The Fate of the Foreskin
Douglas Gairdner, D.M., British Medical Journal Volume 2, 1433 - 1437, December 24, 1949
[for Professionals Mainly] A Classic Paper
… In order to decide whether a child's foreskin should be ablated the normal anatomy and function of the structure at different ages should be understood; … Origins of Circumcision Male circumcision, often associated with analogous sexual mutilations of the female such as clitoric circumcision and infibulation, is practiced over a wide area of the world by some one - sixth of its population … Many of the natives that Columbus found inhabiting the American continent were circumcised. The earliest Egyptian mummies (2300 B.C.) were circumcised, … Development of the Prepuce The prepuce appears in the foetus at eight weeks as a ring of thickened epidermis … Function of the Prepuce It is often stated that the prepuce is a vestigial structure devoid of function. However, it seems to be no accident that during the years when the child is incontinent the glans is completely clothed by the prepuce, … Mortality and Sequelae of Circumcision … Phimosis … Through ignorance of the anatomy of the prepuce in infancy, mothers and nurses are often instructed to draw the child's foreskin back regularly, on the supposition that stretching of the foreskin is what is required ... Conclusions … since during the first few years of life the prepuce is still in process of developing, it is impossible at this period to determine in which infants the prepuce will attain normal retractability … … prepuce of the young infant should therefore be left in its natural state …

General Discussions of Male Circumcision
CIRP, October 10, 2007
[for Professionals Mainly] [Support Groups]
General Articles and Books (An Introduction to full-length articles) Gairdner's article, The Fate of the Foreskin,1 which appeared in 1949, led to a profound reexamination of circumcision in the U.K., … Foley (1966) provides a far ranging discussion … Oster's Further Fate of the foreskin,7 (1968) fully explore the development of the foreskin … Leitch's Circumcision - A Continuing Enigma (1970) influenced the Australian College of Paediatrics … Preston's Whither the Foreskin?9 appeared in 1970 … influenced the American Academy of Pediatrics, … Grimes' Routine Circumcision of the Newborn,12 which appeared in 1978, … This article was the official rejection of male circumcision by the American College of Obstetrics and Gynecology. Metcalf et al.17 (1983) reported an in - hospital complication rate of four percent and a later complication rate of thirteen percent for a total rate of seventeen percent. Wallerstein (1985) gives us a comparison of US practice with that of other nations and suggests corrective actions.19 Poland, who served on the 1989 American Academy of Pediatrics Task Force on Circumcision, showed that the true cause of penile and cervical cancer is the human papilloma virus in 1990 … Hughes reported his findings on the influence that circumcision has on sexuality and marital relations in 1990 … The British Medical Journal has on two occasions (1979 and 1993) published editorials regarding the practice of male circumcision.13,24 The first13 condemned the practice of non - therapeutic neonatal circumcision and the second24 attacked unnecessary post - neonatal circumcision. Denniston (1992) calls male circumcision medically unnecessary and points to the positive value of the intact foreskin.22 Duckett, in a letter addressed the American urological community, cites the strong bias of the urological community in favor of circumcision … LeBourdais (1995) discusses the declining incidence of the practice of neonatal circumcision … Storms (1996) calls attention to the need to update the official reports on male circumcision … Laumann reveals in Circumcision in the United States in 1996 that circumcised males tend to have more sexually transmitted diseases and tend to engage in a wider variety of sexual practices.35 Konopka suggests a possible role of circumcision in the problems of male menopause.35 Zoske brings a man's studies background and perspective to the examination of male circumcision … Roberton describes male neonatal circumcision as "mutilation" …

Routine Circumcision of the Newborn Infant: A Reappraisal
David A. Grimes, M. D., American Journal of Obstetrics and Gynecology, Volume 130 Number 2: Pages 125 - 129, January 15 1978
[for Professionals Mainly]
Prompted by the continuing controversy over routine circumcision of the newborn infant, this review of the limited available literature suggests that the operation may facilitate hygiene of the penis and perhaps decrease the risk of carcinoma of the penis. On the other hand the operation frequently features illogical basis for patient selection, neglect of the requirement to obtain informed consent, an inappropriate operator, a needlessly radical technique, disregard for pain, dubious objectives, and unknown cost effectiveness ...

Gastric Rupture Associated With Prolonged Crying in a Newborn Undergoing Circumcision
Kevin P. Connelly, D. O. et al., Clinical Pediatrics, Volume 31, Number 9, September 1992
[for Professionals Mainly]
… a 2 - day - old infant developed a spontaneous gastric rupture while undergoing a routine newborn circumcision … … scheduled for circumcision … restrained in a dorsal recumbent position on a circumcision board and began crying. After the infant had been crying vigorously and steadily for half an hour, his abdomen became distended and he vomited …

Circumcision: A Study of Current Practices
Thomas J. Metcalf, M.D., et al. Clinical Pediatrics, Volume 22: Pages 575 - 579, August 1983
[for Professionals Mainly]
incidence of circumcision was found not to have changed over the past five years despite the recommendations of the American Academy of Pediatrics Task Force on Circumcision … reflected … tradition, rather than a medical approach. Four per cent … experienced early complications … 13 per cent of experienced later, minor complications … results of this study add evidence for discontinuing neonatal circumcision …

Unnecessary Circumcision
The Female Patient, Vol. 17, Pages 13 - 14, July 1992 George C. Denniston, M.D., MPH
[for Professionals Mainly]

A Temperate Approach to Neonatal Circumcision
John W. Duckett, M.D. Urology, Volume 46, Pages 771 - 772, December 1995
[for Professionals Mainly]

Circumventing circumcision
Anna Maria Konopka, MD, DP New London, N.H. Infectious Diseases in Children Vol 10, No 7, Page 4, July 1997 …
[for Professionals Mainly]

Circumcision: Another Look
George K. Hughes, MD Ohio Medicine, 1990 February, vol. 86(2): p. 92. …
[for Professionals Mainly]

Circumcision in the United States: Prevalence, Prophylactic Effects, and Sexual Practice
Edward O. Laumann, PhD., et al. Journal of the American Medical Association, Vol. 277 No. 13, Pages 1052 - 1057, April 2, 1997 …
[for Professionals Mainly]

Circumcision: No Longer a "Routine" Surgical Procedure
Eleanor LeBourdais Canadian Medical Association Journal, Volume 152 Number 11, Pages 1873 - 1876, June 1, 1995 …
[for Professionals Mainly]

The Question of Routine Neonatal Circumcision
Roland L. Poland, M. D. The New England Journal of Medicine, Volume 22, No. 18, Pages 1312 - 1315, May 3, 1990.
[for Professionals Mainly]

Circumcision: The Uniquely American Medical Enigma
Edward Wallerstein, Urologic Clinics of North America, Volume 12 Number 1, Pages 123 - 132, February 1985
[for Professionals Mainly]

Infant Male Circumcision is Not in the Best Interests of The Health & Rights of the Child
Eskimo.com, April 29, 2003
FACT SHEET
- … rates: Australia 15 % (1), Canada 20 % (2), the United States 60 % (3) …
- The surgery wastes more than $250 million health care dollars annually (4) …
- … non-medically indicated genital mutilation. (5) …
- … This rationale was initiated in the English - speaking countries during the 19th Century …
- … as a cultural ritual rather than the result of …
- … Circumcision has become cultural surgery …
- (Infant) circumcision … traumatically interrupts the natural separation of the foreskin from the glans …
- Circumcision interferes with penile development, …
- Complications are … skin loss, skin bridges, chordee, meatitis, stenosis, urinary retention, glans necrosis, penile loss, hemorrhage, spesis, gangrene, meningitis …
- Poor surgical result is not recognized until years later …
- Infant circumcision causes severe, persistent pain …
- Circumcision has no significant effect on the incidence of common sexually transmitted diseases …
- Circumcision is not harmless …
- … contrary to the motto of medicine, "First Do No Harm." …
- … (74 %) of the Ob / Gyns surveyed perform circumcision. Ob - Gyn fees for circumcision range to $400, averaging $137 nationwide …
- Ob - Gyns not aware of preputial structure … function or growing numbers of men undergoing foreskin restoration …

Doctors Opposing Circumcision (D.O.C.)
D.O.C., 2007
… has members in 50 States, 12 Canadian Provinces and Territories, … six continents … believe that doctors should have no role in this painful, unnecessary procedure inflicted on the newborn … Medical School Curriculum …
- Unnecessary Circumcision, by George Denniston, M.D.
- My Son …
- Circumcision - It's Not Necessary, by Benjamin Spock MD, …
- Letter to the Editor of Canadian Medical Association Journal, by George C. Denniston, M.D. …

Protection of Infant Boys from Wrongful Circumcision in American Hospitals
Circumcision Information and Resource Pages ( CIRP ), March 16, 2002
The American Academy of Pediatrics clearly states that circumcision is an elective non - essential procedure … There are many and persistent reports of boys being circumcised in hospitals in the United States against their parents' wishes. For about 30 years informed consent by a parent has been required by law before a circumcision can be legally performed in most jurisdictions … a jury in Montgomery, Alabama awarded $65,000 in money damages to a boy who was wrongfully circumcised … Obstetricians usually get from $75 to as much as $400 for a circumcision … eager to do as many circumcisions as possible … Typically, all neonate males are put on the uniquely American assembly line for circumcision … extraordinary measures are sometimes necessary to protect an infant boy in hospital from unwanted and unnecessary circumcision by neglect, carelessness, greed, … The circumcision refusal form is a recent innovation … Many physicians improperly believe that the foreskin of an intact, non - circumcised male infants must be forcibly retracted and the glans penis examined …

Circumcision Policy Statement (RE9850)
American Academy of Pediatrics, March 1999
… data are not sufficient to recommend routine neonatal circumcision … yet the procedure is not essential to the child's current well - being … parents of all male infants should be given accurate and unbiased information … If a decision for circumcision is made, procedural analgesia should be provided … There is considerable evidence that newborns who are circumcised without analgesia experience pain and physiologic stress (AS IF THERE WAS ANY DOUBT!?!?) … circumcised infants exhibit a stronger pain response to subsequent routine immunization than do uncircumcised infants … … 2.5 % lidocaine and 2.5 % prilocaine (ONLY!!!) attenuates the pain response … … EMLA cream … concern about the potential for neonates to develop methemoglobinemia … DPNB is very effective in reducing the behavioral and physiologic indicators of pain … neonates with DPNB cry 45 % to 76 % less, … have 34 % to j50 % smaller increases in heart rate, … Hematomas were rarely seen and caused no long - term injury … A single report of penile necrosis … A subcutaneous circumferential ring of 0.8 mL of 1 % lidocaine without epinephrine at the midshaft of the penis was found to be more effective than EMLA cream or DPNB in a recent study … Cancer of the penis is a rare disease; the annual age - adjusted incidence of penile cancer is 0.9 to 1.0 per 100 000 males in the United States.91 In countries where the overwhelming majority of men are uncircumcised, the rate of penile cancer varies from 0.82 per 100 000 in Denmark92 to 2.9 to 6.8 per 100 000 in Brazil93 and 2.0 to 10.5 per 100 000 in India.94 The literature … is difficult to evaluate …

Care of the Uncircumcised Penis Guidelines for Parents
American Academy of Pediatrics, April 24, 2003
Before birth, the foreskin and glans develop as one tissue. The foreskin is firmly attached - really fused - to the glans. Over time, this fusion of the inner surface of the prepuce with the glans skin begins to separate … The discarded cells accumulate as whitish, cheesy "pearls" which gradually work their way out via the tip of the foreskin. … 5, 10, or more years after birth, full separation occurs and the foreskin may then pushed back away from the glans toward the abdomen … The glans at birth is delicate and easily irritated by urine and feces. The foreskin shields the glans; with circumcision this protection is lost … … No harm will come in leaving the foreskin alone … Summary: Care of the uncircumcised boy is quite easy. "Leave it alone" is good advice …

The Case Against Circumcision
Paul M. Fleiss, MD, Mothering: The Magazine of Natural Family Living, Winter 1997, pp. 36 -- 45 …
In antiquity, the expansion of the Greek and Roman Empires brought Westerners into contact with the peoples of the Middle East, some of whom marked their children with circumcision and other sexual mutilations. To protect these children, the Greeks and Romans passed laws forbidding circumcision … Over the centuries, the Catholic Church has passed many similar laws … Circumcision started in America during the masturbation hysteria of the Victorian Era, … doctors circumcised boys to punish them for masturbating. Victorian doctors knew very well that circumcision denudes, desensitizes, and disables the penis … they were soon claiming that circumcision cured epilepsy, convulsions, paralysis, elephantiasis, tuberculosis, eczema, bed - wetting, hip - joint disease, fecal incontinence, rectal prolapse, wet dreams, hernia, headaches, nervousness, hysteria, poor eyesight, idiocy, mental retardation, and insanity.4 … no procedure in the history of medicine has been claimed to cure and prevent more diseases than circumcision … The radical practice of routinely circumcision babies did not begin until the Cold War era … part of the same movement that pathologized and medicalized birth and actively discouraged breastfeeding … hospitals institutionalized routine circumcision without ever consulting the American people. There was no public debate or referendum. It was only in the 1970s that a series of lawsuits forced hospitals to obtain parental consent to perform this contraindicated but highly profitable surgery … Today the reasons given for circumcision have been updated to play on contemporary fears and anxieties; … Now that such current excuses as the claim that this procedure prevents cancer and sexually transmitted diseases … … Thus, the foreskin is an essential part of human sexual anatomy … What Is the Foreskin? … is a uniquely specialized, sensitive, functional organ of touch. No other part of the body serves the same purpose … Retraction of the Foreskin … attached to the glans, very much as a fingernail is attached to a finger … "The foreskin therefore can be likened to a rosebud which remains closed and muzzled. Like a rosebud, it will only blossom when the time is right. No one opens a rosebud to make it blossom."9 The penis develops naturally throughout childhood … What Are the Foreskin's Functions? … numerous protective, sensory, and sexual functions … Care of the Foreskin … How Common Is Circumcision? … How Does Circumcision Harm? … Circumcision denudes: … … desensitizes: … … disables: … … disfigures: … … disrupts circulation: … … harms the developing brain: … … is unhygienic and unhealthy … … is always risky: … … harms mothers: … … violates patients' and human rights: …

The Unkindest Cut of All
John M. Foley, M.D. FACT Magazine, July - August 1966
On July 20, 1964, … a Baltimore physician … called for the compulsory circumcision of all men seeking to get married … he went on to demand Federal legislation … … just why anyone would want circumcision made compulsory may seem puzzling … The only widespread evidence in support of this theory is that Jewish men and Jewish women rarely get cancer of their sexual organs. But granting tat genital cancer is rare among Jews, circumcision is almost certainly not the reason … In Java, the Moslems are ritually circumcised, yet Java has one of the highest incidences of cancer of the penis in the world …

Why Does Circumcision Persist in the United States?
Robert S. Van Howe, M.D., Presented at the Fourth International Symposium on Sexual Mutilations, August 9 - 11, 1996
… United States continues to have the highest rate of circumcision performed for non - religious reasons … Future directives include … demanding that circumcision be held to the same scientific and ethical standards as other surgical procedures, and challenging circumcision advocates to present a balanced non - biased view of the issue …

Circumcision - A Continuing Enigma
I.O.W. Leitch, Austrailian Paediatric Journal, Volume 6: Pages 59 - 65. June 1970
A review of the literature suggests that many of the traditional indications remain unproven … circumcision should be confined to those with a genuine medical indication … … Complications of Operation EARLY … (8 %) … LATE … (7.5 %) …

Circumcision: A Medical or a Human Rights Issue?
Marilyn Fayre Milos, RN, et al. Journal of Nurse - Midwifery, Vol. 37, No. 2 (Suppl.), March / April 1992
Xxx circumcision of infants was initially adopted to prevent masturbation, medical "reasons" were postulated to justify a practice most of the world has never considered ... … For thousands of years, in many different cultures, the genitals have fallen victim to an amazing variety of mutilations and restrictions. For organs that are capable of giving us an immense amount of pleasure, they have been given an inordinate amount of pain. -- Desmond Morris … From myth to medicine … religious ritual or puberty rite into routine surgery for "health" reasons in the English - speaking countries during the nineteenth century … "Within the miasma of myth and ignorance, a theory emerged that masturbation caused many and varied ills. It seemed logical to some physicians to perform genital surgery on both sexes to stop masturbation" … Not until the national circumcision rate had reached 85 % to 90 % (26 years and millions of circumcised babies later) did the American medical community finally issue an official statement regarding circumcision. In 1975, the American Academy of Pediatrics" (AAP) Ad Hoc Task Force … By the end of the 1970, the American College of Obstetricians and Gynecologists had concurred …

Care of the Intact Penis
James E. Peron, Ed. D., Childbirth Educator Today, December 18, 2004
Should the young child's foreskin be retracted for proper cleaning? At what age should the child's foreskin be retractable? - Leave the foreskin alone; wash only what is external and readily visible. - Never forcibly retract your son's foreskin and don't permit anyone else to do so. - Make certain your son's medical attendants understand his foreskin is not to be retracted or tampered with. - Always stay with your son during his doctor visits and exams. - When teaching the child to bathe and care for himself, let the child retract his own foreskin if he wants to. He will not retract it beyond the point of discomfort. - A child's foreskin does not need to be retracted regularly for cleaning until the end of puberty. It should not be retracted during early childhood.* … … Smegma is a natural oily, waxy lubricant formed between the foreskin and the glans. Rarely does it exist in the uncircumcised child whose foreskin has not been forcibly retracted … By mid teenage, the foreskin is retractable and hygiene is a simple matter … What about irritation or itching of the foreskin? - If the infant boy has …

Whither the Foreskin? A Consideration of Routine Neonatal Circumcision
Capt E. Noel Preston, MC, USAF Journal of the American Medical Association, Volume 213 Number 11: Pages 1853 - 1858, September 14, 1970.
the procedure has been found to have been of questionable benefit and to be associated with both immediate and delayed risks and complications … … complications fall into three categories: hemorrhage, infection, and surgical trauma …

AAFP Fact Sheet on Neonatal Circumcision: A Need for Updating
Michelle R. Storms, M.D., American Family Physician, Vol 54, No. 4, pages 1216 - 1217, September 15, 1996.

Male Circumcision: A Gender Perspective
Joseph Zoske, The Journal of Men's Studies, Volume 6, Number 2, Winter 1998, pp. 189 - 208
a societal double standard is noted between the moral outcry against female circumcision and the relative silence toward male circumcision … … amputation of healthy genital tissue driven by the power of tradition and performed without a patient's consent, occurring when he is most vulnerable and completely dependent … … For organs that are capable of giving us an immense amount of pleasure, they have been given an inordinate amount of pain … Routine medical circumcision is similarly rooted in neither science nor medicine. Instead, it grew out of the mid - 19th century's hysteria and superstition about masturbation … As a primary means of controlling masturbation in young children, circumcision peaked between 1850 and 1879 … … Journal of the American Medical Association published a courageous editorial in 1965, written by Morgan and pointedly titled, "The Rape of the Phallus," it wasn't until the 1970s when formal medical organizations came out with official position statements opposing routine circumcision … The American College of Obstetricians and Gynecologists (ACOG, 1983) eventually concurred. Nevertheless, the incidence rate did not change. Instead, the 1980s brought more frequent opinions, studies, and debate in support of the practice … AAP later reviewed existing data and changed its stance to a neutral position … … a consumer movement began adding its opposition voice to the debate. Organizations such as NOCIRC (the National Organization of Circumcision Resources Centers), the ISC (International Symposia on Circumcision), and INTACT (Infants Need To Avoid Circumcision Trauma) were founded in the mid - 1980s … UNCIRC (Uncircumcision Information and Resources Center) … The Canadian Pediatric Society's Fetus and Newborn Committee, … recently conducted an extensive re - examination of this issue. Reviewing 671 medical studies … led them to a clear recommendation: "Circumcision of newborns should not be routinely performed" (CPS, 1996, p. 769). Yet, the debate continues … … If what is routinely done to baby boys started being done to baby girls in the U.S., there would be a great hue and cry and" very legitimate charges child abuse … Illegal in the United Kingdom since the Prohibition of Female Circumcision Act of 1985, "female genital mutilation" became the preferred term at the U.K.'s First National Conference on Female Genital Mutilation in 1989 (Webb & Hartley, 1994). Also, at the International Conference on Population and Development held in Cairo in September, 1994, in response to World Health Organization estimates … REFERENCES … To mutilate in the name of Jehovah or Allah: … … Committee on the fetus and new - born … … Report of the ad hoc task force on circumcision … … Pain and its effects in the human neonate … … The power of myth … … A Jewish perspective … … Body ownership rights of children … … Circumcision: A medical or a human rights issue? … … Circumcision: Power and politics … … The rape of the phallus … … The status of circumcision of newborns … … Effects of neonatal circumcision on pain responses during vaccination in boys … … Female circumcision as a public health issue … … Circumcision: The uniquely American medical enigma …

The Circumcision Decision: An Overview
Mary G. Ray, Mothers Against Circumcision, 1998
Routine Infant Circumcision (RIC) is not practiced in most medically advanced nations …

International Circumcision Information Reference Centre
International Circumcision Information Reference Centre, June 2006
Articles … - … A Guide to a Decision … - … Methods Of Circumcision … - … Glossary of Terms Related … - … Parental Duties - Myths and Lies about Circumcision

CIRP Circumcision Information and Resource Pages
CIRP, June 2005

Recent Medical Studies On Circumcision
Circumcision Resource Center, 2007
Circumcision Results in Significant Loss of Erogenous Tissue … Circumcision Affects Sexual Behavior … Researchers Demonstrate Traumatic Effects of Circumcision … - … may induce long - lasting changes in infant pain behavior because of alterations in the infant's central neural processing of painful stimuli." They also write that "the long - term consequences of surgery done without anesthesia are likely to include post - traumatic stress as well as pain … Circumcised Penis Requires More Care in Young Boys … Poll of Circumcised Men Reveals Harm … Psychological Effects of Circumcision Studied …

What is Lost to Circumcision
Gary L. Harryman, February 14, 1999
When a baby boy's natural and intact penis is "circumcised," this is what is lost forever: - … the single most pleasure producing zone on the male body … - Approximately half of the temperature reactive smooth muscle sheath called the dartos fascia … - … a component of the immune system … - Estrogen receptors the purpose and value of which are not yet fully understood … - … the glans, normally an internal organ -- like the tongue … - … making the circumcised penis defectively thinner than a full - sized intact penis … - … scarring, and shrinkage … - Every year many boys lose their lives from the complications of medically unnecessary circumcisions …

Observe a Circumcision Before You Decide
Mary G. Ray, Mothers Against Circumcision, 1997
If a parent is considering circumcision, their first job as guardian should be knowing what lays ahead for their baby … Many parents are under the impression that the procedure is pain free due to the administration of anesthesia … infection itself is usually painful and can cause the penis to swell. Circumcision is Painful …

Circumcision Fact Sheet
The problematic history of non - therapeutic (routine) male infant circumcision - British and American physicians thought it logical to perform genital surgery on both sexes to prevent or cure masturbation. This rationale originated in Victorian England, and gradually spread, along with the practice of circumcision, to the rest of the English - speaking world …

Questioning Jewish Circumcision
Jewish Circumcision Resource Center
Jewish circumcision is dependent on the acceptance of cultural myths … circumcision, the one that is paramount is the belief that all Jews circumcise … … most Jews do not recognize that circumcision is a choice … Jewish circumcision has been challenged in earlier times … 1840s during the Reform movement in Germany, circumcision was opposed by Jewish parents, physicians, and leaders. Originally only the tip of the foreskin was cut, called milah. This practice lasted about 2000 years … The rabbis of the time decided to change the requirements … This was the start of periah, removing the entire foreskin … … "any child born of a Jewish mother is a Jew, … the religious origin of Jewish circumcision is the Torah. It says that God told Abraham "every male among you shall be circumcised" (Gen. 17) … most Jews are unaware of this origin, and in a survey of American Jews, the large majority (87 %) do not believe that the Torah is the actual word of God. Jewish circumcision has never had anything to do with health concerns … Ritual circumcisers (mohelim) usually use the same clamp devices as doctors … no reason to believe that circumcisions performed by mohelim are less painful for the infant … Maimonides, the renowned physician, philosopher, and rabbi, wrote, "Circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment" …

Circumcision Information Resource Centre
Montréal, CANADA

Centre d'information et de ressources sur la circoncision
Montréal, CANADA
[French]

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Last Updated: 2008/1/18

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