In many hospitals, circumcision has become a routine part of
the care provided for male infants. This author contends that it is
time for the medical establishment to rethink both the reasons for
and the consequences of this procedure.
n recent years, the debate on circumcision has been
conducted on a relatively low plane, with proponents arguing that circumcision
may prevent some unusual or rare conditions. Opponents of circumcision
argue that it has no medical benefits. This article seeks to simplify
the subject and raise it to a higher plane - focusing on the positive
value of the intact foreskin.
Before birth, the glans penis is covered with skin. This skin is not
loosely attached; indeed, it is as tightly attached to the glans as
is the skin on the hand, for example.1
At approximately 17 weeks
gestation, cells in the area of separation between the future foreskin
and the glans initiate the process of creating the preputial space
(ie, the space between the glans penis and the intact foreskin). They
begin to form microscopic balls comprising multiple layers of cells.
As these whorls of cells enlarge, cells at the center are cut off
from nutrients; they die and create a space. These minute spaces coalesce,
eventually becoming the preputial space.1
This process is completed by age 3 in 90% of boys, but it may take
as long as 17 years for some boys to have a fully retractable foreskin.
At birth, the separation
of the foreskin from the glans has just begun. The newborn's penis
is, of course, not yet fully developed. Not only does circumcision
interfere with its development, but it requires that the surgeon tear
the skin from the sensitive glans to permit removal. Perhaps as a
way to avoid confronting this reality, physicians refer to this as
If physicians would simply leave the newborn's penis intact, as Dr
Spock came to recommend,2
the foreskin would be left to fulfill its several functions. In infancy,
the foreskin protects the glans from irritation and from fecal material.
The function of the foreskin in adulthood may at first seem more obscure.
The shaft and usually the glans of an uncircumcised man's penis are
covered by skin. Retracting the foreskin reveals the glans and makes
the skin on the shaft somewhat loose. Of what use is this redundant
skin? During erection, the penile shaft elongates, becoming about
50% longer. The foreskin covers this lengthened shaft and is thus
specifically designed to accommodate an organ that is capable of a
marked increase in diameter and length.
In addition, the foreskin
is one of the most sensitive parts of the penis and can enhance the
quality of sexual intercourse. Anatomical studies demonstrate that
the foreskin has a greater concentration of complex nerve endings
than the glans.3
If there is any possibility that the foreskin can contribute significantly
to sexual enjoyment, is that not a cogent reason for rethinking our
motives for this ritual procedure?
The Case Against Circumcision
History shows that the arguments in favor of circumcision are questionable.
At the beginning of this century, one of the reasons given for circumcision
was to decrease masturbation, which was thought to lead to insanity
and other "morbid" conditions. We now know that circumcision does
not prevent masturbation, nor does masturbation lead to insanity.
More recently, circumcision
was promoted as a means of preventing cervical cancer in the man's
sexual partners; this notion has been proved incorrect.4
The current excuses are that failure to remove the foreskin may contribute
to urinary tract infections and penile cancer, but neither of these
contentions has been proved. Performing 100 mutilative surgeries to
possibly prevent one treatable urinary tract infection is not valid
preventive medicine - it is just another excuse. Penile cancer occurs
in older men at a rate of approximately 1 per 100,000. The idea of
performing 100,000 mutilating procedures on newborns to possibly prevent
cancer in one elderly man is absurd. Applying this type of reasoning
to women would seem to lead to the conclusion that breast cancer should
be prevented by removing the breasts at puberty.
One thousand years ago,
the Jewish sage Maimonides said that the effect of circumcision was
"to limit sexual intercourse, and to weaken the organ of generation
as far as possible, and thus cause man to be moderate...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...deprived of its covering from the beginning. Our
sages say distinctly: it is hard for a woman, with whom an uncircumcised
[man] had sexual intercourse, to separate from him."5
Infants are routinely circumcised
without anesthesia. In the past few years, scientific papers have
demonstrated that infants' responses to pain are similar to those
of adults, indicating that babies do indeed experience pain.6
This is supported by the fact that the quality of an infant's cry
is appallingly different at circumcision.