8 10 240 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>Higher incidence of urethral damage in circumcised boys</h2> A large scale, comprehensive study has found that circumcised boys have a far higher incidence of urethral problems such as meatal stenosis than boys who are left genitally intact (uncircumcised). The nationwide study of over 4 million males in Denmark found that meatal stenosis (narrowing and ulceration of the urinary opening of the penis) affected as many as 20 per cent of circumcised boys, about five times the incidence of such problems in uncircumcised boys. They also experience a far higher incidence of other urethral problems. Among other observations, the authors of the article criticise the American Academy of Pediatrics for its uncritical reliance on a flawed study on circumcision complications by El Bcheraoui et al which claimed to find a negligible incidence of urethral disease among boys circumcised in American hospitals. They point out that the data in this study actually show a high relative risk for such problems. The AAP should have paid attention to a <a href="http://www.cirp.org/library/normal/aap/" rel="noopener" target="_blank">warning it published in 1984</a>: “The foreskin shields the glans; with circumcision this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, meatitis (inflammation of the meatus), and meatal stenosis (a narrowing of the urinary opening). Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life”.** The present study is further evidence that the AAP’s 2012 claim that the “benefits” of circumcision exceed the “risks” is fundamentally false. ** This text was included in the 1984 edition of a leaflet for parents on care of the normal (uncircumcised) penis. When the leaflet was reissued in 1990 the paragraph was deleted, for reasons never explained. Relevant correspondence and a copy of the original leaflet available from <a href="http://www.circumcision.org/pamphlet.htm" rel="noopener" target="_blank">Circumcision Resource Center</a>. The abstract of the paper follows. Background: Meatal stenosis is markedly more common in circumcised than genitally intact males, affecting 5-20 per cent of circumcised boys. However, no population-based study has estimated the relative risk of meatal stenosis and other urethral stricture diseases (USDs) or the population attributable fraction (AFp) associated with non-therapeutic circumcision. Methods: In two nationwide cohort studies (comprising 4.0 million males of all ages and 810 719 non-Muslim males aged 0e36 years, respectively), we compared hospital contact rates for USD during 1977e2013 between circumcised and intact Danish males.Hazard ratios (HRs) were obtained using Cox proportional hazards regression, and the AFp estimated the proportion of USD cases in <10 year-old boys that is due to non-therapeutic circumcision. Results: Muslim males had higher rates of meatal stenosis than ethnic Danish males, particularly in <10 year-old boys (HR 3.44, 95 per cent confidence interval 2.42e4.88). HRs linking circumcision to meatal stenosis (10.3, 4.53e23.4) or other USDs (5.14, 3.48e7.60) were high, and attempts to reduce potential misclassification and confounding further strengthened the association, particularly in <10 year-old boys (meatal stenosis: 26.3, 9.37 e73.9; other USDs: 14.0, 6.86e28.6). Conservative calculations revealed that at least 18, 41, 78, and 81 per cent of USD cases in <10 year-old boys from countries with circumcision prevalences as in Denmark, the United Kingdom, the United States and Israel, respectively, may be attributable to non-therapeutic circumcision. Conclusion: Our study provides population-based epidemiological evidence that circumcision removes the natural protection against meatal stenosis and, possibly, other USDs as well. Frisch M, Simonsen J. Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977-2013, <a href="https://dx.doi.org/10.1016/j.surge.2016.11.002" rel="noopener" target="_blank">The Surgeon, on-line first, 22 December 2016</a>. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Higher incidence of urethral damage in circumcised boys darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>Circumcision always painful for babies</h2> Circumcision is “one of the most painful procedures a baby can undergo”, and no fully effective anaesthetic method has yet been devised. This is the disturbing conclusion of a paper in the Italian Journal of Pediatrics, which examines the various circumcision and anaesthetic techniques in use and finds none of them satisfactory. The authors note that although “relief of human suffering is one of the most important goals for health care providers”, there have been only half-hearted efforts to eliminate the pain of circumcision, partly because the operation originated as a cultural ritual in which endurance of intense pain was part of the rationale. “Unfortunately, even during clinical trials, babies still undergo circumcision without analgesia, and the continuous production of studies for a better analgesia is the sign that a gold standard has not yet been found”, they write. The authors found that the Mogen clamp was less painful than both the Gomco clamp and the Plastibell, though seem to be unaware that the Mogen caused such a high incidence of additional injuries that a series of lawsuits drove the company out of business. It is increasingly common these days for boys to be given a local anaesthetic with a needle, but if the evidence of <a href="https://www.youtube.com/watch?v=VRPv4ryPiTU" rel="noopener" target="_blank">many Youtube videos</a> is to be believed, the needle is itself extremely painful and often causes bleeding. EMLA cream, much vaunted by Australian circumcision salesmen, is neither effective nor recommended for use on young babies. As the authors of the present study conclude, “more research is required to find a better analgesic approach, in order to make circumcision a totally painless procedure without stress or discomfort. Present methods do not yet guarantee a total analgesia during this procedure.” Source: Bellieni CV et al. <a href="http://www.ijponline.net/content/39/1/38" rel="noopener" target="_blank">Analgesia for infants’ circumcision</a>. Italian Journal of Pediatrics 2013 39:38. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Circumcision always painful for babies darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Harm and physical effects of circumcision</h1> In this paper Dr John Warren shows how the harm of circumcision arises from the operation itself, when all goes well and as planned, not merely when there are complications. <h3>Abstract</h3> Male circumcision results in permanent changes in the appearance and functions of the penis. These include artificial exposure of the glans, resulting in its keratinization and altered appearance. Additionally, circumcision results in loss of 30–50% of the penile skin, loss of at least 10,000–20,000 specialized erotogenic nerve endings, loss of reciprocal stimulation of foreskin and glans, and loss of the natural coital gliding mechanism, etc. From the point of view of sensation and function, the most important effect is caused by the tissue loss itself. The most sensitive part of the penis is removed, and the normal mechanisms of intercourse and erogenous stimulation are disturbed. Keywords: Male circumcision, Harm, Complications, Penile anatomy and physiology, Prepuce, Gliding mechanism <h3>Introduction</h3> The physical effects of male circumcision can be considered under the following headings: <ol> <li>Cosmetic effects</li> <li>Glans externalized and keratinized</li> <li>Penile skin and mucosal loss of 33–50%</li> <li>Loss of sensory nerve endings</li> <li>Loss of reciprocal stimulation of foreskin and glans</li> <li>Loss of the gliding mechanism</li> </ol> <h3>1. Cosmetic Effects</h3> Circumcision results in an altered appearance of the penis, which, to all intents and purposes, is permanent. While foreskin restoration may be carried out, it is not straightforward and the results are not perfect. It is comparatively easy for an intact man to be circumcised. Some men are perfectly content to grow up with a circumcised penis, while others can be very disturbed by it. Among circumcised men who have contacted NORM-UK for help, the appearance of their penis is often one of their main complaints. They frequently report avoidance of allowing others, particularly other men, to see them naked, and some, therefore, avoid sports. Penis size This is a subject about which men have strong emotions. The effect of circumcision reduces flaccid penile length and width slightly, as the normal foreskin often overhangs the glans in the non-erect state. Width is reduced because of the loss of the double layer of skin covering the glans. The erect penis may also be somewhat shortened, as there may be insufficient penile skin to permit full erection. An Australian survey showed circumcised men, on average, to have erect penises 8 mm shorter than intact men (Talarico and Jasaitis, 1973; Richters et al., 1995). Skin colour In intact European males, the glans ranges in color from pink to dark purple, while in dark skinned men it ranges from pink to dark brown. Infant circumcision, carried out when the glans is adherent to the foreskin, results in scarring, pitting, and discoloration of the surface of the glans and, over the years, increasing keratinization is likely to lead to further loss of natural color (Fleiss, 1997). <h3>2. Glans Externalized and Keratinized</h3> The normal glans is an internal structure, only exposed briefly during urination, washing, and sexual arousal. Its surface is moist, and is not keratinized. However, circumcision converts the glans into an external organ. Immediately after the operation, it retains its exquisite sensitivity, and contact with clothing causes considerable discomfort, but it soon becomes desensitized, probably as a result of the laying down of a layer of keratin on the epithelium. A few circumcised men report persistent discomfort from contact with clothing throughout their lives. The epithelium takes on the character of skin rather than mucous membrane. Not only is the appearance of the glans altered, but also there is a dramatic loss of sensitivity. Sorrells et al. (2007) mapped fine-touch pressure thresholds in the adult penis in circumcised and uncircumcised men, comparing the two populations. With regard to the sensitivity of the glans, they showed that the glans in the circumcised male is less sensitive to fine-touch pressure than that of the uncircumcised (intact) male. Bleustein et al. (2005) tested vibration, pressure, spatial perception, and temperature on the glans in the dorsal midline in circumcised and non-circumcised men, and failed to show any significant difference in sensation on the glans between the two groups after correcting for age, hypertension, and diabetes. What is clear is that the glans is the least sensitive region of the penis, in any case, and is only supplied with simple nerve endings, which sense deep pressure and pain (Sorrells et al., 2007; Bleustein et al., 2005; Halata and Munger, 1986). <h3>3. Tissue Loss from Circumcision</h3> It is the tissue loss that causes the most important functional effects of circumcision. What is lost? Thirty to fifty percent of the penile skin, the area in an adult being about 15 square inches (96 cm2), comprising nearly all of the inner and outer foreskin, is removed. The frenulum is sometimes (and in USA-style “high and tight” operations, nearly always) removed. The inner foreskin includes the ridged band, a zone of specialized mucosa encircling the distal end of the inner foreskin, first described by Taylor and colleagues (1996). They described the ridged band in this way: When retracted, the inner surface of the prepuce displays two zones, ‘ridged’ and ‘smooth’. The first, a transversely-ridged band of mucosa 10–15 mm wide, lies against the true skin edge, forming the outer surface of the tip of the prepuce. In the dorsal midline, the ‘ridged band’ lies above the level of the adjacent ‘smooth’ mucosa and merges smoothly, on either side, with the frenulum of the prepuce. When magnified, the ridged mucosa has a pebbled or coral-like appearance. Unretracted, the adult ‘ridged band’ usually lies flat against the glans; retracted, the ‘ridged band’ is everted on the shaft of the penis. The remainder of the preputial lining between the ‘ridged band’ and the glans is smooth and lax. There is considerable variation in the degree of ridging: older subjects showed less and younger subjects more marked ridging. Some ridging was seen in all the prepuces examined. Taylor and colleagues further noted that the ridged band is intensely vascularized, which is typical of components of the nervous system. The tightly pleated concentric bands of the ridged band have been likened to the elastic bands at the top of a sock. These expandable pleats arise from the frenulum and encircle the inner lining of the foreskin. They allow the lips of the foreskin to open and roll back, exposing the glans. The ridged mucosa also gives the foreskin its characteristic taper (Fleiss and Hodges, 2002: 7). The importance of the ridged band lies in its innervation. When he described it, Taylor, a pathologist working on histology, reported that it showed focal, spiky, or more rounded and flatter ridges interspersed with sulci. Meissner’s corpuscles were more plentiful in some subjects than others but, perhaps significantly, they were only seen in the crests of the ridges, occasionally in small clumps that expanded the tips of corial papillae. End-organs were not seen in sulci between ridges. Special stains for nerve tissue showed the additional end-organs and myelinated nerve fibers in the ridges. In contrast, histological examination of the smooth zone of the mucosa showed no ridging and few Meissner’s corpuscles. Meissner’s corpuscles are mechanoreceptors for detection of light touch. They are distributed throughout the skin, but concentrated in areas that are particularly sensitive, such as the fingertips, palms and soles, lips, tongue, face, and genitals. It has been calculated that circumcision results in the loss of at least 10,000–20,000 specialized erotogenic nerve endings (Winkelmann, 1959, 1956). Also lost in circumcision is about half the smooth muscle sheath that invests the penis, which is known as the dartos fascia and is temperature sensitive. The frenulum, a highly erogenous V-shaped structure that tethers the underside of the glans to the shaft, is frequently destroyed or damaged during circumcision. Circumcision removes several feet of blood vessels, including the frenular artery. This loss of the rich vascularity interrupts the normal flow to the shaft and glans, damaging the natural blood flow of the penis (Netter, 1997: plates 238, 239). The mucosal surface of the foreskin produces plasma cells, part of the body’s defense system. They secrete antibodies and antibacterial and antiviral proteins, including lysozyme. The list of structures lost includes lymphatic vessels, apocrine glands (producing pheromones, scent signals), sebaceous glands, and Langerhans cells (another part of the defense system). <h3>4. Loss of Sensory Nerve Endings</h3> As already described, circumcision removes the part of the penis most richly supplied with sensory nerve endings, the ridged band. In general, the inner mucosal foreskin is more sensitive than the outer foreskin, which differs little from the shaft skin. This loss is borne out by the results shown by Sorrells et al. If we look at the figure showing fine-touch pressure thresholds, we notice that the lowest threshold is found at position 3, which is the dorsal preputial orifice rim, while the next lowest thresholds are found at 13 and 14, parts of the frenulum, and 4 and 5, which are the mucocutaneous junction and ridged band, respectively. In the circumcised penis, the lowest threshold is found at position 19, the ventral surface of the circumcision scar. <h3>5. Loss of Reciprocal Stimulation of Foreskin and Glans</h3> The mobile sheath of the intact penis allows the foreskin to glide back and forth over the glans. As it does so, it repeatedly folds and unfolds itself. Inevitably, the tactile nerve endings in the glans and, more especially, in the foreskin are strongly stimulated by this action, whether the result of masturbation, foreplay, or penetrative intercourse. During intercourse, the ridged band is alternately stimulated by the glans, when it is turned inwards, and by the vaginal wall, when it is turned outwards. The smooth muscle in the foreskin ensures that it encloses the glans snugly. <h3>6. Loss of the Gliding Mechanism</h3> Bigelow drew attention to the mechanical function of the foreskin during intercourse (Bigelow, 2002: 17). This function provides more enjoyable intercourse for both partners. During sexual arousal, the vagina secretes lubricant fluid allowing penetration to occur comfortably. Then, during intercourse, the intact penis glides in and out of its own skin sheath with each thrust, reducing friction between the penile skin and the vaginal wall, and allowing the vaginal secretions to remain on its surface, rather than being drawn out as they tend to be by the thrusting of the circumcised penis, which during erection may have no slack skin at all. Masturbation is similarly affected. An intact man masturbates by manipulating his foreskin back and forth over his glans. In a circumcised man, this is not possible, and often a lubricant is needed to permit comfortable stimulation. Circumcision was originally brought into medical fashion in the nineteenth century because it was thought to prevent or at least discourage masturbation. Masturbation was then considered to be both immoral and dangerous to health, though this has long since been disproved. In fact, circumcision does not prevent masturbation in the least, but it probably makes it less enjoyable, though this is hard to prove. <h3>Conclusion</h3> In considering the physical effects of circumcision, we have seen how there is a permanent and irreversible change in the appearance of the penis and the exposure of the glans, resulting in its keratinization and altered appearance. From the point of view of sensation and function, the most important effect is caused by the tissue loss itself. The most sensitive part of the penis is removed, and the normal mechanisms of intercourse and masturbation are disturbed. At the same time, we have learned about the function of the male foreskin, a subject that has been neglected by medical scientists in the past. We have not considered complications of the operation, but merely what ensues when everything goes according to plan. <h3>References</h3> Bigelow J. (2002) The Joy of Uncircumcising! 2nd ed. Kearney, NE: Morris Publishing. Bleustein CB et al. (2005) Effects of circumcision on male penile neurologic sensitivity. Urology. 65:773–777. Fleiss PM. (1997) <a href="http://www.foreskin.org/fleiss.htm">The case against circumcision</a>. Mothering Mag Nat Fam Living. Winter: 36–45. Fleiss PM, Hodges FM. (2002) What Your Doctor May Not Tell You About Circumcision. New York, NY: Warner Books. Halata Z, Munger BL. (1986) The neuroanatomical basis for the protopathic sensibility of the human glans penis. Brain Res. 371:205–230. Netter FH. (1997) Atlas of Human Anatomy, 2nd ed. (Novartis 1997). Richters J et al. (1995) Why do condoms break or slip off in use? An exploratory study. Int J STD AIDS. 6(1):11–18. Sorrells ML et al. (2007) <a href="http://www.cirp.org/library/anatomy/sorrells_2007/">Fine-touch pressure thresholds in the adult penis</a>. BJU Int. 99:864–869. Talarico RD, Jasaitis JE. (1973) Concealed penis: A complication of neonatal circumcision. J Urol. 110:732–733. Taylor JR et al. (1996) <a href="http://www.cirp.org/library/anatomy/taylor/">The prepuce: Specialised mucosa of the penis and its loss to circumcision</a>. Br J Urol. 77:291–295. Winkelmann RK. (1956) <a href="http://www.cirp.org/library/anatomy/winkelmann2/">The cutaneous innervation of the human newborn prepuce</a>. J Invest Dermatol. 26:53–67. Winkelmann RK. (1959) <a href="http://www.cirp.org/library/anatomy/winkelmann/">The erogenous zones: Their nerve supply and its significance</a>. Proc Mayo Clin. 34:39–47. John Warren, Physical effects of circumcision, in George C. Denniston, Frederick M. Hodges and Marilyn Fayre Milos (eds), Genital Autonomy: Protecting Personal Choice (Dordrecht, Heidelberg, London, New York: Springer, 2010; ISBN 978-90-481-9445-2 e-ISBN 978-90-481-9446-9) Dr Warren is a general practitioner in the United Kingdom, and a founder of Norm-UK. The book may be purchased <a href="https://www.amazon.com/Genital-Autonomy-Protecting-Personal-Choice/dp/9048194458/ref=pd_rhf_p_t_1">from Amazon</a>. Individual chapters may be bought and downloaded from <a href="http://www.springerlink.com/content/978-90-481-9445-2#section=758210&page=1&locus=0">the publishers, SpringerLink</a>. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Physical harms of circumcision: paper by Dr John Warren darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Sore point</h1> <h3>Circumcision "a source of great anguish"</h3> Circumcision - beloved by the Victorians, crucial to two of the world's great religions, arguably a health boon - can be a cause of great anguish. Richard Johnson meets men finding ways to reverse a cut they wish they'd never had Guardian, Saturday October 29, 2005 Skin constantly renews itself. Foreskin is no different: stretch it, and it will grow. Which is why eight circumcised men are meeting in Watford town hall. They want new foreskins. "When people come to my house," says Laurie, "I don't go 'Hello there, I'm Laurie, I'm growing my foreskin', but I've often got research papers out on the table, so word gets out. I do find people are really very interested in what I'm doing." Laurie is sharing his experience of restoration, as the process of foreskin renewal is called, with fellow members of NORM-UK. In the US, where NORM was born (and where circumcision rates are somewhere around three-quarters of the male population, far higher than in Britain), it stands for National Organisation of Restoring Men. NORM-UK is about more than that, but Laurie is on a roll. And the others don't want to interrupt him - after all, in two and a half years, Laurie has achieved glans coverage when flaccid. In the world of restoration, that is major. NORM-UK meetings are small and intimate. Not usually as small and intimate as this one, but there's been a pile-up on the M1. There are a few handshakes, but otherwise little in the way of physical display - "People are always worried we're going to drop our trousers," says general manager David Smith. Laurie wouldn't be averse to the idea, to show off his stretching. Women stretch skin for reconstruction after a mastectomy. So why shouldn't men stretch a foreskin? Some men can't restore - they are too tightly circumcised and have no tissue left to grow, but others can and are availing themselves of products such as the TLC Tugger, Tug Ahoy and the Your-Skin cone. Some have found their own DIY solutions, using funnels and gaskets to stretch the foreskin, and sash-window weights to provide traction. The whole idea of restoration sounds funny, like the time that Laurie was having a go with sticky tape, the most primitive of the restoration methods. He pulled what skin he had left over his glans, and taped it down. "I only had the tape on for half an hour", says Laurie, "but it was hell. I was walking down the high street and suddenly had to dive into the nearest toilet to check my penis hadn't gone black, green or blue. Or dropped off altogether." It sounds funny, but it isn't. Not if it's happening to you. Smith remembers sitting through the scene in the film East Is East in which the father tries to catch the son and take him to be circumcised. "I remember the cinema was in hysterics," says Smith, "and they were laughing when he was wheeled into the operating theatre, but all I could hear was the boy's screams. My wife turned to me and said, 'I've got to go - I can't watch this.'" When the foreskin is removed, it leaves the glans exposed and that can be difficult - removing a protective layer and sometimes creating soreness. "I always had a problem with my penis giving me stimulation I didn't want," says Kevin, recalling how, as a boy, "I had to keep adjusting it through my pocket. I was near the climbing frame in the playground when, all of a sudden, everyone started chanting 'Kevin is dirty - he's always playing with himself'. I didn't like the feeling of being odd, of being deformed. Suicide would have been a good option." Kevin is now 56 with a fully restored foreskin. But he's left with the question, why was he circumcised in the first place? His mother read the Bible and went to Sunday school. "But I was conceived out of wedlock when she was 17. And my father was a divorcee. They wanted to get married in church, so I think I was circumcised as some kind of apology to Jesus. My father wasn't circumcised himself, so I really don't understand." And that is a feeling he shares with many members of NORM-UK. Meetings are on a first-name-only basis because members don't like to be identified. "Many men who come to meetings won't even speak to their families about the pain they're suffering - we are dealing with victims of abuse here," says Smith. NORM-UK currently has just short of 300 members. Less than one inquiry in 10 results in membership, but it isn't strictly about the numbers. "Men often want the information to restore," says Smith, "but they want to keep it to themselves. They are frightened about being found out. When they ring me up, they say, 'Please ensure that the information is in plain envelopes and don't put me on a mailing list.'" John D was like that. He felt abused because his circumcision was unnecessary - a course of antibiotics had already cleared up his urinary infection. "But my father agreed with the doctor, and told me I was going to have a minor operation," he says. "I remember the nurses giggling as I was taken off to theatre. They wore these big sickly grins, and said, 'We're taking you to be done up now. Hee hee hee.' I was eight, but suffice it to say that they knew what was happening to me and I did not ... I remember waking up," says John D, "after the general anaesthetic had worn off, and looking down. My beloved penis had been replaced with wrinkled skin, a collar of thorns - the black stitches - and an ugly great dome on top. I experienced shock at first, later deep anger and resentment. The stitches disappeared, but the mutilation didn't. My father said, 'I didn't think it would look like that.' It was misinformed consent." There are lots of horror stories about circumcision. Like the time in Baltimore in 1964 that it went so badly wrong that the doctors decided to change the child's sex. Or the time in London in 1991 when a 16-year-old was circumcised so badly that he bled all night and died. But these cases are extraordinary, and far from typical. Even for adults, circumcision is reckoned a safe and easy operation. Opponents of the procedure, however, don't see it like that. John E is blind. But it's not his blindness that keeps him from meetings. "It's the fact I feel I've been more devastated than everyone else," he says. "They've got their lives in order. And they've got sexual partners. I haven't. My life has been ruined by circumcision, although I hate that word. I prefer 'foreskin amputation'. It's not an operation - there's no medical benefit. It's a rite. A faith crime." In the Bible, circumcision was God's covenant with Abraham and the Jewish people. Of all of the commandments in Judaism, the brit milah (literally, covenant of circumcision) is probably the most universally observed. And although circumcision isn't actually mentioned in the Qur'an, it is mentioned in other Islamic texts. Most Muslims believe it's fundamental because Allah ordered Muhammad to follow the way of Abraham. Asked if NORM-UK has Jewish and Muslim members, Smith replies, "Yes we do, but it is difficult to estimate the number because if someone joins us we do not ask their religion, nor are we really interested." Religious circumcisions are frequently performed without anaesthetic, and are painful, even when performed on newborn babies. Adults can testify to the pain for themselves and can give their informed consent - but children can't. If, as opponents claim, circumcision is traumatic, and can result in lifelong damage - including psychological problems and a reduced sex drive - why are religious circumcisions still allowed? NORM-UK says, actually, they aren't allowed: the UN Convention on the Rights of the Child declares that violence to children cannot be justified on grounds of "religion, culture or tradition". Children are not the possessions of their parents to do with as they please - or submit to surgery unless absolutely necessary. We make an exception for circumcision because it's mentioned in Genesis. Dr Zuhair Zarifa, from Docklands in east London, is one of the few surgeons prepared to advertise the fact that he will circumcise males for religious or ethnic reasons. "Why not?" he says. "The operations are permitted by the General Medical Council. And they will happen whether I do them or not. It's much better for the operations to happen in my surgery under clinical conditions with anaesthetic, where I can provide all the necessary aftercare." Even nonpractising Jews tend to circumcise their sons. It was, after all, the first command given to Abraham and the defining physical mark of the Jewish people. Circumcision involves "Hatafat Dam Brit" - a drop of blood that seals a covenant. Which does, for some, suggest that removing the foreskin goes beyond what is required by God. But, according to Rabbi Dr Jeremy Rosen, that is to miss the point. "People are always trying to find rational reasons for Jewish laws," says Rosen. "They ask if our dietary laws improve hygiene. They ask if observing the Sabbath helps mental relaxation. And they ask if circumcision prevents STDs. But even if these rational reasons stood up to objective scrutiny, they wouldn't be a reason for keeping - or abandoning - our laws. One keeps to these rules out of religious commitment. I have no medical expertise," adds Rosen, who runs the London branch of the liberal Yakar Educational Foundation, "but I am convinced that circumcision is harmless, and not traumatic. But even if it is, we Jews have done pretty well on it over the years - and so indeed have Muslims." Circumcision on females was made illegal in the UK in 1985. The same protection is not extended to males precisely because it would involve taking on two of the world's great religions. Most forms of female circumcision are, certainly, more damaging than male circumcision, but the distinction in law between male and female circumcision just can't be justified objectively. It is a double standard. Circumcision was not practised in Britain until the 18th century and it really only gained popularity in the 19th century, after claims that it stopped the vile habit of masturbation. By stopping masturbation, Victorians thought circumcision would cure everything from epilepsy and hip trouble to asthma and alcoholism. In the first world war it was hailed as a defence against venereal disease, and by the second world war it had become an emblem of status; most of the middle and upper classes were eagerly circumcising their sons. Only in the late 1940s, with the introduction of the National Health Service, did numbers begin to fall - it is now estimated that around 20% of the current male population in the UK are circumcised. But whenever a new disease becomes a matter of social concern, circumcision is wheeled out as the cure. A recent paper in the British Medical Journal found a link between an intact foreskin and HIV infection - but a paper in the British Journal Of Urology found exactly the opposite. There is clear medical evidence that circumcision reduces the incidence of cancer of the penis, and of the cervix for the women whose partners are circumcised, but even this is disputed by NORM-UK. It argues that the research is out of date and that a lack of cleanliness is more important to the transmission of disease than the lack of a foreskin. The organisation doesn't want to see circumcision banned altogether. It accepts there are a few medical conditions where it is necessary. The others can be treated by simple, nonsurgical means."We need to educate the medical profession," says Smith, "because they seem unaware of the alternatives to circumcision. They are certainly unaware of the problems that it is causing." John D is typical of NORM-UK members in that circumcision when he was a young boy changed his entire persona. "I became less sociable, and I started talking to myself. I was fearful of changing rooms. I had no close relationship with the opposite sex until I was 41, and I still haven't been able to reach orgasm through sexual intercourse. Over the years, I've had real problems with depression, and I'm sure I could trace it back to that day." These are not the issues foremost in doctors' minds. Take a look at the General Practice notebook, an online medical encyclopaedia used by GPs, and its listing for phimosis - a condition where the foreskin won't retract. Most infants are born with a foreskin that can't be retracted and the foreskin is often tight until after puberty. Phimosis disappears in almost all cases given time. A fully retractable foreskin occurs on its own in 99% of 18-year-olds. But the notebook recommends circumcision. The notebook makes no mention whatever of the noninvasive solutions to the problem - such as stretching, steroid cream or a simpler operation. Similarly, there are nonsurgical solutions to balanitis, a condition where the foreskin retracts too tightly, causing the glans to swell. "It sounds silly," says John D, "but balanitis can be cured by putting the penis in a bowl of sugar. The swelling goes down, and the foreskin returns to its resting position." Zarifa isn't sure about the bowl of sugar - but he insists that doctors always explore noninvasive options first. "The truth of the matter is that stretching can be quite painful," he says. "And it's quite an undertaking for a small child. For some boys, the pain of the stretching is as bad as the pain of the circumcision. And I would say that 40-50% of boys who use steroid cream end up having a circumcision in the end. But it's always the last option." The BMA supports conservative solutions where possible. But unnecessary circumcisions are still happening. And, as the Commons health committee noted, they are happening "because doctors don't understand the natural history of the foreskin". Circumcision for babies and for older people is dismissed as "the snip", but it can still result in serious bleeding, or an adverse reaction to the anaesthetic. "And you cannot cut off normal, healthy, sexually-functioning tissue without cutting off normal, healthy, sexual functioning," says Marilyn Milos, a nurse and director of the National Organisation of Circumcision Information Resource Centres in the US. "It's a sexual issue, and it's a human rights issue." The foreskin isn't a useless flap that evolution should have got rid of long, long ago - it's skin that is rich with blood vessels, highly innervated, and uniquely endowed with stretch receptors. These contribute greatly to the sexual response of the intact male. The stretching of the foreskin over the glans activates nerve endings, enhances sexual excitability, and contributes to the ejaculatory reflex. There's no escaping it - the foreskin is sexual tissue. Laurie can laugh now, but he missed his foreskin (it was removed when he was two). He was getting on for 60, and rapidly losing the feeling in his penis. "To be honest," he says, "sex was like pushing a rolling pin in. And I'm not referring to size when I say 'rolling pin' - you can get little rolling pins. I just could not feel a thing." His glans had been badly desensitised after years of rattling around - so much so that he could have an orgasm and not even feel it. That is when he approached NORM-UK. During heterosexual intercourse with a circumcised man, the penis removes natural lubrication as it moves in and out of the vagina. "So my poor wife was buying artificial lubricant by the gallon," says Laurie. During heterosexual intercourse with an uncircumcised man, the glans moves but the foreskin stays put. And so does the lubrication. The woman doesn't feel friction at all - what she does feel is a variation in pressure. Laurie is delighted. "And so is my wife," he says. "The skin grew in jumps. I did a lot of work for a long time and nothing happened, like with the sticky tape, but suddenly I woke up one morning and thought 'Where's that come from?' " The new foreskin didn't have the nerve endings it once did, but the glans recovered all its sensitivity. "For 40 years my wife and I had to use lubrication. Not any more. We're delighted." David Smith is NORM-UK's one paid employee. He started admitting he worked for the charity only after his parents died - he couldn't bear the questions. (The Charity Commission put the organisation on probation for 12 months to ensure that it was not a cover for pornography.) Smith's wages come out of a grant from Lloyds TSB. But, apart from him, the trustees are all volunteers. Running NORM-UK is a big job: liaising with Great Ormond Street to correct the circumcision "fact file" on the hospital website, setting up meetings with the Family Planning Clinic, and doing mail-outs to midwives, recommending the alternatives to circumcision. Meet the members of NORM-UK and you'll understand that it's more important to look at the complications of circumcision, and its physical and psychological side effects. In time, campaigners hope that routine circumcision will come to be seen as yet another deluded fad, along with bleeding, electro-convulsive therapy and the frontal lobotomy. --- In response to a letter agreeing that circumcision was immoral but questioning the comparison with female genital mutilation, the Guardian published the following letter from John Dalton. As a victim of male circumcision and a subject of Richard Johnson’s article (Sore Point, October 29), I have no wish to belittle the suffering of circumcised girls. I would, however, like to respond to Catherine Long’s objection to male circumcision being compared to female genital mutilation (Letters, November 5). Male and female circumcision both remove normal tissue from normal children without therapeutic need or personal consent. The time has come for children to be protected from non-therapeutic circumcision without prejudice in respect of race, religion or gender. John D Dalton Frizington, Cumbria <a href="http://www.guardian.co.uk/weekend/story/0,3605,1639243,00.html">Guardian Weekend Magazine, 12 November 2005</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource British men seek compensation for circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Numbers aren’t everything: The unquantifiable subjectivities of circumcision harm</h1> Research published in biomedical and social science journals are strongly focused on numbers because quantifiable data can be subjected to a variety of statistical manipulations and are assumed to be objective. This approach works well when you are dealing with discrete, objective entities, such as barrels of oil, correlations between variables or the number of people with particular demographic characteristics who believe x or y. The approach may not be so useful when trying to reach conclusions about people’s subjective feelings and emotions, particularly in the sexual arena, where people are notoriously reluctant to report their real feelings and may be confused or uncertain as to what they really think and want. Recent research into men’s feelings about their penis and, more especially, their circumcision status, have tended to emphasise the apparent conclusion that most men are reasonably happy with their condition, whatever it happens to be, and therefore that there is not really any great problem. But are mere numbers the only important consideration? The most recent <a href="https://www.ncbi.nlm.nih.gov/pubmed/28894958" rel="noopener" target="_blank">study by Bossio and Pukall</a> found that men circumcised as adults were significantly more content with their situation than men circumcised as infants or children, concluding that age of circumcision was an important factor in their level of satisfaction. But it is equally likely that the age at which the operation is performed is actually a proxy, standing in for other factors, such as consent and whether the patient was conscious at the time and thus can remember the procedure. In the following discussion I consider, first, the question of numbers, and secondly outline a hypothesis that four key factors are involved in a male’s level of satisfaction or dissatisfaction with his circumcision status. <h2>Numbers who feel harm: Intensity also matters</h2> It is widely assumed that unless large numbers of men are resentful of or upset about having been circumcised there is really no need for concern or any moves to regulate or restrict circumcision. But are numbers really so important? How many women in regions or cultures that practise female genial cutting (FGC) feel or say they are harmed? Governments did not feel it necessary to prove the harm of FGC or calculate the number of women who felt harmed or otherwise upset or resentful before criminalising it: Third World countries agreed after Western pressure, developed countries acted out of a sense of general repugnance. What is remarkable about the United States is that, in a society of such genital conformity that the circumcised penis is seen as the American norm and parents cut baby boys in order to make sure that they are not teased in the proverbial locker room, any men at all feel resentful rather than grateful at having been circumcised. The anti-circumcision movement arose in the 1980s, a decade when the vast majority of adult men were circumcised, and the incidence of infant circumcision was more than 80%. A more significant metric is the number of adult men who seek circumcision for themselves. In the USA this number is hard to obtain, but there seems to be general agreement that it is very small – as you would expect, given that most adult men are already circumcised, and few have the option. At the same time, there is evidence that plenty of men who have not been circumcised like it that way, and that some who bow to pressure later regret their decision. Figures from Australia give a more accurate picture. According to <a href="https://www.circinfo.org/statistics.html" rel="noopener" target="_blank">Medicare statistics</a>, from 2009 to 2016 the number of circumcisions of boys under 6 months of age fell from 20246 to 14880. In the same period, the number of circumcisions among males aged 10 years and over increased from 3039 to 3205. Some of these are probably the result of a wrongful diagnosis of phimosis, but most would have been done with at least a degree of consent, even for boys under 18, as few parents could force a boy older than 10 years to get circumcised if he really did not want to be. Since Medicare does not give a more detailed breakdown by age, it is not possible to know the number of men over the age of 18 who elect circumcision for themselves; but it is likely that most of the cases in the over 10 years of age category occur before age 18, in order to deal with foreskin tightness problems arising when the penis enlarges at puberty. Even without this detail, and considering that the current male birthrate in Australia is about 160,000 per year, it is clear that the number of competent males electing circumcision for themselves in a society where the majority of men are not circumcised, and the rate of infant circumcision (under 6 months of age) is less than 10%, is miniscule – good evidence that most men like and appreciate their foreskins. One curious piece of evidence is a recent survey of “genital dissatisfaction” by Gaither et al.** They surveyed a sample of about 4000 American men and found that only 62 per cent were “satisfied” with their circumcision status, 35 per cent were “neutral” and 7 per cent were “dissatisfied”. Unfortunately, the researchers failed to ask the respondents to state whether they were circumcised or not, so it is impossible to know how many of the “satisfied” customers were happy because they had not been circumcised or because they had been, and the same uncertainty applies to the “unsatisfied” and “neutral” categories. What is striking about the survey is (1) the low level of satisfaction overall: the highest score was only 64 per cent, relating to the shape of the glans; and (2) the high level of a “neutral” response, suggesting that a high proportion of American men are pretty fatalistic about these matters. From the point of view of assessing attitudes to circumcision, however, the survey tells us almost nothing. ** Thomas W. Gaither et al. <a href="https://link.springer.com/article/10.1007/s10508-016-0853-9" rel="noopener" target="_blank">Characterization of Genital Dissatisfaction in a National Sample of U.S. Men</a>. Archives of Sexual Behaviour 46 (2017): 2123-2130. I think the truth of the matter is that most men are reasonably content with whatever fate has dealt them, or at least resigned to their situation, and I suspect that many of the uncircumcised men who seek circumcision in adulthood are the very ones who would have embarked on foreskin restoration had they been circumcised in childhood. For some men, the grass is always greener in the next paddock. But the situation is not symmetrical: a male who has not been circumcised can always get himself circumcised if that is what he desires; a male who has been circumcised in infancy or childhood does not have the option of getting his foreskin back. <h3>Intensity of feeling, degree of harm</h3> There is also the question of the intensity of feeling. Suppose that in a sample of 100 circumcised men 90 expressed themselves content with their state, while 10 reported discontent or resentment. It looks as though most men are pretty happy, but these raw figures take no account of the intensity of the feelings: it may be that the feelings of the 10 who resent having been circumcised are much stronger than the feelings of satisfaction expressed by the contented majority. If their feelings were, say, 10 times stronger, the overall level of dissatisfaction or resentment would exceed the level of satisfaction. The problem is that intensity of feeling is not a variable that can easily be quantified, so most researchers make little serious attempt to include it in their studies; yet without an accurate assessment of intensity, definite conclusions about the degree of satisfaction or dissatisfaction cannot be reached. Similar considerations apply to the degree of strictly physical harm. At one end of the spectrum there are mild and average circumcision procedures; at the other end the severe penile injuries sustained by Xhosa teenagers in their bush initiation, or by children in clinical settings who suffer excessive tissue removal or loss of their glans or entire penis, not to mention opportunistic infections, bleeding and other adverse side-effects, <a href="http://www.cirp.org/library/death/" rel="noopener" target="_blank">sometimes causing death</a>. When reaching overall conclusions about the incidence of what are euphemistically called “complications”, it is necessary to factor in the severity of the damage, not merely the raw number of incidents. I do not pretend that it is easy to do this, and if it proves to be impossible then medical authorities should be up-front and admit that the real risks of circumcision complications cannot be quantified - as the American Academy of Pediatrics actually <a href="https://www.circinfo.org/United_States_circumcision_policy.html" rel="noopener" target="_blank">conceded in their 2012 policy</a>. But if the mere physical risks cannot be quantified (let alone ethical, psychological and other factors), perhaps (<a href="http://www.cirp.org/library/general/dritsas1/" rel="noopener" target="_blank">as Dritsas argued long ago</a>) there should be a moratorium on non-therapeutic circumcision procedures until we have this information. <h2>Circumcision also objectively harmful</h2> While the subjectivities are important (and cut both ways), I think that circumcision is objectively harmful insofar as it involves cutting of flesh, inflicting injury and removing a normal body part, even if men do not think, or do not say, that they have been harmed. There are certain analogies with slavery and women’s subordination. Slaves endured their servitude, and women their subordination, for centuries without making much of a fuss. It was only when a few agitators, influenced by the development of the concept of human rights in the eighteenth century Enlightenment, started to raise their consciousness that they began to regard themselves as harmed by their condition. Even in the American Civil War the lead in the fight against slavery was taken by northern liberals, not the slaves. Even if circumcision did not cause significant harm it would not amount to a reason why it should performed: for circumcision to be legitimately done, there must be compelling arguments as to why it is significantly better to be circumcised. If it does not make much difference, given the risks and costs, the best (least risk and least cost) course is not to do it. It should not, therefore, be necessary to prove that circumcision is harmful for it not to be performed, merely that it does not do significant net good. I concede that if it is to be legally prohibited, it is necessary to prove harm (on the principle that the role of the law is to prevent persons from harming others), but this rule applies as much to FGC as to MGC. Personally, I have never argued that circumcision should be criminalised, and do not believe that it should be; at the same time, I believe that governments should make more effort to discourage the practice, rather than allowing the open slather that prevails in most places at present. For some of my ideas, see my submission to the <a href="https://www.academia.edu/8658588/Submission_to_Tasmania_Law_Reform_Institute_inquiry_into_non-therapeutic_circumcision_of_male_minors" rel="noopener" target="_blank">Tasmania Law Reform Institute inquiry</a>. <h3>Anecdotal evidence</h3> It is often asserted that claims by men that they have been harmed by circumcision are worthless because they are merely anecdotal evidence. In fact, most claims of harm are not anecdotal at all, but personal testimony: men who have been circumcised reporting their own experience. Anecdotal evidence is properly hearsay – what somebody heard reported about somebody else. Personal testimony is usually reliable evidence: if it is enough to get somebody convicted of a capital offence in a court of law it ought to be enough to persuade an impartial judge or jury that the complainants have suffered harm. <h3>Botched circumcisions?</h3> “Botched circumcision” is a misleading expression that ought not to be used. It suggests that circumcision normally gives what is glibly referred to as “an excellent cosmetic result”, and that something goes wrong in only a very few cases – though sufficiently numerous to drive the Mogen Clamp company out of business as a result of lawsuits. What “botched circumcision” seems to designate are cases where the damage extends beyond the foreskin, such as clipping off portions of the glans, or ripping the body of the penis shaft. I would define it as damage beyond what was intended – but exactly what anatomical result is intended by circumcision is variable and rarely specified. Some writers suggest that excessive skin removal should be regarded as a botched circumcision, but “excessive” is a matter of arbitrary and subjective judgement. In fact, the removal of so much skin that erections at puberty become painful or difficult is quite common and not regarded as a disability by most doctors in places where circumcision is (or was) normative. <a href="http://www.historyofcircumcision.net/index.php?option=com_content&task=view&id=93&Itemid=0" rel="noopener" target="_blank">Shane Peterson had such a severe circumcision</a> that his erections at puberty were both painful and restricted, and he actually considered sexual reassignment surgery and made a suicide attempt. When he sought help from doctors and psychologists they told him that his circumcision was perfectly normal and that the problem was entirely in his head. I have heard (in person or by correspondence) many similar reports from other circumcised men. The question of when skin removal is excessive raises the question of the purpose of circumcision. Is it simply to ensure that the glans is permanently bared, or is to remove as much loose tissue as possible? The Victorian anti-masturbation campaigners wanted to prevent the gliding action that facilitated bad habits, while the anti-syphilis crusaders wanted to ensure that the glans became dry and hardened and thus impermeable (as they thought) to the syphilis microbes. Circumcision does make the glans go dry and hard, but there has never been any proof that circumcised men were less susceptible to infection with syphilis. In the case of HIV, if (as is claimed) the mucosa of the foreskin is the principal Trojan Horse for entry of the virus, it follows that the circumcision procedure should be as radical as possible. <h3>Frenulum not part of the foreskin?</h3> Like excessive skin removal, the definition of the extent of the foreskin is a matter for judgement because there is no clearly demarcated point where the foreskin ends and the rest of the penis begins. The penis is an integrated structure, not one composed of detachable modules – as illustrated vividly in discussions of its embryology. The Renaissance anatomists described the frenulum as the “bridle” that tethered the foreskin and ensured that it rolled back into place when not in use. They also noted that it was highly sensitive to both pain and pleasure. It is of interest that <a href="http://www.cirp.org/library/history/hodges2/" rel="noopener" target="_blank">the ancient Greeks</a> had no separate word for foreskin: posthe was penis, and akroposthion (often translated as foreskin) designated the top, or tip or peak of the penis; they evidently saw the penis as a unitary structure. While circumcision is often likened to snipping off the end of an asparagus stalk, it is really more like tearing the sepals off a rosebud. (This image might be regarded as too emotive; but at least in the case of roses the difference between the petals and the sepals is pretty clear; no such sharp demarcation can be found between the foreskin and the rest of the penis.) These points are illustrated in this description of a circumcision procedure by a Victorian doctor who sought “an improved method of circumcision” because it was difficult “to separate the inner layer [of the foreskin] from the tiny glans, wet and slippery with blood” as it usually was. The virtue of MacLeod’s proposed technique was that it made it easier for doctors to see what they were doing and thus limit damage to what they intended: “The last case operated on, in a child of two years, scarcely admitted the point of a probe through the orifice of the prepuce, but by dilating this orifice forcibly with “sinus forceps”, and the addition of a few tiny snips with scissors round the margin … the foreskin could be drawn back until the point of the glans showed itself. Further retraction was prevented by the adhesions … but these were easily broken down by means of a probe passed between the prepuce and the glans, and this done until the corona glandis was exposed.” (Macleod, Neil (1883), “An improved method of circumcision for congenital phimosis”, Edinburgh Medical Journal, Vol. 28, pp. 807-8) Only then was it possible to start cutting the foreskin off. Whether the frenulum is regarded as part of the foreskin or not, it is nearly always removed in circumcision procedures these days, as even the most cursory survey of internet porn sites will reveal. I have noticed that the penises of Muslim men seem to be particularly severely denuded, but the typical American penis is similar. (Check out some of the tumblr.com accounts if you need visual evidence, especially those specialising in circumcised penises.) <h3>Anatomy texts</h3> Information in anatomy texts is useful, but textbooks are often out of date, as they tend to repeat old information from one edition to the next, and they leave the issue at an abstract level. We are dealing here with flesh and blood, and an organ that is the most loaded and contested site on the human body. There is really no substitute for close visual and tactile examination of the parts in question, not merely in a state of rest, but in actual operation. For this reason, I would give the reports of men who have sex with men (MSM) at least as much credence as those of most medical personnel, especially urologists – who only see people with problems and thus tend to develop a jaundiced view of the body. Most MSM have extensive experience of penises, not merely as objects to look at, but as functioning organs. My impression from internet dating sites is that MSM have a strong preference for the uncut penis, suggesting that in their experience it makes for a more satisfying sexual experience. <h3>Not circumcising the best way to minimise risk of harm</h3> In our paper, <a href="https://www.academia.edu/32233620/Circumcision_sexual_experience_and_harm" rel="noopener" target="_blank">Circumcision sexual experience and harm</a>, Brian Earp and I argued that inadequate information on the harms of nontherapeutic circumcision is a reason for leaving the choice to male minors when they are old enough to make an autonomous choice for themselves. An even more important reason is because it is impossible to predict how a boy will react to discovering that he has been circumcised and what he will feel about it later – happy, indifferent, resentful, suicidal? Not circumcising is simply <a href="http://www.onlineopinion.com.au/view.asp?article=13123&page=1" rel="noopener" target="_blank">the least-risk option</a>. <h2>Resentment or satisfaction:</h2> <h3>The four key factors that determine a circumcised male’s attitude to his circumcision</h3> Hypothesis: Age is not the key factor, but usually a proxy for more important variables, namely: • Autonomy: Elected, consented or coerced • Conformity: Circumcision status of peers • Consciousness: Whether aware at the time • Rationale: Whether therapeutic or non-therapeutic For the purposes of this typology I assume that circumcision can be elected or consented to after puberty or from age 16 (whichever comes later). Procedures before then are characterised as coerced, even where children have requested them, agreed or not expressed objections. Likelihood of satisfaction and absence of resentment – sliding scale from most satisfaction and least resentment to least satisfaction and most resentment. 1. Elected therapeutic or non-therapeutic circumcision (a) where peers mostly circumcised; (b) where peers mostly not circumcised. Non-therapeutic here could mean cultural/religious, cosmetic, conformist, sexual fetish or any other non-medical reason. Therapeutic means correcting a foreskin problem that is causing discomfort, inconvenience or other medical or sexual dysfunction. 2. Infant circumcision (not aware at time) where peers mostly circumcised. Lack of awareness that anything was taken away and absence of experience of possessing a foreskin would be predicted to increase satisfaction and reduce resentment; and the converse applies. This category includes Jewish circumcision and routine circumcision in USA, and expresses the relatively high level of satisfaction and low level of resentment in these groups. 3. Childhood therapeutic circumcision (aware at time) (a) where peers are mostly circumcised; (b) where peers are mostly not circumcised. 4. Childhood non-therapeutic circumcision (aware at time) where peers mostly circumcised. This includes most cultural/religious procedures, notably Muslim and many tribal 5. Infant circumcision (not aware at time) where peers mostly not circumcised. 6. Coerced adult (age 14-plus) circumcision (a) where peers mostly circumcised; (b) where peers mostly not circumcised. Further refinements are possible, such as the difference between actively elected and passively consented to; and it would be possible to give greater weight to the conformity factor (circumcision status of peers). There is a case for switching items 3 and 4, but I have categorised childhood cultural/religious circumcision as likely to generate more resentment and less satisfaction because there are many more of them, so more scope for a range of subjective responses; and because a (genuinely) therapeutic circumcision would remove a source of discomfort and contribute to well-being. There is a Turkish study** showing that a high percentage of boys find their circumcision rite a terrifying and painful ordeal; and any number of videos available on Youtube will confirm this impression. ** Sahin F, Beyazova U, Akturk A. “Attitudes and practices regarding circumcision in Turkey.” Child Care Health and Development 29 (2003): 275-280. <a href="http://www.cirp.org/library/cultural/sahin1/" rel="noopener" target="_blank">Abstract at cirp.org</a>. <h3>Further discussion: Knowledge of alternatives</h3> The second variable above (condition of peers) could be framed more broadly as degree of knowledge that the penis can come with foreskin intact. Such awareness is more likely to the extent that males in that society are not circumcised and less likely to the extent that they are, but knowledge through other means (books, magazines, contact with other places, internet) can also be significant. What is remarkable about the United States is not the fact that most circumcised men seem to accept their condition without complaint, but that any men at all resent their situation. It cannot be an accident that the rise of a community-based anti-circumcision movement developed at precisely the same time as growing awareness that the uncircumcised penis was a viable option and the normal thing on a world scale. Such knowledge came in a variety of forms: increasing international travel, exposure to classical and Renaissance art (especially ancient Greek and Roman sculpture) and – perhaps most importantly – the availability of visual pornography that showed human genitals in explicit detail. This latter resource exploded with the rise of the Internet, which has always been awash with images of human genitalia, including penises. It may reasonably be hypothesised that such exposure to the intact penis, particularly on the bodies of the attractive, athletic men that are typically displayed in pornographic material would be likely to have two effects: (1) to attract women who, as mothers, would then be less likely to seek circumcision for their own sons; and (2) to arouse feelings of envy and inadequacy among men who had been circumcised in infancy or childhood. On top of all this, the development of an anti-circumcision movement led to a public debate that brought the issue into the open and made an immense wealth of alternative information available, particularly through dedicated websites available to anybody with internet access. It has been the ready availability of such alternative sources of information that led to a significant decline in the incidence of routine <a href="https://www.circinfo.org/news_2012.html#korea" rel="noopener" target="_blank">circumcision in South Korea</a>. By contrast, in closed monocultural societies lacking any contact with other cultures, and where all males are circumcised in infancy or childhood, there will never be any opportunity for comparison, and it is thus unlikely that many people (or any people) will suppose that it is possible not to be circumcised, or even capable of imagining such a state. In societies of universal infant circumcision, nobody will even know what a normal adult penis looks like, let alone whether it functions differently. In this situation there is unlikely to be any noticeable discontent; in Jewish communities, for example, there has been strong evidence of dissent from the circumcision rule only during periods when Jewish people were seeking integration into the wider society, notably the Hellenistic period of the ancient Mediterranean; nineteenth century Germany; and the contemporary world. (See <a href="https://www.academia.edu/12088696/The_forgotten_critics_Jewish_arguments_for_and_against_circumcision_have_a_long_history" rel="noopener" target="_blank">The Forgotten Critics</a> for details.) In today’s increasingly globalised, multi-inter-connected world, where even the most poverty-stricken village in darkest Africa has access to television, smart phones and the internet, closed societies of this old type can scarcely exist. In this situation we can expect the strengthening of two opposed trends: increasing opposition to circumcision from young people in cultures where it remains normative; and increasingly desperate efforts on the part of cultural and medical conservatives to preserve the practice. Written for Circumcision Information Australia by Dr Robert Darby </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Unquantifiable subjectivity of circumcision harms darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>Circumcision and sexuality</h2> Perhaps no issue has been more bitterly or emotionally debated than the question of what difference circumcision makes to the experience of sex. Circumcision promoters insist that it makes no difference or even improves a man's sex life and that women prefer circumcised partners. Critics of circumcision point to a considerable body of evidence that circumcision makes a big difference, that there is no evidence that women in general prefer circumcised partners, and that - on the contrary - women may enjoy sex more with uncircumcised men. For much of the twentieth century enthusiasts for routine circumcision have echoed the sentiments of the Victorian sexual health expert (and chastity advocate) William Acton: Although it is possible that it [the foreskin] may increase the pleasure derived from the act of sexual congress, there is no evidence that Jews, and those who have undergone circumcision, do not enjoy as much pleasure in the copulatory act as the uncircumcised; – at any rate, the former do not complain.[1] The claims are clear: first, that circumcision makes no difference to a male’s experience of sex; second, that even if it did men do not complain about what they are missing. An obvious point to note is that Acton’s first assertion directly contradicts the medical knowledge of his own day; throughout history and up to the end of the nineteenth century it was generally held by authorities on medical and sexual matters that the foreskin made a significant contribution to the sexual pleasure of both men and their partners. Far from there being “no evidence”, there is so much that the problem becomes one of selection: from many possible sources we may cite the early eighteenth century surgeon John Marten as representing the orthodox position: This Nut is … cover’d with the preputium or Fore-skin, which is of a loose texture, for the better covering of the Nut, and furling itself up behind the Ring or Hoop, to uncover it; therefore serves as a Cap to the Nut, and to enlarge the pleasure that attends Enjoyment, for in the act of Coition it flips backwards and forwards, being tied together with a membranous String call’d the Fraenum or Bridle, and causes the greater pleasure thereby, both to the Man and the Woman … The cutting of this Preputium or Fore-skin, is done by the Jews, and call’d Circumcision; by having of which taken away, ‘tis said those People lose much of the pleasure in the act of Copulation.[2] Acton’s statement is even inconsistent with the medical wisdom of the Victorian period, since it was precisely the erotic significance of the foreskin that led the physicians of that “anti-sensual age” to urge its removal.[3] As the prominent surgeon Jonathan Hutchinson expressed it: The only function which the prepuce can be supposed to have is that of maintaining the penis in a condition susceptible of more acute sensation than would otherwise exist. It may be supposed to increase the pleasure of coition and the impulse to it. These are advantages, however, which in the present state of society can well be spared, and if in their loss some degree of increased sexual control should result, one should be thankful.[4] Acton himself acknowledged the contribution of the foreskin to sexual pleasure when he denounced it as “a source of serious mischief” and a constant threat to the strict continence he regarded as essential to both morals and health.[5] In the twentieth century the Puritanism of the Victorians gradually softened, and sexual pleasure came to be seen as a good thing, even a human right, rather than a menace to health and virtue.[6] Advocates of routine circumcision thus found it necessary to minimise the adverse effects of such surgery on sexuality and to focus strictly on its benefits for health. For this purpose they have relied heavily on a sloppy and irrelevant piece of research that Masters and Johnson claim to have carried out and published in their much-read book on human sexual response. References 1. Acton, W. The functions and disorders of the reproductive organs in childhood, youth, adult age and advanced life. 3rd edn. Philadelphia: Lindsay and Blakiston, 1865, p 22 2. Marten, J. Gonosologium novum: Or a new system of all the secret infirmities and diseases natural, accidental and venereal in men and women. London, 1709; Facsimile reprint, New York: Garland Publishing, 1985, p 12 3. Moscucci, O. Clitoridectomy, circumcision and the politics of sexual pleasure in mid-Victorian Britain. In: Miller AH and Adams JE ed. Sexualities in Victorian Britain. Bloomington: Indiana University Press, 1996 4. Hutchinson, J. The advantages of circumcision. Medical Review 1900;3:642 5. Darby, R. A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain. Chicago: University of Chicago Press, 2005. chap 6 6. Cook, H. The long sexual revolution: English women, sex and contraception 1800-1975. London: Oxford University Press, 2004 <h3>Three questions</h3> We cannot hope to settle the question here, but three points ought to be made. First, it defies common sense and logic to assume that cutting the part of the penis that contains the vast bulk of the pleasure-sensing nerves could not make a difference to sexual function and sensation. The loss of the mobile sheath of tissue must also make a huge difference. Secondly, although some men who choose circumcision as adults and say that it improved their sex life, you cannot assume that the effects of circumcision in adulthood are the same as the operation in infancy or childhood. If you cover a baby's eyes at birth he will never learn to see properly because he needs the stimulus of light on the optic nerve to activate the neuronal pathways in the brain that control vision. There is evidence (from studies by Immerman and Mackey - both advocates of circumcision, incidentally) that something similar may occur if the foreskin is removed in infancy. It may well be that circumcision did improve the sex lives of some men, but in most cases this would have been because they had severe phimosis that inhibited any movement of the foreskin. Most such problems these days can be fixed by application of steroid cream. Thirdly, why should men have to prove to the satisfaction of the circumcision promoters that the foreskin makes a significant difference to sexual experience before they are allowed to keep it? The foreskin is a natural part of normal human anatomy (indeed, of all mammals), and the default position should be that it is a useful, beneficial or at least non-injurious structure. If the foreskin was as malevolent as the circumcision promoters claim, you would think that evolution might have abolished it by now. <h3>New research into nerve structure of penis shows foreskin to be the sexually dynamic element</h3> Ken McGrath, Senior Lecturer in Pathology at the Faculty of Health, Auckland University of Technology and Member of the New Zealand Institute of Medical Laboratory Scientists discusses his research into the neural anatomy of the human penis and the physical damages caused by circumcision. McGrath is author of The Frenular Delta: A New Preputial Structure published in Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem, Proceedings of the Sixth International Symposium on Genital Integrity: Safeguarding Fundamental Human Rights in the 21st Century, held December 7-9, 2000, in Sydney Australia. Abstract: Textbooks and papers referring to penile function state that the source of penile sensation is solely the glans and often justify the existence of the prepuce by stating it protects the 'sensitive' glans. These statements are contrary to the neuro-anatomical and physiological facts accumulated over more than a century. This study reviews the findings of Taylor, et al., that the prepuce is the primary sensory platform of the penis, and describes a new preputial structure. This interview was taped in Berkeley, California 2010 and from the <a href="http://www.circumcisionharm.org/">Global Survey of Circumcision Harm.</a> Removal of the male foreskin and the female clitoral hood (female foreskin) are anatomically equivalent. However, neurologically speaking, removal of the male foreskin is as destructive to male sexual sensory experience as removal of the clitoris is for females. This video discussion of penile and foreskin neurology explains why. Contrary to popular Western myth, many circumcised women do report the ability to feel sexual pleasure and to have orgasm, albeit in a compensatory manner that differs from intact women [suggested reading: Prisoners of Ritual by Hanny Lightfoot-Klein]. Similar compensatory behaviours for achieving orgasm are at work among circumcised men, who must rely on the remaining 50% or less of their penile nerve endings. Just as clitoridectomized girls grow up not knowing the levels of pleasure they could have experienced had they been left intact, so too are men circumcised in infancy unaware of the pleasure they could have experienced had they not had 50% of their penile skin removed. The above video also explains what's really behind the erroneous comment made by some circumcised men that they 'couldn't stand being any more sensitive'. <a href="https://www.youtube.com/watch?v=DD2yW7AaZFw" rel="noopener" target="_blank">Watch Ken McGrath's lecture on Youtube.</a> <h2>Scientific studies document harm of circumcision</h2> Two careful studies published in the world's leading jounral of urology, BJU International, demonstrate that circumcision damages the penis and cuts both sexual capacity and sexual satisfaction. <h3>Korea: Worse sex life after circumcision</h3> Two Korean researchers, DaiSik Kim and Myung-Geol Pang, studied 373 sexually active men, of whom 255 were circumcised and 118 were not. They found that circumcision reduced sexual pleasure in most cases and that a significant minority of men reported major injury to their penis, causing bleeding, scarring and chronic pain. Summarizing their results, the authors write: "There were no significant differences in sexual drive, erection, ejaculation, and ejaculation latency time between circumcised and uncircumcised men. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision." Conclusion: There was a decrease in masturbatory pleasure and sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings. DaiSik Kim and Myung-Geol Pang, <a href="http://www.cirp.org/library/sex_function/kim2006/">The effect of male circumcision on sexuality</a>. BJU Int 99(3):619-22 <h3>United States: Circumcision cuts sensitivity of penis</h3> Meanwhile, researchers in the United States have found that circumcision removes the most sensitive part of the penis. Researcher Dr Morris Sorrells and others enlisted 159 men from the San Francisco Bay area, 91 of them circumcised, and conducted touch-sensitivity tests, using an instrument that presses with calibrated hairs, on 17-19 different places on their penises. The men could not see where they were being touched. It was found that the most sensitive part of a circumcised penis was on the scar in the middle underneath. But several places on the foreskin were more sensitive than that while the glans of the uncircumcised penis was more sensitive than in the circumcised. The paper is summarised here: Objective: To map the fine-touch pressure thresholds of the adult penis in circumcised and uncircumcised men, and to compare the two populations. Subjects and methods: Adult male volunteers with no history of penile pathology or diabetes were evaluated with a Semmes-Weinstein monofilament touch-test to map the fine-touch pressure thresholds of the penis. Circumcised and uncircumcised men were compared using mixed models for repeated data, controlling for age, type of underwear worn, time since last ejaculation, ethnicity, country of birth, and level of education. Results: The glans of the uncircumcised men had significantly lower mean ( SEM ) pressure thresholds than that of the circumcised men, at 0.161 (0.078) g ( P = 0.040) when controlled for age, location of measurement, type of underwear worn, and ethnicity. There were significant differences in pressure thresholds by location on the penis ( P < 0.001). The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision had lower pressure thresholds than the ventral scar of the circumcised penis. Conclusions: The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis. Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU International 2007;99:864-9 <a href="http://www.cirp.org/library/anatomy/sorrells_2007/">Full text of article from CIRP</a> <a href="http://www.circumstitions.com/Sexuality.html">Further discussion, with diagrams and illustrations at Circumstitions</a> See also a revealing article by Paul Festa in Nerve magazine, <a href="http://www.nerve.com/dispatches/festa/howinsensitive/index.asp?page=1">How insensitive: A new study confirms a long-time fear: Circumcised men are missing out</a> See also <a href="https://www.circinfo.org/quote.html">Historical quotes on circumcision, foreskin and sexual function on this site</a>. <h2>Male circumcision and female sexual pleasure</h2> There is good evidence that male circumcision affects female sexual pleasure - and for the worse, not the better. Circumcision promoters are putting a lot of effort into trying to persuade people that circumcised men make better lovers, or at least that women "prefer" circumcised men. It may be true that in societies where circumcision is widespread, some women say they prefer what they are accustomed to; but it is equally true that in societies that practise female circumcision, men prefer circumcised women because that is what they are accustomed to. It is also true that some women who experience uncircumcised sex for the first time never want to go back. In any case, the imagined sexual preferences of adults are not a valid reason for interfering with children's genitals. Kristen O'Hara (with Jeffrey O'Hara), Sex as Nature Intended It (Hudson USA, Turning Point Publications, 2001) See Kristen's website: <a href="http://www.sexasnatureintendedit.com/">www.SexAsNatureIntendedIt.com</a> O'Hara K, O'Hara J. <a href="http://www.cirp.org/library/anatomy/ohara/">The effect of male circumcision on the sexual enjoyment of the female partner</a>. BJU Int 1999;83 Suppl 1:79-84. Bensley GA, Boyle GJ. <a href="http://www.cirp.org/library/sex_function/bensley1/">Effects of male circumcision on female arousal and orgasm</a>. N Z Med J 2003;116(1181):595-6. <h2>Czech women more likely to experience good orgasms than women in the United States</h2> A study published in the Journal of Sexual Medicine has found that Czech women have more a satisfactory experience of sexual intercourse than women in the United States. The researchers conclude that this is because the key factor in whether a woman has an orgasm is the duration of intercourse, and that the average duration intercourse in Czechoslovakia was more than double that in the United States: 16.2 minutes among the Czechs, compared with only 7 minutes among the Americans. As the authors of the study comment, the results could reflect “a greater appreciation of intercourse and sensuality by Europeans than by Americans.” Since Czech men are generally not circumcised and American men are, they may also reflect the harmful effect of male circumcision on women’s sexual enjoyment.T hese results are in complete contradiction with the story usually told in the popular U.S. media, that circumcised men “can last longer” before climaxing. The study did not consider this factor, but since circumcision is all but known in Czechoslovakia we can be confident that vast majority of the partners of the Czech women were not circumcised. By contrast, given the high incidence of circumcision in the United States, we can also be confident that most of the partners in the U.S. studies were circumcised. The inevitable conclusion is that circumcised men climax sooner, probably because their reduced sensitivity reduces the pleasure they derive from intercourse so severely that the their pleasure is pretty much limited to the orgasm itself. For uncircumcised men, on the other hand, there is as much pleasure in getting there as there is in arriving – a happy situation that clearly benefits women as well. Source: Petr Weis and Stuart Brody, Women’s partnered orgasm consistency is associated with greater duration of penile-vaginal intercourse but not of foreplay, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2008.01041.x/full">Journal of Sexual Medicine, Vol 6 (1), January 2009</a> <h2>Circumcision cuts sensitivity and damages sexual response</h2> A new study has found what thousands of circumcised men already know: that circumcision significantly reduces the sensitivity of the penis and has an adverse impact on male sexual functioning. The study, by researchers at the Department of Urology, Ghent University Hospital, Belgium, confirms earlier findings by <a href="http://www.cirp.org/library/sex_function/">Kim and Pang, Sorrells, Frisch and others</a> that the foreskin is the principal source of sensation in the penis, that it facilitates all kinds of sexual activity and enhances sexual pleasure. ABSTRACT What’s known on the subject? And what does the study add? The sensitivity of the foreskin and its importance in erogenous sensitivity is widely debated and controversial. This is part of the actual public debate on circumcision for non-medical reason. Today some studies on the effect of circumcision on sexual function are available. However they vary widely in outcome. The present study shows in a large cohort of men, based on self-assessment, that the foreskin has erogenous sensitivity. It is shown that the foreskin is more sensitive than the uncircumcised glans mucosa, which means that after circumcision genital sensitivity is lost. In the debate on clitoral surgery the proven loss of sensitivity has been the strongest argument to change medical practice. In the present study there is strong evidence on the erogenous sensitivity of the foreskin. This knowledge hopefully can help doctors and patients in their decision on circumcision for non-medical reason. Objectives To test the hypothesis that sensitivity of the foreskin is a substantial part of male penile sensitivity. To determine the effects of male circumcision on penile sensitivity in a large sample. Subjects and methods The study aimed at a sample size of ≈1000 men. Given the intimate nature of the questions and the intended large sample size, the authors decided to create an online survey. Respondents were recruited by means of leaflets and advertising. Results The analysis sample consisted of 1059 uncircumcised and 310 circumcised men. For the glans penis, circumcised men reported decreased sexual pleasure and lower orgasm intensity. They also stated more effort was required to achieve orgasm, and a higher percentage of them experienced unusual sensations (burning, prickling, itching, or tingling and numbness of the glans penis). For the penile shaft a higher percentage of circumcised men described discomfort and pain, numbness and unusual sensations. In comparison to men circumcised before puberty, men circumcised during adolescence or later indicated less sexual pleasure at the glans penis, and a higher percentage of them reported discomfort or pain and unusual sensations at the penile shaft. Conclusions This study confirms the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning. Furthermore, this study shows that a higher percentage of circumcised men experience discomfort or pain and unusual sensations as compared with the uncircumcised population. Before circumcision without medical indication, adult men, and parents considering circumcision of their sons, should be informed of the importance of the foreskin in male sexuality. Source: Bronselaer GA, Schober JM, Meyer-Bahlburg HF, T'sjoen G, Vlietinck R, Hoebeke PB. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11761.x/abstract">Male circumcision decreases penile sensitivity as measured in a large cohort</a>. BJU Int. 2013 Feb 4. doi: 10.1111/j.1464-410X.2012.11761.x. [Epub ahead of print] <h2>Foreskin has important sexual function: New research</h2> Research by scientists in Slovenia has confirmed <a href="http://www.cirp.org/library/sex_function/">previous research</a>, common knowledge and much personal testimony that the foreskin has an important sexual function. A paper by Simon Podnar, published in BJU International – the world’s leading urological journal – found that a reflex action known as the “penilo-cavernosus reflex” is rarely experienced by circumcised men. What this means in ordinary language is that circumcision, by excising the most important nerves of the penis, makes it less sensitive and less functional. The is result that men who retain their foreskins experience greater sexual excitability, better orgasm control and more pleasure. Writing in response to the article, Australia’s Greg Boyle welcomed the article for further developing the work of the late John Taylor and actually doing some objective, scientific investigation of the functions of the foreskin. This was a refreshing change from the ideologically-driven propaganda that pours out of the United States, more interested in exterminating foreskins than in understanding them. In fact, the foreskin is such a miracle of biological engineering that to destroy one without genuine need is an act of wanton vandalism. As Professor Podnar comments, “I see the prepuce as an ingenious device engineered to provide a strong sensory stimulation in a slippery environment”, the evolutionary purpose of which is to maximise the desire to reproduce. <h3>New research on the sexual function of the foreskin: The penilo-cavernosus reflex</h3> “It is known that foreskin, but not glans penis, contains a high density of fine-touch mechanoreceptors. Clinically the penilo-cavernosus reflex provides information on function of the sacral nerves. The study demonstrated that in the majority of circumcised men this reflex cannot be elicited clinically, but can be measured neurophysiologically.” Research by scientists in Slovenia has confirmed previous research by Dr John Taylor and others, common knowledge and much personal testimony that the foreskin plays an important role in male sexual response. A paper by Simon Podnar, published last year in BJU International – the world’s leading urological journal – found that a reflex action known as the “penilo-cavernosus reflex” is rarely experienced by circumcised men. What this means in ordinary language is that circumcision, by excising the most important nerves of the penis, makes it less sensitive and less functional; the result is that circumcised men experience less sexual excitability, less orgasm control and less pleasure. As Podnar writes, “The present study confirmed my previous observations that the penilocavernosus reflex is more difficult to elicit clinically in circumcised men. … The probable reason for this finding in circumcised men is the elimination of the most sensitive part of the penis (i.e. the foreskin), and to a lesser extent, desensitization of sensory receptors in the penile glans.” While the nerves of the foreskin are highly sensitive to light touch and gentle manipulation, those of the glans respond only to strong pressure, heat and pain. These findings have significance for treatment of male sexual dysfunction, including premature ejaculation, as well as urinary and bowel control. Source: Podnar S. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2011.10364.x/abstract">Clinical elicitation of the penilo-cavernosus reflex in circumcised men</a> . BJU Int 2012; 109: 582–5. <h3>Commentary on Podnar’s research</h3> Writing in response to the article, Australia’s Greg Boyle welcomed the article for further developing the work of <a href="http://research.cirp.org/">the late John Taylor</a> and actually doing some objective, scientific investigation of the functions of the foreskin. It was refreshing to find a government sponsoring research aimed at improving our (highly inadequate) understanding of the anatomy and physiology of the foreskin, instead of merely cooking up yet more justifications for cutting it off. We will never understand the biology of the mature foreskin unless we can observe and study it in operation, as it were, and this will not be possible if it is routinely amputated in infancy. The full text of Greg Boyle’s letter and Simon Podnar’s reply follows: 1. Greg Boyle’s letter In a recent issue of the BJUI, Professor Podnar [1] reported his findings concerning the clinical elicitation of the penilo-cavernosus reflex in genitally intact men as compared with circumcised men. Previously, Taylor [2] had reported that, “Almost certainly, removal of the prepuce and its ridged band distorts penile reflexogenic functions but exactly how and to what extent still remains to be seen”. While Podnar’s study attempted to ascertain the magnitude of this reflexogenic disability, it is notable however that he used different stimulatory techniques in genitally intact vs circumcised men. As reported in his paper, Podnar tested the penilo-cavernosus reflex in intact men by squeezing the glans through the overlying foreskin, thereby stimulating the sensory receptors both within the foreskin itself as well as in the glans, whereas in circumcised men, the stimulus necessarily could only be applied to the glans (which is relatively devoid of fine-touch sensory receptors as compared with the inner foreskin with its dense innervation of Meisners’ corpuscles) [2–6]. This procedural discrepancy raises questions as to the validity of Podner”s clinical findings reported for circumcised and genitally intact men respectively. Circumcision and premature ejaculation In regard to PE, Podnar [1] repeated the common myth that “the glans is too sensitive”. To the contrary, PE with little or no sensation/feeling would suggest that the glans is not very sensitive at all. Many circumcised young men ejaculate prematurely but feel very little pleasurable sensation [7]. It would appear that PE may occur before there is much build-up of sexual excitement/tension, so that ejaculation is pretty much a “non-event”. Anecdotally, in the USA where most males have been subjected to routine neonatal circumcision, many young women have commented to their male partner, “Is that it?” Is it not more likely that it is precisely the lack of neurological control over the timing of ejaculation resulting from the severed neuronal circuitry after circumcision that is a major causal factor in PE? Indeed, Bollinger and Van Howe [8] pointed out that, “circumcised men are 2.56 times more likely to suffer from premature ejaculation, and, when the data were adjusted to include erectile dysfunction, that risk rose to 4.88 times”[9]. Moreover, “A recent multinational population survey using stopwatch assessment of the intravaginal ejaculation latency time (IELT) found that in Turkish men, the vast majority of whom are circumcised, had the shortest IELT [10,11]. This report is yet another small piece of the puzzle regarding the adverse effects of circumcision on sexual function [12,13], but cross-validation on much larger samples would seem important. There appears to be a paucity of research funds available to objectively investigate foreskin neurology, physiology, anatomy and sexual function, whereas formidable research resources appear to go to projects aimed at finding “justifications” for ablating the male foreskin. The whole area is still shrouded in myths and distorted by the fact that so much research is carried out in “foreskin-free zones” such as the USA. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11250.x/full">Full text with references available from BJUI, 16 August 2012</a> 2. Simon Podnar’s reply There is a long lasting dispute about the physiological role of the prepuce in human. I see it as a tinny [sic] structure sitting at the evolutionary pinnacle, where our “selfish genes” fight their way into the next generation. Competition here is harsh, with no room for redundancy. I see the prepuce as an ingenious device engineered to provide a strong sensory stimulation in a slippery environment of a copiously lubricated vagina. Evolution achieved this by the tubular prepuce sliding during sexual activity over the conically shaped glans as far as the frenulum allows. Both, the prepuce and the frenulum, have rich mechanoreceptor innervation [1] sending a large sensory input to the brain. The goal of this mechanism is to achieve maximum procreative efficiency of the semen by optimising ejaculation in place and time. To achieve this, the brain also needs to be finely tuned with the genital sensory structures. Intuitively, removal of the penile most sensitive genital structure would lead not only to reduced sexual sensation [2], but also to more difficult achievement of ejaculation. This reasoning – named by Professor Boyle “common myth”– logically leads to a thought that circumcision might be a useful therapy for premature ejaculation (PE). In line with this, in my paper [3] I cited a report that found a reduction in PE in three of seven patients [4] circumcised due to different penile pathology (e.g., phimosis, balanitis, condyloma, etc.). However, I have to admit that these penile conditions made this empirical support unconvincing. Professor Boyle, by contrast, cites studies showing higher frequency of PE [5] and shorter intravaginal ejaculation latency time (IELT) [6] in circumcised men. Of these, higher frequency of PE in the circumcised seems more convincing, as no effect of circumcision status on IELT could be found in an international study after the exclusion of Turkey [6]. Islamic or Asian background was suggested to be a risk factor for PE irrespective of circumcision status [7]. Nevertheless, anything but lower frequency of PE and longer IELT in the circumcised sounds contra intuitive, and needs explanation. The answer, I believe, is neuroplasticity – changes in the thresholds and connectivity that occur within the CNS after circumcision. The method of the penilo-cavernosus reflex elicitation I used in my study [3] indeed activated only deep pressure and pain receptors [8] in the glans in the circumcised men. By contrast, in the intact men, the Meisners’ corpuscles [9] within the foreskin were also stimulated. However, I do not share the opinion of Professor Boyle that this reduces validity of my clinical findings. In both, the intact and circumcised men, I activated all the available sensory receptors at the tip of the penis, and I showed unequivocal differences in the elicitability of the penilo-cavernosus reflex in the two populations of men [3]. The finding is relevant both for using the reflex as a clinical test, and also for demonstration of possible functional differences. During sexual activity both the glans and the overlying foreskin are stimulated in intact men, as discussed above. However, I do agree that using this approach I could not differentiate absence of Meisners’ corpuscles in the foreskin or desensitisation of deep pressure and pain receptors in the glans as the reason for the reduced reflex elicitability found in the circumcised men. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11250_2.x/full">Full text with references available from BJUI, 16 August 2012</a> <h2>Denmark study: Circumcision cuts sexual satisfaction in men and partners</h2> Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark. Frisch M, Lindholm M, Grønbæk M. Male circumcision and sexual function in men and women: A survey-based, cross-sectional study in Denmark, International Journal of Epidemiology 40 (5), October 2011, 1367-1381. ABSTRACT BACKGROUND: One-third of the world's men are circumcised, but little is known about possible sexual consequences of male circumcision. In Denmark (~5% circumcised), we examined associations of male circumcision with a range of sexual measures in both sexes. METHODS: Participants in a national health survey (n = 5552) provided information about their own (men) or their spouse's (women) circumcision status and details about their sex lives. Logistic regression-derived odds ratios (ORs) measured associations of circumcision status with sexual experiences and current difficulties with sexual desire, sexual needs fulfilment and sexual functio ning. RESULTS: Age at first intercourse, perceived importance of a good sex life and current sexual activity differed little between circumcised and uncircumcised men or between women with circumcised and uncircumcised spouses. However, circumcised men reported more partners and were more likely to report frequent orgasm difficulties after adjustment for potential confounding factors [11 vs 4%, OR(adj) = 3.26; 95% confidence interval (CI) 1.42-7.47], and women with circumcised spouses more often reported incomplete sexual needs fulfilment (38 vs 28%, OR(adj) = 2.09; 95% CI 1.05-4.16) and frequent sexual function difficulties overall (31 vs 22%, OR(adj) = 3.26; 95% CI 1.15-9.27), notably orgasm difficulties (19 vs 14%, OR(adj) = 2.66; 95% CI 1.07-6.66) and dyspareunia [painful intercourse] (12 vs 3%, OR(adj) = 8.45; 95% CI 3.01-23.74). Findings were stable in several robustness analyses, including one restricted to non-Jews and non-Moslems. CONCLUSIONS: Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment. Thorough examination of these matters in areas where male circumcision is more common is warranted. <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=21672947" rel="noopener" target="_blank">Abstract of study available here</a> <a href="http://www.circumstitions.com/Sexuality.html#denmark" rel="noopener" target="_blank">Report of study with graphic illustrations</a> <a href="http://www.davidwilton.com/files/mc-and-sexual-function---denmark-2011.pdf" rel="noopener" target="_blank">Download study in full as pdf file</a> <h2>Researchers defend Danish study showing that male circumcision has adverse effect on sexual satisfaction</h2> In 2011 <a href="https://www.circinfo.org/controversy.html#frisch1">Circinfo.org reported a study</a> by Danish researchers which found that circumcision reduces sexual satisfaction not only in circumcised men, but also in their female partners. The study by Morten Frisch et al, published in the International Journal of Epidemiology in October 2011, examined the association of male circumcision with a range of sexual measures in both sexes. It found that circumcision was “associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment.” Not surprisingly, these conclusions did not please circumcision advocates such as Brian Morris, who has set himself the daunting task of proving not only that circumcision is a “biomedical imperative for the 21st century” for various "health" reasons, but also that that the amputation of the foreskin has no impact at all on sexual function (and may even improve the operation and appearance of of the penis). He fired off a lengthy critique in reply, denouncing Frisch’s motives as much as his methodology. In his response (International Journal of Epidemiology, February 2012), Frisch not only debunks these criticisms, but reveals that following publication Morris sent emails to his supporters, urging them to send letters of complaint about the article to the editors of the journal, and (what is worse) disclosing the fact (meant to be kept confidential) that he was one of the original peer reviewers and had recommended that the paper not be published at all. Compromising the confidentiality of the peer review process in this manner is a serious breach of publication ethics. In his dignified reply to this blatant lobbying, Frisch highlights the implausibility of Morris’s attempts to portray himself as a “neutral and unbiased authority” on the “medical benefits” of circumcision, while attacking anybody who dares to disagree with him as ideology-driven anti-circumcision activists. He points out that Morris obviously has his own agenda, revealed in an impressive record of anti-foreskin activism going back to the 1990s. Frisch defends the conclusions of his own study as supported by good evidence and casting grave doubt on optimistic (?) claims that circumcision has no impact on sexual function. <h3>Full text of Morten Frisch’s reply to Morris et al</h3> Morten Frisch, Author’s Response to: Does sexual function survey in Denmark offer any support for male circumcision having an adverse effect? Novel findings in our population-based survey, which had participation rates of 48% in men and 54% (not 40%, as wrongly mentioned by Morris et al.) in women, suggest, but by no means prove, the existence of non-trivial associations of male circumcision with frequent orgasm difficulties in men and with a range of frequent sexual difficulties in women, including orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment. Morris et al. should not be blamed for feeling unconvinced by our findings. However, as these critics repeatedly refer to Morris’ pro-circumcision manifesto [1] as their source of knowledge, their objectivity must be questioned. Morris et al. express concern over possible overfitting in our logistic regression models because we included a number of potentially confounding variables that differed between circumcised and uncircumcised men and between women with circumcised and uncircumcised spouses. However, as seen in Tables 3–6 of our paper, models with adjustment only for age provided odds ratios (ORs) similar to those obtained in the fully adjusted model, suggesting that this is mostly a theoretical concern. Next, Morris et al. suggest that we should have corrected for multiple testing even though such statistical manoeuvres are, at best, unnecessary and, at worst, deleterious to sound statistical inference in most epidemiological studies. [2] Morris et al. also claim that prevalence ratios would have been more appropriate measures of association than ORs. However, despite Morris et al.’s firm statement to the contrary, there is nothing inherently inappropriate about using ORs in cross-sectional studies, even in situations with common outcomes. In such situations, however, ORs should not be misinterpreted as prevalence ratios. We would have been wrong to claim that our OR of 3.26 implied that frequent sexual difficulties were 3.26 times more common in women with circumcised spouses than in women with uncircumcised spouses. Nowhere in our paper did we interpret ORs in such a flawed manner. In accordance with the cited reference [3] we simply noted that frequent sexual difficulties were more common in women with circumcised spouses and that the associated fully adjusted OR was 3.26. Next, Morris et al. argue that our finding of considerably higher rates of frequent orgasm difficulties in (partially) circumcised than uncircumcised Danish men (11 vs 4%, OR1/43.26) may not apply in countries where circumcision means complete amputation of the foreskin. This may well be the case. If partial amputation of the foreskin truly entails frequent orgasm difficulties in a noticeable proportion of men (as experienced by 11% of circumcised men in our study), comparable proportions may well be larger and associated ORs even higher in countries where circumcised men experience greater tissue loss due to more extensive circumcision procedures. Obviously, more data are needed from rigorous studies using carefully constructed questionnaires. The questionnaires used to assess potential sexual problems in the two cited randomized controlled trials in Kenya and Uganda were not presented in detail in the original publications. [4,5] Rather than blindly accepting such findings as any more trustworthy than other findings in the literature, it should be recalled that a strong study design, such as a randomized controlled trial, does not offset the need for high-quality questionnaires. Having obtained the questionnaires from the authors (RH Gray and RC Bailey, personal communication), I am not surprised that these studies provided little evidence of a link between circumcision and various sexual difficulties. [4,5] Several questions were too vague to capture possible differences between circumcised and not-yet circumcised participants (e.g. lack of a clear distinction between intercourse and masturbation-related sexual problems and no distinction between premature ejaculation and trouble or inability to reach orgasm). Thus, non-differential misclassification of sexual outcomes in these African trials probably favoured the null hypothesis of no difference, whether an association was truly present or not. Morris et al. should be commended for their creative attempt to dismiss the higher prevalence of frequent dyspareunia in women with circumcised (12%) than uncircumcised (4%) spouses (ORs between 4.17 and 9.00). They suggest that Danish women with circumcised spouses may be so psychologically troubled by the shape of their spouse’s penis that it might result in painful intercourse. A more plausible explanation would be that reduced penile sensitivity may raise the need among some circumcised men for more vigorous and, to some women, painful stimulation during intercourse in their pursuit of orgasm. Two of the authors, Morris and Waskett, both internationally recognized circumcision activists, [6,7] forget to declare their conflicts of interest. Even in situations that are out of context, Morris promotes himself as a neutral ‘authority on the extensive medical benefits of this simple surgical procedure’, [8] whereas at the same time he argues that neonatal male circumcision ‘should be made compulsory’ and that ‘any parents not wanting their child circumcised really need good talking to’. [9] In contrast, we conducted our survey without setting up any a priori hypotheses, because the limited and inconclusive literature on possible sexual consequences of circumcision would permit almost any imaginable a priori hypothesis. We had no intent to prove an already known ‘truth’ or disprove its contradiction. It is ironic that Morris et al. question the credibility of our findings, postulating that I have an ‘active involvement in opposition to male circumcision’. I have never expressed any objection, ethical, medical or other, against male circumcision as such. Unlike Morris, who believes that ‘circumcision is a biomedical imperative for the 21st century’, [1] I could not care less whether fully informed, healthy adults choose to get circumcised or not. Likewise, when foreskin pathology is present (which does not include the physiological tightness of the foreskin experienced transiently by most boys), and the problem cannot be treated conservatively, preputioplasty or partial circumcision may be a relevant solution, even in minors and others who are unable to consent to the operation. However, because ethical discussions about ritual circumcision are sometimes distorted by strong personal views, I openly declared that I have participated in national debates over ethical issues surrounding male and female circumcision. Like in critical letters to the editor following other recent studies that failed to support their agenda, [10–12] Morris et al. air a series of harsh criticisms against our study. As seen, however, the points raised are not well founded. It seems that the main purpose, as with prior letters, is to be able in future writings to refer to our study as an ‘outlier study’ or one that has been ‘debunked’, ‘rejected by credible researchers’ or ‘shown wrong in subsequent proper statistical analysis’. This in spite of the fact that our study was carried out using conventional epidemiological and statistical methods, underwent peer-review and was published in an international top-ranking epidemiology journal. I would like to thank the IJE editors for withstanding the pressure from one particularly discourteous and bullying reviewer who went to extremes to prevent our study from being published. After the paper’s online publication, I have received emails from colleagues around the world who felt our contribution was useful and potentially important. One colleague informed me that the angry reviewer was the first author of the above letter to the editor. In an email, Morris had called people on his mailing list to arms against our study, openly admitting that he was the reviewer and that he had tried to get the paper rejected. To inspire his followers, Morris had attached his two exceedingly long and aggressive reviews of our paper (12,858 words and 5291 words, respectively), calling for critical letters in abundance to the IJE editors. Breaking unwritten confidentiality and courtesy rules of the peer-review process, Morris distributed his slandering criticism of our study to people working for the same cause. Rather than resorting to such selective distribution among friends, Morris should make both reviews freely available on the internet by posting them in their entirety on his pro circumcision homepage (www.circinfo.net). Alternatively, interested readers should feel free to request them from me at the e-mail address above. Despite poorly founded criticisms and attempts at obstruction our findings suggest that male circumcision may be associated with hitherto unappreciated negative sexual consequences in a non-trivial proportion of men and women. Further carefully conducted studies are needed. <h3>References</h3> 1. Morris BJ. Why circumcision is a biomedical imperative for the 21st century. Bioessays 2007;29:1147–58. 2. Perneger TV. What’s wrong with Bonferroni adjustments. Br Med J 1998;316:1236–38. 3. Barros AJ, Hirakata VN. Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 2003;3:21. 4. Krieger JN, Mehta SD, Bailey RC et al. Adult male circumcision: effects on sexual function and sexual satisfaction in Kisumu, Kenya. J Sex Med 2008;5:2610–22. 5. Kigozi G, Watya S, Polis CB et al. The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention, Rakai, Uganda. BJU Int 2008;101:65–70. 6. Circleaks. http://circleaks.org/index.php?title1/4Brian_Morr is (8 August 2011, date last accessed). 7. Circleaks. http://circleaks.org/index.php?title1/4Jake_H._ Waskett (8 August 2011, date last accessed). 8. Morris BJ. Renin, genes, and beyond: 40 years of molecular discoveries in the hypertension field. Hypertension 2011;57:538–48. 9. YouTube. http://www.youtube.com/v/7yDvL4hNny4 (8 August 2011, date last accessed). 10. Morris BJ, Wodak A. Circumcision survey misleading. Aust N Z J Public Health 2010;34:636–37. 11. Waskett JH, Morris BJ, Weiss HA. Errors in meta-analysis by Van Howe. Int J STD AIDS 2009;20:216–18. 12. Waskett JH, Morris BJ. Fine-touch pressure thresholds in the adult penis. BJU Int 2007;99:1551–52. SOURCE: Morten Frisch, Author’s Response to: Brian Morris et al, Does sexual function survey in Denmark offer any support for male circumcision having an adverse effect? International Journal of Epidemiology 41 (1), February 2012, 312-314. Morris’s letter in reply can be read in the same issue of the journal. The original article was Morten Frisch, Morten Lindholm and Morten Grønbæk, Male circumcision and sexual function in men and women: A survey-based, cross-sectional study in Denmark, International Journal of Epidemiology 40 (5), October 2011, 1367-1381. <h2> <a id="boyle" name="boyle"></a>Complications and harms of circumcision greater than thought</h2> In two recent papers, psychology professor Dr Greg Boyle considers the physical and mental harms of non-therapeutic circumcision. After reviewing the extensive literature in medical and scientific journals, he finds that not only are the risks and complications of the surgery greater than commonly believed, but also that the harms of foreskin loss itself (i.e. without complications) are far more extensive than most people think. These are very harms of circumcision that are completely ignored by circumcision advocates and bureaucratic policy makers (such as the US Centers for Disease Control), who talk narrowly about “risks vs benefits” and ignore the usefulness of the foreskin (contrary to what the <a href="http://www.cirp.org/library/cultural/maimonides/" rel="noopener" target="_blank">Jewish philosopher Maimonides</a> stated) and regard the removal of a healthy foreskin as no different from the removal of a diseased appendix. Professor Boyle particularly rejects recent claims by Morris and Krieger that circumcision “makes no difference” to sexual function as implausible and contradicted by the evidence, and notes that other experts have found serious flaws in their analysis. <h3>Short and long-term effects of infant and childhood circumcision</h3> ABSTRACT Non-therapeutic infant male circumcision is a permanent surgical alteration to the penis that may cause significant physical, sexual and psychological harm. Physical harms include unintended adverse effects of the surgery itself (e.g., complications such as bleeding, infection, excessive removal of foreskin leaving insufficient shaft skin to accommodate erections, etc.), as well as the inherent loss of healthy, functional tissue. Sexual harms that necessarily follow from circumcision include the loss of all sensation in the foreskin itself, and the loss of all sexual functions that involve the physical manipulation of the foreskin. Additional sexual harms that may follow circumcision include reduced sexual sensation in the remaining penile structures, difficulty with masturbation, increased chafing in both the circumcised man and his sexual partner, as well as reduced overall psychosexual/psychological tension relief and subjective satisfaction. Psychological harms include short-term trauma as well as the potential for long-term emotional disturbances, including sadness, frustration, distress, and anger—akin to post-traumatic stress disorder (PTSD). In this paper, the extent and severity of these various harms are considered and it is argued that they are more serious and more widespread than is commonly believed. Boyle, G. (2015) <a href="http://www.scirp.org/Journal/PaperInformation.aspx?PaperID=55727#.VTAz26Z5gmZ" rel="noopener" target="_blank">Circumcision of Infants and Children: Short-Term Trauma and Long-Term Psychosexual Harm</a>. Advances in Sexual Medicine, 5, 22-38. doi: 10.4236/asm.2015.52004. <h3>Fallacies of Morris, Krieger claims about circumcision and sexual satisfaction exposed</h3> A paper in a recent issue of Advances in Sexual Medicine shows that the literature survey in which Morris and Krieger claims to show that circumcision makes no difference to sexual experience is deeply flawed and inconsistent with the full range of the evidence. The abstract reads as follows: Morris and Krieger (2013) have argued that male circumcision does not impact adversely on sexual sensation, satisfaction, and/or function. In the present paper, it is argued that such a view is untenable. By selectively citing Morris’ own non-peer-reviewed letters and opinion pieces purporting to show flaws in studies reporting evidence of negative effects of circumcision, and by failing adequately to account for replies to these letters by the authors of the original research (and others), Morris and Krieger give an incomplete and misleading account of the available literature. Consequently, Morris and Krieger reach an implausible conclusion that is inconsistent with what is known about the anatomy and functions of the penile foreskin, and the likely effects of its surgical removal. Gregory J. Boyle, Does Male Circumcision Adversely Affect Sexual Sensation, Function, or Satisfaction? Critical Comment on Morris and Krieger (2013). <a href="http://www.scirp.org/Journal/PaperInformation.aspx?PaperID=55256#.VScSRqZ5gmY">Advances in Sexual Medicine, 31 March 2015</a>. <h2> <a id="bossio" name="bossio"></a>Where does the pleasure of penile stimulation come from?</h2> <h3>Thoughts on recent research by Bossio et al and their critics</h3> Research by Jen Bossio and colleagues on the nature of penile sensation in circumcised and normal males is to be welcomed. However uncertain or provisional some of their conclusions may be, their work represents a genuine attempt to shed light on an under-researched area of physiology and should stimulate further investigation. In the immediate term their research has provoked a strong <a href="http://www.huffingtonpost.com/brian-earp/does-circumcision-reduce-_b_9743242.html" rel="noopener" target="_blank">dissent from Brian Earp</a>, who argues that their principal conclusion – that circumcision makes little or no difference to penile sensitivity – is neither supported by their own evidence nor consistent with previous research on this question. A major cause of this disagreement may be that Bossio et al’s research methodology takes the foreskin and penis as separate structures whose properties can be analysed individually, while Earp regards them as elements of a single structure that produce the best results if they work together and which, therefore, should be analysed as a dynamic ensemble. There is sense in this view: when it comes to actual sexual activity, most uncircumcised men are not particularly interested in whether their foreskin, glans or penis shaft is more sensitive to light touch, heat or pain, but rather in the sensations arising from the movement of the foreskin over the glans, or from the friction between the inner foreskin (retracted and everted with erection) and whatever flesh or device is providing the pressure. As nineteenth century advocates of circumcision as a remedy for masturbation warned, it was the mutual stimulation of foreskin and glans that was the problem. The weakness of Bossio’s research methodology is that it examined the penis as a series of static and disconnected objects rather than as a system in motion. In other words, the problem with these touch tests (and it also affects the <a href="http://www.cirp.org/library/anatomy/sorrells_2007/" rel="noopener" target="_blank">Sorrels study</a>, which never got to the heart of the matter) is that they bear no relation to what actually happens during sex. In any sexual activity (wanking, oral, intercourse or whatever) the foreskin is under pressure and stimulated from both sides: from whatever is touching it on the outside, and by the pressure of the glans and shaft on the other side. Since foreskin and glans work together and mutually stimulate each other it is unrealistic to try to separate them and ask which makes the greater contribution to sexual sensation. They need to be studied together in actual situations where sex is taking place. So where should researchers go from here? One possibility is suggested by an informal experiment conducted by New Zealand pathologist Ken McGrath (University of Technology, Auckland) some years ago. He arranged for several adult volunteers (not circumcised) to masturbate to orgasm. In a subsequent session he deadened their foreskins with a local anaesthetic, got them to masturbate again, and to describe the sensations they experienced in comparison with normal conditions on the previous occasion. The results were striking. All subjects took far longer to reach orgasm and reported: <ul> <li>severe loss of sensation and pleasure;</li> <li>awareness of sensation from the glans (mostly from the frenular attachment and to a lesser extent the corona) of which they were normally unaware and which commenced quite late in the episode (i.e. just prior to orgasm);</li> <li>need for more pressure and vigour in stimulation;</li> <li>lack of rising pleasure during the period from the onset of tumescence to awareness of orgasmic approach (in contrast to their normal experience of steadily increasing sensation and pleasure);</li> <li>a sudden and unanticipated onset of orgasm (a lack of warning which surprised them);</li> <li>perception of deepness of sensory origin rather than a surface one as they normally experienced.</li> </ul> All participants found the anaesthetized prepuce experience far less enjoyable, lacking the intense sensation they normally experienced, and rather unsatisfying in comparison. It could not be claimed that this small experiment to be in any way decisive. The sample size was absurdly small, the methodology was unapproved, and it might not have been possible fully to isolate the nerves of the foreskin in such as way as would correspond to the effects of circumcision. Nonetheless, the exercise is suggestive as a pilot study, and offers a different approach to the question – one that requires no expensive equipment or preparations, and carries no risk of harm to any of the participants. In a university research environment with the full range of medical specialists, including anaesthetists, it should be possible to overcome the methodological difficulties, and recruit sufficient volunteers to secure a robust result. <h1>Letters in urology journal criticise Bossio study</h1> A study by Bossio et al published in the Journal of Urology in June 2016 was widely misreported as showing that circumcision made no difference to the sensitivity of the penis. Even leaving aside the vagueness of this measure (do they mean sensitivity to pain or to pleasure? what about other measures of sexual functionality and satisfaction?) the reports seriously misrepresented the findings of the study, which actually showed that men with foreskins had a lower threshold of sensitivity and circumcised men a higher threshold – in other words, that men with foreskins were more sensitive to touch, and circumcised men less sensitive. As the authors admit in their reply to criticisms of their article published in a later issue of the journal, “the foreskin was observed to be most sensitive to fine touch pressure thresholds.” Of course, there are other issues to be taken into account, some of which are raised in the letters criticising the paper, but there is not the slightest basis for media and other reports that circumcision “makes no difference” to sexual experience. The following letters criticising the Bossio et al study on circumcision and penis sensitivity were published in the December 2016 issue of the Journal of Urology, with a reply by the original authors. 1. Professor Morten Frisch Bossio et al assessed penile sensitivity in circumcised and intact males using quantitative sensory measures, and concluded that infant circumcision likely entails only “minimal long-term implications for penile sensitivity.” However, this conclusion does not follow logically from their findings. Despite a small sample size (62 sexually non-dysfunctional males 18 to 37 years old, of whom 30 were neonatally circumcised and 32 were intact), the study confirmed findings from a prior <a href="http://www.cirp.org/library/anatomy/sorrells_2007/" rel="noopener" target="_blank">investigation by Sorrells et al</a>, which revealed significantly lower tactile thresholds (i.e. greater tactile sensitivity) in the foreskin compared to other examined penile sites (the glans and 2 shaft positions). Additionally the current study found significantly greater warmth sensitivity at the foreskin than at the glans (p = 0.02). Finally, the authors assessed thresholds for tactile pain and heat pain, and failed to find any significant evidence that the foreskin is more or less pain sensitive than other parts of the penis. These results suggest that 1) the foreskin is more sensitive to gentle touch than any other tested penile site, replicating prior research, 2) the foreskin may be more sensitive to subtle variations in temperature, at least compared to the glans, and 3) the foreskin appears to be no more or less sensitive to potentially uncomfortable tactile or temperature induced stimuli leading to sensations of penile pain. From these observations the logical conclusion would be that neonatal circumcision appears to be associated with reduced sensitivity in the adult penis. It is noteworthy that the findings of Bossio et al of greater foreskin sensitivity to tactile and temperature related stimuli emerged despite the fact that the examined outer cutaneous part of the foreskin may not even be the most sensitive part of this complex, double layered structure. Figure 2 in the article combines individual sensitivity threshold scores from the 30 circumcised and 32 intact males. To better understand the relevance and meaning of the study findings, I kindly urge the authors to repeat their analysis and provide a supplementary figure, in which they divide the results depicted in figure 2 into 2 separate panels (1 for intact and 1 for circumcised males), illustrating each of the 4 sensory threshold graphs as demonstrated for the combined group of 62 males in this figure. An additional simplified 4-graph panel for the 32 intact males may help readers to judge whether and to what extent the foreskin is more sensitive than other parts of the intact penis. Due to the apparent lack of statistically significant differences in sensitivity among the various non-foreskin penile sites, I suggest that Bossio et al recombine the original 5 tested anatomical sites, i.e. the foreskin, other penile sites (including the glans and the 2 penile shaft sites) and the forearm, to gain statistical power. I also would be interested to see the associated p values provided in a manner similar to that used in figure 2. Morten Frisch, Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark 2. Dr Alexandre Rotta In a study fraught with methodological problems Bossio et al conclude that “circumcision is not associated with changes in penile sensitivity” and believe they have provided “preliminary evidence to suggest that the foreskin is not the most sensitive part of the penis.” However, neither of these assertions is supported by their data. Although nowhere explicitly stated in the article, we assume that all penile sensitivity tests were performed in penises in the flaccid state. Such a testing condition can only provide an indirect hint as to what would occur during sexual arousal, which is the relevant situation to consider when studying penile sensitivity in this context. For unclear reasons the authors tested only a single site on the foreskin – a location on the dorsal unretracted external skin, somewhat proximal to the more sensitive tip of the penis - that previous research has already indicated may be less sensitive than other parts of the foreskin. Specifically if the authors wanted to determine the sensory thresholds of the foreskin of intact men compared to other penile sites, why would they not test its most sensitive point, or at least include a site representing the (widely considered to be) more sensitive transitional or internal surfaces of the foreskin that become exposed when the structure is pulled back? Due to differences in erection mechanics in the intact and circumcised penis, the tested sites on the penile shaft may not be comparable between the 2 groups during sexual activity. The penile shaft skin of circumcised males does not move back and forth a great deal during sex, so the penile shaft sites tested by Bossio et al in flaccid circumcised males may serve as a reasonable proxy for what those same subjects will experience while erect but not for their intact counterparts. During intercourse a considerable part of the penile shaft of intact males is covered intermittently by the everted mucosal portion of the foreskin, which rolls back and forth over the glans. During penetration the skin that covered the penile shaft in the flaccid state moves proximally closer to the pubis. Consequently the penile shaft skin measurements by Bossio et al are unlikely to represent analogous penile sites in sexually aroused intact and circumcised males. To provide a more meaningful comparison of penile shaft sensitivities in intact and circumcised males that might serve as a plausible proxy for what occurs in the erect state, penile shaft sensitivity tests in the flaccid state should have been carried out with the foreskin pulled back (as typically will be the case during sexual arousal) in intact males. Even with its underpowered sample and inadequate choice of cutaneous testing sites the conclusion of the authors that the foreskin is not the most sensitive part of the penis is certainly puzzling in light of figure 2, part A in the article, which shows the foreskin to be significantly more sensitive than any other tested site. The inference that surgical removal of this most sensitive penile segment would not decrease penile sensitivity seems logically and anatomically incoherent. Alexandre T. Rotta, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio 3. Professor Robert Van Howe et al This study examining penile sensitivity left us with several concerns. The report fails to adequately describe the main outcomes of the study, namely measurements broken down by circumcision status. Instead of average scores and standard deviations, the reader is provided with p values, statements about failing to find a statistically significant difference and a figure that collapses the data from the 2 groups into 1 group. Of interest is whether fine touch sensitivity was reduced in the glans in the flaccid penis of circumcised men, as has been reported in 3 previous studies. However, these results were not provided. Instead, the authors provide what could be characterized as pilot data, along with the number of participants needed for a more definitive study, while failing to report the results that are needed to design such a study. Several of the conclusions of Bossio et al do not follow from their findings. Although several of their tests were underpowered, and the maximum participant age was only 37 years (mean 24.2), the authors make sweeping generalizations regarding long-term implications of circumcision on penile sensitivity. Similarly they state that “this study challenges past research suggesting that the foreskin is the most sensitive part of the penis,” while at the same time reporting that the “foreskin of intact men was more sensitive to tactile stimulation.” Finally, the authors conclude that they “failed to consistently replicate the findings by Sorrells et al across stimuli” when they did, in fact, replicate our findings along the only dimension that was consistent - and hence even potentially replicable - between the 2 studies, namely assessment of fine touch thresholds. The authors struggle to explain some of their results but the histology may help. The glans is innervated mainly by free nerve endings, which primarily sense deep pressure and pain, so it is not surprising that the glans was more sensitive to pain. By contrast, the foreskin has a paucity of free nerve endings and is primarily innervated by fine touch neuroreceptors, so it was comparatively less sensitive to pain. On a positive note, it is heartening that the term “intact” has replaced “uncircumcised,” which is considered by many to be a pejorative term. Robert S. Van Howe, Department of Pediatrics, Central Michigan University College of Medicine; with Morris L. Sorrells, James L. Snyder, Mark D. Reiss and Marilyn F. Milos <h3>Reply by authors</h3> Based on a careful review of these letters, we believe that our conclusions have been misconstrued in different ways by the authors (and others, as apparent in media reports and on social media). We will attempt to clarify what our article indicates, what it does not indicate and how the responses to it highlight the need to improve the empirical rigor of research on the impact of circumcision on the sexual lives of men and their partners. Despite the widespread global practice of circumcision, as well as the public beliefs about the procedure, there is limited objective peer-reviewed research assessing the sexual correlates of circumcision. The purpose of our study was to use objective measures to assess penile sensitivity across circumcision status (intact, circumcised). We examined sensitivity on certain penile areas, as well as on the forearm, with a focus on the glans penis and the foreskin, using touch (punctate or fine touch pressure, pain) and heat (warmth detection, heat pain). The stimulus modalities we used are expected to activate penile nerve fibers more likely associated with sexual pleasure than measuring fine touch pressure thresholds alone. Statistical analyses revealed that the sensory thresholds of intact and circumcised men were remarkably similar - hence, the data were collapsed across the 2 groups. Although presented in graphic format in the full article, we have included a breakdown of descriptive statistics in this response, as requested by Frisch and Van Howe et al (see table). To reiterate the findings of the study, the foreskin was observed to be most sensitive to fine touch pressure thresholds. Indeed, this finding replicated the results reported by Sorrells et al. However, fine touch pressure, which was only 1 of 4 stimulus modalities assessed, activates nerve fibers that are likely less relevant for sexual pleasure than fibers activated by the other stimuli used in this study (stimuli that did not exhibit significant between group differences). Therefore, we maintain that we “failed to consistently replicate the findings by Sorrells et al across stimuli” (emphasis added). We also urge caution in the over-interpretation of this result (that the fine touch pressure threshold at the foreskin was significantly less than in other areas). This finding alone does not prove that circumcision reduces penile sensitivity, and it also does not prove that circumcision has no impact on the sexual lives of men. Insisting that this finding supports either the pro or anti-circumcision “camp” is not warranted, as it does not take into account the other study findings and ignores the limitations (e.g. small sample size). Instead, we consider the outcome of this study an indication of the need for further examination. In light of the misinterpretations of our findings we believe it necessary to further clarify what the results of this particular study do not indicate. The results of this series are not to be taken as the definitive answer concerning the circumcision debate. As we discuss in the article, the results do not address the role of the foreskin during sexual activity, nor was the study, as Rotta suggests, an exploration of the biomechanics of the foreskin during intercourse (an interesting question, indeed, but one that would be incredibly difficult to measured and one that we did not examine). This study was not an exploration of the direct impact of circumcision status on sexual function or on the experience of sexual pleasure. Furthermore, and importantly, we do not state whether the findings offer support to either side of the circumcision debate, but instead highlight the need for more empirically rigorous research. The strong reactions to this self-described preliminary study highlight the need for more research and serve as a “call to arms” for researchers interested in examining the sexual correlates of circumcision. This body of research is plagued by weak study design, such as the inclusion of non-random samples, equating outcomes of adult and neonatal circumcision without evidence to suggest that the 2 are comparable, failure to control for participant expectations of study outcomes and reliance on self-report to the exclusion of objective measures. These shortcomings represent a serious problem in this contentious field because they allow room for participant and author bias. One does not have to search far for these biases in the circumcision literature, such as frequent references to non-peer-reviewed articles and author involvement in anti or pro-circumcision advocacy groups. Are we, as scientists, not responsible for stepping back from questions about which we have a personal stake in the outcome? Research in this area should be conducted by those who are not personally invested in the circumcision debate. That was our initial goal. But following the severe reactions we have received, we wonder about who would want to continue (or even start) working on this topic without biased motivations. However, that is not what science is about. As comedian John Oliver stated in a recent commentary on the current state of science, “In science you don’t just get to cherry pick the parts that justify what you were going to do anyway.” We will continue to report what the data show, regardless of whether that reflects the popular vote, and hope that others in this field do the same. Journal of Urology, Vol. 196 (December 2016), 1821-26. References and the table referred to in the authors’ reply have been omitted. The original article, Examining Penile Sensitivity in Neonatally Circumcised and Intact Men Using Quantitative Sensory Testing by J.A. Bossio, C.F. Pukall and S.S. Steele, was published in Journal of Urology, Vol. 195 (June 2016) 1848-53. <h2>Impact of circumcision on body image and sexual function</h2> ABSTRACT Research exploring the impact of circumcision on the sexual lives of men has failed to consider men’s attitudes toward their circumcision status, which may, in part, help to explain inconsistent findings in the literature. … Men who were circumcised as adults or intact men reported higher satisfaction with their circumcision status than those who were circumcised neonatally or in childhood. Lower satisfaction with one’s circumcision status—but not men’s actual circumcision status—was associated with worse body image and sexual functioning. These findings identify the need to control for attitudes toward circumcision status in the study of sexual outcomes related to circumcision. Future research is required to estimate the number of men who are dissatisfied with their circumcision status, to explore the antecedents of distress in this subpopulation, and to understand the extent of negative sexual outcomes associated with these attitudes. Jennifer Bossio, Caroline Pukall. Attitude Toward One’s Circumcision Status Is More Important than Actual Circumcision Status for Men’s Body Image and Sexual Functioning. <a href="https://www.ncbi.nlm.nih.gov/pubmed/28894958" rel="noopener" target="_blank">Archives of Sexual Behaviour, early view, 11 September 2017</a> What this study really found is that men are more likely to be happy with being circumcised if they have freely elected the operation for themselves. In other words, the key issue is not age, but consent. <h3> <a id="tim" name="tim"></a>Tim Hammond writes in response:</h3> The Archives of Sexual Behavior recently published findings by Canadian researchers Bossio and Pukall who identify a subpopulation of men subjected to nontherapeutic circumcision as children who experience distress over this genital modification. I personally consider this a validation of my two "circumcision harm" surveys that were published in <a href="http://www.noharmm.org/bju.htm" rel="noopener" target="_blank">1999 (BJU International)</a> and 2017 (<a href="https://www.academia.edu/34195618" rel="noopener" target="_blank">International Journal of Human Rights</a>, with co-author Adrienne Carmack). Although Bossio downplays that the distress might be related to any actual physical or sexual harm, she believes that a man's attitude toward his circumcision plays a larger role in the distress. Many years ago, circumcision advocate Edgar Schoen dismissed men's concerns by saying he thought the problem with these men lies more between their ears than between their legs. At the time, I took great offense to that comment, but I have come to believe that such comments presaged what is now being discussed relative to childhood MGM. To her credit Bossio consistently refers to the intact penis and to intact men, rather than uncircumcised, and discusses the "loss of the natural foreskin". She also called for more research into the "antecedents" of circumcision distress. I consider that the adverse physical, sexual, emotional and self-esteem consequences of NTC addressed in both of my surveys are among the "antecedents" to which refers. In her present article, Bossio did reference my 1999 survey, but not in relation to harm, rather with regard to the phenomenon of foreskin restoration. The 2017 Hammond/Carmack survey was just published in March of this year, so I'm sure it was not yet on Bossio's radar as she prepared her manuscript. Also to her credit Bossio suggests that this circumcision "distress" experienced by an as yet undetermined number of adult men should be addressed by medical associations when formulating any future policy statements regarding infant circumcision. I heartily agree. Tim Hammond is founder of the <a href="http://www.circumcisionharm.org/" rel="noopener" target="_blank">Circumcison Harm Survey</a>. References Earp, B. D., & Darby, R. <a href="http://pennjil.com/2017-penn-jil-online-symposium-circumcision-in-germany/" rel="noopener" target="_blank">Circumcision, sexual experience, and harm</a>. University of Pennsylvania Journal of International Law, 37(2) 2017, online symposium. Robert Darby & Laurence Cox. <a href="https://www.academia.edu/7104780/Objections_of_a_sentimental_character_The_subjective_dimension_of_foreskin_loss" rel="noopener" target="_blank">Objections of a sentimental character: The subjective dimensions of foreskin loss</a>. See also in-depth discussion on this site: <a href="https://www.darboninstitute.org/unquantifiable_subjectivity_circumcision_harms" rel="noopener" target="_blank">The unquantifiable subjectivities of circumcision harm</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Circumcision cuts sexual satisfaction darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>Males also victims of sexual violence</h1> <h2>Sexual violence against males a feature of recent armed conflicts</h2> Sexual violence against men and boys is a pervasive feature of armed conflicts. A recent paper by Australian researchers available from Australian Policy On-line provides commentary, recent data, and advice on the care and support of male survivors. The researchers point out that there is increasing awareness that armed conflict brings danger of sexual violence against men and boys. Such violence — including rape, sexual torture, mutilation, castration, sexual humiliation, forced incest, forced rape, and sexual enslavement — is sharply under-represented in official statistics, but is a pervasive feature of armed conflicts around the globe. One study in Liberia found that 32.6% of former male combatants had experienced sexual violence, mostly at the hands of armed forces. Males, like females, are particularly vulnerable to sexual violence in detention, with surveys of male torture survivors consistently showing rates of sexual violence of over 50%. <h3>Summary</h3> Male survivors of both adult and childhood sexual violence display a wide range of severe physical and psychological consequences of their experiences, with particularly high rates of post-traumatic stress disorder and major depression. Men and boys face many of the same barriers to reporting sexual violence as women and girls do, including shame; confusion and ignorance; guilt; fear; and isolation. Meanwhile, doctors, counsellors and humanitarian workers often do not pick up sexual violence against males due to lack of training and gender stereotyping. This briefing paper provides commentary and recent data on sexual violence against men and boys in conflict settings. It highlights promising programming and therapeutic approaches in the care and support of male survivors, ranging from public information campaigns to themes for therapeutic care and support for individuals. The payoff for helping male survivors has the potential to extend beyond the individuals involved to help families and communities, and to combat violence against women and girls as well. The report points out that sexual violence can take many forms, and includes both physical and mental violence that is carried out through sexual means or that targets the victim's sexuality and sexual and reproductive health. Directed against males, it generally falls into three overall patterns: <ul> <li>forcing a man or boy to take part in sexual acts, often humiliating ones;</li> <li>inflicting pain and/or damage to the genitals with the overt or covert threat of interfering with future sexual pleasure;</li> <li>inflicting damage to the genitals designed to prevent future reproduction.</li> </ul> Sexual violence against males is sometimes committed with the intent of ultimately causing the victim's death — for instance, through heavy bleeding as a result of violence to the victim's genitals or anus. The report warns that sexual violence against males appears to be increasing. In the last decade alone, sexual violence against male civilians and combatants, both adults and children, has been reported in 25 conflicts across the world. If one includes sexual exploitation of boys displaced by violent conflicts, the list encompasses the majority of the 59 armed conflicts identified in the 2003 Human Security Report. Until recently, there has been little statistical information on levels of sexual violence against males during conflicts—largely because men and boys are often very reluctant to report such violence, but also partly due to a lack of awareness on the part of those collecting information or offering help. However, recent studies on conflict-related sexual violence, as well as existing studies on torture, paint a disturbing picture. In Liberia, according to a study of 1666 adults conducted in 2008, 32.6% of the study's 367 male former combatants had experienced sexual violence, mostly at the hands of soldiers or rebels. Of these, 81% reported current symptoms of post-traumatic stress disorder, and 14% had attempted suicide. Where boys are concerned, figures on sexual violence and abuse against children in displacement are extremely hard to obtain. However, to give a general idea of the scale of childhood sexual abuse, the World Health Organization has estimated that in a single year (2002), 73 million boys as well as 150 million girls experienced forced sexual intercourse or other forms of sexual abuse. <h2>Circumcision a form of sexual violence?</h2> The report does not mention circumcision, but there is evidence from other studies that men and boys have been the victims of assaults involving forcible circumcision, to say nothing of the daily violence inflicted on male infants and boys during “routine” circumcision procedures. In Aceh, Indonesia, Islamic extremists assaulted and forcibly circumcised Indonesian Christians, both male and female, and reports of circumcisions carried out by violent mobs in parts of Africa (Uganda, Kenya etc) are becoming more common as American aid agencies “roll out” their circumcision programs. It is perfectly obvious that such attacks on adults are criminal assaults, but why would the same actions become legal when directed against children? The United Nations Convention on the Rights of the Child (1989) states: Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation, including sexual abuse, while in the care of parent(s), legal guardian(s) or any other person who has the care of the child. (Article 19 (1)) Parties shall take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children. (Article 24 (3)) It is hard to know what Article 24 (3) could refer to unless it was genital mutilation of children, and it has generally been interpreted as having this intent. Following the adoption of the convention, many western countries and some Australian states introduced legislation criminalising any form of female genital mutilation, and in 1993 the Queensland Law Reform Commission looked into the possibility of a law along the same lines to protect boys. Its conclusion was that circumcision of minors was already technically illegal on two grounds: first, under the common law, and secondly under the specific assault provisions of the Queensland Crimes Act. The reasons why the wording of the Convention on the Rights of the Child was so vague may be guessed, but that it was intended to refer to both male and female genital cutting was made clear in some of the subsequent consultations, such as in Lesotho, where a local committee reported: Culture is a component of education. Cultural activities like circumcision are not to be a hindrance to a child’s right to education. It is proposed that proper medication be administered at circumcision schools. Children should be allowed to decide at 21 years of age whether or not they want to be circumcised. (Committee on the Rights of the Child, Initial reports of States parties due in 1994: Lesotho. 20/07/98. CRC/C/11/Add.20. (State Party Report), seen at http://www.unhchr.ch/tbs/doc.nsf/(Symbol)/739266a4d55f1969802566e2003f7b92?Opendocument) The reference here is to children’s right to decide, meaning both boys and girls. In Guinea-Bissau another report made clear that “traditional practices” were those affecting all children, not just girls: The report states that traditional practices and customs are causing serious problems for children and women. The circumcision of boys aged 9 to 13 years and female genital mutilation in girls aged between 7 and 12 years among the Fula and Mandinga ethnic groups are the most cruel and harmful practices. There are no effective measures at the national level to eliminate them. (Committee on the Rights of the Child Considers Initial Report of Guinea-Bissau, United Nations Press Release, 22 May 2002, seen at http://www.unhchr.ch/huricane/huricane.nsf/view01/39E976491EF5DD8DC1256BC20029E249?opendocument) Despite the reference to children, however, the rest of the report forgot about boys and went on to talk about the need for campaigns against female genital mutilation, and made no further mention of circumcision of males. This tendency for “traditional practices prejudicial to … children” to be increasingly interpreted as applying to girls only was deplored in a report to the United Nations by the National Organization of Circumcision Information Resource Centers, which pointed out: That international humanitarian law, insofar as it provides protection against rape and other sexual assaults, is applicable to men as well as women is beyond any doubt as the international human right not to be discriminated against (in this case on the basis of sex) does not allow derogation. Males may not be discriminated against in the application of human rights principles. United Nations experts have acknowledged that at least under certain circumstances male circumcision constitutes a human rights violation. (Submission by Nocirc to the U.N. Sub-Commission on the Promotion and Protection of Human Rights, 23 March 2002, Document E/CN.4/Sub.2/2002/NGO/1. Available at: http://www.cirp.org/library/ethics/) The reference in the last sentence is to a UN report on the civil war in Yugoslavia, which states that as well as women suffering rape and other forms of sexual violence, “Men are also subject to sexual assault. … They have also been subjected to castration, circumcision or other sexual mutilation.” (United Nations Security Council, Commission of Experts’ Final Report [on the former Yugoslavia], 27 May 1994, document S/1994/674, part IV, section F. Seen at http://www.his.com/~twarrick/commxyu1.htm) <h3>Sexual violence against West Papuan men</h3> A glaring example of sexual violence against males is <a href="http://www.circumstitions.com/news/news44.html#papua-force2">provided by recent news</a> that the Indonesian overlords of West Papua planned to “require circumcision” of all indigenous Papuan men (i.e., forcibly circumcise them, presumably at the point of a gun if they object). This unbelievably authoritarian ruling was described and justified as an AIDS control measure, but it obviously has far more to do with religious conformity and Islamic cultural imperialism than tender concern for indigenous health, reminiscent of the Aceh extremists who could not bear the thought of infidels living nearby, and violently assaulted them in order to enforce at least anatomical conformity. The West Papuan authorities have since backtracked and announced that they do not plan to “require circumcision” but have emphasised its importance as an AIDS control tactic. We may be sure that even if men will not be forced, there will at least be strong pressure to get circumcised, with both sticks and carrots likely to be deployed, as in Africa. A striking feature of the episode has been the deafening silence of the United Nations, Amnesty International and other human rights organisations on what, by any yardstick, would be as gross a violation of individual human rights as would be possible to imagine. <h2>Circumcision: Sexual violence against males</h2> A paper just published in the Journal of Medical Ethics shows that forced circumcision (i.e. circumcision without the informed consent of the subject) is both far ore common than generally believed, and argues that it is a serious human rights violation that should be of concern to human rights agencies. The author, Michael Glass (an independent Sydney researcher), gives many examples of situations in which adult men have been forcibly circumcised against their will, and observes that both the media and human rights bodies have paid surprisingly little attention such violence; in situations where both males and females have been victims, the media have consistently highlighted the suffering of the women while ignoring or downplaying what was done to the men. Mr Glass concludes: “No man should be circumcised against his will. Reports of forced circumcisions must not be dismissed as sporadic incidents, but recognised as widespread, recurring sexual assaults. Assailants should be punished accordingly. When forced circumcisions happen during war or civil strife, they must be seen, as with rapes, as sexual terrorism and war crimes.” ABSTRACT The forced circumcision of men is a widespread human rights abuse that often accompanies other human rights violations. It occurs in clashes between circumcising and non-circumcising cultures, or when individuals in circumcising cultures reject circumcision. This article documents the forced circumcision of men against their will, shows how evidence of forced circumcision has been downplayed and discounted, and outlines and discusses some measures that could help to reduce its prevalence. Source: Michael Glass. <a href="https://dx.doi.org/10.1136/medethics-2013-101626">Forced circumcision of men.</a> Journal of Medical Ethics, on-line first, 6 September 2013 This is a very telling paper, for if it is true that forced circumcision of an adult male is a violation of his human rights, it must follow that forced circumcision of a male minor – a boy or an infant – is a violation of his human rights and equally wrong. The age at which it is done does not matter – as you can see from this thought experiment. <h3> <a id="thought" name="thought"></a>Circumcision thought experiment</h3> It is held by many people in Australia and the United States that parents have the right to circumcise their (male) children, and by even more people in the Middle East, North Africa and South East Asia that they have the right to circumcise their female children. How old do the children have to be before parents lose this right? Would it be OK for parents to forcibly circumcise a 25-year-old, male or female? (Most would say no.) What about an 18-year old? A 15-year-old? Ten years? Five years? Two years? Six months? We may predict that the number of people answering yes will increase as we go down the scale, but what is the basis for their judgement? Where is the dividing line where circumcision without consent becomes unacceptable (going up), or acceptable (going down)? And what are the criteria for placing it there? The fact is that it makes no difference when a boy is circumcised; it is just as much a violation of his (or her) physical integrity and personal autonomy, and the result is just the same: permanent loss of a functional body part. No matter when it is done the result is the same: for the rest of his life he will be deprived of his foreskin, and she will bear the scars of whatever operation was performed on her. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Sexual violence against males darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>American cases from the 1930s show traumatic impact of operations on children </h2> Just how sensitive even very young boys can be to interference with their penis was revealed in a paper by David Levy published in 1945. He was a psychiatrist who treated children with psychological and behavioural problems. In many cases he found that their difficulties could be traced to an operation in early childhood or infancy, and that operations on the penis were especially likely to leave psychological and emotional, as well as physical, scars. Many of David Levy’s cases offer striking evidence of the traumatic effect of operations such as circumcision and meatotomy on young boys. Both of these procedures were in vogue in the USA in the 1920s and 1930s, especially among the richer classes, who seem to have been always fretting fussing over the condition of their children’s genitals. Particularly disturbing is the revelation that it was not uncommon for young boys to be subjected to an operation known as meatotomy, that is, surgical enlargement of the opening of the urethra at the end of the penis (more commonly known as the piss-slit). Much like circumcision itself, this operation was recommended as a routine by some doctors, on the erroneous assumption that they knew better than nature - that because the opening looked small, it was not adequate to its purpose. In 1950 a contributor to the British Medical Journal commended the opinion of an American urologist that all male babies should be circumcised, and that “in addition to complete removal of the prepuce, the urethral meatus should be examined and if any obstruction is found, meatotomy should be performed” – all within “a few days after birth” (C.A. Royde, British Medical Journal, 21 January 1950, 182). What is remarkable about the cases below is how vividly and bitterly the boys remembered what was done to them even at very young ages, and how their experience made them fearful and distrustful of doctors, and indeed their parents. It is also clear that the operations mentioned below were completely unnecessary: “long foreskin” is not an indication for circumcision (the foreskins of young boys are meant to be long); and there is nothing wrong with the foreskin of 3-year-old not being easily retractable (in fact, it’s not meant to be pulled back that early). Overall, Levy’s cases present a sorry tale of medical ignorance, and of cruelty to children that, in any context but the privileged space of “medical procedure” or “health” would be regarded as child abuse. <h3>“They cut my penis. I wish I was dead.”</h3> Case 117: Fear of closed rooms and suicidal impulses, with intensification of destructive behaviour, following a circumcision at 6 years 7 months. A boy aged 7 years 0 months, the eldest of 3 children, was referred because of soiling, negativistic behaviour, temper tantrums and suicidal impulses. His soiling was started at the age of 6 years 3 months, when he was displaying intense jealousy of the younger sibling. At the same time he started baby talk and returned to the habit of taking his toy bunny to bed with him, a habit he had given up three years previously. At 6 years 7 months he was circumcised because of a long foreskin. He was not told what was going to happen to him. He was brought into the hospital by his father and operated on immediately. While still under the influence of ether he was put into an automobile and taken home. While riding home in a state of anaesthesia he repeated many times, “They cut my penis”, and “I wish I was dead.” He kept close to his mother the rest of the day and repeated the same statements. In his play of the operation during treatment the patient became very active and dramatic. He had a boy escape from an automobile and shoot his father. Then, “the next day”, the father, now resuscitated got the boy as far as the elevator, whereupon the boy escaped, tore up the hospital sign, blew up the hospital and knocked the father down. A chase between father and son ensued. In the next play he placed the father on the operating table, had the son in the role of surgeon and stuck a dart in the patient’s neck. Killing the father, the physician, “more doctors and then “more people” ended the play. Asked about his actual memory of the operation, he stated that he didn’t want to go to the hospital. His father forced him and the doorman fooled him. The doorman said, “There’s a pigeon inside. You get into the car, and I’ll catch the pigeon.” That’s how they got him into the car. When he knew he was fooled he began to fight. The door was locked. He knew he was on the way to the hospital by the way his father acted. Since “that” he never goes near that hospital. When his father got him in, they took him up in the elevator. After he was upstairs he tried to get down. After they put him in “the white thing”, he got half dressed again. Then his father pushed him. “When they had the ether on, it looked as though you were seeing a lot of colours. It was red and yellow, and it got louder and louder.” He illustrated with loud noises. “I could see more and more colours, and the taste of it got more and more worse. When the voices got as terrible as it could go, and the taste got worse as it could go, then it stopped, and it wasn’t long.” After the operation he was dizzy, and he rode home in the car. The examiner asked him what the operation was. he didn’t know. I asked if he remembered saying “They cut my penis.” He didn’t. The father reported that the anaesthetic used for the operation was ethyl chloride. He felt he had to trick the child into going. The child fought against undressing, fought off the physicians and had to be forcibly anaesthetised before they could get him undressed and into the operating room. The father and the anaesthetist applied the force. The father “felt sick about it for a week”, the whole experience was “so brutal”. The patient had repressed the memory of the operation itself. When told about it, he interrupted and drew on a paper a picture showing how they cut the foreskin off. When this was repeated in play he said suddenly, “I’m trying to remember. I said, ‘Buy me a gun and shoot me; if you don’t I’ll shoot myself’.” But he never recovered the memory of his saying “They cut my penis.” After the operation there was an intensification of all previous symptoms, especially the tantrums with destructive behaviour. Until that time the tantrums were relatively mild. Suicidal impulses were first observed immediately after the operation. Fears of being in a room alone also developed thereafter, though the patient was not afraid of the dark. It developed into a true phobia. When he took a bath the door had to remain open. If his mother closed it he would jump out of the tub. <h3>“He won’t hurt the wee-wee?”</h3> Case 61: Anxiety-provoking experiences of operative procedures, starting at 16 months [sc. meatotomy: cutting of penis to enlarge urethral opening] A boy aged 10 years 4 months, the elder of two boys, was referred because he was “afraid of everything, including terrors and nightmares.” In infancy he had a strong startle reaction to noise. The mother noticed that he often shuddered in response to noise when sleeping, and that he was “terror-stricken” when a door banged. At the age of 2 years, in a subway station, he shrieked whenever a train approached. Later, for several years, in the same situation he would put his hands to his ears. He reacted strongly to anything unfamiliar, and yet presented no difficulty at 3 years when his family moved to another apartment. He was afraid of the dark from infancy to the age of 8 years. Then he asked to have lights turned out at night, in order to “fight off” his fear. He also had a fear of moving pictures, but in the two years previous to his referral had “forced himself to go”. Except for vaccination and injections of toxin anti-toxin at 6 months, to which he had no untoward reaction, his first operative procedure was a meatotomy because of a narrow urethral opening at 16 months of age. It was done by a quick incision without an anaesthetic. At that time his only words were “da-da” and “No”. Before the operation was done he clamped his hand down over his penis. There was some struggling and crying. The mother held him in position for the operation. A year later, when taken to the same physician for a general physical examination, he had “a look of terror” and asked, “He won’t hurt the wee-wee?” (By 22 months he was “using good sentences.”) He had night terrors and a “terrified shriek” in his sleep preceding the age of 2 years and following the operation an 16 months. Almost nightly since the age of 4 or 5 years he shrieked, cried or just sat up in bed trembling. … At four and a half years a number of moles on his hand were removed by excision. The mother held him again for this operation. It was during this period that a governess told him that if he masturbated his penis would be cut off. Four or five weeks before he was referred the maid found him with a rope around his neck, the other end tied to the doorknob. The maid asked what he was doing. He said he wanted to choke himself, but having changed his mind, turned it into a play. His night terrors were of chopped-up hands, people chopped up and his trying to put them together unsuccessfully, and especially a witch trying to kill him. In all his dreams it was a woman who attacked him. He actually thought that his mother was plotting against him. “I always think she’s going to plot on me, something I inherited, something I got.” Frequently his dreams dealt with sensations of anaesthesia, and with is ideas of birth. … His fears all resolved into a fear of castration by his mother. He insisted that he remembered the first operation clearly. He said, “My mother never told me. I remember it clearly. It was the same doctor and the same table I had my tonsils out. I was a baby. Maybe 1 or 2 years old. The way I picture it, I was 2 years old. I remember it hurt a lot. I was always scared about my penis being hurt, but only on the tip. A lot of things happened to my penis. Once it hurt and swelled up where the blackhead is. My aunt told me to put a cold rag on it. I was scared I’d always have the pain and someone would have to rip it apart to get the pain out. They’d rip it apart and sew it up again. It hurt because they used a thin knife. There’s a line running in back of the penis, and if you cut at the tip, then the knife will go down the line, and the penis will be cut all open. I get scared while I talk about it.” He thought that if they didn’t put a hole in his penis he would be unable to urinate, and his kidneys would burst. … Beside night terrors and his fears about his penis, he had fears of the dark, of staying home alone, of an illustrated Bible (because it had “scary” pictures in it), and of the room in which it was, of long hallways and closets, of physicians and nurses, and going places. Of his play in early childhood, a report from his nursery school teacher states that when he was 4 years old his play “centred around the destruction of things” and threats towards his teacher, of cutting her up, burning her up, etc. During a rest period he yelled from his bed, “I’ll cut my face off, I’ll cut my head off, I’ll cut my hands off, I’ll cut my wee-wee off.” <h3>Fear of doctors after circumcision</h3> Case 47: Fear of physicians and taxis following an operation [circumcision] at 3 years A boy aged 8 years 10 months was referred for psychic vomiting and fears. At the age of 2 years he had been frightened by a foghorn on a boat. He stuttered at intervals for two to three weeks thereafter. At the age of 2 years 3 months he screamed at an examination of his throat. His tonsils an adenoids were removed at that age because of frequent colds. … Because of a tight foreskin his penis had since his birth been occasionally retracted. Circumcision was necessary, and at the age of 3 years 8 months this operation was performed with general anaesthesia. After leaving the hospital he was afraid to enter a taxicab. Previously, taxicabs had evoked no fear; in fact, he had an unusual interest in taxicabs and other automobiles and travelled frequently to nursery school in taxicabs. Also, fear of physicians was noted at this time. <h3>“Is my penis all right?”</h3> Case 23: Fear of haircuts and of the dark and increased frequency of bed-wetting following an operation [meatotomy] at 2 years 11 months A boy aged 5 years 9 months was referred for disobedience and incorrigibility at school. He had always been sensitive to noise, though there was no history of “startling” to noise in infancy. At 2 years 11 months a meatotomy had been performed with gas anaesthetic at a physician’s office. He was taken there by his parents. The father was with him in the office, while the mother was in the waiting room. The whole operation, from the time he entered the room until the time he left, lasted ten minutes. When he saw his mother after the operation, he said, ‘That’s a bad doctor. I don’t like him”, and then, “Is my penis all right?” He was brought back twice for dressings, and cried but did not struggle. The mother picked him up and comforted him. At the first post-operative examination the physician stretched the glans penis to note the opening of the urethra. No sutures were taken. The mother applied lotion for ten days. Previously the child had wet the bed occasionally; after the operation he did so nightly. Also, he refused for two months to have his hair cut. For a period, too, he wanted a light in his room. Source: David M. Levy, Psychic trauma of operations in children; and a note on combat neurosis, American Journal of Diseases of Children, Vol. 69, 1945, 7-25 NOTE: It is not clear from Levy’s account whether the boys subjected to meatatomy had already been circumcised when younger. If they had already been circumcised it may be that the meatotomy operation was in fact necessary, since meatal stenosis (ulceration and narrowing of the urethral opening) is a common complication of circumcision. Persad R, Sharma S, McTavish J, et al. <a href="http://www.cirp.org/library/complications/persad/">Clinical presentation and pathophysiology of meatal stenosis following circumcision</a>. Br J Urol 1995;75(1):91-3 Robert Van Howe, Incidence of meatal stenosis following neonatal circumcision in a primary care setting, Clinical Pediatrics, Vol. 45, Jan-Feb 2006 ABSTRACT The objective of this study was to prospectively document the incidence of meatal stenosis in boys. The study included a consecutive sample of boys whose visit with the physician included a genital examination in a private primary care pediatric practice in rural northern Wisconsin. Meatal stenosis was diagnosed in boys from 1.94 to 12.34 years of age. The diagnosis was made in 24 of 329 circumcised boys who were Tanner I development and older than 3 years of age (7.29%, 95%CI=4.48-10.10%). Nearly all required meatotomy to resolve their symptoms. All of the boys with meatal stenosis were circumcised neonatally (exact OR=3.54, 95%CI=0.62-infinity). The ratio of circumcised boys to noncircumcised boys in this study provided 80% power to demonstrate a 21.4% difference in the incidence of meatal stenosis between circumcised and noncircumcised Tanner I boys 3 years and older. Meatal stenosis may be the most common complication following neonatal circumcision. The frequency of this complication and the need for surgical correction need to be disclosed as part of the informed consent for neonatal circumcision. A careful meatal examination is indicted in any circumcised boy with abdominal or urinary complaints. <h2>Circumcision and psychological harm today</h2> In an article in the US magazine Psychology Today, Professor Navaez stresses the psychological damage of circumcision, pointing out that in addition to the physical damage, the pain of infant circumcision affects the brain; the fact of being circumcised can cause distress, resentment, anger and depression in adult men; older children are likely to experience operations on their private parts as traumatic invasions of their identity and suffer other forms of psychological harm. There is good evidence emerging that many boys circumcised as children or adolescents suffer post-traumatic stress disorder. Finally, she warns that by encouraging circumcision, advocates are teaching men to despise and be ashamed of their bodies: “If the CDC guidance is followed, medical providers will be communicating a psychologically damaging message to boys with intact genitals—that their penises are somehow “bad” or inferior. The negative effects of such communications have been studied with regard to intersex children and have been found to be frightening, shaming, and embarrassing to the child. This is a particularly cruel message to send to adolescents, many of whom are already experiencing concerns regarding body image.” Source: Darcia Narvaez, <a href="http://www.psychologytoday.com/blog/moral-landscapes/201501/circumcision-s-psychological-damage" rel="noopener" target="_blank">Circumcision’s psychological damage</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Psychological harms of circumcision: accounts from the USA darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h1>100+ circumcision deaths each year in United States</h1> Each year in the United States more than 100 newborn baby boys die as a result of circumcision and circumcision complications. This is the alarming conclusion of a study, published in the <a href="http://www.berghahnjournals.com/view/journals/boyhood-studies/4/1/bhs040106.xml" rel="noopener" target="_blank">Journal of Boyhood Studies</a> which examined hospital discharge and mortality statistics in order to answer two questions: (1) How many baby boys dies as a result of circumcision in the neonatal period (within 28 days of birth)? (2) Why are so few of these deaths officially recorded as due to circumcision? The study, by researcher Dan Bollinger, concluded that approximately 117 neonatal deaths due directly or indirectly to circumcision occur annually in the United States, or one out of every 77 male neonatal deaths. This compares with 44 neonatal deaths from suffocation, 8 in automobile accidents and 115 from Sudden Infant Death Syndrome, all of which losses have aroused deep concern among child health authorities and stimulated special programs to reduce mortality. (Remember those red noses?) Why, the study asks, has the even greater number of deaths from circumcision not aroused the same response? Part of the answer lies in the fact that most circumcision-related deaths are not officially as recorded as due to circumcision at all, but to the immediate cause, most commonly stroke, bleeding, infection or reactions to anaesthesia. Medical statistics are thus at fault in that they do not give the true cause of death at all. Previous studies have given wildly varying estimates the death toll from circumcision. In 1949 paediatrician Douglas Gairdner found that sixteen British boys died each year, while more recent estimates range from a low of two boys per year to a high of as many as 230. Some textbooks and most circumcision promoters claim that there have never been any deaths from circumcision in a modern clinical context (whatever may happen in the insanitary conditions of the Third World). For his study Bollinger collected data from hospital records and government sources to attempt to provide a more accurate estimate of the magnitude of the problem. But another part of the answer lies in the unique place that circumcision occupies in American medical culture, as an entrenched cosmetic ritual that many parents feel they have to submit their baby boys to, and as a lucrative sideline that doctors are reluctant to abandon. American obstetricians can’t seem to rid themselves of the notion that circumcision of boys is somehow an integral part of childbirth. The study points out that “These boys died because physicians have been either complicit or duplicitous, and because parents ignorantly said ‘Yes,’ or lacked the courage to say ‘No.’” It further points out that because circumcision is a completely unnecessary operation, all these deaths are easily avoidable, and thus characterises the annual loss as neither a beneficial surgery nor a beneficent rite of passage, but as “an unrecognized sacrifice of innocents.” Because circumcision is unnecessary surgery (there being no pathology to treat in a normal male baby), the old calculus of surgical risk vs benefit is not nearly enough. “Risk assessment for an unnecessary surgery must be held to a higher standard than that for a life-saving surgery. We accept that a heart transplant carries with it a substantial risk of death, but without it there is a certainty of death. On the other hand, the risk from circumcision, which has no therapeutic value, needs to be zero for the infant’s sake, all the moreso because he is never consulted about whether he wishes to take his chances.” Bollinger argues that the scale of the problem remains unrecognised because of the inadequacies of the death-certificate system and unwillingness on the part of the doctors who performed the surgery or the hospitals where it took place to admit responsibility, or even to acknowledge that circumcision is a surgical operation which, like all surgery, carries real risks. Too often they have tried to blame incorrect care on the part of parents, or even the peculiarities of the boy himself. As well as analysing the figures, the study runs through some of the few prominent instances where circumcision was recognised as the true cause of death, including the Ryleigh McWillis case in Canada, and several United States deaths that somehow made it into the news. Some of these make chilling reading, as these excerpts from the article show: The first known reported circumcision-related deaths were in New York City, where circumcision was introduced. The first was Julius Katzenstein in 1856 and the second was one-week-old Myer Jacob Levy in 1858. Both boys were circumcised by a Dr. Abrahams, and the same coroner reviewed both deaths. The coroner found that Abrahams had performed the surgeries properly, and that the boys died from blood loss as a result of parental neglect. Neither boy had received a follow-up examination. Allen Ervin, born 1985, was in a coma for more than six years before he died. He had been on life support after his brain was damaged from oxygen deprivation during his circumcision. Demetrius Manker was born in 1993 and died soon thereafter from blood loss. The coroner’s examination found a large, gaping wound on the underside of the boy’s penis extending almost to the scrotum. The coroner listed cause of death as blood loss due to penile circumcision; however, there is no mention of further action being taken. A West Virginia child, whose name was withheld, was born in 1996 without incident and circumcised prior to hospital release. A few days later, the parents rushed him to the emergency room because he was having seizures and his penis had turned green in color. He died the next day from septicemia. Because the penis is highly vascularized, blood-loss is a risk even for boys circumcised past the neonatal period. In 2008, a 6-week-old Native American, Eric Keefe, died from massive blood loss. Hospital officials claimed that his circumcision was not to blame, but instead faulted the parents because they had administered over-the-counter pain medication that, they also claimed, thinned his blood. Death sometimes occurs following repair of a circumcision complication. Dustin Evans Jr., was circumcised soon after being born in 1998. The surgeon took so much shaft skin that the scar healed as a tight “collar” around his penis, preventing him from urinating. When he was later given an anesthetic in order to repair the damage, he immediately died of cardiopulmonary arrest. His father lamented, “You think, ‘What could go wrong with a circumcision?’ The next thing I know, he’s dead.” <h3>To stop killing boys, stop circumcising them</h3> The solution to the problem, Bollinger suggests, does not lie in improving surgical techniques or giving operator better training. “The problem is this: circumcision is a killer of baby boys. No one, except for some human-rights activists, is trying to save them. It is unlikely that improving circumcision techniques would eliminate these deaths. No matter how skilled the physician is, some deaths will always occur.” The only effective way to eliminate this death toll and save these boys is to admit that circumcision is unnecessary and potentially harmful surgery and stop performing it on neonates and minors. This would give all boys the chance to decide for themselves whether they wish to be circumcised, and (if they do) would allow them to choose it for themselves as adults, when the surgical risks are so much less severe. Source: Dan Bollinger, <a href="http://www.berghahnjournals.com/view/journals/boyhood-studies/4/1/bhs040106.xml" rel="noopener" target="_blank">Lost boys: An estimate of U.S. circumcision-related infant deaths</a>, THYMOS: Journal of Boyhood Studies, Vol. 4, No. 1, Spring 2010, 78-90. <h2>More circumcision death and injury in United States</h2> <h3>$429,000 awarded for circumcision disfigurement</h3> In August a Californian jury awarded $429,484 to an infant whose penis was disfigured for life by surgery. On Nov. 12, 2006, Evan Tank was circumcised by pediatrician Ralph Berberich, who accidentally cut the tip of Evan’s penis. Plaintiff’s counsel claimed that Berberich failed to remove adhesions tethering the foreskin to the glans, causing the glans to be pulled into the clamp along with the foreskin. Hence the glans was cut off along with the foreskin. Berberich countered that penis trauma is a recognized complication of the procedure and that Evan’s parents had accepted the risk The doctor argued that, rather than an error on his part, Evan probably had an unusual penile anatomy that caused his penis to be pulled into the clamp. Source: Recorder (San Francisco) August 12, 2009 Interesting that the operator tried to blame the infant’s anatomy rather than admitting negligence in his own technique. The fact is that all penises are different; if surgeons are going to muck around with them, they ought to examine each one carefully before they charge in. It's also interesting that the operator tried to defend himself by admitting that (additional) damage to the penis was so common as to be "a recognised complication of the procedure". A bit like Russian roulette. <h3>Parents sue over baby’s death after circumcision</h3> The parents of a 6-week-old boy who bled to death after a circumcision at Rosebud’s Indian Health Service Hospital last year are suing the government for wrongful death. According to documents filed Wednesday in federal court, Eric Keefe underwent a circumcision on June 13, 2008. His mother gave him Motrin and Tylenol for pain and he suffered massive blood loss at home that night, dying at the hospital the next morning. His parents, Forrest and Mary Keefe of Wood, say Dr. Douglas Lehmann failed to inform them of the type of pain medication they should have used. The Keefes are seeking $2 million for personal injury and wrongful death. Sturgis lawyer Mick Strain, who represents the plaintiffs, said he and the parents wouldn’t talk about the case until it is tried or settled. The file lists no attorney for the government. Source: Argus Leader [South Dakota], September 18, 2009 <h3>$2.3 million awarded for botched circumcision</h3> A Fulton County jury (Georgia, U.S.A.) has awarded $1.8 million in damages to a boy whose penis was severed in a botched circumcision. The state court jury gave another $500,000 to the boy’s mother in the decision rendered Friday. The case involves a child, identified only as D.P. Jr., who was born at South Fulton Medical Center in 2004. In a suit filed two years later, his mother contended that the doctor who circumcised him removed too much tissue and that his pediatrician failed to respond when a nurse complained of excessive bleeding. The tip of the penis was placed in a biohazard bag and might have been reattached if a urologist had attended to the boy within eight hours, one of the mother’s lawyers, David J. Llewellyn of Atlanta [and ARC] said. The jury found that both the pediatrician, Dr. Cheryl Kendall, and the physician who performed the circumcision, Dr. Haiba Sonyika, were negligent. South Fulton Medical Center was absolved of liability. The pediatrician’s lawyer, Roger Harris, said he disagreed that the jury’s decision indicated that Dr. Kendall was negligent because she didn’t go to the hospital. He hinted at an appeal. “We believe there was error committed during the course of the trial,” he said. Dr. Sonyika’s lawyer could not be reached for comment. Llewellyn said the money awarded by the jury is to cover the cost of medical treatments and psychiatric counseling for the boy and his family. The jury did not award punitive damages. The Atlanta Journal-Constitution is not naming the mother to avoid identifying the child. “This case does point out one of the dangers of circumcision that every parent must seriously consider when having the procedure done,” Llewellyn said. He contended that parents are not told of the risks of the procedure. Source: <a href="http://www.ajc.com/metro/content/metro/atlanta/stories/2009/03/30/botched_circumcision_suit.html">Atlanta Journal-Constitution</a>, Monday, March 30, 2009 <h3>Claim for circumcision damage in Chicago</h3> A Northwestern Memorial Hospital obstetrician is being sued for allegedly botching a circumcision of a 1-day-old baby and cutting off a portion of the infant's penis, <a href="http://www.wbbm780.com/pages/4206807.php?contentType=4&contentId=3833024">according to WBBM-AM 780</a>. The suit, filed Tuesday in Cook County Circuit Court by David Burden on behalf of his son Daniel Burden, claims that on Oct. 5, 2007, one day after Daniel was born, Dr. Marc Feldstein performed a circumcision on the boy. However, rather than removing only the foreskin, the doctor cut and removed a portion of the baby's penis, the suit said. After the procedure, baby Daniel was transferred to Children's Memorial Hospital to have emergency corrective surgery. Burden accuses Dr. Feldstein, Northwestern Women's Health Associates and Northwestern Memorial Hospital of medical negligence. The suit asks for more than $50,000. <a href="http://www.chicagobreakingnews.com/2009/04/lawsuit-claims-botched-circumcision.html" rel="noopener" target="_blank">Chicago Breaking News Centre, 15 April 2009</a> <h2>Utah (USA) study: Circumcision complications up to 5 times higher than expected</h2> INTRODUCTION AND OBJECTIVES: Circumcision remains a very common procedure in the United States. Published complication rates are lower than clinical practice suggests. We aimed to use a population-based claims database to define the regional 2 year complication rate in boys who underwent circumcision. We hypothesized that this rate would be between 1 and 5%. METHODS: The Utah All-Payer Claims Database (UAPCD) contains data from health insurance carriers, Medicaid, and third party administrators in Utah. The data consist of medical and pharmacy claims as well as insurance and health care provider data, and all residents in the State of Utah are included unless they opt out. The UAPCD was queried for all male patients aged 0-730 days undergoing circumcision (CPT 54150, 54160 and 54161) during the year 2013. Subjects were censored if they had less than 2 years of post-procedure data. Demographic, medical and procedure-specific data was abstracted. ICD-9 and -10 codes were used to identify infectious, bleeding, urethral, skin and wound healing-related complications. Encounters for circumcision revision (CPT 54161, 54163), or lysis of penile adhesions (CPT 54162) were noted. RESULTS: In 2013 there were 26,069 male births and 6298 circumcisions were captured. The mean age at circumcision was 9.8 days for those who had circumcision with a clamp (CPT 54150), 16.3 days for those who had a surgical circumcision other than clamp (CPT 54160) and 309.3 days for boys who had a formal circumcision after the neonatal period (CPT 54161). 725 (11.5%) complications were identified. The two most common complications were phimosis in 433 (6.9%) and other wound related complications such as acquired torsion, buried penis and edema in 168 (2.7%). Infectious/inflammatory (1.2%), urethral (0.5%), and bleeding (0.3%) complications were rare. 101 (1.6%) patients underwent surgical revision or lysis of penile adhesions. Complications did not differ significantly between patients who h the original circumcision in a hospital vs. an outpatient setting (p=0.33) or in an urban vs. rural location (p=0.22). When adjusted for healthcare setting and location, the difference in complications between patients less than 90 compared to those 90 to 730 days old was not significant. CONCLUSIONS: The incidence of post-circumcision complications at 2 years is much higher than expected at 11.5%, but does not appear to be influenced by age at circumcision, healthcare setting or a rural vs. urban location. A minority of subjects needed reoperation during the ensuing 2 years. Glen Lau, Jaewhan Kim, Anthony Schaeffer. Identification of circumcision complications using a regional claims database. <a href="http://spuonline.org/abstracts/2018/P21.cgi" rel="noopener" target="_blank">Spuonline reports</a>, February 2018. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Circumcision deaths in the USA darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>Seven-day old baby died after circumcision</h2> DETECTIVES are investigating the death of a seven-day-old baby after he was circumcised. Stunned relatives at the Jewish ceremony saw the toddler experience breathing difficulties. He was taken to hospital but died eight days later. A post mortem found the infant died from cardiac arrest and oxygen starvation. Police are to interview family members and the senior rabbi who performed the operation at Golders Green Synagogue in North London. Concerns raised by doctors treating the baby have led to the probe being led by Scotland Yard’s child abuse investigators. Police and Home Office sources said the investigation was “highly unusual”. A Scotland Yard spokesman stated: “The death is being treated as unexplained at this early stage.” The baby died two weeks ago at University College Hospital, Central London. Circumcision of boys is an operation in which the foreskin is removed from the penis. With small babies, local anaesthetic is often sufficient and avoids the risks of a general anaesthetic. Some people believe the skin is redundant and gets in the way of hygiene. Others say it is a vital part of the male anatomy and should not be removed. Judaism considers circumcision to be an important ritual. The operation is usually performed by a mohel - a specialist in the procedure and its rituals. Many British mohels are doctors, rabbis or both. All have received appropriate medical and religious training. A spokesman for The United Synagogue, a membership of 35 orthodox synagogues in Greater London, said: “We are awaiting the results of the police enquiry and until then it would not be appropriate for us to comment further." The Mirror (London), 15 February 2007, Exclusive by Stephen Moyes <a href="https://tinyurl.com/2db9x5">http://tinyurl.com/2db9x5</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Circumcision deaths and complications in the UK darby