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29 May 2006
The American Penis: In Circumcision We Trust
by Paul A.

In the mid 20th century the vast majority of males in the English speaking world were circumcised shortly after birth. By the end of the century the percentage (excepting the U.S.) hovered in the single digits. In New Zealand and Britain the neo-natal circumcision rate is below one percent. It is a stunning reversal, a medical about-face in the same league as Thalidomide. But it didn't happen overnight. It happened in different times and places for different reasons.

In Britain, the procedure was de-listed by the National Health Service (NHS), following the publication of Douglas Gairdner's article, The Fate of the Foreskin, which was perhaps the first substantive criticism of prophylactic circumcision. The rate of circumcision dropped sharply after the NHS stopped subsidizing it, suggesting that while parents might have been comfortable with hacking a chunk from their baby's penis, they weren't actually prepared to pay for it.

In 1970 an American Academy of Pediatrics (AAP) Committee on Fetus and Newborn Infants declared that there were "no valid medical indications for circumcision in the neo-natal period." In the face of reactive criticism the AAP subsequently appointed a task force to study the issue. The task force largely reiterated the earlier findings and suggested that "good hygiene would offer all the advantages of routine circumcision." Ultimately however, the AAP, ever politically mindful, recommended that the decision be left to the parents and doctors of the newborn. But given cultural inertia and the financial self-interest of the doctors, it's perhaps not surprising that routine circumcision continued more or less unabated in Canada and the U.S. It's also debatable how widely-read the report was, after all, the publications of the AAP don't often figure in bestseller lists. And in any case, it would take more than the watery recommendations of an esoteric task force to change the direction of a juggernaut like routine infant circumcision.

But the cultural tide did begin to turn in the early eighties. In 1980, Edward Wallerstein, a secular Jew, published Circumcision: An American Fallacy. Although not widely read at the time, the book represented the first unambiguous broadside directed at the practice of routine circumcision. Other anti-circumcision tracts followed, but nobody was more influential in the anti-circumcision movement than a nursing student named Marilyn Milos. In a 2002 interview with Cat Saunders, Milos described witnessing her first infant circumcision...


...the baby let out a piercing scream - his reaction to having his foreskin pinched and crushed as the doctor attached a clamp to his tiny penis. The infant's shriek intensified when the doctor inserted an instrument between the foreskin and the head of the penis, tearing them apart. Then the baby started shaking his head back and forth - the only part of his body he could move - when the doctor used another clamp to (lengthwise) crush the foreskin, which he then cut. This made the foreskin opening large enough to insert a circumcision instrument designed to prevent the head of the penis from being severed during the surgery. During the last stage of the operation, the doctor crushed the foreskin against the circumcision instrument, and then, finally, amputated it. By that time, the baby was limp, exhausted, spent. To see part of a baby's penis being cut off - without anesthesia - was shocking. Even more shocking was the doctor's comment, barely audible under the piercing screams of the infant: "There's no medical reason for doing this."

Milos was transformed by the incident. She began a campaign to inform parents at the hospital where she worked of the trauma their infant sons would face. One can imagine this was the last thing parents, who had already decided on circumcision, wanted to hear. The hospital brass told her to keep her mouth shut so she made a video of a circumcision. When told that the video was too much for parents to see, Milos retorted; "Then, it's too much for a baby to endure!" The hospital did what any organization does when faced with an employee telling a stark and disquieting truth - they fired her. Far from shutting her up though, the dismissal gave Milos the time and energy to pursue her crusade unfettered. In 1986, she formed the National Organization of Circumcision Information Resource Centers (NOCIRC), a coalition made up of anti-circumcision activists.

From its inception NOCIRC proved adept at grass roots organization and self-promotion. Perhaps no single entity has done more to place circumcision within an ethical rights based frame of reference: boys had the right to an intact foreskin. Parents and doctors had NO right to subject children to the pain of surgery and the permanent loss of this birthright. This shift to a moralistic perspective allowed passion to enter the debate and, as anyone who has witnessed an anti-globalization rally can attest, moral indignation can be powerful force.

Thanks to the tireless efforts of Marilyn Milos and NOCIRC volunteers, infant circumcision became a salient issue with surprising speed. Scarcely a year after NOCIRC was formed; Phil Donahue devoted an entire hour to the debate. A year later the man who came to define pediatric medicine, Dr. Benjamin Spock, reversed his original position and came down hard against infant circumcision. "Leave his poor little penis alone," implored the eminent Dr. Spock. By the 1990's, the anti-circumcision movement was a global force. The first International Symposium on Circumcision held in 1989 adopted a declaration of basic rights and NOCIRC is now a member of the International Coalition for Genital Integrity, an umbrella organization for anti-circumcision groups worldwide.

NOCIRC, which now boast 110 centers, spawned a veritable alphabet soup of similar minded organizations, each sporting a clever acronym. There's the National Organization to Halt the Abuse and Routine Mutilation of Males (NOHARMM - Get it? The first dictum of medicine: "First do no harm") Then there's Doctors Opposing Circumcision (DOC), Musicians United to Stop Infant Circumcision (MUSIC), and of course the National Organization for Restoring Men (NORM), a support group for men who want to restore their foreskins.

But the problem with any moralistic cause is that it's often defined (or hijacked) by zealots who take positions that are so freakishly out-there, they alienate those who might otherwise join the movement. Such may be the case with those who suggest that the psychological shockwaves of infant circumcision are life-long, and are in part responsible for the violence endemic in American society. The case apparently hinges on the fact that America is one of the very few countries where the majority of males are still routinely circumcised at birth and America is violent so... hey, connect the dots.

The argument loses its foundation, however, when one considers that other countries that still practice universal infant circumcision - South Korea being the obvious example - are largely non-violent. Ditto for the Jews who - Book of Joshua aside - are not generally defined by their murderous rampages. For the men who claim to feel "overwhelming fury, rage and a desire for vengeance, desire to torture, maim and utterly destroy any human being who ever had anything to do with performing, ordering or requesting circumcision," I'm going to suggest other contributory issues may be at work.

Despite the fact that international sentiment has turned decidedly against the practice, routine infant circumcision continues to have its defenders. In fact, one could say a backlash to the backlash has begun to take root. Several websites are devoted to the promotion of infant circumcision and there are indications that rates in the United States may actually be increasing. Next week, thin as it may be, I'll present the case for circumcision.

Pic & quote courtesy NOCIRC




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