Human Sexuality: an Encyclopedia edited by Vern L. Bullough and
Bonnie Bullough New York: Garland Pub., 1994. p. 119122
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CIRCUMCISION: MALE - EFFECTS UPON HUMAN SEXUALITY
Dr.Joe's Data Base
Circumcision, once accepted as the norm in the United States, has
become controversial. Technically, circumcision is the surgical
removal of the skin that normally covers and protects the head,
or glans, of the penis. At birth, the penis is covered with a
continuous layer of skin extending from the pubis to the tip of
the penis where the foreskin (prepuce) folds inward upon itself,
creating a double protective layer of skin over the glans penis.
The inner lining of the prepuce is mucous membrane and serves to
keep the surface of the glans penis (also mucous membrane) soft,
moist, and sensitive. The prepuce is often erroneously referred
to as ``redundant'' tissue, which allows the medical community
and societyatlarge to consider the foreskin an optional part of
the male sex organ and, therefore, to condone its routine removal
in a variety of procedures collectively known as ``circumcision.'
'
Circumcision, however, was also a part of religious ritual,
including Judaism and Islam as well as others. However, 85
percent of the world's male population is not circumcised.
Circumcision in 1992 was still the most commonly performed
surgical procedure in America, where 59 percent of newborn males
underwent this operation. Circumcision reached its peak of 85 to
90 percent during the 1960s and 1970s. The surgery, usually
performed on baby boys within the first few days of life, is
often considered ``routine.'' The most popular methods, the Gomco
clamp and the Plastibell procedures, differ somewhat in technique
and instrumentation but the effects on the penis and the baby are
basically the same. Most of the American circumcisions are not
done for religious reasons, but rather, for hygienic ones.
Medical Procedure
Usually, the procedure for circumcision in America involves the
baby being strapped spreadeagle to a plastic board, with his
arms and legs immobilized by Velcro straps. A nurse scrubs his
genitals with an antiseptic solution and places a surgical drape
- with a hole in it to expose his penis - across his body. The
doctor grasps the tip of the foreskin with one hemostat and
inserts another hemostat between the foreskin and the glans. (In
96 percent of newborns, these two structures are attached to one
another by a continuous layer of epithelium, which protects the
sensitive glans from urine and feces in infancy and childhood.)
The foreskin is then torn from the glans. The hemostat is used to
crush an area of the foreskin lengthwise, which prevents bleeding
when the doctor cuts through the tissue to enlarge the foreskin
opening. This allows insertion of the circumcision instrument.
The foreskin is crushed against this device circumferentially and
amputated.
Anesthesia was not used to alleviate infant suffering until
recently because it was believed that babies do not feel pain.
Additionally, it was recognized that anesthesia was risky for the
newborn, thus contributing to the medical reluctance to use it
for painful procedures on infants, such as circumcision.
Currently, some doctors use a dorsal penile nerve block to numb
the penis during infant circumcision. While not always effective,
this anesthesia may afford some pain relief during the surgery,
although it offers no pain relief during the recovery period
(which can last up to 14 days) when the baby urinates and
defecates into the raw wound.
Function of the Foreskin
To understand the function of the prepuce, it is necessary to
understand the function of the penis. While it is commonly
recognized that the penis has two functions - urination and
procreation - in reality, it is essential only for procreation,
since it is not required for urination.
For procreation to occur, the normally flaccid penis must become
erect. As it changes from flaccidity to rigidity, the penis
increases in length about 50 percent. As it elongates, the double
fold of skin (foreskin) provides the skin necessary for full
expansion of the penile shaft. But microscopic examination
reveals that the foreskin is more than just penile skin necessary
for a natural erection; it is specialized tissue, richly supplied
with blood vessels, highly innervated, and uniquely endowed with
stretch receptors. These attributes of the foreskin contribute
significantly to the sexual response of the intact male. The
complex tissue of the foreskin responds to stimulation during
sexual activity. Stretching of the foreskin over the glans penis
activates preputial nerve endings, enhances sexual excitability,
and contributes to the male ejaculatory reflex. Besides the
neurological role of the preputial tissue, the mucosal surface of
the inner lining of the foreskin has a specific function during
masturbation or sexual relations.
During masturbation, the mucosal surface of the foreskin rolls
back and forth across the mucosal surface of the glans penis,
providing nontraumatic sexual stimulation. During heterosexual
activity, the mucosal surfaces of the glans penis and foreskin
move back and forth across the mucosal surfaces of the labia and
vagina, providing nontraumatic sexual stimulation of both male
and female. This mucousmembranetomucousmembrane contact
provides the natural lubrication necessary for sexual relations
and prevents both the dryness responsible for painful intercourse
and the chafing and abrasions which allow entry of sexually
transmitted diseases, both viral and bacterial.
When normal, sexually functioning tissue is removed, sexual
functioning is also altered. Changes of the penis that occur with
circumcision have been documented. These may vary according to
the procedure used and the age at which the circumcision was
performed, nevertheless penile changes will inevitably occur
following circumcision.
Circumcision performed in the newborn period traumatically
interrupts the natural separation of the foreskin from the glans
that normally occurs somewhere between birth and age 18. The raw,
exposed glans penis heals in a process that measurably thickens
the surface of the glans and results in desensitization of the
head of the penis.
When circumcision is performed after the normal separation of the
foreskin from the glans, the damage done by forcible separation
of these two parts of the penis is avoided, but the glans must
still thicken in order to protect itself from constant chafing
and abrasion by clothing.
The thickened, drier tissue covering the glans of the circumcised
penis may necessitate the use of synthetic lubricants to
facilitate nontraumatic sexual intercourse. Often, it is
erroneously considered the woman's lack of lubrication that makes
intercourse painful rather than the lack of natural male
lubrication, which is more likely the cause. During masturbation,
the circumcised male must use his hands for direct stimulation of
the glans, and this may require synthetic lubrication as well.
In addition to the predictable physical changes that occur with
circumcision, there are inherent risks and potential
complications from the surgery. These include, but are not
limited to, hemorrhage, infection, surgical damage and, while
rare, death. Surgical damage and healing complications can result
in extensive scarring, skin bridging, curvature of the penis, and
deformities of the glans penis and urethral meatus (urinary
opening). Extreme mutilations have resulted from inappropriate
electrocautery use in circumcision, causing loss of the entire
penis. Sexchange operations have been used as a ``remedy'' for
this iatrogenic condition.
While circumcision has potential risks and alters normal, sexual
functioning of the penis, proponents of the practice consider it
to confer many ``prophylactic'' benefits on the recipient. This
rationale was initiated in the Englishspeaking countries during
the 19th century when the etiology of diseases was unknown. At
that time, circumcision evolved from a religious ritual or
puberty rite into routine surgery for ``health'' reasons.
Within the miasma of myth and ignorance, a theory emerged that
masturbation caused many and varied ills, so some physicians
thought it logical to perform genital surgery on both sexes to
stop masturbation. In 1891, P.C. Remondino advocated circumcision
to prevent or to cure alcoholism, epilepsy, asthma, hernia, gout,
rheumatism, curvature of the spine, and headaches. As scientific
research uncovered legitimate pathological etiology for diseases
previously thought to be prevented or cured by circumcision, new
rationales were postulated to validate the practice. Prophylactic
circumcision of females fell out of vogue in Englishspeaking
countries, but the incidence of male circumcision steadily rose.
In the early 20th century, circumcision was advocated as a
hygienic measure. Though criticism of the practice mounted, it
was not until 1975 that the American Academy of Pediatrics came
out in opposition, arguing that good personal hygiene would offer
all the advantages of routine circumcision without the attendant
surgical risk. The advent of antibiotics negated the rationale
that circumcision was needed to prevent venereal disease.
As a religious ritual, circumcision is practiced by Jews and
Moslems in accordance with the biblical account of Abraham's
covenant with God. Even so, the ``purpose'' of the Jewish ritual
of circumcision has been argued by Jews throughout history. Noted
Rabbi Moses Maimonides, in the Guide of the Perplexed, explains a
rationale for circumcision that merits attention when
circumcision is considered relative to human sexuality.
As regards circumcision... [s]ome people believe that
circumcision is to remove a defect in man's formation; but every
one can easily reply: How can products of nature be deficient so
as to require external completion, especially as the use of the
foreskin to that organ is evident. This commandment has not been
enjoined as a complement to a deficient physical creation, but as
a means for perfecting man's moral shortcomings. The bodily
injury caused to that organ is exactly that which is desired; it
does not interrupt any vital function, nor does it destroy the
power of generation. Circumcision simply counteracts excessive
lust; for there is no doubt that circumcision weakens the power
of sexual excitement, and sometimes lessens the natural
enjoyment; the organ necessarily becomes weak when it loses blood
and is deprived of its covering from the beginning.
The Moslems, who also circumcise in accordance with the biblical
covenant between Abraham and God, traditionally circumcised their
males at age 13. More recently, however, Moslem boys are
circumcised at varying ages from birth to puberty.
In the United States, the religious rights of parents are being
questioned in regard to the constitutional rights of infants and
children. Freedom of religion became a legal issue when it was
introduced in a circumcision lawsuit claiming a male had been
denied his right to freedom of religion when his body was marked
by circumcision in accordance with his parents' religion.
The inalienable body ownership rights of infants and children
continue to be addressed within the U.S. legal system in lawsuits
asserting that the only person who can legally consent to a
circumcision is a person making this personal decision for
himself. The reports of dissatisfaction with parental
circumcision decisions by circumcised men help to illustrate this
point. Performed on their penises without their consent,
thousands are now undergoing foreskin restoration, either medical
or surgical, to reconstruct what they consider was violently
taken from their bodies early in their lives. The Declaration of
the First International Symposium on Circumcision acknowledges
the unrecognized victims of circumcision and, in support of
genital ownership rights of infants and children, states: ``We
recognize the inherent right of every human being to an intact
body. Without religious or racial prejudice, we affirm this basic
human right.'' Due to the lifelong consequences of the permanent
surgical alteration of children's genitals, it becomes imperative
that children have the right to own their own reproductive organs
and to preserve their natural sexual function.
These, then, are the human genitals. Considering their great
delicacy, complexity and sensitivity, one might imagine that an
intelligent species like man would leave them 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)
REFERENCES
American Academy of Pediatrics. Care of the Uncircumcised Penis.
Evanston, Ill.: American Academy of Pediatrics, 1984.
American Academy of Pediatrics' Task Force on Circumcision.
Report of the Task Force on Circumcision. Elk Grove Village,
Ill.: 1989.
Morris, D. Body Watching. New York: Crown, 1985.
Remondino, P.C. History of Circumcision From the Earliest Times
to the Present. Philadelphia: F.A. Davis Co., 1892. Republished
New York: AMS Press, 1974.
Wallerstein, E. Circumcision: An American Health Fallacy. New
York: Springer Publishing Co., 1980.
Marilyn Fayre Milos Donna R. Macris ----------------------------
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