The baby, Phil, is less than a day old. His tiny head still slightly misshaped, his eyelids puffy, his mouth half-open in his sleep. The nurse has taken him from his mother and is carrying him to another room in the pediatric ward. The nurse clicks on a white metal lamp with a twist of her fingers, removes the child from a cozy blue blanket, and lays him in a cold molded plastic form that is bolted tightly to the counter. This form fitting shell is called a Circumstraint. There are indentations for the babys arms and legs. The nurse methodically binds the secure restraining straps around his limbs, bends the flexible metal light over him and steps back. The baby is naked and spread-eagle, and he begins to cry. For many boys, life begins with circumcision, a painful cut to the sensitive skin on his penis. Is it necessary?Every 30 seconds a baby boy is circumcised. It is the most common surgery performed in America. It is usually done without anesthesia, and often without the consent of the parents.
I never questioned it, says Mr. Theodore, the father of a circumcised boy. The doctor took him away, performed the operation and brought him back. Thats just the way it was done. I was circumcised; he was circumcised. I dont even remember signing a consent form.
Thats typical, according to Craig Shoemaker, M.D., a North Dakota pediatrician and member of the American Academy of Pediatrics (AAP) task force on circumcision. Many doctors do not adequately counsel parents regarding circumcisionwhat the risks are, what the potential benefits are, how much it costs. Performing a circumcision without such counseling is inappropriate. Some people would call it criminal assault. Most parents dont know what circumcision really is, and yet 65 percent of them still allow doctors to do the surgery.
America is the only country in the Western world that routinely circumcises newborn boys. Eighty-five percent of the worlds men are uncircumcised. The practice violates all seven principles of the American Medical Associations code of ethics, charges George Denniston, M.D., a Seattle physician and founder of Doctors Opposing Circumcision. By definition its not even surgery. Surgery is removal of diseased tissue, or a repair of some kind. Nonsense, says Edgar Schoen, M.D., director of perinatal screening at Kaiser Permanente Medical Center in California, and an outspoken proponent of circumcision. There are numerous medical reasons for it. This pro and con argument has been raging in the medical community for almost three decades. Meanwhile, the circumcisions continue.
The doctor enters the room, scrubs his hands in the sink, and snaps on plastic gloves. The nurse passes him a package, and he opens it on the counter beside the child. Inside are several large, light blue cloth napkins; some squares of gauze; a squeeze-tube of Betadine (an antiseptic ointment); and an assortment of stainless-steel utensils: a pair of scissors, two hemostats (small needle-nose pliers), a heavy metal clamp attached to a hollow cone, a scalpel handle, and a scalpel in a sterile packet.
If youre like most American men, youre circumcised. But you probably havent given it any thought since junior high school, when you first noticed that not every kid in the locker room looked the same. In fact, if youre single or childless now, you may think that its purely a father/son issue of little concern to you. Think again. Circumcision removes one-third to one-half of the skin on the penile shaft, says Ronald Goldman, Ph.D., executive director of the Circumcision Resource Center in Boston and author of Circumcision: The Hidden Trauma. The average circumcision cuts off what would grow into about 12 square inches of sexually sensitive skin.
According to Canadian pathologist John Taylor, M.B., the foreskin is one of the key erogenous zones of the male body. Its 240 feet of nerves and 1,000 nerve endings are similar to those on the fingers and lips.
The fact is, says Goldman, when it comes to sex, circumcised men dont know what theyre missing. But a few do. Increasingly, men who were circumcised as adults (for various medical reasons) are speaking out against circumcision, providing firsthand accounts of sex before and after.
I had ample sexual experience, and I was quite happy as an intact male, says Rick Thomas, who was circumcised on advice of his doctor at age 26. After my circumcision, that pleasure was utterly gone. On a scale of 10, the uncircumcised penis experiences pleasure of at least 11 or 12; the circumcised penis is lucky to get to 3. If men who were circumcised at birth knew the loss of pleasure they would experience, they would storm the hospitals and not permit their sons to undergo this.
Douglas MacArthur, a 55-year-old locksmith from Pennsylvania who was also circumcised as an adult, reports similar problems. Sex before circumcision was like driving a luxury car with automatic transmission, he explains. I used to just glide along. Sex now is like driving a tiny, powerless compact with a manual transmission. It takes a lot of work to get anywhere. My penis has lost 90 percent of its sensitivity.
Only in the last decade have scientists devoted in-depth studies to the structure and function of the foreskin. The foreskin is a complex, two-layer organ similar to the eyelid; its designed to protect the head of the penis from abrasion and infection. Its surface represents 50 percent of all penile skin, and folds around the opening of the penis. Its inside surface is composed of a soft mucosa that secretes antibacterial and antiviral lubricants called smegma, which further protect the glans from friction and infection. Because the glans is sheathed in this moist envelope, it retains its sensitivity. During sex, the foreskin glides along the penile shaft, providing lubrication and stimulation.
Says one spouse of her uncircumcised husband: Theres a big industry in this country selling lubricants and jellies to enhance sex, but theyre unnecessary for those of us lucky enough to have married an uncircumcised man. An intact mans glans is naturally moist and juicy.
The doctor swabs the babys testicles and penis with antiseptic-soaked gauze, then lays one cloth over his torso, another over his legs, and a third, with a small hole in the middle, over his genitals. He pops the tiny penis through the hole. The baby is still crying. The nurse mentions that babies feel safest in the fetal position. She says they hate having their arms held away from their bodies. The parents are not in the room. The nurse shuts the door.
Outside of the Jewish community, where its a religious rite, circumcision was practically unheard of in America until 1870, when Lewis Sayre, M.D., claimed to have cured a 5-year-old boy of paralysis by stretching out his foreskin and snipping it off. For the next two decades, Dr. Sayre and his associates crusaded for circumcision, claiming it could cure hip-joint disease, epilepsy, hernia, convulsions, elephantiasis, poor eyesight, tuberculosis, and rectal prolapse, among other things. This was all disproved, of course, and circumcision would probably have vanished from the American medical scene had its backers not found a compelling new way to sell it: as a cure for masturbation.
To the publicly puritanical but privately lascivious Victorians, masturbation was the root of numerous social maladies and physical illnesses, including blindness and even insanity. Naturally, they believed, if circumcision could prevent masturbation, it would prevent other diseases as well.
Doctors of the time reported that removal of the protective covering of the glans tends to dull the sensibility of the penis and thereby diminishes sexual appetite. In 1888, John Harvey Kellogg, M.D., of cereal fame, summed up the medical professions opinion and gave justification for the next 60 years of foreskin removal. A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the pain attending the operation will have a salutary effect upon the mind.
The doctor snaps the scalpel blade onto the handle, then places it beside the baby. Lifting the hemostat, which resembles a sharp-tipped pair of pliers, he begins. Holding the penis in one hand, he moves the point of the hemostat through the hole at the end of the foreskin. The foreskin is tightly attached to the glans, like a fingernail to a finger. The doctor begins pushing the point between the foreskin and glans. The operation is similar to running a razor blade underneath the fingernail. The baby bucks on the plastic form, in obvious pain.
By the end of World War II it was clear that circumcision was not stopping men from masturbating; but, by then, the procedure was institutionalized. It had become the norm for white, middle-class American men. The uncircumcised were often recent immigrants or African-Americans. Probably as a result of racial prejudice, the uncircumcised penis was viewed as unhygienic and unclean. But this, too, turns out to be false.
The uncircumcised penis is self-cleaning, explains Robert Van Howe, M.D., a pediatrician from Wisconsin who has been studying the causes of circumcision for 20 Years. Every time you urinate, you flush out the preputial cavity. The hygiene issue was just another excuse. Since its inception, circumcision has been a surgery looking for a rationale. First it was disease, then masturbation, then hygiene; now its back to disease. In 1971 the American Academy of Pediatrics (AAP) stated that circumcision was medically unnecessary. At the time more than 80 percent of American baby boys were circumcised. Then in 1989, the AAP released a new position paper that equivocated: Newborn circumcision has potential medical benefits, as well as disadvantages and risks. Still, by the following year, the rate was down to 59 percent. Dr. Schoen chaired the AAP task force that made that reversal. He still stands by the position, claiming that the foreskin is the genital equivalent of the appendix, and that newborn circumcision is a preventive health measure analogous to immunization.
The most important health benefit of circumcision is the decreased risk of urinary-tract infections, explains Dr. Schoen, citing a well-known 1985 study, which he says has since been overwhelmingly confirmed by other studies. But Martin Altschul, M.D., a pediatrician and M.I.T.-trained mathematician, has reexamined the evidence and finds it fraught with problems.
The whole body of research on this issue is a how-to-lie-with-statistics classic, argues Dr. Altschul. Depending on how you collect the data, you can get almost any result you want. Dr. Altschuls own research also found that many of the urinary-tract infections in uncircumcised boys were attributable to congenital anomalies. Recently, several studies have suggested that neonatal circumcision may actually increase the infection rate.
Dr. Schoen cites two other medical benefits of circumcision, namely decreased risks of developing penile cancer and contracting sexually transmitted diseases, such as HIV and syphilis.
Youre more likely to be struck by lightning than to suffer from penile cancer, counters Dr. Van Howe. Japan, Norway, Finland, and Denmark all have lower rates than the United States, and they dont circumcise their boys.
In fact, in 1996, representatives of the American Cancer Society wrote a letter to the AAP in which they pointed out that fatalities caused by circumcision accidents may approximate the mortality rate from penile cancer. The letter also stated that perpetuating the mistaken belief that circumcision prevents cancer is inappropriate.
Penile cancer is extremely rare-less than one case for every 100,000 men, adds Dr. Altschul. Its preposterous to even suggest that because we have some minuscule risk of disease, we should cut off the foreskin of every little boy.
Breast cancer in women is common, says Dr. Denniston, more common than all the purported health risks of the foreskin combined. Does that justify cutting off all breasts at puberty? What about circumcised men and STDs? A recent study published in the Journal of the American Medical Association found that circumcised men did have a lower incidence of syphilis and HIV. But they had a higher rate of infection with herpes, hepatitis, and chlamydia. Overall, the study authors wrote, We found no evidence of a prophylactic role for circumcision, and a slight tendency in the opposite direction.
The bottom line, says Dr. Denniston, is that the alleged benefits of circumcision dont approach the risks.
The child struggles against the straps. The foreskin is attached firmly to the glans, and its difficult to pry loose. The doctor scrapes the point of the hemostat in a circular motion around the glans, tearing the skin off the head of the penis. The child continues to buck on the plastic form. This is why the Circumstraint is bolted to the counter.
July 3,1991; Oakland, California: While circumcising a 12-hour-old baby, the doctor cuts off one-third of the glans. The severed head is reattached, but the child is disfigured. A court awards the minor plaintiff $256,000.
September 12,1992; San Diego, California: During a circumcision, a doctor cuts off a boys glans. The doctor claims that since there is no apparent loss of function, he met the standard of care. A jury awards the minor plaintiff $36,400 in damages.
July 18, 1995; Houston, Texas: A 5-year-old boy goes into a coma while being circumcised. He dies a week later.
The complication rate for circumcision varies from 2 to 6 percent, says Dr. Van Howe. The average male will have more health problems from being circumcised than from being left alone.
Some medical professionals believe that circumcision for other than religious purposes would disappear from America if it werent covered by insurance. This is what happened in England, where the circumcision rate prior to World War II was roughly equivalent to that in the United States. After the war, British doctors could find no compelling evidence to continue the surgery, and it was dropped from the list of covered services. Within a decade, the circumcision rate dropped from 50 percent among the working class and 85 percent among the upper class to less than half a percent in both.
Bibliography:Oech, R. (1998). A whack on the side of the head. New York, NY: Warner Books, Inc.
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