Table Of ContentUnderstanding Circumcision
A Multi-Disciplinary Approach to a
Multi-Dimensional Problem
Un derstanding Circumcision
A Multi-Disciplinary Approach to a
Multi-Dimensional Problem
Edited by
George C. Denniston
University of Washington
Seattle. Washington
Frederick Mansfield Hodges
Yale University
New Haven. Connecticut
and
Marilyn Fayre Milos
National Organization of Circumcision Information Resource Centers
San Anse/mo. California
Springer Science+Business Media, LLC
Proceedings of the Sixth International Symposium on Genital Integrity: Safeguarding Fundamental
Human Rights in the 21st Century, held December 7-9, 2000, in Sydney, Australia
ISBN 978-1-4419-3375-1 ISBN 978-1-4757-3351-8 (eBook)
DOI 10.1007/978-1-4757-3351-8
© 2001 Springer Science+Business Media New York
Originally published by Kluwer Academic/ Plenum Publishers, New York in 2001.
Softcover reprint ofthe hardcover Ist edition 2001
http://www.wkap.nl
10987654321
A c.I.P. record for this book is available from the Library of Congress.
All rights reserved
No part of Ihis book may be reproduced, stored in a retrieval system, or transmitted in any form
or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise,
without written permission from the Publisher
Preface
This year, the parents of approximate1y l3 million boys and 2 million
girls will hand their children over to a circumciser who will cut off part or aIl
of their external sexualorgans. This phenomenon is not restricted to
primitive third-world cultures but is also found in a few industrialized
countries as weIl. Regardless of the amount of sexual tissue that is amputated
from each child and no matter who performs the surgery - be it a doctor, a
witch doctor, a barber, or a "holy man," the parents who do this to their
children do so with the best of intentions. Whether motivated by custom,
religious belief, identity issues, medical routine, fear, or superstition, most of
these parents feel they have no alternative. Most have probably never
considered that there could be an alternative way to achieve the benefits they
believe they gain through the circumcision of their children.
Children are rare1y subjected to circumcision for no reason. Instead, each
culture that performs circumcision on children believes that a complex and
enticing list of benefits will accrue from the practice. In many African
countries, parents have their sons circumcised because they believe that the
operation will trans form their boy into a man. Circumcision to them is not a
symbol or a marker of the passage from childhood to adulthood, but the
agent responsible for that physical and cultural change of status. Also in
Africa, many parents have their daughterscircumcised because they believe
that the sexual parts tagged for amputation will prevent their daughter from
becoming a respectable and marriageable adult. In Egypt, even though
female circumcision has been recently banned, the medical profession has
endorsed and continues to endorse female circumcision and has evolved a set
of medical rationale for the procedure that convince even the most educated
Egyptian parents that female circumcision and clitoridectomy have the
v
VI Preface
backing of science, and that they are simple procedures with low morbidity
and with a number of real medical benefits that accrue over a lifetime.
At the time of the tremendous political turmoil, social uncertainty, and
economic confusion of the post-World War 11 era, the United States joined
the ranks of these traditionally circumcising third-world countries and gained
the dubious distinction of being the only western nation that circumcises the
majority of its newborn males. The reasons that American parents today give
for permitting this to occur are just as sincerely feIt as those given by
African parents. American parents are told that the surgery is necessary, that
it is harmless, and that whatever limitations might be placed on these two
attributes, it is imperative that they conform. Prior to this time, circumcision
had first emerged in the nineteenth century as an alleged therapeutic and
eugenic measure designed to cure and prevent such diseases and behaviors
as masturbation, insanity, epilepsy, 'excess' sexual drive, nervousness,
noctumal seminal emissions (sperm~torrhrea), venereal disease, enuresis,
convulsions, hip-joint disease, tuberculosis, strabismus, malnutrition, and a
host of other conditions. While few doctors at this time advocated
circumcision as a routine, patients and parents on behalf of children accepted
the rationale for therapeutic circumcision for the same reasons that they
accepted the other dominant forms of nineteenth-century therapeutics, i.e.,
bleeding, purging, and major limb amputations. These interventions were the
most modem and seemingly effective treatments that modem medical
science had yet evolved. After World War 11, when birth moved from the
horne to the hospital, the radical idea of systematically circumcising every
newborn male baby became feasible and was quickly implemented in most
major urban hospitals. Interestingly, in those other English-speaking western
nations that had similar histories with therapeutic circumcision in the
nineteenth century, such as the United Kingdom, South Africa, New
Zealand, and Australia, pro grams of indiscriminate mass circumcision were
either rejected, as in Britain and white South Africa, or abandoned soon after
they were implemented, as in New Zealand and Australia.
While medicalized circumcision in the United States is indisputably a
relic of a long history of medical error, medical misconduct, and a history of
unwelcome, uninvited, intrusive, and invasive over-regulation of the private
lives of the populace, the force behind the continuation of circumcision is no
longer driven simply by medical administrators, although they still play a
major part in the perpetuation of this practice. Parents have internalized the
pro-circumcision propaganda that has been fed to them their entire lives, and
they have learned to expect and choose circumcision for their newborn
babies. As in all cases of supply-Ied demand, they choose it because they
have been told to choose it. They also demand it because it has entered the
realm of cultural artifacts that are beyond critical evaluation.
Preface VII
As with female-circumcising cultures that downplay or deny the harm
caused by female circumcision, those cultures that circumcise their boys
likewise trivialize the damage inflicted and are silent to the abuse of human
rights involved. Many people are uncomfortable with the linking of male and
female circumcision. They may deny that there is any analogy between the
two rituals, stating that the negative health consequences of female
circumcision are far more severe than anything circumcised males might
suffer. Human suffering, however, cannot be so easily measured or
calibrated according to the amount of tissue lost or the degree to which
function is impaired. Suffering is deeply personal, and it behooves us as
civilized beings to take seriously anyone who feels that he or she has been
injured, especially when that injury is claimed to have been unjustly
inflicted. Those who claim that male circumcision is acceptable while female
circumcision is unacceptable because far more tissue is removed during a
female circumcision procedure would hardly become supporters of female
circumcision if the reverse were true. This is because they unconsciously
recognize that the fundamental violation of female circumcision is the
cutting of another person's body without that person's informed consent,
which has voluntarily been given, free of any coercion or undue influence.
The violation occurs with the very first cut into the genitals of another
human being. The true analogy between male and female circumcision lies
not in the points of structural correspondence and the amount of tissue
removed, but in the human rights violation posed by any degree of
involuntary cutting of the genitals.
The amount of tissue lost in male circumcision, however, is just as
variable as that lost in female circumcision. The functional impairment that
results from any degree of tissue loss is generally unrecognized because, in
circumcising cultures, those performing, advocating, and permitting the
circumcision of children were generally themselves circumcised as children.
They are unaware of their loss because they have no conscious awareness of
ever having had intact genitals. They have no basis for comparison. In the
United States, the amount of tissue amputated from the penis is highly
variable, but, on average, at least 50% of the penile shaft skin is amputated
during neonatal circumcision.t•2 Elsewhere, however, circumcision is more
extensive and involves the removal of all the skin from the penis. Practiced
in parts of Saudi Arabia,3 the aggressive form of circumcision, known as
'pubic circumcision,' skin stripping,' or 'penile flaying,' cuts away all the
skin from the navel to the anus, including the entire external male genitalia.
Hot oil is then applied to the massive wound. Pubic circumcision was
reported to have been practiced in Yemen and may still prevail there.4 The
death rate is high and the risk ofpost-circumcision penile cancer is markedly
V111 Preface
increased,5-6 but remarkably few objections have been raised against this
practice.
Likewise, the severely mutilating tradition of penile subincision,
practiced by certain Australian aboriginal tribes, consists of slicing off the
prepuce and then splicing open the urethra on the ventral aspect of the penis
from the tip of the glans to the seroturn and splaying it out. 7 Again, no one
seems to care how many boys die, almost die, or suffer a life-time of
impaired penile function as a result of this ritual. In India, and perhaps
elsewhere, millions of parents are induced to hand their young boys over to
the hijra sect, who not only amputate the prepuce, but amputate the entire
penis, as weIl as the seroturn and testicles. Confirmation that adolescent boys
are also kidnapped and forcibly sexually mutilated by hijras has done
nothing to elicit sympathy from western governments. The severe, life-Iong
debility suffered by the 1.1 million Indian pre-pubescent boys who have
been forcibly turned into eunuchs has elicited no outcries among western
intellectuals or those who decry the clitoridectomy and infibulation of
females in Africa. lust as American boys are circumcised by circumcised
adults, so these unfortunate Indian boys are castrated by adult eunuchs. Even
amongst those African tribes whose male circumcision practice removes the
same amount of penile skin as in an American hospital circumcision, the
morbidity and mortality is alarmingly high.8-12 Where are the voices of
compassion and indignation when African boys are killed in these 'mild'
circumcision rituals? What of the American or Australian boys who are
killed or severely injured in circumcision accidents at the hands of doctors?13
Is their suffering to be dismissed and ridiculed simply because they are boys
or because the perpetrators are medical doctors? lust as no reasonable person
would encourage an African female circumciser who has just killed a girl to
be more careful the next time, and would, instead, encourage her to lay down
her knife, so it only makes sense for us to find ways to encourage western
doctors to lay down the knife and spare young boys the indignity of having
their right to sovereignty over their own bodies violated. Compassion, if it is
to have any meaning, cannot make any gender distinction. As Shane
Peterson' s paper eloquently attests, circumcision accidents of any degree can
have a devastating effect on a human life. There can be no justification for
consigning anyone anywhere to a lifetime of shame, degradation, debility,
and deformity to any degree.
It is instructive to note that most of the western world today unanimously
rejects any degree of surgical interference with the genitals of females while
simultaneously remaining silent about even the severest forms of ritualized
surgical interference with the genitals of males. Even the genital trauma
inflicted on the youngest of male babies arouses little if any feeling. Why are
male genitals so extremely devalued when female genitals are so highly
Preface 1X
prized? Clearly, one of the reasons is that the powerful and dominant
American medical profession actively supports and practices male
circumcision, thereby contributing to the legitimization of any and every
comparable tribaI ritual anywhere on the globe. One can only assume that, if
the American medical profession still carried out female circumcision and
c1itoridectomy with the zeal it did during the Victorian era,14-16 western
opposition to female circumcision in Africa would not exist.
In this age of cultural, ethical, scientific, and technological advancement,
why does circumcision - a relic of a primitive, barbarous, and superstitious
past - persist? The papers presented in tbis volume attempt to find an
answer to that question, examining it from a variety of angles. While we can
never know what compulsions induced the first human ever to take a knife to
a child's genitals, we can, in fact, discover and examine the myths, excuses,
and justifications that have subsequently been invented to rationalize the
spread and perpetuation of this practice.
One of the forces driving the practice of circumcision is willful ignorance
of the basic anatomy and physiology of the structures being cut off. As Ken
McGrath points out in his paper, it was not until 1996, with the publication
of Dr. John Taylor's ground-breaking anatomical study of the innervation of
the male prepuce,17 that the medical profession was forced to confront the
fact that circumcision resulted in a serious loss in penile sensitivity and
functionality. Dr. McGrath's paper presents the fruits ofthe latest anatomical
research into this remarkable human genital structure. The arrogant,
circumcision-supporting medical dogma to the effect that the prepuce is 'just
a worthless little tag of skin' must now be forever assigned to the growing
scrap heap of self-serving medical errors.
Another force that helps perpetuate circumcision is the ignorance
surrounding the origins of circumcision. When most westerners consider the
origins of circumcision, they instinctively give first consideration to the
familiar biblical narrative concerning the origin of the ritual circumcision
rite ofthe Jews. The mere fact that this blood rite is mentioned in the Torah,
however, does not account for its survival among the Jews of the present
day. Given that the theocratic, priest-centered, temple Judaism in which the
practice of ritual Jewish circumcision originated has long been superceded,
why has circumcision survived among the Jews of today? Furthermore,
given the corresponding fact that the vast majority of Jews for the last 2000
years have consciously and willingly rejected the majority of the many rules,
regulations, and prohibitions that defined that type of antique, Torah-based
Judaism - even most or all of the restrietions considered so important in
their day as to require the death penalty for anyone who failed to observe
them - how could ritual circumcision have persisted? Dr. Leonard Glick
presents a probing and original analysis of the unique socia! circumstances
x Preface
that have given circumcision such a powernd meaning for the Jews over the
centuries. The answer, he argues, lies not in the acceptance of circumcision
by the Jews, but its rejection by the nations and religions with which the
Jews have had their most stressful and uneasy relationships.
Given the prominent role that the Bible and its stories have played and
continue to play in western culture today, it is easy to lose sight of the fact
that the Bible only provides a heavily mythologized and reworked
explanation for the origin of circumcision among the Jews. It does not
provide an explanation for the origin of circumcision, for instance, in the
United States, Australia, New Zealand, or South Korea. This simple and
seemingly obvious fact may come as a surprise to the majority of Americans.
In almost all popular and medical accounts of the origins of medical
circumcision in the United States, especially those accounts that appear in
medical journals, the true history of American medical circumcision is
glossed over. Instead of full disclosure, this secret history is routinely
replaced by a summary of the biblical account of the origin of circumcision
among the ancient Hebrews. This act of cultural and historical substitution
gives the impression that there has never been a time when Americans did
not practice circumcision, and that circumcision has been practiced by all of
humanity since biblical times. This also implies that the history of the
Hebrews, as presented in the Bible, is the history of all peoples, and that
there are no peoples more ancient than the Jews. While the true history of the
origin of male and female circumcision in American medical practice has
been outlined in the first volume of this series,18 the present volume provides
a useful and fascinating disc10sure of the origins of circumcision in
Australia, New Zealand, and South Korea.
In their original paper detailing the surprising history of male
circumcision in South Korea, Drs. Myung-Geol Pang, Sae Chul Kim, and
Dai Sik Kim go beyond the obvious fact that circumcision was deliberately
imposed on the defeated and humiliated Korean people by the conquering
Americans, through the agencies of American military-controlled hospitals,
following the Korean War. Instead, they underscore the powerful role that
sociological factors have played in the perpetuation of male circumcision in
South Korea despite the end of active American control of Korean political,
economic, military, and medical affairs. In the last fifty years since
circumcision was introduced in South Korea, an elaborate web of medical
and cultural myths, misunderstandings, distortions, and even deliberate lies,
have conspired to make South Korea the nation with the highest rate of
circumcision in the world today.
The Korean experience demonstrates just how quickly a nation's
traditional cultural values can be destroyed by circumcision and its
accompanying culture of frantic post-hoc rationalizations. It also proves that
