Circumcised banana

Circumcised banana is very unnatural unless you get used to it. And what do you think will happen to the exposed part after its natural protective covering is removed?

What is circumcision?

What is circumcision?

Surgical amputation of the foreskin, frenulum and about one-third to one-half of the skin of the penis.

What?? Half of the skin from the penis?

Approximately 15 square inches, yup.

It’s just a flap of skin though.

Actually, it’s not just skin. It’s skin on the outside with a thin, sensitive muscle sheath underneath and the same exquisitely sensitive mucosa as the inner edges of your lips on the inside. Right around the edge of the foreskin is a ridged band of tissue which attaches at the frenulum to the underside of the glans. (Together, that band and the frenulum are considered the primary erogenous zone in males - the head of the penis is secondary and much less sensitive.) The foreskin contains about 240 feet of nerves and somewhere around 40,000 nerve endings. You don’t need to be an anatomy expert to understand the basic concept that lost nerves equals lost sensation.

But most circumcised guys say if they were any more sensitive they’d go nuts!

The term ‘more sensitive’ isn’t defined. Men needlessly circumcised as adults have reported the sensitivity & sensation before and after the circumcision like the difference between seeing in colour (being intact) and only seeing in black & white (circumcised). With this analogy, a man circumcised as an infant might say “I have 20/20 vision - it doesn’t get any better than that!” because since he has never experienced seeing in colour, he cannot conceive how it could be different, richer or better.

So they slide the foreskin back and then they trim it off or something?

No, actually it doesn’t even begin to slide back until around age 2 or 3 at the earliest, and generally much later, even during puberty. In a newborn, the foreskin is tightly fused to the glans (head) and shaft of the penis - much like a fingernail is fused to the nail bed. It doesn’t slide back at all.

How do they get it separated to cut it off?

A blunt probe is shoved up into the synechia (the bond holding the foreskin & glans together) to separate them. They rotate the probe around and then rip the foreskin up. The sensation would be like having a fingernail ripped off, except the “fingernail” in this case is on the penis, the most sensitive part of the body. The head of the penis looks very raw and bloody.

Then they cut it off?

They slice into the foreskin and then they usually crush it with a clamp for a few minutes. Then they cut it off. Alternately, they put a plastic bell over the head, and tie a ligature around the foreskin, then cut the foreskin off.

I’m having a hard time picturing this.

Here’s a description of the procedure, with photos which might help.

It all sounds really painful. But they use anesthetic, luckily, right?

The majority of infant circumcisions are done without any anesthetic actually. Here’s a vid of a circumcison performed with a topical anesthetic.

Well, it’s much healthier to circumcise, isn’t it?

There is no medical reason for routine infant circumcision, and no national medical association anywhere in the world recommends it.

But they need it done later on.

No. Routinely amputating healthy tissue to prevent future circumcisions is somewhat like removing the breast tissue of all girls to prevent later breast cancer… except the risk of getting breast cancer over a woman’s lifetime is one in eight, whereas the need for circumcision for any reason is at less than one-half of one percent.

Circumcision doesn’t do any harm though.

Assuming you mean other than the harm of removing the foreskin itself, which always causes the glans of the penis to become keritanized (hardened and less sensitive), and the meatus (the opening of the urethra) to scar up and frequently narrow, requiring surgery to fix it about ten percent of the time, yes, it causes other harms. The latest statistics show that circumcising is actually the cause of more medical expense over a child’s lifetime versus not circumcising. Circumcision complications are deadly serious.

Alright, but it’s cleaner.

Like circumcising a baby girl would make her cleaner? The foreskin requires no special care. Wipe off or wash only the outside of the penis during infancy & childhood. DO NOT RETRACT. As the boy grows older, he will discover when he is retractable and can rinse his glans with water in the shower or bath just like he cleans his other body parts. He may forget to wash behind his ears, but penises generally get quite a bit of attention.

But he’ll be teased by other boys & men!

Doubtful, since barely half of the boys born in America today are circumcised (52% in 2003 and decreasing each year), Canada’s rate is even lower (around 13%) and on the decline as well. Worldwide 85% of men and boys are not circumcised. Instead of cutting normal, healthy tissue off our babies, why not teach them to be proud of their bodies?

Uncircumcised penises look….well…funny.

Only because you are used to seeing circumcised penises rather than whole, normal ones. We don’t amputate other healthy, normal parts of our kids’ bodies without their consent because they offend our tastes - why don’t genitals deserve the same respect?

He’ll definitely want it done when he gets older.

If that was true, then most of the men in the world would be circumcised as adults. However, they aren’t doing that, because they are happy to be whole. That being said, if your son decides he wants to be circumcised when he is old enough to give legal consent he can be, and the operation is much less painful, traumatic and less prone to complications.

Shouldn’t the baby boy match his dad?

There are many inborn differences between fathers and sons and also between brothers. What if the father is missing a finger or has scars from an accident or any other surgery? Should we amputate & cut the baby so he’ll match dad then? If older brothers are circumcised it’s simple to tell the boys that when the older brother was born his penis looked like the younger boy’s penis but back then the parents thought it was a good idea to cut off his foreskin (and that they thought that was a good idea when Daddy was born, too, if that’s relevant) but now we know that we don’t need to do it anymore. It really is that simple, honest!

What about family traditions though?

For most North Americans your “family tradition” is likely about two or three generations old at most and involves your father, possibly his father, and you. The real tradition, the one that goes back centuries, is to have a whole, normal penis, not one with an amputated foreskin. Routine newborn circumcision was unknown in the U.S. outside of Jewish families until the beginning of the 20th century, and the circumcision rate peaked in the 1970s at about 90%. It’s been dropping ever since, and is now right around 50% in the U.S. and 13% in Canada. Many Jewish & Muslim families are choosing to leave their children intact and let them decide whether they want to be circumcised.

Hmmmm… No medical benefits… Definite harms… Intense pain… Not any cleaner… Rather unethical…

Gee, there’s really no reason to do it at all!

You’ve got it.

Navelgazing Midwife: Uncircumcised Bat

Navelgazing Midwife: Uncircumcised Bat

"Deciding Whether or Not to Circumcise Your Baby Boy"

Ask Dr. Sears

Circumcision is a decision that many parents face. There are many misconceptions and out-of-date information that parents may read. Here is a summary of the pertinent issues that you should consider when making this decision.

1. Medical benefits — THERE ARE NONE! Do not circumcise your baby because you think there are some medical benefits. A recent review by the American Academy of Pediatrics looked at all the data from the past decades to see if there truly were any medical benefits. Their conclusion — NO. There are no significant medical benefits that make circumcision worth doing. Here are a few benefits that we used to think were true, and now know are not.

2. Religious reasons — some people choose to circumcise for religious or cultural reasons. This is a personal decision.

3. Don't want to be teased — while this may have been true in the U.S. decades ago, the truth is that your uncircumcised kids will be in good company in the locker room when they are teenagers. Less and less people in the U.S. are now circumcising their boys.

4. Too much trouble to take care of — some people think that an intact penis is too much trouble to pull back and clean, especially during childhood. Well, the truth is, you are not even supposed to pull back the foreskin until it naturally comes back on its own between age 3 years and adolescence. So there really isn't anything to even take care of until then.

5. Want your boy to look like dad — the main difference that your child will notice between him and dad is the hair. He won't even notice any difference in the penis until he is old enough that you can then explain the difference to him.

So, what are the reasons TO circumcise?
Here is the list:
Religious reasons — as discussed above.
That is all. There really is no good reason to circumcise other that personal preference and religious reasons. ...read the full article

Circumcision is a decision that many parents face. There are many misconceptions and out-of-date information that parents may read. Here is a summary of the pertinent issues that you should consider when making this decision.

1. Medical benefits — THERE ARE NONE! Do not circumcise your baby because you think there are some medical benefits. A recent review by the American Academy of Pediatrics looked at all the data from the past decades to see if there truly were any medical benefits. Their conclusion — NO. There are no significant medical benefits that make circumcision worth doing. Here are a few benefits that we used to think were true, and now know are not.

2. Religious reasons — some people choose to circumcise for religious or cultural reasons. This is a personal decision.

3. Don't want to be teased — while this may have been true in the U.S. decades ago, the truth is that your uncircumcised kids will be in good company in the locker room when they are teenagers. Less and less people in the U.S. are now circumcising their boys.

4. Too much trouble to take care of — some people think that an intact penis is too much trouble to pull back and clean, especially during childhood. Well, the truth is, you are not even supposed to pull back the foreskin until it naturally comes back on its own between age 3 years and adolescence. So there really isn't anything to even take care of until then.

5. Want your boy to look like dad — the main difference that your child will notice between him and dad is the hair. He won't even notice any difference in the penis until he is old enough that you can then explain the difference to him.

So, what are the reasons TO circumcise?
Here is the list:
Religious reasons — as discussed above.
That is all. There really is no good reason to circumcise other that personal preference and religious reasons.

Are there any reasons NOT to circumcise? Consider these:

1. Leave nature alone — whether you believe God created men with a foreskin, or nature simply evolved this way, there must be some reason men have foreskins. Why change something that God/nature has created?

2. Sensation and sexual pleasure — the foreskin is filled with nerves, and is therefore extremely sensitive to touch. This enhances sexual pleasure.

3. Protects the glans (head) of the penis — the glans is another highly sensitive area. The foreskin protects the glans from constant rubbing and chaffing against clothing that can desensitize it over the years. This preserves sexual pleasure.

4. Ethical issues — there are groups of people worldwide, including medical societies, that oppose routine circumcision because they feel it is unethical for a parent to decide to alter the penis of their child without the child's consent. Parents who are deciding whether or not to circumcise their son may wish to consider the impact this may have in the future if the child decides they wish they were not circumcised.

So, when making this decision, the first thing to ask yourself is this — "Do I have any good reason to circumcise my baby?" If your answer is for religious reasons, then follow your faith. If not, and you can't think of any other significant reason other than just "because", then consider the above information as you make your decision.

Gimme Some Skin

Try this exercise: Find a 3x5 index card. One side, 15 square inches, equals the average surface area of a man's foreskin — about half of the total surface area of his penis.

Now fold the card in half lengthwise and bring the two short ends together to form a cylinder. The outside of the cylinder represents the external foreskin, a more sensitized, retractable extension of the skin on the penile shaft. The inside represents the delicate, lubricating mucosal lining that sheathes the glans, or head, of the penis.

These outside and inside folds are comparable to the external and internal aspects of the foreskin's closest anatomical analog, the eyelid. And, like the eyelid, the foreskin bristles with nerve endings: about 36% of the total penile allotment.

With this simple overview, you probably already know more about the foreskin than your doctor does. What most American health professionals are taught about it is even more succinct: It's the part of the male anatomy removed in a circumcision.

Despite its highly articulated, specialized physiology, the foreskin is commonly considered as disposable as the paper version you've just created. Every year the foreskins of an estimated 1 million U.S. infants end up in the trash.

Click the following link for the complete article:

http://www.rhrealitycheck.org/blog/2007/07/12/gimme-some-skin

Did you know that . . . ?

Did you know -

• that most men in the world and the great majority of men in Europe, Scandinavia, Central and South America or Asia are not circumcised?
• that "medical" infant circumcision was introduced to prevent masturbation?
• that until a few decades ago, female genital cutting was promoted in the western world for many of the same reasons as male circumcision?
• that infant circumcision was fashionable in the English-speaking world 50 years ago but is now rare (except in the US)?
• that babies are strapped down to be circumcised?
• that circumcision with a PlastiBell^TM does involve cutting?
• that before the foreskin can be cut (or crushed) off, it must be torn away from the glans?
• that circumcision removes 50% of the skin of the penis?
• that no medical association anywhere in the world supports neonatal circumcision (male or female) on medical grounds?

Circumstitions

Circumstitions

[Inquirer, 23/5/02]

M. L. Tan

"Routine male circumcision is NOT necessary!" The capital letters and the exclamation point are in the original statement, a letter from Dr. Reynaldo Joson who chairs the Department of Surgery at the Ospital ng Maynila Medical Center.

Joson wrote me asking if I could help me campaign against this pagtutuli, especially since it has become a summer ritual sponsored by all sorts of groups from the Catholic Women's League to Kodak Philippines (Smile, you've just been cut!). The "Operation Tuli" banners always intrigue foreigners because really, we are one of the few countries left in the world that insist on, well, let me use a strong term, mutilating our males.

I actually wrote about the circumstitions or myths around circumcision back in 1999. (I'm borrowing the term "circumstitions" from someone named Hugh, a New Zealander who has a website on this controversy. Will give you the address at the end of this article.) At that time, the American Academy of Pediatrics had just issued a statement stating that "the foreskin plays very little or no role in the spread of sexually transmitted diseases", which was the rationale for routine infant circumcision in the States.

Among western countries, it's been mainly the Americans who have clinged on to the practice, with strange reasons. At one time, American doctors thought circumcision could prevent masturbation. Remember that in the 19th century and, I suspect for some moralists in the 21st century, there was this myth that masturbation had harmful effects. Some doctors even thought you could masturbate to death – no wonder they had this mad search for preventive methods.

Then there was this idea that uncircumcized males were "unclean" and that the "dirt" causes diseases in their partners. In fact, Filipinos tend to tease uncircumcized men by wrinkling their noses when they pass by, insinuating that the stench from the "dirt" is so overwhelming. This is of course total nonsense – junior's state of hygiene depends less on a piece of skin than what you do, or don't do, with it. I worry, for example, about how Filipinos avoid taking a bath after sex because they think this causes pasma. I think that belief creates more problems of sexual hygiene than being uncut.

In the last few years there has been speculation that circumcision might prevent HIV/AIDS. One theory is that the uncircumcized male's foreskin provides more surface area for the virus to enter but I think this is not very scientific – the virus' entry into the body, and its causing an infection, involves more of blood vessels than skin. The bottom line is that Filipino circumcized men are being infected with HIV/AIDS so it may actually be dangerous to propagate the idea that a cut penis protects you from AIDS.

Circumcision in the Philippines persists because of many other folk beliefs. Let me refute them. First, circumcision does not make help to make a person taller. Once puberty sets in, you will grow with or without circumcision, your height pretty much a function of genetics and nutrition. Second, circumcision does not make you more fertile – how many children you have depends on you're the quantity and quality of your sperm, and your sense of sexual responsibility. Third, circumcision doesn't give you a longer penis – having a pedro or a pedrito involves a bit of genetics. Nutrition, as far as I know, does not play a significant role. (Some of our readers will remember how they had [to] bring out a magnifying glass with that superhunk of a partner). Finally, circumcision doesn't make you a better lover – that you pick up from experience and reading Inquirer columnists. Moreover, Margy Holmes (who you should also read, even if she isn't in the Inquirer) will tell you the research shows that the foreskin is exquisitely sensitive and that supot males have more pleasurable sexual sensations than their "cut" brothers.

So where does this leave us – tuli or not tuli? (I just had to reuse that column title from 1999.) Let's hear from our medical experts. Joson wrote his colleagues at the Pamantasan ng Lungsod ng Maynila's Department of Family and Community Medicine for their stand and they agree: "Routine circumcision has no therapeutic basis." The doctors do not recommend infant circumcision and they worry that circumcision done with "bare" health facilities, such as in charity medical missions, may cause more harm than benefit.

At the same time, the doctors recognize the strong cultural pressures to continue the practice. Circumcision is a ritual of passage, with an entire barkada of boys on the verge of puberty going through the guillotine together. The doctors recognize, too, the stigma attached to being supot, and have this interesting observation: the pressure to circumcize is said to be "psychologically ingrained and culturally embedded in the collective psyche of Filpino women". No wonder sometimes it's mothers who drag their sons, screaming and begging for mercy, to the chopper.

The doctors worry that if they stop circumcizing, there may be more problems because Filipino boys will end up in the hands of traditional practitioners, who will perform the lethal procedure with a bamboo sliver or broken glass, spitting on a wad of guava leaves after the coup de grace.

It looks like circumcision's going to be around in the Philippines for some time. Our doctors will just have to keep speaking out, explaining the risks and disadvantages involved with circumcision including infections, bleeding, reduction of sexual pleasure. At the same time, they will have to keep on explaining that so-called benefits such as increased height, fertility, virility and a long dong are all myths.

Meanwhile, I do recommend you visit www.circumstitions.com, which is both informative and entertaining. (The website's slogan is: A trombone can play more notes than a bugle.) The site includes an entire section on the Philippines. Do note that the site has some photos of cut and intact manoys so prudes should just keep out. Uy, finish reading the Inquirer first.

Today's Parents Say No to Circumcision

A CIRCUMCISION

A CIRCUMCISION

by Rio Cruz [1]

I never saw anything wrong with it either until I witnessed my own son being circumcised. The doctor assured me it was a simple little snip of extra skin that had no function and that really didn't hurt the infant. "You want him to look like you, don't you?" Well, since I really hadn't thought much about it, and since I, too, had gone under the knife at birth, I said: "Sure. I guess so. Why not?"

He did not answer the "Why not?" but it was soon apparent to me. My newborn son was taken from his mother's warm, nourishing breast and placed naked on a cold, plastic board called a circumstraint. His little legs were spread-eagled and strapped down with Velcro bands and his arms were strapped to his sides. He immediately protested and began to cry. The doctor draped a thin cloth with a hole in the centre over his shivering body and drew his little penis through the hole.

The doctor washed my baby's penis with an antiseptic solution. He took a pair of steel haemostats and, holding the penis in one hand, inserted the tip of the haemostat into the opening of the foreskin and began pushing it between the foreskin and the glans, ripping the two structures apart. The foreskin and glans were tightly fused together by the normal balanopreputial membrane called the synechia, similar to the membrane that attaches the fingernail to the finger. It's the body's way, in part, of protecting against harmful bacteria.

My baby was shrieking now, his protest going from a simple cry to what sounded like screams of sheer terror. His body was rigid, contorted as he strained against the straps and the pain. If the circumstraint had not been bolted down, it and my child would have crashed to the floor. Every instinct I had told me this was not right, that I should be protecting my son instead of acquiescing to the barbaric spectacle before me. But I am a "civilized man". I have been socialized to accept what the doctor is doing. It's the right thing to do. Right?

The foreskin did not easily give up its hold on my son's glans. The doctor continued to rip the skin with the haemostat. My son was shaking, tossing his head from side to side, his fists and eyes were clenched, sweat beaded on his brow.

The doctor finally got the glans and foreskin separated, then clamped the foreskin tight with another haemostat and cut the skin vertically with scissors. The wound was bleeding profusely. He tried to insert a steel cone into the tissue but had to force it because the incision was too short. My son stopped screaming. His eyes were glazed and rolled back. He appeared to be sleeping, but was really in a state of complete shock.

The doctor put a large metal clamp around the bleeding foreskin, the cone supposedly to protect the glans, and he proceeded to crush the nerves, the blood vessels and tissue of the foreskin with the clamp. He took a knife and sliced around the clamp, letting the foreskin drop onto the cloth. My son lay motionless on the board, completely dissociated into some other more hospitable space. The doctor looked at me and winked. He left the room. A nurse gave my son back to his mother.

---

[1] Genital mutilation American style. Fathering magazine 1998.

http://fathermag.com/health/circ/gmas

Ritual and Medical Circumcision among Filipino boys

TITLE:
Ritual and Medical Circumcision among Filipino boys: Evidence of Post-traumatic Stress Disorder

AUTHOR(S):
Samuel Ramos
Gregory J. Boyle, Bond University

DOCUMENT TYPE: Book Chapter

Pre-print version of a paper presented at the proceedings of the Sixth International Symposium on Genital Integrity: Safeguarding Fundamental Human Rights in the 21st Century, 7-9 December, Sydney, Australia and published in; Understanding Circumcision: A Multi-Disciplinary Approach to a Mult-Dimensional Problem; edited by George C. Denniston, Frederick Mansfield Hodges and Marilyn Fayre Milos; ©2001 Kluwer Academic/Plenium Publishers, New York.
The original publication is available at SpringerLink

• Download the Document (PDF format - 290 K) - December 2000
• Tell a colleague about it.

ABSTRACT:
A total of 3,253 boys aged 11 to 16 years took part in this study of the psychological effects associated with circumcision procedures (medical vs. ritual circumcision) in the Philippines. Participants were recruited from five different schools in the Batangas province upon securing permission from appropriate authorities (human rights chair, school principals, class advisers and the children's parents or guardians). The boys completed a two-part questionnaire. The preliminary part requested biographical information including any history of other traumatic events, and their perception of the circumcision experience. The second part assessed the presence of post-traumatic stress disorder (PTSD) symptoms. Some 1,577 boys satisfied the prescribed criteria (1,072 boys were circumcised under medical procedures; 505 boys were subjected to ritual circumcision) and were followed-up to ascertain whether the perceived trauma from genital cutting developed into symptoms of PTSD. Almost 70% of boys subjected to ritual circumcision and 51% of those subjected to medical circumcision fulfilled the DSM-IV criteria for a diagnosis of PTSD.

more at: http://epublications.bond.edu.au/cgi/query.cgi

Luscious Beauty

Luscious Beauty...
by Leilah McCracken

Luscious Beauty and Sadness Beyond Words(love song for the intact penis)
I am a foreskin novice. I have never known a lover with an intact penis; my six sons, of course, are intact, but I do not examine their penises! (Nor clean them for that matter, they clean themselves.) So in researching this newsletter, I was looking at pictures of intact penises on activist websites... and my response to them startled me. I will share my experiences here, in the interest of at least one mother or father reading this thinks twice about circumcising their baby boy.
I used to think penises were rather bland and straightforward - nowhere near as interesting as the external female genitalia. But then I saw photos of intact, erect, adult male penises... and wow. Crazy arousal, sadness - mad thoughts ran through my mind, won't share them here, but my jaw was on the floor... I simply had no idea how luscious and sexy men could be. Intact penises look so hot... everything about them looks so wild and amazing. The foreskin adds such a level of sexy beauty to penises - a wild, sexy mystery. It is like a... veil that is drawn back, and slowly, dark, wet male beauty is revealed.
Wow. Apparently on some TV show women were talking about non-circumcised men (I think it was "Sex in the City" or something) and they said "eeewww!" Well I say "eeeewww" to their silly reaction!!! Luscious mystery; intact loveliness; beauty and wild ecstasy unveiled... wow. Intact penises are the sexiest things I have ever seen. Their beauty makes my head dizzy. They - say the women who have been intimate with them - feel like silk, and are beautiful to have inside them. Men say foreskins feel good for them too - like soft, long hair caressing their penises. But it's built in...
My husband is circumcised. Excuse me while I @%^$#%$&%&^*%&^%$$% out loud about that - what beauty have we both been deprived of? - what sweetness of ecstasy? Foreskins account for an enormous amount of the male sensory experience - and the female... sweet sliding skin that lubricates itself - wow. Wish I could have some, but I can't, never will, and it hurts. It really hurts. I am a one man woman, I love my husband. But my heart hurts. I wish so badly that he didn't get his penis cut apart as a baby boy - not just for my own selfish reasons of course, but also for his - can you imagine the pain of it - the foreskin, says one intact man, "isn't the wrapper on the candy, it's the candy". It feels good. So can you imagine the pain of having it sliced off???
My husband says it doesn't bother him that he is circumcised. Well I'd say the same thing if my clitoris were cut off as a girl, and I'd never know the ecstasy of it. I'd not let it matter. But it would!!! A comparison that many women will relate to: women who have episiotomies (their vaginas cut open by their doctors or midwives in birth) often have reduced sexual sensation afterwards - the cut permanently severs sex-receptive nerves. "At least I have a healthy baby" - they will rationalize their loss of ecstasy with that - but- what if it's not true? What if the cut was done so the baby would just pop out instead of ease out? (Episiotomies have been proven in mountains of research papers to be cruel and pointless.) How could she rationalize that? "I lost my orgasms so my doctor could get home in time for dinner" - can you imagine the rage that she would experience if she understood what was lost? (And does she dare touch the rage, and see what lies beyond it?)
Translate that into the male experience. If all those men who were ever circumcised understood that their penises could be have been particularly exquisite tools for pleasure (and that "health and hygiene" reasons for circumcising amount to nil) would they be so eager to circumcise their own little boys because it was "good enough for them"? Do they dare touch the sex that was so quickly and permanently lost? It's a pain beyond rage. Why are beautiful bodies medical platforms for invasion? Why do cut genitals equate "medical care"?
I am so sad that neither my husband nor I can ever know him in his most natural form: intact- perfect- beautiful. He is beautiful as he is now, but he bears the mark of the wounded baby... and a mutilated man. And for this I will always be sorry.

Where Is My Foreskin?

MOTHERING: The Magazine of Natural Family Living.

Winter 1997. Pages 36-45. Santa Fe, New Mexico, USA.

Where Is My Foreskin?
The Case Against Circumcision
Paul M. Fleiss, MD

Western countries have no tradition of circumcision. In antiquity, the expansion of the Greek and Roman Empires brought Westerners into contact with the peoples of the Middle East, some of whom marked their children with circumcision and other sexual mutilations. To protect these children, the Greeks and Romans passed laws forbidding circumcision.[1] Over the centuries, the Catholic Church has passed many similar laws.[2,3] The traditional Western response to circumcision has been revulsion and indignation.
Circumcision started in America during the masturbation hysteria of the Victorian Era, when a few American doctors circumcised boys to punish them for masturbating. Victorian doctors knew very well that circumcision denudes, desensitizes, and disables the penis. Nevertheless, they were soon claiming that circumcision cured epilepsy, convulsions, paralysis, elephantiasis, tuberculosis, eczema, bed-wetting, hip-joint disease, 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 cure and prevent more diseases than circumcision. As late as the 1970s, leading American medical textbooks still advocated routine circumcision as a way to prevent masturbation.[5] The antisexual motivations behind an operation that entails cutting off part of the penis are obvious.
The radical practice of routinely circumcising babies did not begin until the Cold War era. This institutionalization of what amounted to compulsory circumcision was part of the same movement that pathologized and medicalized birth and actively discouraged breastfeeding. Private-sector, corporate-run hospitals institutionalized routine circumcision without ever consulting the American people. There was no public debate or referendum. It was only in the 1970s that a series of lawsuits forced hospitals to obtain parental consent to perform this contraindicated but highly profitable surgery. Circumcisers responded by inventing new "medical" reasons for circumcision in an attempt to scare parents into consenting.
Today the reasons given for circumcision have been updated to play on contemporary fears and anxieties; but one day they, too, will be considered irrational. Now that such current excuses as the claim that this procedure prevents cancer and sexually transmitted diseases have been thoroughly discredited, circumcisers will undoubtedly invent 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 circumcise came first, the "reasons," later.
Millions of years of evolution have fashioned the human body into a model of 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 glans of 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, behind closed doors, straps babies down and cuts their foreskins off. The billion-dollar-a-year circumcision industry has bombarded Americans with confusing rhetoric and calculated scare tactics.
Information about the foreskin itself is almost always missing from discussions about circumcision. The mass circumcision campaigns of the past few decades have resulted in pandemic ignorance about this remarkable structure and its versatile role in human sexuality. Ignorance and false information about the foreskin are the rule in American medical literature, education, and practice. Most American medical textbooks depict the human penis, without explanation, as circumcised, as if it were so 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 the penile shaft skin, the foreskin covers and usually extends beyond the glans before folding under itself and finding its circumferential point of attachment just behind the 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, comprising 80 percent or more of the penile skin covering,[6] or at least 25 percent of the flaccid penis's length.
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 longitudinal fibers. These muscle fibers are whorled, forming a kind of sphincter that ensures optimum protection of the urinary tract from contaminants of all kinds.
Like the undersurface of the eyelids or the inside of the cheek, the undersurface of 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 penis and contains ectopic sebaceous glands that secrete emollients, lubricants, and protective antibodies. Similar glands are found in the eyelids and mouth.
Adjacent to the soft mucosa and just behind the lips of the foreskin is the ridged mucosa. This exquisitely sensitive structure consists of tightly pleated concentric bands, like the elastic bands at the top of a sock. These expandable pleats allow the foreskin lips to open and roll back, exposing the glans. The ridged mucosa gives the foreskin its characteristic taper.
On the underside of the glans, the foreskin's point of attachment is advanced toward 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 with the smooth muscle fibers, helps return the retracted foreskin to its usual forward position over the glans.
Retraction of the Foreskin
At birth, the foreskin is usually attached to the glans, very much as a fingernail is 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 its own 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 likened to a rosebud which remains closed and muzzled. Like a rosebud, it will only blossom when 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 foreskin lips can normally dilate only enough to allow the passage of urine. This ideal feature protects 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 is no 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 he has 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 Technology use human foreskins as the raw materials for a type of breathable bandage.
What 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 keeps its surface soft, moist, and sensitive. It also maintains optimal warmth, pH balance, and cleanliness. The glans itself contains no sebaceous glands--glands that produce the sebum, or oil, that moisturizes our skin.[11] The foreskin produces the sebum that maintains 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 immunological defense. Glands in the foreskin produce antibacterial and antiviral proteins such as lysozyme.[12] Lysozyme is also found in tears and mother's milk. Specialized epithelial Langerhans cells, an immune system component, abound in the foreskin's outer surface. Plasma cells in the foreskin's mucosal lining secrete immunoglobulins, antibodies that defend against infections.
* Erogenous Sensitivity: The foreskin is as sensitive as the fingertips or the lips of the mouth. It contains a richer variety and greater concentration of specialized nerve receptors than any other part of the penis.[15] These specialized nerve endings can discern motion, subtle changes in temperature, and fine gradations of texture.[16, 17, 18, 19, 20, 21, 22, 23]
* Coverage during Erection: As it becomes erect, the penile shaft becomes thicker and longer. The double-layered foreskin provides the skin necessary to accommodate the expanded organ and to allow the 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 back and 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 beyond the glans. This wide range of motion is the mechanism by which the penis and the orgasmic 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 between the mucosal surfaces of the two partners during intercourse. The foreskin enables the penis to slip in and out of the vagina nonabrasively inside its own slick sheath of self-lubricating, movable skin. The female is thus stimulated by moving pressure rather than by friction only, as when the male's foreskin is missing.
The foreskin fosters intimacy between the two partners by enveloping the glans and maintaining it as an internal organ. The sexual experience is enhanced when the foreskin slips back to allow the male's internal organ, the glans, to meet the female's internal organ, the cervix--a moment of supreme intimacy and beauty.
The foreskin may have functions not yet recognized or understood. Scientists in Europe recently detected estrogen receptors in its basal epidermal cells.[24] Researchers at the University of Manchester found that the human foreskin has apocrine glands.[25] These specialized glands produce pheromones, nature's chemical messengers. Further studies are needed to fully understand these features of the foreskin and the role they 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 and wash 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 intact penis clean.[26]
The white emollient under the child's foreskin is called smegma. Smegma is probably the most misunderstood, most unjustifiably maligned substance in nature. Smegma is clean, not dirty, and is beneficial and necessary. It moisturizes the glans and keeps it smooth, soft, and supple. Its antibacterial and antiviral properties keep the penis clean and healthy. All mammals produce smegma. Thomas J. Ritter, MD, underscored its importance when he commented, "The animal kingdom would probably cease to exist without smegma."[27]
Studies suggest that it is best not to use soap on the glans or foreskin's inner fold.[23] Forcibly retracting and washing a baby's foreskin destroys the beneficial bacterial flora that protect the penis from harmful germs and can lead to irritation and 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, according to their own self-determined needs.
How Common Is Circumcision?
Circumcision is almost unheard of in Europe, South America, and non-Muslim Asia. 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 western US has now fallen to 34.2 percent.[30] This relatively diminished rate may surprise American men born during the era when nearly 90 percent of baby boys were circumcised automatically, with or without their parents' consent.
How Does Circumcision Harm?
The "medical" debate about the "potential health benefits" of circumcision rarely addresses its real effects.
* Circumcision denudes: Depending on the amount of skit cut off, circumcision robs a male of as much as 80 percent or more of his penile skin. Depending on the foreskin's length, cutting it off makes the penis as much as 25 percent or more shorter. Careful anatomical investigations 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's muscles, glands, mucous membrane, and epithelial tissue are destroyed, as well.
* Circumcision desensitizes: Circumcision desensitizes the penis radically. Foreskin amputation means severing the rich nerve network and all the nerve receptors in the foreskin itself Circumcision almost always damages or destroys the frenulum. The loss of the protective foreskin desensitizes the glans. Because the membrane covering the permanently externalized glans is now subjected to constant abrasion and irritation, it keratinizes, becoming dry and tough. The nerve endings in the glans, which in the intact penis are just beneath the surface of the mucous membrane, are now buried by successive layers of keratinization. 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 mobility destroys the mechanism by which the glans is normally stimulated. When the circumcised penis becomes erect, the immobilized remaining skin is stretched, sometimes so tightly that not enough skin is left to cover the erect shaft. Hair-bearing skin from the groin 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 susceptible to cracking and bleeding.
* Circumcision disfigures: Circumcision alters the appearance of the penis drastically. It permanently externalizes the glans, normally an internal organ. Circumcision leaves a large circumferential surgical scar on the penile shaft. Because circumcision usually necessitates tearing the foreskin from the glans, pieces of the glans may be torn off, too, leaving it pitted and scarred. Shreds of foreskin may adhere to the raw glans, forming tags and bridges of dangling, displaced skin.[32]
Depending on the amount of skin cut off and how the scar forms, the circumcised penis may be permanently twisted, or curve or bow during erection.[33] The contraction of the scar tissue may pull the shaft into the abdomen, in effect shortening the penis or burying it completely.[34]
* Circumcision disrupts circulation: Circumcision interrupts the normal circulation of blood throughout the penile skin system and glans. The blood flowing into major penile arteries is obstructed by the line of scar tissue at the point of incision, creating backflow instead of feeding the branches and capillary networks beyond the scar. Deprived of blood, the meatus may contract and scarify, obstructing the flow of urine.[35] This condition, known as meatal stenosis, often requires corrective surgery. Meatal stenosis is found almost exclusively among boys who have been circumcised.
Circumcision also severs the lymph vessels, interrupting the circulation of lymph and sometimes causing lymphedema, a painful, disfiguring condition in which the 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 circumcision has longlasting detrimental effects on the developing brain,[36] adversely altering the brain's perception centers. Circumcised boys have a lower pain threshold than girls or intact boys.[37] Developmental neuropsychologist Dr. James Prescott suggests that circumcision can cause deeper and more disturbing levels of neurological damage, as well. [38, 39]
* Circumcision is unhygienic and unhealthy: One of the most common myths about circumcision is that it makes the penis cleaner and 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 and meatus of the circumcised penis are constantly exposed to abrasion and dirt, making the circumcised penis, in fact, more unclean. The loss of the protective foreskin leaves the urinary tract vulnerable to invasion by bacterial and viral pathogens.
The circumcision wound is larger than most people imagine. It is not just the 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, literally skinning it alive. This creates a large open area of raw, bleeding flesh, covered at best with a layer of undeveloped protomucosa. Germs can easily enter the damaged tissue and bloodstream through the raw glans and, even more easily, through the incision itself.
Even after the wound has healed, the externalized glans and meatus are still forced 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 cervical cancer,[40] nor does circumcision prevent penile cancer.[41] A recent study shows that the penile cancer rate is higher in the US than in Denmark, where circumcision, except among Middle Eastern immigrant workers, is almost unheard of.[42] Indeed, researchers should investigate the possibility that circumcision has actually increased the rate of these diseases.
Circumcision does not prevent acquisition or transmission of sexually transmitted diseases (STDs). In fact, the US has both the highest percentage of sexually active circumcised males in the Western world and the highest rates of sexually transmitted diseases, including AIDS. Rigorously controlled prospective studies show that circumcised American men are at a greater risk for bacterial and viral STDs, especially gonorrhea,[43] nongonoccal urethritis,[44] human papilloma virus,[45] herpes simplex virus type 2,[46] and chlamydia.[47]
* Circumcision is always risky: Circumcision always carries the risk of serious, even tragic, consequences. Its surgical complication rate is one in 500.[48] These complications include uncontrollable bleeding and fatal infections.[49] There are many published case reports of gangrene following 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 the child is predisposed to infection.
Medical journals have published numerous accounts of babies who have had part or all of their glans cut off while they were being circumcised.[53 54 55] Other fully conscious, unanesthetized babies have had their entire penis burned off with an electrocautery gun.[56,57,58] The September 1989 Journal of Urology published an 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 them into girls. The March 1997 Archives of Pediatrics and Adolescent Medicine described one young person's horror on learning that "she" had been born a normal male, but that a circumciser had burned his penis off when he was a baby.[60] Many other similar cases have been documented[61,62] Infant circumcision has a reported death rate of one in 500,000.[63,64]
* Circumcision harms mothers: Scientific studies have consistently shown that circumcision disrupts a child's behavioral development. Studies performed at the University of Colorado School of Medicine 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 unbearable pain, the circumcised babies withdrew into a kind of semicoma that lasted days or even weeks.
Numerous other studies have proven that circumcision disrupts the mother-infant bond during the crucial period after birth. Research has also shown that circumcision disrupts 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 did would not look into their mothers' eyes.[66]
* Circumcision violates patients' and human rights: No one has the right to cut off any part of someone else's genitals without that person's competent, fully informed consent. Since it is the infant who must bear the consequences, circumcision violates his legal rights both to refuse treatment and to seek alternative treatment. In 1995, the American Academy of Pediatrics Committee on Bioethics stated that only a competent patient can give patient consent or informed consent.[67] An infant is obviously too young to consent to anything. He must be protected from anyone who would take advantage of his defenselessness. The concept of informed parental permission allows for medical interventions in situations of clear and immediate medical necessity only, such as disease, trauma, or deformity. The human penis in its normal, uncircumcised state satisfies none of these requirements.
Physicians have a duty to refuse to perform circumcision. They also must educate parents 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 certainly would never have chosen for himself.
Common Sense
To be intact, as nature intended, is best. The vast majority of males who are given the choice value their wholeness and keep their foreskins, for the same reason they keep their other organs of perception. Parents in Europe and non-Muslim Asia never have forced their boys to be circumcised. It would no more occur to them to 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. It is conservative in the best sense of the word.
A circumcised father who has mixed feelings about his intact newborn son may require gentle, compassionate psychological counseling to help him come to terms with his loss and to overcome his anxieties about normal male genitalia. In such cases, the mother should steadfastly protect her child, inviting her husband to share this protective role and helping him diffuse his negative feelings. Most parents want what is best for their baby. Wise parents listen to their hearts and trust their instinct to protect their baby from harm. The experience of the ages has shown that babies thrive best in a trusting atmosphere of love, gentleness, respect, acceptance, nurturing, and intimacy. Cutting off a baby's foreskin shatters this trust.
Circumcision wounds and harms the baby and the person the baby will become. Parents who respect their son's wholeness are bequeathing to him his birthright--his body, perfect and beautiful in its entirety.
Paul M. Fleiss, MD, MPH, is assistant clinical professor of pediatrics at the University of Southern California Medical Center. He is the author of numerous scientific articles published in leading national and international medical journals.
Notes (see source)
For More Information
Organizations
Doctors 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) Box 2512 San Anselmo, CA 949792512 415-488-9883 www.nocirc.org
The National Organization to Halt the Abuse and Routine Mutilation of Males (NOHARMM) PO Box 460795 San Francisco, CA 94146-0795 415-826-9351 www.nohammm.org
Nurses for the Rights of the Child 369 Montezuma, Suite 354 Santa Fe, NM 87501 505-989-7377 www.cirp.org/nrc/
Books Available from bookstores, from the publishers, or from NOCIRC
Bigelow, Jim, Ph. D. 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 Practice Affects 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 Circumcisions: 40 Compelling Reasons Why You Should Respect His Birthright and Keep Your Son Whole. 2nd ed. Aptos, CA: Hourglass, 1996.
Video
Whose Body, Whose Rights? Examining the Ethics and the Human Rights Issue of Infant Male Circumcision. Award-winning documentary. 56 min. VHS.
Personal use: VideoFinders, 1-800-343-4727
Educational Facilities: UC Center for Media and Independent Learning 2000 Center Street 4th Floor Berkeley CA 94704 510-642-0460

DR. RONALDO JOSON, MD

Question and Answer: Dr. Reynaldo Joson on Project Xtulepinoy
2003

Why are you doing an advocacy against routine circumcision?

I want to save millions and generations of Filipino children from unnecessary circumcision, its pain and its risk of complications including death.

When did you start doing this advocacy and what initiated it?

At a personal level, in 1999, when I started realizing the senselessness of this practice. I started discouraging parents and colleagues.

In 2001, I completely stopped doing non-therapeutic circumcision, after I advised and convinced my son not to go for the tradition-driven circumcision. I felt I should not have double standards, i.e., not doing circumcision on my son and yet doing circumcision on patients other than my son. I remember vividly I turned down a request from a surgeon-colleague to do circumcision for his son on that year.

Publicly, in 2002, when I was the chairperson of the Department of Surgery of Ospital ng Maynila Medical Center, I received a letter of invitation from the Philippine Society of General Surgeons to conduct Operation Tule in Ospital ng Maynila Medical Center. I politely turned down the invitation and started an in-depth review of the issues of circumcision. Our department conducted a debate on pros and cons of circumcision and after which we decided to make a stand on NO to routine circumcision and NO to Operation Tule. Our department committed itself to spearhead an advocacy against tradition-driven circumcision as part of its social responsibility program.

Are you alone in this advocacy? If not, who are with you in this advocacy?

Initially, I was alone. Then, the Department of Surgery of OMMC was with me. Then, other surgeons and physicians all over the country joined us. Then, the whole hospital of OMMC supported us. OMMC is the first hospital in the Philippines that has openly declared its stand against tradition-driven and non-therapeutic circumcision.

I like to mention though, even before I was into my advocacy, there were already individuals who were into this advocacy already, like Dr. Michael Tan, the anthropologist, and Dr. Jaime Licauco, author of Inner Awareness.

What is/are your stand on circumcision?

We are for therapeutic circumcision such as in patients with phimosis (restrictive foreskin) with recurrent urinary tract infection, paraphimosis (too tight foreskin), and balanitis (infection of the glans penis).

We are against the performance of tradition-driven, non-therapeutic circumcision in children, both in the newborns and adolescents.

We are against the holding of Operation Tule, which promotes the performance of tradition-driven, non-therapeutic circumcision in adolescents.

We are not against the performance of circumcision on adult males who request it done for cosmetic reason.

Why are you against tradition-driven circumcision?

Primarily because it is non-therapeutic, that is, of no medical benefits, therefore, unnecessary. Doing an unnecessary circumcision inflicts on the subject, usually a male newborn or boy, unnecessary pain and unnecessary risk of complications which include the possibility or danger of death.

What is/are the origins and bases of the practice of circumcision?

The exact origins and bases of the practice of circumcision are not definitely known.

As to origins and bases of the practice of circumcision, these may be classified as religion-based or non-religion-based. Under religion-based origins, we have to study the how and why of its practice by the Christians, Muslims, and Jews. Under non-religion-based origins, we have to look at medical and non-medical reasons. Under medical reasons, we have to consider how circumcision can promote health and prevent disease. Under non-medical reasons, we have to look at the origin of the non-religious rituals.

What is the most common basis for the practice of circumcision in the Philippines?

As part of the non-medical non-religious rituals, as a rite of passage to manhood for the adolescent male children, as a result of fear of cultural stigma of being teased “supot”, as a result of peer pressure and as a result of the belief that all males should be circumcised with no specified reason. If there is a reason expressed by a parent, especially the mother, the reason is usually a myth, such as circumcision will make the boy cleaner, grow faster and taller.

Is the religion basis a strong justification or contributory factor for the rampant practice of circumcision in the Philippines?

NO. With majority of the Filipinos being Catholic and with the Catholic Church not requiring circumcision for salvation, the religion basis is not a strong contributory factor for the rampant practice of circumcision in the Philippines.

What are the evidences on the medical benefit of routine circumcision?

Using evidence-based medicine study approach, with analysis of almost 40 years of medical research on circumcision, the American Academy of Pediatrics in 1999 has come out with a stand that the benefits are not significant enough to recommend circumcision as a routine procedure.

Using number of patients needed to treat principle, routine circumcision is not warranted to prevent urinary tract infection and penile cancer. Urinary tract infection secondary to phimosis and penile cancer are uncommon if not rare.

Using the benefit-risk ratio, an invasive and painful procedure such as circumcision is not warranted to promote hygiene of the penis and to prevent diseases such as sexually transmitted diseases and cervical cancer. There are equally effective, non-invasive and painless procedures available such as meticulous mechanical cleaning, hygienic sexual practice, avoidance of multiple partners and sexual promiscuity.

Thus, for the above reasons, routine or tradition-driven, non-therapeutic circumcision is not indicated.

Is there such a thing as “painless circumcision”?

NO. Circumcision, just like any operative procedure which involves cutting of body tissues, entails some degree of pain, both during and after the operation.
Considering that there are NO strong religious and medical reasons and considering the procedure is NOT without pain and complications, how do you intend to reduce if not stop the tradition-driven non-therapeutic circumcision in the Philippines?
To reduce the tradition-driven non-therapeutic circumcision in the Philippines is to change the tradition and the peer pressure.
The challenge really consists of three aspects. One is how to change the belief of parents who will have their male children undergo routine circumcision because of the tradition. Two is how to reduce, if not abolish the peer pressure that will make the male adolescents and adults undergo routine circumcision. Three is how to convince physicians to stop doing routine circumcision, especially those who have already acquired the habit of doing the procedure left and right and those who tend to ride on all traditions to avoid any conflict.
What do I propose to do to meet the challenges? Basically, public health education and advocacy.
Public health education will consist essentially of sending the message to the public through all forms of media that "TULE – HINDI NA KAILANGAN! MASAKIT PA!"
Advocacy will consist essentially of actively campaigning against routine male circumcision by first explaining the issues and then convincing the public, especially the parents and male children that TULE – HINDI NA KAILANGAN! MASAKIT PA! Hopefully, with the advocacy, the belief and behavior will change and peer pressure removed.
To meet the third challenge, which constitutes the physicians, advocacy will also consist of enlightening and convincing the physicians on the non-necessity of routine circumcision.
The strongest strategy in the advocacy is for the physicians to speak out against routine circumcision. The public considers the physicians as the professionals to turn to when it comes to issues on circumcision. The public still has high respect for physicians in the Philippines.
What have you done so far? How successful are you now in your advocacy?
A lot have been done already but there is still a lot to be done. We need your help and all the help from every Filipino parents and physicians.
We have done a lot of information dissemination since April, 2002, in the newspapers, radio, and television, health magazines, Internet, and public forums. We have created a website for this purpose: http://xtulepinoy.tripod.com/
We have written to practically all medical associations and the Department of Health to get their stand. We are still awaiting their stand.
We have enlightened and convinced organizations who have sponsored Operation Tule before not to do it anymore and do something else like cleft lip and palate mission and thyroid mission.
Our end-points in this advocacy are: less if not zero routine circumcision in adolescent boys, less if not zero routine neonatal circumcision, and, less if not zero Operation Tule, At the moment, we don’t have the figures, both baseline and ongoing. It is not easy to get figures on these parameters.

At present, we measure the degree of success just in terms of concrete achievements or events, such as the following:

Presence of a manifesto of surgeons against routine circumcision (January, 2003)
Presence of several medical departments and institutions against routine circumcision and have stopped holding Operation Tule (OMMC, PGH, JRMH, PCMC, ZCMC)

Presence of several organizations that have stopped sponsoring Operation Tule (REACT, Metrobank Foundation)

Number of parents convinced not to go for routine circumcision for their children. (about 1,000 as of March, 2003)

Presence of school physicians who came out with circulars on the pros and cons of circumcision to their students and parents (Xavier School)

What is your appeal for the parents, boys, and physicians in your advocacy?

For the parents,

TULE – HINDI NA KAILANGAN! MASAKIT PA!

Do not hurt your boys anymore.

For the boys,

TULE – HINDI NA KAILANGAN! MASAKIT PA!

Huwag madadala sa tukso!

For the physicians,

TULE – HINDI NA KAILANGAN!

Do not hurt the Filipino children anymore! PRIMUM NON NOCERE!

Continuing doing tradition-driven circumcision puts you at risk of a malpractice suit because of violation of bioethical principles and human rights of children.

Dr. Reynaldo Joson may be reached at rjoson2001@yahoo.com
Website: http://xtulepinoy.tripod.com/