Mom, Baseball, Apple Pie, and Circumcision?
by Donald Morgan
[This article was published in the June 1996 issue of Sound Views, monthly newsletter of the Humanists of North Puget Sound, La Conner, WA]
The nonreligious circumcision (NRC) of American males is as American as mom, baseball, and apple pie. In fact, it is a uniquely American custom which is not duplicated in any other country in the world.
While the vast majority of American males are circumcised, the vast majority of the world's males are not. The practice here, for example, contrasts sharply with that of the Scandinavian countries where NRC is not, and never has been, routinely practiced and where it is estimated that less than 5% of all males are circumcised.
The current rate of NRC in the United States is now about 70%, down from its peak in the late 1960s when about 95% of all newborn males who were born in hospitals were circumcised. In some regions, notably the Midwest and the Northeast, the NRC rate remains at almost 90%. In others, notably California, it is considerably less. Still, NRC remains the norm in most areas of the country. This is especially true in the case of white, middle-class America.
Few Americans likely realize that NRC was originally promoted in this country in the last half of the 19th century in an attempt to curb masturbation and the countless ills and dire consequences that were thought to be associated with it. Here is one of the many examples which could be cited reflecting the then current wisdom regarding masturbation:
In all cases which male children are suffering nerve tension, confirmed derangement of the digestive organs, restlessness, irritability, and other disturbances of the nervous system, even to chorea, convulsions, and paralysis, or where through nerve waste the nutritive facilities of the general system are below par and structural diseases are occurring, circumcision should be considered as among the lines of treatment to be pursued. [Charles E. Fisher, M.D., A Handbook on the Diseases of Children ...., Chicago: Medical Century Co., 1895, p. 875]
In fact, there was hardly an illness or disease that could not be, and was not, attributed to masturbation. In addition to those previously mentioned, the list included insanity, blindness, epilepsy, convulsions, tuberculosis--you name it. Often, a drastic circumcision performed without anaesthesia was the preferred "treatment."
Dr. Kellogg, founder of the corn flake company bearing his name, had this to say:
A remedy for masturbation which is almost always successful in small boys is circumcision.... The operation should be performed by a surgeon without administering anaesthetic, as the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment. [John Harvey Kellogg, M.D., Plain Facts for Young and Old, Burlington, Iowa: F. Segner & Co., 1888, p. 295]
It began to be noticed, of course, that circumcision did not always prevent or cure masturbation and that masturbation did not cause the numerous illnesses and dire consequences that had been attributed to it.
Other medical justification was then found for continuing the practice of NRC. It was alleged, for example, that it made personal hygiene easier, precluded the need for circumcision at a later age, prevented cancer of the penis, lowered the risk of cervical cancer in one's partners, lowered the risk of prostate cancer, lowered the risk of sexually transmitted diseases (STDs), etc. The latest alleged benefits are a reduction in urinary tract infections (UTIs) in infant boys and HIV infections in adult men.
The list of alleged benefits has grown so long that the mere presence of a foreskin would seem to be a major health hazard--a ticking time bomb about to destroy its owner and any female that might be unfortunate enough to come into contact with him.
Because of this, it has not always been easy for an intact male to remain that way. Circumcision was and is often recommended by well-meaning physicians, certain that they are doing their patients a favor.
Beginning in the 1970s, the prevailing medical wisdom regarding circumcision began to be questioned on a number of fronts. Many of the alleged medical benefits proved to be completely bogus. Most of the others turned out to be so negligible as to be offset by the disadvantages and risks.
In 1971, the American Academy of Pediatrics (AAP) announced its position that the routine circumcision of newborn males is medically unwarranted. This position was slightly modified in 1989 to reflect the fact that there are potential benefits as well as inherent risks, although the previously stated position that the routine circumcision of newborn males is medically unwarranted remained unchanged.
Nevertheless, the practice of routine NRC was so firmly entrenched in American culture that the AAP's position had only a small impact on NRC rates. Many Americans continued to believe that there were significant health benefits. In addition, new justification based on psychological and cultural considerations was offered and is often used today in support of the continued practice of NRC.
Many parents, for example, feel that it is important for a son to match dad, brothers, cousins, and/or peers. They fear that a boy may be teased and/or feel "different" if he is not circumcised. Many feel that it is simply more "aesthetic" to be circumcised.
Many parents are also convinced that--even if there are no good reasons in favor of NRC--there are certainly no good reasons not to do it. Parents and physicians alike tend to see circumcision as a trivial operation with few if any contraindications.
Unfortunately, most parents, and even many physicians, are unaware of either the frequency or seriousness of complications that are associated with circumcision.
A recent study states that the realistic complication rate is about 5%. Considering that more than 1,300,000 boys a year undergo this procedure in the U.S., this means that every year 65,000 will suffer some sort of complication, and some of those complications will be serious.
Circumcision complications and accidents do not often receive widespread publicity. Many times, nothing at all is reported in the media. For example, here in our own backyard just a few months ago, a La Conner infant (the son of the brother of a friend of the author's daughter) developed a severe infection as a complication of a "routine" circumcision on the fourth day of his life. This resulted in the loss of all the skin between the lower abdomen and upper thighs, inclusive.
This unfortunate child has already undergone several surgeries with many more to come. Extensive pig-skin grafting will be done. There is little chance that he will ever achieve normal sexual function.
This, by the way, is not the worst outcome that has been reported in the medical literature. Loss of a portion of or all of the penis--and even death--are not unheard of.
Though such unfortunate consequences are quite rare, the potential for harm as a consequence of circumcision cannot be easily dismissed.
Even when a circumcision is "normal," there is a loss involved. A recent study indicates that a typical circumcision removes tissue that not only plays an important part in the erogenous sensitivity of the male but is, in fact, more sensitive than that which is left.
The prepuce provides a large and important platform for several nerves and nerve endings.... The glans, by contrast, is insensitive to light touch, heat, cold, and, as far as the authors are aware, to pin prick. Le Gros Clark noted that the glans penis is one of the few areas on the body that enjoys nothing beyond primitive sensory modalities. [The Prepuce, Specialized Mucosa of the Penis, and Its Loss to Circumcision, British Journal of Urology, February 1996, pp 291-5]
Another consideration is the matter of pain. Although it was long believed that infants do not really feel pain, there are now a number of studies which prove otherwise.
Newborn infant responses to pain are similar to but greater than those in adult subjects. [Pain and its Effects in the Human Neonate and Fetus, New England Journal of Medicine, November 19, 1987, pp 1321-1329]
Many adults who have been present at a neonatal circumcision, typically performed without anaesthesia, have been so horrified at the obvious pain felt by the child that this alone has been enough to cause them to decide against NRC for their own son(s).
There are a number of reasons, however, that neonatal circumcisions are usually performed without anaesthesia. There are still a number of physicians who insist that infants do not feel pain. Worse, it has recently been determined that the injection of local anesthesia into free tissue can cause serious and permanent vascular and nerve damage. And general anaesthesia is simply too risky to use in the case of neonates.
In addition to all of these more obvious problems, there is also a human rights issue involved. Human rights activists feel strongly that every child has the right to an intact body. They believe that it is wrong for parents to seek, or physicians to engage in, genital surgery on children in the absence of a clear medical need. To remove normal, healthy, functional, erogenous tissue, from an infant or child who has not given informed consent is seen as a violation of the basic tenets of medical ethics.
In February 1995, the AAP Committee on Bioethics released a statement on informed consent. The Committee stated that medical interventions should only be undertaken in situations of clear and immediate medical necessity, such as disease, trauma, or deformity. The Committee suggested that nonessential treatments which could be deferred without substantial risk should be postponed until the individual's consent can be obtained.
The Committee's statement regarding unnecessary surgical procedures in the case of unconsenting minors seems to conflict with the AAP's position that routine, neonatal circumcision, though not medically justified, is a valid elective procedure that can be performed by its physician members in response to the simple, stated, aesthetic preference of parents.
The human rights issue in regard to circumcision will be thoroughly explored at the Fourth International Symposium on Sexual Mutilations which will be held in August, in Lausanne, Switzerland. The Ashley Montagu Resolution to End the Genital Mutilation of Children Worldwide will be presented. And, for the first time ever, the practice of routine circumcision in the United States will be specifically targeted.
Humanitarians everywhere decry female genital mutilation, and rightly so. It is time to do the same with regard to the practice of unnecessary genital surgery on infants and boys.
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