Male Circumcision: A Gender Perspective

Joseph Zoske
Journal of Men's Studies, p. 189-208, vol. 6, no. 2, Winter 1998 (www.mensstudies.com)

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The practice of routine medical circumcision of newborn male infants remains the norm in the United States, occurring to more than one million baby boys annually. This article examines the history and continuing debate surrounding this surgery, and places it within the context of gender identity. The rise of the activist anti-circumcision movement is described, as medical, moral, psychological, and legal issues surrounding this controversy are identified. The continuing practice of male circumcision is framed as an abusive wounding of males, which holds lifelong implications. A differentiation is made between the conventional medical amputation of the foreskin, from that which is solely ritual, religious-based. Further, a societal double standard is noted between the moral outcry against female circumcision and the relative silence toward male circumcision.

Routine medical male circumcision, the surgical removal of a healthy male infant's foreskin, is "the most common surgical operation carried out in the United States" (Cendron, Elder, & Duckett, 1996, p. 2149). While a majority of men throughout the world remain uncircumcised (Wallerstein, 1985), annually circumcision is performed on more than one million American infants. Most authors, however, agree that the incidence of circumcision in the United States has fallen from a high of 80 to 90% during the 1980s to a low of nearly 65% at present. Inconsistent reports by hospitals and insurance companies leave national data unreliable and, in all probability, somewhat conservative (e.g., facilities often do not separate circumcision from the collective itemization of delivery services; see Graves, 1995). Regardless, circumcision will be a reality for a majority of male infants given a medical establishment that still condones it and a health insurance system that readily pays for it - estimated at $140 million in 1988 (Poland, 1990).

Circumcision is, however, more than a benign medical procedure. It is fundamentally an elective 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.

Strong arguments ...support viewing circumcision as a societal act
of physical and sexual assault

Broad medical, psychological. and ethical debates continue to surround this practice, displaying a perplexing lack of resolution. It continues to be readily authorized and infrequently questioned by parents or hospital personnel and not generally considered by and of the parties to be an act of violence. However, there are strong arguments that support viewing circumcision as a societal act of physical and sexual assault; an event that holds deep significance for men's psychosexual development, reinforces cultural attitudes of disregard for the well-being of men's bodies, and tacitly accepts violence as a part of men's lives. This article intertwines these ideas and presents routine neonatal circumcision as a fundamental men's issue. Framed within an historical context and an ongoing medical debate, circumcision should be seen as the first psychological and somatic wounding of men - a cultural act of gender betrayal and brutality. As questions surrounding this procedure are examined, a challenge is made to the continued acceptance of this widespread practice.

Technical details

To avoid the discussion becoming lost in the abstract, it is important to understand the medical specifics of this surgery. Circumcision requires that a male infant be taken from his parents and placed on a restraint table with his extremities fastened or held down, while a variety of surgical instruments (probes, clamps, scalpel) are used to grasp the foreskin, separate it from the glans, slit it, stretch it, crush it, and amputate it (Cohen, 1992; Gelbaum, 1993). It has also most often been performed without anesthesia due to medical contraindications, or with the use of a painful local anesthetic injection (the dorsal nerve block). However, the latter "is not widely used due to concerns of sufficient safety, the additional time required to perform the block, and the continued belief that the pain of neonatal circumcision is insignificant" (Howard, Howard, & Weitman, 1994, p. 641). Numerous studies have clearly identified traumatic pain responses in infants, and specifically the severe and persistent pain of circumcision (Anand & Hickey, 1987; Stang, Gunner, Snellman, Condon, & Kesterbaum, 1988). While investigators are exploring the efficacy of topical anesthesia (Benini, Johnston, Faucher, & Aranda, 1993), there remains lasting impact from the pain experience of current practice. Taddio, Goldbach, Ipp, Stevens, and Koren (1995) found continuing pain response in baby boys at four to six months, and expressed concern for possible long-term effects of the intense pain of circumcision. Anand and Hickey (1987), concluding their review of more than 200 citations, spoke of the "memory of pain in neonates" and cautioned about circumcision's possible long-term psychological effects (p. 1325). Ritter (1992), an activist anti-circumcision physician, describes the procedure as a "great human and humane transgression" in which the baby's first perception of genital sensation is needless pain (p. 3-1).

"The potential for complications from circumcision is real
and ranges from the insignificant to tragic"

Beyond pain, there are many other risks. "Although not technically difficult," Gluckinan, Stoller, Jacobs, and Kogan report (1995), "it results in a large number of reported and unreported complications annually.... The potential for complications from circumcision is real and ranges from the insignificant to tragic" (p. 778). Among the complications noted we find: bleeding, infections (localized and systemic), excess foreskin removal, glans necrosis or amputation, removal of penile shaft skin, psychosocial problems in adulthood, erectile dysfunction, and death. "The fairly high rate (1.5% to 15%) reflects the fact that the procedure is often performed by an inexperienced individual without attention to basic surgical procedures" (p. 778).

History

One might imagine that an intelligent species like man would leave them (the human genitals) alone. Sadly, this has never been the case. 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. (Morris, 1985, p. 218)

Ritual circumcision (as differentiated from modern medical circumcision) has existed throughout history. Among the many 19th and 20th century authors who have studied its historical, religious, and cultural aspects, there is a consensus that its roots originated thousands of years ago, predating Judaism, with depiction of circumcision found even in Stone-Age cave drawings (Bitschai, 1956; Wallerstein, 1980; Wrana, 1939) Rites of initiation, fertility rituals, control of sexual drives, and tribal identification - for men and women - are considered the primary purposes for circumcision's many variations (Campbell, 1988; Zindler, 1990).

"The ritual [circumcision] has absolutely nothing whatsoever to do
with medicine, health, or science in practically all cases"

Male ritual circumcision involves various degrees of foreskin removal, while female circumcision ranges from clitoridectomy to vulvectomy to infibulation (known as Pharaonic circumcision - the most severe and mutilating form). However, whether past or present, ritual circumcision serves cultural purposes, as opposed to justification as a health promoting practice (Aldeeb Abu Sahlieh, 1994). As James DeMeo (1990) succinctly states, "The ritual [circumcision] has absolutely nothing whatsoever to do with medicine, health, or science in practically all cases" (p. 108). Regrettably, ritual circumcision of females, unlike males, is still extensively performed in many cultures throughout the world - especially within African and Arab Islamic nations - where, for example, 80-90% of Somalian and Sudanese girls are infibulated by age seven or eight (Hicks, 1993; Hosken, 1982; Lightfoot-Klein, 1989; Van der Kwaak, 1992). Further cultural/religious discussion of ritual circumcision (male or female), however, is beyond the scope of this article. What is significant is the acknowledgment of the depths of circumcision's origins. It is a practice deeply imbedded within global consciousness - interwoven within centuries of cultural myths, values, and customs. All of which contribute to the resistance of 20th century thinking in releasing it from modern U.S. medical practice.

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. Given the sexual mores of that time, child-rearing practices, and the lack of understanding of much disease etiology, masturbation was blamed for a litany of ills. Insanity, epilepsy, blindness, and even death were its feared results, with circumcision viewed as a "treatment" (Remondino, 1891/1974; Romberg, 1985). As a primary means of controlling masturbation in young children, circumcision peaked between 1850 and 1879 with even physicians recommending its use (deMausse, 1974, p. 49).

This was a time in American history when pervasive change was sweeping the nation: the Industrial Revolution, abolitionism, the Civil War and reconstruction, and the women's rights and labor movements, to cite a few. The practice of medicine itself was also changing. The emergence of the germ theory as the predominant scientific paradigm and the organization of professional medical societies - the American Medical Association was founded in 1847 - signaled the profession's turn from its traditions in the healing arts (Coulter, 1994). The developing allopathic model of medical care took hold and began its evolution into a commodity of industrial capitalism (Brown, 1979). Within this cultural milieu the incidence of male circumcision steadily grew.

It took about 100 years for a different viewpoint, a more enlightened one, to grow within the medical community, stemming from the British physician Douglas Gairdner's (1949) critical article "The Fate of the Foreskin." For the first time, a direct challenge was made to the practice of routine circumcision. Physicians were encouraged to delay circumcision for 2-3 years, until its "minor advantages" could be better assessed. The message was heard within the structure of the British National Health Service. Together with its 1948 policy restrictions on elective surgery (Romberg 1985) the circumcision rate in England - always less than the circumcision rate found in the United States - dropped dramatically (Wallerstein, 1985). In the United States, however, it would take another generation for alternative ideas to take hold.

"Linked to antisexual sentiment in the 19th century
...currently money-making interests in the U.S. lie behind
this superfluous, often damaging, and sometimes lethal operation."

Circumcision received a boost during World War II, with the justification that it helped minimize wartime "hygiene problems" (Gellis, 1978). Then, in the postwar years, another dynamic took hold - the growing class distinction in accessibility and utilization of health care. From the early 1940s to the late 1950s, "Educated middle-class parents almost always had their newborn sons circumcised," while, "the infant sons of poor parents were usually uncircumcised because their parents were unaware of the benefits [sic] and could not afford the cost" (Schoen, 1990, p. 1308). This rectified itself in the early 1960s with the rise of third-party reimbursement systems. While references to the contrary could be found in some medical texts of the time, for example, a standard urological medical text discrediting medical indications for circumcision (Campbell, 1963), by then, "circumcision became the American standard" (Schoen, 1990, p. 1309). A researcher from Johns Hopkins University made an acute cultural criticism of this interplay. "Linked to antisexual sentiment in the 19th century ... currently money-making interests in the U.S. lie behind this superfluous, often damaging, and sometimes lethal operation." (Money, 1989).

Though the 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 Academy of Pediatrics (AAP, 1971) formed an Ad Hoc Task Force Committee on Circumcision that reported its objection and reiterated its stand once again in 1975: "There is no absolute medical indication for routine circumcision of the newborn" (Thompson, King, Knox, & Korones, 1975). 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. The AAP later reviewed existing data and changed its stance to a neutral position. While acknowledging issues of pain contraindications of anesthesia, and the role of good hygiene, it concluded with the noncommittal statement that "newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks" (AAP, 1989, p. 390).

With the repudiation of masturbation as an illness, physicians were now citing fears of infectious disease and cancer as justifications. Countless studies and articles were reporting on the protective effect of circumcision relative to: urinary tract infections (with a small projected 1.4% incidence rate), penile cancer (a serious albeit very rare malignancy occurring in 2/l00,000 cases), HIV; cervical cancer in female sex partners, STDs, and minor inflammations and/or infections of the foreskin or urethral meatus (i.e., opening at the tip) (Wiswell, 1992, 1993). Further, adherence to tradition and custom were raised in arguments of "convenience" in personal hygiene and a need to "look like dad."

Circumcision is an assault on the boy's sexuality and his right to an intact body.

Consensus, however, remained illusive, and a consumer movement began adding its opposition voice to the debate. Organizations such as NOCIRC (the National Organization of Circumcision Information Resource Centers), the ISC (International Symposia on Circumcision), and INTACT (Infants Need To Avoid Circumcision Trauma) were founded in the mid-1980s. National networks of men's support groups also formed, for example, UNCIRC (Uncircumcising Information and Resource Center). More recently, medical professionals started taking radical stands in the face of conventional practice. Some nurses began courageously to identify themselves as "conscientious objectors," citing an ethical view that circumcision is an assault on the boy's sexuality and his right to an intact body. They offered testimony to their experience of having participated in too many "botched" procedures, leaving males with lifelong complications such as scarring, painful erections from excess foreskin removal, bowing and curvature, and hypospadias (Miya, 1994). Their ethical conflict is poignantly drawn in a letter from the nurses who founded Nurses for the Rights of the Child, "After years of strapping the babies down for this brutal procedure and listening to their screams, we couldn't take it any longer" (Sperlich & Conant, 1994). Physicians, too, organized, most notably by Dr. George C. Denniston's founding of the organization D.O.C. (Doctors Opposing Circumcision).

The Canadian Pediatric Society's Fetus and Newborn Committee, which officially agreed with the AAP in 1975, recently conducted an extensive re-examination of this issue. Reviewing 671 medical studies on circumcision's medical efficacy as a protective factor, and also performing a cost-benefit analysis, led them to a clear recommendation: "Circumcision of newborns should not be routinely performed" (CPS, 1996, p. 769). Yet, the debate continues.

There is a disturbing silence regarding such significant issues as foreskin physiology,
the normalcy of the intact penis, loss and grief, and circumcision's impact
upon a man's overall psychosexual development.

Advocates speak of preventive medicine, while opponents call for an end to violence and the teaching of proper hygiene practices. The former group feels they are acting in the child's best interest, while the latter argues that the medical dictum "Primum Non Nocere" (First, do no harm) should guide this issue. Beyond the ongoing medical debate, however, there is a disturbing silence regarding such significant issues as foreskin physiology, the normalcy of the intact penis, loss and grief, and circumcision's impact upon a man's overall psychosexual development.

The Question of Normalcy

Clearly, a sensitive understanding of the normalcy of penile foreskin
and its functional purposes is needed.

Medical warnings of potential problems for uncircumcised men persist, and parents continue to be approached for authorization for the permanent alteration of their newborn's healthy genitalia. Clearly, a sensitive understanding of the normalcy of penile foreskin and its functional purposes is needed. Indeed, even referring to it as "skin" dismisses its complex, specialized, biochemical nature. Fundamentally, the foreskin is a safety mechanism for the penis. It offers protection for the glans and shaft from external trauma, clothing abrasions, contact with potential infection sources (i.e., urine or feces), and thermal changes. Without the foreskin sheath, the glans becomes much more vulnerable. The American Academy of Pediatrics stated in a health education brochure, "Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life" (AAP 1984).

Such fundamental understanding, however, has gotten lost. A primary reason for this is the personal and professional experience of U.S. physicians themselves. "'Because most males in the United States are circumcised" [including male physicians], writes Niku and his associates (1995)", "there is little opportunity to observe the natural history of the uncircumcised penis; several errors have crept into American medical practice as a result"(p. 58). Most noteworthy, the unwarranted and forcible retraction of the foreskin, which creates the primary complications physicians use to justify circumcision.

"Why is the operation of circumcision practiced?
One might as well attempt to explain the rites of voodoo!"

Not naturally retractable at birth, the foreskin may take until adolescence until it is fully retracted. Niku (et al, 1995) elaborates, "Some "physicians who have been denied the opportunity to observe the development of the uncircumcised penis are convinced that the prepuce must be retractable at an early age." (p. 58). That is unnecessary, and further perpetuates the myth and custom surrounding this practice. The opposing argument is that the intact penis is natural, in need of neither surgical improvement nor emotional fear. "It cannot be emphasized too strongly that no special care of the uncircumcised penis is required. The child should be encouraged to cleanse the area under his prepuce just as he is encouraged to wash behind his ears" (Niku et al, 1995, p. 58). Again, the British perspective is illustrative of the interplay between culture and clinical practice. Almost fifty years ago, Gairdner (1949) presented that foreskin development is normal in 99% of boys by the age of fifteen, and how only 15% of boys have a retractable foreskin by six months. More recent British researchers discuss, how "Confusion over the term phimosis [i.e., the normal unretracted foreskin at birth versus the forcible retraction by a physician] continues, so that many children are thought to have a pathological condition when often there is none" (Williams, Chell, & Kapila, 1993, p. 29), and concludes with the point that physicians lack adequate understanding of this issue. Almost thirty years earlier, Morgan (1965) made the same arguments, though in a much more biting manner. Speaking candidly to his colleagues, "Why is the operation of circumcision practiced? One might as well attempt to explain the rites of voodoo! A nonretractable foreskin should not be used as pretext for lopping off an innocent and useful appendage. Appendicitis causes many more deaths every year in the United States than does cancer of the penis but nobody yet recommends routine appendectomy" (p. 123-124).

Sexuality

The foreskin also has an intricate role in sexual physiology. The 18th century masturbation-cure proponents knew that very well. Stimulation via the foreskin was a source of sexual pleasure that they were intent on reducing.

The foreskin also has an intricate role in sexual physiology.

Nature intended for "the glans of the unaroused penis to remain an internal organ (similar to the female clitoris shielded by its hood) with a lubricating mucous membrane as its outer surface, rather than becoming an external skin layer. During the arousal phase, the foreskin retracts gradually thereby allowing the glans to retain its highest tactile sensitivity until fully exposed during complete penile erection. The permanently exposed glans forms a dried, less sensitive skin layer called the corneum, as a somatic response to needing a protective replacement for the foreskin. The impact of circumcision upon the sexual nature of boys and men deserves consideration. A man's foreskin after all is not an anachronistic error by nature, but an important functional aspect of masculine sexuality.

Rather than being solely a subject of disease and hygiene, the foreskin - together with the corona, glans - is an integral party of the "pleasure dynamics" of movement, sensation, and lubrication that occur during masturbation, foreplay, and intercourse. Current research has shown the foreskin has a high concentration of nerve endings that actually enhance the sensory function of the glans and shaft (Taylor, Lockwood, Taylor, 1996). However, as Taylor and his associates note, "'Teaching on the anatomy of the prepuce (foreskin) has undergone little change since ... the 15th century" (p. 294). Another physician-author succinctly challenges us to face the fact that, "Our foreskin, like our tonsils, does have a purpose in life ... and ... if new attitudes persist, the coming generation can revel in the new experience of having sex with a foreskin" (Purvis, 1992, p. 32). However, since male-affirmative messages regarding circumcision are not widely available to parents, and since most men and women have no experience with an intact penis - many without even a visual image of one - a change in awareness and behavior will undoubtedly require considerable time.

When the natural state of male genitalia has been altered
...how is a man's psychosexual experience changed?

In light of the knowledge society has gained about the complex interplay of psyche, soma, and sexuality, the continued medical practice of circumcision raises significant issues. When the natural state of male genitalia has been altered (i.e., a penis existing without an external, sliding, lubricating, stimulating sleeve of loose skin), how is a man's psychosexual experience changed? What of men whose skin on their shafts is too painful or desensitized during erection, from having had excess foreskin removed? Are there implications in sexual dysfunctions and difficulties of relationship formation? Beyond the individual, what affect does it have on sexual partners and what does it imply about our culture? As DeMeo (1990) has noted

The fact that so many [Americans] are ready to defend the practice in the face of contrary epidemiological evidence is a certain give-away to hidden, unconscious motives and disturbed emotional feelings about the penis and sexual matters in general ... before such painful and traumatic mutilations can be perceived as "good"... other antisexual and antichild social factors must be present and thriving. (p. 108)

Discussion of circumcision's negative impact upon a male's psychosexual development is limited, but Freud (1913) spoke to it. Regarding the trauma associated with the surgery, he wrote that a child's level of understanding of circumcision leads him to "equate it with castration" (p. 153, n1). Interestingly, a clinical-historian's review of Freud's other theoretical writings, letters, and dream accounts suggests that even Freud's own traumatic experience with the circumcision of his brother, Julius, provided the unconscious motivation for his conceptualization of the castration complex and its centrality to human development. Colman (1994) writes, "His [Freud's] writings are replete with emphasis on the importance of the penis and its destiny," and the argument is made that this significant circumcision event provides causal support to his "penis attention" (p. 603). Another psychoanalytic investigation into a 13-year-old boy's abnormal sadomasochistic sexual behavior attributed psychopathology to the overwhelming ego trauma of his circumcision (Kennedy, 1989). However, broad scope psychological research is lacking.

Low self-esteem, sexual avoidance, trauma reactions, social interactional difficulties,
and treatment considerations are more readily articulated about
the female experience of circumcision...
Voicing the male counterpart to this surgical assault, however, has been much rarer.

Relevant issues such as low self-esteem, sexual avoidance, trauma reactions, social interactional difficulties, and treatment considerations are more readily articulated about the female experience of circumcision (Bengston & Baldwin, 1993; Miller, 1992; Toubia, 1994). Psychotherapist Miller (1992) discusses the phenomena of women perpetuating the victimization of female circumcision to the next generation. "They were unable to defend themselves as young girls and were forced to repress their feelings. Today, as a result of their repression, they can justify the procedure as harmless and necessary (p. 74). Bengston and Baldwin (1993) specifically recommend counseling strategies for women similar to those used for a victim of sexual assault or for a woman grieving the loss of a female body part as in mastectomy. Toubia (1994), writing in the prestigious New England Journal of Medicine, speaks to circumcision's psychological effects on women often being subtle and buried in layers of denial and acceptance of social norms. Voicing the male counterpart to this surgical assault, however, has been much rarer. Psychologist Ronald Goldman (1997), after years of research, activism, and surveys of men regarding circumcision, contends that deep and lasting psychological damage does occur, and is directly contributory to certain emotional problems of men. This line of psychosexual inquiry begins with a specific premise. "All that takes place in the first days of life on the emotional level shape the pattern of all future reactions. How could a being so aggressed in this way, while totally helpless, develop into a relaxed, trusting person?" (Calderone, 1983, p. 10). Other psychotherapists, like Pharis and Eisler (1990), challenge clinicians to consider diagnostically the psychological reactions of children to genitourinary surgery. They recommend the incorporation of questions regarding circumcision and other genital surgeries into their clinical history-taking of men, so that the therapists "might evaluate and treat a variety of presenting complaints with a greater appreciation for the fears and body integrity issues which are likely to be common elements in such cases" (p. 473).

Loss

Men have expressed intense loss and rage - feelings arising from deep within their mind-body
memories that speak to this as "an act of assault, pain, and violation of innocence."

When a man is circumcised, a significant loss has occurred - one that represents a symbolic as well as a somatic amputation. While an individual's identification of and reaction to this will vary, many men do experience circumcision as a traumatic event. In numerous workshops led and attended by this author, where issues of circumcision have been examined, men have expressed intense loss and rage - feelings arising from deep within their mind-body memories that speak to this as "an act of assault, pain, and violation of innocence." Such personal accounts are also beginning to be found in print.

I feel anger at the system that intimidated my parents to proceed with this senseless and risky mutilation. I feel resentment for the collusion of physicians and my parents which made that decision for me, abusing my rights and destroying my birthright. (Green, 1991, p. 116; see also: Briggs, 1985).

"Every man has a profoundly different penis. For some, the foreskin is an impediment
to pleasure; for others, it's the most erogenous area of their bodies"

Brietzke (1996) published survey accounts of men's personal reactions to their own circumcision. With numbers of men reporting unhappiness about the loss of their foreskins being equal to those who were content, the findings led to, "Our conclusion: every man has a profoundly different penis. For some, the foreskin is an impediment to pleasure; for others, it's the most erogenous area of their bodies" (p. 10).

A dramatic male response to this conceptualization of circumcision-as-loss has been the "restoration movement," that is, the growing popularity of surgical and non-surgical methods of foreskin reconstruction. There are various means of stretching penile shaft skin until it covers the glans. Though this new foreskin does not fully equate with a natural foreskin, many men report increased sensitivity and the return of a pleasurable gliding sensation during masturbation and intercourse (Bigelow, 1995; Griffen, 1991; Money, 1991). While it may require a considerable investment of time, discomfort, and money, it is a proactive response by some men who feel victimized by the unnecessary loss of their natural anatomical wholeness. In telling his personal account, Whipple (1987), with the added perspective as a public health medical investigator, writes,

[C]hange is not so easy. While foreskin restoration has probably been with us since the first man's penis was forcibly altered, today's American medical professionals will test your masculinity, your personality, sanity and your financial resources before agreeing that you really want a pseudo-foreskin. (p. 113)

Activism on this issue have spawned several self-help networks, including: BUFF (Brothers United for Future Foreskins), NORM (National Organization of Restoring Men), RECAP (RECover A Penis) [NOHARMM Note: RECAP is now NORM], and dozens of Internet Web sites and discussion groups (Rodrick, 1995).

The above statements and actions of men speak of circumcision in more graphic, personal, and political terms, providing a non-clinical framework in which to conceptualize this medical practice. This different language both broadens and confronts many prevailing cultural ideas regarding the surgery.

Cultural Denial

Through his linguistic studies, Mario Pei (1965) demonstrates language's cultural power in maintaining many ritualized activities over the centuries via its written, spoken, gestural, and symbolic forms. "Language," he writes, "is an all-pervasive conveyor, interpreter and shaper of humankind's social and scientific endeavors" (p. 29). When circumcision, then, is viewed by the culture as a "prophylactic surgical procedure performed by medical personnel as part of standard hospital practice," it creates a narrow framework in which to consider its implications upon the personal life of the boy and man. Boyd (1990) argues for the term "genital mutilation" when speaking about circumcision, as clinical words tend to trivialize and dismiss the depth of emotional and physical implications of foreskin removal. Such a term "is not only scientifically accurate, but also honors the feelings of those who feel they are victims of circumcision" (Boyd, 1990, p. 8). Directly speaking to men, Boyd further writes

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 of child abuse. But we've come to accept male circumcision as normal. The force of tradition has shut our cries at our own violation, our mutilation, and we've adapted to the silent denial. (p. 37)

This conceptualization is new for men, but not for women.

Such language directly confronts cultural denial, that is, the forgetting that normal male genitalia has been intentionally altered, made unnatural not by the male's choice. This conceptualization is new for men, but not for women.

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 of more that 2 million circumcisions performed on girls and women each year, a uniform condemnation statement read, "Governments are urged to prohibit female genital mutilation wherever it exists." (International Conference on Population and Development, 1994). Both of these progressive international bodies, though, were silent on the same occurring to boys and men.

In 1984, invoking law and judicial case precedent, Brigman labeled "child mutilation through routine neonatal circumcision of males.. as barbarous as female circumcision," and called for it to be acknowledged as the "most widespread form of child abuse in (U.S.) society" (p. 337). In exploring the constitutionality of parental decision-making rights and the child's rights to privacy and protection. He argues that neither physicians nor parents should be safe from government authority to prohibit non-medically warranted circumcision, and suggests a class-action civil rights suit as an effective societal response to "child mutilation." Farrell's (1986) words similarly confront our denial of the trauma of male circumcision by referring to it graphically as when "their penises are taken to the blade of a knife and cut," and underscores "the subconscious lack of caring about men that is displayed" (p. 231).

Re-framing circumcision into issues of abuse and rights is more than a conceptual shift. A generation ago, noted biologist and species analyst Desmond Morris (1973) called circumcision a form of "adult aggression" (p. 243). Today, however, more radical politicized anti-circumcision statements name it as "a crime" (K, 1995) and an act of "terrorism" (Worth, 1995), and consider it a core link to the perpetuation of fear, rage, and violence within men. It has also become the focus of citizen action. For example, the activist group NOHARMM (i.e., the National Organization to Halt the Abuse and Routine Mutilation of Males) was founded in 1992, and conducts national advocacy and information campaigns in defense of the child's right to an intact body, and in support of the empowerment of men.

Each successive pain violation upon the man is a further cutting,
which continues to separate him from connection with the web of life.

The pro-feminist philosopher Mazis (1993), writing on the social construct of masculinity, looks at male experience with pain as the embodiment of masculine identity. Each successive pain violation upon the man is a further cutting, which continues to separate him from connection with the web of life. "Violence has become a haunting presence within the masculine psyche" (p. 36), an outgrowth of the hero model of masculinity and its insistence upon pain tolerance, the emotional armoring it fosters, and the cultural violence to self and others it perpetuates. The long-term impact of these cultural messages of masculinity upon male mortality and morbidity has been devastating. Men continue to suffer disproportionate rates of disease, injury, crime victimization, disability, suicide, incarceration, and premature death (Farrell, 1993; Goldberg, 1976; Zoske, 1996). Men's health specialist Ken Goldberg (1993) calls "the notion that men are supposed to be bulletproof, to suffer through pain quietly and alone" (p. xxiii), a continuing male myth that still stands as a powerful barrier to gender well-being.

"Hurting another, in violating their flesh or psyche,
is actually very debilitating to the perpetrator."

With sensitivity to the issue of male-as-perpetrator as well as male-as-victim, Mazis further writes, "hurting another, in violating their flesh or psyche, is actually very debilitating to the perpetrator" (p. 37). In the case of circumcision, it is the physician - most often male - who acts out the violence against the male baby. For physician-perpetrators, their choice extends from their history, their personal experience of penises, and their culture - including their elevated social status, and the economic and persuasive power they hold.

In routine newborn circumcision, unlike most other surgical procedures, the newborn patient is obviously never able to consent or to be part of the decision making process. As such, parental cultural preferences and prejudices, presumed health benefits, and aesthetic choice of family, physicians and society play a large role in determining whether the procedure is done. Studies suggest that the single most important determinant is the physician's attitude. (Wilkes & Blum, 1990, p. 245)

A Gender Perspective

The implications of continued routine neonatal circumcision go to a depth that is personal, cultural, and beyond. Kipnis (1991) suggests that it is part of a larger socialization process affecting men's gender identity.

"At every stage of a man's development there is negative imprinting about the phallic aspect of maleness. Men are often taught that there is something wrong, nasty, or even evil about the penis. Often a little of it is cut off just after we're born" (Kipnis, 1991, p. 43)

Circumcision's role (is) that of a "sacrament"... which initiates men into a life script
that is based upon power relationships, violence, and warrior mentality

Integrating male psychology and myth, Sam Keen (1991) goes further and defines circumcision's role as that of a "sacrament" in our culture, which initiates men into a life script that is based upon power relationships, violence, and warrior mentality. Keen goes on

Circumcision remains a mythic act whose real significance is stubbornly buried in the unconscious. That men and women who supposedly love their sons refuse to stop this barbaric practice strongly suggests that something powerfully strange is going on here. Feel the violation of your flesh, your being. What indelible message about the meaning of manhood [is] carved into your body? Masculinity requires a wounding of the body, a sacrifice of the natural endowment of sensuality and sexuality. A man is fashioned by a process of subtraction. We gain manhood by the willingness to bear mutilation. (pp. 30-31)

"The ceremony itself... do(es) not celebrate the male body, but use(s) the violence of
male dominant masculinity to deny the existence of an inherent masculine sensuality."

Newman (1991) concurs and discounts any relevance to circumcision's legacy as a legitimate rite of initiation. Preferring to call it a "false initiation," his integrative cultural-spiritual-political perspective describes circumcision as a ceremony of violence, a deconstruction of the male phallic image. "The ceremony itself and the rhetorical androgyny which embellishes the ceremony do not celebrate the male body, but use the violence of male dominant masculinity to deny the existence of an inherent masculine sensuality." The results are simply pain and mutilation "for those of us who were cut before we even knew we had a body, before the world was anything but us" (p. 19).

A further bridge can be made between the modern and the ancient. In a Jungian study of phallos and its significance in identity formation and psychotherapy, Monick (1987) discusses how "men need to understand the psychological underpinnings of their gender and their sexuality better than they do," and that "to respect their sacred symbol" is a critical aspect (p. 9). With the existence of ancient images of phallus as an uncircumcised penis, found as far back as the 6th century B.C.E., the medical practice of circumcision leaves American men cut off not only from their foreskins, but from an inheritance of eons of universal male imagery. Monick argues that a connection is severed to an ancient identification of masculinity, leaving men damaged at an archetypal depth (p. 32).

Conclusion

In the face of a growing body of opposing scientific evidence and an increasingly vocal anti-circumcision movement by both consumers and professionals, the majority of newborn American males continue to experience non-consensual amputation of healthy genital tissue. Pro-circumcision empiricists pursue a search for scientific evidence that supports prophylactic benefits of surgery; however, their findings remain narrow and ambiguous. Their opponents submit that, as the United States holds a global minority stance on this medical custom, American males do not hold a distinction of being born in need of immediate surgical correction, and that simply good hygiene would allay concerns with medical risks, patient rights, and psychological trauma. Others take a middle ground and defer the issue to the process of informed consent between physician and parents. Finally. activists and victims speak about violence against innocent baby boys, urging that nature and justice prevail over social custom.

This article has attempted to show that beyond the biomedical aspects of routine medical circumcision lie complex societal issues that affect core elements of masculinity. Medical literature tends to avoid or obscure this via its more reductionistic clinical approach.

"For over a hundred years, it has been a surgery in search of a justification"
Unless health studies and men's studies combine,
this search may continue in its circular fashion.

However, considering the massive scale upon which this elective neonatal surgery is performed, to one particular gender, an integrative cultural-based examination of this issue seems necessary., The broadest, most male-affirming statement found has been made by two female pioneering anti-circumcision advocates and nurses, Milos and Macris (1992b). They raise the debate about routine medical circumcision of U.S. boys to a global level, and speak to issues shared by both genders.

Women have struggled to achieve rights of body ownership for themselves. It is imperative that mutual respect for these inalienable human rights be extended, not only to the women in Africa with whom we can identify, but also to men, male children, and male newborns. (p. 94S)

Boyd (1990) summarizes the issue concisely, "For over a hundred years, it has been a surgery in search of a justification" (p. 42). Unless health studies and men's studies combine, this search may continue in its circular fashion.

See also:
   Male Genital Mutilation (Circumcision): A Feminist Study of a Muted Gender Issue

The Effect of Male Circumcision on the Sexual Enjoyment of the Female Partner 

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Joe Zoske, CSW is an independent health care consultant in Albany, New York, and an organizational trainer within the Public Training program of Hudson Valley Community College in Troy, New York. Specializing in program design and teaching of men's health and wellness issues, he blends his 25 years in health care with credentials as a health educator, clinical social worker, program manager, teacher, nationally certified massage therapist, and men's activist. Zoske presents at national conferences on men's health, consults with organizations on improving men's health services, and formerly maintained a private mind-body oriented psychotherapy practice for men. Correspondence concerning this article should be sent to Joe Zoske, 315 S. Allen St., #1B, Albany, NY 12208-2066. [zoskej@crisny.org]

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