalisations of 30 newborn males during circumcisions of varying levels of invasiveness, Porter, Miller, and Marshall (1986) found that the invasiveness of the procedure was positively correlated with duration of crying, more pronounced peak fundamental frequencies, reduced harmonics, and greater variability of the fundamental. Crying extended to a day after circumcision and was interrupted by greater periods of quiet when anaesthesia was provided (Dixon, Snyder, Holve, & Bromberger, 1984). It is also notable that adult listeners agreed on the urgency of these cries as a function of the intensity of the pain-producing stimulus. Levine and Gordon (1982) reviewed literature on the spectrographic analysis of pain-induced vocalisations (PIV) in infants and found remarkable similarity with the basic features of PIV in animals.

Despite the obvious unavailability of self-report, further evidence of pain has been demonstrated through observation of the facial expressions of infants undergoing circumcision. Regarded as the most definitive behavioural evidence of pain in the infant, it consists of a lowered brow, eyes squeezed shut, deepened nasolabial furrow, opened mouth, and a taut cupped tongue (Grunau, Johnston, & Craig, 1990). This expression closely resembles the adult facial expression of pain, but it occurs with even greater consistency in infants undergoing painful procedures such as circumcision.

Infants also evidence considerable autonomic arousal during noxious stimulation. Of course, this generalises to other situations such as fear and frustration too. However, in combination with the facial and vocal evidence, such arousal is highly informative about the pain the infant is undergoing. For example, Porter, Porges, and Marshall (1988) observed that vagal tone significantly declined during circumcision, a result which was paralleled by significant increases in pitch of the infant's cries. The further discovery that vagal tone prior to circumcision predicted physiological reactivity to subsequent stress leaves little doubt that circumcision is highly noxious to the infant.

With regard to motor behaviour, infants tend to be a bit more limited than adults in responding to noxious stimuli (Tyler, 1988). This has occasionally been mistaken as an indication that infants experience less pain than adults. However, the infant's overall rigidity of the torso and limbs are indicative of pain (Johnston & Strada, 1986). With increasing age and postnatal maturation of the somatosensory system, there is greater motor responsiveness to pain-producing stimuli like circumcision.

Pain pathways are well-developed late in gestation and neurochemical systems associated with pain transmission are functional (Anand & Hickey, 1987). Many scientists (e.g., Field, 1995; Fitzgerald, 1987) have stated that we should now safely assume that all viable newborns feel pain. What is more critical is how pain is modulated in infancy. Andrews and Fitzgerald (1997) have reviewed the neurobiological evidence suggesting that the relative immaturity of the infant's nervous system may raise excitability in the spinal cord. Thus, the system for modulation of pain signals appears to be less developed in infants and this may render them highly susceptible to pain during procedures such as circumcision (Fitzgerald, 1998). Moreover, cognitive coping strategies (Fernandez, 1986; Fernandez & Turk, 1989; Maiz & Fernandez, 2000) and other descending cortical influences postulated as part of the gate control theory of pain (Melzack & Wall, 1965) evidently are far less developed in infancy than later in life.

The pain that is apparent in circumcised infants and is intensified by their lack of coping resources can have further ramifications. Prescott (1989) referred to the stress hormones triggered by intense pain and the adverse effects they may exert on brain development, sexual function, and behaviour. Anand and Scalzo (2000) postulated that severe pain during infancy may permanently and irreversibly alter neurological circuitry responsible for pain perception and memory. Hepper (1996) documented functioning memory prior to and immediately after birth. An adverse painful perinatal event, through a process of classical conditioning, may sensitise the infant to pain later in life (Chamberlain, 1989, 1995; Field, 1995; Jacobson et al., 1990). Thus, Taddio et al. (1997) found that circumcised boys displayed heightened physiological pain responses to vaccinations four to six months after circumcision suggestive of an infant analogue of post-traumatic stress disorder, as compared with genitally intact children.



Circumcision trauma
A traumatic experience is defined in DSM-IV as the direct consequence of experiencing or witnessing of serious injury or threat to physical integrity that produces intense fear, helplessness or (in the case of children) agitation (American Psychiatric Association, 1994). The significant pain and distress described earlier is consistent with this definition. Moreover, the disturbance (e.g., physiological arousal, avoidant behaviour) qualifies for a diagnosis of acute stress disorder if it lasts at least two days or even a diagnosis of post-traumatic stress disorder (PTSD) if it lasts more than a month. Circumcision without anaesthesia constitutes a severely traumatic event in a child's life (Lander, Brady-Freyer, Metcalfe, Nazerali, & Muttit, 1997; Ramos & Boyle, 2001; Taddio, Katz, Ilersich, & Koren, 1997). It is possible that the trauma of genital surgery might have long-lasting psychological effects (Bigelow, 1995; Levy, 1945; Jacobson & Bygdeman, 1998; Anand & Scalzo, 2000).

Van Howe (1996, p. 431) reported that, "Newborn males respond to circumcision with a marked reduction in oxygenation during the procedure, a cortisol surge, decreased wakefulness, increased vagal tone, and less interactions with their environment following the procedure..." Rhinehart (1999) in a report of clinical cases noted that the only response available to the infant is shock, wherein the central nervous system is overwhelmed by pain, followed by numbing, paralysis, and dissociation. Possibly, dissociation of the traumatic experience and emotional pain may be employed by the infant as a psychological defence (Chu & Dill, 1990; Noyes, 1977; Rhinehart, 1999). While some babies have been described as being "quiet" after circumcision, Rhinehart concluded that the observed stillness most likely represents a state of dissociation or shock in response to the overwhelming pain.

Consistent with the early reports of Anna Freud (1952), McFadyen (1998) observed psychological trauma in her son following circumcision. This is sometimes extreme enough to impede the maternal-infant bonding (Marshall et al., 1982; Van Howe, 1996). As reasoned by Herman (1992) and Rhinehart (1999) the common factor underlying circumcision trauma is an experience of violence and powerlessness--inflicted by other human beings. Such an event was described in a study of 12 Turkish boys circumcised in late childhood. Cansever (1965, p. 328) reported that "Circumcision is perceived by the child as an aggressive attack upon his body, which damaged, mutilated, and, in some cases, totally destroyed him." Ritual circumcision appeared to be associated with increased aggressiveness, weakening of the ego, withdrawal, reduced functioning and adaptation, and nightmares consistent with PTSD.

Ramos and Boyle (2001) investigated the psychological effects associated with medical and ritual "operation tuli" circumcision procedures in the Philippines. Some 1577 boys aged 11 to 16 years (1072 boys circumcised under medical procedures; 505 subjected to ritual circumcision) were surveyed to see if genital cutting led to the development of PTSD. Interestingly, Mezey and Robbins (2001) estimated the incidence of PTSD as 1.0% to 7.8% in the general British population where circumcision is not very prevalent. On the other hand, using the PTSD-I questionnaire (Watson et al., 1991) in a predominantly circumcised population, Ramos and Boyle observed an incidence of PTSD of almost 70% among boys subjected to ritual circumcision, and 51% among boys subjected to medical circumcision (with local anaesthetic). Long-term follow-up would be needed to gauge the extent to which PTSD persists over the lifespan of these circumcised boys.

The outcome of painful childhood trauma includes long-lasting neurophysiological and neurochemical brain changes (Anand & Carr, 1989; Anand & Scalzo, 2000; Ciaranello, 1983; Taddio et al., 1997; van der Kolk & Saporta, 1991). Richards, Bernal, and Brackbill (1976) found that circumcision may impact adversely on the developing brain, and that reported "gender differences" may actually arise from behavioural changes induced by infant or childhood circumcision.

Rhinehart (1999) in a report of adult clinical cases concluded that a man circumcised as a child is more likely to react with terror, rage and/or dissociation when confronted with situations interpreted as threatening. As in any situation of post-traumatic stress, an event resembling any aspect of the original traumatic experience is more likely to provoke negative emotions such as panic, rage, violence, or dissociation.

It is therefore not surprising that PTSD may result from childhood circumcision (Goldman, 1997, 1999, Menage, 1999; Ramos & Boyle, 2001), just as it does from childhood sexual abuse and rape (Bownes, O'Gorman, & Sayers, 1991; Deblinger, McLeer, & Henry, 1990; Duddle, 1991). Several researchers have concluded that PTSD may result from circumcision and/or from circumcision-related sequelae in later life. For example, Rhinehart (1999) reported finding PTSD in middle-aged men who had been subjected to infant circumcision. Circumcision involves an imbalance of power between perpetrator and victim, contains both aggressive and libidinal elements, and threatens a child's sexual integrity by amputating part of the genitalia. Some men circumcised in infancy or childhood without their consent have described their present feelings in the language of violation, torture, mutilation, and sexual assault (Bigelow, 1995; Hammond, 1997, 1999).

Even if the psychological sequelae of circumcision do not coalesce into a formal diagnosis of PTSD, it is possible that there may be long-lasting effects on a man's life, particularly in psychologically sensitive individuals with comorbidity factors (cf. Mezey & Robbins, 2001). Presumably responding to their current interpretation and feelings, many circumcised men who have recognised the loss of a highly erogenous, irreplaceable part of their penis have reported long-lasting emotional suffering, grief, anxiety, and depression, and a sense of personal vulnerability (Hammond, 1997, 1999). Avoidance or obsessive preoccupation with such a loss, along with anger, can be difficult to reconcile for some men depending on their particular personality (Bigelow, 1995; Maguire, 1998; van der Kolk, 1989). Emotional numbing, avoidance of the topic of circumcision, and anger are potential long-term psychological consequences of the circumcision trauma (Bigelow, 1995; Bensley & Boyle, 2001; Boyle & Bensley, 2001; Gemmell & Boyle, 2001; Goldman, 1997, 1999). In extreme cases, there might be aggressive, violent, and/or suicidal behaviour (Anand & Scalzo, 2000; Bradley, Oliver, & Chernick, 1998; Jacobson et al., 1987; Jacobson & Bygdeman, 1998).

Circumcision and sexuality
Sigmund Freud (1920) asserted that circumcision was a substitute for castration, suggesting a possible connection between castration fears, neuroses, and circumcision. Documented cases exist of circumcision resulting in a life-impairing level of castration anxiety (Ozturk, 1973). More recently, Immerman and Mackey (1998) described circumcision as "low-grade neurological castration." They argued that the resultant glans keratinisation and neurological atrophy of sexual brain circuitry (due to loss of sensory input to the brain's pleasure centre) may serve as a social control mechanism which produces a male who is less sexually excitable and therefore more amenable to social conditioning.

Indeed, for centuries, circumcision has been used as a strategy to reduce sexual gratification (Maimónides, 1963, p. 609). According to Saperstein (1980), quoting Rabbi Isaac Ben Yedaiah, as well as the empirical findings of Bensley and Boyle (2001), and O'Hara and O'Hara (1999), heterosexual intercourse is less satisfying for both partners when the man is circumcised. Due to the neurological injury caused by circumcision, and the resultant reduction of sensory feedback (Immerman & Mackey, 1998), it is highly likely that circumcision may promote sexual dysfunction such as premature ejaculation, and consequently, also the reduction of female sexual pleasure (cf. Money & Davison, 1983). The possible deleterious effects on social and marital relationships (cf. Hughes, 1990) may be considerable, especially in countries where most men have been circumcised.

Structural Changes
Among the structural changes circumcised men may have to live with are surgical complications such as skin tags, penile curvature due to uneven foreskin removal, pitted glans, partial glans ablation, prominent/jagged scarring, amputation neuromas, fistulas, severely damaged frenulum, meatal stenosis, and excessive keratinisation. In addition, Immerman and Mackey (1998) and Prescott (1989) postulated that severing of erogenous sensory nerve endings in the foreskin during infancy leads to atrophy of non-stimulated neurons in the brain's pleasure centre during the critical developmental period.

Gemmell and Boyle (2001) surveyed 162 self-selected men (121 circumcised; 41 intact) and found that circumcised men reported significantly less penile sensation as compared with genitally intact men. Participants rated their current level of penile sensation (on a scale from 1 to 10) as compared with that experienced at age 18 years (allocated 10 out of 10). Circumcised men complained significantly more often than did genitally intact men of a progressive decline in penile sensation throughout their adult years--presumably due to increasing keratinisation of the exposed glans and inner foreskin remnant in circumcised men. Gemmell and Boyle also found that a significantly higher proportion of circumcised as compared with intact men reported bowing or curvature of the penis (also reported by Lawrence, 1997), shaft skin uncomfortably/painfully tight when erect, and scars/damage to the penis. Although the frenulum was reported as an area of heightened erogenous sensitivity, in the typical circumcised male, either no frenulum remains or only a small severely damaged remnant exists. The complex innervation of the foreskin and frenulum has been well-documented (Cold & McGrath, 1999; Cold & Taylor, 1999; Fleiss, 1997; Taylor et al., 1996), and the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings--many of which are lost to circumcision, with an inevitable reduction in sexual sensation experienced by circumcised males (Immerman & Mackey, 1998; O'Hara & O'Hara, 1999).

Functional Changes
There are also serious functional consequences of circumcision. Impaired sexual functioning was reported by 84% of respondents in a survey of circumcised men (Hammond, 1997). Taylor, Lockwood, and Taylor (1996) provided anatomical and histological support for these self-reports of circumcised men by documenting the irreplaceable loss of specialised erogenous mucosa through circumcision. Further difficulties attributed to circumcision included intimacy problems (45%) and addiction/dependency problems (26%). Specific physical problems reported included glans insensitivity (55%), need for excess stimulation to enable ejaculation (38%), prominent scarring (29%), and insufficient residual shaft skin to accommodate full, untethered erections (27%).

Circumcised males may also be at risk of premature ejaculation, or alternatively may have to resort to prolonged thrusting during intercourse in order to stimulate sufficiently the residual erogenous penile nerve endings to trigger ejaculation (Bensley & Boyle, 2001). They report that the unnatural dryness of their circumcised penis often makes coitus painful, resulting in chafing and/or skin abrasions (Gemmell & Boyle, 2001). Concomitantly, O'Hara and O'Hara (1999) found that female partners reported significantly greater sexual pleasure from intercourse with genitally intact men as compared with circumcised men. Money and Davison (1983) had previously documented a loss of stretch receptors in the prepuce and frenulum and an associated diminution in sexual response, thereby restricting a circumcised man's ability to achieve arousal. Consequently, erectile dysfunction may be a complication of male circumcision (Glover, 1929; Ozkara, Asicioglu, Alici, Akkus, & Hattat, 1999; Palmer & Link, 1979; Stief, Thon, Djamilian, Allhoff, & Jonas, 1992; Stinson, 1973).

Bensley and Boyle (2001) surveyed women and gay men who had previously had sexual intercourse with both genitally intact and circumcised men. Bensley and Boyle's samples comprised 35 women, and 42 gay men. In addition they surveyed 83 self-selected men (53 circumcised; 30 genitally intact) who provided self-reports regarding their sexual and psychological functioning. The overall results (women partners and gay male partners combined) were that circumcised partners were significantly less happy about their sexual functioning than were genitally intact partners.

In Bensley and Boyle's (2001) study, sexual dysfunction was more often reported by circumcised men who complained either of premature ejaculation (with little sexual sensation), and/or difficulty in gaining or maintaining an erection--the two most prevalent forms of erectile dysfunction. Reduced or insufficient neural feedback may account for circumcised men's inability to detect the moment when ejaculation is imminent. Premature ejaculation previously has been ascribed to learning or conditioning factors. For example, where a teenage boy is raised in an environment in which sexual pleasure is regarded as "sinful or dirty" he may have to hurry masturbation in order to avoid being "caught in the act." Premature ejaculation would therefore be negatively reinforced by avoiding an aversive or punitive consequence (cf. Schwartz & Reisberg, 1991, pp. 121-122). However, information is now emerging on the role of the prepuce in preventing premature ejaculation, wherein the foreskin serves to protect the corona of the glans penis from direct stimulation during intercourse (Halata & Munger, 1986; Zwang, 1997). Overall, circumcised men expressed significantly greater dissatisfaction with their sex lives than did genitally intact men. This result is consistent with the findings by Hammond (1997, 1999), and O'Hara and O'Hara (1999), that circumcision may impede psychosexual and emotional intimacy between partners.

Altered Sexual Behaviours
Apart from reducing sexual sensation and pleasure (Bensley & Boyle, 2001; Gemmell & Boyle, 2001; Immerman & Mackey, 1998; Milos & Macris, 1994; Money & Davison, 1983; O'Hara & O'Hara, 1999), circumcision also leads to changes in sexual practices. For example, Laumann, Masi, and Zuckerman (1997) reported that circumcision is associated with more elaborate sexual behaviours. It is possible that reduced sexual sensation may impel some circumcised men to engage in more elaborate sexual practices in order to attain sexual gratification. In regard to unsafe sex practices, Bensley and Boyle (2001) found that circumcised men were significantly less likely to use condoms than were genitally intact men. Presumably, use of a condom reduces sexual sensation, which may be of somewhat greater concern to circumcised men (cf. Gemmell & Boyle, 2001; Van Howe, 1999).



Other psychological considerations in circumcised men
In Gemmell and Boyle's (2001) survey, involuntary circumcision impacted negatively on various psychological measures. They found that as compared with genitally intact men, circumcised men were often unhappy about being circumcised, experienced significant anger, sadness, feeling incomplete, cheated, hurt, concerned, frustrated, abnormal, and violated (cf. Hammond, 1999). They also found that circumcised men reported lower self-esteem than did genitally intact respondents.

Rhinehart (1999) stated that psychological problems were almost universally noted by his self-selected circumcised respondents. These included reports of a sense of personal powerlessness, fears of being overpowered and victimised, lack of trust, a sense of vulnerability to violent attack, guardedness in relationships, reluctance to have relationships with women, defensiveness, diminished sense of masculinity, feeling damaged, sense of reduced penile size or amputation, low self-esteem, shame about not "measuring up," anger and violence towards women, irrational rage reactions, addictions and dependencies, difficulties in establishing intimate relationships, emotional numbing, a need for greater intensity in sexual experiences, decreased intimacy, decreased ability to communicate, as well as feelings of not being understood.

Hammond's (1997) sample of circumcised men reported emotional harm (83%), physical harm (82%), general psychological harm (75%), and low self-esteem (74%). The circumcised men frequently reported feeling mutilated (62%), unwhole (61%), resentful (60%), abnormal/unnatural (60%), that one's human rights had been infringed (60%), angry (54%), frustrated (53%), violated (50%), inferior to genitally intact males (47%), impeded sexually (43%), and betrayed by one's parents (34%). Similar findings emerged from a larger sample of 546 circumcised men studied by Hammond (1999).

Anecdotal Accounts of Circumcision-Related Psychological Distress
Circumcised men have often provided anecdotal reports pertaining to their negative feelings about involuntary circumcision. For example, one man who contacted one of the authors (RG) at the Circumcision Resource Center in Boston told of an indelible scene when he was four. He was talking with a genitally intact boy who showed him his penis and explained circumcision to him. He was shocked and ashamed at what had been done to him and thought, "Why would somebody want to do that to me? They just chopped it off. It didn't make any sense to me." As an adult he thinks about it "every time I take a shower or urinate" (personal communication, December, 1993).

Another example of discovering the difference between being genitally intact as compared with being circumcised is the following retrospective anecdotal story also told to the same author (RG):

The shock and surprise of my life came when I was in junior high school, and I was in the showers after gym... I wondered what was wrong with those penises that looked different than mine... I soon realized I had part of me removed. I felt incomplete and very frustrated when I realized that I could never be like I was when I was born-intact. That frustration is with me to this day. Throughout life I have regretted my circumcision. Daily I wish I were whole (personal communication, October, 1992).

Likewise, an Australian man recently wrote to another author (GB) at Bond University:

I have been disadvantaged by inferiority and non-assertiveness in the workplace and in social life so much that I recently had to go onto a disability pension for chronic anxiety/anger disorder. My lifelong psychological distress of being circumcised definitely contributed strongly to steering me into this pattern of human interaction. I have no spare funds to take individual legal action, and no living person to sue for my poor quality of life, but if ever a class action for damages due to circumcision is mounted, I wish to add my name to it (personal communication, April, 2001).

Many similar anecdotal stories by circumcised men telling about psychological unhappiness that they perceived to be related to involuntary circumcision have been reported, for example, by Bigelow (1995) and Goldman (1997).



Methodological caveats
Sampling
One limitation of some of the foregoing research is that random sampling was not always enforced in subject recruitment (e.g., Rhinehart, 1999; Hammond, 1997, 1999). This may be understandable because of the difficulties in boosting sample sizes and the fact that participants were sometimes confined to certain "captive groups." In any case, the result is that there may be a self-selection bias as widely noted in survey research. Arguably, this could have led to inflation of some statistical effects of circumcision-related sequelae.

Underestimation
Conversely, it is possible that problems related to circumcision may be greater than reported. The following speculations may explain why we don't hear more from many circumcised men about how they may truly feel (see Goldman, 1998, pp. 43-44):

The pressure to accept sociocultural assumptions regarding circumcision may prevent some men from recognising and feeling dissatisfaction. For example, some men were told when young that circumcision was necessary for health reasons and they did not question that assertion. In countries where circumcision is commonplace, its effects may become familiar and it is possible that these effects may be interpreted as "normal" (Bigelow, 1995; Goldman, 1997).
Verbal expression of preverbal feelings requires conscious awareness. Because preverbal traumas are generally unconscious, such feelings are expressed nonverbally through behavioural, emotional, and physiological forms (Chamberlain, 1989; Terr, 1988, 1991; van der Kolk, 1989).
Any negative emotions associated with circumcision that may emerge into the conscious psyche may be very intense and disturbing. Repressing such emotions may serve to protect men from possible anguish. This may be compounded by the fear of dismissal or ridicule of one's feelings. If negative thoughts and/or feelings do momentarily become conscious, it is likely they will be suppressed.
Privacy surrounding matters of sexuality may inhibit men from speaking out.
Nonverbal expression, lack of awareness and understanding of possible psychosexual sequelae related to circumcision, emotional repression, and fear of disclosure may help to keep circumcision feelings a secret. It is conceivable that the effects of circumcision trauma might become chronic and deeply embedded within the unconscious psyche, making it difficult to distinguish them from personality traits or effects due to other causes. In any case, more research is needed to address the conscious and unconscious psychological effects of circumcision on men.

Cognitive dissonance
Although in recent years cognitive dissonance theory has fallen somewhat into disrepute (Walker, Burnham, & Borland, 1994, p. 535), the theory may still be useful in explaining certain entrenched attitudes surrounding circumcision. Thus, the common resistance of some parents and doctors to information associating circumcision with harm invites speculation to explain it. Generally, people have a desire for coherence and consistency in their beliefs and experiences and it is possible that this factor may contribute to some extent to the perpetuation of cognitions supportive of circumcision. When inconsistency occurs, thereby creating cognitive dissonance, people may align their beliefs to fit their experience (Festinger & Carlsmith, 1959). Choosing to seek or to provide parental consent and then to circumcise or to allow one's child to be circumcised is a serious and irreversible choice. In accordance with cognitive dissonance theory, it would be expected that once the decision has been made and the circumcision carried out, most people would tend to appreciate the chosen alternative (circumcision) and depreciate the rejected alternative (leaving the child genitally intact)--(cf. BreHydromax, 1956).

As a result, beliefs may be adopted to conform with one's decision to circumcise. An example of these beliefs involving the psychological defence mechanisms of denial and rationalisation is the myth that newborn infants do not feel or remember pain. Even though studies suggest long-lasting memory of circumcision pain--particularly when the circumcision occurred during post-infancy childhood years (Chamberlain, 1989; Hepper, 1996; Rhinehart, 1999), some doctors who circumcise normal healthy boys may simply ignore this information (Stang & Snellman, 1998). As well, a small proportion of doctors may proceed with the surgery on the basis of ill-informed beliefs. Others, by invoking psychological defences, may be perceptually blind to the pain associated with circumcision--perhaps as a result of their own circumcised status.

Inconsistency can also be reconciled by altering our beliefs. A common misconception is that the prepuce has no useful purpose. One circumcision advocate stated, "I believe the foreskin is a mistake of nature" (Wiswell, 1994). We may perceive and accept only information that fits our beliefs. Some physicians who support circumcision dismiss outright new information that conflicts with their preconceived view (Briggs, 1985). The tendency to avoid new information increases when the discrepancy between beliefs and experience increases (Kumpf & Gotz-Marchand, 1973). Even after learning something new, people better remember information that supports established beliefs than they remember conflicting information (O'Sullivan & Durso, 1984). Avoidance of new information about the possible psychosexual sequelae of circumcision may lead to rigidity of thinking and a dependence on previously acquired dogma and cultural myths to counteract and subdue doubts, thereby maintaining cognitive harmony. As Bigelow (1995, pp. 105-106) stated. "This effect is very detectable among parents who have elected to circumcise their son--especially since they cannot retract their choice! These parents frequently do not want to hear anything negative about infant circumcision...."



Future directions
Foreskin Restoration
If involuntary circumcision can bring about psychological consequences through the aftermath of trauma, then it is possible that "uncircumcision" (Schultheiss, Truss, Stief, & Jonas, 1998) may go some way towards attenuating those effects. In recent years, there has been an increasing awareness among circumcised men about the possibility of restoring a foreskin (albeit devoid of the amputated erogenous nerve endings), through a process of stretching and skin expansion over some years (Bigelow, 1995). Some men who have undergone foreskin restoration have reported discernible recovery of sexual sensation and function previously lost to circumcision, and sometimes a lessening of associated negative emotions (Goodwin, 1990; Greer, Mohl, & Sheley, 1982; Griffiths, 2001; O'Hara & O'Hara, 2001).

Mohl, Adams, Greer, and Sheley (1981) failed to mention that one of the main reasons for circumcised men to restore themselves genitally was the crucial loss of prepuce function during sexual activity. Instead, they claimed that men who sought foreskin restoration were homosexually orientated with psychopathology including narcissistic and exhibitionistic body image, depression, inadequate early mothering, and egocentrism. Yet this conclusion was based on an unrepresentative sample of only eight men. These 20-year old results suffer from an analysis based on what today would be considered outdated therapeutic and discriminatory social prejudices against individuals with a homosexual orientation. Even so, Bigelow (1995), and Griffiths (2001) reported that most men undergoing foreskin restoration are in fact heterosexual. As Schultheiss et al. (1998, p. 1996) stated, "Nowadays, the understanding of the psychological motivations for uncircumcision is increasing, and the problem is dealt with more seriously.... the majority of the males performing skin-stretching are heterosexual." Postulated psychosexual benefits resulting from foreskin restoration have been discussed by Bigelow (1995).

Circumcision Advocacy
Even though research suggests harmful effects of circumcision (e.g., Denniston & Milos, 1977; Denniston, Hodges, & Milos, 1999; Cold & Taylor, 1999; Hammond, 1999; Van Howe et al., 1999), psychological factors may make it difficult for circumcision advocates to stop promoting the practice (Goldman, 1997, 1998, 1999). Presumably, grief for the lost sexual body part and its functions, and the resultant denial of loss is important because it may explain the circumcised "adamant father" (who unreasonably insists on the circumcision of a son in the face of contrary evidence) as well as other manifestations of the circumcised male such as the "I'm circumcised and I'm fine" syndrome (Bigelow, 1995; Ritter & Denniston, 1996). Grief and denial in relation to involuntary circumcision may well play a role in the psychology of the circumcised male (Parkes, 1998). Such factors may figure even more prominently among those doctors who devote their entire medical practice or a substantial portion thereof to circumcising normal healthy boys when there is no medical reason to do so (cf. Bigelow, pp. 94-99). Some trauma victims experience a compulsion to re-enact the trauma (van der Kolk, 1989). Circumcising infants may to some extent involve re-enacting the trauma of one's own circumcision. A survey of randomly selected physicians showed that circumcision was more often supported by male doctors who themselves happened to be circumcised (Stein, Marx, Taggert, & Bass, 1982).



Conclusion
The body of empirical evidence reviewed here suggests that there is severe pain at the time of circumcision and shortly thereafter in unanaesthetised boys, as well as heightened pain sensitivity for some considerable period of time afterwards. Evidence has also started to accumulate that male circumcision may result in lifelong physical, sexual, and sometimes psychological harm as well. A variety of forces are converging from fields as diverse as psychology, medicine, law, medical ethics, and human rights, all questioning the advisability of circumcision which originated millenia ago and was promoted in the Victorian era. As Chamberlain (1998) pointed out, "parents are not warned that their infants will endure severe pain and will be deprived of a functional part of their sexual anatomy for life." Non-therapeutic circumcision of male minors is now being questioned by legal and ethics scholars in an unprecedented way. The mental health community can play an important role in the growing debate about circumcision. We encourage closer examination of this issue and even more empirical research into the psychosexual sequelae associated with circumcision.



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--------------------------------------------------------------------------------
Citation:
Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychology 2002;7(3):329-43.

 

[kong1971]

NEGATIVE ASPenis EnlargementCTS OF ROUTINE INFANT CIRCUMCISION
by Wayne Hampton
19 November 1994

This document discusses routine neonatal circumcision from the negativepoint of view, because there are no good reasons to subject an infant to this unnecessary and painful procedure.


"There is no absolute medical indication for routine
circumcision of the newborn."
Report of the Ad Hoc Task Force on Circumcision
Pediatrics, v56 #4, October 1975, p610-611


"My own preference, if I had the good fortune to have another
son would be to leave his little penis alone."
Dr. Benjamin Spock, Redbook, April 1989


"The ... doctors who still perform circumcision are violating
the first rule of good medicine -- primum non nocere --
first, do no harm. Few ... really understand what they are
doing when they amputate the foreskin, for they have never
studied how the penis develops before birth. Since the penis
is used for procreation only a few times in the entire life
of the individual, sexual pleasure must also be one of its
major functions, and the foreskin is an integral part of that
sexual pleasure."
George Denniston, MD,
University of Washington
School of Medicine


"Whatever is done to stop the terrible practice of
circumcision will be of tremendous importance. There is no
rational medical reason to support it."
Dr. Frederick Leboyer, author, Birth Without Violence

Therefore, the reasons often given to justify it are mentioned below only with the intention of rebutting them. The onus of proof that such a procedure is justifiable rests on the shoulders of those who propose and perform the surgery. Nonetheless, rather than risk leaving parents uninformed, this paper seeks to show that routine circumcision is not well supported by medical evidence, and that it bears serious risks, and that it can cause long term sexual impairment. The American Academy of Pediatrics says:

"...the procedure has potential medical benefits and
advantages, as well as inherent disadvantages and risks."
AAP Press Release, March 6, 1989

Note that the benefits and advantages are only "potential", while the disadvantages and risks are "inherent". In other words, all circumcised babies suffer the inherent disadvantages and risks, while some may receive potential benefits. One of those disadvantages is severe pain, which is directly contradictory to the whole notion of birth without violence.

"...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."
Dr. Frederick Leboyer, author, Birth Without Violence


"...(From) the very beginning of life, a child's sexuality is
an integral part of its being. In my opinion, any crippling
interference with childrens' normal bodily functions is a
form of emotional as well as physical abuse."
Mary Calderone, MD, MPH, Fetal Erection and its Message
to Us, SEICUS Report, May-July 1983. p9-10.


"All that takes place in the first days of life on the
emotional level shapes the pattern of all future reactions.
How could a being aggressed in this way, while totally
helpless, develop into a relaxed, trusting person?"
Dr. Frederick Leboyer, author, Birth Without Violence


"The consequences for impaired bonding are significant."
Dr. Rima Laibow, MD, Circumcision and its Relationship
to AttacHydromaxent Impairment, Second International Symposium
on Circumcision, April 1991


"All of the western world raises its children uncircumcised
and it seems logical that, with the extent of health knowledge
in those countries, such a practice must be safe."
C. Everett Koop, MD, Former Surgeon General of the US
Saturday Evening Post, July 1982

Although the "circumcision decision" will likely be thrust upon new parents in the US, this is the exception, rather than the rule in the worldwide context. Most parents in the world do not have to face this question, and there is growing concern that just asking the question contravenes laws in various states preventing solicitation for unnecessary surgery. The US is the only industrialized nation that still circumcises a (slight: 60%) majority of its baby boys. However it should be clear already from the quotations above that the practice does not enjoy unanimous support from the medical community. In the absence of such unanimity, the best advice for expectant parents would be to go with their hearts in the near universal desire of parents to protect their children from pain and harm, and to not make a permanent mistake with their sons, but rather to react to problems when and if they arise.
However, this paper should not be taken as medical advice. It is only a compilation of facts and opinions from various sources. Medical advice must be sought from a qualified practitioner. Also, this document is about "routine" circumcision of infants and children, that is - without medical indication. While the same risks and problems may occur with circumcisions performed to treat some diagnosed problem, when it is done as a result of medical necessity at least the risks and problems have been offset by some explicitly expected benefit.

REASONS GIVEN FOR ROUTINE INFANT CIRCUMCISION
BY THE AMERICAN ACADEMY OF Penis EnlargementDIATRICS

The following benefits were listed in the AAP's latest (1989) press release regarding circumcision. It must be borne in mind that the policy statements of the AAP seek to justify an income producing procedure for their membership.

-Urinary Tract Infections(UTI's)-

The AAP noted that a study had been published that found a higher incidence of UTI's among uncircumcised babies. Then they admit the study was flawed. They go on to say that "...in the absence of well-designed prospective studies, conclusions regarding the relationship of urinary tract infection to circumcision are tentative." It makes you wonder why they would mention such a study at all when they themselves admit that the study was flawed and shows only association, not that foreskin causes a problem. In any case, other studies [Altschul, Am Fam Physician v41 #3, March 1990 p817-821] have failed to confirm the results. The bottom line:


"The diagnoses and [antimicrobial] management of UTI in
infants and children are usually routine and outcome is
generally good. Because the long term outcome of UTI in
uncircumcised male infants is unknown, it is inappropriate
at this time to recommend circumcision as a routine
medically indicated procedure"
George H. McCracken, MD, Options in Antimicrobial
management of UTI's in Infants and Children, Ped Inf
Dis J v8 #8, 1989.

"SuBathmateitting your son to the procedure to prevent urinary tract
infections makes only a little more sense than buying
insurance against being gored by a unicorn in Riverside."
Eugene Robin, MD, Stanford University Medical School
San Francisco Examiner, November 5, 1987. p.E-5.

-Cancer of the Penis-
This cancer affects elderly men with a history of poor hygiene, to the extent that the rate in the US is about 1:100000. Unfortunately for those advocating circumcision as a preventative measure, this rate is about the same as the penile cancer rate in Scandinavia, and higher than the Japanese rate. These other countries do not practice routine circumcision, yet most American males have been circumcised. If circumcision was preventative, we should see an improvement over these foreign rates. But we do not.


"To me, the idea of performing 100,000 mutilative procedures
on newborns to possibly prevent cancer in one elderly man
is absurd."
George Denniston, MD, Unnecessary Circumcision
The Female Patient, p14, July 1992

-Sexually Transmitted Diseases-
Here is the full text on this issue from the AAP's 1989 press release:


"Evidence regarding the relationship of circumcision to
sexually transmitted diseases is conflicting. Although
published reports suggest that canchroid, syphilis, human
papillomavirus and herpes simplex virus type 2 infection are
more frequent in uncircumcised men, methodologic problems
render these reports inconclusive."

Again we have material presented by the AAP, only to be denied. Why?
Since 1989 circumcision has been proposed as a means of lowering the spread of AIDS. However, let’s look at the situation around us. The US has a virtual epidemic of AIDS, in a population that has its majority of males circumcised. What does that say about the effectiveness of circumcision as a preventative for AIDS? People would be better advised to save the money they would have spent on circumcision and invest it for their children to buy condoms with instead.

-Cervical Cancer-

Here is the full text on this issue from the AAP's 1989 press release:


"Evidence linking uncircumcised men to cervical carcinoma
is also inconclusive, the statement notes. However, an
increased incidence of cancer of the cervix has been found in
sexual partners of uncircumcised men infected with human
papillomavirus.

The strongest predisposing factors in cervical cancer are
a history of intercourse at an early age and multiple sex
partners."

Even assuming surgery on one individual to protect another unknown one from cancer made any kind of sense, it is clear that HPV is the culprit, not the presence of foreskin. Again, why was inconclusive research even mentioned? It is kind of like the tabloid trick of using a headline like "Elvis Spotted in Dallas", so you buy it, then you find out that it was a picture of Elvis on some truck dashboard. Misleading, but lucrative.
The above are the only circumcision-positive arguments presented in the AAP’s 1989 press release under their own headings, all of them refuted to some degree within the very document listing them. The conclusion also mentions circumcision as a prevention for phimosis, paraphimosis, and balano-posthitis. However, these problems involve the foreskin directly, so circumcision prevents these problems in the same way as pulling teeth would prevent cavities. None of these problems are themselves life threatening, and they can often be dealt with in non-surgical ways.

Phimosis, is a condition that occurs when the opening of the foreskin is too small to permit the glans to be uncovered painlessly. This problem cannot be diagnosed in infancy because the foreskin is immovable in early infancy. In Europe, the first treatments involve gentle stretching, sometimes combined with steroid creams. Para-phimosis is a similar problem except that when the foreskin is retracted the opening is tight enough to restrict blood flow to and from the glans. It is treatable in the some way as phimosis is. Balano- posthitis is an infection of the glans and foreskin which is normally treatable with antibiotics. Surgery should be a last resort, not an initial treatment.

OTHER COMMON REASONS FOR CIRCUMCISION

-Hygiene-

Some seem to be frightened about the prospect of cleaning a baby's penis. Cleaning a baby's penis is easy. Just wash the outside, and do not forcibly retract the foreskin. As the foreskin becomes naturally retractable during childhood, rinsing under it will suffice. Boys can be taught to do this themselves before they enter school. Cleaning a circumcised adult penis is slightly easier than cleaning an intact one. And cleaning an intact one is easier than cleaning female genitalia. This is a poor argument for painful surgery.


"Isn't it insulting to the average male's intelligence to
think that surgery is preferable because he can't be entrusted
with washing his genitals when somehow he manages to brush his
teeth, clean his ears and blow his nose?"
Louanne Cole, Ph.D. Sexologist
San Francisco Examiner, pB-7, August 11, 1993.

"If a 30 year old male began to bathe himself at the age of
five, and, if he spend 20 seconds a day retracting and
rinsing under his foreskin, he will have invested 50 hours
of his life in penile hygiene...This whole exercise has made
me, as a circumcised male closer to age 60 than 30, wonder
just what I've accomplished with my 'gift' of nearly 100 hours
of spared time. Upon reflection, I'd like to think that I've
invested those hours in the writing of this book!"
James Bigelow, Ph.D, author of The Joy of
Uncircumcising! ISBN 0-9630482-1-X

-Cosmetic-
It is not unreasonable that many Health Care Insurers in the US consider circumcision a cosmetic procedure, and refuse to pay for it. Some of the commonest reasons for having it done are: "So he'll look like his Daddy", and "So he won't look different in the locker room." But the most visible difference between a father and son is pubic hair. Should all fathers shave themselves to look like their sons? And in California the majority of newborn boys are not being circumcised, so keeping a son intact would be a safer bet here these days. This argument seeks to save a child from the psychological harm of being different, and perhaps being teased. However there are always differences between individuals, and psychological harm can result from the circumcision itself (below).

Routine circumcision was stopped in Great Britain in 1949. In the few years following, cosmetically generated problems would have had a chance to flourish. Strangely, no papers were published about the traumatic impacts on British youth as a consequence. This problem appears to be overblown.

-Religious-

There are many religions in the world today. Some rejoice in the intact body, for example Taoism and Buddhism. Some require bodily alterations, such as male or female circumcision, subincision, hemi- castration, infibulation, tribal marking, etc. Many require no such payment for membership. Some religions have adapted away from activities that today would seem anachronistic, such as blood sacrifice and sealing a betrothal by intercourse with 3 year olds. Today, there are those within the circumcising religious communities who are looking at circumcision as yet another anachronism. Moslem scholars point out that Mohammed never commanded Muslims to circumcise. Jews sometimes replace brit millah with brit shalom, a bloodless baby naming ceremony.

Membership in a religion is not an immunization from problems resulting from activities like circumcision. The percentage of Jews in the National Organization of Restoring Men exceeds the fraction of Jews in the general population by several times. Religions parents who are concerned about the various negatives surrounding circumcision might seek information from the Circumcision Resource Center, PO Box 232, Boston MA 02133, which specializes in religious issues.

RISKS OF CIRCUMCISION


"Although hemorrhage and sepsis are the main causes of
morbidity, the variety of complications is enormous. The
literature abounds with reports of morbidity and even death
as a result of circumcision."
Williams and Kapila, Complications of Circumcision,
Brit J Surg v80, Oct 1993, p1231-1236.

-Pain-
On November 19, 1987 Anand and Hickey published a comprehensive study of infant pain in the New England Journal of Medicine. Not surprisingly much of the data came from infants undergoing circumcision. The study states that babies do feel severe pain from the procedure, in fact more than older children and adults would. The study recommends anaesthesia and pain management for circumcision, but these recommendations have not been widely implemented due to the added risks. The report also mentions (on p.1324) that even when anaesthesia is attempted, it is not always successful.

In a more recent study researchers comment on the use of Tylenol:


"The pain of circumcision is too severe to be controlled
by a mild analgesic", they concluded, even though most
circumcisions in the United States are done without
pain killers. Babies do experience great and persistent
pain during and after the surgery, based on crying,
increased heart and breathing rates and other measurements,
which also seems to interfere with breastfeeding in some
babies.
Pediatrics, April 4, 1994

Surely the benefit of this procedure would have to be great to permit such systematic torture of tiny babies! And it is. Doctors can charge up to $300 for the procedure in Los Angeles.
-Hemorrhage-

Excessive bleeding is one of the two most frequent complications, after pain. While usually managed within a hospital setting, it can require transfusions, with the attendant blood supply risks for HIV and other disease organisms. However, sometimes babies die as a result, such as the baby mentioned in the Des Moines (Iowa) Register which reported on November 20, 1982 the bleeding death of an infant following circumcision. Another similar incident was reported in the June 26, 1993 issue of the Miami Herald.

-Infection-


"Infection occurs after circumcision in up to 10% of
patients."
Williams and Kapila, Complications of Circumcision
Brit J Surg v80, Oct 1993, p1231-1236.

Infection is the other of the two most frequent medical complications, after pain. Again death is not common, but it can be the result, as can a range of other problems. For example, in 1986 the circumcision of a baby born in Alaska resulted in severe infection and toxic shock. The baby sustained profound brain damage and kidney damage. He was blinded, and will likely never walk or talk. The legal matters have been delayed because the hospital "lost" his records.
Hemorrhage and infection are the only known physical complications of circumcision that may result in death. When Britain abolished routine neonatal circumcision in 1949, one of the reasons cited was the high death rate. While opinions vary about what death rates might be acceptable for necessary procedures, there is little agreement on acceptable death rates for unnecessary procedures. Some believe in "zero tolerance", while others believe that any practice must do more good than harm (on average). Circumcision has never been shown to do more good than harm, and it is scant comfort to a parent whose child dies as a result of any unnecessary procedure that "on average" it might be beneficial.


"It is an incontestable fact at this point that there are more
deaths each year from complications of circumcision than from
cancer of the penis."
S Gellis, MD, Circumcision
Am J Dis Ch, v132 #12 December 1978. p1168.

-Surgical Errors-

"The nature of circumcision dictates that errors of omission
and commission, i.e.: too little or too much, in assessing how
much foreskin to remove are likely to happen, and one of the
commonest complaints is of an unsatisfactory cosmetic result."
Williams and Kapila, Complications of Circumcision
Brit J Surg v80, Oct 1993, p1231-1236.

Such errors range from the slipped scalpel that cost a Marin County baby the tip of his penis in May 1993 (as reported July 8th in the Bay Area Reporter), to the two boys who lost their entire penis during circumcision in November 1985 at Atlanta's Northside Hospital, as reported by the East Cobb Neighbor. But those are rare and extreme examples. It is much more common for too much skin to be taken off, ranging from total denudation of the penis which requires skin grafting, to merely chronic painful erections for the rest of the patient's life, and possible bowing and curvatures resulting from uneven pull of the remaining skin. The Williams and Kapila paper is replete with descriptions of surgical mishap. Another good reference with plenty of gory pictures is: Pediatric Trauma, ed. Robert J. Toulakian MD, Yale University School of Medicine, publ. John Wiley & Sons.
-Healing Problems-

The healing process does not always go smoothly. Commonly reported problems with the healing of circumcisions are:


skin tags - irregular bits of left over skin at the scar site.
skin bridges - which occur when the raw edge of the cut
foreskin joins up with the glans. This can occur because
when the foreskin is peeled away from the glans during
circumcision, the glans surface becomes one large open
wound, which permits the raw edge of the foreskin to
join with it. The results range from aesthetic problems
to painful erections and bowing and curvatures.
prominent scarring - which result from keloid formations at
the incision. This is the most common physical
complaint.
stitch tunnels - can arise when sutures are necessary to
control bleeding, or when circumcision occurs after
infancy. Small holes and loops of skin are a common
result.
glans pitting - as the foreskin is peeled away from the glans
preparatory to the circumcision, sometimes bits of the
glans come off, leaving indentations in the glans.
miscellaneous - Other problems such as iatrogenic phimosis,
and granulomas and cysts (small benign tumors which are
sometimes painful caused by foreign matter getting into
the incision during the operation) have been reported.

-Aesthetic Problems-
Men have reported dissatisfaction regarding the appearance of their circumcisions in a landmark survey "Awakenings" published by NO HARMM in 1994. A common complaint is the ugliness of the scar area itself which is often characterized (in Caucasians) by a dark brown ring created by the crush of the circumcision clamp. Other men complain that circumcision itself is unnatural by world standards of appearance, and that they have therefore been disfigured. However aesthetic problems, and dissatisfied "customers" are not usually recognized as complications by the medical profession. Nonetheless parents should not assume they do their children a favor on this score.

-Psychological Problems-


"Any surgical interference with the child's body may serve as
a focal point for the activation, reactivation, grouping and
rationalization of ideas of being attacked, overwhelmed, or
castrated."
Anna Freud, The Role of Bodily Illnesses in the Mental
Life of Children, Int'l University Press, 1952. p75.


"Institutionalized child abuse like circumcision, which in
this country legitimizes the sexual abuse of about 60% of male
infants, is in my opinion, one of the primary causes of
unconscious male rage and violence."
Aaron Kipnis, Ph.D., Male Privilege or Privation?
ReSource, Summer 1992, p1.

"The most important influence on violence is experience. The
way in which people are treated in infancy and childhood has a
great deal to do with how they treat others."
Dorothy Otnow Lewis, MD, A Touch for Evil
Boston Globe Magazine, July 7, 1991. p12.

"Circumcision is perceived by the child as an aggressive
attack on his body, which damaged, mutilated and in some cases
totally destroyed him. The feeling of 'I am now castrated'
seems to prevail in the psychic world of the child. As a
result he feels inadequate helpless and functions less
efficiently."
Cansever G, Psychological Effects of Circumcision
Br J Med Psychology 1965, #38 p321-331.

"...immediately after the anaesthesia wore off, he said over
and over: 'They cut my penis. I wish I were dead'. The rest of
the day the patient never left the mother's side. Thereafter
his previous temper tantrums developed into destructive rages.
During the treatment he played numerous killing games, in
which his father was the principle victim. The operation
represented a castration by his father."
Levy D M, Psychic Trauma of Operations in Children
Am J Dis Ch January 1945, 69 (1) p7-25.

"(Sexual) abuse seems to be a biology altering experience. It
changes the brain's stress response system." Putnam said, and
Teicher added that brain wave differences between abused and
non-abused are as significant as "between normal people and
those who have Alzheimer's disease or schizophrenia."
USA Today, May 24, 1994.

There is a wide range of reactions males can have as a result of their circumcisions. Many men choose to ignore it. Many men cannot. The Levy study quoted above conclusively linked circumcision to suicidal thoughts and feelings. We'll never know the rate of suicides successfully completed in response to circumcision.
The incidence of psychological harm has never been scientifically researched, despite the clear indications of possible harm, and the ongoing creation of new victims each and every day.

The NO HARMM "Awakenings" survey found the following statistics among men who had asked NORM for foreskin restoration information. This sample does not represent American society at large, so results are only indicative for this group of men. However, they reveal the character of the undercurrent.


Feeling % of Survey
---------------------------
dissatisfaction 69
resentment 60
anger 54
frustration 53
betrayal 33.9
mutilated 62
rights violated 60
"raped" 49.5

Percent claiming some form of emotional harm: 83%.

Another unofficial circumcision poll taken on the Internet the Fall of 1994 found 21% of its approximately 100 respondents complaining of some form of harm. Presumably these men are unhappy with their circumcisions.
Another survey undertaken by Journeyman Magazine in 1992 found in an open, but self-selected survey:


Status Glad Dissatisfied
------ ---- ------------
Circumcised 38% 20%
Intact 78% 3%

Circumcised men who had conflicting feelings about what had been
done to their genitals: 41%.

There is ample reason to be concerned about the effect of circumcision on the minds of its recipients.
DISADVANTAGES OF CIRCUMCISION

Disadvantages consequential to neonatal circumcision may be evident at various times in life. The following problems can occur within the first few years of life.

-Bonding Impairment-


"Neonatal bonding affects every male infant, while penile
pathology affects few."
Dozor, Robert, MD, Routine Neonatal Circumcision
Am Fam Physician v41 #3, March 1990, p820-822


"Circumcision performed in the neonatal period is associated
with marked behavioral changes that may last up to 24 hours.
... Allied to this is a change in sleep pattern with prolonged
non-rapid eye movement sleep. This change has been interpreted
as consistent with a theory of conservation - withdrawal to
stressful stimulation."
Williams and Kapila, Complications of Circumcision,
Brit J Surg v80, Oct 1993, p1231-1236.

A layman would say that the babies just "pass out". An unconscious baby is not in a bonding situation. And the lingering pain can have other effects as well. Imagine what happens when a new mother picks up her newly circumcised baby, perhaps to breastfeed. The baby's wounded penis, perhaps with a disposable clamp still attached, is pressed between himself and his mother. He screams in pain. Association of mother with pain is not the kind of bonding that serves us well.
-Meatal Stenosis-


"Meatal stenosis is generally a direct consequence of
circumcision that is seldom encountered in uncircumcised men.
...The incidence of meatal ulceration following circumcision
is from 8 to 20%."
Williams and Kapila, Complications of Circumcision,
Brit J Surg v80, Oct 1993, p1231-1236.

Meatal stenosis is the narrowing of the urinary opening as a result of ulcerations at the opening, which are made possible by the removal of the protective foreskin. The ulcerations can cause considerable discomfort to the baby, and serious stenosis may require surgery to reopen the meatus.
-Non Specific Urethritis-

Since the opening to the urethra is exposed by the removal of the foreskin, it is easier for irritating chemicals, such as soap, to get to the sensitive urethra, causing pain. This affects males and females of all ages, but circumcision makes it worse for males.

Later in life the sexual disadvantages of circumcision may become apparent.

-Excessive Tightness-

Being circumcised too tightly was the second commonest physical complaint mentioned in the NO HARMM survey. It affects the sexual enjoyment of both men and women. Some men with this condition suffer from bent erections. Some men circumcised too tightly report painful erections and painful intercourse with bleeding from the scar site or tears elsewhere. Women complain of painful intercourse due to what they interpret as insufficient lubrication. However as a gentleman recently pointed out on the Internet:

> Message-ID: < CyAHyw.3Dt@news.cis.umn.edu>

> My gf prefers my uncut penis to the other, cut peni that she's made the
> acquaintance of, because, as she puts it "It works better. It's
> easier to bring you to orgasm, and it's a lot less hassle." This is
> because the foreskin acts as a linear bearing (why yes, I'm an
> engineering geek, how did you guess? ). It simply works as a penis
> should, as it evolved to work, and hacking bits off doesn't improve on
> the original design.


"Circumcised males sometimes need an additional lubricant
(e.g. Lubrin suppository, KY jelly) for non-irritating
intercourse. The sheath within a sheath of the normal penis
obviates such a need."
Thomas J. Ritter, MD, Say No to Circumcision!
ISBN 0-9630482-0-1

And it gets worse later in life.

"Certainly atrophic vaginitis secondary to estrogen withdrawal
is the most important factor in the production of dyspareunia
(painful intercourse), but one would be foolish to discount
the circumcised man's immobile penile skin sheath as
contributing to abrasive vaginal discomfort."
Thomas J. Ritter, MD, Say No to Circumcision!
ISBN 0-9630482-0-1

"The foreskin of the male has a very definite physiological
function which is more apparent to the man over fifty. At some
time after this age, depending on his sexual equipment, the
erection is not so rigid as it was in the earlier years. After
45, the vaginal secretion in the wife is never so abundant as
it was before the climacteric. Under these conditions the
foreskin acts as an introducer which definitely facilitates
intercourse."
David S. Hillis, MD, Concerning Circumcision
Archives of Pediatrics v57. p525.

So women should not blame themselves for insufficient lubrication, but rather the doctors of their circumcised males.

"I became obsessed with the idea that my boyfriend should be
circumcised. We were very happy together, and much in common,
and best of all we were very compatible in bed. But I refused
to get married until he was circumcised -- and he gave in.

That little operation completely destroyed our life together.
Before he had fabulous staying power, but after the operation
he would have an orgasm in five minutes and leave me high and
dry. To make things worse, sex became very painful to me.
Twice I had to see a doctor due to minor infections from the
chafing. Our beautiful sexual togetherness became a nightmare
of staying creams, lubricants and frustrations

He says he will never forgive me, and we no longer speak to
each other...but I cannot forget what a stupid mistake I made
which altered the life of a lovely person."
Carolyn LaRoc, letter to Playgirl, February 1975

This letter alludes to another benefit of foreskin. An intact male with a sufficiently loose foreskin can glide in and out of his own sheath more or less during intercourse by varying the length of his stroke. The foreskin provides less stimulation, so a man can extend the time taken during intercourse by such a technique, generating greater and longer pleasure in the female.
-Insufficient Sensitivity-

There are two sensitivity problems for the circumcised man. First he has lost the nerves in the foreskin itself.


"Much of the primary erotic stimulus comes from the skin . . .
two types of erogenous zones exist in the skin: specific and
nonspecific...the non-specific regions perceive simply an
exaggerated form of tickle...it is the specific regions
when one speaks of erotic sensations originating in the skin.
The specific type of erogenous zones are found in the
mucutaneous regions which include the prepuce. This anatomy
favors acute perceptions. The rete ridges are well formed
and more of the organized nerve tissue rises higher (than in
other skin-type regions). In the prepuce the mucocutaneous
end-organs extend from the distal margin (tip) of the prepuce
down to the site (on the shaft) at which the hairy skin
begins, at which point they diminish and disappear."
R. K. Winkelmann, The Erogenous Zones: Their Nerve
Supply and Significance, Mayo Clinic, 1959

And his exposed glans has thickened from years of abrasion, dramatically reducing sensitivity. This was the commonest form of sexual impairment noted by respondents to the NO HARMM survey. Again the effect is more pronounced in older males, although loss of pleasure occurs at every age.

"During a boy's growth the foreskin protects the sensitive
glans. Normally the surface of the glans is composed of a
smooth, glistening membrane only a few cells in thickness. The
surface cells are alive, and the naked nerve endings are
distributed among these cells. After circumcision, when the
glans is exposed to soiled diapers and rough clothing, this
membrane becomes ten times thicker, and the free nerve endings
disappear. The surface becomes covered with an adherent layer
of dead cells, rough, dry and insensitive."
John M. Foley, MD, The Unkindest Cut of All
Fact, 1966

Sexual studies have not been able to discover a significant difference in time-to-ejaculation between circumcised and intact males, in a clinical setting. However, with the differences in sensitivity cited above, it follows that even in such a contrived situation the uncircumcised man feels more, and therefore obtains more pleasure.
ETHICS

It is clear that no baby in history, female or male has ever consented to their circumcision. "Informed consent" is a meaningless term for them. And by their screams they tell us as eloquently as they can to stop it.

Some people have trouble with "ethics", beyond what they learn in Sunday school. But most people can recognize certain values when they hear them. Let's look at some in a special way that highlights what psychologists call "cognitive dissonance" -- when the mind and reality do not match up -- as they relate to circumcision. Nearly everybody will be able to relate to the ethical principles below, while understanding what happens in real life that violates the principles:

"We hope our baby doesn't have any birth defects."
except for aposthia (lack of foreskin) which we would sort of like.

"We'd never suBathmateit our baby to a surgical procedure without a diagnosis."
except for circumcision, which doctors let us decide about.

"It is not OK to hurt babies."
except when they 'have to be' circumcised.

"We'd never unnecessarily place our baby at risk of infection or injury."
except to get him circumcised.

"We'd never permit healthy tissue to be removed from our baby."
unless it is his foreskin.

"It is our job to protect our baby from pain."
except from his circumcision.

"We must aid and comfort our baby when he is injured."
except during his circumcision which we'll pretend doesn't hurt.

"We'd never take the easy way out of caring for our baby."
unless it is a boy. Then we'll have his penis altered so we
won't have to take care of the great unknown: foreskin.

"We'd never allow anything to impair our baby's bonding with his mother."
except for the pain of circumcision.

"We want our baby to grow up happy with his body."
but we'll jeopardize his self-esteem by cutting the center of
his male body image: his penis.

"We'd never let our child feel robbed of something if we could prevent it."
except for his foreskin which we hold to be worthless
(and we don't care what he might think).

"We'd never place our child at a disadvantage where he could be ridiculed."
except we'll alter his penis so it doesn't look like or function
like the vast majority in the world.

"We wouldn't want our baby to doubt our commitment to him."
but we'll let a stranger cut off his foreskin, and we'll let
him grow up knowing that we couldn't or wouldn't protect him
from this invasion of his body.

"We'd never do anything to make our baby doubt our love."
except we'll have part of his body destroyed by circumcision.

"We'd never do anything to our baby just because it was done to us."
except we'll circumcise him so he'll be just like his Daddy.

"We don't hold with tribal markings just to make children feel part of a clan as they do in primitive cultures."
except we'll circumcise our boys in the (vain) hope that they'll
all look alike in the locker room.

"We would not compromise our baby just to bend to societal pressures."
except we'll circumcise him because the grandparents expect it,
and what would the neighbors say?

"We'd never impose our will on our child against his future wishes."
except we'll rush to circumcise him before he can even
formulate his wishes.

"We'd never compromise our baby's future happiness."
but we will remove an erogenous part of his body.

"We'd never make an irreversible decision to alter our child's appearance in a way he might one day regret, such as tattooing."
unless it is to alter the appearance of his penis in a way -we- want.

"We want our baby to grow up a -human- being."
but we'll teach him, by circumcising him, that human rights
don't amount to much.

"We'll love our baby in all his glory."
except for his foreskin which we'll have cut off and thrown
in the trash.

"God made our baby with love, care and wisdom."
except for his penis which needs to be 'fixed'.

"We hold that all parts of our baby's body are sacred."
except for his foreskin which is ours to alter as we will.

"It is wrong to deprive someone of a healthy part of their body."
unless it is the male foreskin. And, if you live in North
Africa, a girl's clitoris and labia minora.

As you can see, circumcision breaks a lot of "rules" and generally accepted principles. Let's stop breaking them. Ethics had better supersede "Big Medicine" or we are all in big big trouble. Without ethical prevention, nothing prevents the introduction of female circumcision or any other intrusive thing that comes along that looks like it might prevent disease.


"It is high time that such a barbaric practice comes to an
end."
Dr. Frederick Leboyer, author, Birth Without Violence

 

[kong1971]

Routine Circumcision of Male Minors:
Human Rights Implications

Tim Hammond
Presented 4 October 1996 at Roundtable Discussion: Emerging Issues in Health & Human Rights
Second International Conference on Health & Human Rights - Harvard University, 3-5 October 1996


NOTE: Links with a right-facing blue arrow will take you off this site.

Desmond Morris, author of Babywatching, once wrote:

“The commonest form of assault the sexual organs have suffered is male and female circumcision. Although it is a piece of deliberate wounding of children by adults, it has always been done with the best of intentions."

With these good intentions, each year over 15 million children globally are subjected to these so-called circumcisions. The severity and the rationalizations for altering children's healthy genitals differ from circumciser to circumciser, between genders and from culture to culture. For male minors, whether the reason is tribal, religious or alleged medical prophylaxis, circumcision without their consent raises serious human rights concerns. In some religious circles, increasing numbers of Jews and Moslems are asserting that even religion cannot justify these violations. My focus today, however, is to share new information that is emerging on this issue and to clarify how the medical practice of routine circumcision violates human rights of the boy-child.

I'm going to focus right now on just five of circumcision's many relevant human rights issues, these being security of the person, physical integrity, physical and mental health, self-determination and Article 24.3 of the Convention on the Rights of the Child. I want to stress that these are universal rights that take affect the moment we leave the womb.

ROUTINE CIRCUMCISION VIOLATES THE HUMAN RIGHT TO SECURITY OF Penis EnlargementRSON

It was proved scientifically in the 1980s that babies being circumcised feel pain acutely. Unlike adults being circumcised, the vast majority of infants do not receive anesthesia. We allow ourselves to do to a boy-child, what we would abhor if done to any other class of unconsenting human. Put yourself in the baby's place. First, you are strapped to a board called a Circumstraint. Then your healthy genital tissue is cut into and amputated. Babies often pass out from the pain. But for the unlucky majority who remain conscious, these are just a few seconds of the unearthly sounds that continue throughout this quarter hour ordeal [recorded screams played].

The U.S., where almost 98% of infant circumcisions are done for non-religious reasons, is the last nation in the world to continue subjecting the majority of its male infants to this obsolete abuse of medicine. The national rate is 60%. That's over 1.25 million babies a year, more than 3,300 boy children a day, one infant every 26 seconds.

But anesthesia is not the answer, because...

ROUTINE CIRCUMCISION VIOLATES THE HUMAN RIGHT TO PHYSICAL INTEGRITY

The prepuce is not vestigial or redundant skin. It is normal, functioning sexual tissue. New anatomical research published in the British Journal of Urology reveals that the:

prepuce provides a large and important platform for several important nerves
it's an important and specialized component of the overall sensory mechanism of the penis
and that infant circumcision is not a little "snip," but removes what becomes, in the average adult, 12 to 15 square inches of highly erogenous tissue comprising 30% - 50% of the penile shaft skin
Preputial functions are detailed in tonight's film, Whose Body, Whose Rights?, but in brief, they involve maintaining the glans (or penile head), as the internal organ that nature designed both it, and the female clitoris, to be. It also preserves the sexual sensitivity of the glans penis, supplies the skin necessary for a full and comfortable erection, and serves as a stimulation and lubrication mechanism that enhances the sexual well-being of both the male and the female.

But this is not just about sex.

ROUTINE CIRCUMCISION VIOLATES THE HUMAN RIGHT TO PHYSICAL AND MENTAL HEALTH

When you cut into a healthy person's body, there are risks that compromise that health. Most of these neonatal complications can be immediately apparent. Some don't manifest until later, with other complications becoming more prominent and troublesome in adulthood. These long-term consequences may be physical, sexual or psychological, which many circumcised males do not easily acknowledge or report. These adverse outcomes have not been investigated by the medical community.

We do know, however, the results of a 1993 NGO (non-governmental organization) survey of over 300 circumcised men, published in a report titled Awakenings, found circumcised respondents suffered a wide range of consequences from this surgery they did not choose. These included: progressive sensitivity loss in the glans, pain and bleeding upon erection, sexual dysfunctions, prominent scarring, various physical deformities, feelings of violation and inferiority to intact men, and depression, rage and betrayal over what was done to them. Many authors from the men's movement are now examining the role of genital mutilation in larger issues of men's health and patterns of male violence.

ROUTINE CIRCUMCISION ALSO VIOLATES THE HUMAN RIGHT TO SELF-DETERMINATION

When you cut into someone's healthy body without their consent, you compromise their human right to choose what is best for their well-being. From a human rights perspective, before imposing what we think is good on another person, even our own children, we must take into account the effect of that intervention on their human rights. Especially since infant circumcision is an elective, non-essential, and controversial intervention that contravenes various human rights of the child, it should not be undertaken until the child is old enough to make his own choice.

Because of the adverse impact of infant circumcision on male physical integrity, physical and mental health, and self-determination, the National Organization of Restoring Men formed in 1990 to offer moral and technical support for non-surgical skin expansion to help men regain their physical integrity. The very existence of this group demonstrates that circumcised men are becoming aware that they have been harmed and violated and are doing something about it.

ROUTINE CIRCUMCISION ALSO VIOLATES THE CONVENTION ON THE RIGHTS OF THE CHILD

Article 24.3 of the Convention calls for the abolition of "traditional practices prejudicial to the health of children." To apply this we have to ask: Is circumcision beneficial or prejudicial to health, and, is it a traditional practice?

Health benefits alleged by some studies suggest infant circumcision as prophylaxis against urinary tract infections, male and female genital cancers, sexually transmitted diseases, and now AIDS. These studies are controversial because most are retrospective, methodologically flawed, conflicting, inconclusive and skewed by cultural, religious and financial influences. For every problem circumcision is alleged to prevent, there are effective alternative methods of non-surgical prophylaxis and treatment that respect children's bodily integrity.

Is circumcision healthy? The medical community has consistently failed to prove conclusively and unequivocally that infant circumcision carries any significant health advantage over the intact state for the vast majority of males. Is circumcision prejudicial to health? The emerging evidence presented earlier substantiates that the answer is yes.

Is this a traditional practice? Ask any doctor who's tried to convince parents who still want their son circumcised even after he's explained there are no medical benefits. Look at studies about the parental decision making process on circumcision. They all confirm this is a social tradition. More than medical fears, parents have fears about family or social conformity.

This tradition in the U.S. was started 100 years ago by physicians trying to control the sexuality of children. They documented a whole host of physical and mental problems associated with masturbation. The cure was various forms of male and female circumcision. Then, earlier in this century, a military tradition of circumcising soldiers took hold that created several generations of circumcised fathers, who then began family traditions of circumcising their sons. Now we have an American medical tradition of routine circumcision that has spawned a profitable circumcision industry catering to this tradition. It involves physicians, hospitals, health insurers, pharmaceutical companies, equipment suppliers - and now even bio-tissue companies that harvest discarded foreskins to produce artificial skin for burn victims and for testing cosmetics. These male newborns have become involuntary organ donors.

SO HOW DO WE EFFECT CHANGE?

First, we need overcome our own cultural biases that advocate for protecting the bodily integrity of the girl-child but ignore the bodily integrity of the boy-child. To change religious or tribal customs that do not respect that integrity, advocates for change within those cultures will need our support. To change medical practices that do not respect these rights, we must understand that the U.S. tradition of forced male genital conformity was instituted and is perpetuated by the medical community. Physicians created the social demand for this practice and it's the duty of physicians to deconstruct the mythology perpetuating it. As advocates for human rights, we must call physicians to conscience on the human rights issues.

To this end, the Fourth International Symposium on Sexual Mutilations convened this last summer in Switzerland with representatives present from the World Health Organization and Amnesty International. It was the first time in the history of the movement against sexual mutilation that circumcised women and circumcised men discussed common efforts to protect children from these violative traditions.

Many circumcised women at the symposium agreed that male genital mutilation must also be eradicated. Although their public statements have been limited to female genital mutilation, their words also call us to conscience about protecting the genital integrity of the boy-child. Dr. Nahid Toubia wrote recently:

“The unnecessary removal of a functioning body organ in the name of tradition, custom or any other non-disease related cause should never be acceptable to the health profession. All childhood circumcisions are violations of human rights and a breach of the fundamental code of medical ethics. It is the moral duty of educated professionals to protect the health and rights of those with little or no social power to protect themselves."

Educated professionals are advocating for the health and human rights of the boy-child; namely, Doctors Opposing Circumcision, and Nurses for the Rights of the Child.

In closing, I'd like to again invite you to tonight's screening of Whose Body, Whose Rights? and to express my hope that together we can awaken the adult world to see even the tiniest baby as a full person, deserving of all human rights, respect and dignity. From the moment we leave the womb, the flame of human rights is ignited and needs to be protected.

 

[kong1971]

KJS Anand and PR Hickey: Neonatal pain and its effects


THE NEW ENGLAND JOURNAL OF MEDICINE, Volume 317, Number 21: Pages 1321-1329,
19 November 1987.





SPenis EnlargementCIAL ARTICLE




PAIN AND ITS EFFECTS IN THE HUMAN NEONATE AND FETUS
K.J.S. ANAND, M.B.B.S., D.PHIL., AND P.R. HICKEY, M.D
From the Department of Anesthesia, Harvard Medical School, and Children's
Hospital, Boston. Address reprint requests to Dr. Anand at the Department of
Anesthesia, Children's Hospital, 300 Longwood Ave., Boston, MA 02115.
THE evaluation of pain in the human fetus and neonate is difficult because pain
is generally defined as a subjective phenomenon.1 Early studies of neurologic
development concluded that neonatal responses to painful stimuli were
decorticate in nature and that perception or localization of pain was not
present.2 Furthermore, because neonates may not have memories of painful
experiences, they were not thought capable of interpreting pain in a manner
similar to that of adults.3-5 On a theoretical basis, it was also argued that a
high threshold of painful stimuli may be adaptive in protecting infants from
pain during birth.6 These traditional views have led to a widespread belief in
the medical community that the human neonate or fetus may not be capable of
perceiving pain.7,8
Strictly speaking, nociceptive activity, rather than pain,should be
discussed with regard to the neonate, because pain is a sensation with strong
emotional associations. The focus on pain perception in neonates and confusion
over its differentiation from nociceptive activity and the accompanying
physiologic responses have obscured the mounting evidence that nociception is
important in the biology of the neonate. This is true regardless of any
philosophical view on consciousness and "pain perception" in newborns. In the
literature, terms relating to pain and nociception are used interchangeably; in
this review, no further distinction between the two will generally be made.
One result of the pervasive view of neonatal pain is that newborns are
frequently not given analgesic or anesthetic agents during invasive procedures,
including surgery.9-19 Despite recommendations to the contrary in textbooks on
pediatric anesthesiology, the clinical practice of inducing minimal or no
anesthesia in newborns, particularly if they are premature, is widespread.9-19
Unfortunately, recommendations on neonatal anesthesia are made without reference
to recent data about the development of perceptual mechanisms of pain and the
physiologic responses to nociceptive activity in preterm and full-term neonates.
Even Robinson and Gregory's landmark paper demonstrating the safety of narcotic
anesthesia in preterm neonates cites "philosophic objections" rather than any
physiologic rationale as a basis for using this technique.20 Although
methodologic and other issues related to the study of pain in neonates have been
discussed,21-23 the body of scientific evidence regarding the mechanisms and
effects of nociceptive activity in newborn infants has not been addressed
directly.

ANATOMICAL AND FUNCTIONAL REQUIREMENTS FOR PAIN Penis EnlargementRCEPTION
The neural pathways for pain may be traced from sensory receptors in the
skin to sensory areas in the cerebral cortex of newborn infants. The density of
nociceptive nerve endings in the skin of newborns is similar to or greater than
that in adult skin.24 Cutaneous sensory receptors appear in the perioral area of
the human fetus in the 7th week of gestation; they spread to the rest of the
face, the palms of the hands, and the soles of the feet by the 11th week, to the
trunk and proximal parts of the arms and legs by the 15th week, and to all
cutaneous and mucous surfaces by the 20th week.25,26 The spread of cutaneous
receptors is preceded by the development of synapses between sensory fibers and
interneurons in the dorsal horn of the spinal cord, which first appear during
the sixth week of gestation.27,28 Recent studies using electron microscopy and
immunocytochemical methods show that the development of various types of cells
in the dorsal horn (along with their laminar arrangement, synaptic
interconnections, and specific neurotransmitter vesicles) begins before 13 to 14
weeks of gestation and is completed by 30 weeks.29
Lack of myelination has been proposed as an index of the lack of maturity
in the neonatal nervous system30 and is used frequently to support the argument
that premature or full-term neonates are not capable of pain perception.9-19
However, even in the peripheral nerves of adults, nociceptive impulses are
carried through unmyelinate (C-polymodal) and thinly myelinated (A-delta)
fibers.31 Incomplete myelination merely implies a slower conduction velocity in
the nerves or central nerve tracts of neonates, which is offset completely by
the shorter interneuron and neuromuscular distances traveled by the impulse.32
Moreover, quantitative neuroanatomical data have shown that nociceptive nerve
tracts in the spinal cord and central nervous system undergo complete
myelination during the second and third trimesters of gestation. Pain pathways
to the brain stem and thalamus are completely myelinated by 30 weeks; whereas
the thalamocortical pain fibers in the posterior limb of the internal capsule
and corona radiata are myelinated by 37 weeks.33
Development of the fetal neocortex begins at 8 weeks gestation, and by 20
weeks each cortex has a full complement of 109 neurons.34 The dendritic
processes of the cortical neurons undergo profuse arborizations and develop
synaptic targets for the incoming thalamocortical fibers and intracortical
connections.35,36 The timing of the thalamocortical connection is of crucial
importance for cortical perception, since most sensory pathways to the neocortex
have synapses in the thalamus. Studies of primate and human fetuses have shown
that afferent neurons in the thalamus produce axons that arrive in the cerebrum
before mid-gestation. These fibers then "wait" just below the neocortex until
migration and dendritic arborization of cortical neurons are complete and
finally establish synaptic connections between 20 and 24 weeks of gestation
(Fig. 1).36-38
Functional maturity of the cerebral cortex is suggested by fetal and a
neonatal electroencephalographic patterns, studies of cerebral metabolism, and
the behavioral development of neonates. First, intermittent
electroencephalograpic bursts in both cerebral hemispheres are first seen at 20
weeks gestation; they become sustained at 22 weeks and bilaterally synchronous
at 26 to 27 weeks.39 By 30 weeks, the distinction between wakefulness and sleep
can be made on the basis of electroencephalo- graphic patterns.39,40 Cortical
components of visual and auditory evoked potentials have been recorded in
preterm babies (born earlier than 30 weeks of gestation),40,41 whereas olfactory
and tactile stimuli may also cause detectable changes in electroencephalograms
of neonates.40,42 Second, in vivo measurements of cerebral glucose utilization
have shown that maximal metabolic activity in located in sensory areas of the
brain in neonates (the sensorimotor cortex, thalamus, and mid brain- brain-stem
regions), further suggesting the functional maturity of these regions.43 Third,
several forms of behavior imply cortical function during fetal life.
Well-defined periods of quiet sleep, active sleep, and wakefulness occur in
utero beginning at 28 weeks of gestation.44 In addition to the specific
behavioral responses to pain described below, preterm and full-term babies have
various cognitive, coordinative, and associative capabilities in response to
visual and auditory stimuli, leaving no doubt about the presence of cortical
function.45
Several lines of evidence suggest that the complete nervous system is
active during prenatal development and that detrimental and developmental
changes in any part would affect the entire system.25,26,42,46 In studies in
animals, Ralston found that somatosensory neurons of the neocortex respond to
peripheral noxious stimuli and proposed that "it does not appear necessary to
postulate a subcortical mechanism for appreciation of pain in the fetus or
neonate."47 Thus, human newborns do have the anatomical and functional
components required for the perception of painful stimuli. Since these stimuli
may undergo selective transmission, inhibition, or modulation by various
neurotransmitters, the neurochemical mechanisms associated with pain pathways in
the fetus and newborn are considered below.

Figure 1. Schematic Diagram of the Development of Cutaneous Sensory
Perception,25
Myelination of the Pain Pathways,32 Maturation of the Fetal Neocortex,33-37 and
Electroencephalographic Patterns38-40 in the Human Fetus and Neonate.

NEUROCHEMICAL SYSTEMS ASSOCIATED WITH PAIN Penis EnlargementRCEPTION
The Tachykinin System
Various putative neurotransmitters called the tachykinins (substance P,
neurokinin A, neuromedin K, and so forth) have been identified in the central
nervous system, but only substance P has been investigated thoroughly and shown
to have a role in the transmission and control of pain impulses.48-56 Neural
elements containing substance P and its receptors appear in the dorsal-root
ganglia and dorsal horns of the spinal cord at 12 to 16 weeks of gestation.57 A
high density of substance P fibers and cells have been observed in multiple
areas of the fetal bran stem associated with pathways for pain perception and
control and visceral reactions to pain.58-63 Substance P fibers and cells have
also been found in the hypothalamus, mamillary bodies, thalamus, and cerebral
cortex of human fetuses early in the development.58 Many studies have found
higher densities of substance P and it receptors in neonates than in adults of
the same species, although the importance of this finding is unclear.61,64-68
The Endogenous Opioid System
With the demonstration of the existence of stereospecific opiate
receptors69,70 and their endogenous ligands,71 the control of pain was suggested
as a primary role for the endogenous opioid system.72 Both the enkephalinergic
and the endorphinergic systems may modulate pain transmission at spinal and
supraspinal levels.56,73 In the human fetus, however, there are no data on the
ontogeny and distribution of specific cells, fibers, and receptors (mu-, delta-,
and kappa opiate receptors) that are thought to mediate the antinociceptive
effects of exogenous and endogenous opioids.74 However, functionally mature
endorphinergic cells in fetal pituitary glands have been observed at 15 weeks of
gestation and possibly earlier.75,76 Beta-endorphin and beta-lipotropin were
found to be secreted from fetal pituitary cells at 20 weeks in response to in
vitro stimulation by corticotropin- releasing factor.77 In addition, more
production of beta-endorphin may occur in fetal and neonatal pituitary glands
than in adult glands.78-79
Endogenous opioids are released in the human fetus at birth and in
response to fetal and neonatal distress.80 Umbilical-cord plasma levels of
beta-endorphin and beta-lipotropin from healthy full-term neonates delivered
vaginally or by cesarean section have been shown to be three to five times
higher than plasma levels in resting adults.78,81 Neonates delivered vaginally
by breech presentation or vacuum extraction had further increases in
beta-endorphin levels, indication beta-endorphin secretion in response to stress
at birth.82 Plasma beta-endorphin concentrations correlated negatively with
umbilical-artery pH and partial pressure of oxygen and positively with base
deficit and partial pressure of carbon dioxide, suggesting that birth asphyxia
may be a potent stimulus to the release of endogenous opioids.81,83-87
Cerebrospinal fluid levels of beta-endorphin were also increased markedly in
newborns with apnea of prematurity,88-90 infections, or hypoxemia.83,91,92 These
elevated values may have been caused by the "stress" of illness,93 the pain
associated with these clinical conditions, or the invasive procedures required
for their treatment. However, these high levels of beta-endorphin are unlikely
to decrease anesthetic or analgesic requirements,94 because the cerebrospinal
fluid levels of beta-endorphin required to produce analgesia in human adults
have been found to be 10,000 times higher than the highest recorded levels in
neonates.95
The high levels of beta-endorphin and beta-lipotropin in cord plasma
decreased substantially by 24 hours after birth87,96 and reached adult levels by
five days, whereas the levels in the cerebrospinal fluid fell to adult values in
24 hours.87,97,98 In newborn infants of women addicted to narcotics, massive
increases in plasma concentrations of beta-endorphin, beta-lipotropin, and
metenkephalin occurred within 24 hours, with some values reaching 1000 times
those in resting adults. Markedly increased levels persisted for up to 40 days
after birth.87 However, these neonates were considered to be clinically normal,
and no behavioral effects were observed (probably because of the development of
prenatal opiate tolerance).

PHYSIOLOGIC CHANGES ASSOCIATED WITH PAIN
Cardiorespiratory Changes
Changes in cardiovascular variables, transcutaneous partial pressure of
oxygen, and palmar sweating have been observed in neonates undergoing painful
clinical procedures. In preterm and full-term neonates undergoing
circumcision99,100 or heel lancing,101-103 marked increases in the heart rate
and blood pressure occurred during and after the procedure. The magnitude of
changes in the heart rate was related to the intensity and duration of the
stimulus104 and to the individual temperaments of the babies.105 The
administration of local anesthesia to full-term neonates undergoing circumcision
prevented the changes in heart rate and blood pressure,99,100,106 whereas giving
a "pacifier" to preterm neonates during heel-stick procedures did not alter
their cardiovascular or respiratory responses to pain.101 Further studies in
newborn and older infants showed that noxious stimuli were associated with an
increase in heart rate, whereas non-noxious stimuli (which elicited the
attention or orientation of infants) caused a decrease in heart rate.22,107,108
Large fluctuations in transcutaneous partial pressure of oxygen above and
below an arbitrary "safe" range of 50 to 100 mm Hg have been observed during
various surgical procedures in neonates.109-111 Marked decreases in
transcutaneous partial pressure of oxygen also occurred during
circumcision,106,112 but such changes were prevented in neonates given local
analgesic agents.100,106,112 Tracheal intubation in awake preterm and full-term
neonates caused a significant decrease in transcutaneous partial pressure of
oxygen, together with increases in arterial blood pressure113-115 and
intracranial pressure.116 The increases in intracranial pressure with intubation
were abolished in preterm neonates who were anesthetized.117 In addition,
infants' cardiovascular responses to tracheal suctioning were abolished by
opiate-induced analgesia.118
Palmar sweating has also been validated as a physiologic measure of the
emotional state in full-term babies and has been closely related to their state
of arousal and crying activity. Substantial changes in palmar sweating were
observed in neonates undergoing heel-sticks for blood sampling, and
subsequently, a mechanical method of heel lancing proved to be less painful than
manual methods, on the basis of the amount of palmar sweating.120
Hormonal and Metabolic Changes
Hormonal and metabolic changes have been measured primarily in neonates
undergoing surgery, although there are limited data on the neonatal responses to
venipuncture and other minor procedures. Plasma renin activity increased
significantly 5 minutes after venipuncture in full-term neonates and returned to
basal levels 60 minutes thereafter; no changes occurred in the plasma levels of
cortisol, epinephrine, or norepinephrine after venipuncture.121 In preterm
neonates receiving ventilation therapy, chest physiotherapy and endotracheal
suctioning produced significant increases in plasma epinephrine and
norepinephrine; this response was decreased in sedated infants.122 In neonates
undergoing circumcision without anesthesia, plasma cortisol levels increased
markedly during and after the procedure.123,124 Similar changes in cortisol
levels were not inhibited in a small number of neonates given a local
anesthetic,125 but the efficacy of the nerve block was questionable in these
cases.
Further detailed hormonal studies126 in preterm and full-term neonates
who underwent surgery under minimal anesthesia documented a marked release of
catecho- lamines,127 growth hormone,128 glucagon,127 cortisol, aldosterone, and
other corticosteroids,129,130 as well as suppression of insulin secretion.131
These responses resulted in the breakdown of carbohydrate and fat
stores,127,132,133 leading to severe and prolonged hyperglycemia and marked
increases in blood lactate, pyruvate, total ketone bodies, and nonesterified
fatty acids. Increased protein breakdown was documented during and after surgery
by changes in plasma amino acids, elevated nitrogen excretion, and increased
3-methyl- histidine:creatinine ratios in the urine (Anand KJS, Aynsley-Green A:
unpublished data). Marked differences also occurred between the stress responses
of premature and full-term neonates (Anand KJS, Aynsley-Green A: unpublished
data) and between the responses of neonates undergoing different degrees of
surgical stress.134 Possibly because of the lack of deep anesthesia, neonatal
stress responses were found to be three to five times greater than those in
adults, although the duration was shorter.126 These stress responses could be
inhibited by potent anesthetics, as demonstrated by randomized, controlled
trials of halothane and fentanyl. These trials showed that endocrine and
metabolic stress responses were decreased by halothane anesthesia in full-term
neonates 35 and abolished by low-dose fentanyl anesthesia in preterm
neonates.136 The stress responses of neonates undergoing cardiac surgery were
also decreased in randomized trials of high-dose fentanyl and sufentanil
anesthesia.126,137,138 These results indicated that the nociceptive stimuli
during surgery performed with minimal anesthesia were responsible for the
massive stress responses of neonates. Neonates who were given potent anesthetics
in these randomized trials were more clinically stable during surgery and had
fewer postoperative complications as compared with neonates under minimal
anesthesia.126,129 There is preliminary evidence that the pathologic stress
responses of neonates under light anesthesia during major cardiac surgery may be
associated with an increased postoperative morbidity and mortality (Anand KJS,
Hickey PR: unpublished data). Changes in plasma stress hormones (e.g., cortisol)
can also be correlated with the behavioral states of newborn infants,124,139,140
which are important in the postulation of overt subjective distress in neonates
responding to pain.

BEHAVIORAL CHANGES ASSOCIATED WITH PAIN Penis EnlargementRCEPTION
Simple Motor Responses
Early studies of the motor responses of newborn infants to pinpricks
reported that the babies responded with a "diffuse body movement" rather than a
purposeful withdrawal of the limb,2 whereas other studies found reflex
withdrawal to be the most common response.141-143 More recently, the motor
responses of 24 healthy full-term neonates to a pinprick in the leg were
reported to be flexion and adduction of the upper and lower limbs associated
with grimacing, crying, or both, and these responses were subsequently
quantified.144,145 Similar responses have also been documented in very premature
neonates, and in a recent study, Fitzgerald et al. found that premature neonates
(<30 weeks) not only had lower thresholds for a flexor response but also had
increased sensitization after repeated stimulation.146
Facial Expressions
Distinct facial expressions are associated with pleasure, pain, sadness,
and surprise in infants.147 These expressions, especially those associated with
pain, have been objectively classified and validated in a study of infants being
immunized.102,148 With use of another method of objectively classifying facial
expressions of neonates, different responses were observed with different
techniques of heel lancing and with different behavioral states149 (and Grunau
RVE, Craig KD: unpublished data). These findings suggest that the neonatal
response to pain is complex and may be altered by the behavioral state and other
factors at the time of the stimulus.150
Crying
Crying is the primary method of communication in newborn infants and is
also elicited by stimuli other than pain.151 Several studies have classified
infant crying according to the type of distress indicated and its spectrographic
properties.152-154 These studies have shown that cries due to pain, hunger, or
fear can be distinguished reliably by the subjective evaluation of trained
observers and by spectrographic analysis.155-160 This has allowed the cry
response to be used as a measure of pain in numerous recent studies.
22,99,100,102,106,152
The pain cry has specific behavioral characteristics and spectrographic
properties in healthy full-term neonates.161-164 Pain cries of preterm neonates
and neonates with neurologic impairment, hyperbilirubinemia, or meningitis are
considerably different, thereby indicating altered cortical function in these
babies.165-168 Changes in the patterns of neonatal cries have been correlated
with the intensity of pain experienced during circumcision and were accurately
differentiated by adult listeners.169 In other studies of the painful
procedures, neonates were found to he more sensitive to pain than older infants
(those 3 to 12 months old) but had similar latency periods between exposure to a
painful stimulus and crying or another motor response.99-101,103,152,170 This
supports the contention that slower conduction speed in the nerves of neonates
is offset by the smaller inter-neuron distances traveled by the impulse.
Complex Behavioral Responses
Alterations in complex behavior and sleep-wake cycles have been studied
mainly in newborn infants undergoing circumcision without anesthesia. Emde and
coworkers observed that painful procedures were followed by prolonged periods of
non-rapid-eye-movement sleep in newborns and confirmed these observations in a
controlled study of neonates undergoing circumcision without anesthesia.171
Similar observations have been made in adults with prolonged stress. Other
subsequent studies have found increased wakefulness and irritability for an hour
after circumcision, an altered arousal level in circumcised male infants as
compared with female and uncircumcised male infants, and an altered sleep-wake
state in neonates undergoing heel-stick procedures.103,172,173 In a
double-blind, randomized controlled study using the Brazelton Neonatal
Behavioral Assessment Scale, 90 percent of neonates had changed behavioral
states for more than 22 hours after circumcision, whereas only 16 percent of the
uncircumcised infants did.174 It was therefore proposed that such painful
procedures may have prolonged effects on the neurologic and psychosocial
development of neonates.175 A similar randomized study showed the absence of
these behavioral changes in neonates given local anesthetics for
circumcision.176 For two days after circumcision, neonates who had received
anesthetics were more attentive to various stimuli and had greater orientation,
better motor responses, decreased irritability, and a greater ability to quiet
themselves when disturbed. A recent controlled study showed that intervention
designed to decrease the amount of sensory input and the intensity of stressful
stimuli during intensive care of preterm neonates was associated with improved
clinical and developmental outcomes.177 Because of their social validity and
communicational specificity, the behavioral responses observed suggest that the
neonatal response to pain is not just a reflex response.178-180

MEMORY OF PAIN IN NEONATES
The persistence of specific behavioral changes after circumcision in
neonates implies the presence of memory. In the short term, these behavioral
changes may disrupt the adaptation of newborn infants to their postnatal
environment,174-176 the development of parent-infant bonding, and feeding
schedules.182,183 In the long term, painful experiences in neonates could
possibly lead to psychological sequelae,22 since several workers have shown that
newborns may have a much greater capacity for memory than was previously
thought.183-186
Pain itself cannot be remembered, even by adults187; only the experiences
associated with pain can be recalled. However, the question of memory is
important, since it has been argued that memory traces are necessary for the
"maturation" of pain perception,3 and a painful experience may not be deemed
important if it is not remembered. Long-term memory requires the functional
integrity of the limbic system and diencephalon (specifically, the hippocampus,
amygdala, anterior and mediodorsal thalamic nuclei, and mamillary nuclei)188;
these structures are well developed and functioning during the newborn period.42
Furthermore, the cellular, synaptic, and molecular changes required for memory
and learning depend on brain plasticity, which is known to be highest during the
late prenatal and neonatal periods.189,190 Apart from excellent studies in
animals demonstrating the long-term effects of sensory experiences in the
neonatal period,191 evidence for memories of pain in human infants must, by
necessity, be anecdotal.178,192,193 Early painful experiences may be stored in
the phylogenically old "procedural memory," which is not accessible to conscious
recall.182,183,194 Although Janov195 and Holden196 have collected clinical data
that they claim indicate that adult neuroses or psychosomatic illnesses may have
their origins in painful memories acquired during infancy or even neonatal life,
their findings have not been substantiated or widely accepted by other workers.

CONCLUSIONS
Numerous lines of evidence suggest that even in the human fetus, pain
pathways as well as cortical and subcortical centers necessary for pain
perception are well developed late in gestation, and the neurochemical systems
now known to be associated with pain transmission and modulation are intact and
functional. Physiologic responses to painful stimuli have been well documented
in neonates of various gestational ages and are reflected in hormonal,
metabolic, and cardiorespiratory changes similar to but greater than those
observed in adult subjects. Other responses in newborn infants are suggestive of
integrated emotional and behavioral responses to pain and are retained in memory
long enough to modify subsequent behavior patterns.
None of the data cited herein tell us whether neonatal nociceptive
activity and associated responses are experienced subjectively by the neonate as
pain similar to that experienced by older children and adults. However, the
evidence does show that marked nociceptive activity clearly constitutes a
physiologic and perhaps even a psychological form of stress in premature or
full-term neonates. Attenuation of the deleterious effects of pathologic
neonatal stress responses by the use of various anesthetic techniques has now
been demonstrated. Recent editorials addressing these issues have promulgated a
wide range of opinions, without reviewing all the available evidence.197-201 The
evidence summarized in this paper provides a physiologic rationale for
evaluating the risks of sedation, analgesia, local anesthesia, or general
anesthesia during invasive procedures in neonates and young infants. Like
persons caring for patients of other ages, those caring for neonates must
evaluate the risks and benefits of using analgesic and anesthetic techniques in
individual patients. However, in decisions about the use of these techniques,
current knowledge suggests that humane considerations should apply as forcefully
to the care of neonates and young, nonverbal infants as they do to children and
adults in similar painful and stressful situations.
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Citation:
Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. New
Engl J Med 1987;317(21):1321-1329.

 

[kong1971]

All of this material is basically the basis and reference to most of the claims I have made on this website. Although I have been accused of making things up, what AC calls "bro-telligence", this is just ignorance and cowardice in the face of such an atrocity, tantamount to the claims that the holocaust "never happened". The truth is, we are coming up on a crisis of faith, at which point the denial of the damage of circumcision will no longer be able to be ignored or shouted down, and men in the US finally wake their asses up and realize what exactly has been done to us as a gender for the last 130 years.

I've always been a light sleeper!

 

[kong1971]

KONG IS FINISHED-- DEBATE, DENY, I DON'T CARE-- HOW LONG AND HARD DO I HAVE TO SHAKE YOU GUYS TO GET YOU TO WAKE UP? I'M TIRED OF GETTING KICKED AND BEING TOLD THAT YOU WANT TO SLEEP JUST A FEW MORE MINUTES!!!

Note: I'm not "shouting" with the caps. Just trying to mark the end of my posts in this thread.

 

[kong1971]

COUPLE ARTICLES ON MALE BONDING AND MENS RIGHTS:

Do men understand being male?


By: Alan Barron
Email: alanjb@mioms.com


--------------------------------------------------------------------------------

Date: Thursday, 26th November 2003
Author: Alan Barron.

(1,600 words)

The wisdom of Ralph Waldo Emerson was way ahead of his time. Today more than ever, his words are so relevant: \"society everywhere is in conspiracy against the manhood of every one of its members.\"

Most human institutions that dominate western culture have been built up by masculine virtues such an entrepreneurial spirit, hard work, assertiveness and sense of competiveness.

In the West over the past forty odd years, the focus has been entirely on women. While society generally would say `men and women are equal\', and should be regarded as equal under the law, but then push comes to shove, it doesn\'t pan out this way. Why? It\'s because both men and women fall back and draw on the subconscious when it comes to gender.

Buried deep in the human subconscious is the acknowledgment that men are stronger than women. This primeval belief is rooted in past historical experiences and ingrained into every human brain. Conventional wisdom (sic) works on the assumption is that males are capable of looking after themselves. On the other hand, females are vulnerable, and if they are to compete with males on a level playing field, they will need assistance. If this is to happen, men must be constrained in some way so .

Over the years a plethora of reverse discrimination, affirmative action and `special measures\' have been introduced to assist women to gain `equality \' in the workplace, education, and throughout every strata of society - including the inner sanctum - the family home.

While society generally, particularly male decision makers, have been made aware of female needs and wants, and a genuine effort to understand and help women has been made, yet no corresponding effort has been made to understand men, their psychology, what makes them tick, and what their needs are -if any. All society know is that males have too much of everything, and females don\'t have enough - even if men did legitimately acquire their fame, fortune, job, power, status etc.

It has been assumed that we know what men are like. But do we? Our perception of maleness has been irreconcilably damaged by the machinations of political correctness which in the main has been negative and based upon unproven assumptions about maleness.

Modern decision makers have uncritically accepted the assumption gender roles are the product of a malignant socialisation. It is fool hardy to expect boys to conform to an equality ideal which is based on a jaundiced ideology rather than validated scientific research.

The underlying thinking today is that testosterone is to blame for every malignancy known to women - and men too for that matter. What is lost sight of is simple - men and women while equal in status are fundamentally different. They may well be socialised into certain roles and ways of thinking. The fact is men and women are affected by the hormones which flow throughout every square millimetre of their bodies.

MALENESS IS THE PRIMARY PRODUCT OF BIOLOGY - NOT SOCIALISATION.

Men don\'t understand themselves

The problem is that men do not understand themselves. They do not understand the deleterious effects the drive to equality are having on them. The drive to create a genderless society has seen men disenfranchised - by political fiat - by their own kind, on a wholesale scale not seen in the past annals of history.

Men tend to see themselves and other males as self - sufficient and autonomous. Men see other men as competitors, and if they have not bonded in a positive way to other men, will tend to be wary of men in general for no other reason than they lack a positive view of maleness.

Part of the problem is that modern society has entered uncharted regions in gender relations. In the late 20th and early 21st centuries, many were swept up in the feminist vortex to equalise the roles of the sexes. They believed social change was inevitable and overwhelmingly positive. While some may have some reservations about some aspects of equality, it was more important to go along with the tide rather than to buck the march towards a more alleged `enlightened\' future for women.

Let me make it clear - no-one in their right mind wants to deny women a genuine fair go. On the other hand, any man who tries to stand up for male rights or even vaguely hints at criticising equality for women, is viewed - at worst as reactionary - at best as churlish.

But slowly the reality is dawning on many men - and women - that it is legitimate for men to raise genuine concerns with equality. Because a person has genuine concerns doesn\'t not make one a misogynist, a `sexist\', or a reactionary.

The innate trouble for men is that because the way modern society is structured, young males and females learn to relate to women from a very early age. Firstly as mother, then later as teachers and still later as friends and lovers. A young male today finds it hard therefore to relate to other males. All his emotional apparatus has been fined tuned - and then some - to female needs and ways of thinking.

Female bonding

The truth is unless men stop and think about what has happened, and is happening to them. they will continue to be marginalised. Women deep down in their subconscious, see themselves as belonging to the herd. Just as female elephants in the animal kingdom band together and marginalise the males, so too do human females identify with their kind, not only for companionship, but also to protect themselves against the odd rogue male who happens to pass by every now and then.

Women therefore tend to be more emotive and subjective than men. Men are more objective and less irrational in their thinking. (Please note key word `more\'.) Women unwittingly favour their kind, this is why I think it is dangerous to appoint them as personal officers. When women are appointed to key recruiting and promotional roles, the number of women appointed is bound to increase. Look at modern education for example. It is dominated by women whose hegemonic philosophy wants to retain and expand the female sphere of influence. Men are seen interlopers - as threats to the sisterhood. Make no mistake control of education is about power and whose agenda gets implemented.

Women then primarily identify with women. Men on the other hand seek to identify with both men and women. But because of their gyno-centric socialisation, they end up strongly identifying with women mostly.

Lack of male bonding

It is no accident that increasing levels of male unemployment and loss of career opportunity has been accompanied by increasing levels of male suicide, male unemployment, marriage breakdown and general loss of male status in society.

When the modern man is presented with affirmative action programs masquerading as equal opportunity, he sees nothing wrong with such programs and is more than happy to go into bat for women. While he would not see himself as anti-male, yet he is oblivious to male needs and does not identity with them in any meaningful way and so in reality negates many civil and political rights for men by default.

This is because men are reluctant to be emotionally attached to other men out of a misguided tendency to view this as some sort of covert latent homosexuality. This is not the case at all. Men need to identify with other men - this is perfectly healthy.

The lack of male bonding in modern society is a sociological phenomena peculiar to the 20th and 21st centuries. It is an unnatural state of being. The major reason why men don\'t identify with male needs and concerns is because from a very early age males are tuned in to a female modality only.

This is why men side with women generally when it comes to gender equality. The only place men bond today is mostly in male sports clubs and the few remaining male only service clubs.

Then coupled with this the innate biological impulses to protect females and to regard other males are competitors who need to be driven off, is it any wonder men are isolated from each other, and marginalised in a society fixated with female needs and equal outcomes for women.

Men must learn to bond again with other men to balance the innate male biological tendency to protect females, seeing other males as threats, and to help overcome the strong emotional ties that they as children form with their mothers and other female care givers. One hundred years ago men learnt to bond with other men. Fifty per cent of people once lived in rural areas, and sons learnt to bond with their fathers. Men bonded with men in a male dominated workplace, and also at their local sporting clubs.

Today there is scare opportunity for men to bond with men in a wholesome way. Men need to realise their responsibiloty to other men. Top achieving men should support and uphold other men\'s right to function as primary breadwinner for their families; otherwise men at the bottom end of the pyramid will continue to be marginalised by a matriarchal gyno-centred society which is being driven by a strident anti-male and anti-family mentally.

So then men should defend the political and social rights of their fellows. The big need of today is for men to break the chains of political correctness which bind the political arena, the workplace and education, and to free them from gyno-centred policies which disenfranchise and marginalise men.

 

[kong1971]

FOR THOSE WHO DO NOT BELIEVE THAT CIRCUMCISION CAN MAKE YOUR Penis EnlargementNIS SMALLER...

UROLOGY, Volume 8, Number 5: Pages 472-474,
November 1976.



Iatrogenic microphallus secondary to circumcision.
Levitt SB, Smith RB, Ship AG

Three cases of apparent microphallus secondary to overzealous circumcision are presented. Proper diagnosis avoids unnecessary diagnostic studies. Moreover, a good functional and cosmetic result is virtually assured with appropriate resurfacing and thick split thickness skin grafting of the penile shaft. The best treatment would appear to be prevention of the complication by adequate instruction to personnel doing routine circumcisions.

ALSO.....

BOSTON MEDICAL AND SURGICAL JOURNAL, Volume 191, Number 26: Pages 1216-1218.
December 26, 1924.



THE TOAD IN THE HOLE CIRCUMCISION — A SURGICAL BUGBEAR

BY DOUGLAS H. STEWART, M. D.. F. A. C. S.

The term “Toad in the Hole” is derived from the Hebrew kitchens and cook-books; and it is here used because the writer never has heard any other name for the condition about to be described. The clearest mention of the matter is the following paragraph from the pen of Dr. Thomas H. Lanman of Boston*: “There is one type of case that should be especially mentioned because it is the sort for which circumcision is inadvisable. It is that the boy has a very small penis and a large pad of suprapubic fat, and post-operative care and cleanliness are made very difficult. Extreme cases present the appearance of an umbilical polyp, and this is alarming to the parents.

The present writer admits at once that he has never produced a toad in the hole, therefore there is no case here of a burnt child dreading fire. It is somewhat like the child who fears and shuns fire because he has seen a friend and companion burnt. While it is true that the writer has no troublesome case of his own, it is equally true that he has had troubles sufficient in explaining away the results obtained by others. As Dr. Lanman states, those “results” are “alarming,” and this is so whether the operation has been performed by a surgeon or a mohl.

As to the religious rite when performed by mohl, the parents are much overwrought by a toad in the hole result; because they hold tenaciously to the opinion that if a surgeon had done the work, the accident would not have occurred. Instances, facts of a sort, gossip, and so called evidence furnish a perfect deluge of words by way of proof of this contention. On the contrary, when the operator was a surgeon, orthodox relatives, perhaps not unstimulated by mohl and rabbi, make it their duty to impress upon the parents that the calamity (so called) is a direct visitation of a just God in his wrath for a sinful violation of the plain written law. To add to the hurly-burly, the wretched parents assert and are assured that their child is forever impotent and will have no children. Surely under all the circumstances one may easily understand that some unenlightened people are brewing a very pretty kettle of obstinately maintained misapprehensions which soon are to be masqueraded as facts.

Why the matter has not been brought into the courts is incomprehensible; because the people interested have a way of talking things over and stirring each other up, until their outlook become vicious and their hatred for the operator grows boundless. What decision a judge and jury would come to is unfathomable. Particularly so in view of the fact that physicians themselves, who are not familiar with the condition under discussion, appear to maintain a condemnatory silence when brought into its presence. There are now two patients under observation (aged 4 years and 63 years) who have presented about all of the angles of the toad in the hole result. The operations were performed by two different and competent surgeons. For the purpose of this paper the writer has taken them aside in private and has asked them the hypothetical question: “If placed under oath, would you feel bound to say that the operator was at fault?” Thus far the answers have been affirmative. At the same time it should be clearly stated that explanation and demonstration always caused a reversal of opinion. The writer’s opinion is that, of an exhibition of a toad in the hole patient to a jury could be managed, the verdict would coincide with the amount demanded and the defendant in a malpractice suit would pass many unhappy hours, not matter how innocent he might be. And he would have the greatest trouble to escape punitive damages, if he did finally escape. Yet the whole thing us but a bugbear, and like most bugbears, no matter how slight itself, it makes for a very real alarm. All one has to do is to show that the alarm is unwarranted and unjustified by any fact of the case. Yet this is not a simple matter, since it include explaining away of a parent’s insistence on believing what he sees with his own eyes; untaught and untrained as they are. “He saw with his own eyes that the child had a penis before operation; and he now sees that the child has no penis, or has only a damaged one.”

The way some of the mothers howl and cry over the toad in the hole condition is most startling. One woman made such a terrific noise that all the ambulant patients rushed out of the building and into the street in a panic. The psychology of the unreasoning expression of terror that can be evidenced by Russ-pol Jewess is most interesting, but would carry us too far afield; therefore this sketchy portrait will furnish example enough.

In managing toad in the hole patients it is well for the physician to be forearmed with some sort of formula that will carry hope, comfort and peace to the nervous, frightened parents—something that the wayfaring man, though a fool, cannot mistake. Here is one: “Stop fussing. We will get the boy a good wife yet.” The language may not be polished but the people understand it, and its effect as a wiper away of tears is prompt and satisfactory; whereas gentleness and kindness would be misunderstood, unappreciated and might add fuel to the fire.

Photographs of the toad in the hole condition have not been satisfactory, because the picture shown the penis plainly and not at all as seen by the untrained or careless eye. In reality the parts all fit together with a marvelous adjustment. So perfect is it at times that two ellipses, one within the other, drawn upon the back of the clenched fist will make a good illustration. Let the inner ellipse represent the glans and penis. Let the outer ellipse represent the rime of the socket or curb of the well, as it were. Then with a cotton swab and some tinct. Iodine or other color let this be drawn (as stated, upon the dorsum of the first).


In some instances with a flaccid penis at rest in the hole there is little or no protrusion or protuberance. The penis can be lifted or drawn out of the socket, or the pad of fat can be pushed back; but when erect the penis climbs out, as it were. In the child patient at present under observation the non-protrusion and smoothness would have to be seen to be appreciated.

The treatment of the child is planned according to a routine that was formulated many years ago and it has served its purpose well. It is merely the diet for and the treatment for obesity. The child is supposed to be weighted weekly and its diet so regulated that the weight is kept down to standard for age. As has already been pointed out, the condition is brought about by a more or less localizied obesity, together with a small sized penis. After severance of the foreskin, which in this instance may be compared to a sort of suspensory ligament, the penis sinks into a sort of well in the excessive supra-pubic fat pad. The curb of the well is formed by a fold of the skin. For cleansing purposes, fill the hole and applying freely in its neighborhood, one heaping teaspoonful of Sod. Bicarb. Plus one level teaspoonful of Sod. Perborate dissolved in a tumblerful of warm water acts like an alkaline non-irritant H2O2 and thus lessens the usual difficulty of maintaining post-operative cleanliness.

The adult (aged 63) under observation states that he always needed circumcision and was so advised by various physicians. However, the matter was put off until he was 40 years of age, when he wished to marry and therefore had a circumcision performed; after which his penis promptly fell down the hole. He found no trouble with sexual intercourse that was satisfactory to both parties. His wife has three healthy children. He can have intercourse when he wishes but is rationally abstentious. In this patient when the penis is flaccid all is so smooth that a cursory glance from the side (lateral), when the man is lying down on his back, might mistake pad, penis, and socket for a vulva. However, at the least erection the lips of the socket are shoved apart sidewise and the penis projects quite as it should. Manifestly this patient neither required nor desires treatment. He came for a herniotomy which was successfully performed.

A colleague suggests by way of conclusion that about the most valuable thing in treatment is a suggestion, that comes from the writer’s advice to the mothers: “Bring your child to me on the fourth Thursday of each month and I will watch over his development.” This it appears works out pretty well in keeping the mother from wandering about with her child and thus obtaining all sorts of misunderstood and disquieting opinions. The patients are usually brought for two or three months and by that time the parents have seen the child with an erect penis; or they have become accustomed to the appearance of things so that they are persuaded that the child has a penis, or they have become convinced by some weird and unknown reason that all their worry was but a false alarm in every way. After such conviction they come occasionally, perhaps once in five years. At least they come if they are at all uneasy in mind, or they come to show the doctor how well the child did come along. In one instance they came to talk about the child’s fruitful marriage and to make arrangements for his wife’s approaching confinement.

*Boston Med. and Surg. Jour., p. 628, April 10, 1924.


--------------------------------------------------------------------------------
Citation:
Stewart DH. The toad in the hole circumcision — a surgical bugbear. Boston Med Surg J 1924;191(26):1216-8.

AND....

http://www.cirp.org/library/complications/talarico1/

AND....

http://www.cirp.org/library/complications/horton1/

AND...

http://www.cirp.org/library/complications/vanduyn1/

AND...

http://www.cirp.org/library/complications/sotolongo1/



Publication Types:

Case Reports
PMID: 790749 [PubMed - indexed for MEDLINE]

I think it is high folly to believe that even mild scarring, slight denuding of penile shaft skin and loss of circulatory structures would not result in having a penis that is or appears smaller that a man's genetically destined size. In MILD cases of size reduction, which would not be considered a complication needing repair, Penis Enlargement and FR techniques come in quite handy in getting the constrained portion of the penis free of the pubic cavity.

 

[kong1971]

Okay, Now I'm Really Done This Time!!! :d I'm Gonna Go Have A Couple More Beers And Then Hit The Hay! Later, Doods!!!

 

[thefranchise]

boys have a penis, girls have a vagina

 

[Rod Buster]

Seems a little over simplified....can we get some data?

 

[Shithead]

Don't ask me why im doing this, im just bored and want a break from study.

Benefits of circumcision

I was actually very anti circumcism, but that site has some really good points and im not so sure where i stand now. I'll quote some of the interesting stuff from it to save some people from reading through it all, though it is a good read.

It had been suggested that the foreskin protected the glans from drying out and becoming keratinized. However, histological examination has shown the same amount of keratin in the skin of the head of the penis irrespective of circumcision status [279].

A retrospective study of boys aged 4 months to 12 years found uncircumcised boys exhibited significantly greater frequency of penile problems (14% vs 6%; P less than 0.001) and medical visits for penile problems (10% vs 5%; P less than 0.05) compared with those who were circumcised. In infants born in Washington State from 1987-96, 0.2% had a complication arising from their circumcision, i.e., 1 in every 476 circumcisions [50]. It was concluded that 6 urinary tract infections could be prevented for every circumcision complication, and 2 complications can be expected for every penile cancer prevented [50].

Long term psychological, emotional, and sexual impediments from circumcision are anecdotal [190, 311] and can be discounted.

There's a paragraph on why this is so in the article.

Anti-circ activists make unusual claims about the smegma and even claim there are glands under the foreskin that secrete pheromones important in sexual attraction. There is no support for such claims and all of their statements should be regarded as fantasies unless proved otherwise by credible scientific evidence.

The wet tip of an uncircumcised penis could permit quicker penetration. However, the requirements of the modern woman generally differ somewhat from this kind of sex, which might have had some benefit for primitive humans who may have wanted to complete the sex act quickly to minimize the time they were vulnerable to predators.

Theres a big ass list and explanations of all the physical problems of a forskin in the article too.

In 1982 it was reported that 95% of UTIs in boys aged 5 days to 8 months were in uncircumcised infants [105].

uncircumcised had an 11-fold higher incidence of UTIs [321].

There's a crap load of stats on UTI's in there.

Uncircumcised men have twice the incidence of prostate cancer compared with circumcised [14, 84]

Lack of circumcision:

# Is responsible for a 12-fold higher risk of urinary tract infections. Risk = 1 in 20.

# Confers a higher risk of death in the first year of life (from complications of urinary tract infections: viz. kidney failure, meningitis and infection of bone marrow).

# One in ~400-900 uncircumcised men will get cancer of the penis. A quarter of these will die from it and the rest will require at least partial penile amputation as a result. (In contrast, invasive penile cancer never occurs or is infinitesimally rare in men circumcised at birth.) (Data from studies in the USA, Denmark and Australia, which are not to be confused with the often quoted, but misleading, annual incidence figures of 1 in 100,000).

# Is associated with balanitis (inflammation of the glans), posthitis (inflammation of the foreskin), phimosis (inability to retract the foreskin) and paraphimosis (constriction of the penis by a tight foreskin). Up to 18% of uncircumcised boys will develop one of these by 8 years of age, whereas all are unknown in the circumcised. Risk of balanoposthitis = 1 in 6. Obstruction to urine flow = 1 in 10-50.

# Means increased risk of problems that may necessitate circumcision later in life. Also, the cost can be 10 times higher for an adult.

# Is the biggest risk factor for heterosexually-acquired AIDS virus infection in men. 8-times higher risk by itself, and even higher when lesions from STDs are added in. Risk per exposure = 1 in 300.

# Is associated with higher incidence of cervical cancer in the female partners of uncircumcised men.

etc etc, im getting back to study.

 

[Priapologist]

...but that site has some really good points and im not so sure where i stand now.

Shithead,

This site provides a lot of 'information' in a digest format, along with the author's pro-circ-biased opinions. The problem that I have with the article is that it often portrays opinion as fact, makes ad hominem attacks on sources that the author disagrees with, and does not have references available for the in-text citations. This article is not compelling evidence for a pro-circ argument.

Peace.
Pri

 

[Priapologist]

All of this material is basically the basis and reference to most of the claims I have made on this website. Although I have been accused of making things up, what AC calls "bro-telligence", this is just ignorance and cowardice in the face of such an atrocity, tantamount to the claims that the holocaust "never happened". The truth is, we are coming up on a crisis of faith, at which point the denial of the damage of circumcision will no longer be able to be ignored or shouted down, and men in the US finally wake their asses up and realize what exactly has been done to us as a gender for the last 130 years.

I've always been a light sleeper!

Kong,

This is great that we now have the source of your angst available to analyze. Some of this is scientifically sound, some of it is opinion. During the past week, I found the source of Swank's angst (second post in thread), which is equally compelling. His third post in the thread asks why we can't just stick to this being an FR forum, which I think is a great idea.

My impression is this, most of the 'nay-sayers' complain about two things: 1) the claim that all circumcised penises are broken, impotent, mutilated, et cetera; 2) that some of the 'facts' used to back up the anti-circ agenda are often opinions and sometimes out right fabrications. They are justified (in my opinion) in their feelings about these topics. Many men are happy with being circumcised and don't feel at all mutiliated or broken. Many men aren't, and some just don't give a shit. In light of this, it is understandable that all of the anti-circ rhetoric would get up some people's asses. The second issue just adds fuel to the fire caused by the first issue. Basically, men are being told that their dicks are fucked up by circumcision, but the evidence used to drub that point home is often just opinion and sometimes spurious nonsense.

Am I against routine infant circumcision? HELL YES. Do I think that all circumcision is bad? NO. Let's not throw out the baby with the bathwater just to make a point: RIC is largely unnecessary and cruel, but circumcision is a valid surgical proceedure that is not inherently bad, nor done solely to make doctors wealthy.

Here's my suggestion: let us use the FR forum for restoration-related topics and put the circumcision discussions in Deep Thoughts. These pro-circ/anti-circ arguments are not helping this forum, and I think they may be hurting it.

Peace.
Pri

BTW, Kong, don't take the Bro-telligence thing so personally. There is a broad issue of opinion-as-fact bullshit on the forums, hell, most internet forums, so I don't think that the BT thing was directed solely at you. But, I could be mistaken....AC?

 

[Priapologist]

This all needs to end, and these "come hither" threads by which beg for a flame need to end.

AC,

Come on, you love the DRAMA! You were practically begging Kong to post again, so you could have another go at him

Peace.
Pri

 

[kong1971]

I'm not begging for a flame war. I do not understand why my postings seem to be confrontational. I do not know how to write any other way. I honestly don't. I write just how I talk and do not sit at my desk chortling to myself "haha, that will get them riled up." I write quickly and off the top of my head. If you could please explain to me what it is about my writing style that makes me seem combative, I would like to hear it. You tell me not to take things personal, but even critique how I word my postings. How can I not take things personal in that light? Jeez, cut me some slack!

Shithead, please do not change your anti-circ opinion because of that poorly written website. The amount of disinformation there is staggering. Every point they make can easily be countered with real facts.

Of course it would seem like uncircumsied boys exhibit greater frequency of penile problems. They have their whole penis. That means there's more parts to get sick. You'd never have leg cramps if your legs were amputated either.

Also, problems like tight shaft skin, peno-scrotal webbing, curvature, length reduction and sensitivity loss [all side-effects of circumcision] are not considered to be medical complications. They only consider it a complication if the thing rots and falls off or they have to do another surgery to fix the first one.

UTIs can be cured with antibiotics less invasively and far less painfully than with a scalpel. I'd hate to get an ear infection by that reasoning...ouch!

"Long term psychological, emotional, and sexual impediments from circumcision are anecdotal [190, 311] and can be discounted. " Um, yeah, thanks. I guess that's one way to address a problem. Ignore it. Good thinking! There are alot of men who complain of long term psychological, emotional and sexual impediments, and these are actually points brought up in some of the professional articles I posted, namely the Journal of Health Psychology, written by actual medical doctors and scholars, not some guy with a circumcision fetish.

Finally, all the stats you quoted just do not make sense if you look at it from a common-sense approach. More susceptible to AIDS? Then why do the countries that have the highest population of circumcised men also have the highest rates of AIDS? Japanese men, who are mostly uncircumcised, have the lowest rates of penile cancer, as do countries like Sweden, Holland, etc. Pencile cancer have very little to do with circumcision, if you look at the big picture, because some of the highest rates are in the countries that do circumcise. It doesn't add up.

It's all misinformation and lies and that's what I'm trying to get people to see here. Why restore? Because we've been lied to. Because there is something better to be had if you have the fortitude and patience. Because you have a choice.

Now, do you choose to believe or do you choose to ignore?

 

[VladtheImpaler]

Kong, you really shouldnt give a fuck about what these weird fuckers think, if they were really had something intelligent on their mind, they wouldnt be in the FR forum anyway, except to stir up shit....

Don't ask me why im doing this, im just bored

I think this quote can account for 99% of drama taking place here..... :s

 

[Shithead]

This site provides a lot of 'information' in a digest format, along with the author's pro-circ-biased opinions. The problem that I have with the article is that it often portrays opinion as fact, makes ad hominem attacks on sources that the author disagrees with, and does not have references available for the in-text citations. This article is not compelling evidence for a pro-circ argument.

Yeah the site is written by a guy who seems a bit biased, but the great majority of the facts he accumulates are inarguable.

Of course it would seem like uncircumsied boys exhibit greater frequency of penile problems. They have their whole penis. That means there's more parts to get sick. You'd never have leg cramps if your legs were amputated either.

umm, i think its a little more complicated than that kong.

Also, problems like tight shaft skin, peno-scrotal webbing, curvature, length reduction and sensitivity loss

They address a lot of these problems, did you even read the site?

UTIs can be cured with antibiotics less invasively and far less painfully than with a scalpel. I'd hate to get an ear infection by that reasoning...ouch!

The problem was the rate of UTI's that go on to produce cancer.

Um, yeah, thanks. I guess that's one way to address a problem. Ignore it. Good thinking!

He's not ignoring any problems, christ kong, be friggen rational, could we once have a civilized debate.

There are alot of men who complain of long term psychological, emotional and sexual impediments, and these are actually points brought up in some of the professional articles I posted, namely the Journal of Health Psychology, written by actual medical doctors and scholars, not some guy with a circumcision fetish.

You know all the numbers throughout all the writting on that site, there reference numbers, so you can go look them up in the reference list, which consists of "actual medical doctors and scholars".

Could you put your emotion asside and your predispostions. Im a real skeptical bastard, but this site has almost changed my mind on the whole thing. Rather than just rant off how shit the site is, bring up points where the site has made a mistake and then find somthing in your articles that proves it, doesn't that sound nice and mature?

 

[Vectormatch]

At what age do most men develop penile cancer, if they ever do? Plus, by the time I'm that age, they will have a cure for it probably. I still could get testicular, prostate, bone, skin and a lot of other cancers that don't require and operation as a baby.

My sister had some UTIs growing up. I'm sure she was in less pain then I was after the operation. Once antibiotics were discovered, that argument is no longer valid.

And at first I was glad I was cut as a baby so I wouldn't remember it, but the fact that I had no say in the matter disturbs me. And I still haven't heard any reason that makes me glad that I've been cut.

And why doesn't this topic get discussed in biology classes and health classes in school? The Discovery Health should do an episode on this topic. I still don't know how I found out about circumcision, but I was 23 years old when I did.

 

[Shithead]

I'll start the ball rolling: AIDS

Over 80% of these infections have arisen from vaginal intercourse [139].

Epidemiological data from more than 40 studies shows that HIV is much more common in uncircumcised, as opposed to circumcised, heterosexual men [91]. A wealth of evidence indicates that male circumcision protects against HIV infection, as acknowledged in the major journals Science [138] and Nature [3 05], and its promotion in HIV prevention is advocated [76].

(Lack of circumcision)Is the biggest risk factor for heterosexually-acquired AIDS virus infection in men. 8-times higher risk by itself, and even higher when lesions from STDs are added in. Risk per exposure = 1 in 300.

Medical journals with evidence HIV is significantly more common in uncircimcised males. So now refute it with facts, or point out the flaws in it.

 

[kong1971]

From the AAP:

"Evidence regarding the relationship of circumcision to
sexually transmitted diseases is conflicting. Although
published reports suggest that canchroid, syphilis, human
papillomavirus and herpes simplex virus type 2 infection are
more frequent in uncircumcised men, methodologic problems
render these reports inconclusive."

Look, Shithead, I could fire just as many reports and studies at you as you could at me, but what point does it serve? Circumcision is not the cure to AIDS. If it was, the US and Africa would be virtually AIDS free. Do you not see the common sense reasoning behind this? Are you just arguing for arguments sake? Abstinence and condoms are the only real prevenion for AIDS. Now, if you recommend that men go out and fuck whoever they want without protection just because they're circumcised, then go right ahead.

PS-- UTIs do not cause cancer. The HPV virus and poor penile hygeine is what is believed to cause cervical and penile cancer... and that's a big maybe because, like I said, many countries that do not practice circumcision actually have LOWER rates than we do! UTIs can be fixed with antibiotics. HPV can be cleared up with water and a washrag. The argument is not that circumcision doesn't help prevent these problems [maybe]. The argument is that circumcision is unnecessarily invasive, painful and damaging when the two health problems can be easily addressed with good personal hygiene and mild antibiotics.

PPS-- Please don't get personal and imply I am being irrational and uncivilized. I am actually in a very good mood and being very rational. How long do you think the other forum members are even going to continue paying attention to that tired ploy? They know I'm not crazy.

 

[kong1971]

Point taken. I see where you are coming from now.

I will stay out of your way for now on, as I myself am far from perfect. So each of these threads in the FR forum doesn't turn into flames which could happen, I apologize.

Thank you, AncientChina. I very much appreciate that.

 

[Shithead]

From the AAP:

"Evidence regarding the relationship of circumcision to
sexually transmitted diseases is conflicting. Although
published reports suggest that canchroid, syphilis, human
papillomavirus and herpes simplex virus type 2 infection are
more frequent in uncircumcised men, methodologic problems
render these reports inconclusive."

Look, Shithead, I could fire just as many reports and studies at you as you could at me, but what point does it serve?

It serves a very important point, its the same point as to why you made this thread. Anyway, your quote doesn't address AIDS

 

[Mr. Nine]

I'm not being a smart ass but have you considered a complete departure from all forum activity? I have found that frequent hiatuses clear my mind. For me, there is no validity to the theory that you have to post in a forum to grow your dick. I catch myself from time to time trying too hard to convey deep ideas and beliefs to guys on an anonymous forum that I really don't know at all.

My remedy has helped tremendously and probably has kept me from being banned many times.

 

[Priapologist]

Yeah the site is written by a guy who seems a bit biased, but the great majority of the facts he accumulates are inarguable.

They are very "arguable".

The problem was the rate of UTI's that go on to produce cancer.

Kong is correct, UTIs do not cause cancer.

You know all the numbers throughout all the writting on that site, there reference numbers, so you can go look them up in the reference list, which consists of "actual medical doctors and scholars".

I already addressed this issue, Shithead. There are reference numbers in-text, but there is no reference list in the article. Reference numbers are meaningless if they don't reference anything. The article is, at this juncture, nothing more than one man's opinion.

Peace.
Pri

 

[LambdaCalc]

This probably should be in the deep thoughts section, as someone mentioned earlier.

Kong: People are debating with you because you present your information as if it has been handed to you by an infallible god. Any time information is presented this way someone will undoubtedly take up the other side just as hardcore as the original presenter.

 

[kong1971]

Shithead, you made your point and I made mine. Let's leave it at that. I'm not trying to "win" or "beat you", just discuss ideas. The opinions are out there on the floor. It's done.

You believe that circumcision helps prevent the spread of AIDS.

I say the evidence is inconclusive and condoms and abstinence work better without the damage of cutting off erogenous tissue.

Let's agree to disagree on this topic.

 

[kong1971]

Lambda, I've been told that before. I'm honestly not trying to sound that way. Seriously, do you start every sentence with "I believe..." and "It's my opinion that..." ? I write the way I write. No one else on this forum is required to qualify every statement they make, so why should I? The only reason some attempt to censor my contributions is that circumcision is a controversial subject. If it's too much for you to handle, go to the porno section or picture proof and look at the pictures... and I say that not in anger but in a mild teasing manner with a little smilie so as not to offend!

It's my opinion that this thread is better suited for the FR forum because it contains a lot of info on WHY to restore, but if any other moderators believe it should be moved, then they can do so. It wouldn't bother me either way.

 

[9cyclops9]

I think the thread is fine here. But that's just my opinion, I have no references to back me up.

 

[Priapologist]

I think the thread is fine here. But that's just my opinion, I have no references to back me up.

LOL! Smartass! rofl

Thanks man, this thread needed some levity.

 

[Shithead]

They are very "arguable".

There are hundreds of statements and theories in that article, i said lots are inarguable and you replied by saying the lot are shithouse?!? how about point one out and say why, otherwise you sound just like what you claim this guy to be.

Kong is correct, UTIs do not cause cancer.

Yeah i dunno much about this, i'll take ya word for it.

I already addressed this issue, Shithead. There are reference numbers in-text, but there is no reference list in the article. Reference numbers are meaningless if they don't reference anything. The article is, at this juncture, nothing more than one man's opinion.

If you go to the top of the page and click on REFERENCES you will quickly directed to a page that shoots the shit outa that argument.

Let's agree to disagree on this topic.

Yeah i reckon we could do that, how about we agree that their are strong and factual arguments on both sides of the debate.

 

[MDC]

Shithead,
Even if there are benefits to being circumcised, such as cleaning yourself will be less complicated, circumcising infants is unjustifiable.

 

[kong1971]

Some of those references are to publications that are 30+ years old, you know. I'd rather not get into a "my references are bigger than yours" battle. It doesn't solve anything. Pri or I could make a thousand arguments and present a thousand studies, but you either have to believe or not believe after a point. The tide is turning right now as far as medical research and medical opinion, so it is all going to be a moot point anyway before long. I'm curious what you actually believe, tho. Do you actually believe circumcision fixes anything? Would you have prefered to be cut or uncut if you had had a choice? Will you have your kids cut? Have you thought about restoration?

 

[Shithead]

Some of those references are to publications that are 30+ years old, you know. I'd rather not get into a "my references are bigger than yours" battle.

What!? you can't just throw an attack and then follow it up by saying the argument would be pointless. It's like me calling you a cockhead and then saying "well name calling is unnecessary".


You've managed to show a lot of credible sources for anti-circumcision, and as you've said, we could both provide hundreds of journals and reports.

I'm not trying to prove cirumcision right or wrong, there is a huge lack of information on the positives of circumcision here, and i would rather people go look into both sides of the argument instead of making their opinion entirely from the bias in this forum section.



As for what i believe, i don't really know yet, and since i won't be having kids for a very long time im probably not gonna be thinking about it much until then.
The #1 reason for me why circumcision shouldn't be practiced is the lack of sensitivity possibility.
The #1 reason for me why it should be done is because of its origin, and that numerous isolated cultures practiced circumcision, how did so many cultures coincidently take up the same practice?

I'm not gonna do FR coz my circumcision was fine and my forskin is fine the way it is now.

 

[kong1971]

I presented my argument. What about it didn't you understand? Are you trying to bait me into getting frustrated? I'm not going to keep repeating myself. For you, I'll say it one last time. My argument against circumcision as prevention of AIDS is two-fold. The AAP admitted that, although circumcision seems to help reduce the incidence of STDs, the testing was somewhat ambiguous and they cannot say for sure. The second part of my argument was that condoms prevent AIDS without cutting off erogenous tissue.

Although I personally feel that the way circumcision is done in the US is morally wrong and physically damaging, I would never presume to impose my beliefs on anyone. I think we should all have a choice in the matter, but there is no such thing as "choice" when there is a lack of education. There is no lack of information on the pro-circumcision side. It is an institutionalized practice that is ingrained into our very culture and driven more by profit than actual medical concerns. There is a definite lack of education on the anti-circumcision side, and that is what I'm trying to combat here.

I'm glad you're open-minded about it and still looking into it. I'd hate to think you were just playing devil's advocate here. As to why so many cultures have adopted the practice, I read an article that I found very interesting. In it, the author stated that circumcision sprang up as a kind of group protective mechanism, a way to curb the male libido and make them a little more tractable, less destructive to the group and a little less distracted by sexual urges so that they could be better providers.

I think you should restore your foreskin, tho. Non-conformity is cool!

 

[MDC]

The problem with studies comparing STD rates among circumcised and uncircumcised poplulations is that they don't account for cultural differences. One group in Africa that circumcises may be very different with regards to promiscuity, when compared to another group that does not practice circumcision. STD rates between those groups has nothing to do with circumcision status, though that is the nature of the "study".

 

[Priapologist]

There are hundreds of statements and theories in that article, i said lots are inarguable and you replied by saying the lot are shithouse?!?

I said nothing like that, Shithead. I said that they were "arguable". Almost any topic that you care to bring up is "arguable", since not everyone agrees on every topic. Some people still believe that the Earth is flat and "argue" passionately in favor of that point of view.

...how about point one out and say why, otherwise you sound just like what you claim this guy to be.

I will, but I needed the references that he is citing. The link that you provided starts the webpage below the section where the References link is located. Since the convention is to put references at the end of the article (bottom of the page), I could not find them. Thanks for pointing them out.

It will take me several days to wade through the scientific and medical literature that he has linked to. I have already read several of the referenced papers and have found those to be conjectural and scientifically weak. I will provide specific points, both pro-circ and anti-circ, after I have had a chance to fully analyze the literature.

Pri

 

[golarge]

Does any of this chatter REALLY matter? I really don't care the way someone else wears their hair, or builds their muscles. We do this for ourselves, and maybe our partners. So the banter back and forth is, to me, a waste of energy. Plus this is one of those topics that is similar to religion and politics, it can easily become a fire fight. I ask myself....

Why do I do FR?

- Because I like the way it makes my penis look.
- Because it makes my head and skin more sensitive, and that feels good TO ME.
- Because I'm hoping looser skin will aid in Penis Enlargement.

Simple as that. I don't bother with statistics that don't and will likely never affect me.

Golarge

 

[kong1971]

Good post, golarge. Point taken.

My motivation for putting myself out there and doing all this-- spending my free time trying to educate men about this issue-- is very simple. I wish I had found out about it sooner. It wasn't "out there" when I first needed it. I just stumbled across it by accident. I don't think that FR should be a fringe thing, the little secret we don't talk about. I think every man who was circumcised without his consent should be educated about reversing the procedure if he should choose to do so.

 

[Shithead]

Does any of this chatter REALLY matter? I really don't care the way someone else wears their hair, or builds their muscles. We do this for ourselves, and maybe our partners. So the banter back and forth is, to me, a waste of energy. Plus this is one of those topics that is similar to religion and politics, it can easily become a fire fight. I ask myself....

Why do I do FR?

- Because I like the way it makes my penis look.
- Because it makes my head and skin more sensitive, and that feels good TO ME.
- Because I'm hoping looser skin will aid in Penis Enlargement.

Simple as that. I don't bother with statistics that don't and will likely never affect me.

Golarge

wait, AC had a term for this, Preach somthing or whatever. haah

 

[Priapologist]

Does any of this chatter REALLY matter? I really don't care the way someone else wears their hair, or builds their muscles. We do this for ourselves, and maybe our partners. So the banter back and forth is, to me, a waste of energy. Plus this is one of those topics that is similar to religion and politics, it can easily become a fire fight. I ask myself....

Why do I do FR?

- Because I like the way it makes my penis look.
- Because it makes my head and skin more sensitive, and that feels good TO ME.
- Because I'm hoping looser skin will aid in Penis Enlargement.

Simple as that. I don't bother with statistics that don't and will likely never affect me.

Golarge

Golarge,

It is fine that you don't find this interesting or important, but some people do. I am a scientist, so it is very compelling to me to seek out the most rationale explanation for things, and I invariably learn something in the process. Research for me is pleasurable, as is debate.

I share your reasons for doing FR, but that doesn't mean that I have to be incurious as to why it needs to be done, how it works, why it works, and conjecture as to how it can be done better. Simply put, if you think that this is a waste of energy, then don't read it.

Peace.
Pri

 

[samzman]

I am a scientist

what is your field?

 

[PETER DICK]

For those of you that believe in GOD, you know that he wouldn't make a mistake like this when he created man. If GOD wanted us to not have a foreskin, he would have created us without it.

For those of you that believe in evolution, you know that if the foreskin was not needed we would have evolved over millions of years to not have one.

Why don't we also start cutting infant boy's eyelids off. That way they can see all the time.

 

[Priapologist]

what is your field?

I'm a second-year graduate student in Physiology and Pharmacology. I've done some work with IGF-1 and P-glycoproteins, and I'm now in a lab working on novel cancer-drug delivery methods.

 

[Shithead]

For those of you that believe in GOD, you know that he wouldn't make a mistake like this when he created man. If GOD wanted us to not have a foreskin, he would have created us without it.

For those of you that believe in evolution, you know that if the foreskin was not needed we would have evolved over millions of years to not have one.

I can understand the religious types accepting that idea, but your evolution idea... come on, what about the apendix, canine teeth, finger nails...etc.

 

[kong1971]

For those of you that believe in GOD, you know that he wouldn't make a mistake like this when he created man. If GOD wanted us to not have a foreskin, he would have created us without it.

For those of you that believe in evolution, you know that if the foreskin was not needed we would have evolved over millions of years to not have one.

Why don't we also start cutting infant boy's eyelids off. That way they can see all the time.

Christians are not supposed to circumcise. Saul of Tarsis said to beware of the circumcisers and scolded the Jewish circumcisers travelling around trying to get the new Christians to take up the practice to cut off their own weiners if they wanted to do it so much. Christ's suffering and crucifixion was enough to pay for our sins... God doesn't need your foreskin, too!

All mammals have a prepuce. So far as I know, we're the only mammal that cuts ours off. I have read that there are laws in some places here in the US that outlaw circumcising farm animals... Have people actually done this so there would have to be a law against it ?!?! It didn't evolve to protect the penis from tall grass or whatever, because all mammals evolved it and retain it. It is a functional part of the penis, not a vestigial tail or appendix. If you started restoring and actually FELT the difference you'd know why it is there!

 

[Priapologist]

I can understand the religious types accepting that idea, but your evolution idea... come on, what about the apendix, canine teeth, finger nails...etc.

Okay, I'll give you the appendix, but I use my canine teeth and finger nails often.