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NOHARMM Position Statement on
Non-Therapeutic Circumcision of Male Children
( rev. 11-12-97)
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We agree with the positions of world medical associations
that infant circumcision is a non-therapeutic intervention that should not be performed.(1-4) As a children's rights organization composed primarily of men
subjected to childhood circumcision, we work to protect the ability of male children to
enjoy the benefits of a whole and healthy body, as well as their inherent and fundamental
human rights to physical integrity and self-determination. Non-therapeutic circumcision of
unconsenting children is a social custom that denies these benefits and contravenes these
rights. Accordingly, there is no parental right to subject children to
non-therapeutic circumcision. We are unopposed to circumcision as a treatment of last
resort for disease or injury. We assert that it is inappropriate and unethical for members
of the medical profession to surgically alter the genitals of unconsenting children based
on social custom, religion, tribal identity or family tradition.
VALUING INTACT GENITALS
- The normal human penis, complete
with a prepuce, is intact. It is not "uncircumcised," just as people with an
appendix, tonsils or two breasts are not "unappendectomized,"
"untonsillectomized," or "unmastectomized."
- A whole body is a firmer basis for
sound body image than one with surgically reduced genitalia. Knowledge that one is intact
and unimpaired is a sound defense against potential teasing for one's natural appearance.
- The prepuce provides a large
and important platform for several nerves and nerve endings and is an
important part of the sensory apparatus of the penis.(5) The
foreskin is highly innervated with specialized erogenous nerve endings of greater
sophistication than the glans (penile head). Incomplete genitals cannot experience their
natural potential for a full range of sensual responsiveness.
- The intact
human penis has a moveable foreskin that covers and protects the glans penis from injury,
discomfort, and unintended stimulation. The foreskin prevents meatal ulceration, a common
injury in circumcised infants that can lead to meatal stenosis.(6)
- The moveable
foreskin offers a fuller range of sensual experience during sexual activities than the
non-intact penis. The foreskin allows the penis to glide within its own mobile sheath
during intercourse,(7) stimulating the male and his partner through
pressure and movement rather than undesirable friction and abrasion.
- The foreskin
captures the males natural lubricating fluid and distributes it over the glans as
the foreskin retracts. This lubricates the glans for easier penetration during sexual
intercourse and heightens glans sensitivity. The foreskin lessens or eliminates the need
for artificial sexual lubricants.(8)
- Smegma is a natural lubricant that
protects the glans. It is no more or less of a health risk than female smegma. Normal
hygiene by both sexes prevents smegma from accumulating and becoming offensive.(8)
PRIMITIVE & OBSOLETE FORM OF MEDICINE
- There is no scientifically valid or
methodologically sound evidence that the foreskin is responsible for urinary tract
infections or increased kidney failure, either in children or adults. If a causal
relationship were to be proven, however, male urinary tract infections are nonetheless
relatively rare, and can be effectively prevented or treated by other conservative
tract infections can be prevented naturally and effectively by breastfeeding.(10)
- It is
important for doctors and parents to know that the foreskin continues to develop through
adolescence.(11) A diagnosis of penile phimosis is premature and
invalid until late adolescence. Ballooning of the foreskin upon urination is not an
indication for circumcision, as long as there is adequate urine stream.
problems of the foreskin, such as phimosis or paraphimosis, almost always respond well to
conservative non-surgical treatments, making circumcision obsolete.(12-14)
- We agree
with officials of the British Medical Association, who state, "(T)o circumcise where
medical research has shown other techniques to be as effective and less invasive would be
unethical and inappropriate.(15)
- We concur
with officials at the American Cancer Society, who state that "Perpetuating the
mistaken belief that circumcision prevents cancer is inappropriate" and
distracts the public from the task of avoiding the behaviors proven to
contribute to penile and cervical cancer: especially cigarette smoking and unprotected
sexual relations with multiple partners."(16)
- We embrace
recent research that reveals circumcision provides no discernible prophylactic benefit and
may in fact increase the likelihood of STD contraction.(17)
Chlamydial infection correlates strongly with the circumcised condition. We assert that
more reasonable and effective means of preventing STDs include abstinence, monogamy, sex
and health education programs, condom use, and good personal hygiene behaviors.
- We concur
with many world AIDS authorities, who remain suspicious of unproved claims of a few
researchers that circumcision reduces risk of HIV infection. We share these
organizations concerns that media repetition of these unproved claims has the
dangerous potential to mislead the public into a false sense of security about
circumcision as a form of AIDS prevention, and is counter-productive to AIDS education
recognize that circumcision was introduced into the Unites States as an attempt to reduce
sexual pleasure (e.g., masturbation). Recent research suggests that circumcision may
indeed hinder sexual response,(17) compelling circumcised men to
compensate with quantity of partners (promiscuity) and variety of sexual behaviors (oral
and anal sex). These behaviors may increase stimulation, but they also increase ones
risk of sexually transmitted diseases, including AIDS.
IMMEDIATE CONSEQUENCES OF INFANT
demonstrates that circumcision is unquestionably painful(19) and that
the severe pain of circumcision causes long-term central nervous system effects, resulting
in demonstrable hypersensitivity to pain for months after the surgery.(20)
It is not known when, or if, these effects disappear. It is currently unknown how this
imprints the rapidly developing nervous system's processing of painful stimuli and its
subsequent long-term deleterious impact.
recognize that immediate and lingering circumcision pain impairs breastfeeding,(21) which can have a deleterious impact on child health.
anesthetics may reduce, but they do not eliminate, circumcision pain.(22)
To avoid subjecting children to unnecessary pain, a more ethical position for physicians
would be to refuse to subject unconsenting children to non-therapeutic circumcision.
- The dangers of dorsal penile nerve
block (DPNB) have been minimized. While short-term consequences appear to be few,
potential long-term damage to the sensory apparatus of the penis, or the developing
nervous systems response to pain, has never been studied.
- Infant circumcision removes a large
portion of the penile skin. Almost all of the mucosal skin is excised and, by adulthood,
the total amount of deficient skin approaches or exceeds 50% of the penile shaft.(5)
- The exact
incidences of complications and death are unknown,(23) due to
unreporting, underreporting and misreporting.
LONG-TERM CONSEQUENCES OF
- Circumcision alters the natural
appearance and full functioning of the penis, resulting in what significant numbers of
circumcised men regard as a disfigurement and mutilation.
- Body image
surveys(24) consistently find 20% of circumcised males displeased
with the results of this surgery they did not choose. It is probably a conservative
estimate. This percentage is likely to increase as more men become aware of how this
surgery inherently damages the physiological functioning of the penis.
- Hundreds of
circumcised men have documented with NOHARMM their experiences of tight erections,
bleeding at the scar site, inadequate sensitivity and other sexual disadvantages resulting
from circumcision. NOHARMM surveys have found that widespread ignorance of male anatomy
perpetuates men's lack of awareness as to how these problems are a consequence of
- Circumcised men and boys have
reported to NOHARMM their psychological and emotional issues arising from circumcision,
such as feelings of violation, loss, mutilation and betrayal by parents and physicians.
This is especially so among those who know others who were allowed to remain intact.
- In the Spring of 1997, hundreds of
circumcised men shared their stories of damage in letters to the American Academy of
Pediatrics. This warrants investigation into the adverse long-term physical, sexual and
psychological outcomes of infant circumcision on male health and well-being.
- Denial of harm and other
psychological coping mechanisms among circumcised individuals often makes it difficult for
them to approach this subject in a rational and unbiased manner. Members of the medical
community are not immune to this personal or professional denial.
- Doctors who knowingly perform
non-indicated amputative surgery on children should not be surprised by later expressions
of anger directed at them by their former patients or by the threat of litigation.
- As the percentage of intact males in
the U.S. increases, parents of circumcised sons can reasonably expect their sons to be
dissatisfied when they discover they have less penis than their peers. They may also come
to resent that they were not afforded the opportunity to experience the benefits of
unaltered genital integrity.
SOCIETY AND LAW
- U.S. physicians who advocate for
children's rights at home or abroad will be increasingly held accountable for failing to
recognize and safeguard the male child's rights to physical integrity and
- Federal and state legislation has
been enacted to protect the physical (i.e., genital) integrity of female children. Equal
protection considerations demand that we affirm the inherent human right of male children
to their physical integrity. Genital mutilation is not an issue of severity, but
sovereignty over ones body.
- Where circumcision is customary in
developing nations, boys and girls are often circumcised under rudimentary and unsanitary
conditions with high rates of morbidity and mortality. Medicalizing such customs to
protect children from non-medical circumcisers may reduce some risks, but does not
mitigate long-term physical, sexual or psychological consequences, nor does it resolve
ethical and human rights violations inherent in circumcision of healthy, unconsenting
children. We maintain that physician involvement in these social customs, in developing
and developed nations, is inappropriate and unethical.
- Although generally our society has
given parents wide latitude in decision-making for their minor children, the medical
profession and society do not accord parents the right to subject their children to
non-therapeutic surgical body modifications, especially those whose known damage exceeds
potential for improved health.
POLICY, ETHICAL PRACTICE AND
- In cultures with a history of
childhood circumcision, medical association policies that discourage non-therapeutic
circumcision can only be truly effective by implementing aggressive educational programs
designed for parents and physicians.
- We urge the medical community to
more widely adopt existing conservative (non-surgical) alternatives to circumcision for
prophylaxis and treatment of penile problems. We encourage usage and further development
of more alternatives that preserve the genital integrity of the patient, regardless of
- We advocate improved curricula in
medical schools to teach the anatomy, development, functions and proper care of the intact
penis, as well as teaching non-surgical alternatives for the prevention and treatment of
- We encourage the use of medical
textbooks that illustrate the human penis in its intact state. Illustrations of
circumcised male or female genitals depict the results of cultural surgeries. These should
not be used as the anatomical norm.
- We call on the medical community to
reassure parents that intact male hygiene is a simple matter, and is effective in the vast
majority of males for the prevention of almost every penile problem that circumcision is
alleged to prevent.
- We strongly urge the media, in its
coverage of circumcision issues, to more fully and accurately report the important
lifelong functions of the male prepuce, circumcisions adverse outcomes to male
health, and the ethical and human rights implications of imposing non-therapeutic
circumcision on unconsenting minors.
- In cases where circumcision
continues to be performed, we call for an accurate and annually updated national registry
of the number of such circumcisions performed in medical facilities (hospitals, clinics
and doctors offices); the number of circumcision-related complications (based on
pre-determined diagnostic criteria); and the number of circumcision-related deaths.
- We call on the health insurance
industry to create a level playing field for all insurers by affirming across the board
that neonatal circumcision is not to be considered a legitimate covered
- We call for an immediate cessation
of solicitation for newborn circumcision by hospital staff who routinely present parents
with a circumcision consent form.
- We question
the morality and legality of biotissue companies harvesting infant foreskins for the
creation of profit-making artificial skin products.(26) We strongly
advocate that alternative sources for these important products be developed. Despite
potential benefits of these products, the present situation constitutes
bio-thievery and relegates male newborns to the status of involuntary organ
Non-therapeutic circumcision of
unconsenting children should cease. Its inherent risks, disadvantages and significant
level of dissatisfaction among those upon whom it is imposed violate fundamental medical
ethics(27) and contravene human rights of the patient.(28) It is the moral duty of educated professionals, the media, religious
bodies, the courts, legislators, parents and the general public to protect the health and
rights of those with little or no social power to protect themselves. It is incumbent upon
all segments of society to hold those institutions and individuals accountable who
advocate, condone or are responsible for perpetuating removal of healthy body parts from
- Neonatal Circumcision
Revisited, Fetus and Newborn Committee, Canadian Paediatric Society. Canadian Medical
Association Journal, vol. 154, no. 6, March 5, 1996:769-780. back
- Circumcision of Male
Infants: Guidance for Doctors, British Medical Association, September, 1996. back to text
- Position Statement: Routine
Circumcision of Normal Male Infants and Boys. Australian College of Paediatrics, May 27,
1996. back to text
- Guidelines for Circumcision,
Australasian Association of Paediatric Surgeons, April, 1996. back
- Taylor, J. The prepuce: specialized mucosa of
the penis and its loss to circumcision. British Journal of Urology, vol. 77,
1996:291-295. back to text
- Williams, N. and Kapila, L. Complications of Circumcision.
British Journal of Surgery, vol. 80, no. 10, October, 1993:1231-1236. back
- Milos, M. Circumcision:Male-Effects Upon Human Sexuality. Human Sexuality:
An Encyclopedia, Vern & Bonnie Bullough (eds.), Garland Publishing, New York,
1994:119-121. back to text
- Fleiss, P. The Foreskin is Necessary. Townsend Letter
for Doctors and Patients (Port Townsend, WA), issue 153, April, 1996:64-68. back to text
- Male Health & Genital
Care:Previous Circumcision Rationale and Modern Alternatives (chart). Doctors Opposing
Circumcision, 2442 N.W.Market St., Suite 42, Seattle, WA 98107. back
- Pisacane, A. et al
Breastfeeding and Urinary Tract Infection. Journal of Pediatrics, vol. 120, 1992:87-89. back to text
- Newborns: Care of the
Uncircumcised Penis (brochure, 1/94). American Academy of Pediatrics, Div. of
Publications, 141 Northwest Point Blvd., Elk Grove Village, IL 60009. back to text
- Wright, J. Treatment of
Childhood Phimosis with Topical Steroid. Australia-New Zealand Journal of Surgery, vol.
64, 1994:327-328. back to text
- Jorgensen, E. Treatment of
Phimosis in Boys with a Potent Topical Steroid. Acta Dermato-Venereologica, vol. 73,
1993:55-56. back to text
- Illingworth, R. The
Normal Child: Some Problems of the Early Years and their Treatment. Churchill
Livingstone, 1983:101. back to text
- British Medical Association
letter, "Ethical Status of Male Circumcision," dated 26 February 1996 from Dr.
Fleur Fisher (Head of Ethics, Science and Information Division) to Dr. John Warren. back to text
- American Cancer
Society letter dated February 16, 1996 from Hugh Shingleton, M.D and Clark W. Heath,
Jr., M.D. to Dr. William Oh of the American Academy of Pediatrics. back
- Laumann, E. Circumcision in
the United States. Journal of the American Medical Association, vol. 277, no. 19, April 2,
1997:1052-1057. back to text
- Petition to the Task Force
on Circumcision of the American Academy of Pediatrics from International AIDS Organizers,
(available from NOHARMM, PO Box 460795, San Francisco, CA 94146). back
- Anand, K.J.S. Pain and its
Effects in the Human Neonate and Fetus. New England Journal of Medicine, vol. 317, no.21,
1987:1321-1329. back to text
- Taddio, A. et al. Effect of
Neonatal Circumcision on Pain Responses During Vaccination in Boys, Lancet, vol. 345,
1995:291-292. back to text
- Marshall, R. Circumcision:
II. Effects upon Mother-Infant Interaction. Early Human Development, vol. 7, 1982:367-374.
back to text
- Use of EMLA Prior to
Circumcision. Annals of Pharmacotherapy, vol. 30, no. 11, November, 1996:1327-1330. back to text
- Report of the Task Force on
Circumcision of the American Academy of Pediatrics. Pediatrics, vol. 84, no. 4, August,
1989: 388-391. back to text
A Preliminary Poll of Circumcised Men, NOHARMM, PO Box 460795, San Francisco, CA
94146. back to text
- Hammond, T. Long-Term Consequences of Neonatal Circumcision. Sexual
Mutilations: A Human Tragedy. Plenum Press, New York, 1997:125-129. back to text
- Rosenberg, R. Companies See
$1.5b Market in Replacement Skin Products. Boston Globe, October 19, 1992:22-23. back to text
- Kirkey, S. Circumcision is assault, ethicist says. Montreal Gazette, October
18, 1997:A9. back to text
- Svoboda, S. Routine Infant Male Circumcision: Examining Legal and Constitutional
Issues. Human Rights Advocates, vol. 27, Summer, 1996:7-9. back
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