Circumcision in America

By Debra S. Ollivier
First published by Salon (1998). Reposted with permission.
Read more from Ollivier here at Salon.

PART ONE

When I told people that our newborn son would not be circumcised, I didn't realize that a tiny but vital part of his penis would touch off deeply held convictions about cultural mores, aesthetics, psychology, hygiene, father-son relations, American identity and thousands of years of biblical traditions. In fact, I hadn't given penises much thought since my teenage years, when every penis was a circumcised penis and the only issue of overriding concern as the tentative probings of adolescence bloomed into full-blown sexuality was: "How does this thing work?" Years later, I was given a detailed, hand-etched poster called "Penises of the Animal Kingdom"; in this vast forest of mammalian genitalia the only thing more striking than the banality of man's penis next to that of the 20-foot gray whale was the fact that all of them, including man's, were intact. Aside from this brush with reality, however, the mushroom leitmotif of the circumcised penis remained the unequivocal, unquestioned status quo of my youth and of all my peers. It was the uncircumcised penis, with its strange fleshy retractability, that was somehow freakish, a slightly vestigial aberration, like being born with a tail or a set of gills.

Years of living in Europe and being married to a French (intact) Catholic changed all that. Because only Jews and Arabs practice routine circumcision in Europe -- in fact, the United States is the only country in the industrialized world to practice it across the board -- I eventually grew so accustomed to the intact penis that a circumcised one now looks startlingly bereft. Still, when I told people in the States that our son would not be circumcised it was as if, in keeping his little foreskin intact, I was committing a perfidious impropriety: refuting both my Jewish and American identity and, in so doing, robbing my son of both. For all those who expressed their convictions, however -- the astonished Jewish relative, the slightly repelled girlfriend, the perturbed American husband -- a number of questions hung in the air, unanswered. Why, exactly, do we circumcise? How did circumcision evolve from a strictly Jewish and Muslim ritual to a standard medical procedure performed on a vast majority of American males, irrespective of religion? Why is the United States the only Western nation in the world to practice it routinely, despite overwhelming evidence debunking medical claims and enduring myths? More important, what exactly is the foreskin, what happens when we remove it and why do we continue to opt for circumcision?

It doesn't take much to realize that nature didn't intend the foreskin and the penis to be separated at birth. Try retracting the foreskin of a newborn's penis and you're struck by the steadfast, tenacious grip it has on the glans, or head. The foreskin is sealed to its bounty like a silo, and only slowly, over the years, yields to full retractability. But it's far more than just a sheath. The foreskin contains thousands of highly sensitive sensory receptors called Meissner corpuscles, which are more abundant there than in any other part of the penis. Richly endowed with a profusion of blood vessels, it also has a ridged band of peripenic muscles that protects the urinary tract from contaminants, and an undersurface lined with mucocutaneous tissue found nowhere else on the body, which contains ectopic glands that produce natural emollients and antibacterial proteins similar to those found in mother's milk. With its frenar ridges and its thousands of nerve endings, the foreskin not only protects the glans, which in an intact male is extremely sensitive, it also accounts for roughly one-third of the penis' sexual perceptivity. In short, evolution has seen to it that the penises of all mammals come protected in a remarkably fine-tuned and responsive foreskin.

After nine months of infinitely complex and elegant work at literally becoming whole persons, however, the majority of American newborn males have their foreskins removed. [Editor's Note: The CDC reported the rate of male circumcision dropped from 56% in 2006 to 32% in 2009. Today the majority of newborn American males remain intact.] Curiously, in a culture where the rights of every living thing are vigorously endorsed by the vox populi, most parents opt neither to view nor to question the mechanics of this procedure. Dr. Hiram Yellen, one of the two inventors of the Gomco Clamp, a tool used in circumcision, describes the standard procedure for circumcision in the following passage:

"... the prepuce is put on a stretch by grasping it on either side of the median line with a pair of hemostats. No anesthesia is used. A flat probe, anointed with Vaseline, is then inserted between the prepuce and the glans ... In cases where the prepuce is drawn tightly over the glans, a dorsal slit will facilitate applying the cone of the draw stud (the bell) over the glans. After anointing the inside of the cone, it is placed over the glans penis ... The prepuce is then pulled through and above the bevel hole in the platform and clamped in place. In this way the prepuce is crushed against the cone causing hemostasis. We allow this pressure to remain five minutes, and in older children slightly longer. The excess of the prepuce is then cut with a sharp knife."

Within minutes, three feet of veins, arteries and capillaries, 240 feet of nerves and more than 20,000 nerve endings are destroyed; so are all the muscles, glands, epithelial tissue and sexual sensitivity associated with the foreskin. Finally, what nature intended as an internal organ is irrevocably externalized.

Perhaps for parents who don't watch a circumcision (the majority don't; the minority that do wish they hadn't), the reality here -- the strapping, forcing, cutting, bleeding, stripping, slicing and creating of immeasurable pain -- is a little like the Bomb: something you'd rather not think about unless you absolutely, positively must. But the fact remains that millions of American newborns routinely undergo this procedure, and most parents don't really know why. How did this come to pass?

Research into circumcision's history suggests that it dates back to around 3000 B.C., when it was performed in ancient Egypt as a mark of slavery and as a religious rite. Aside from Jews and Muslims, however, people considered circumcision to be a repugnant form of genital mutilation, and both the Greeks and Romans passed laws forbidding its practice. Thus, for a few millennia at least, most men worldwide enjoyed the virtues of an intact penis. In fact, routine circumcision didn't take off in America until the Victorian era, and didn't reach cruising altitude until the Cold War years, when technology, medicine and big business came together in the interest of institutionalized birthing.

The systematic removal of the foreskin owes its ubiquity in America to one man named Dr. Lewis Sayre, once known as the "Columbus of the prepuce" by his colleagues. In 1870, Sayre drew a correlation between the foreskin and an orthopedic malady in a young boy. Through a series of bizarre medical experiments, Sayre and his colleagues eventually determined that links existed between the foreskin and a vast range of ailments that included gout, asthma, hernias, epilepsy, rheumatism, curvature of the spine, tuberculosis and elephantiasis. But what drove circumcision deeper into the bedrock of pediatric medicine was the strident belief that masturbation, thought to be the root of everything from bed-wetting to intractable forms of insanity and mental retardation, could be "cured" with circumcision.

Dr. Peter Charles Remondino, a well-known physician, public health official and champion of universal circumcision, typified the Zeitgeist. Remondino wrote that the foreskin, which he referred to as an "unyielding tube" and "a superfluity," made the intact male "a victim to all manner of ills, sufferings ... and other conditions calculated to weaken him physically, mentally, and morally; to land him, perchance, in jail, or even in a lunatic asylum."

Dr. John Harvey Kellogg, a well-known fundamentalist health reformer and medical journalist (his 1888 "Plain Facts for Old and Young" included roughly 100 pages dedicated to "Secret Vice [Solitary or Self Abuse]") who went on to create the world's preeminent corn flake, was more direct in his approach. "A remedy for masturbation which is almost always successful in small boys is circumcision," he wrote. "The operation should be performed by a surgeon without administering an anesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment. In females, the author has found the application of pure carbolic acid to the clitoris an excellent means of allaying the abnormal excitement."

As astonishing as it may seem, Kellogg's views were shared by most prominent practitioners of the time. In Robert Tooke's popular book "All About the Baby," published in 1896, circumcision is recommended for preventing "the vile habit of masturbation." And Dr. Mary Melendy, author of "For Maidens, Wives and Mothers," wrote that masturbation "lays the foundation for consumption, paralysis and heart disease ... It even makes many lose their minds; others, when grown, commit suicide." Appealing to parents who might question the protracted afflictions associated with masturbation, Melendy warned, "Don't think it does no harm to your boy because he does not suffer now, for the effects of this vice come on so slowly that the victim is often very near death before you realize that he has done himself harm."

Circumcision was not only bound up with deeply irrational fears about masturbation at the turn of the century; it was also tied to sociocultural changes as vast waves of immigration flooded American cities. Circumcision became a mark of social class that distinguished gentrified, "real" Americans from the "insalubrious" immigrant masses at a time when cleanliness was synonymous with godliness. Eventually, circumcision staked its claim on the American male and his problematic penis, and became so accepted as the norm that by the early 1900s standard medical textbooks depicted the normal penis without its foreskin. In this highly charged atmosphere, American parents who chose not to circumcise their sons were almost criminally negligent, if not freakishly nonconformist.

By the Cold War era, roughly 90 percent of American males were systematically circumcised at birth. It was simply something you did -- a medical procedure as unquestioned as the cutting of the umbilical cord -- and so deeply entrenched in America that it was upheld as standard practice long after the theories by which it was justified were debunked. People had long forgotten that circumcision was not based on any supreme medical imperative but rather on the fantastically phobic mores of a Victorian society, and the medical establishment did little to clear the smoke on what had become a profitable business. Was this a perception/reality problem, or a morality/reality problem?

It wasn't until the '70s -- after French obstetrician and natural-birthing pioneer Frederick Leboyer's "Birth Without Violence," after extensive studies discrediting longstanding medical claims, after lawsuits that forced hospitals to obtain parental consent before circumcising, and after millions of foreskins had been left on the cutting-room floor -- that Americans (and Jews all over the world) began questioning circumcision.

By 1975, the American Academy of Pediatrics (AAP) had reversed its pro-circumcision stance in "Standards and Recommendations for Hospital Care of Newborn Infants," by stating: "there is no absolute medical indication for routine circumcision of the newborn." And in 1984, it published "Care of the Uncircumcised Penis," which, clearly supporting the intact penis, concluded by saying, "The foreskin protects the glans throughout life." But despite a slow decline in the circumcision rate, accompanied by a new awareness of the rights of newborns -- and despite rigorous campaigning against circumcision by doctors worldwide, in the form of international symposiums, in-depth studies, human rights legislation, information resource centers and more -- circumcision remains the most commonly performed neonatal surgical procedure in America. And in this, America stands alone.

PART TWO

Why is the most "advanced" nation in the industrialized world alone in practicing a disturbing archaism from less enlightened times? In "The Saharasia Connection," Dr. James DeMeo, who calls circumcision "an ancient blood ritual ... that has absolutely nothing whatsoever to do with medicine, health, or science in practically all cases," puts forth this hypothesis: "The fact that so many circumcised American men, and mothers, nurses, and obstetricians are ready to defend the practice in the face of contrary epidemiological evidence is a certain giveaway to hidden, unconscious motives and disturbed emotional feelings about the penis and sexual matters in general."

It remains to be seen to what extent "unconscious motives" are responsible for the perpetuation of circumcision today. However, "emotional feelings about the penis" may very well be knit into the fabric of certain long-standing myths that persist in the United States despite logical or empirical evidence to the contrary. After much verbal intercourse with friends over the years about near misses and close calls with the intact penis, it seems evident that three persistent myths or biases dominate.

The mother of all myths, now locker-room gospel, is that a circumcised penis is more hygienic than an intact one. This comes as no surprise in a culture where the art of sterilization is so pervasive that certain foods have a half-life that probably exceeds that of plutonium. Still, doctors discredited hygiene as an advantage of circumcision years ago. When I asked our pediatrician what I needed to clean my son's intact penis, he replied: "Common sense." The American Academy of Pediatrics (AAP) put it another way: "Good personal hygiene would offer all the advantages of routine circumcision without the attendant surgical risk." (This, of course, is the case for both sexes: Leave any body part unattended for too long and things get, well, unpleasant.) Yet another doctor posited in "Circumcision: A Medical or Human Rights Issue?" that removing the foreskin for hygiene's sake is like removing one's eyelid for a cleaner eyeball.

Another popular and profoundly baffling myth is that circumcision is painless. Studies indicate that those babies who appear to sleep through a circumcision have most likely slipped into a semicomatose state, and a slew of recent studies on newborns, traumatic experience and sensory perception support this hypothesis.

Equally strange is the cultural bias for the aesthetics of a circumcised penis. In moments of free-associative candor, girlfriends have compared the looks of an intact penis to everything from an elephant trunk to a dachshund. The queerness of it was reinforced by the unsettling feeling that it required at best a refresher course on basic anatomy, at worst a whole new sex education, as if an intact man were some sort of Minotaur. To the extent that the circumcised penis is endorsed largely through culturally determined views about hygiene and aesthetics, one wonders if it's not in some odd way a metaphor for America itself: sleek and streamlined, the way we like our cars and buildings, connoting speed and unimpeded verticality; but also surgical and sanitized, and thus thoroughly modern. By contrast, the intact penis is a little too unruly, too Paleolithic, a little too, well, animal. (If penises could walk and talk, the circumcised penis would be a suit and tie, a clean shave and a shoulder-high salute. The intact penis would be a rumpled shirt, a five o'clock shadow and a finger flipping you the bird.)

Either way, passing judgment on an intact penis in America is like passing judgment on a real nose in a country where rhinoplasty is imposed at birth. Quite simply, most Americans have forgotten that an intact penis is actually the norm, and that for thousands of years the only people who were circumcised were Jews and Muslims.

Which leads me to a word about Jews and the penis. When I mentioned to certain relatives that my son would remain as nature intended him, the conversation, once the shock wore off, went something like this:

"But honey, what about the, er, Covenant of Abraham?"

"What exactly is the connection between the Covenant of Abraham and my son's penis?"

"Well, I'm not sure. Let me put Sam on the phone."

Sam wasn't sure about the God-penis-Covenant connection either. Neither was Ruth. Nor Morley. Nor were any of my Jewish friends or relatives.

In fact, the Covenant was a pact between God and Abraham, an expression of both faith and tribal belonging that set the "chosen people" apart, and which has been passed on to all Jews. Jewish identity, however, is not determined by circumcision nor is it passed through the penis. As most Jews know, Jewish identity is passed through the mother, hence the traditional and immemorial Jewish concern about assimilation through intermarriage. The "Encyclopedia Judaica" reaffirms this: "Any child born of a Jewish mother is a Jew, whether circumcised or not." I'm reminded of a Jewish friend who insisted that his son be circumcised despite the fact that his wife was Catholic. "Circumcision," his rabbi reminded him, "will not make your son Jewish." (His wife's conversion to Judaism, however, would.)

Despite all this, the issue of Jewish identity, in which circumcision is inextricably bound up, remains one of the most complex, thorny and eternally debated subjects around. Volumes have been written on the subject, and everything is up for personal interpretation. With this in mind, and given that a vast number of Jews do not know what the Covenant really is -- their sons are circumcised in hospitals without a bris; they are not Orthodox, and do not keep kosher -- one can only surmise that circumcision is not an act of religious conviction but rather one of deeply entrenched cultural conformity rooted in the deep past. In fact, a cruel irony lingers here: Originally, biblical circumcision involved cutting only the tip of the foreskin (called brith milah), which still left enough foreskin for certain Jewish men to stretch it forward and pass as gentiles. This gave rise to a rabbinical movement called Brith Periah. Much more radical in nature, Brith Periah essentially removed the entire foreskin, making it impossible for Jews to emulate gentiles. Modern circumcision is based on this much more radical procedure of Brith Periah -- a strange medical twist that has leveled the playing fields of the penis among Jews and gentiles alike.

Jew or gentile, to the extent that "God" is behind circumcision and the oft-cited Covenant, one can only wonder: Why ordain the removal of such a fundamental part of the penis? And why the penis? Here the views of Moses Maimonides, a medieval Jewish philosopher, rabbi and figure in the codification of Jewish law, are enlightening in a more universal context. In "Guide to the Perplexed," Maimonides wrote that the commandment to circumcise "has not been prescribed with a view to perfecting what is defective congenitally, but to perfecting what is defective morally." Celebrated for his chastity by the sages, Maimonides elaborates: "With regard to circumcision one of the reasons for it is, in my opinion, the wish to bring about a decrease in sexual intercourse and a weakening of the organ in question, so that this activity be diminished and the organ be in as quiet a state as possible ... The fact that circumcision weakens the faculty of sexual excitement and sometimes perhaps diminishes the pleasure is indubitable. For if at birth this member has been made to bleed and has had its covering taken away from it, it must indubitably be weakened."

Maimonides' views evoke not only the Victorians, the doctrines that underlie female circumcision and the "unconscious motives" Dr. DeMeo wrote about: They also hark back to the forbidden fruits of sex and religion that have festered in the gardens of earthly delight ever since Adam and Eve discovered the apple.

Considering the troubling history of circumcision in light of my own son's corpulent little penis, I'm reminded that it is the choice -- and in some cases, the courage -- of American parents that will determine whether the next generation of American men reclaims what is rightfully theirs to begin with. In this regard it might be the late Dr. Benjamin Spock who stands for conventional wisdom at its best. When asked about circumcision in an interview with Redbook in 1989, he said quite simply, "My own preference, if I had the good fortune to have another son, would be to leave his little penis alone."

Photo courtesy of peaceful parenting mom, Christina King. 

Intact related onesies and tees from Made By Momma.

Additional resources (scholarly books, articles, websites) on the prepuce, intact care and circumcision at Are You Fully Informed?