By Daniel N. MacClymont

“Everyone’s doing it,” “He slept right through” and “It’s just a snip!”, as is commonly said—circumcision in the US is thought to be harmless, painless, and beneficial to a child’s health. Afforded as much consideration as tying one’s shoes, this Victorian-era punishment-for-masturbation has managed to embed itself in American culture.¹ However, its irreversible impact is profound—from the effects of trauma on the developing brain, to the loss of sexual function, to the estimated 100+ infant deaths a year in the United States.² Circumcision is a deeply misunderstood and medically unnecessary surgery with lasting consequences. 

Typically performed within the first few days of an infant male’s life, circumcision amputates the foreskin, an integral part of the genitals making up around half of the penile-skin system.³ Its harm is diverse but can roughly be broken down into three compounding categories briefly outlined below. The first is the direct result of overwhelming pain for extended durations of time on an infant who lacks the ability to resist. The second is the lifelong loss of sexually functional tissue and the accompanying litany of complications. And the third, is the emotional impact on the child into adulthood and throughout life. Further outlined below, is how these modes of harm warrant the expansion of existing US legislation, which presently only protects females from circumcision, to include all children—male, female, and intersex—as well as how an organization called the ‘Genital Autonomy Legal Defense and Education Fund’ (GALDEF) can help to make this happen.

The Loss of the Foreskin

The foreskin is double-layered and nerve-laden specialized sexual tissue consisting of the majority of pleasure receptors of the penis.⁴ Of its many functions, one is the facilitation of intercourse, made possible by both its natural lubricant secretion and roller-bearing-like gliding motion. This unique action is not replicated by any other human anatomy. It involves unfolding back past the head before subsequently enfolding over the top of it while gliding back and forth on the shaft. During this erotogenic motion, a number of sexual structures that are lost to circumcision, such as the ridged band and frenulum, are stimulated in concert to make for a more complete sensory experience. Many have likened the foreskin’s substantial impact on improving sexual pleasure to the difference between seeing in color as opposed to black-and-white.⁵

In addition, the foreskin also serves to protect the head of the penis, retaining its moist and sensitive state as a mucosal and sexually sensitive tissue. When the foreskin is lost, layers of protein cells called keratin build up upon the surface of the skin, burying pleasure receptors and creating reduced sensation with age.⁶

Though prevalent, the vast complications of circumcision go largely unacknowledged by the American medical industry. They include tight or painful erections stemming from an insufficient remainder of skin after the surgery. This outcome affected as many as one-quarter to one-half of self-selected respondents on surveys of circumcision harm.^7, 8 It has also been known to lead to friction and painful intercourse as skin from the pubic area is pulled forward causing hair to be present on the shaft. Other complications include amputation of the head or entire penis, skin bridges, excessive scarring, disfigurement, chordee or excessive penile curvature, erectile dysfunction, buried penis, the partial or complete loss of sensation, as well as bleeding, infection, and death, among dozens of others.⁹

The Pain and Trauma

There is no effective pain relief for infant circumcision, and historically it has most often been omitted entirely.^{10, 11} The circumcision surgery involves strapping the infant’s limbs to a restraining-board known as a Circumstraint™ such that the only moveable part of his body becomes his head. Subsequently, it entails a ripping, crushing and finally cutting of the genitals as part of the process of separating the highly innervated foreskin from the rest of the penis and leaving in its place a permanent scar. 

Dozens of studies as well as observable infant reactions have confirmed the intense pain of circumcision.¹² Increases in heart rate of over 50 beats per minute with levels of the stress hormone, cortisol, reaching 3 to 4 times that of baseline have been recorded.^13, 14 Other times, infants appear to be unresponsive, leading observers to believe they are sleeping through the surgery when in fact they have lapsed into a semi-comatose state. As psychologist Ron Goldman, Ph.D. put it “Since the infant cannot escape physically, he attempts to escape psychologically.”¹⁵ Those that stay conscious however, cry and scream vigorously, and gasp for air. Sometimes they develop cyanosis, or a blueness of the skin from oxygen deficiency, in the process.¹⁶ Others have been known to vomit from the pain creating an associated risk of choking, and in one instance, an infant ruptured his stomach after 90 minutes of vehement crying.^{17, 18}

The Emotional and Psychological Impact

It is a widely held assumption that the limited ability of adults to recall their infancy suggests that pain experienced in this timeframe is inconsequential. In actuality, the mind and body are historical repositories that remember everything. Immediately observable symptoms of trauma are apparent in infants following circumcision such as disruptions to sleep patterns, a reluctance towards breastfeeding, and an inability to be consoled.^19, 20 Furthermore, many studies have shown that adverse experiences of a newborn can abnormally alter brain development and behavior in later life.^{21, 22, 23, 24, 25}

While it is tacitly assumed that men are happy with their circumcised condition, many describe their feelings towards it in the language of violation, torture, mutilation, and sexual assault.²⁶ “Anger is a pallid euphemism for what I felt…” wrote one.²⁷ “The physical scar is hideous, but the emotional scar equates to rape…” explained another.⁸ Circumcision has been connected with reduced emotional expression in adults, as well as the avoidance of intimacy, low self-esteem, feelings of distrust, sexual anxieties, phobias and dysfunctions, and a limited capacity for pleasure, among others.²⁸

The Call for Equal Rights

The right to bodily integrity is a fundamental one that has been enshrined in the United Nations Declaration of Human Rights since 1948. However, since 1997 when female genital cutting was first outlawed at the federal level, US law has only protected females while male and intersex children have been left behind. This is an affront to the US Constitution which proclaims that all persons are to be guaranteed equal protection under the law. It furthermore contravenes numerous state-wide Equal Rights Amendments, the Hippocratic Oath, the American Medical Association’s Code of Medical Ethics, the World Association for Sexual Health’s Declaration of Sexual Rights, and both the United Nations Convention on the Rights of the Child as well as the Convention Against Torture.

In 2012, a German regional court declared in a landmark case that the circumcision of children constitutes “grievous bodily harm.”²⁹ This set in motion a ripple effect that has grown into the recognition of the Worldwide Day of Genital Autonomy by over 90 organizations internationally. It is long past time that the United States follows in this direction, and the formation of GALDEF was undertaken with this pursuit in mind. GALDEF believes that specific and targeted legal action, known as impact litigation, can resonate throughout society, the judicial system, and beyond to answer the call for equal rights and stop the harm of non-consensual child genital cutting. To this end, GALDEF continues to work to create a world in which the right of everyone to bodily integrity and the freedom to choose what’s done to their own genitals, when they are old enough to understand the consequences, is legally protected. 

Sources

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3. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol. 1996 Feb;77(2):291-5. doi: 10.1046/j.1464-410x.1996.85023.x. PMID: 8800902. ↩︎
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