Circumcision and Human Behavior

Authors

• Hill George
• iconbuster Website: http://genitalintegr…

Abstract

Psychologists now recognize that male circumcision affects emotions and behavior. This article discusses the impact of male circumcision on human behavior.

Introduction

Medical doctors adopted male circumcision from religious practice into medical practice in England in the 1860s and in the United States in the 1870s. No thought was given to the possible behavioral effects of painful operations that excise important protective erogenous tissue from the male phallus. For example, Gairdner (1949) and Wright (1967), both critics of male neonatal non-therapeutic circumcision, made no mention of any behavioral effects of neonatal circumcision.^1,2

The awakening

Other doctors, however, were beginning to express concern about the behavioral effects of male circumcision.
Levy (1945) studied the behavioral effects of various operations, including circumcision, on young children.³_He found that children who had undergone operations experienced an increase in anxiety and various fears, including night terrors, fear of physicians, nurses, and strange men. The oldest age group exhibited greater hostility and aggression. Levy compared their behavior to that of soldiers who suffered from what was then called “combat neurosis,” and now recognized as_post-traumatic stress disorder.
Anna Freud (1952) pointed out that operations on the genitals, such as circumcision, would cause “castration anxiety.”⁴_Cansever (1965) tested Turkish boys before and after circumcision.⁵_Cansever reported severe disturbances in functioning, including regression in behavior, and withdrawal of the ego as protection against outside threats. Cansever also observed various anxieties, including castration anxiety. Richards_et al._(1976) noticed certain studies that indicated behavior change and called for further study.⁶_Foley (1966) noticed that circumcised men are more likely to be biased in favor of circumcision.7_Moreover, he said that circumcised men are more likely to engage in “problem-masturbation” but non-circumcised men were equally unlikely to engage in “problem-masturbation.” Grimes (1978) (another critic of non-therapeutic neonatal circumcision), apparently unaware of the research described above, sounded an alarm:
“In contrast to the sometimes dramatic somatic responses of the neonate to operation without anesthesia, the psychological consequences of this trauma are conjectural. Psychoanalyst Erik Erickson has described the first of eight stages of man as the development of basic trust versus basic mistrust. For the baby to be plucked from his bed, strapped in a spread eagle position, and doused with chilling antiseptic is perhaps consistent with other new-found discomforts of extrauterine existence. The application of crushing clamps and excision of penile tissue, however, probably do little to engender a trusting, congenial, relationship with the infant’s new surroundings.”⁸

Behavior during unanesthetized circumcision

Gunnar et al._(1981) studied the relationship of system cortisol levels to behavioral state. Gunnar_et al._report that, as system cortisol rises, infants increase wakefulness and crying.⁹_Malone et al. (1985) report that infants show little change in behavior due to limb restraint (of the type used for circumcision).¹⁰_Porter et al. (1986) report that newborn infants who are undergoing unanesthetized cirumcision emit cries of extreme urgency.¹¹The studies, carried out with the aid of computer spectrographic analysis, show that infants who have been circumcised vocalize their anguish with higher pitch, fewer harmonics and shorter cries. The most invasive procedures produced the most urgent cries, as judged by observers. Porter et al. (1988) report that vagal tone decreases as the pitch of the cry increases.¹²__Gunnar et al. (1988) report that infants decrease distressed behavior when given a non-nutritive pacifier, although system cortisol does not decrease.¹³

Behavior immediately after unanesthetized circumcision

Studies show that circumcision affects the sleep of newborn boys. Emde et al.(1971) studied the sleep of boys who had had a non-therapeutic circumcision with the Plastibel^® device.¹⁴Emde et al.report that non-therapeutic circumcision “was usually followed by prolonged nonrapid eye movement (NREM) sleep.” The authors considered this type of sleep “to be consistent with a theory of conservation-withdrawal in response to stressful stimulation.” Anders & Chalemian (1974) studied the sleep of boys who had had a non-therapeutic circumcision with a circumcision clamp. They report significant increases in wakefulness after circumcision.¹⁵

Marshall et al._(1979) studied newborn infant behavior using the Brazelton Neonatal Behavior Assessment Scale.¹⁶_The study shows that infants change their behavior for at least 22 hours after circumcision. In a second study, Marshall et al. (1982) showed that circumcised infants kept their eyes closed during feeding or did not feed at all. Marshall et al. considered that mother-infant interaction and bonding was disrupted by the stress of circumcision.¹⁷

Numerous observers report that circumcision inteferes with the normal feeding behavior of circumcised boys. La Leche League leaders (1981) suggest that circumcision should be delayed for a time.¹⁸_Marshall et al. (1982) found that circumcision interfered with normal feeding behavior.¹⁷_Howard et al. (1994) report that “babies feed less frequently and are less available for interaction after circumcision.”¹⁹_Howard_et al._report that some newly circumcised babies are unable to suckle at the breast and require formula supplementation. Lee (2000) also comments on the difficulty with feeding that circumcised boys exhibit.²⁰_Breastfeeding provides the best nutrition for infants and is of key importance in giving an infant a good start in life with optimum mother-infant bonding, health, and well-being,²¹_so non-therapeutic infant circumcision should not be allowed to interfere with breastfeeding.

Behavior at vaccination

Hepper (1996) surveys and reports research that indicates memory commences to function in the fetus at about the 23rd week of gestation.²²_ Infant memory continues to function through the birth experience and afterward. Anand & Hickey (1987) firmly established that newborn infants have fully functioning pain pathways.²³_ When an infant is subjected to a painful and traumatic experience all the necessary factors are present to create post traumatic stress disorder (PTSD). Boyle_et al._(2002) describe the etiology of PTSD:

“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. The significant [circumcision] 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.”24 PTSD is a normal response to an abnormal and terrifying experience. One would, therefore, expect to find PTSD in circumcised boys.

Taddio_et al._(1995) compared the behavior of circumcised boys with the behavior of girls at the age of 4 to 6 months when vaccination with DPT occurred. Taddio_et al._report that circumcised boys demonstrate a much greater response to the pain of the vaccination than do girls.²⁵_In a second study, Taddio_et al._(1997) compared the behavior of circumcisied boys with the behavior of non-circumcised boys at vaccination.²⁶_Similarly, the circumcised boys demonstrated a greater response to the pain of vaccination than did the non-circumcised boys. Taddio commented:

“It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an infant analogue of a_post-traumatic stress disorder_triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.”²⁶_Taddio_et al._suggested that the pain of circumcision “may have long-lasting effects on future infant behaviour.”²⁶
Circumcision of boys is nearly universal in the Philippine Islands for cultural reasons. Ramos & Boyle (2001) studied the psychological effects of circumcision in Philippine boys. They report a high incidence of PTSD in these boys. Sixty-nine percent of boys who had been circumcised by the traditional “tuli” Philippine ritual circumcision and 51 percent of boys who had been medically circumcised satisfied the DSM-IV criteria for PTSD.²⁷

Behavior in later life

There is increasing evidence that male circumcision influences the behavior of adult males. Menage reports PTSD after genital surgery.²⁸_ More specific to male circumcision, Rhinehart reports finding PTSD in adult males in his clinical practice in which the stressor was neonatal circumcision. ²⁹_Rhinehart lists symptoms of:

• a sense of personal powerlessness
• fears of being overpowered and victimized by others
• lack of trust in others and life
• a sense of vulnerability to violent attack by others
• guardedness in relationships
• reluctance to be in relationships with women
• defensiveness
• diminished sense of maleness
• feeling damaged, especially in the presence of surgical complications such as skin tags, penile curvature due to uneven foreskin removal, partial ablation of edges of the glans and so on
• sense of reduced penile size, a part cut off or amputated
• low self-esteem
• shame about not “measuring up”
• anger and violence toward women
• irrational rage reactions
• addictions and dependencies
• difficulties in establishing intimate relationships
• emotional numbing
• need for more intensity in sexual experience
• sexual callousness
• decreased tenderness in intimacy
• decreased ability to communicate
• feelings of not being understood²⁹

Van der Kolk (1989) reports that persons who have been traumatized have a compulsion to repeat the trauma and to find new victims on which to re-enact the trauma they suffered.³⁰_This may apply with full force to victims of circumcision. The circumcision of an infant is a way to reenact the trauma of circumcision.³¹_The compulsion to circumcise isvery strong and has resulted in unlawful batteries and abductions to circumcise an unwilling victim.^32-36

There is some evidence that adverse experiences in the perinatal period (from the 28th week of gestation through the first seven days of extra-uterine life) cause self-destructive behavior in adult life.^37-40_Circumcised males may tend to be more self-destructive, but more research is needed to verify the effect traumatic non-therapeutic circumcision has on self-destructive behavior.

The condition of the male phallus impacts a male’s feeling of well-being. A phallus diminished by the loss of the erogenous foreskin to circumcision necessarily adversely affects one’s feelings about one’s self, resulting in uncomfortable feelings of low self-esteem. There is, therefore,a strong tendency to deny that any loss occurred. Minimization of the loss is a common defense mechanism; ridicule of the subjectis another. Persons who have lost body parts must grieve their loss.⁴¹_Failure to grieve and accept the loss puts one in permanent denial of loss.⁴²_Many men who have been circumcised do not want non-circumcised males, including their own sons,around to remind them of their irreversible loss. For these emotional reasons, as Foley (1966) observed, there tends to be a strong irrational bias in favor of universal circumcision among circumcised males.⁷_Many fathers who were victims of neonatal circumcision, for the reasons described above,adamantly insist that any male offspring be circumcised.24_This phenomenon has come to be called “the adamant father syndrome.” Circumcision, therefore is a repeating cycle of trauma in which circumcised infant males grow up to be adult circumcisers.³¹

Behavior of circumcised medical doctors

Medical doctors in Australia, Canada, and the United States practiced circumcision in the twentieth century, so these nations have a heavy proportion of circumcised men, some of whom become medical doctors. These circumcised male doctors share the same bias in favor of male circumcision as do other circumcised males.^7,31,43_Male doctors who were circumcised as infants are more likely to recommend circumcision of infants to parents.⁴⁴

The Australian Paediatric Association recommended non-circumcision—genital integrity—in 1971;⁴⁵_thereafter, the incidence of circumcision among Australia’s newborn plummeted.⁴⁶_At the present time, in regard to genital integrity status, Australia is, in effect, two nations, one of which has mostly circumcised men and the other that has mostly intact men. The dividing point is the year 1978, because the incidence of genital integrity among newborn boys rose above 50 percent in that year.⁴⁶_The ever-increasing percentage of genitally intact younger men in the population is causing increasing anxiety and distress among some older circumcised males. There now is a peculiar phenomenon happening in Australia, where one sees middle-aged men desperately trying to restore Australia’s medical practice back to that which prevailed before 1971. This is, of course, an attempt to defend their culture-of-origin and is carried out for the emotional reasons described here, although, as Goldman reports, pseudo-scientific reasons are advanced.³¹

Behavior of circumcised medical authors

The high proportion of circumcised males in the medical community create a distorted, biased medical literature.⁴⁷ _Goldman (1999) writes:

“One reason that flawed studies arepublished is that science is affected by cultural values. A principal method of preserving cultural values is to disguise them as truths that are based on scientific research. This ‘research’ can then be used to support questionable and harmful cultural values such as circumcision. This explains the claimed medical ‘benefits’ of circumcision.”³¹ Hill (2007) writes:

“The medical literature on circumcision is voluminous and contentious. Circumcised doctors create papers that overstate benefits and minimize harms and risks. When these doctors publish such claims, other doctors come forward to refute them….The result is an unending debate driven by the emotional compulsion of circumcised men.”⁴³ Female doctors from a circumcising culture of origin have been known to contribute pro-circumcision pieces.
Boyle & Hill (2012) said:
“MC changes human and sexual behaviour. Most doctors favouring MC are circumcised themselves . Circumcision status ‘plays a huge role in whether doctors are in support of circumcisions or not’. Circumcised doctors often defend circumcision by producing flawed papers that minimise or dismiss the harm and exaggerate alleged benefits .⁴⁸⁷
…
“Invariably, when biased opinions promoting MC are published by doctors trying to justify their own psychosexual wounding, uncircumcised doctors (who mostly see no need for amputating anatomically normal healthy erogenous tissue) are quick to refute such overstated claims. We fully expect that this distortion of the medical literature will continue until non-therapeutic male circumcision is prohibited by law and most circumcised male doctors have passed from the scene.”⁴⁷
Most American medical editors are circumcised men. They share the pro-circumcision bias of other circumcised men. They tend to select papers for publication that conform to their bias.⁴⁸ The literature, therefore, is filled with pro-circumcision papers written by circumcised doctors.⁴⁸ The behavior of these circumcised doctors has served for a century to prolong the practice of a nineteenth century surgical operation that has no medical indication and is injurious to infants and children.

Behavior of medical societies

Medical societies in the English-speaking nations have a high proportion of male members (fellows) who are circumcised.The societies that represent medical specialities that practice circumcision have found themselves unable to adequately address the problem of circumcision and to repudiate this harmful, outmoded practice.

Goldman (2004) writes:

“Although medical committee members highly value rationality, a rational and objective evaluation of an emotional and controversial topic like circumcision can be difficult. It is suggested that the potential psychological and social factors surrounding the practice of circumcision could affect the values and attitudes of circumcision policy committee members, the attitude toward evaluating the circumcision literature, and the publishing of circumcision literature itself. If the members are polarized, the process of negotiating to arrive at a consensus statement could introduce additional psychosocial factors that could affect the final policy.”⁴⁹
Dr. Goldman published the two articles cited here in the United Kingdom and Canada, not the United States. This may be a testimony to the bias and censorship present in the medical literature of the United States.

Conclusion

All of the behavioral changes described in this paper are negative, unfavorable, or maleficial in nature. No positive, favorable, or beneficial behavioral changes have been found.

The English-speaking nations have a high proportion of circumcised males and, therefore, a high proportion of psychically-wounded males. A society containing so many psychically-wounded males cannot be as healthy as it should be. The United States has clung to circumcision even after Australia and Canada have rejected circumcision of infants. Consequently, the United States has the highest proportion of circumcised males to intact males and the greatest injury to society.

The best way to stop the cycle of trauma is to stop circumcising infants.^31,42_ Non-traumatized intact infants usually do not grow up to become circumcisers, so the cycle of trauma would end.
References
1. Gairdner D. The fate of the foreskin: a study of circumcision. Br Med J_1949;2:1433-7. [Full Text]
2. Wright JE. Non-therapeutic circumcision. _Med J Aust_1967;1:1083-6. [Full Text]
3. Levy D. Psychic trauma of operations in children: and a note on combat neurosis. _Am J Dis Child_1945; 69: 7-25. [Full Text]
4. Freud A. The role of bodily illness in the mental life of children. _Psychoanalytic Study of the Child_ 1952; 7: 69-81.[Full Text]
5. Cansever G. Psychological effects of circumcision. _Brit J Med Psychol_ 1965;38:321-31. [Full Text]
6. Richards MPM, Bernal, JF, Brackbill Y. Early behavioral differences: gender or circumcision? _Dev Psychobiol_ 1976;9(1):89-95. [Full Text]
7. Foley JM. The unkindest cut of all. _Fact_ 1966;3(4):2-9. [Full Text]
8. Grimes DA. Routine circumcision of the newborn: a reappraisal. Am J Obstet Gynecol 1978;130(2):125-29. [Full Text]
9. Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981; 6(3):269-75. [Full Text]
10. Malone SM, Gunnar MR, Fisch RO. Adrenocortical and behavioral responses to limb restraint in human neonates. Dev Psychobiol 1985;18:435-46. [Abstract]
11. Porter FL, Miller RH, and Marshal RE. Neonatal pain cries: effect of circumcision on acoustic features and perceived urgency. Child Dev 1986;57:790-802. [Abstract]
12. Porter, FL, Porges SW, Marshall RE. Newborn pain cries and vagal tone: parallel changes in response to circumcision. Child Dev 1988;59:495-505. [Abstract]
13. Gunnar MR, Connors J, Isensee, Wall L. Adrenocortical activity and behavioral distress in human newborns. Dev Psychobiol 1988;21(4):297-310. [Abstract]
14. Emde RN, Harmon RJ, Metcalf D, et al. Stress and neonatal sleep. Psychosom Med 1971;33(6):491-7. [Full Text]
15. Anders TF, Chalemian RJ. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med 1974;36(2):174-9. [Full Text]
16. Marshall RE, Stratton WC, Moore JA, et al. Circumcision I: effects upon newborn behavior. Infant Behavior and Development 1980;3:1-14. [Full Text]
17. Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Hum Dev 1982; 7(4):367-74. [Full Text]
18. Anonymous.The Womanly Art of Breastfeeding, 3rd ed. Franklin Park, IL: La Leche League International, 1981: 92-93. (ISBN 0-912500-10-7) [Text Extract]
19. Howard CR, Howard FM, and Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics 1994;93(4):641-46. [Full Text]
20. Lee N. Circumcision and breastfeeding. J Hum Lact 2000;16(4):295. [Full Text]
21. Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 2005;115(2):496-506. [Full Text]
22. Hepper PG, Fetal memory: Does it http://www.cirp.org/library/pain/anand/? What does it do? Acta Pædiatr (Stockholm) 1996; Suppl 416:16-20. [Full Text]
23. Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. New Engl J Med 1987;317(21):1321-9. [Full Text]
24. Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol 2002;7(3):329-43. [Full Text]
25. Taddio A, Goldbach M, Ipp E, et al. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet 1995;345:291-2. [Full Text]
26. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349(9052):599-603. [Full Text]
27. Ramos S, Boyle GJ. Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder. In: Denniston GC, Hodges FM, Milos MF (eds) Understanding circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem. New York: Kluwer Academic/Plenum Publishers, 2001: pp. 253-70.
28. Menage J. Post-traumatic stress disorder in women who have undergone obstetric and/or gynaecological procedures. J Reprod Infant Psychol 1993;11:221-28. [Abstract]
29. Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis J 1999;29(3):215-21. [Full Text]
30. van der Kolk BA. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am 1989;12(2):389-411. [Full Text]
31. Goldman R. The psychological impact of circumcision. BJU Int 1999;83 Suppl. 1:93-103. [Full Text]
32. Anonymous. Man killed for not going to circumcision school. SAPA, South Africa, Monday, 27 June 2005. [Full Text]
33. Anonymous. Man forcibly circumcised as crowd watches. The Nation, Nairobi, Kenya, 23 August 2002. [Full Text]
34. Vusi Mona. A bit mundane and a little more light. [opinion] City Press, South Africa, 13 July 2002. [Full Text]
35. Anonymous. ‘Spy’ cut up about initiations. African Eye News Service, 27 August 2002. [Full Text]
36. Anonymous. Take boys home, parents urged. South African Press Association (SAPA), 3 July 2002. [Full Text]
37. Salk L, Lipsitt LP, Sturner WQ, et al. Relationship of maternal and perinatal conditions to eventual adolescent suicide. Lancet 1985;i:624-7. [Abstract]
38. Jacobson B, Eklund G, Hamberger L, et al. Perinatal origin of adult self-destructive behavior. Acta Psychiatr Scand 1987;76(4):364-71. [Abstract]
39. van der Kolk BA, Perry JC, Herman JL. Childhood origins of self-destructive behavior. Am J Psychiatry 1991; 148;1665-71. [Abstract]
40. Jacobson B, Bygdeman M. Obstetric care and proneness of offspring to suicide. BMJ 1998; 317:1346-49. [Full Text]
41. Maguire P, Parks CM. Coping with loss: surgery and loss of body parts. BMJ 1998;316(7137):1086-8. [Full Text]
42. Denniston GC. An Epidemic of Circumcision. Third International Symposium on Circumision, University of Maryland, College Park, Maryland, May 22-25, 1994. [Full Text]
43. Hill G. The case against circumcision. J Mens Health Gend 2007;4(3):318-23. [Full Text PDF]
44. LeBourdais E. Circumcision no longer a “routine” surgical procedure. Can Med Assoc J 1995;152(11):1873-6. [Full Text]
45. Belmaine SP. Circumcision. Med J Aust 1971;1:1148. [Full Text]
46. Young H. Circumcision in Australia. [Full Text]
47. Boyle GJ, Hill G.Circumcision-generated emotions bias medical literature._BJU Int_2012;109:e11. doi:10.1111/j.1464-410X.2012.10917.x [Full Text]
48. Fleiss PM. An analysis of bias regarding circumcision in American medical literature.In: Denniston GC, Hodges FM, Milos MF. (eds)_Male and Female Circumcision: Medical, Legal, and Ethical Consideratons in Pediatric Practice._ New York: Kluwer Academic/Plenum Publishers, 1999: pp. 379-402. [Abstract]
49. Goldman R. Circumcision policy: a psychosocial perpective. Paediatr Child Health 2004;9(9):630-3. [Full Text]

Additional Reading

Miller A. Appendix:_The Untouched Key: Tracing Childhood Trauma in Creativity and Destructiveness. Anchor Books (Doubleday) New York, 1991.
Goldman R. Circumcision: The Hidden Trauma. Boston: Vanguard Publications, 1997.
Fleiss P, Hodges FM._What your Doctor May Not_Tell You About Circumcision. New York: Warner Books, 2002.
Ritter TJ, Denniston GC. Doctors Re-examine Circumcision. Seattle: Third Millennium Publishing Company, 2002.

Il Prepuzio

Normal development of the prepuce:
Birth through age 18

Introduction

The genital organs are in a very immature stage of development at birth. The growth and development continues through puberty and into adulthood. This page and the indexed articles provide information on that normal development. Articles are indexed in chronological order.

"The Phony Phimosis Diagnosis"

The normal growth and development of the prepuce of the human male has been greatly misunderstood both by the medical community and by the public. This misunderstanding has led to many unnecessary, contraindicated circumcisions being performed on young boys.

Typically, when a baby boy is born, the prepuce is long with a narrow tip.^4,5 Retraction is not possible in the majority of infants because the narrow tip will not pass over the glans penis. Moreover, the inner mucosal surface of the prepuce is fused with the underlying mucosal surface of the glans penis.^2,4,6,11 This also prevents retraction. This normal developmental narrowness is sometimes improperly diagnosed as phimosis (a fairly rare pathological condition, characterized by hardening of the tip of the foreskin, and a whitish ring of hardened tissue). In fact, the normal developmental narrowness is not phimosis. It is simply a normal stage of development.

The fusion of the foreskin to the underlying glans penis is often improperly called "adhesions." The fused foreskin and glans sometimes will separate by age 3-5, but usually this takes longer. Øster observed boys in which this normal process was not completed until after puberty.⁶

Fig. 1 Non-retractile foreskin of infant boy
(normal for age) BMJ 1996;312:299.

As the infant matures into a boy and the boy into a man, a number of changes occur: The tip of the prepuce becomes wider, the tip seems to become shorter as the shaft of the penis grows. The membrane that bonds the inner surface of the prepuce with the glans penis spontaneously disintegrates and releases the prepuce to separate from the glans. The prepuce spontaneously becomes retractable.

Fig. 2 Normal foreskin at 15 months of age.

Many medical doctors in the United States receive no training in the normal development of the prepuce. Thus they improperly diagnose a normal developmental condition as "phimosis."⁹

As noted above, a large number of medical doctors have not had the benefit of the information contained on this page, because it has not become part of the standard medical curriculum. Many physicians today are unable to distingish between normal developmental tightness (as described here) and clinical phimosis. Nor are they able to answer with accuracy when the prepuce should become retractable.⁹ These ill-trained doctors may attempt to prematurely retract the foreskin which is traumatic for the child.⁹ Parents should guard against this possibility.

The prepuce contains muscle fibers that work to keep the tip closed when the child is not urinating.^1,9 This may cause parents and physicians to believe that the opening is smaller than it really is. Catzel explains how to examine a child's prepuce correctly to avoid misdiagnosis.¹¹

The false diagnosis of phimosis in boys is very common in the United States and the United Kingdom. See here for more information.

Ballooning

There is a phase of development during which some boys may experience "ballooning." Ballooning is the inflation of the prepuce during urination by the pressure of urine inside. This can occur if the inner layer of the prepuce is separating or has separated from the glans, which typically happens around three years of age, before the prepuce has become fully retractable. Ballooning is an indication that the normal separation of the foreskin from the glans penis has occurred. Ballooning is a transient condition that goes away as the prepuce continues its natural growth and development and the opening at the tip further enlarges. Babu et al. report that ballooning does not interfere with voiding.²⁰ Ballooning is not injurious, and it is not a cause for concern. Ballooning is not an indication for circumcision.

The maturation of the penis may take years to complete. Each boy develops at his own rate. The maturation of the prepuce continues beyond puberty as described below.

The appearance of the infant penis does not reflect on the appearance of the adult penis. Sexual development after puberty causes many changes, which include retractibility of the foreskin.

Douglas Gairdner (1949)

Gairdner, a British pediatrician, observed 100 newborns and about 200 boys of varying ages through age 5. Gairdner reported that 4% of newborns had a fully retractable prepuce, In 54% the glans could only be uncovered enough to reveal the external meatus, and in 42% even the tip of the glans could not be uncovered. He also said that, in boys of six months of age, four out of five or 80% still had non-retractable prepuces. By 1 year of age, 50% still had non-retractable prepuces. By two years about 20% and by 3 years about 10% of boys still had a non-retractable prepuce.⁴

Gairdner also noted that the separation of the prepuce was incomplete at these ages and this incomplete separation is the cause of the non-retractabality. He said the surfaces should not be torn apart because this causes bleeding and infection. Gairdner provided a table which showed:

Age Percent retractable. Birth 4 Age 1 50 Age 2 75 Age 3 90 Age 4 91 Age 5 92

Gairdner in 1949 had collected no data beyond age 5, which led some authors improperly to assume that circumcision was necessary if the prepuce was not retractable by that age.

Gairdner's figures on percentage of retractability, collected in the 1940s,⁴ are now known to be too high.^{12 17,18} Unfortunately, many doctors still erroneously use these outmoded figures and this causes improper diagnosis of phimosis in normal boys and leads to unnecessary circumcisions. Later studies^{6,13,14, 16} have indicated that only about 40-50 percent of boys have fully retractable foreskins at age ten. (see below).

Jakob Øster (1968)

The normal development of the prepuce beyond age 5 was first documented by Jakob Øster, a Danish pediatrician, who published his work in 1968.⁶

Øster reported progressive increase in the retractability of the prepuce with increasing age. Øster, a school health officer, was responsible for the physical examinations of large numbers of boys of school age. Neonatal circumcision is not practiced in Denmark, so all of the boys were intact. Øster conducted examinations of boys aged 6 to 17 years old from school year 1957-58 through 1964-65.

Øster classified two grades of tightness of the prepuce: A non-retractable prepuce was termed phimosis, and a prepuce that could be retracted with difficulty he called tight prepuce. He found that the percentage of boys with "phimosis" or "tight prepuce" steadily declined with increasing age. Dr. Øster's work is presented in his article in such a fashion that it is somewhat difficult to understand. He presented findings on "phimosis", "tight prepuce" and "adhesions" separately. Actually, all of those conditions prevent free and easy retraction of the foreskin so it is necessary to consider incidence of the three conditions together to determine the percentage of boys that have complete retractability. The Circumcision Reference Library restates Øster's work here by combining his findings into one table. The combined total of boys by age who do not have complete retractability is shown in the table:

Øster's6 Retraction Data Restated17
Age	Phimosis	Tight prepuce	Not fully separated	Total percent non-retractable	Total percent retractable
6-7	8%	6%	63%	77%	23%
8-9	6%	2%	58%	66%	34%
10-11	6%	2%	48%	56%	44%
12-13	3%	3%	34%	40%	60%
14-15	1%	1%	13%	15%	85%
16-17	1%	1%	3%	5%	95%

Øster's figures refute Gairdner's claims that 90 percent are retractable at age five, Øster found that the 90 percent retractable stage is not reached until about age 16.

Grogono (1979)

E. B. Grogono, a school medical officer, observed that boys, with a non-retractile prepuce at age 11, have a fully retractile prepuce by age 14 or 15. Grogono further reported that the non-retractile prepuce caused no problems.⁸

Hiroyuki Kayaba (1996)

Kayaba, a Japanese doctor, recorded the findings on examination of 603 Japanese boys.¹³ Kayaba classified the prepuce types into five categories. Kayaba noted a steady progression to increasing retractability with increasing age.¹³

Kayaba's work refutes the findings of Gairdner and confirms the work of Øster. Kayaba reported that about 40 percent of boys in the 8-10 age group are fully retractable, this leaving about 60 percent with some degree of non-retractability, He also reported that 62.9 percent of the boys in the 11 to 15 year old age group had completely retractable prepuces, thus leaving 37.1 percent with some degree of non-retractability. The prepuce is still developing in the 11-15-year-old group. Kayaba's findings are similar to those of Øster.

Kayaba made no reports beyond age 15.

Kayaba's report thus confirms the work of Øster; we see that full retractability is not reached by about 1/2 of boys until the teen-age years. This is normal, and treatment is usually not required.

Imamura (1997)

Imamura's study, carried out in Japan, shows that the non-retractile prepuce is the normal condition in preschool age boys.¹⁴ Imamura found that only 38.4 percent of children three years old have a fully retractable prepuce. Imamura's data are similar to that of Kayaba.¹³ Imamura advises that no treatment is necessary for non-retractile prepuce.¹⁴ Imamura's findings¹⁴ provide further evidence of the incorrectness of Gairdner's⁴ data.

Cold & Taylor (1999)

Fig. 2. Incidence of preputial adhesions in various age groups, after Øster [20].	Fig. 3. Retractability of the prepuce in various age groups. After Kayaba et al.[22]. The tight preputial ring is shown in green and the type IV and V as red; a type IV prepuce retracts to the glans corona and type V retracts to completely expose the glans.

Drs. Christopher J. Cold and John R. Taylor have included a discussion of the normal development of the prepuce under the "Embryology" heading of their landmark article on the human prepuce.¹⁵ The development of retractability is shown in graphic form.

Concepción-Morales (2002)

A study performed in Cuba by Concepción-Morales et al. further confirms the work of Øster and Kayaba. The work, published in Spanish, has an English language abstract.¹⁶

Ishikawa and Kawakita (2004)

Ishikawa and Kawakita investigated preputial retractability in 242 Japanese boys. They found that no boys had a retractable prepuce at birth but in the age group 11-15, 77 percent had a retractable prepuce while 23 percent remained non-retracable. This confirms previous evidence that, for many boys, the prepuce does not become retractable until after puberty.¹⁹

Thorvaldsen and Meyhoff (2005)

Thorvaldsen conducted a survey of young men in Denmark. They found that the average age of first foreskin retraction is 10.4 years.²¹

Agawal, Mohta, and Anand (2005)

Agawal, Mohta, and Anand carried out a study in Delhi, India of boys up to age 12. Their study found that preputial retractability continues to develop through age 12, confirming the work of Oster (1968), Kayaba et al. (1996), and Thorvaldsen (2005).²²

Beyond age 18

There are no studies in the medical literature of development of the prepuce beyond age 18. Anecdotal evidence indicates that most of the few males who still have a tight prepuce at age 18 find that the prepuce eventually stretches and enlarges so that full retractability of the foreskin is obtained in the early 20s.

Conclusion

Almost all boys are born with narrow non-retractile foreskin which are fused with the glans beneath. This is a normal developmental physiological condition and is not a cause for concern. Some parents needlessly worry that the opening is not large enough.

Retraction of the foreskin should never be forced. It will retract when it is ready. There is no "right" age for retraction to occur.

A narrow non-retractable prepuce in boys is within the normal range of development and usually causes no problems. The prepuce usually will spontaneously widen until complete retractability is obtained. About 50-60 percent of boys at age ten do not have fully retractable foreskins.¹⁷ This is normal.¹⁷ After puberty, the percentage of boys with full retractability rapidly increases spontaneously.¹⁷

If a narrow or non-retractile prepuce becomes a problem, a wide variety of conservative alternative treatments to circumcision are are now available. Circumcision is an outmoded, radical, traumatic, disproportionate, unnecessary surgery for a minor problem.

After you have studied this page and its linked articles, you will know more about the normal development of the prepuce than most medical doctors.

Library Holdings

1. Jefferson G. The peripenic muscle; Some observations on the anatomy of phimosis. Surgery, Gynecology, and Obstetrics (Chicago) 1916;23(2):177-181.
2. Deibert, GA. The separation of the prepuce in the human penis. Anat Rec 1933;57:387-399.
3. Hunter RH. Notes on the development of the prepuce. J Anat 1935;70(1):68-75.
4. Gairdner D. The fate of the foreskin. Brit Med J 1949:2:1433-7.
5. Spence J. On Circumcision. Lancet 1964;2:902.
6. Øster J. Further Fate of the Foreskin: Incidence of Preputial Adhesions, Phimosis, and Smegma among Danish Schoolboys. Arch Dis Child, April 1968. p. 200-202.
7. Wright, Joyce. Nature's assurance that the uncircumcised glans penis will function smoothly is provided by smegma. Sexology (New York), Vol 37, no. 2 (September 1970) pp. 50-53.
8. Grogono EB. The case against circumcision. Br Med J 1979;1:1423.
9. Lakshmanan S, Prakash S. Human prepuce: Some aspects of structure and function. Indian Journal of Surgery 1980;(44):134-7.
10. Osborn LM. Metcalf TJ, Mariani EM. Hygienic care in uncircumcised infants. Pediatrics 1981; 67:365-7.
11. Catzel P. The normal foreskin in the young child. (letter) S Afr Mediense Tysskrif [South Afr Med J] 1982 (13 November 1982) 62:751.
12. Wright JE. Further to "The further fate of the foreskin": Update on the natural history of the foreskin. Medical Journal of Australia (7 February 1994) ;160:134-135.
13. Kayaba H, et al. Analysis of shape and retractability of the prepuce in 603 Japanese boys. Journal of Urology, 1996;156(5):1813-1815.
14. Imamura E. Phimosis of infants and young children in Japan. Acta Paediatr Jpn 1997;39(4):403-5.
15. Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 Suppl. 1:34-44.
16. Morales Concepción JC, Cordies Jackson E, Guerra Rodriguez M, et al. ¿Debe realizarse circuncisión en la infancia. Arch Esp Urol 2002;55(7):807-11.
17. Hill G. Circumcision for phimosis and other medical indications in Western Australian boys (Letter). Med J Aust 2003;178(11):587.
18. Hill G. Triple incision to treat phimosis in children: an alternative to circumcision (letter). BJU Int 2004;93(4):636.
19. Ishikawa E, Kawakita M. [Preputial development in Japanese boys]. Hinyokika Kiyo 2004;50(5):305-8.
20. Babu R, Harrison SK, Hutton KA. Ballooning of the foreskin and physiological phimosis: is there any objective evidence of obstructed voiding? BJU Int 2004;94(3):384-7.
21. Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? Ugeskr Læger 2005;167(17):1858-62.
22. Agawal A, Mohta A, Anand RK. Preputial retraction in children. J Indian Assoc Pediatr Surg 2005;10(2):89-91.
23. Ko MC, Lui CK, Lee WK, et al. Age-specific prevalence rates of phimosis and circumcision in Taiwanese boys. J Formos Med Assoc 2007;106(4):302–7.

Information for parents

The following pamphlets have been prepared for the information of parents:

• Newborns: Care of the Uncircumcised Penis. Elk Grove Village: American Academy of Pediatrics, 1984.
• Peron JE. Care of the intact penis. Midwifery Today (November) 1991; Issue 17:24. (Childbirth Education Foundation, Oxford, PA.)
• Questions about your son's intact penis. San Anselmo: NOCIRC, 1997. (Link to www.nocirc.org)
• Care of the Uncircumcised Penis. Elk Grove Village, IL: American Academy of Pediatrics, 1999.
• Questions About Premature (Forcible) Retraction of Your Young Son's Foreskin. (Pamphlet) San Anselmo: NOCIRC, 2000. (Link to www.nocirc.org)
• American Academy of Pediatrics. Care of the Uncircumcised Penis. Elk Grove Village, IL: American Academy of Pediatrics, 2000.
• Circumcision: Information for Parents. Ottawa: Canadian Paediatric Society, November 2004.

External irritants can sometimes cause a previously retractable prepuce to become non-retractable due to swelling of the tissues. If a child whose prepuce was retractable becomes non-retractable, environmental factors should be investigated. One known culprit is bubble bath. If a child is taking bubble baths and the prepuce becomes non-retractable, the bubble bath should be discontinued. See Penile Hygiene in the Intact Non-circumcised Male for comprehensive information on foreskin care.

History of Circumcision in the U.S.

A Short History of Circumcision in the U.S. In Physicians' Own Words

1860: 0.001% of the U.S. male population circumcised
"In cases of masturbation we must, I believe, break the habit by inducing such a condition of the parts as will cause too much local suffering to allow of the practice being continued. For this purpose, if the prepuce is long, we may circumcise the male patient with present and probably with future advantage; the operation, too, should not be performed under chloroform, so that the pain experienced may be associated with the habit we wish to eradicate." Athol A. W. Johnson, On An Injurious Habit Occasionally Met with in Infancy and Early Childhood, The Lancet, vol. 1 (7 April 1860): pp. 344-345.
1871: 1% of the U.S. male population circumcised
"I refer to masturbation as one of the effects of a long prepuce; not that this vice is entirely absent in those who have undergone circumcision, though I never saw an instance in a Jewish child of very tender years, except as the result of association with children whose covered glans have naturally impelled them to the habit." M. J. Moses, The Value of Circumcision as a Hygienic and Therapeutic Measure, NY Medical Journal, vol. 14 (1871): pp. 368-374. 1887: 10% of the U.S. male population circumcised
"Hip trouble is from falling down, an accident that children with tight foreskins are especially liable to owing to the weakening of the muscles produced by the condition of the genitals." Lewis L. Sayer, Circumcision For the Cure of Enuresis, Journal of the American Medical Association, vol. 7 (1887): pp. 631-633. "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." Angel Money, Treatment of Disease in Children. Philadelphia: P. Blakiston. 1887, p. 421. 1888: 15% of the U.S. male population circumcised
"A remedy [for masturbation] which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment." John Harvey Kellogg [the breakfast cereal tycoon], Treatment for Self-Abuse and Its Effects, Plain Facts for Old and Young, Burlington, Iowa: P. Segner & Co. 1888, p. 295. 1891
"In consequence of circumcision the epithelial covering of the glans becomes dry, hard, less liable to excoriation and inflammation, and less pervious to venereal viruses. The sensitivity 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." Jefferson C. Crossland, The Hygiene of Circumcision, NY Medical Journal, vol. 53 (1891): pp. 484-485. 1891
"Measures more radical than circumcision would, if public opinion permitted their adoption, be a true kindness to many patients of both sexes." Jonathan Hutchinson, On Circumcision as Preventive of Masturbation, Archives of Surgery, vol. 2 (1891): pp. 267-268. 1895
"In all cases in which male children are suffering nerve tension, confirmed derangement of the digestive organs, restlessness, irritability, and other disturbances of the nervous system, even to chorea, convulsions, and paralysis, or where through nerve waste the nutritive facilities of the general system are below par and structural diseases are occurring, circumcision should be considered as among the lines of treatment to be pursued." Charles E. Fisher, Circumcision, in A Hand-Book On the Diseases of Children and Their Homeopathic Treatment. Chicago: Medical Century Co., 1895. p. 875. 1895: 15% of the U.S. male population circumcised
"In all cases of masturbation circumcision is undoubtedly the physicians' closest friend and ally ... To obtain the best results one must cut away enough skin and mucous membrane to rather put it on the stretch when erections come later. There must be no play in the skin after the wound has thoroughly healed, but it must fit tightly over the penis, for should there be any play the patient will be found to readily resume his practice, not begrudging the time and extra energy required to produce the orgasm. It is true, however, that the longer it takes to have an orgasm, the less frequently it will be attempted, consequently the greater the benefit gained ... The younger the patient operated upon the more pronounced the benefit, though occasionally we find patients who were circumcised before puberty that require a resection of the skin, as it has grown loose and pliant after that epoch." E. J. Spratling, Masturbation in the Adult, Medical Record, vol. 24 (1895): pp. 442-443. 1896
"Local indications for circumcision: Hygienic, phimosis, paraphimosis, redundancy (where the prepuce more than covers the glans), adhesions, papillomata, eczema (acute and chronic), oedema, chancre, chancroid, cicatrices, inflammatory thickening, elephantiasis, naevus, epithelioma, gangrene, tuberculosis, preputial calculi, hip-joint disease, hernia. Systemic indications: Onanism [masturbation], seminal emissions, enuresis, dysuria, retention, general nervousness, impotence, convulsions, hystero-epilepsy." Editor, Medical Record, Circumscisus, Medical Record, vol. 49 (1896): p. 430. 1897
"The prepuce is an important factor in the production of phthisis [tuberculosis]. This can be proven by the immunity of the Jewish race from tubercular affections." S. G. A. Brown, A Plea for Circumcision, Medical World, vol. 15 (1897): pp. 124-125. 1898
"Clarence B. was addicted to the secret vise practiced among boys. I performed an orificial operation, consisting of circumcision ... He needed the rightful punishment of cutting pains after his illicit pleasures." N. Bergman, Report of a Few Cases of Circumcision, Journal of Orificial Surgery, vol. 7 (1898): pp. 249-251. 1899
"Not infrequently marital unhappiness would be better relieved by circumcising the husband than by suing for divorce." A. W. Taylor, Circumcision - Its Moral and Physical Necessities and Advantages, Medical Record, vol. 56 (1899): p. 174. 1900: 25% of the U.S. male population circumcised
"Finally, circumcision probably tends to increase the power of sexual control. The only physiological advantages which the prepuce can be supposed to confer is that of maintaining the penis in a condition susceptible to more acute sensation than would otherwise exist. It may increase the pleasure of coition and the impulse to it: but these are advantages which in the present state of society can well be spared. If in their loss, increase in sexual control should result, one should be thankful." Editor, Medical News. (A Plea for Circumcision) Medical News, vol. 77 (1900): pp. 707-708. 1900
"It has been urged as an argument against the universal adoption of circumcision that the removal of the protective covering of the glans tends to dull the sensitivity of that exquisitely sensitive structure and thereby diminishes sexual appetite and the pleasurable effects of coitus. Granted that this be true, my answer is that, whatever may have been the case in days gone by, sensuality in our time needs neither whip nor spur, but would be all the better for a little more judicious use of curb and bearing-rein." E. Harding Freeland, Circumcision as a Preventive of Syphilis and Other Disorders, The Lancet, vol. 2 (29 Dec. 1900): pp. 1869-1871. 1901
"Another advantage of circumcision ... is the lessened liability to masturbation. A long foreskin is irritating per se, as it necessitates more manipulation of the parts in bathing ... This leads the child to handle the parts, and as a rule, pleasurable sensations are elicited from the extremely sensitive mucous membrane, with resultant manipulation and masturbation. The exposure of the glans penis following circumcision ... lessens the sensitiveness of the organ ... It therefore lies with the physician, the family adviser in affairs hygienic and medical, to urge its acceptance." Ernest G. Mark, Circumcision, American Practitioner and News, vol. 31 (1901): pp. 121-126. 1901
"Frequent micturition [urination], loss of flesh, convulsions, phosphatic calculus, hernia, nervous exhaustion, dyspepsia, diarrhea, prolapse of rectum, balanitis, acute phimosis and masturbation are all conditions induced by the constricted long prepuce, and all to be rapidly remedied by the simple operation of circumcision." H. G. H. Naylor, A Plea for Early Circumcision, Pediatrics, vol. 12 (1901): p. 231. 1902
"I have repeatedly seen such cases as convulsions, constant crying in infants, simulated hip joint diseases, backwardness in studies, enuresis, marasmus, muscular inco-ordination, paralysis, masturbation, neurasthenia, and even epilepsy, cured or greatly benefited by the proper performance of circumcision." W. G. Steele, Importance of Circumcision, Medical World, vol. 20 (1902): pp. 518-519. 1912: 35% of the U.S. male population circumcised
"The little sufferer lay in his mother's lap. The dropsy ... had taken the form of hydrocephalus ... I then circumcised the child ... The head diminished in size and in two weeks the condition of hydrocephalus had disappeared and the child was once more dismissed as cured." E. H. Pratt, Circumcision, Orificial Surgery: Its Philosophy, Application and Technique. Edited by B. E. Dawson. Newark: Physicians Drug News Co. 1912. pp. 396-398. 1912
"Circumcision promotes cleanliness, prevents disease, and by reducing oversensitiveness of the parts tends to relieve sexual irritability, thus correcting any tendency which may exist to improper manipulations of the genital organs and the consequent acquirement of evil sexual habits, such as masturbation." Lydston G. Frank, Sex Hygiene for the Male. Chicago: Riverton Press, 1912. 1914
"It is generally accepted that irritation derived from a tight prepuce may be followed by nervous phenomena, among these being convulsions and epilepsy. It is therefore not at all improbable that in many infants who die in convulsions the real cause of death is a long or tight prepuce. The foreskin is a frequent factor in the causation of masturbation ... Circumcision offers a diminished tendency to masturbation, nocturnal pollutions, convulsions and other nervous results of local irritation. It is the moral duty of every physician to encourage circumcision in the young." Abraham L. Wolbarst, Universal Circumcision, Journal of the American Medical Association, vol. 62 (1914): pp. 92-97. 1915
"Circumcision not only reduces the irritability of the child's penis, but also the so-called passion of which so many married men are so extremely proud, to the detriment of their wives and their married life. Many youthful rapes could be prevented, many separations, and divorces also, and many an unhappy marriage improved if this unnatural passion was cut down by a timely circumcision." L. W. Wuesthoff, Benefits of Circumcision, Medical World, vol. 33 (1915): p. 434. 1915
"The prepuce is one of the great factors in causing masturbation in boys. Here is the dilemma we are in: If we do not teach the growing boy to pull the prepuce back and cleanse the glans there is the danger of smegma collecting and of adhesions and ulcerations forming, which in their turn will cause irritation likely to lead to masturbation. If we do teach the boy to pull the prepuce back and cleanse his glans, that handling alone is sufficient gradually and almost without the boy's knowledge to initiate him into the habit of masturbation ... Therefore, off with the prepuce!" William J. Robinson, Circumcision and Masturbation, Medical World, vol. 33 (1915): p. 390. 1920: 50% of the U.S. male population circumcised
"Circumcision is an excellent thing to do; it helps to prevent hernia due to straining, and later it helps in preventing masturbation. The ordinary schoolboy is not taught to keep himself clean, and if he is taught he thinks too much about the matter." I. Solomons, For and Against Circumcision, British Medical Journal, 5 June 1920, p. 768. 1928
"Phimosis may be a predisposing cause of masturbation in some cases ... Hemorrhage following circumcision at birth cannot be considered seriously as a contraindication. Meatal ulcer due to ammoniacal diapers in the circumcised is not a contraindication ... Routine circumcision at birth is warranted." Editor, Routine Circumcision at Birth?, Journal of the American Medical Association, vol. 91 (1928): p. 201. 1935: 55% of the U.S. male population circumcised
"I suggest that all male children should be circumcised. This is 'against nature', but that is exactly the reason why it should be done. Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often. I am convinced that masturbation is much less common in the circumcised. With these considerations in view it does not seem apt to argue that 'God knows best how to make little boys.'" R. W. Cockshut, Circumcision, British Medical Journal, vol. 2 (1935): 764. 1941
"[Routine Circumcision] does not necessitate handling of the penis by the child himself and therefore does not focus the male's attention on his own genitals. Masturbation is considered less likely." Alan F. Guttmacher, Should the Baby Be Circumcised?, Parents Magazine, vol. 16 (1941): pp. 26, 76-78. 1971: 90% of the U.S. male population circumcised
"There are no valid medical indications for circumcision in the neonatal period." Committee On Fetus and Newborn. Standards and Recommendations for Hospital Care of Newborn Infants, 5th edition. Evanston, IL: American Academy of Pediatrics. 1971. p. 110. 1994: 60% of newborn males in the U.S. circumcised
"Circumcision causes pain, trauma, and a permanent loss of protective and erogenous tissue ... Removing normal, healthy, functioning tissue for no medical reason has ethical implications: circumcision violates the United Nations' Universal Declaration of Human Rights (Article 5) and the United Nations' Convention on the Rights of the Child (Article 13)." Leo Sorger, To ACOG [American College of Obstetrics and Gynecology]: Stop Circumcisions, Ob Gyn News, 1 Nov. 1994, p. 8. 1998
"Circumcision is not a medical decision. Preventing an improbable future infection is a spurious indication. The standard of care is antibiotics, not amputation." Eileen Marie Wayne, MD, Letters (Nothing to debate on circumcision), American Medical News, 27 July 1998, p. 27. "As editor of a newspaper dedicated to infectious diseases, you know that antibiotics are the standard of care for infection and that surgery is a last resort for body parts for which there is no other cure. Perpetrating sexual surgery on healthy non-consenting minors, under the legal age of informed consent or refusal, to purportedly prevent an unlikely and curable future infection, is unacceptable. Intentionally amputating healthy erogenous genital tissue from tethered, protesting infants is a surgical act of sexual sadism.
      "Kaiser Foundation's Edgar Schoen ignores the erogenous benefits of the foreskin and a man's birthright to the sexual fulfillment he was born to experience. He would do well to stop promoting and perpetrating sexual surgery. He withholds from parents, who have no ethical right to consent to unnecessary sexually disendowing surgery on their children, the fact that the foreskin has sexual and erogenous functions. He contends that circumcision protects against sexually transmitted disease!
      "Dr. Schoen's failed attempt to justify surgical genital abuse is a willful act of misrepresentation. It is a disgrace and discredit to the medical profession and Infectious Diseases in Children. It is imperative that you also remove this tainted material to minimize liability to this publication from harmed patients, especially circumcised victims who developed AIDS in spite of being circumcised. Beyond patient harm, beyond medical ethics, publishing misinformation is a licensing and disciplinary issue of grave import to all involved."
      Eileen Marie Wayne, MD, Letters (Circumcision -- sexual sadism?), Infectious Diseases in Children, Vol. 11, No. 2, February 1998.

Adult Men Discuss Their Circumcisions

Wishing They Were Left Intact: Adult Men Discuss Their Circumcisions

Posted by Dawn on September 21, 2012 49 Comments

When I write a piece on circumcision in any forum, including here on Everything Birth Blog, inevitably, someone will explain that if circumcision were such a big deal, men would be speaking up, not just “crazy moms.”  I know men in real life that wish they hadn’t been circumcised, but speaking out about it can be embarrassing, humiliating or just plain difficult. Sure, some men don’t realize the impact their circumcision has had on their lives. Others, like my husband, do understand but choose not to discuss it. As my friend, Jon Stevenson, from Michigan said, “I wish I was uncut, but don’t feel like there’s much else I can say about that…”
Yet, there are other circumcised men who are as vocal as the Intactivist women I know. There are men who are able to tell their stories. It took me all of a few hours and a single “internet shout-out” to find them.
I will warn all of you in advance, this article has been emotionally difficult to write and also that what these men have to say may be hard to read, but I urge you to hear them. They have a moral right to be heard.
I ask for your sensitivity in this issue towards me and towards the participants that I have interviewed because this is an extremely emotional topic.  This post is not to hurt anyone’s feelings. It is not to make anyone feel guilty because of anything that has been done in the past. I wrote it so that people can consider the full implications of what they may be about to do.
While preparing this article, a song kept coming to mine, humming in the background of my awareness. The song “Daughters” by John Mayer has always touched me. It exposes the lasting implications of a girl’s hurt during her youth on her adult relationship. Though many parents have commented on this blog that they feel it is disgusting to worry about their sons future sexuality, they must concede that it is every parent’s hope that our infant sons will one day become adult men.  Like it or not, one’s sexuality is a significant part of adulthood. Always, while listening to this song, I’ve wished there was a similar song for our sons:

Learning They Were Circumcised.

Men expressed a variety of reactions to learning they were cut. Generally, they had to figure it out on their own, which saddens me even more, that boys seem to not even be entitled to an explanation that they were born with protective skin and nerve endings that they no longer have. I wonder how strange it must be to feel that you know your body only to discover it had been altered shortly after birth. Jeff Hodapp from California discovered he was circumcised when he was about 8 or 9 years old. He recalled his initial confusion, “I was looking at an anatomy book and it showed an intact penis and a circumcised penis. I immediately identified with the circumcised one. I didn’t read the page, I put the book down and walked away thinking that there were two types of penises.” I learned that often, men realized what was done to them in school. Imagine learning something so profound about such a significant part of yourself, while surrounded by peers in a classroom…

There ARE Long Term Negative Consequences of Circumcision

We already know that there are certain risks from infant circumcision, including a risk of death and infection. We have even come to understand that, as with my son, adhesions in the weeks and months following circumcision are not rare. But there are other long term physical consequences. Some are merely an irritating physical reminder of what was taken from these men, some are much more painful.
Jeff Hodapp explained, “When I was entering puberty, erections were extremely painful, to the point where it just seemed like something was not right. I asked my friends about it and heard similar stories, so I thought it was normal. I never associated it with circumcision because nobody ever talked about it. We really didn’t understand what had happened to us. I remember a joke my friend would tell every now and again” Q. ‘whats grosser than gross?’ A. ‘getting a boner and running out of skin.’” See, when a man has been circumcised, it is common for him to not have enough foreskin to accommodate the erection. At times, there is so very little skin left that the penis is unable to even extend out fully. This often causes pain, in addition to limiting its length.
One man I interviewed explained that as he got older, his lack of sensation increased so much that he started reading about erectile dysfunction (ED) and wondered if it was happening to him. If men begin to lose sensation, they often get anxious, and a cycle of doubt and insecurity is created. It is not uncommon for circumcision and the lack of sensation that can accompany decades of chaffing and callousing to be at the root of ED.

“Restoring” the Foreskin

Because of these long term consequences, many men have chosen to try to “restore” their foreskin. Restoring foreskin is a process more and more men are undergoing to increase the amount of skin on their penis. The nerve endings can never be replaced, but it does offer protection to the sensitive tip of the penis and helps to provide the intended gliding mechanics that the foreskin would normally provide during intercourse. It is a very long and arduous process, but many feel the end result is worth it.
David Runyan, of Illinois, told me, “For as long as I can remember I have had a pain in my glans when walking around clothed when my penis shifts and the exposed glans of my penis rub against the harsh fabric of my underwear; this sensation has diminished since I have restored enough foreskin that when flaccid my glans are almost completely covered.” Runyan explained to me the significant improvement, restoring the skin has had on his relationship, “I’ve also noticed an increased stamina and vigor, I am able to retain an erection longer, hold off climax longer, and maintain my erection after climax and be able to continue intercourse. In short, since I’ve regrown my foreskin, my love making has become more intense, intimate, passionate, and satisfying, our relationship has improved, and after eight years we feel like newlyweds again.”
Kris Bullock, of Arizona, who is in the also process of “restoring” explains, “[B]efore I began restoring, my penis would regularly become chafed after sex, no matter how much lubrication was used.  Sometimes it would take 2 or 3 days to fully heal.” He went on to say, “Now that I have been restoring for 8 months, I experience much less chafing, if any at all.”
While it’s wonderful that men have the option to try to grow more skin, it saddens me that they must chose to regrow skin to “substitute” something that they were born with. I also became acutely aware that they will never regrow the nerve endings that were permanently removed as Runyan remarked to me, “I love the benefits of restoration, however I am irritated that I have to go through a tedious lengthy physical therapy in order to restore my body to as whole as possible, there is no way to get the 20,000 nerve endings that were ripped from my body, there is no real substitute for the way natural foreskin tightens at the tip to keep the skin in place. The best I can hope for is ‘close enough.’”

Their Feelings Toward Their Parents

While some men felt that their parents’ consent to their circumcision has caused serious strains on their relationships with them, most of the men I interviewed had no lasting anger towards their parents for choosing to have them circumcised. I noticed that the anger was directly proportional to the amount of negative physical effects their circumcision caused them as well as how old they were when and the way in which they learned that they had been circumcised. All of the men though, expressed a sincere animosity towards the doctors that performed their surgeries and the establishment that perpetuates the practice. Jeff Hodapp told me, “I didn’t and still don’t hold them [his parents] completely responsible. I feel more violated by the Doctor who influenced my mother. The medical industry is to blame for perpetuating this barbarism.”

Grieving Over What Was Cut From Them

Kris Bullock has accepted his loss and told me that dwelling on the past wasn’t going to change anything. He, as I mentioned, decided to try to take back some of the control through his restoration process, but as he described his feelings of empowerment, one statement stuck out and I fought back tears as I read words that spoke of his grief. Bullock said, “I look forward to restoring the gliding action that is a result of the extra skin being in place.  As well as the significantly reduced need for artificial lubrication. But I am still pretty bummed that I can’t restore the 20,000+ nerve endings that were removed forever.  And every time I see an intact penis, I am envious of the nerve endings.  I would love for one second to know what they feel like.”
Did you catch that? He said, “I would love for one second to know what they feel like.”
I suppose for the Establishment of Circumcision, it’s a good thing that these men will never know that feeling.  I can only imagine the sheer rage that would come of men experiencing for ONE second what their birthright should have entitled them to, and then knowing that that was taken from them.
A man would have to physically feel the sensation to fully comprehend the loss of those nerve endings. Even without ever feeling what he has lost, James Stewart from Missouri, was 16 years old in his high school child development class when he learned what circumcision was. He explained that, upon realizing what happened to him, he was angrier than he had ever been. He felt disgusted and completely violated. He expressed to me that he felt resentment towards his parents that he has not been able to let go of to this day. He even explained, “I don’t think I would be able to control myself in the presence of the so called ‘doctor’ who is responsible. I fear I would become irrationally violent.” Stewart, who is also undergoing the long process of restoration, explained, “I didn’t lose my virginity until after I had begun restoring. My partner told me that I felt as comfortable inside her as an intact man. I imagine that I would have felt more if I had more to feel with.”  I’m not sure I can even fathom how much more intensely this man’s anger would be felt if he was given one second to feel what he cannot.
I take for granted my nerve endings, because I got to keep mine. They are exactly as they are supposed to be. A basic understanding of fetal development tells me that I have a pretty good idea of the sensations these men will never feel. Mothers-to-be reading this: A moments’ reflection on your own nerve endings might give you a clearer understanding as well…

Right to Bodily Integrity?

Sometimes there is no pain, and only minor and occasional irritation, as is the case with Evan Sarver, a US native, now living in the Ukraine. Sarver says that his circumcision-inflicted irritation is usually only noticed “after especially active sex, sometimes from swim trunks.” Nevertheless, when asked if he felt his civil rights were violated when he was cut, Sarver told me, “I feel my human rights (not civil) were violated. I think bodily integrity is the base of all human rights.”
Eric Williamson, from Oregon, put it very simply and calmly, “It’s my body and should have been my choice. And personally, I would have never made that choice for myself.”
Jeff Hodapp said, “I think the under-educated doctors who perform the procedure and the medical establishment that supports are manipulating research data and releasing less than honest information should be held accountable for human rights, and ethics violations.” Hodapp emphasized, “I think that circumcision is a form of child abuse. A healthy, functional, and significant part of my body was taken from me.”
Garrett Wolfe, who resides in California, told me, “I was robbed of normal sexual function, normal sexual sensation and pleasure, normal appearance and lied to all my life about it. I was made to feel that I was the one with the problem, not the victim. It’s as if I was blinded with red hot poker in infancy, and then told blindness is normal and good for me, and that I must have a problem for not appreciating it.” He said that to say he felt violated is an understatement. “My basic human right to a whole body, my right to express my OWN religion, my right to choose how I experience sex for my entire life, my right choose how I protect myself from STDs, HIV, and UTIs, my right to control how I appear nude, my right to experience life the way I was built and meant to, my sense of trust, of being protected and loved, was all ripped away along with the flesh of my genitals, when all I could do in protest was scream. Yes, my civil rights were violated.”


David Runyan, on the other hand, passionately questioned why his rights were not considered: “I was given no consideration, I gave no consent, and I feel that I was abused and sexually assaulted by both my parents and the doctor who mutilated me. There was no one there to protect me, from a procedure that if successful would and did mutilate me for life, and if ‘botched’ could have ended my life before it began, or could have totally destroyed my penis before I even finished developing. People talk to me about parents’ rights, religious rights, where do my rights come into play? When does what I want for my body matter?”
And then, there’s my son. He’s not yet an adult, but he wanted to have his say as well, “No right,” he proclaimed.  I heard the silent, “You had,” that prefaced his statement, but let’s face it, it’s hard to say something like that to your mom.
Mothers, be good to your sons.
Sons will love like you do.
Sons become lovers who turn into fathers.
So, fathers, be good to your sons too.

I’d like to extend extreme gratitude to the brave men who have helped me with this piece as well as to The WHOLE Network for their accommodations, dedication, and information.