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NOCIRC NEWSLETTER
FALL 1992
VOL. 6, NO. 2
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"THE FORGOTTEN FORESKIN"
"In America alone this year, 1.3 million boys will sacrifice their
foreskins to the surgeon's knife - 1/2 inch of discarded penile
anatomy. What is this thing which is treated with so much disdain
by so many? Has the supreme being made a minor blunder in his
blueprint for the male of the species?"
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"WHAT IS THIS THING CALLED A FORESKIN?"
"The penis is not just a club to be used to batter its way through
the portals of love. It is a wonder of natural hydraulic engineering
equipped at its tip with a dense mat of nerve endings that make it
one of the most sensitive organs in the male body, designed to fire
off impulses to our pleasure center in the brain and spinal cord
with the slightest touch. It is clear that such a delicate and
sensitive piece of machinery should be protected from the ravages of
nature and its local environment when not in Use - a function
provided by the humble foreskin. Whether it be on request or on its
own initiative, this guardian of the male member gracefully slides
back to expose its sensitive core, charged and ready for action. To
call it a skin is to do it an injustice because it is far more. To
remind us of its sexual significance it is equipped with an
intricate biochemical apparatus that makes it responsible to the
male sex hormone. Indeed human foreskins have been studied by
hormone researchers for many years in an attempt to unlock some of
the secrets of how the male hormone acts. It also contains highly
specialized glands that squeeze out an oily substance on the penile
head to prevent it from drying out and to hinder attack by bacteria
and fungus. Some have suggested that this oil may also serve as a
sexual perfume to attract and excite the female during sexual play.
Let us not forget that women too have foreskins, small and well
hidden but nevertheless fulfilling the function of its male
equivalent...
"Man has slit, skewered, and hacked pieces of his penis skin since
he first discovered it hanging there between his legs." How much
skin he removed from it depended on the culture to which he
belonged... Why? you may ask. In some cultures it appeared to
represent an initiation ceremony at puberty. Boys could show how
macho they were by smiling while their genitals were being
mutilated. Experts have also pointed out that this ritual spilling
of blood may also represent a symbolic menstruation – a sign of the
happy times to come. Other societies had more religious reasons.
As mentioned earlier, circumcision can be thought of as a symbolic
castration that was the ultimate offering to the gods.
"The bad news starts from the day we say good bye to our foreskins."
Not only are there complications of the operation itself, such as
bleeding and infection, but also our newly uncovered glans is now
uncomfortably exposed to ammonia and other harmful chemicals from
urine and feces, and suffers the abrading influence of toilet paper
and clothing. The result can be painful sores and a condition
called meatal stenosis, which is the hardening and narrowing of the
urethral opening.
"With loss of the foreskin the man loses a natural gliding mechanism
that helps with the sex act." With a foreskin it is possible for
the shaft to move back and forth within the loose outer skin. This
is especially helpful during sex with women who have poor
lubrication because the reduced friction during intercourse is less
irritating ... After circumcision, the delicate and sensitive skin
of the head of the penis gradually changes character. After years
of rubbing against underwear and denim jeans, it begins to resemble
normal skin and loses some of its sensitivity, with a reduction in
the intensity of sensations for the man during intercourse as a
possible result...
"If it is not yet obvious to the reader, the message is clear and
undeniable: Our foreskin, like our tonsils, does have a purpose in
life, and it is time that one-sixth of the world's population faced
the reality of that fact. Happily, in America if new attitudes
persist and current trends continue, the coming generation, unlike
the previous one, can revel in the new experience of having sex with
a foreskin." - Kenneth Purvis, M.D., Ph.D., The Male Sexual Machine,
An Owner's Manual
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"Physicians and other health,care providers have a responsibility to
teach hygiene and the care of normal body parts and to explain their
normal anatomical and physiological development and function
throughout life."
Declaration of the First International Symposium on Circumcision,
March 3, 1989
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EDITORIAL
This issue of the NOCIRC Newsletter, besides being mailed to over
20,000 members, is also being made available to the anticipated
5,000 physicians attending the 1992 Annual Meeting of the American
Academy of Pediatrics. It is for these physicians, and for the
parents who so often request this information, that we have focused
specifically on the structure and function of the normal penis and
how to care for it.
Due to the increasing number of intact male infants and children in
the United States and the determination of parents to protect their
son's intact bodies, it becomes imperative for those American
physicians who have not had experience in caring for intact male
genitalia to become informed about the normal anatomy and physiology
of the intact penis and its care.
Unfortunately, the AAP's 1989 Task Force on Circumcision obfuscated
the informed consent component of the circumcision discussion by
failing to address the benefits of retaining a normal, intact
(noncircumcised) penis. Informed consent must include information
regarding alternative procedures and, for circumcision, requires
discussion on the advantages of maintaining the integrity of the
normal penis. The world's 85% intact male population, and the vast
majority of females who are intact, provide us with an enormous
resource from which to study the benefits and advantages of
preserving genital integrity.
The General Assembly of the International Symposium on Circumcision
on March 3, 1989, set the standard for research guidelines for
future study of the issues involved in routine circumcision of
infants and children.
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"In view of the serious physical and psychological consequences
that we have witnessed in victims of circumcision, we hereby
oppose the performance of a single additional unnecessary
foreskin, clitoral, or labial amputation procedure.
We oppose any further studies which involve the performance of
the circumcision procedure upon unconsenting minors. We
support any further studies which involve identification of the
effects of circumcision."
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Missing from the current scientific data available on circumcision
of newborns and infants are longitudinal studies which investigate
the psychological, emotional and physical effects of performing
circumcision on unconsenting infants and children.
Any discussion on the issue of circumcision of infants and children,
either male or female, must address the issue's central component:
human rights. The removal of healthy, normal tissue from infants
and children's genitals raises profound ethical questions. Body
ownership rights of infants and children were acknowledged in the
first tenet of the Declaration of the First International Symposium
on Circumcision:
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"We recognize the inherent right of all human beings to an
intact body. Without religious or racial prejudice, we affirm
this basic human right."
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THE FORESKIN:
RECOGNIZING NORMAL AS NORMAL
"It is time fore the medical establishment to rethink both the
reasons for and the consequences of the practice," said George
Denniston, M.D. MPH, (The Female Patient, July 1992). He puts the
circumcision debate ("circumcision prevents some unusual or rare
conditions vs. it has no medical benefit") aside to focus on the
positive value of the intact foreskin.
ANATOMY AND PHYSIOLOGY:
"Before birth, the glans penis is covered with skin. This skin is
not loosely attached; indeed, it is as tightly attached to the
glans as is the skin on the hand, for example."
"At approximately 17 weeks' gestation, cells in the area of
separation between the future foreskin and the glans initiate the
process of creating the preputial space (i.e., the space between
the glans penis and the intact foreskin). They begin to form
microscopic balls comprising multiple layers of cells. AS these
whorls of cells enlarge, cells at the center are cut off from
nutrients; they die and create a space. These minute spaces
coalesce, eventually becoming the preputial space. This process
is completed by age 3 in 90% of boys, but it may take as long as
17 years for some boys to have a fully retractable foreskin."
"At birth, the separation of the foreskin from the glans has just
begun. The newborn's penis is, of course, not yet fully
developed. Not only does circumcision interfere with its
development, but it requires that the surgeon tear the skin from
the sensitive glans to permit removal. Perhaps as a way to avoid
confronting this reality, physicians refer to this as 'breaking
adhesions.'"
"If the physicians would simply leave the newborn's penis intact,
as Dr. Spock came to recommend, the foreskin would be left to
fulfil its several functions. In infancy, the foreskin protects
the glans from irritation and from fecal material. The function
of the foreskin in adulthood may at first seem more obscure. The
shaft and usually the glans of an uncircumcised man's penis are
covered by skin. Retracting the foreskin reveals the glans and
makes the skin on the shaft somewhat loose. Of what use is this
redundant skin? During erection, the penile shaft elongates,
becoming about 50% longer. The foreskin covers this lengthened
shaft and is thus specifically designed to accommodate an organ
that is capable of a marked increase in diameter and length."
"In addition, the foreskin is one of the most sensitive parts of
the penis and can enhance the quality of sexual intercourse.
Anatomical studies demonstrate that the foreskin has a greater
concentration of complex nerve endings than the glans.(*) If
there is any possibility that the foreskin can contribute
significantly to sexual enjoyment, is that not a cogent reason for
rethinking our motives for this ritual procedure?"
*Editors note: This information was presented at the Second
International Symposium on Circumcision, San Francisco, May 1,
1992 by Canadian pathologist, Dr. John Taylor.
Understanding the Separation Process:
Consultant paediatrician Surgeon at Singapore General Hospital,
Dr. Tan Hock Lim, clarifies myths about the foreskin (Annals
Academy of Medicine, Singapore, 1985, Oct., 14(4):626-30):
"The foreskin is non-retractable at birth. The prepuce becomes
progressively detached from the glans and...this process is
complete in 90% of boys by the age of five, but Oster states that
full retractability does not occur until early teenage years. The
term Phimosis (muzzled in Greek) therefore should not be used to
describe a non-retractable foreskin (which is) neither uncommon
nor pathological in the young...(it) is physiological, and serves
to protect the glans from ammoniacal dermatitis. That this is so
is attested to by the prevalence of meatal stenosis following
circumcision, reported to occur in 8 to 31% of children
circumcised."
Tan describes one of the most misunderstood aspects of the
separation process:
"Some parents express concern because of accumulation of thick
whitish yellow creamy 'pus' under the foreskin. This is smegma, a
collection of shedding epithelial cells. Often smegma will
accumulate, forming thick white smegma cysts. This gradually
separates from the glans penis and inner prepuce, and
spontaneously discharges...and does not demand any form of
treatment at all, except for reassurance that this does not
constitute an infection. The smegma actually helps in separating
the two layers of epithelium."
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"The foreskin plays an important protective role in the young.
Let us therefore not interfere with it, but give it the respect it
deserves."
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"True phimosis is caused by a thick white fibrous ring that forms
around the prepuce...Balanitis Xerotica Obliterans...the skin
becomes pale gray, thin and parchment like, and the foreskin loses
its suppleness. There is atrophy and thinning of the epidermis,
replacement of the underlying dermis with dense collagenous tissue
infiltrated with chronic inflammatory cells." (The disease is
progressive and removal of the affected tissue is necessary.
Total ablation of the foreskin is not.)"
"Recurrent balanitis...is not too uncommon for a growing
child...during the separation process...Circumcision for this or
because the prepuce is still adherent is a radical measure."
"Ballooning of the foreskin is attributed to the malalignment of
the external urethral meatus and the preputial orifice. It can
also arise solely because of the laxity and the length of the
foreskin. Unless it is causing symptoms, no treatment is
necessary. Symptomatic problems can be treated with
hydrocortisone or by progressive gentle retraction."
In closing, Tan offers these words of wisdom:
"The foreskin plays an important protective role in the young.
Let us therefore not interfere with it, but give it the respect it
deserves."
Inflammation ("It's Red, What'll We do?"):
When a boy's foreskin becomes inflamed, parents can be reassured
that the foreskin is protecting the underlying glans penis and
urinary meatus (opening). A red or irritated foreskin is cause
for concern, but is certainly no reason for circumcision.
However, the cause of the irritation should be determined. In
infancy, the most common cause is urea in the urine, which is
changed to ammonia by certain bacteria that live in the bowel.
The red area is really a small burn caused by the action of
ammonia--generally the result of a wet and dirty diaper. Diapers
need to be changed frequently and cloth diapers should be rinsed
several times to remove the soap (alkaline). Other causes of
irritation are: exposure to foreign bacteria introduced by
parent, caregiver, or physician manipulation of the foreskin,
bubble baths, swimming pools, infrequent bathing, excessive fruit
juice or insufficient water intake, or a change in laundry
detergent. Frequent warm water baths (without soap) and fresh air
help the body to heal itself. Physicians also recommend ointments
such as A & D, Desitin or petroleum jelly to protect the healing
area from further irritation. If the inflammation persists,
parents should consult their child's physician. Informed consent
discussion of choices must include the option to treat medically,
not surgically, including treatment with antibiotics and/or
hospitalization. Successful treatment of an inflamed foreskin is
successful treatment and is not an indication for subsequent
elective circumcision.
Paraphimosis ("The Foreskin's Stuck, What'll We Do?"):
There are several maneuvers to bring the foreskin forward if it
gets stuck behind the head (glans) of the penis (paraphimosis), a
condition that occurs with premature and/or forcible retraction.
By applying pressure on the head of the penis, the swelling is
reduced, and the foreskin is able to return to its forward
position. Paul Fleiss, M.D., MPH, Assistant Clinical Professor of
Pediatrics at the University of Southern California, suggests
placing the child's penis between the first and second fingers
(like holding a cigarette) and, with the thumb, pushing the glans
into the opening of the foreskin. In most instances, circumcision
is not necessary to correct paraphimosis. Boys and their parents
should be taught that the foreskin should not be retracted
prematurely or forcibly and, after retraction, it should be
returned to the forward position.
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THE PEDIATRIC EXAMINATION OF THE PENIS
Prior to any physical examination, both the parents and their
son's health-care provider are responsible for establishing the
fact of the intact status of the child's penis. A boy should
always be made to feel his penis is normal. In addition, health
care providers should disclose their personal position regarding
examination of the intact penis, including testing foreskin
retractability.
The AAP pamphlet, "Care of the Uncircumcised Penis," advises: "Do
not retract the foreskin in an infant, as it is almost always
attached to the glans. Forcing the foreskin back may harm the
penis, causing pain, bleeding, and possibly adhesions. The
natural separation of the foreskin from the glans may take many
years. After puberty, the adult male learns to retract the
foreskin and cleanse under it on a daily basis."
If there is a clinical indication for retraction of the foreskin,
the American Academy of Pediatrics recommends "...hold the penile
shaft with one hand and with the other hand, push the foreskin
back gently--never forcibly--perhaps 1/8 of an inch...If there is
any discomfort in your baby or if you feel resistance, stop."
When a child is old enough to follow instructions, the doctor can
ask the boy to retract his own foreskin, thereby eliminating the
possibility of causing pain, local trauma, and/or inadvertently
introducing foreign bacteria. Examination of the penis, including
retraction of the foreskin, is a clinically inappropriate and
unnecessary intervention when unrelated to the child's presenting
problem.
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INTERNATIONAL NEWS
Female genital mutilation is becoming a worldwide concern. Alice
Walker's new book, Possessing the Secret of Joy, brings the issue
to Americans. Other countries have already begun to address the
ethical and legal issues involved with the practice. The
Australian Law Reform Commission's Current Discussion Paper NR 48
(1991-92) states "Female genital mutilation is not expressly
prohibited but there is little doubt that it would constitute an
assault. For a parent's consent on a child's behalf to the
procedure to be lawful, it would have to be shown that it is
therapeutic. A parent may validly authorise a non-therapeutic
operation only if it is not actively against the child's
interests. It would be no defence to a charge of assault or
battery that the operation was performed in a hospital by a doctor
rather than a traditional practitioner...The UN Convention on the
Rights of the Child, recently ratified by Australia, guarantees
the right of children belonging to ethnic, religious or linguistic
minorities to enjoy their own culture. However, the Convention
also calls upon the parties to 'take all effective and appropriate
measures with a view to abolishing traditional practices
prejudicial to the health of children.'" They go on to state that
"One approach to the eradication of this practice is to enact
special legislation to prohibit female genital mutilation. This
course was taken in England in 1985. Another approach, adopted in
France, si to use the existing criminal law." Americans may be
unaware that this practice has reached our shores.
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LETTERS TO THE EDITOR
Bruised Penis: "We had a harrowing experience with our 4-year old
son who had a bruised penis from playing "ruff wrestling" at a
picnic party with 8 other boys his age. We took him to the local
emergency room because he kept screaming. The doctor's advice was
to circumcise within the hour! We left the hospital. Our son is
fine and intact. We learned a great deal from our experience.
Please send information to this doctor so he can keep on learning,
too."--L.W., Ohio
Child Abuse: "I recommend the books by Alice Miller for anyone
who is interested in the various forms of child abuse, their
origins, and the reason why parents and other adults take the side
of adults at the terrible expense to children. We are all damaged
as children and, when we grow up, we act it out on society or on
ourselves by self-destructive behavior (addictions, suicide, self-
mutilation, etc.). I believe circumcision is a major wound to
males which is acted out by battering, wars, rape, child abuse,
and random violence."--M.L., Illinois
It's Just Not the Same: "I would like to have information on
reconstruction of a prepuce for myself before approaching my
doctor to get this procedure done. I was circumcised when I was
12 and I just flat do not feel the same. My father insisted it be
done. I would give just about anything to get a prepuce
reconstructed. I have felt naked."--E.E., North Carolina
Doctor Changed His View: "I am not surprised that more people are
concerned about their childhood circumcision and have decided to
restore their foreskins. I became interested in this problem two
years ago when a young, intelligent, rational male was concerned
that he had no foreskin and wanted restoration. His sincerity had
a major impact on me. I now see circumcision as an abuse and an
assault without consent."--A.O., M.D., California
It's Those Screams Again: "It makes me so happy that some
organization is working to prevent the mutilation of infant males.
The screams I've heard in various hospitals make me shiver."--Dr.
R.H.F., Ohio
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BULLETIN BOARD
The Third International Symposium on Circumcision, still planned
for Washington, D.C., has been postponed until Spring 1994.
Abstracts for presentation should be submitted by June 30, 1993.
Watch for details in the Spring Newsletter. For information
contact: International Symposia on Circumcision, P.O. Box 2400,
Sixteenth Street, Suite #250, San Francisco, CA 94103.
New Books:
-A Woman's Odyssey into Africa, tracks across a life, by Hanny
Lightfoot-Klein
-Breaking Down the Wall of Silence, by Alice Miller
-Possessing the Secret of Joy, by Alice Walker
-Raising a Son: Parents and the making of a Healthy Man, by Don
Elium and Jeanne Elium
-Say No To Circumcision! 40 Compelling Reasons Why you Should
Leave Your Son Whole, by Thomas Ritter, M.D. (Available from
NOCIRC, P.O. Box 2512, San Anselmo, CA 94979, $10.95 plus $2.
postage and handling, California residents add $0.95 sales tax.)*
-The Joy of Uncircumcising! Restore Your Birthright and Maximize
Sexual Pleasure, by Jim Bigelow, Ph.D. (Available from UNCIRC,
P.O. Box 52138, Pacific Grove, CA 93950, $16.95 plus $2. postage
and handling, California residents add $1.45 sales tax.)*
-The Male Sexual Machine, An Owner's Manual, by Kenneth Purvis,
M.D., Ph.D.
*Editor's note: NOCIRCers, you can help by making sure these
books are available at your local bookstore.
New Pamphlets & Reprints:
-"Circumcision: A Medical or Human Rights Issue?" Marilyn Milos
and Donna Macris, Journal of Nurse-Midwifery, March/April 1992, is
available. Send SASE and $3. to NOCIRC, P.O. Box 2512, San
Anselmo, CA 94979.
-"Keeping Clean is Easy," the second issue of "Good News for Boys,
A 'Newspaper' for Boys Who Are Intact (Not Circumcised)," J.C.
Jensen, MSW, P.O. Box 584, Tacoma, WA 98401.
-"Foreskin Restoration Resource Guide," RECAP/San Jose, P.O. Box
2894, Santa Clara, CA 95055.
-"Reclaiming Our Bodies, The physical and emotional advantages of
male foreskin restoration", R. Wayne Griffiths, RECAP, 3205
Northwood Drive, Suite #209, Concord, CA 94520.
-"Respect Your Son's Body, The benefits of foreskin and why
routine infant circumcision is unnecessary," R. Wayne Griffiths,
RECAP, 3205 Northwood Drive, Suite #209, Concord, CA 94520.
-"Stop Child sex abuse, Support Initiative 142" is available from
Ted Pong, 8907 NE 127th Street, Kirkland, WA 98034.
Audio/Video Tapes:
-"The Uncut Version," a short video on the benefits of having a
foreskin, is available from Cadigan Productions, P.O. Box 793,
Mountain View, CA 94042-0793, (415)965-7776, at $19.95 each plus
$2.95 shipping and handling, and CA residents add $1.65 sales tax.
-"Circumcision: Breaking the Silence," by Ronald Goldman, 60-
minute cassette tape of talk at Interface in Cambridge, MA.
Discusses sexual, psychological, and cultural impact of
circumcision and healing approaches. Includes illustrations.
Send $11.50 to Circumcision Resource Center, P.O. Box 232, Boston,
MA 02133.
-"NOCIRC Composite Video," a 16-minute VHS videotape, with both
male circumcision and female genital mutilation, available from
NOCIRC with your $20 tax-deductible donation.
Services:
-PErSONA Counselling Services is a circumcision information and
recovery resource in the Portland area. Contact Ron Fisher, 2459
S.E. TV Highway, #237, Hillsboro, Oregon 97123, (503)693-6988.
-The National Men's Resource Calendar, P.O. Box 800, San Anselmo,
CA 94979-0800, formerly Men's Resource Hotline Calendar, provides
referral and information on men's books, publications, research,
conferences and events, films and videos, organizations, groups,
services and cultural events.
Studies:
-How does neonatal trauma affect the brain? Perinatal trauma is
known to affect brain development and behavior. Magnetic
Resonance Imaging (MRI), Positron Emission Tomography (PET) scans
and electroencephalograph (EEG) studies are needed to evaluate
possible brain injury caused by the perinatal trauma of
circumcision according to developmental neuropsychologist James W.
Prescott, Ph.D. Interested pediatric neurologists may contact Dr.
Prescott, c/o NOCIRC, P.O. Box 2512, San Anselmo, CA 94979-2512.
Politics:
-Circumcision Outlawed in Washington? 200,000 signatures are
needed to present Initiative 142, which will prohibit genital
mutilation of children and infants in the state of Washington, to
the Legislature of the State of Washington. For more information
contact Ted Pong (206) 623-8123 or Frank Cranbourne (206) 547-
0120.
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"THE SILENT KNIFE: WHY ISN'T CIRCUMCISION A MEN'S ISSUE?"
"It has only been recently that I have thought about the event of
circumcision and asked myself how it may have influenced my
feelings about myself. I've just now begun to wonder how it might
have effected my body image and feelings of self-esteem. We know
that children register feelings even when in utero and certainly
have strong feelings after birth. What is it like for an infant
boy, a boy born perfect, whole and complete, to have part of his
body removed? What is the effect of having a larger person, most
often a man, spread his little legs and cut away the end of his
genitals? Could the trauma from this event have anything to do
with our later feelings of shame about our bodies, our concern
about the size of our penises, our anguish over sexual
performance, our frozen feelings, or the male ability (liability?)
to ignore pain?"
"Each time I tried to begin the chapter on child abuse for my
book, The Warrior's Journey Home: Healing Men's Addictions,
Healing the Planet, I began to cry. Some body memory told me
something terrible had happened when I was a child...I found a
book...began reading an account. For the first time I understood
the depth of my tears..."
"In order to begin healing our wounds we need to remember what
happened to us and name it correctly. Cutting the genitals of
newborn male babies is child sexual abuse. I encourage all men
who have the courage to remember to join in ending this practice
now and forever."--Jed Diamond, ReSource, Summer 1992
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"We categorically state that circumcision has unrecognized
victims."
-Declaration of the First International Symposium on Circumcision.
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Publisher: National Organization of Circumcision Information
Resource Centers
Editor: Marilyn Fayre Milos, R.N.
Assoc.Editor: Donna Macris, CNM, MSN
Consultants: Sheila Curran, R.N.; Paul Fleiss, M.D., MPH; Sara
Pitta, CNM; James L. Snyder, M.D., F.A.C.S.
National Organization of Circumcision Information Resource Centers
P.O. Box 2512
San Anselmo, CA
U.S.A. 94979-2512
Tel. (415) 488-9883
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