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The First Cut

Circumcision is the most common operation in the nation.
But have American males been getting the short end of the stick?

A.J. Jacobs
M Magazine, p. 91-92, September 1992

For the typical American male, life gets off to a rough start. It's not enough that he's evicted from his warm home of nine months, passed around like a football, then stuck in an antiseptic hospital room. He also gets another surprise: a steel scalpel whittling away at his private parts.


Circumcision, the fate of 1.25 million American boys a year, is the most common operation in the nation. But this painful welcome to the world - once considered as natural as cutting the umbilical cord - has fallen under increasingly bitter debate, producing enough extremists to qualify the foreskin as the Middle Fast of male anatomy.

Doctors and lay people are asking not only if there are enough viable health benefits to warrant the surgery, but also whether circumcision impairs sexual pleasure as an adult.

To one group, the foreskin is standard bodily equipment, put there to protect and serve us in bed and out. Its removal isn't just medically unnecessary - it's "child abuse," "mutilation" and a violation of United Nations-guaranteed human rights Their adversaries call the foreskin a "curse" and an anatomical "redundancy." They claim its surface is a breeding ground for diseases ranging from urinary tract infections to AIDS, with circumcision as the effortless antidote. Kid

In spite of zealots' cries, most of us probably rate circumcision near hangnails on our list of important issues. But there do seem to be some real questions here, and the more you listen to these people, the more you wonder: should we thank our parents for relieving us of some anatomical deadwood, or have American males been getting the short end of the stick?

Surprisingly, in the 1970s and most of the 1980s, all signs pointed to the latter. Citing a lack of evidence, the American Academy of Pediatrics (AAP) declared in 1975 that circumcision had no medical justification. Dr. Benjamin Spock came out against it. The foreskin became "genital chic," its fans flourishing in groups with impressive acronyms like ETHIC (End the Horror of Infant Circumcision) and VOICE (Victims Of Infant Circumcision Enounce). So strong was foreskin fever that a handful of circumcised men, saying they felt deprived, began a Holy Grail-like quest to regain their lost foreskins through reconstructive surgery or by more desperate homespun methods. The recovery movement at its most literal.

Such sentiments reduced the number of circumcisions nationwide, taking it from nearly 70 percent of newborn American males in 1979 to less than 60 percent in 1988, still a far cry from the rest of the world, where the circumcision rate is a scant 25 percent. Though a religious rite for 5,000 years, circumcision came late to medicine and didn't last long on foreign soils. Its practice began in the Victorian era when scalpel-happy doctors saw it as a panacea for everything from bed-wetting to alcoholism to masturbation. Later, circumcision was linked to promoting hygiene and preventing penile cancer, but nearly every country except our own - where most infant boys continued to be pared out of force of medical habit - dropped it for lack of convincing evidence.

That evidence may now be coming in. Armed with new studies, the pro-circumcision lobby has made a comeback in painting the foreskin as a villain. Compelled to modify its position, the AAP issued a fence-straddling statement in 1989: "Circumcision has potential benefits and advantages," it said in a task force report, but added that there are also "disadvantages and risks." According to several recent studies, uncircumcised babies are 10 times as likely to contract urinary tract infections (UTIs) than their circumcised peers, the incidence increasing from .1 percent to 1 percent of baby boys. The infections can lead to more serious problems like high blood pressure or kidney failure.

"If I can circumcise 1,000 or even 10,000 boys to prevent one boy from getting a kidney transplant, I believe it's worth it," says Dr. Thomas Wiswell, a pediatrician at the Walter Reed Memorial Hospital in Washington, D.C., who conducted one of the studies.

"Female circumcision could decrease similar types of infections,
and no one ever suggests that."

But if UTIs are more common in uncircumcised babies, that doesn't budge foreskin conservationists. "Women have hundreds of times the rate of urinary tract infections," says Dr. Dean Edell, who gives medical advice on over 300 TV and radio stations nationwide. "Female circumcision could decrease similar types of infections, and no one ever suggests that.... Where do you stop? You won't get breast cancer if you do operations on young girls to remove breasts. We could pull teeth to prevent decay."

Similar issues surround penile cancer, basically an affliction of the foreskin wearer. Among uncircumcised men, the rate is 2.2 cases per 100,000, while the disease is virtually unheard of among those who have been snipped. Lay down our scalpels, foreskin foes declare, and penile cancer cases would skyrocket. But comparisons between countries show that prevention is often just a question of good hygiene.

For years, people have claimed the foreskin is prime real estate for housing sexually transmitted diseases like herpes and syphilis, but the recent AAP report calls studies on the subject "conflicting" and "inconclusive." And, saying results were too preliminary, the AAP report didn't even address the latest hot button in the debate - AIDS. A study conducted in 1989 by Francis Plummer of the University of Manitoba in Winnipeg and William Cameron of the University of Ottawa showed circumcision decreased the likelihood of AIDS among Kenyans five- and eightfold. Another study in Africa supported the conclusion.

"There's definitely a risk factor with AIDS," says Dr. Edgar Schoen, who wrote an article about circumcision in the New England Journal of Medicine. "Previously, the [anti-circumcisionists] moved in because there was a vacuum. Now there's pretty good documented medical data that the benefits far exceed the costs."

Sex Lite instead of the Real Thing.

But many doctors - including Cameron - say the AIDS studies were flawed and shouldn't be used to justify circumcision. "I don't think surgical intervention will make a huge impact on individual risk," says Cameron. Safe sex, not circumcision, is the best way to prevent AIDS, he says. If medical benefits are negligible, you have to wonder why one part of our otherwise biologically sound bodies is routinely lopped off. Which brings us to an interesting question: why exactly did Mother Nature put a hunk of skin on the end of our penises? Many doctors say the foreskin is a vestigial protective organ from our days of hunting and gathering in the buff. Hard-core anti-circumcisionists have a more distressing answer for the American man: it enhances sexual pleasure.

There it is. Nothing causes more partisan sniping in this already partisan debate than the suggestion - which has little chance of being scientifically verified - that most American males are having Sex Lite instead of the Real Thing.

"We've all been had."

According to some, there are two reasons why separating boys from their hoods makes for "sexually challenged" men. First, the head of a circumcised penis is constantly rubbing against underwear and pants, so it builds up a layer of cells to protect itself. These extra cells, like the callous on the palm of a squash player, blunt the skin's sensation. Second, the foreskin itself is loaded with nerves and blood vessels, so circumcision deprives us of an extra node of pleasure.

It's not only the foreskin fanatics making these claims. Dr. Edell gives the theory his nod of approval: "There's no question there is a difference in terms of sensitivity," he says. So does the director of the Masters and Johnson Institute: "It's like the covering of the clitoris," says director William Young. "We've all been had."

"Before circumcision, the sensitivity was like color TV.
Afterwards, it's like black and white."

To back up the claims, anti-circumcisionists bring out their star witnesses: men who have been circumcised as adults. A Washington, D.C. social worker who was circumcised when he was 19 because he felt self-conscious says, "Before circumcision, the sensitivity was like color TV. Afterwards, it's like black and white." Others in his position say sex with a foreskin, measured on a scale of one to 10, is a 12. Sans foreskin, it's a three.

Also piping up are the men who were circumcised as infants but who have now regained a faux foreskin. Consider R. Wayne Griffiths of NORM (Blue_ArrowD096.gif (140 bytes)National Organization of Restoring Men), a San Francisco-based group of men who favor a method of taping weights to their penises in hopes of stretching the skin (they like to compare it to African tribesmen who stretch their earlobes). "My sensitivity has gone up five- or sixfold," says Griffiths. "It's delightful."

"...(M)ost men have learned to live with their minimalist members."

But so far these claims have failed to make a hit in mainstream scientific thought. Surely, for most men, sex without a foreskin seems pleasurable enough. And surely most men have learned to live with their minimalist members. Anger toward our parents is useless. For most, the procedure, like a tonsillectomy or a silly haircut, was just something they were expected to authorize without thinking. They had their reasons: a child's potential embarrassment at being thought of as "different" in the locker room, or the religious considerations of Jews and Muslims.

Look back in anger? By the time you're lucid, It's too late.

But still, it's hard to block out the thought that our sex lives aren't living up to their maximum potential. You can't help asking, What if?

A J. Jacobs is a writer in San Francisco. He's had two operations in his life, but he doesn't remember the first.

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