The Female Patient, Volume 17: Pages 13-14, July 1992.
George C. Denniston, M.D., MPH
In many hospitals, circumcision has become a routine part of the care provided for male infants. This author contends that it is time for the medical establishment to rethink both the reasons for and the consequences of thisprocedure.
In recent years, the debate on circumcision has been conducted on a relatively low plane, with proponents arguing that circumcision may prevent some unusual or rare conditions. Opponents of circumcision argue that it has no medical benefits. This article seeks to simplify the subject and raise it to a higher plane—focusing on the positive value of the intact foreskin.
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.1
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 (ie, 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.1 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 re quires 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 physicians would simply leave the newborn's penis intact, as Dr Spock came to recommend,2 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.3 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?
History shows that the arguments in favor of circumcision are questionable. At the beginning of this century, one of the reasons given for circumcision was to decrease masturbation, which was thought to lead to insanity and other "morbid" conditions. We now know that circumcision does not prevent masturbation, nor does masturbation lead to insanity.
More recently, circumcision was promoted as a means of preventing cervical cancer in the man's sexual partners; this notion has been proved incorrect.4
The current excuses are that failure to remove the foreskin may contribute to urinary tract infections and penile cancer, but neither of these contentions has been proved. Performing 100 mutilative surgeries to possibly prevent one treatable urinary tract infection is not valid preventive medicine-it is just another excuse. Penile cancer occurs in older men at a rate of approximately 1 per 100,000.
This is an annualized rate based on the lifetime risk of contracting penile cancer.
The idea of performing 100,000 mutilating procedures on newborns to possibly prevent cancer in one elderly man is absurd. Applying this type of reasoning to women would seem to lead to the conclusion that breast cancer should be prevented by removing the breasts at puberty.
"Not only does circumcision
interfere will penile
development, but it requires
that the surgeon tear the skin
from the sensitive glans to
One thousand years ago, the Jewish sage Maimonides said that the effect of circumcision was "to limit sexual intercourse, and to weaken the organ of generation as far as possible, and thus cause man to be moderate...for there is no doubt that circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment; the organ necessarily becomes weak when ... deprived of its covering from the beginning. Our sages say distinctly: it is hard for a woman, with whom an uncircumcised [man] had sexual intercourse, to separate from him.5
Infants are routinely circumcised without anesthesia. In the past few years, scientific papers have demonstrated that infants' responses to pain are similar to those of adults, indicating that babies do indeed experience pain.6 This is supported by the fact that the quality of an infant's cry is appallingly different at circumcision.
"To me, the idea of performing
100,000 mutilative procedures
on newborns to possibly
prevent cancer in one elderly
man is absurd."
Who has the right to order or perform such surgery on a newborn infant? I contend that no one does, not even a physician or the parent, especially as there is no proven medical reason to do so, and the procedure may even be harmful. It can always be performed in adulthood for men who desire it, with fully informed consent.
I believe that physicians who continue to perform routine circumcision are not only harming infants but are also harming the integrity of the medical profession. It is hard to accept that these physicians, most of whom have been circumcised themselves are using their medical licenses to mutilate others. This is tragedy perpetuating itself.
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