Psychological impacts of male circumcision
This menu page indexes and links articles relevant to an
understanding of the psychological, neurological, and
sociological sequelae and effects of male circumcision. The
material within each category is arranged in order of
In medical circles, neonatal male circumcision was long
assumed to be psychologically and emotionally benign. It was
believed that newborn infants had "poorly developed"
neurologic systems; that newborns could not feel pain; or, if
they did feel the pain, they would not remember it. According
to that orthodoxy, the experience of neonatal circumcision
could never have any lasting effect on a child and could not
traumatize a child.
It was also a common belief that the foreskin had no
particular structure and no useful function; and that the
patient would never later regret its loss.
Enough evidence now exists to say with confidence that
male circumcision causes psychological changes. The trauma of
the experience is injurious.24,47,47
It can have long-term deleterious effects later in
However, the specific neurological, psychological, and
behavioural changes resulting from early genital trauma have
never been carefully investigated. Much more study is needed
to further elaborate these changes.
The study of the psychology of circumcision can be divided
into several interrelated areas:
- The effects of pain and perinatal trauma on the
- Grieving the loss of a body part;
- Effects of early trauma and loss in the adult;
- The effects on the parent (parental-infant
- The effects on society;
- Factors influencing parents and doctors to request or
Although the literature on the psychological impacts of
circumcision is far from complete, some information is
available. New material is gradually appearing and will be
added to these pages as it becomes available.
Perinatal trauma. Circumcision is a form of
perinatal (birth) trauma.35 Cansever
tested boys before and after circumcision and found that the
trauma causes severe disturbance of normal function.6 Taddio and
others have documented behavioral changes at six months
of age, suggestive of PTSD in circumcised boys.37
Yilmaz et al. have demonstrated PTSD in boys in the
phallic period who are undergoing circumcision for
has documented posttraumatic stress disorder resulting from
the perinatal trauma of circumcision in middle-aged
substantial evidence that perinatal trauma16,33,45,46,47,49,52,57
and/or deprivation of pleasure8,19
contribute to later aggressive, violent, and/or suicidal
behaviour. Anand and
Scalzo suggest that early trauma predisposes to altered
pain sensitivity, stress disorders, ADD/hyperactivity, and
self-destructive disorders.65 Van der
Kolk identified a compulsion in traumatized persons to
repeat the trauma.18 Goldman
reports that the performance of circumcision by a circumcised
male doctor may be a reenactment of one's own circumcision
Denial of loss. Persons who have lost body parts
must grieve their loss.41,42,43,45
The first stage of grief is denial of the loss.25 Fitzgerald and Parkes state that
"Anything that seriously impairs sensory or cognitive
function is bound to have profound psychological effects, not
only on the person who is affected but also on family,
friends, workmates, and caregivers."42
The thought of permanent loss of sensory function is so
painful that persons deny their loss in order to avoid facing
the painful feelings.42
Denial of loss causes a flight from reality. Parkes et al. state that persons
in denial may minimize their loss.41-43
Circumcision causes the loss of a body part and all of its
functions including a drastic loss of erogenous sensory
function, so denial of loss is not uncommon in circumcised
males. Circumcised males may experience the full range of
distress and emotional dysfunction resulting from loss. This
frequently results in circumcised fathers adamantly insisting
that a son be circumcised.25,29, 57
Fathers are frequently unable to vocalize their feelings.
They will say that "I want my son to look like me," even
though the child may be different in eye color, hair color,
and other aspects. In fact, what the father really may be
feeling is, "I don't want a son with an intact penis to
remind me of what I have lost."
Effects of denial on medical doctors. Goldman
states that some circumcised male medical doctors misuse the
medical literature to support, rationalize, and justify their
own loss; and to defend the practice of circumcision.47 Denniston reports that doctors "who have
been cut themselves may be unable to stop cutting
reports that the likelihood of a baby being circumcised is
determined by the circumcision status of the a father; the
sex, age, and circumcision status of the physician; amongst
other factors. Goldman
reports that doctors who are older, male, and circumcised are
more likely to condone circumcision.47
Members of medical societies may have emotional issues that
may preclude the objective formulation of policy concerning
non-therapeutic male circumcision.55
Parents need to be aware that circumcision is dangerous.
It involves traumatic loss of a body part. There is a
definite potential for long-lasting psychologic injury.
However, children differ unpredictably in their resilience to
pain, trauma, and loss. Some individuals will be affected
more seriously than others. Much more research is needed
before we can fully understand the psychologic and social
consequences of this traumatic life event.
- In the late 19th and early 20th Century, Sigmund Freud
identified castration anxiety resulting from fear of
operations on the genitals.1
- Cole (1927) reported a fearful reaction that may have
been the first reported case of a posttraumatic stress
disorder (PTSD) flashback in which the stressor was
circumcision, although he could not have known what he was
reporting because PTSD was not recognized as a disorder
until years later.
- As early as 1929, British analyst Edward
Glover reported a case of impotence secondary to
castration anxiety caused by a particularly brutal
circumcision. Glover also reported the behaviour of a
medical doctor with an apparent obsessive-compulsive need
to perform circumcisions.3
- In 1945, David M. Levy, M.D., reported a study of many
children who had undergone various surgical operations,
including circumcisions. He found that many suffered from
"combat neurosis", an early name for what is now known as
posttraumatic stress disorder.4
- Child psychiatrist Anna
Freud discussed the role of bodily illness in the
mental life of children in 1952. Freud stated that the
combination of pain and anxiety can have devastasting
effects on children.5
- Child psychologist Gocke
Cansever (1965) assessed 12 Turkish boys before and
after they were circumcised. Cansever reported severe
disturbances with functioning after the circumcision as
measured by psychological testing.6
- James Prescott (1975) reports on the
origins of violence. Prescott believes that the deprivation
of body pleasure contributes to the development of violent
Circumcision removes the pleasure
sensors in the foreskin and so deprives the individual
of body pleasure.
et al (1976) observed behaviour differences in male
children in the US that were not found in male children in
Europe. The US male children were circumcised while the
European children were not circumcised. Richards suggested
that the changes were due to circumcision.9
apparently unaware of the work of Freud, Cansever, or
Richards, wrote in 1978 that "[t]he application of crushing
clamps and excision of penile tissue... probably do little
to engender a trusting, congenial relationship with the
infant's new surroundings."10
reported the case of an adolescent boy traumatized by
subsequently reported on the need for additional study of
psychic trauma. He cited the trauma of circumcision as an
- The Diagnostic Manual of the American Psychiatric
Association (DSM III) first identified the conditions that
contribute to the development of post-traumatic stress
disorder (PTSD) in 1980. The 1987 DSM-III-R reports the
conditions described for the pathogenesis of PTSD.
These are exactly similar to those experienced by the
helpless infant undergoing circumcision.15
- Perinatal psychologist David
Chamberlain (1989) demonstrated that people under
hypnosis can remember their birth and traumatic events
associated with it.17
der Kolk (1989) reported that victims of trauma tend to
reenact the trauma.18
These findings apply to many kinds of child abuse, and may
help to explain why men and women who were victims of
circumcision violence are more likely to perpetuate male
and female circumcision violence.
(1989) contrasts the pain and trauma of circumcision with
the pleasure and peace of avoided circumcision. He
identifies the pain and lack of pleasure associated with
circumcision with changes in brain development and
behaviour. Prescott argues that the early genital pain of
circumcision "encodes" the brain for later sadomasochistic
tendencies, including violent destructive
Miller (1991) discusses the effects of early child
abuse and trauma on later violent and self-destructive
- Walter and
Streimer have reported a case of body dysmorphic
disorder secondary to circumcision.21
and Parkes confirm that grief is common in persons who
have lost body parts40.
- Bigelow (1992,1995) reported that circumcised men who
have become fathers in circumcising cultures often exhibit
a behaviour described as "adamant father syndrome." The
"adamant father" insists that his son be circumcised, even
after a rational discussion is provided.25
(1993) found post-traumatic stress disorder in women who
have undergone genital procedures.26
Williams and Kapila surveyed the complications of
circumcision in 1993. This is believed to be the first
medical journal article of this type to discuss psychologic
complications of circumcision in any detail.27
- George C. Denniston, MD, MPH, (1994)
discusses the psychological effects and behavior changes in
adult men resulting from of denial of loss by penile
- David Chamberlain, Ph.D. (1995)
discusses the perinatal origin of later violent
Dr. Chamberlain argues that babies should not be
(1996) reviews the literature that shows that fetal memory
commences to operate well prior to birth and continues
across the birth experience into the newborn period.34
provides a psychosexual follow-up report on the case of
"John/Joan," who was "sexually reassigned" and raised as a
girl following the total loss of his penis to a
circumcision disaster. "John" was circumcised to treat a
"fused foreskin"---even though this is a normal
developmental condition in newborn boys.35
"John" (David Reimer of Winnipeg, Canada) was the subject
of a book, As Nature Made Him, by journalist John
(1997) demonstrated that the pain of neonatal circumcision
remembered at six months of age. The observed behaviour is
suggestive of an infant analogue of post traumatic stress
- Psychologist Ronald Goldman reports the effects of the
trauma of circumcision on the individual and society in a
(1997) reports the tendency of circumcised doctors and
religious officials to cite false medical or religious
grounds to justify circumcision.39
- British child psychiatrist McFadyen
(1998) reported the psychologic trauma experienced by her
son following a circumcision operation.40
McFayden's description of her son's trauma is consistent
with the early reports of Anna Freud4
- British psychiatrists Maguire
and Parkes (1998) reported on the need to grieve the
loss of body parts.41
Failure to grieve the loss leaves the individual in a state
of denial of loss and disconnected from the reality of the
loss and injury.
et al. report on the failure of sex reassignment
surgery in the management of penile ablation secondary to
- Menage (1998) reports on the
psychological harm of male circumcision.45
- Jacobsen and Bygdeman (1998) report
that traumatic and/or painful procedures in the perinatal
period seem to cause a greater propensity to suicide. The
effect is markedly greater in males.46
Goldman, Ph. D. (1999) discusses the impact of
circumcision on the child, on parents, on adults, on
medical doctors, and on society.47
- Psychiatrist John
Rhinehart, MD, (1999) documents four cases of PTSD from
his psychiatric practice.48
& Bensley report a survey of the psychological and
sexual effects of male circumcision on men.50
- Boyle and colleagues survey the psychological and
sexual effects of infant circumcision.52
- Yilmaz et al. administered psychological test to boys
before and after circumcision. They found evidence that
circumcision causes anxiety similar to post-traumatic
- Goldman discusses psychological, cultural, and
religious factors that influence medical doctors who
determine circumcision policy.55
See also The Birth Scene, a site having an
excellent discussion of circumcision in four articles by
NOHARMM maintains a webpage listing therapists in various
parts of the United States who are knowledgeable in helping
men who have issues resulting from their circumcision.
The psychology of male circumcision
- Freud S. (1913) Totem and
Taboo. Standard Edition, (13),1-161.
- Cole EM. Circumcision and the abreaction of
fear. J Neurol Psychopathol 1927;7(27):237-8.
- Glover E. The
`screening' function of traumatic memories. Int J
Psychoanal 1929; 10:90-93.
- Levy DM. Psychic
trauma of operations in children and a note on combat
neurosis. Am J Dis Child 1945;69(1):7-25.
- Freud, Anna. The role of
bodily illness in the mental life of children.
Psychoanalytic Study of the Child 1952; Vol 7:
- Cansever G. Psychological
effects of circumcision. Brit J Med Psychol
(1965), 38, p 321.
- Oztürk O. Ritual
circumcision and castration anxiety. Psychiatry
1973; 36: 55
- Prescott JW. Body pleasure and the origins of
violence. Bulletin of the Atomic Scientists
1975; November:10-20. (Link to www.violence.de)
- Richards MPM, Bernal JF, and
Brackbill Y. Early
behavioural differences: gender or circumcision? Dev
- Grimes DA. Routine
circumcision of the newborn infant: A reappraisal. Am
J Obstet Gynecol 1978; 130(2): 125-129.
- Carter, Nicholas. Routine
circumcision: The tragic myth. London: Londinium Press;
Torrance, Calif.: Noontime Press, c1979.
- Salk L, Lipsitt LP, Sturner
WQ, et al. Relationship
of maternal and perinatal conditions to eventual adolescent
suicide. Lancet 1985;i:624-627.
- Kennedy H. (1986) Trauma in
Childhood. Psychol Study Child 41:209-219.
- Yorke, C (1986). Reflections
on the problem of psychic trauma. Psychol Study
- American Psychiatric
stress disorder. Diagnostic and Statistical
Manual III-R (DSM-III-R), Washington 1987.
- Jacobson B, Eklund G,
Hamberger L, et al. Perinatal
origin of adult self-destructive behaviour. Acta
Psychiatrica Scandinavia 1987;76:364-371.
- Chamberlain DB. "Babies
Remember Pain." Pre- and Peri-natal Psychology
Journal, Summer 1989. (courtesy Primal Psychotherapy Page)
- van der Kolk, B. The
compulsion to repeat the trauma: re-enactment,
revictimization, and masochism. Psychiatric Clinics
of North America 1989;12: 389-411.
- Prescott, J. Genital
pain vs. genital pleasure: why the one and not the
other. The Truth Seeker 1989;1(3):14-21.
- Miller A. Appendix: The Newly
Recognized, Shattering Effects of Child Abuse. In:
The Untouched Key: Tracing Childhood Trauma in
Creativity and Destructiveness. Anchor Books
(Doubleday) New York, 1991.(ISBN 0-385-26764-9) (Originally
published as Der gemiedene Schlüssel by
Suhrkampt Verlag am Main, 1988).
- Walter G, Streimer J. Genital
self-mutilation: Attempted foreskin reconstruction.
Brit J Psych 1990;156:125-7.
- Chamberlain DB. (1991) Babies Don't Feel Pain: A Century of
Denial in Medicine. Presented at The Second
International Symposium on Circumcision, San Francisco,
California, May 2, 1991 (link to www.nocirc.org).
- van der Kolk BA, Saporta J.
biological mechanisms and treatment of intrusion and
numbing. Anxiety Research 1991;4:199-212.
- van der Kolk BA, Perry JC,
Herman JL. Childhood
origins of self-destructive behavior. Am J
Jim, Ph. D. Chapter 10, Psychological Factors Related
to Infant Circumcision, pp.89-112. In:The Joy of
Uncircumcising!, Hourglass Book Publishing, Inc., Aptos
CA 95001, 1992, 1995. (ISBN 0-934061-22-X)
- Menage J. Post-traumatic
stress disorder in women who have undergone obstetric
and/or gynaecological procedures: a consecutive series of
30 cases of PTSD. Journal of Reproductive and Infant
Psychology 1993; 11:221-228.
- Williams N, Kapila L.
Complications of circumcision. Brit J Surg
- Diamond, Jed. The
Warrior's Journey Home: Healing Men, Healing the
Planet. New Harbinger Publications, Inc., 1994.
- Denniston GC. An Epidemic of Circumcision. Paper
presented at the Third International Symposium on
Circumision, University of Maryland, College Park,
Maryland, May 22-25, 1994. (link to www.nocirc.org)
Stress Disorder. In: American Psychiatric Association.
Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV). Washington:
American Psychiatric Association, 1994. (ISBN
- Gunnar MR, Porter FL, Wolf
CM, et al. Neonatal stress receptivity: predictions to
later emotional temperament. Child Dev 1995; 66:
- Davis M, Emory E. Sex
differences in neonatal stress reactivity. Child Dev
- Chamberlain, David B. Birth and the origins of violence.
Pre- and Perinatal Psychology Journal (Winter) 1995;
10(2): 57-74. (Link to www.birthpsychology.com)
- Hepper PG. Fetal
memory: does it exist? What does it do? Acta
Paediatr Scand 1996, Suppl 416:16-20.
- deMause L. Restaging fetal traumas in war and social
violence. Pre- & Perinatal Psychology
Journal 1996, 10(4), 227-258. (Link to
- Diamond M. Sex
reassignment at birth: a long term review and clinical
implications. Archives of Pediatric & Adolescent
Medicine 1997; 151;298-304.
- Taddio A, Katz J, Ilersich
AL. Effect of
neonatal circumcision on pain response during subsequent
routine vaccination. Lancet 1997; 349 (9052):
Ronald F. Circumcision: The Hidden Trauma.
Vanguard Publications, 1997. (ISBN 0-9644895-3-8)
- Hill G. Abolish
circumcision in non-consenting children (letter) .
Townsend Letter for Doctors and Patients, May 1997;
- McFadyen A. Children
have feelings too. BMJ 1998; 316:1616.
- Maguire P, Parkes CM. Coping
With Loss: Surgery and loss of body Parts. [Part 4/10.]
Brit Med J 1998; 316(7137)
- Fitzgerald RG, Parkes CM. Coping with loss: Blindness and loss of
other sensory and cognitive functions..BMJ
- Parkes CM. Coping with loss: Facing loss.
BMJ 1998;316:1521-1524. [Part 10/10]
- Bradley SJ, Oliver GD,
Chernick AB. Experiment
of Nurture: Ablatio Penis at 2 Months, Sex Reassignment at
7 Months, and a Psychosexual Follow-up in Young
Adulthood. Pediatrics 1998;102(1):e9.
- Menage J. (1998) Circumcision and psychological harm.
(Link to www.norm-uk.co.uk)
- Jacobson B, Bygdeman M. Obstetric care and proneness of offspring
to suicide. BMJ 1998; 317:1346-49. (Link to
- Goldman R. The
psychological impact of circumcision. BJU
International 1999; 83, Suppl. 1:93-102.
- Rhinehart, John. Neonatal
circumcision reconsidered. Transactional Analysis
Journal 1999 Jul; Vol 29(3):215-221.
- Boyle, G. J. (2000).
Discurso tonico: El
trastorno por estrés postraumático (PTSD) de
larga duración como resultado de la cirugía
genital de los menores. III Congresso Nacional de
Psicología: "Violencia y Salud Mental." San
Salvador, El Salvador, 6 y 7 octubre 2000. (en
- Boyle GJ, Bensley GA. Adverse
sexual and psychological effects of male infant
circumcision. Psychological Reports
- Boyle GJ. Los
efectos adversos sobre la salud mental de larga
duración como resultado de la circuncisión no
terapéutica de los niños. VI Congreso
Iberoamericano de Psicología de la Salud.
Universidad Maimónides, Buenos Aires, 30 de
septiembre al 3 de octubre, 2001. (en español)
- Boyle GJ, Goldman R, Svoboda
JS, Fernandez E. Male
circumcision: pain, trauma and psychosexual sequelae.
J Health Psychology 2002;7(3):329-43.
- Boyle G. J. (2002). La
Circuncisión No Terapéutica de los
Niños y su Relación con el Estrés
Postraumático. 9° Congreso Internacional de
Psiquiatría, Buenos Aires, Octubre 22-25, 2002. (en
- Yilmaz E. Batislam E, Basar
MM, Basar H. Psychological
trauma of circumcision in the phallic period could be
avoided by using topical steroids. Int J Urol
- Goldman R. Circumcision policy: a psychosocial
perpective. Paediatr Child Health
2004;9(9):630-3. (Offsite link)
- Behrendt A, Moritz S. Posttraumatic Stress Disorder and Memory
Problems After Female Genital Mutilation. Am J
- Hill G. Circumcision and human behavior.
Genital Wholeness 2012.
The neurology of male circumcision
The study of neurological changes secondary to
circumcision is in its infancy. Neurological changes have
been demonstrated secondary to pain, stress, and
Fitzgerald et al. report experimentation in animals.59,60
In addition, brain atrophy/dis-organization by sensory
deprivation after removal of the pleasure
sensors in the prepuce has been hypothesized by Immerman
- Goleman D. Early
Violence Leaves Its Mark on the Brain. The New York
Times, Tuesday, October 3, 1995, Pg. C1.
- Bower B. Exploring
trauma's cerebral side. Science News
- Stein M, Koverola C, Hanna
C, et al. Hippocampal volume in women victimized by
childhood abuse. Psychol Med 1997;27:951-9.
- Fitzgerald M. The
birth of pain. MRC News 1998; Summer:20-23.
- Fitzgerald M, Walker S. The
role of activity in developing pain pathways. In:
Dostovsky JO, Carr DB, Koltzenburg M (eds). Proceedings
of the 10th World Congress on Pain. Progress in Pain
Research and Management, Vol. 24. Seattle: IASP Press,
2003, pp 185-96.
The next two documents are problematical.63,64
Immerman & Mackey (1998) set forth an informed hypothesis
that removal of the sensors in the prepuce cause brain
disorganization/atrophy. Thereafter they seek to justify
circumcision by arguing that brain disorganization/atrophy
has desirable social effects. This is not consistent with the
principles of good medicine. Immerman and Mackey's defense of
circumcision's maleficial effect on the brain in these
articles may illustrate Goldman's
revelation that some medical doctors may use
'Intellectual activity ...as an extremely clever apparatus
precisely for the avoidance of facts, as an activity which
distracts from reality' when they write about
This is a way in which many circumcised men deny the reality
of their loss.38
This sometimes manifests itself in the scientific
Anand & Scalzo (2000) hypothesize that early abnormal
stimulation of the nervous system (such as the pain of
circumcision) affect the development of the nervous system
and influence behavior.64
- Immerman RS,
Mackey WC. A
biocultural analysis of circumcision: a kinder gentler
tumescence. Soc Biol 1998; 44:265-275.
- Immerman RS, Mackey WC. A
proposed relationship between circumcision and neural
reorganization. J Genet Psychol 1998;
- Anand KJ, Scalzo FM. Can adverse
neonatal experiences alter brain development and subsequent
behavior? Biol Neonate 2000;77(2):69-82.
[See also The
Anthropology and Sociology of Circumcision.]