Guest guest Posted January 22, 2009 Report Share Posted January 22, 2009 This is from My Ped. It is a grate Article. The Case Against CircumcisionPaul M. Fleiss, MDPaul M. Fleiss, MD, MPH, is assistant clinical professor of pediatrics at the Universityof Southern California Medical Center. He is the author of numerous scientific articlespublished in leading national and international medical journals.Published in Mothering: The Magazine of Natural Family Living, Winter 1997, pp. 36--45.Created as aMothers Against Circumcision Web Page w/express permission from the author and Mothering."Routine circumcision of babies in the United States did not begin until the ColdWar era. Circumcision is almost unheard of in Europe, Southern America, and non-MuslimAsia. In fact, only 10 to 15 percent of men throughout the world are circumcised.""The natural penis requires no special care. A child's foreskin, like his eyelids,is self-cleansing. Forcibly retracting a baby's foreskin can lead to irritation andinfection. The best way to care for a child's intact penis is to leave it alone."The Foreskin Is NecessaryBy Paul M. Fleiss, MD, MPH Western countries have no tradition of circumcision. In antiquity, the expansionof the Greek and Roman Empires brought Westerners into contact with the peoples ofthe Middle East, some of whom marked their children with circumcision and other sexualmutilations. To protect these children, the Greeks and Romans passed laws forbiddingcircumcision.1 Over the centuries, the Catholic Church has passed many similar laws.2,3The traditional Western response to circumcision has been revulsion and indignation. Circumcision started in America during the masturbation hysteria of the VictorianEra, when a few American doctors circumcised boys to punish them for masturbating.Victorian doctors knew very well that circumcision denudes, desensitizes, and disablesthe penis. Nevertheless, they were soon claiming that circumcision cured epilepsy,convulsions, paralysis, elephantiasis, tuberculosis, eczema, bed-wetting, hip-jointdisease, fecal incontinence, rectal prolapse, wet dreams, hernia, headaches, nervousness,hysteria, poor eyesight, idiocy, mental retardation, and insanity.4 In fact, no procedure in the history of medicine has been claimed to cureand prevent more diseases than circumcision. As late as the 1970s, leading Americanmedical textbooks still advocated routine circumcision as a way to prevent masturbation.5The antisexual motivations behind an operation that entails cutting off part of thepenis are obvious. The radical practice of routinely circumcising babies did not begin until theCold War era. This institutionalization of what amounted to compulsory circumcisionwas part of the same movement that pathologized and medicalized birth and activelydiscouraged breastfeeding. Private-sector, corporate-run hospitals institutionalizedroutine circumcision without ever consulting the American people. There was no publicdebate or referendum. It was only in the 1970s that a series of lawsuits forced hospitalsto obtain parental consent to perform this contraindicated but highly profitablesurgery. Circumcisers responded by inventing new "medical" reasons for circumcisionin an attempt to scare parents into consenting. Today the reasons given for circumcision have been updated to play on contemporaryfears and anxieties; but one day they, too, will be considered irrational. Now thatsuch current excuses as the claim that this procedure prevents cancer and sexuallytransmitted diseases have been thoroughly discredited, circumcisers will undoubtedlyinvent new ones. But if circumcisers were really motivated by purely medical considerations,the procedure would have died out long ago, along with leeching, skull-drilling,and castration. The fact that it has not suggests that the compulsion to circumcisecame first, the "reasons," later. Millions of years of evolution have fashioned the human body into a modelof refinement, elegance, and efficiency, with every part having a function and purpose.Evolution has determined that mammals' genitals should be sheathed in a protective,responsive, multipurpose foreskin. Every normal human being is born with a foreskin.In females, it protects the glans of the clitoris; in males, it protects the glansof the penis. Thus, the foreskin is an essential part of human sexual anatomy. Parents should enjoy the arrival of a new child with as few worries as possible.The birth of a son in the US, however, is often fraught with anxiety and confusion.Most parents are pressured to hand their baby sons over to a stranger, who, behindclosed doors, straps babies down and cuts their foreskins off. The billion-dollar-a-yearcircumcision industry has bombarded Americans with confusing rhetoric and calculatedscare tactics. Information about the foreskin itself is almost always missing from discussionsabout circumcision. The mass circumcision campaigns of the past few decades haveresulted in pandemic ignorance about this remarkable structure and its versatilerole in human sexuality. Ignorance and false information about the foreskin are therule in American medical literature, education, and practice. Most American medicaltextbooks depict the human penis, without explanation, as circumcised, as if it wereso by nature.What Is the Foreskin? The foreskin is a uniquely specialized, sensitive, functional organ of touch.No other part of the body serves the same purpose. As a modified extension of thepenile shaft skin, the foreskin covers and usually extends beyond the glans beforefolding under itself and finding its circumferential point of attachment just behindthe corona (the rim of the glans). The foreskin is, therefore, a double-layered organ.Its true length is twice the length of its external fold and comprises as much as80 percent or more of the penile skin covering.6,7 The foreskin contains a rich concentration of blood vessels and nerve endings.It is lined with the peripenic muscle sheet, a smooth muscle layer with longitudinalfibers. These muscle fibers are whirled, forming a kind of sphincter that ensuresoptimum protection of the urinary tract from contaminants of all kinds. Like the undersurface of the eyelids or the inside of the cheek, the undersurfaceof the foreskin consists of mucous membrane. It is divided into two distinct zones:the soft mucosa and the ridged mucosa. The soft mucosa lies against the glans penisand contains ectopic sebaceous glands that secrete emollients, lubricants, and protectiveantibodies. Similar glands are found in the eyelids and mouth. Adjacent to the soft mucosa and just behind the lips of the foreskin is theridged mucosa. This exquisitely sensitive structure consists of tightly pleated concentricbands, like the elastic bands at the top of a sock. These expandable pleats allowthe foreskin lips to open and roll back, exposing the glans. The ridged mucosa givesthe foreskin its characteristic taper. On the underside of the glans, the foreskin's point of attachment is advancedtoward the meatus (urethral opening) and forms a bandlike ligament called the frenulum.It is identical to the frenulum that secures the tongue to the floor of the mouth.The foreskin's frenulum holds it in place over the glans, and, in conjunction withthe smooth muscle fibers, helps return the retracted foreskin to its usual forwardposition over the glans.Retraction of the Foreskin At birth, the foreskin is usually attached to the glans, very much as a fingernailis attached to a finger. By puberty, the penis will usually have completed its development,and the foreskin will have separated from the glans.8 This separation occurs in itsown time; there is no set age by which the foreskin and glans must be separated.One wise doctor described the process thus, "The foreskin therefore can be likenedto a rosebud which remains closed and muzzled. Like a rosebud, it will only blossomwhen the time is right. No one opens a rosebud to make it blossom."9 Even if the glans and foreskin separate naturally in infancy, the foreskinlips can normally dilate only enough to allow the passage of urine. This ideal featureprotects the glans from premature exposure to the external environment. The penis develops naturally throughout childhood. Eventually, the child will,on his own, make the wondrous discovery that his foreskin will retract. There isno reason for parents, physicians, or other caregivers to manipulate a child's penis.The only person to retract a child's foreskin should be the child himself, when hehas discovered that his foreskin is ready to retract. Parents should be wary of anyone who tries to retract their child's foreskin,and especially wary of anyone who wants to cut it off.Human foreskins are in great demand for any number of commercial enterprises, and the marketing of purloined baby foreskins is a multimillion-dollar- a-year industry. Pharmaceutical and cosmetic companies use human foreskins as research material.Corporations such as Advanced Tissue Sciences, Organogenesis, and BioSurface Technologyuse human foreskins as the raw materials for a type of breathable bandage.10What Are the Foreskin's Functions? The foreskin has numerous protective, sensory, and sexual functions.Protection: Just as the eyelids protect the eyes, the foreskin protects the glans and keepsits surface soft, moist, and sensitive. It also maintains optimal warmth, pH balance,and cleanliness. The glans itself contains no sebaceous glands-glands that producethe sebum, or oil, that moisturizes our skin.11 The foreskin produces the sebum thatmaintains proper health of the surface of the glans.Immunological Defense: The mucous membranes that line all body orifices are the body's first line of immunologicaldefense. Glands in the foreskin produce antibacterial and antiviral proteins suchas lysozyme.12 Lysozyme is also found in tears and mother's milk. Specialized epithelialLangerhans cells, an immune system component, abound in the foreskin's outer surface.13Plasma cells in the foreskin's mucosal lining secrete immunoglobulins, antibodiesthat defend against infection.14Erogenous Sensitivity: The foreskin is as sensitive as the fingertips or the lips of the mouth. It containsa richer variety and greater concentration of specialized nerve receptors than anyother part of the penis.15 These specialized nerve endings can discern motion, subtlechanges in temperature, and fine gradations of texture.16, 17, 18, 19, 20, 21, 22,23Coverage During Erection: As it becomes erect, the penile shaft becomes thicker and longer. The double-layeredforeskin provides the skin necessary to accommodate the expanded organ and to allowthe penile skin to glide freely, smoothly, and pleasurably over the shaft and glans.Self-Stimulating Sexual Functions: The foreskin's double-layered sheath enables the penile shaft skin to glide backand forth over the penile shaft. The foreskin can normally be slipped all the way,or almost all the way, back to the base of the penis, and also slipped forward beyondthe glans. This wide range of motion is the mechanism by which the penis and theorgasmic triggers in the foreskin, frenulum, and glans are stimulated.Sexual Functions in Intercourse: One of the foreskin's functions is to facilitate smooth, gentle movement betweenthe mucosal surfaces of the two partners during intercourse. The foreskin enablesthe penis to slip in and out of the vagina nonabrasively inside its own slick sheathof self-lubricating, movable skin. The female is thus stimulated by moving pressurerather than by friction only, as when the male's foreskin is missing.The foreskin fosters intimacy between the two partners by enveloping the glans andmaintaining it as an internal organ.The sexual experience is enhanced when the foreskin slips back to allow the male'sinternal organ, the glans, to meet the female's internal organ, the cervix-a momentof supreme intimacy and beauty. The foreskin may have functions not yet recognized or understood. Scientistsin Europe recently detected estrogen receptors in its basal epidermal cells.24 Researchersat the University of Manchester found that the human foreskin has apocrine glands.25These specialized glands produce pheromones, nature's chemical messengers. Furtherstudies are needed to fully understand these features of the foreskin and the rolethey play.Care of the Foreskin The natural penis requires no special care. A child's foreskin, like his eyelids,is self-cleansing. For the same reason it is inadvisable to lift the eyelids andwash the eyeballs, it is inadvisable to retract a child's foreskin and wash the glans.Immersion in plain water during the bath is all that is needed to keep the intactpenis clean.26 The white emollient under the child's foreskin is called smegma. Smegma isprobably the most misunderstood, most unjustifiably maligned substance in nature.Smegma is clean, not dirty, and is beneficial and necessary. It moisturizes the glansand keeps it smooth, soft, and supple. Its antibacterial and antiviral propertieskeep the penis clean and healthy. All mammals produce smegma. Thomas J. Ritter, MD,underscored its importance when he commented, "The animal kingdom would probablycease to exist without smegma."27 Studies suggest that it is best not to use soap on the glans or foreskin'sinner fold.28 Forcibly retracting and washing a baby's foreskin destroys the beneficialbacterial flora that protect the penis from harmful germs and can lead to irritationand infection. The best way to care for a child's intact penis is to leave it alone.After puberty, males can gently rinse their glans and foreskin with warm water, accordingto their own self-determined needs.How Common Is Circumcision? Circumcision is almost unheard of in Europe, South America, and non-MuslimAsia. In fact, only 10 to 15 percent of men throughout the world are circumcised,the vast majority of whom are Muslim.29 The neonatal circumcision rate in the westernUS has now fallen to 34.2 percent.30 This relatively diminished rate may surpriseAmerican men born during the era when nearly 90 percent of baby boys were circumcisedautomatically, with or without their parents' consent.How Does Circumcision Harm? The "medical" debate about the "potential health benefits" of circumcisionrarely addresses its real effects.Circumcision denudes: Depending on the amount of skin cut off, circumcision robs a male of as much as80 percent or more of his penile skin. Depending on the foreskin's length, cuttingit off makes the penis as much as 25 percent or more shorter. Careful anatomicalinvestigations have shown that circumcision cuts off more than 3 feet of veins, arteries,and capillaries, 240 feet of nerves, and more than 20,000 nerve endings.31 The foreskin'smuscles, glands, mucous membrane, and epithelial tissue are destroyed, as well.Circumcision desensitizes: Circumcision desensitizes the penis radically. Foreskin amputation means severingthe rich nerve network and all the nerve receptors in the foreskin itself. Circumcisionalmost always damages or destroys the frenulum. The loss of the protective foreskindesensitizes the glans. Because the membrane covering the permanently externalizedglans is now subjected to constant abrasion and irritation, it keratinizes, becomingdry and tough. The nerve endings in the glans, which in the intact penis are justbeneath the surface of the mucous membrane, are now buried by successive layers ofkeratinization. The denuded glans takes on a dull, grayish, sclerotic appearance.Circumcision disables: The amputation of so much penile skin permanently immobilizes whatever skin remains,preventing it from gliding freely over the shaft and glans. This loss of mobilitydestroys the mechanism by which the glans is normally stimulated. When the circumcisedpenis becomes erect, the immobilized remaining skin is stretched, sometimes so tightlythat not enough skin is left to cover the erect shaft. Hair-bearing skin from thegroin and scrotum is often pulled onto the shaft, where hair is not normally found.The surgically externalized mucous membrane of the glans has no sebaceous glands.Without the protection and emollients of the foreskin, it dries out, making it susceptibleto cracking and bleeding.Circumcision disfigures: Circumcision alters the appearance of the penis drastically. It permanently externalizesthe glans, normally an internal organ. Circumcision leaves a large circumferentialsurgical scar on the penile shaft. Because circumcision usually necessitates tearingthe foreskin from the glans, pieces of the glans may be torn off, too, leaving itpitted and scarred. Shreds of foreskin may adhere to the raw glans, forming tagsand bridges of dangling, displaced skin.32 Depending on the amount of skin cut off and how the scar forms, the circumcisedpenis may be permanently twisted, or curve or bow during erection.33 The contractionof the scar tissue may pull the shaft into the abdomen, in effect shortening thepenis or burying it completely.34Circumcision disrupts circulation: Circumcision interrupts the normal circulation of blood throughout the penile skinsystem and glans. The blood flowing into major penile arteries is obstructed by theline of scar tissue at the point of incision, creating backflow instead of feedingthe branches and capillary networks beyond the scar. Deprived of blood, the meatusmay contract and scarify, obstructing the flow of urine.35 This condition, knownas meatal stenosis, often requires corrective surgery. Meatal stenosis is found almostexclusively among boys who have been circumcised. Circumcision also severs the lymph vessels, interrupting the circulation oflymph and sometimes causing lymphedema, a painful, disfiguring condition in whichthe remaining skin of the penis swells with trapped lymph fluid.Circumcision harms the developing brain: Recent studies published in leading medical journals have reported that circumcisionhas long-lasting detrimental effects on the developing brain,36 adversely alteringthe brain's perception centers. Circumcised boys have a lower pain threshold thangirls or intact boys.37 Developmental neuropsychologist Dr. James Prescott suggeststhat circumcision can cause deeper and more disturbing levels of neurological damage,as well. 38, 39Circumcision is unhygienic and unhealthy: One of the most common myths about circumcision is that it makes the penis cleanerand easier to take care of. This is not true. Eyes without eyelids would not be cleaner;neither would a penis without its foreskin. The artificially externalized glans andmeatus of the circumcised penis are constantly exposed to abrasion and dirt, makingthe circumcised penis, in fact, more unclean. The loss of the protective foreskinleaves the urinary tract vulnerable to invasion by bacterial and viral pathogens. The circumcision wound is larger than most people imagine. It is not justthe circular point of union between the outer and inner layers of the remaining skin.Before a baby is circumcised, his foreskin must be torn from his glans, literallyskinning it alive. This creates a large open area of raw, bleeding flesh, coveredat best with a layer of undeveloped proto-mucosa. Germs can easily enter the damagedtissue and bloodstream through the raw glans and, even more easily, through the incisionitself. Even after the wound has healed, the externalized glans and meatus are stillforced into constant unnatural contact with urine, feces, chemically treated diapers,and other contaminants. Female partners of circumcised men do not report a lower rate of cervicalcancer,40 nor does circumcision prevent penile cancer.41 A recent study shows thatthe penile cancer rate is higher in the US than in Denmark, where circumcision, exceptamong Middle-Eastern immigrant workers, is almost unheard of.42 Indeed, researchersshould investigate the possibility that circumcision has actually increased the rateof these diseases. Circumcision does not prevent acquisition or transmission of sexually transmitteddiseases (STDs). In fact, the US has both the highest percentage of sexually activecircumcised males in the Western world and the highest rates of sexually transmitteddiseases, including AIDS. Rigorously controlled prospective studies show that circumcisedAmerican men are at a greater risk for bacterial and viral STDs, especially gonorrhea,43nongonoccal urethritis,44 human papilloma virus,45 herpes simplex virus type 2,46and chlamydia.47Circumcision is always risky: Circumcision always carries the risk of serious, even tragic, consequences. Itssurgical complication rate is one in 500.48 These complications include uncontrollablebleeding and fatal infections.49 There are many published case reports of gangrenefollowing circumcision.50 Pathogenic bacteria such as staphylococcus, Proteus, Pseudomonas,other coliforms, and even tuberculosis can cause infections leading to death.51,52 These organisms enter the wound because it provides easy entry, not because thechild is predisposed to infection. Medical journals have published numerous accounts of babies who have had partor all of their glans cut off while they were being circumcised.53, 54, 55 Otherfully conscious, unanesthetized babies have had their entire penis burned off withan electrocautery gun.56, 57, 58 The September 1989 Journal of Urology publishedan account of four such cases.59 The article described the sex-change operation as"feminizing genitoplasty," performed on these babies in an attempt to change theminto girls. The March 1997 Archives of Pediatrics and Adolescent Medicine describedone young person's horror on learning that "she" had been born a normal male, butthat a circumciser had burned his penis off when he was a baby.60 Many other similarcases have been documented.61, 62 Infant circumcision has a reported death rate ofone in 500,000.63, 64Circumcision harms mothers: Scientific studies have consistently shown that circumcision disrupts a child'sbehavioral development. Studies performed at the University of Colorado School ofMedicine showed that circumcision is followed by prolonged, unrestful non-REM (rapid-eye-movement)sleep.65 In response to the lengthy bombardment of their neural pathways with unbearablepain, the circumcised babies withdrew into a kind of semicoma that lasted days oreven weeks. Numerous other studies have proven that circumcision disrupts the mother-infantbond during the crucial period after birth. Research has also shown that circumcisiondisrupts feeding patterns. In a study at the Washington University School of Medicine,most babies would not nurse right after they were circumcised, and those who didwould not look into their mothers' eyes.66Circumcision violates patients' and human rights: No one has the right to cut off any part of someone else's genitals without thatperson's competent, fully informed consent. Since it is the infant who must bearthe consequences, circumcision violates his legal rights both to refuse treatmentand to seek alternative treatment. In 1995, the American Academy of Pediatrics Committeeon Bioethics stated that only a competent patient can give patient consent or informedconsent.67An infant is obviously too young to consent to anything. He must be protectedfrom anyone who would take advantage of his defenselessness. The concept of informedparental permission allows for medical interventions in situations of clear and immediatemedical necessity only, such as disease, trauma, or deformity. The human penis inits normal, uncircumcised state satisfies none of these requirements. Physicians have a duty to refuse to perform circumcision. They also must educateparents who, out of ignorance or misguidance, request this surgery for their sons.The healthcare professional's obligation is to protect the interests of the child.It is unethical in the extreme to force upon a child an amputation he almost certainlywould never have chosen for himself.Common Sense To be intact, as nature intended, is best. The vast majority of males whoare given the choice value their wholeness and keep their foreskins, for the samereason they keep their other organs of perception. Parents in Europe and non-MuslimAsia never have forced their boys to be circumcised. It would no more occur to themto cut off part of their boys' penises than it would to cut off part of their ears.Respecting a child's right to keep his genitals intact is normal and natural. Itis conservative in the best sense of the word. A circumcised father who has mixed feelings about his intact newborn son mayrequire gentle, compassionate psychological counseling to help him come to termswith his loss and to overcome his anxieties about normal male genitalia. In suchcases, the mother should steadfastly protect her child, inviting her husband to sharethis protective role and helping him diffuse his negative feelings. Most parentswant what is best for their baby. Wise parents listen to their hearts and trust theirinstinct to protect their baby from harm. The experience of the ages has shown thatbabies thrive best in a trusting atmosphere of love, gentleness, respect, acceptance,nurturing, and intimacy. Cutting off a baby's foreskin shatters this trust. Circumcisionwounds and harms the baby and the person the baby will become. Parents who respecttheir son's wholeness are bequeathing to him his birthright-his body, perfect andbeautiful in its entirety.Top of PageReturn to Mothers Against Circumcision HomepageFor More InformationOrganizationsDoctors Opposing Circumcision (DOC) 2442 N.W. Market Street, Suite 42 Seattle, WA 98107 206-368-8358 weber.u.washington.edu/~gcd/DOC/The National Organization of Circumcision Information Resource Centers (NOCIRC), PO Box 2512 San Anselmo, CA 94979-2512 415-488-9883 http://www.nocirc.orgThe National Organization to Halt the Abuse and Routine Mutilation of Males (NOHARMM) PO Box 460795 San Francisco, CA 94146-0795 415-826-9351 http://www.noharmm.orgNurses for the Rights of the Child, 369 Montezuma, Suite 354 Santa Fe, NM 87501 505-989-7377 http://www.cirp.org/nrc/BooksAvailable from bookstores, from the publishers, or from NOCIRC.Bigelow, Jim, PhD. The Joy of Uncircumcising! Exploring Circumcision: History, Myths,Psychology, Restoration, Sexual Pleasure and Human Rights. 2nd ed. Aptos, CA: Hourglass,1995.Denniston, George C., MD, MPH, and Marilyn Fayre Milos, RN, eds. Sexual Mutilations:A Human Tragedy. (Proceedings of the Fourth International Symposium on Sexual Mutilations,Lausanne, Switzerland, 1996). New York: Plenum Press, 1997.Goldman, Ronald, PhD. Circumcision: The Hidden Trauma: How an American Cultural PracticeAffects Infants and Ultimately Us All. Boston: Vanguard Publications, 1997.Goldman, Ronald, PhD. Questioning Circumcision: A Jewish Perspective. 2nd ed. Boston:Vanguard Publications, 1997.O'Mara, Peggy, ed. Circumcision: The Rest of the Story-A Selection of Articles, Letters,and Resources 1979- 1993. Santa Fe, NM: Mothering,1993.Ritter, Thomas J., MD, and George C. Denniston, MD. Say No to Circumcision! 40 CompellingReasons Why You Should Respect His Birthright and Keep Your Son Whole, 2nd ed. Aptos,CA: Hourglass, 1996.VideoWhose Body, Whose Rights? Examining the Ethics and the Human Rights Issue of InfantMale Circumcision. Award-winning documentary. 56 min. VHS. Personal use: VideoFinders, 1-800-343-4727Educational facilitiesUC Center for Media and Independent Learning 2000 Center Street, 4th Floor Berkeley,CA 94704 510-642-0460. Quote Link to comment Share on other sites More sharing options...
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