once accepted as the norm in the United States, has become controversial.
Technically, circumcision is the surgical removal of the skin that
normally covers and protects the head, or glans, of the penis.
At birth, the penis is covered with a continuous layer of skin extending
from the pubis to the tip of the penis where the foreskin (prepuce)
folds inward upon itself, creating a double protective layer of skin
over the glans penis. The inner lining of the prepuce is mucous membrane
and serves to keep the surface of the glans penis (also mucous membrane)
soft, moist, and sensitive. The prepuce is often erroneously referred
to as "redundant" tissue, which allows the medical community and society-at-large
to consider the foreskin an optional part of the male sex organ and,
therefore, to condone its routine removal in a variety of procedures
collectively known as "circumcision."
however, was also a part of religious ritual, including Judaism and
Islam as well as others. However, 85 percent of the world's male population
is not circumcised. Circumcision in 1992 was still the most commonly
performed surgical procedure in America, where 59 percent of newborn
males underwent this operation. Circumcision reached its peak of 85
to 90 percent during the 1960s and 1970s. The surgery, usually performed
on baby boys within the first few days of life, is often considered
"routine." The most popular methods, the Gomco clamp and the Plastibell
procedures, differ somewhat in technique and instrumentation but the
effects on the penis and the baby are basically the same. Most of
the American circumcisions are not done for religious reasons, but
rather, for hygienic ones.
procedure for circumcision in America involves the baby being strapped
spread-eagle to a plastic board, with his arms and legs immobilized
by Velcro straps. A nurse scrubs his genitals with an antiseptic solution
and places a surgical drape - with a hole in it to expose his penis
- across his body. The doctor grasps the tip of the foreskin with
one hemostat and inserts another hemostat between the foreskin and
the glans. (In 96 percent of newborns, these two structures are attached
to one another by a continuous layer of epithelium, which protects
the sensitive glans from urine and feces in infancy and childhood.)
The foreskin is then torn from the glans. The hemostat is used to
crush an area of the foreskin lengthwise, which prevents bleeding
when the doctor cuts through the tissue to enlarge the foreskin opening.
This allows insertion of the circumcision instrument. The foreskin
is crushed against this device circumferentially and amputated.
not used to alleviate infant suffering until recently because it was
believed that babies do not feel pain. Additionally, it was recognized
that anesthesia was risky for the newborn, thus contributing to the
medical reluctance to use it for painful procedures on infants, such
as circumcision. Currently, some doctors use a dorsal penile nerve
block to numb the penis during infant circumcision. While not always
effective, this anesthesia may afford some pain relief during the
surgery, although it offers no pain relief during the recovery period
(which can last up to 14 days) when the baby urinates and defecates
into the raw wound.
of the Foreskin
the function of the prepuce, it is necessary to understand the function
of the penis. While it is commonly recognized that the penis has two
functions - urination and procreation - in reality, it is essential
only for procreation, since it is not required for urination.
to occur, the normally flaccid penis must become erect. As it changes
from flaccidity to rigidity, the penis increases in length about 50
percent. As it elongates, the double fold of skin (foreskin) provides
the skin necessary for full expansion of the penile shaft. But microscopic
examination reveals that the foreskin is more than just penile skin
necessary for a natural erection; it is specialized tissue, richly
supplied with blood vessels, highly innervated, and uniquely endowed
with stretch receptors. These attributes of the foreskin contribute
significantly to the sexual response of the intact male. The complex
tissue of the foreskin responds to stimulation during sexual activity.
Stretching of the foreskin over the glans penis activates preputial
nerve endings, enhances sexual excitability, and contributes to the
male ejaculatory reflex. Besides the neurological role of the preputial
tissue, the mucosal surface of the inner lining of the foreskin has
a specific function during masturbation or sexual relations.
the mucosal surface of the foreskin rolls back and forth across the
mucosal surface of the glans penis, providing nontraumatic sexual
stimulation. During heterosexual activity, the mucosal surfaces of
the glans penis and foreskin move back and forth across the mucosal
surfaces of the labia and vagina, providing nontraumatic sexual stimulation
of both male and female. This mucous-membrane-to-mucous-membrane contact
provides the natural lubrication necessary for sexual relations and
prevents both the dryness responsible for painful intercourse and
the chafing and abrasions which allow entry of sexually transmitted
diseases, both viral and bacterial.
sexually functioning tissue is removed, sexual functioning is also
altered. Changes of the penis that occur with circumcision have been
documented. These may vary according to the procedure used and the
age at which the circumcision was performed, nevertheless penile changes
will inevitably occur following circumcision.
performed in the newborn period traumatically interrupts the natural
separation of the foreskin from the glans that normally occurs somewhere
between birth and age 18. The raw, exposed glans penis heals in a
process that measurably thickens the surface of the glans and results
in desensitization of the head of the penis.
is performed after the normal separation of the foreskin from the
glans, the damage done by forcible separation of these two parts of
the penis is avoided, but the glans must still thicken in order to
protect itself from constant chafing and abrasion by clothing.
drier tissue covering the glans of the circumcised penis may necessitate
the use of synthetic lubricants to facilitate nontraumatic sexual
intercourse. Often, it is erroneously considered the woman's lack
of lubrication that makes intercourse painful rather than the lack
of natural male lubrication, which is more likely the cause. During
masturbation, the circumcised male must use his hands for direct stimulation
of the glans, and this may require synthetic lubrication as well.
to the predictable physical changes that occur with circumcision,
there are inherent risks and potential complications from the surgery.
These include, but are not limited to, hemorrhage, infection, surgical
damage and, while rare, death. Surgical damage and healing complications
can result in extensive scarring, skin bridging, curvature of the
penis, and deformities of the glans penis and urethral meatus (urinary
opening). Extreme mutilations have resulted from inappropriate electrocautery
use in circumcision, causing loss of the entire penis. Sex-change
operations have been used as a "remedy" for this iatrogenic condition.
has potential risks and alters normal, sexual functioning of the penis,
proponents of the practice consider it to confer many "prophylactic"
benefits on the recipient. This rationale was initiated in the English-speaking
countries during the 19th century when the etiology of diseases was
unknown. At that time, circumcision evolved from a religious ritual
or puberty rite into routine surgery for "health" reasons.
Within the miasma
of myth and ignorance, a theory emerged that masturbation caused many
and varied ills, so some physicians thought it logical to perform
genital surgery on both sexes to stop masturbation. In 1891, P.C.
Remondino advocated circumcision to prevent or to cure alcoholism,
epilepsy, asthma, hernia, gout, rheumatism, curvature of the spine,
and headaches. As scientific research uncovered legitimate pathological
etiology for diseases previously thought to be prevented or cured
by circumcision, new rationales were postulated to validate the practice.
Prophylactic circumcision of females fell out of vogue in English-speaking
countries, but the incidence of male circumcision steadily rose. In
the early 20th century, circumcision was advocated as a hygienic measure.
Though criticism of the practice mounted, it was not until 1975 that
the American Academy of Pediatrics came out in opposition,
arguing that good personal hygiene would offer all the advantages
of routine circumcision without the attendant surgical risk. The advent
of antibiotics negated the rationale that circumcision was needed
to prevent venereal disease.
As a religious
ritual, circumcision is practiced by Jews and Moslems in accordance
with the biblical account of Abraham's covenant with God. Even so,
the "purpose" of the Jewish ritual of circumcision has been argued
by Jews throughout history. Noted Rabbi Moses Maimonides, in the Guide
of the Perplexed, explains a rationale for circumcision that
merits attention when circumcision is considered relative to human
The Moslems, who also circumcise in accordance with the biblical covenant
between Abraham and God, traditionally circumcised their males at age
13. More recently, however, Moslem boys are circumcised at varying ages
from birth to puberty.
As regards circumcision... [s]ome people believe
that circumcision is to remove a defect in man's formation; but
every one can easily reply: How can products of nature be deficient
so as to require external completion, especially as the use of
the foreskin to that organ is evident. This commandment has not
been enjoined as a complement to a deficient physical creation,
but as a means for perfecting man's moral shortcomings. The bodily
injury caused to that organ is exactly that which is desired;
it does not interrupt any vital function, nor does it destroy
the power of generation. Circumcision simply counteracts excessive
lust; for there is no doubt that circumcision weakens the power
of sexual excitement, and sometimes lessens the natural enjoyment;
the organ necessarily becomes weak when it loses blood and is
deprived of its covering from the beginning.
In the United
States, the religious rights of parents are being questioned in regard
to the constitutional rights of infants and children. Freedom of religion
became a legal issue when it was introduced in a circumcision lawsuit
claiming a male had been denied his right to freedom of religion
when his body was marked by circumcision in accordance with his
body ownership rights of infants and children continue to be addressed
within the U.S. legal system in lawsuits asserting that the only person
who can legally consent to a circumcision is a person making this
personal decision for himself. The reports of dissatisfaction with
parental circumcision decisions by circumcised men help to illustrate
this point. Performed on their penises without their consent, thousands
are now undergoing foreskin restoration, either medical or surgical,
to reconstruct what they consider was violently taken from their bodies
early in their lives. The Declaration
of the First International Symposium on Circumcision acknowledges
the unrecognized victims of circumcision and, in support of genital
ownership rights of infants and children, states:
Due to the lifelong consequences of the permanent surgical alteration
of children's genitals, it becomes imperative that children have the
right to own their own reproductive organs and to preserve their natural
"We recognize the inherent right of every human being
to an intact body. Without religious or racial prejudice, we affirm
this basic human right."
These, then, are the human genitals. Considering
their great delicacy, complexity and sensitivity, one might imagine
that an intelligent species like man would leave them alone. Sadly,
this has never been the case. For thousands of years, in many
different cultures, the genitals have fallen victim to an amazing
variety of mutilations and restrictions. For organs that are capable
of giving us an immense amount of pleasure, they have been given
an inordinate amount of pain. (Morris, 1985)
American Academy of Pediatrics. Care
of the Uncircumcised Penis. Evanston, Ill.: American Academy of
American Academy of Pediatrics' Task Force on Circumcision. Report
of the Task Force on Circumcision. Elk Grove Village, Ill.: 1989.
Morris, D. Body Watching. New York: Crown, 1985.
Remondino, P.C. History of Circumcision From the Earliest Times
to the Present. Philadelphia: F.A. Davis Co., 1892. Republished
New York: AMS Press, 1974.
Wallerstein, E. Circumcision: An American Health Fallacy.
New York: Springer Publishing Co., 1980.
Marilyn Fayre Milos
Donna R. Macris