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 (uncircumcised) 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. 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:
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?
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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.
