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by Rose Pastore
March 31, 2011
Something is happening to American penises. It’s unclear, why, but there is a revolution underway in hospitals across the country—foreskins are staying on baby boys.
Before Callum was born, when the only defining characteristic of his imminent life was his gender, a thorough discussion of his genitals was underway. His mother Angele had no answer for the hospital doctor who would inevitably ask, scalpels and clamps nearby: “Do you want to have your son circumcised?” She had heard that there were some health benefits. But what if the procedure went horribly wrong, damaging her son for life? Would an older, uncircumcised Callum suffer teasing and rejection, because his parents decided to forgo circumcision? Angele’s husband Jerry, like most American parents for the past 50 years, was initially swayed by this latter concern—he wanted his son to look like the other boys in the locker room. But on second thought, was he even sure what locker rooms actually look like today? Both journalists, Angele and Jerry checked the statistics and were shocked to find that the majority of male babies born in 2009 were not circumcised. So much for the “locker room” argument.
When Jerry was born, circumcision was automatic. Most men living in the United States (U.S.) today—8 in 10—were circumcised as newborns. But for some reason, these men are making a different choice for their sons. (baby gooroo has explored the circumcision debate before). Fewer than half of baby boys born in the past few years, and possibly as few as one-third, had their foreskins removed at birth. This reversal seems strange at a time when the United Nations is newly recommending circumcision to prevent HIV transmission, and recent studies suggest that circumcised men are less likely to spread the cervical cancer-causing human papillomavirus (HPV).
Angele sought out every bit of data she could find. Discussions with her pediatrician gave way to painstaking analyses of medical journals. After coming across an article about the bizarre history behind the world’s second-oldest surgery (the oldest is the cutting of the umbilical cord), her questions transformed into serious doubts. With the old standard gone, the search for a decision would take Angele’s family to questions ranging from human rights to fitting in, from the dark experiments of early 20th century doctors to an impassioned present-day battle, waged mostly online, over the uniquely American practice of medical circumcision.
A history of circumcision
No one knows who first decided to use a sharp stone to cut off someone else’s foreskin, nor does anyone know why so many people thought it was a good idea. But evidence of the procedure spans thousands of years, from early aboriginal tribes in Australia to the ancient Egyptians.
Before 1870, the Western world knew circumcision as a religious rite of Jews and Muslims. Then a Manhattan orthopedic surgeon named Lewis Sayre made an astonishing discovery: he could seemingly cure paralysis of the legs by circumcising. His patient was a 5-year-old boy whose foreskin had contracted painfully around his penis, causing severe, excruciating inflammation. The chronic pain made walking all but impossible. After his circumcision, the boy was healed. Excited by his breakthrough, Sayre began circumcising similar patients with equally remarkable results, and soon other doctors took up the practice. But the new medical innovation came at an interesting time. The sex-obsessed Victorians were squelching lasciviousness wherever they found it, and the miraculous curing power of circumcision was too tempting to be left to the realm of orthopedics.
Masturbation was perceived as the great evil of the young century. It was the suspected culprit behind everything from insanity to impotence, and circumcision became the most promising treatment. One of the most ardent crusaders against autoeroticism was John Harvey Kellogg, the zealous Michigan doctor whose bland corn flakes were also thought to discourage salacious thoughts in young people. But Kellogg was dissatisfied with Sayre’s method, which involved mercifully knocking out the young men with chloroform before the surgery. His unfortunate patients went without anesthesia; he thought the procedure’s pain was crucial to its lust-inhibiting effectiveness. As one of his followers noted, “the rightful punishment of cutting pains” would serve as a strong deterrent to future sin.
Only wealthy parents could afford this state-of-the-art treatment for their sons (and sometimes daughters). Clitorises were often removed for similar moral and medical justifications, but female circumcision never gained the popularity that male circumcision did. Like many things only available to rich Americans, having an altered penis became a mark of class. It was increasingly more common for middle and upper class women to give birth in hospitals, and doctors were quick to suggest the innovative procedure to new parents who were only too eager to give their sons the best of modern medicine.
Over time, as standards of living increased and medical care became less expensive, almost all babies began to be born in hospitals rather than at home. By the 1970s and 1980s, most boys were being circumcised within days or hours of birth. The American Academy of Pediatrics (AAP) endorsed it as a routine procedure for all male babies. Preventing masturbation was no longer one of the advertised benefits, but there were other, more compelling advantages: a reduced risk of urinary tract infections for infants, a smaller chance of contracting certain sexually transmitted diseases, and a near elimination of the extremely rare threat of penile cancer.
But today, Angele is not buying it. She read the studies that suggest, for example, a reduced risk of acquiring HIV, and thought they were gravely flawed. For one thing, the research was conducted in Africa and weren’t applicable to developed nations. She scoured the Internet for more information and learned that the U.S. is alone in performing widespread, non-religious circumcision of infants. The evidence was not adding up. Where were any convincing justifications for this once-universal surgery?
In 1999, the AAP changed their circumcision policy to a neutral stance, stating: “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.” For the anti-infant-circumcision activists, also known as “intactivists” because they want babies left intact, Angele’s choice will either make her a human rights violator or another parent won over by what they see as indisputable facts.
The circumcision debate
Georganne Chapin is the executive director of Intact America, an organization that wants to protect children from what they call a “medically unnecessary, painful, risky and unethical” surgery. Chapin is confident that the more information parents know about circumcision, the less likely they will be to choose it for their sons. The challenge is getting parents to look for facts about a decision many take for granted. Fortunately for intactivists, help has come in the form of the Internet. The Web has changed practically everything about modern life, and our genital preferences are apparently no exception. Parents can find anything they want to know about circumcision. Before YouTube, most parents had only a vague idea of how their son’s foreskin was removed. Now, a quick search for “circumcision” will bring up numerous videos of infants undergoing the procedure. And it’s not pretty. The techniques differ depending on the doctor, but the general method is the same: the baby is restrained; a clamp is used to separate the foreskin from the glans of the penis; the clamp is left in place long enough to stop blood flow to the foreskin; and finally, the foreskin is cut away. Anesthesia may or may not be used, depending on the doctor’s preference. The wound usually heals in a week.
Chapin is angry; to her, this surgery is tantamount to mutilation. She is exasperated by what is probably the most common rationalization for circumcision—that it makes penises more hygienic or more aesthetically pleasing. This fear of uncleanliness, she says, is just as ludicrous as the Victorian fear of masturbation. And one wonders what the wholesome Dr. Kellogg would have to say about circumcising to make penises more attractive. She also thinks the research showing medical benefits, like protection from sexually transmitted diseases, is bogus. Even if being circumcised makes a man slightly less likely to contract a disease, she asks, does that justify a painful, nonconsensual surgery?
But Chapin is oversimplifying the issue, says Douglas Diekema, a Seattle pediatrician who serves on the American Academy of Pediatrics Task Force on Circumcision. He argues that the medical benefits of circumcision are well-documented and intactivists tend to overstate the risks of the procedure, which, while real, are extremely rare. Diekema and a small group of pediatricians meet every few years to decide if the circumcision policy needs to be updated. Their current view is that the procedure comes with both modest benefits and slight risks, and so the choice should be relegated to parental preference. But this neutral approach is not nearly proactive enough, not when babies are being subjected to bodily harm every day, says Chapin. If circumcision is not medically needed, Chapin wants to know why it is still permitted? It is not as though doctors are allowed to perform other unnecessary surgeries on babies simply because a parent asks. Diekema responds that the health benefits make the choice justifiable. Still, for Chapin, there are no two sides to this issue. “Your baby is not sick. The foreskin is not a birth defect.”
Angele knew nothing about the intactivist debate when she was investigating circumcision two years ago. But it is possible some of their many websites, blogs, and articles made their way into her research, because she and Jerry came to a similar conclusion: to circumcise Callum would be cruel and unnecessary. And they have not doubted their decision once, not even when Angele’s nephew had to have a circumcision at 9 months for medical reasons. It is difficult, Angele says, to have to dedicate so much thought to a single body part on your future son, especially when that body part is a penis. “No one is looking to hurt their sons,” Angele says. “Parents all want what is best for them.” The problem is figuring out what that is.
Besides the influence of intactivists, the newfound neutrality of pediatricians and the abundance of information available online, there are other possible reasons that so few boys are being circumcised. The US has a growing Hispanic population, a culture that traditionally does not circumcise. And many insurance providers stopped covering the procedure after 1999 when the AAP announced it was not medically necessary.
Parents like Angele and Jerry often start out with a simple opinion on circumcision—they just want their son to be normal, to look like all the other boys in the proverbial locker room. But then things get complicated. There is no normal American penis anymore.
Rose Pastore is a Chicago-based freelance writer specializing in science and health topics. She studied magazine journalism at Northwestern University.
Copyright ©2012 baby gooroo, inc.
