The two day-old naked infant boy was strapped down and spread eagle on a restraining board in a Marin General Hospital surgery room. He screamed and struggled as the doctor inserted a Plastibell without anesthesia, a surgical device used to forcefully separate the boy’s foreskin from his penis gland so that the targeted tissue can be cut off.
“There is no medical reason for doing this,” the doctor muttered to the group of 20 nursing school students from College of Marin standing around him.
As Marilyn Milos, a nursing school student and mother of four, witnessed this routine circumcision two months before her 1979 graduation, she knew she would dedicate her life to fighting the practice.
Six years later, Milos’ outspokenness got her fired from her nursing job at that same hospital. Three mothers complained about her description of circumcision. Milos is now a San Angelo anti-circumcision activist and founder of the National Organization of Circumcision Information Resource Centers (NOCIRC). After 26 years of activism, she is known as the movement’s matriarch. She is heading one of the first and biggest anti-circumcision movements in the world.
The issue of routine infant circumcision of males is the subject of increasing debate. The United States currently has the highest rate of male circumcision among developed countries. A growing and diverse anti-circumcision movement of “intactivists” is attacking the practice for many reasons, including medical, legal, ethical, cultural and religious. Many intactivists are involved in the National Organization of Restoring Men (NORM), an international foreskin restoration support movement for circumcised men engaging in a self-administered practice to restore what they lost.
Whereas proponents of circumcision argue that the practice has numerous lifelong health benefits related to hygiene and infection risks, intactivists argue that the benefits are insignificant and do not legitimize such an invasive surgery that amputates healthy tissue.
Male circumcision, a partial or full removal of the foreskin covering the penis gland, is performed by a doctor during the first one or two weeks of an infant boy’s life, often with no anesthesia. Jewish and Muslims circumcisions, which comprise a small number of U.S. cases, are traditionally performed on infant boys as part of a religious ritual.
Circumcision for secular reasons, which is uncommon in most of Europe, Central and South America and Asia, appeared in the United States during the second half of the nineteenth century. A small number of medical doctors argued that it was essential for good hygiene and was an effective cure against masturbation, which, at the time of widespread sexual repression, was considered sinful and harmful.
In the U.S. at the turn of the 19th century, there was a wide shift towards a medicalization of the human body and an institutionalization of health care. Childbirth, which before had been handled at home by midwives who did not perform circumcision, was being performed in hospitals where doctors both advocated and performed circumcision. There are no exact or reliable national statistics on circumcision rates, leaving both proponents and opponents guessing what the future trend will be.
The most reliable statistics show a decline in U.S circumcision rates from 84 percent of infants in 1985 to 56 percent in 2003, according to the National Center for Health Statistics. Circumcision proponents downplay the significance of the declining rate. They point out that the statistics, based only on hospital discharge surveys from less than 5 percent of U.S hospitals, exclude religious and subsequent circumcisions.
Circumcision proponents largely base their arguments on scientific research. They quote studies showing that circumcision lowers the risk of urinary tract infections. According to the American Pediatrics Association these infections affects about 1 percent of uncircumcised infants boys. Circumcision prevents bacteria from accumulating under the foreskin, which can cause local skin infections. It also lowers the risk of contracting HIV and other sexually transmitted diseases that can be contracted through small abrasions that occurs in the foreskin during intercourse.
Proponents also argue that it is easier for circumcised men to keep themselves clean. Many young men boys are unable to retract the foreskin, a condition called phimosis that usually corrects itself but which in about one percent of uncircumcised men requires circumcision at at an older age.
The intactivist movement avoids the use of the term “uncircumcised” because it owns up to circumcision as the norm, something it wishes to change. Instead, it uses terms like “intact” or “natural” to emphasize that which is the biological norm.
“Circumcision is always fear-based,” Milos said. “Every excuse has been consistent with the dreaded disease of the time.”
According to Milos, the foreskin is normal tissue that not only has a protective purpose but also a sexual one. “(The foreskin) has 10,000 to 20,000 nerve endings that allows a man to know where he is in relation to the orgasmic threshold,” said Milos and points out that sensitivity is not relegated to the penis glands.
The effects of circumcision on sensitivity and sexual functioning is a disputed issue that is currently being looked at in the Penile Sensitivity Touch Test Study, a San Fransisco study awaiting publication later this year. When the foreskin, which covers and moistens the mucosal cells of the penis gland, is removed, the glands become an external organ and the skin hardens in a process called keratinization. Many men involved in NORM have reported an almost complete loss of sensitivity in the penis gland prior to foreskin restoration and subsequently, a regaining of sensitivity and an increase in sexual satifaction.
Complications such as excessive bleeding, infections and even death, are rare and occur in between 0.2 and 0.6 percent of hospital circumcisions, according to an American Pediatrics Association 1999 statement on circumcision. The APA states that although there are potential medical benefits of infant male circumcision, these are not sufficient to recommend the practice. Milos and other intactivists call the APA statement a compromised document and point out that no medical association in the world recommends routine circumcision.
Intactivists argue that the motive for the practice is financial. The procedure takes anywhere from 5 to 45 minutes and can cost between $100 to $750.
“There’s a lot of money to be made from it,” said Matthew Hess, a San Diego intactivist and President of MGMBill.org, a private non-profit organization lobbying to ban circumcision. “Many parents are victims as well because they are not being given enough information,” said Hess.
The MGMBill proposal would ban all forms of male circumcision, including for religious practice, until the male is 18 years old and can decide for himself. The proposal was sent out for the third time on Feb. 6, 2006, during MGMBill’s annual bill submission, to about 2,700 state and federal legislators in 15 states around the nation.
“Overall we’re not getting a lot of response,” said Hess, who attributes the legislators cold shoulders and their unwillingness to sponsor the bill to the controversial nature of the issue. “It might cost them a lot of votes, especially from Muslim and Jewish communities.”
A nationwide lobbying effort by the International Coalition for Genital Integrity, has sucessfully removed male circumcision from Medicaid coverage in 16 U.S. states including California.
“The only thing doctors learn about the foreskin in medical school is a two sentence phrase: the foreskin is that which is in front of the glands and that which we cut off in circumcision,” said Wayne Griffiths, 72, the co-founder and director of the National Organization of Restoring Men.
Griffiths, who was circumcised at birth, has fully resto
red his foreskin with a three-quarter inch of overhang, through a process called tissue expansion that took him a year and a half to complete.
There are many different devices used to restore foreskin by tissue expansion, ranging from a simple taping to the use of coaxing devices such as the bestselling TLC Tugger, which is sold online for $46. The TLC Tugger, which includes two silicone cones that keeps the penis shaft skin rolled over the gland and attaches to a knee strap or a weight that pulls the skin over the gland, can be worn under regular clothing.
According to Griffiths and Jim Bigelow, a psychologist and author of “The Joy of Uncircumcising,” the quintessential guide to foreskin restoration, what works best is a moderately applied tugging force. Griffiths suggests a 7 to 10 ounces weight be applied for four to eight hours per day, 5 days a week.
“You have to be consistent with the regimen,” says Griffiths, who emphasizes patience.
NORM, which started in 1989, has grown into 10 groups in the US along with groups in seven other countries. The organization holds monthly meetings where men, introduced only on a first-name basis, can ask questions and share their own experiences. Griffiths estimates that between 20,000 and 30,000 men have requested information from NORM and are restoring themselves. He now gets about 10 requests per day and spends about 15 hours per week of his spare time corresponding with men interested in restoration.
NOCIRC, a pioneering umbrella organization, has grown to include more than 110 local chapters throughout the United States and centers in 17 different countries. The intactivists movement is largely Internet-based and focuses on education.
“There needs to be more prominent doctors speaking out against circumcision,” said Richard Russell, 63, a Moreno Valley English teacher and retired Air Force attorney turned intactivist.
Russell, a circumcised Georgia-born who describes himself as an unlikely candidate for activism, is working to launch a local Los Angeles NOCIRC chapter and is planning to set up a booth at local baby shows. Like most intactivists, Russell is hopeful that circumcision will have disappeared in his own lifetime.
“Circumcision is a cure in search of a disease,” said Russell, who is enjoying life as a restored man. “Sex is much better than it ever was before.”
Daniel Harju can be reached at firstname.lastname@example.org