FQ, Volume 13. March 1990.
FQ, Volume 13. March 1990.
Note:
A study of the medical literature on circumcision over the last hundred years reveals some odd facts about motives and lets us draw some conclusions about why there are so many variations in both methods and results.
Originally doctors saw circumcision as both a preventative and a cure for masturbation. The beliefs of the Victorian era held masturbation in disrepute. It was sinful, therefore it must be harmful. We need not dwell on the variety of illnesses attributed to masturbation during the late 19th century.
Since the instinctive way to masturbate is to fist the foreskin back and forth on the penis, one obvious way of stamping out masturbation was to remove the foreskin. Once this practice was started among people for whom circumcision was not a religious injunction, there were soon many other reasons found for it. A tight foreskin was the cause of venereal disease, of irritation leading to masturbation, bedwetting, nervousness, and a long list of other disorders. The practice of circumcision evolved until today we find a wide variety of motives among the doctors who perform it, which accounts for the differences in surgical techniques and amounts of tissue removed.
We can put these motives - and doctors - in categories ranging from the altruistic to the sadistic. The pain inflicted by the operation varies, as does the nature of the ensuing complications. Lets look at these categories, in the awareness that some of them overlap and that the doctors often have more than one motive.
This type of doctor sees himself as a crusader against masturbation and immorality, and his purpose is to suppress the sensitivity of the penis. He not only tries to make masturbation as difficult as possible for his patient; he believes that a radical circumcision will prevent what he sees as excessive sexual sensitivity.
He removes as much shaft skin as he can, and all of the sensitive inner lining, to attain a very tight cut. He also removes the frenulum, the sensitive band on the underside of the head, to suppress sensitivity further. The result is a glans that is totally bareheaded, exposed to urine from the diaper and to friction from clothing.
Often this doctor cuts off so much that when the baby has an erection, the edges of the wound pull apart and bleed. There is also danger of bleeding from the frenular artery, which is cut when the frenulum is removed. In extreme cases, with too much shaft skin removed, the ring of the circumcision lies well back of the rim; since there is no inner lining, the space fills with granulation tissue and looks like the scarring that results from a bad burn.
As the boy grows, there isnt enough skin left on his shaft to accommodate the increasing size of his penis, so the skin is pulled tightly all the time. Upon erection there isnt enough skin to move freely and the boy must resort to a lubricant to aid his masturbation. Some men have reported that the size of their erection has been slightly reduced by so tight a circumcision. [N. B. Happening in the very tightly cut man who has, during erection, a thinnish, tightly stretched remnant of penile skin, this shortened erect penis occurs since the main bulk of the erect penis has not enough outer skin envelope to attain the full length, so some of the length of the penis is kept back in the pelvis.]
This doctor is concerned with retraction of the foreskin for cleaning, which is unnecessary for a baby. The foreskin and glans are still fused together, which often makes retraction impossible. The foreskin protects an infant from diaper ammonia and other irritations.
The doctor doesnt remove the entire foreskin if he feels that removing only the forward part will allow sufficient room for retraction. He instructs the mother to be sure and wash the penis every day, for hygiene. If he is concerned about penile odor, he may excise the entire foreskin, paying special attention to the inner lining and removal of the Tysons glands, which produce one component of smegma. He doesnt necessarily remove the frenulum.
Not removing the entire foreskin can cause one complication: adhesion of the cut edges to the glans; these may be cut apart later by the pediatrician, but with further pain to the baby.
This doctor simply likes the look of the bareheaded penis and lovingly tailors the babys organ to suit his own idea of masculine beauty. He is probably circumcised himself and thinks that the bare look is normal and that a flaring corona is the symbol of such beauty. He may believe that the size of the glans and flare of the corona are determined not by heredity but by the tightness of the foreskin. Hence he removes enough foreskin to expose the glans to the corona, to allow unhampered growth. The frenulum being unimportant to this purpose, he may leave it on. He also will not cut too tightly, just enough to denude the glans, leaving enough slack for masturbatory efforts by the boy.
The doctor does as esthetic a job as he can, and the result is usually a neat-looking circumcision ring, not the jagged line resulting from other types of operation.
This doctor sees circumcision simply as a way to earn an extra fee and uses whatever method he has been taught in medical school. He wants to get the operation over with as soon as possible, to present the mother with her sons bandaged penis as proof that hes earned his fee. He may cut a lot, or only a little. The odds are overwhelming that he uses one of the clamp techniques, which are quick and dont result in the radical circumcision of the freehand method.
This profiteer type runs a mass-production business and usually waits until he has several babies for a quick session of assembly-line circumcisions. He goes down the line hurriedly, with results that vary from one penis to another. Some babies escape with relatively minor mutilation; others are skinned back severely. This doctor is antagonistic to the use of anesthesia because it entails an extra step. He doesnt care about the babys screams, knowing that theyre an ineffective complaint.
This doctor removes the foreskin reluctantly and only because the parents want it done. He takes care in cutting, doesnt remove too much- perhaps performing a minimal circumcision that leaves the head mostly covered- and almost always spares the frenulum. He is the type most deeply concerned about the baby's pain and most likely to use local anesthesia. Before operating, hell allow time for the anesthetic to take effect, injecting more [into the penis] as necessary to prevent any pain for the baby.
This type is rarely documented in medical literature, but unofficial reports by medical personnel opposed to circumcision reveal that some doctors enjoy performing this surgery, laughing and making lewd remarks while doing so.
The sadistic doctor derives a clearly sexual pleasure from cutting a babys penis, sometimes getting an erection during the operation. He enjoys the babys pain and takes his time doing his job. He never uses any sort of anesthetic; that would spoil it for him. He may lie to the mother, telling her that the baby is too young to feel any pain. In some instances he will fondle the babys penis before operating, producing an erection. This helps the doctor determine how much skin to leave on, but he has an ulterior motive as well.
The amount of skin he removes varies according to his personal whim. He proceeds slowly and carefully, prolonging the operation for as much time as possible. Sometimes the baby gets an erection during or after the surgery, as reflex reaction to the intense pain, which the doctor enjoys.
We may note that there also exist sadistic nurses who enjoy assisting at circumcisions. Their job includes jabbing the baby with a syringe- injecting a dose of vitamin K to aid blood clotting- and strapping the baby down for the surgery. Such nurses enjoy watching the operation and bandaging the bloody penis afterward. When changing the bandage, they may rip it loose forcefully, causing more bleeding and pain.
Following circumcision, the baby cries whenever he urinates, as the hot, acid urine contacts the raw tissue of the cut. The sadistic nurse may take her time changing the diaper or leave the baby crying in his wet diaper for many minutes while she busies herself with something else nearby. Some of these nurses are man haters who enjoy seeing a helpless male being sexually mutilated and suffering the pain of sexual surgery without anesthesia.
The freehand method, involving scissors or scalpel, leads to wide variation in results. If the doctor uses the guillotine technique, pulling the foreskin forward and cutting off the part extending beyond the glans, the amount of skin removed depends on the tension he exerts. If he uses the dorsal-slit-and-side-cuts technique, the amount depends on his arbitrary choice of a line. The penis may be left totally bareheaded or partially covered. Working freehand, the doctor may or may not remove the frenulum and will leave a varying amount of the mucous inner lining.
The GOMCO clamp is a bell-shaped metal device that fits over the head of the penis. Because the infants foreskin is tight, the doctor usually has to slit it along the top to work in the bell. The GOMCO has a ring that clamps down on the foreskin after the doctor pulls the latter over the bell. The amount of skin removed varies, but never totals the amount possible in a freehand operation.
The Plastibell is a plastic bell that fits over the head of the penis. The doctor slits the foreskin to widen the opening, inserts the bell, and pulls the foreskin up over it. There is a groove in the Plastibell for a cord that cuts off circulation. Once the doctor has tied the cord in place, he removes the skin forward of the cord, leaving the bell on the penis. The bell falls off in about a week. Because of the approximately one-quarter-inch section of bell behind the cord groove, there is always slack when the bell falls off, leaving a cuff of skin behind the head.
In cases where the doctor tries for a very tight cut, the bell exerts a lot of pressure on the glans and surrounding tissue, causing indentations which may be permanent or even loss of blood circulation in the glans.
Whatever his method, the doctor has to tear loose the foreskin of some babies, those whose inner lining and glans have not yet separated. The tearing and the slitting are more painful- because they take more time- than the clamping and cutting. If the lining has to be torn loose, patches of the delicate mucous membrane of the glans often come with it. This is the cause of the pockmarks sometimes seen on the glans of an older male. Tearing patches from the surface of the glans further deadens sensitivity.
We have seen changes in techniques and results over the years. Forty or fifty years ago, when masturbation hysteria was still prevalent, the favored style of circumcision was the streamlines, clean-cut look, with very little shaft skin left. The skin was very tight, even in the immature penis, and the glans stood out prominently. The frenulum was often partly or totally cut away.
With the advent of clamps and the accumulation of experience in their use- and the abatement of the masturbation phobia- we began to see circumcised penises with their glans denuded but a generous cuff of skin left in the groove behind the head. The streamlined look was out, and there was concern to leave enough skin to allow for erections and for growth. Today we see more partial circumcisions- with enough hood left to cover the head at least halfway- because most of the doctors who push circumcision recognize that radical mutilation is undesirable.
The different motives and techniques account for the differences we see in circumcised penises. Even among circumcised boys in the same family, we can see differences if the boys were delivered by different obstetricians, or if one was circumcised by the obstetrician and another by the family doctor. One will be cut tightly, another loosely, and a third may have most of his foreskin left.
Parental preference affect the results. Some mothers want their son to match their husband. If the latter was cut tightly, the mother may feel cheated if the boy isnt, and may complain or demand a re-circumcision. The same demand may be made by a mother who is an avid crotch-watcher and likes to view the compound curves of a glans unshrouded by any skin. Sometimes parents express their preferences to the doctor in advance.
There is no standard method and no agreement on what constitutes a good circumcision. The result of all this is a greater range of differences among remodeled organs than among the natural, intact one.
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