STOP Circ

Myth: Circumcision Inevitable Later
by Mary G. Ray ©1997, All Rights Reserved

       “The overwhelming majority of uncircumcised boys never develop medical problems.” [Pantell] The fear that circumcision will be required later is unwarranted. Rates in all countries other than the U.S. are miniscule. They range from 1 in 200 in some, to as low as 1 in 600 in others.  Which is Worse - Adult or Infant Circumcision?   (...Do You Think He'll Need it When He's Old?)

       Compared to 22 other medically advanced nations, the U.S. rate of circumcision after the neonatal period is unusually high at 8% to 10%. Anti-circumcision advocates suspect that money plays a role. Circumcisions performed after the neo-natal period can become quite expensive. Some people blame the higher rate of circumcision, during and after infancy, on cultural bias against the intact penis.

       To begin with, the majority of Americans are circumcised. In a culture where the circumcised penis is dominant and encouraged, doctors rarely encounter an intact male who needs treatment. The largest group of intact men are over 55 years old. They rarely, if ever, experience a problem related to their intact state. American doctors have few opportunities to consider and practice alternative methods of care. Non-surgical remedies exist. Unfortunately, American doctors tend to recommend radical circumcision no matter what. “...circumcision should be used only when there is evidence that conservative treatment is unlikely to be effective or that it has failed.” [British]

       During a child’s early years, a lot of unnecessary attention is placed on the intact penis for fear that something will go wrong. Boys and men are often circumcised later in life for the slightest of problems. Radical circumcision is routinely recommended as the only cure. Parents are rarely advised that non-surgical remedies exist and are usually just as effective no matter what the problem might be. Some circumcisions are done based on misinformation and some ultimately occur for no reason at all.

       Many boys are circumcised later because the foreskin is blamed for a UTI (urinary tract infection ). UTIs are most often associated with urologic disorders and abnormalities. [Boston] Many parents are incorrectly instructed by medical professionals that they need to retract and clean underneath the foreskin from infancy onward. “There should be no rush to achieve full retraction.” [Schmitt] It occurs naturally, usually by puberty.

       “It has been proven that retraction and washing of the infant foreskin can cause urinary tract infections...” [Fleiss-1] In any event, the UTI can be treated with antibiotics. The results are usually effective. Overzealous attempts to clean the foreskin should be completely avoided. For more information on this type of infection, see UTIs Rarely Caused by Foreskin

       Because the foreskin is fused to the penis during infancy and early childhood, forced retractions are painful. It is not possible to pull a fused foreskin back without tearing it. Doing so can cause a UTI. Scarring, phimosis and other serious injuries can occur. Invasive medical interference often occurs because of misinformation, improper guidance, supposition and unnecessary exploration by medical professionals.

       Phimosis (persistent tight foreskin) is a rare condition that cannot be diagnosed until adolescence or later. [Gairdner] [Oster] The term is often incorrectly applied to any foreskin that cannot be retracted. Many people think the foreskin should retract during infancy. In fact, the foreskins of infants and young boys are naturally fused to the glans. Retraction is a very gradual process. A non-retractable foreskin is normal in childhood and should not be confused with phimosis. Phimosis is commonly misunderstood and misdiagnosed. It is the leading excuse to circumcise young boys when their foreskins have not retracted by the ages of 2, 3 or 4 years old. [Derifield] “Using the surgical treatment of circumcision to prevent phimosis is a little like preventing headaches by decapitation.” [Robin]

       Para-phimosis can also be caused by rigorous or unclean retraction attempts. [Schmitt ] This is when the foreskin becomes stuck behind the head of the penis. In either situation, the foreskin is inappropriately blamed and circumcision is recommended. However, phimosis and para-phimosis can usually be treated non-surgically by gentle stretching and/or steroid creams.

       “Infections under the foreskin (posthitis) and a persistent tight foreskin (phimosis)...are uncommon conditions... probably due to excessive and/or unclean attempts to retract the foreskin.”[ Schmitt ]

       One 1993 study indicates that excessive washing can cause repeated infections (balanitis). [Birley] The washing dries out the mucous membrane and leads to non-specific dermatitis that is frequently diagnosed as infection or inflammation. The cure is to reduce the washing and apply emolient oils.

       Women deal with all types of vaginal infections throughout their lives. Vaginal infections are treated with anti-biotics or suppositories. It is true that an intact male may occasionally experience a minor infection. Simple, efficient treatments are available for the male as well. Sexual partners may even be passing an infection back and forth because one partner gets treated while the other is not.

       Compared to the male, the female genitals are likely a more fertile breeding ground for infection and disease. Yet our culture does not modify the female for so-called ‘health reasons.’

       We used to think that douching was necessary for proper hygiene among women. It has been found, however, that not only is it unnecessary, but douching and overly agressive cleaning methods can cause infections in females as well.

       Urinary problems in adult and older men may often be mistakenly blamed on the foreskin. “The prostate gland is not only an important gland all men are born with, it also has a tendency to cause problems.” [Morganstern] During the course of the normal male life span, odds are at some point he will experience a prostate problem. It has been called “the gland that always goes wrong.”[Morganstern] The gland can become congested, infected or enlarged. The causes for these problems are numerous including sexual abstinence, the failure to wash hands properly after a bowel movement, chronic constipation, sex with multiple partners, unprotected anal intercourse, exposure to vaginal yeast infections, staph infections.[Morganstern] The causes are too numerous to include here.

       For the baby or small child who manages to avoid routine circumcision, the majority of any later complications are blamed on the foreskin. In fact, they are most often brought on due to improper fiddling by medical professionals and well meaning parents. As a result, parents are often told circumcision is necessary after all. When people finally realize and accept that the foreskin requires no special attention, its chances of avoiding amputation will be greatly increased.

       Once in a great while a medical necessity for circumcision does occur. However, if the foreskin is left alone during the first few years and handled very gently throughout life (by not being subjected to forced retractions and aggressive cleaning attempts), 99% will never have any problems with their foreskin that cannot be treated nonsurgically. [Verner] The odds that American women will develop breast cancer are much higher. Her chances are one in 10, and yet no one suggests that breasts should be automatically amputated in order to prevent an onset of the disease.

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Last Revised 2/16/99



References:

Birley HDL, Walker MM, Luzzi GA. Bell R et al., Clinical Features and Management of Recurrent Balanitis; Association with Atopy and Genital Washing. Gentitourin Med 1993; 69: 400-403.

Boston Children’s Hospital, The New Child Health Encyclopedia, p. 701, Dell Publishing, 1987.

British Medical Journal, Vol. 312, p. 377, 2/10/96

Derifield, Ken, Medical Fraud, Part III, Phimosis, Intact Network Newsletter, August 1996, Vol. 2:2.

Fleiss(1), M.D., Paul M. and Frederick Hodges The Foreskin is Necessary, in the Townsend Letter for Doctors and Patients, April 1996

Fleiss(2), P.M., Explanation for False Positive Cultures Obtained by Bag Technique. Archives of Pediatrics and Adolescent Medicine 1995; 149:1041-1042.

Gairdner, D., Fate of the Foreskin. Br Med J 1949: 2:1433

Morganstern, M.D., Steven and Allen Abrahams, Ph.D.,The Prostate Sourcebook, Lowell House, 1993.

Oster, J., Further Fate of the Foreskin. Arch Dis Child 1968; 43:200-3

Pantell, M.D., Robert H., James F. Fries, M.D. and Donald M. Vickery, M.D., Taking Care of Your Child, 3rd Ed., by p. 38, Addison-Wesley Publishing Co., Inc., 1993.

Robin ED. Circumcision: Take A Tip From Science. San Francisco Examiner 1987 Nov 5; E-4.

Schmitt, M.D., Barton, D., Your Child’s Health, Bantam Books Revised Ed. Sept., 1991.

Schlager, T.A., Hendley, J.O., Dudley, S. et al. Explanation for False Positive Cultures Obtained by Bag Technique. Archives of Pediatrics and Adolescent Medicine 1995; 149:170-3.

Verner, Robin "Boys with Tight Foreskins" [ http://www.xs4all.nl/~sheldon/circ/boy-care2.html].