Psychological injury of male circumcision: Difference between revisions

Male [[circumcision]] is a surgical [[amputation]] of the [[foreskin]], which contains more than one-half of the erogenous epithelium of the [[penis]]. Doctors who perform [[circumcision of the newborn]] do not advise or warn parents of these risks.

 

The [[amputation]] is most frequently carried out on infants and small boys who cannot and do not give consent for the loss of so much of their [[penis]].<ref name="andersen2025" /> There are many '''psychological issues of male circumcision''' that arise from the [[pain| painful]], [[trauma| traumatic]], involuntary loss of the part of the [[penis]] with the erogenous tissue that provides much sexual sensation.<ref name="andersen2025" /><ref name ="uberoi2022">{{REFjournal

[[Moses Maimonides]] wrote in the 12th century:

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  |author-link=Moses Maimonides

  |publisher={{UNI|University of Chicago|UChicago}} Press

== Profound lack of understanding of psychological issues ==

 

[[Intact America]] (2023) reported that [[intact]] males were shamed.<ref>{{REFweb

  |url=https://intactamerica.org/foreskin-phobia-intact-penis-shamed/

  |title=Foreskin Phobia: How The Intact Penis Has Been Shamed

  |last=Anonymous

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  |date=2023-12-21

  |accessdate=2023-12-31

David Levy (1945) reported on abnormal behavior in children who had undergone surgical operations, including [[circumcision]], among other operations. Levy reported such emotional sequelae as:

* Dependency fears and regressions

* Latent fear

* Phobias

* Anxiety states

* Hostility reactions

* Obsessions

Levy saw a relationships to what was then called ''combat neurosis'' and now known as post traumatic stress disorder ([[PTSD]]).<ref name="levy1945">{{REFjournal

[[Anna Freud]], daughter of [[Sigmund Freud]], and a pioneer child psychologist read Levy's paper. She wrote (1952):

  Ever since the discovery of the castration complex analysts have had ample opportunity in their therapeutic work to study the impact of surgical operations on normal and abnormal development. By now it is common knowledge that surgical interference with the child's body may serve as the focal point for the activation, reactivation, grouping and rationalization of ideas of being attacked, overwhelmed and (or) castrated.<ref name="freud1952">{{REFjournal

Turkish child psychologist [[Gocke Cansever]] tested twelve Turkish boys before and after [[circumcision]]. Cansever (1965) confirmed the conclusions of Anna Freud (1952) and reported:

The results of the tests showed that [[circumcision]], performed around the phallic stage is perceived by the child as an act of aggression and castration. It has detrimental effects on the child's functioning and adaptation, particularly on his ego strength. By weakening the controlling and defensive mechanisms of the ego, and initiating regression, it loosens the previously hidden fears, anxieties, and instinctual impulses, and renders a feeling of reality to them. What is expressed following the operation is primitive, archaic and unsocialized in character. As a defensive control and protection against the surge of the instinctual forces coming from within and the threats coming from outside, the ego of the child seeks safety in total withdrawal, this isolates and insulates itself from disturbing stimuli.<ref name="cansever1965">{{REFjournal

  |DOI=10.1111/j.2044-8341.1965.tb01314.x

Emde et al. (1971) being curious about changes in infant behavior after painful heel sticking, decided to test baby boys before and after routine (non-therapeutic) [[circumcision]] performed without anesthesia. Not surprisingly, they found that circumcision changed behavior. They concluded:

Routine hospital circumcision, done without anesthesia, was chosen as a potential stressor which might be expected to produce prolonged bombardment of pain pathways. Two studies, one without polygraphic manipulation and one with EEG and polygraphic manipulation and one with EEG and polygraphic recording, resulted in similar findings. Circumcision was usually followed by prolonged, non-REM sleep. Effects of circumcision were demonstrable in terms of an increase in the amount of non-REM sleep (p<0.01) and a decrease in latency to the onset of non-REM sleep (P<0.05). Infants were used as their own controls and were compared with non-circumcised males for statistical analysis. Post circumcision increase in non-REM sleep was also reflected in an increased total number of non-REM sleep periods and an increased number of extremely long non-REM sleep periods.<ref name=emde1971">{{REFjournal

Researchers in [[United Kingdom| Britain]] and [[United States of America| America]] noticed that male infants in America, where most males were [[circumcised]] in the 1970s behave differently from female infants, while [[intact]] male infants in Britain do not behave differently from female infants. Richards, Bernal, & Brackbill (1976) said:

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In contrast to the sometimes dramatic somatic responses of the neonate to operation without anesthesia, the psychological consequences of this trauma are conjectural. Psychoanalyst Erik Erickson has described the first of eight stages of man as the development of basic trust versus basic mistrust. For the baby to be plucked from his bed, [[Circumstraint|strapped in a spread eagle position]], and doused with chilling antiseptic is perhaps consistent with other new-found discomforts of extra-uterine existence. The application of crushing clamps and [[excision]] of penile tissue, however, probably do little to engender a trusting, congenial, relationship with the infant's new surroundings.<ref name="grimes1978">{{REFjournal

The focus then turned to investigation of the effects of unanesthetized infant circumcision. Doctors then falsely believed that newborn infants could not feel [[pain]],<ref name="cope">{{REFjournal

Luther, Kraybill & Potter (1976) tested cortisol and cortisone in the blood of newborn infants before and after [[circumcision]]. Dramatic increases in cortisol and a lesser increase in cortisone was recorded.<ref name="luther1976">{{REFjournal

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Rawlins, Miller & Engel (1980) investigated the blood oxygen content after [https://www.thefreedictionary.com/unanesthetized unanesthetized] non-therapeutic [[circumcision]]. They reported that blood oxygen content decreased during non-therapeutic neonatal circumcision, although it returned to baseline or above later.<ref name="rawlins-miller-engel1980">{{REFjournal

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Marshall et al. (1980) tested newborn boys before and after plastibel circumcision. They reported that boys have a greater capacity for memory than previously believed, that infants behave differently after [[circumcision]], that future researchers must consider and record the circumcision status of their subjects, and that boys might actually be feeling pain. They suggested that anesthesia by dorsal penile nerve block might be appropriate.<ref>{{REFjournal

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  |title=Circumcision I: Effects upon newborn behavior

Gunnar et al. (1981) studied the effect of circumcision of male infants on serum cortisol and behavior. The authors identified circumcision as "a potential traumatic event experienced by the majority of newborn males in this country (United States)."  The authors reported that serum cortisol during unanesthetized circumcision rose to about four times the pre-circumcision level. Behavior paralleled the increase in cortisol. They reported that "neonatal circumcision is performed without anesthesia and it is clearly stressful for the infant.<ref name="gunnar1981">{{REFjournal

Marshall et al. (1982) studied the effect of [[circumcision]] on mother-child interaction (primarily breastmilk substitute feeding behavior) in a hospital setting.  They reported: "The experimental group exhibited fewer intervals of uninterrupted feeding than did the control group."<ref name="marshall1982">{{REFjournal

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  |title=Circumcision: II effects upon mother-infant interaction

Gunnar et al. (1984) tested the effects of a pacifier during [[circumcision]]. They reported:

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Porter et al. (1986) recorded the [[pain]] cries of boys undergoing [[circumcision]]. They reported that "Subjective judgments and objective quantitative data converge to demonstrate that infants' cries are perceived as varying and objectively, do systematically vary with respect to the the intensity of the painful stimuli."<ref name="porter1986">{{REFjournal

Porter et al. (1988) recorded the cries of boys undergoing non-therapeutic child [[circumcision]]. They found that the pitch of the cries increased as stress ([[euphemism]] for [[pain]]) increases.<ref name="porter1988">{{REFjournal

The research reported in this section clearly establish the the distress shown by male infants during unanesthetized circumcision does not come from being restrained, that infants feel extreme [[pain]], that sucking on a pacifier does not reduce pain, although it may reduce crying, and that neonatal non-therapeutic [[circumcision]] is traumatic for the child.

 

There is now extensive evidence of the effect of the [[trauma]] of non-therapeutic [[circumcision]] on behavior later in life.

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[[Anna Taddio| Taddio]] et al. (1995) (1997) studied the behavior of [[circumcised]] boys in comparison to the behavior of [[intact]] boys at the time of routine vaccination. Taddio et al. (1995) reported:

Male circumcision is the most common neonatal surgical procedure. It causes intense pain and measurable changes in behaviour that last up to 1 day. We found that circumcision status was associated with increased infant pain response to routine vaccination at 4-6 months. [[Circumcised]] boys had significantly longer crying bouts and higher pain scores. That both outcome measures, pain index, and cry duration, were influenced by circumcision lends credibility to our observations. During the second (HIB) vaccination, circumcision status was more clearly associated with the observed pain response than after DPT. The DPT injection might have had a priming effect in [[circumcised]] infants which led them to exhibit even more pain after the HIB injection. The effects of memory and reinforcement on later nocioceptive experience in neonates are not known. Because memory of pain is believed to be important in subsequent pain perception, and the main structures for memory are functional in the neonatal period, it is conceivable that pain from circumcision may have long-lasting effects on pain response and/or perception.<ref name="taddio1995">{{TaddioA etal 1995}}</ref>

Taddio et al. (1997) followed with a larger second study in which [[circumcised]] boys were compared with [[intact]] boys at time of vaccination four to six months after birth. Three measures to determine [[pain]] were used. Once again [[circumcised]] boys showed greater response to the pain of vaccination than [[intact]] boys.

Taddio et al. reasoned that:

It is, therefore, possible that the greater vaccination response in the infants [[circumcised]] without anaesthesia may represent an <u>infant analogue of a post-traumatic stress disorder</u> triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.

The results of this study are consistent with studies of pain response in animals and behavioural studies in humans showing that injury and tissue damage sustained in infancy can cause sustained changes in central neural function, which persist after the wound has healed and influence behavioural responses to painful events months later. Pretreatment and postoperative management of neonatal circumcision pain is recommended based on these results. Investigation of the neurological basis of these effects is warranted.<ref name="taddio1997">{{TaddioA KatzJ IlersichAL KorenG 1997}}</ref>

Male circumcision (called ''[[tuli]]'') is part of the culture of the Philippine Islands. Boys usually are not neonatally circumcised. Instead, [[Tuli| circumcision]] is done when they are somewhat older. Some are medically circumcised while others are [[circumcised]] in a traditional manner. Ramos & Boyle (2001) studied the psychological effects of [[circumcision]] on Philippine boys. They reported that sixty-nine percent of traditionally circumcised boys and fifty-one percent of medically circumcised boys met the criteria for a diagnosis of post-traumatic stress disorder ([[PTSD]]).<ref name="ramos-boyle2001">{{REFbook

  |first2=Gregory J.

  |author2-link=Gregory J. Boyle

Boyle et al. (2002) report:

A traumatic experience is defined in DSM-IV as the direct consequence of experiencing or witnessing of serious injury or threat to physical integrity that produces intense fear, helplessness or (in the case of children) agitation (American Psychiatric Association, 1994). The significant pain and distress described earlier is consistent with this definition. Moreover, the disturbance (e.g., physiological arousal, avoidant behaviour) qualifies for a diagnosis of acute stress disorder if it lasts at least two days or even a diagnosis of post-traumatic stress disorder ([[PTSD]]) if it lasts more than a month. Circumcision without anaesthesia constitutes a severely traumatic event in a child's life.<ref name="boyle2002">{{BoyleGJ GoldmanR SvobodaJS FernandezE 2002}}</ref>

Famed trauma expert [[Bessel van der Kolk]], {{MD}} (1989) reports that traumatized persons tend to repeat the [[trauma]] on themselves or others, resulting in harm to others, harm to self, or being re-victimized. He writes:

Some traumatized people remain preoccupied with the [[trauma]] at the expense of other life experiences and continue to re-create it in some form for themselves or for others.<ref name="vanderkolk1989">{{VanderKolkBA 1989}}</ref>  

De Mause (1996) argued that early [[trauma]] results in aggressive adult behavior.<ref name="demause1996">{{REFjournal

  |journal=Pre- and Perinatal Psychology Journal

  |url=http://www.mattes.de/buecher/praenatale_psychologie/PP_PDF/PP_08_2_deMause.pdf

Rhinehart (1999) was a practicing psychiatrist who had patients with later life problems stemming from their neonatal [[circumcision]]. He listed some possibilities:

* feeling damaged, especially in the presence of surgical complications such as [[skin]] tags, penile curvature due to uneven foreskin removal, partial ablation of edges of the glans and so on

[[Ronald Goldman|Goldman]] (1999) described the long-term psychological effects of [[circumcision]] as "anger, sense of loss, shame, sense of having been victimized and violated, feal, distrust, grief, and jealousy of [[intact]] men.<ref name="goldman1999">{{REFjournal

[[Ronald Goldman|Goldman]] reported reasons why [[circumcised]] men say little about how they truly feel:

[[Circumcised]] men are likely to use minimization and ridicule as an ego defense when addressing the subject of circumcision.

It is now well established that [[circumcised]] men who become a father of a boy overwhelmingly want the boy to be [[circumcised]].<ref name="brown-brown1987">{{REFjournal

}}</ref> Such [[circumcised]] fathers are driven to repeat the [[trauma]] of their own [[circumcision]] decades ago on their own son even acting contrary to current medical advice.<ref name="goldman1999" />

However [[Ronald Goldman|Goldman]] pointed out several reasons (from the viewpoint of the child) that a father should not insist on circumcising a boy:

Most male doctors in the [[United States]] are men who were [[circumcised]] as infants. Consequently, despite being medical doctors, they have no personal knowledge of or appreciation for the human [[foreskin]]. These male doctors share the [[trauma]] and attitudes of other [[circumcised]] men and are just as likely to want to repeat the [[trauma]]. [[Eleanor LeBourdais| LeBourdais]] (1995) pointed out that the "age of the attending physician, sex and circumcision status" were important factors in determining the likelihood of a baby boy being [[circumcised]].<ref>{{REFjournal

  |title=Circumcision no longer a "routine" surgical procedure

[[Ronald Goldman|Goldman]] also points out that, in making the decision regarding [[circumcision]], parents tend to follow the perceived norm.

[[Ronald Goldman|Goldman]] (1999) points out that some physicians allow their religious views on circumcision to influence the outcomes of scientific paper regarding male circumcision. This has created many scientifically flawed studies that distort, confuse the circumcision issue, and [[bias]] the outcome in favor of circumcision.<ref name="goldman1999" /> Some examples are [[Abraham L. Wolbarst]], Ernest Hand, [[Abraham Ravich]], [[Edgar J. Schoen]], and [[Aaron J. Fink]].

[[Ronald Goldman|Goldman]] (2005) observes when [[Circumcised doctors| circumcised doctors]] are appointed to a committee to develop circumcision policy they bring their cultural and personal biases to the table. Doctors who perform circumcisions need to justify their practice. [[Circumcised]] doctors may be under a compulsion to repeat the [[trauma]].<ref name="vanderkolk1989"/> Risks and certain injury are likely to be understated, while benefits are exaggerated. [[Human rights]] issues may be ignored. The likely result is a policy statement heavily [[bias| biased]] in favor of [[circumcision]].<ref name="goldman2005">{{REFjournal

}}</ref> [[Circumcised]] men historically have protected their feelings by ''denying that they have lost anything''.<ref>{{REFbook

}}</ref> Trivialization of the loss is a frequent defense mechanism. Another is the production of fantasies about the alleged horrors of [[smegma]], [[Pheromone| aroma]], and [[Acroposthion| appearance]].

}}</ref>'' Research done since the 1960's forward to the present day has elucidated the nature, functions, and purpose of the [[foreskin]]. Circumcised men are learning what they have lost from the Internet, so they are less able to maintain the ego defense of ''denial of loss'',<ref name="watson2017">{{REFjournal

  |first=Lindsay R.

  |author-link=Lindsay R. Watson

}}</ref> so they increasingly responding with feelings of anxiety, [[Suicide| suicidal thoughts]], depression, rage, [[PTSD]] and grief.<ref name="watson2017"/> Anger'' is the second stage of grief.<ref name="kr1969"/> <ref name="cc2022"/>

 

 

''[[Depression]]'' is the fourth stage of grief.<ref name="kr1969"/> <ref name="cc2022"/> Several cases of [[suicide]] have been reported.<ref name="lowbridge2019">{{REFnews

}}</ref> <ref name="watson2014">{{REFbook

 

DeMause (1996) reported that early [[trauma]] results in war and social violence.<ref name="demause1996" />

}}</ref>

 

Unfortunately, Watson & Golden (2017) report:

We found that therapists were reluctant to accept that the grief was real, were unaware of foreskin functions, denied circumcision had physical or psychological sequelae and minimized patient grief using humor, cultural aesthetics, controversial  

Watson & Golden (2017) recommend that [[circumcised]] men "embrace the anguish and try to feel it as strongly as they can." They also recommend non-surgical [[foreskin restoration]] "since it empowers the patient."<ref name="watson2017" />  

There is a new blog at Reddit, where grieving [[circumcised]] men discuss their feelings of grief.<ref>{{REFweb

There is another blog at Reddit, where non-surgical [[foreskin restoration]] is discussed.<ref>{{REFweb