United States of America
The United States of America are also known as the United States or simply America or by initialism such as USA or US or U.S.A. or U.S. (Please note that America also is the name of two geological continents: North America and South America which include many more countries than just the United States of America which are the topic of this article. See also: Category:Americas.)
America is predominantly an English-speaking nation. As in other English-speaking nations, non-therapeutic circumcision of boys was popularized in the late nineteenth century. Due to the rates of infant circumcision that formerly approached 90 percent, the vast majority of male doctors were neonatally circumcised and have no real knowledge of a normal body part. Such doctors frequently give poor advice to parents on the care of the intact penis. They are also much more likely to injure intact boys during office visits by premature forcible foreskin retraction (PFFR).
The United States is unique in having a medical industry that aggressively promotes the practice of medically-unnecessary, non-therapeutic infant circumcision. The decline of the unnecessary practice has been slowed by continual encouragement and promotion of circumcision by the medical industry. However, the practice of non-therapeutic circumcision of boys is now in decline.
Despite the financially self-serving promotional efforts of the circumcision industry, the incidence of non-therapeutic circumcision of infant boys was reported to have continued its slow decline to 52.1 percent in 2016.
Jews have lived in America since before the Revolutionary War. They have always practiced ritual circumcision, (Brit Milah), of boys on the eighth day of life in accordance with the Abrahamic covenant, however this was only for a very small percentage of the population.
One may be certain that the eighteenth century Founding Fathers of the United States of America were men with intact foreskins as were the foreskinned men who fought the American Civil War (1861-1865).
Non-therapeutic circumcision of males for non-religious reasons originated with Claude François Lallemand in 1836 in France but soon spread to the United Kingdom in the early nineteenth century, from which it eventually spread to other English-speaking nations.
Late nineteenth century
The late nineteenth century was characterized by various medical doctors advancing all sorts of absurd reasons for the performance of non-therapeutic circumcision.
The first recorded non-religious circumcision of a boy in the United States occurred in 1870 when Lewis Albert Sayre, a prominent New York City doctor, circumcised a boy of five years of age for paralysis. Sayre then continued to advocate circumcision for numerous reasons until his death in 1900. According to Sayre, circumcision was recommended for paralysis, epilepsy, hernia, lunacy, curvature of the spine, and clubfoot.
Seventh-day Adventist John Harvey Kellogg, M.D.[a 1], of Battle Creek, Michigan, was an important 19th century promoter of male circumcision. Although masturbation is never mentioned in the Bible, Dr. Kellogg believed that masturbation was immoral, sinful, and caused one to dream "impure dreams", which he believed was harmful to the mental faculties, resulting in mental disorders, such as feeblemindness. He believed that the urge to masturbate could be prevented by eating bland foods, for which purpose, he and his brother invented corn flakes.
Dr. Kellogg perhaps is most famous for his book, Plain facts for young and old (1879), in which he advocated circumcision of boys as punishment for masturbation.
Elizabeth Blackwell, M.D.[a 1], (1821 – 1910), was born in England, but attended medical school in the United States. She was the first woman to become a medical doctor in the United States. Blackwell thought masturbation was immoral but that circumcision was not the way to correct it. She wrote against it in her 1894 book:
Appeals to the fears of uninstructed parents on the grounds of cleanliness or of hardening the part are entirely fallacious and unsupported by evidence. It is a physiological fact that the natural lubricating secretion of every healthy part is beneficial, not injurious to the part thus protected, and that no attempt to render a sensitive part insensitive is either practicable or justifiable. The protection which nature affords to these parts is an aid to physical purity by affording necessary protection against constant external contact of a part which necessarily remains keenly sensitive; and bad habits in boys and girls cannot by prevented by surgical operations. Where no malformation exists, bad habits can only be forestalled by healthy moral and physical education.
Peter Charles Remondino, M.D.[a 1], was a San Diego, California physician, who was born in Turin (Torino) in 1846, but migrated with his family to the United States at the age of eight. There is some reason to believe that he was of Sephardic Jewish descent and had been circumcised while still in Turin, however this is uncertain.
Remondino clearly was highly intelligent. He mastered English, started medical school at age 17, treated wounded soldiers during the Civil War, and later moved to San Diego for his health.
After moving to San Diego, he practiced medicine, served as an officer of several medical societies, and other regulatory agencies.
When Remondino discussed the foreskin, he used the most horrific, derogatory, and disparaging language. He devoted thirteen chapters to the alleged evils and faults of the foreskin. It is not clear why he had such an extreme dislike for a natural and functional body part. His recommendation, of course, was for circumcision.
By the end of the nineteenth century, America had at least one prominent physician and surgeon on the east coast promoting circumcision and another prominent physician and surgeon on the west coast promoting circumcision. There was no real medical science with which to dispute and discredit their false claims. Non-therapeutic circumcision of males was now well-established in the United States.
Early twentieth century
The early twentieth century is characterized by advocacy of circumcision based on false claims to prevent cancer and sexually transmitted (venereal) disease; and by the involvement of the United States military services in the promotion of circumcision.
Ernest G. Mark (1901) noted that the "pleasurable sensations that are elicited from the extremely sensitive" inner lining of the foreskin may encourage a child to masturbate, which is why he recommended circumcision since it "lessens the sensitiveness of the organ".
Abraham L. Wolbarst, M.D.[a 1], a Jewish New York doctor, apparently considered Holt's paper to be an attack on ritual circumcision or perhaps Judaism itself. He collected opinions from other doctors of the alleged value of circumcision for health and published those opinions as scientific fact in a 1914 JAMA article. Wolbarst's paper appeared shortly before the start of World War I. It is thought that Wolbarst's false claims inspired some military commanders to require men under their command to be circumcised so as to reduce venereal disease (VD).
Wolbarst (1932) put forward his claim again that circumcision would prevent penile cancer in the British journal, The Lancet. In those long ago days, the true causes of cancer were unknown so it was impossible to disprove Wolbarst's falsehoods.
Laumann et al., writing in 1997, reported an incidence of circumcision of 31 percent in 1933.
Hiram S. Yellen and Aaron Goldstein invented the Gomco clamp in 1934-1935. The clamp, by crushing the foreskin in an intensely painful procedure, reduced the risk of hemorrhage, but increased the pain. The availability of the Gomco clamp increased the popularity of non-therapeutic infant circumcision.
Laumann et al. (1997) reported an incidence of circumcision of 53 percent in 1941.
World War II. America entered the war after the Empire of Japan attacked the American naval base at Pearl Harbor, Hawaii on 7 December 1941. This was followed by Germany declaring war on the United States.
The information on military circumcision in WWII is sketchy and anecdotal. It appears that many foreskinned American men were encouraged and, in some cases, forced to be circumcised. It seems that the American military's foreskin-phobia and circumcision policy persisted through the Korean War (1950-52) but was discontinued by a change in policy thereafter.
The "Sand Myth" circulated among English-speaking armies. According to the Sand Myth, foreskinned men who fought in the Saharan desert had medical issues due to sand collecting under the foreskin. Intact Italian and German men who fought in the same desert had no such problems.
Post-war era. In the post-war era after WWII, the popularity of non-therapeutic circumcision, driven by medical promotion by doctors seeking a nice surgical fee as an alleged preventive of penile cancer and by the adamant request of circumcised men home from the war who became fathers.
Non-therapeutic, medically-unnecessary circumcision of boys had become a "routine" surgical operation that usually was performed automatically on newborn boys even without consent from anyone.
Laumann et al. (1997) reported an incidence of non-therapeutic circumcision of boys of 85 percent in 1948.
The publication of a landmark article by Douglas Gairdner (1949) in the United Kingdom showing that infant circumcision is non-therapeutic, unnecessary, causes deaths, and which called for preservation of the foreskin was totally ignored by the circumcision industry in the United States.
Late twentieth century
The late twentieth century was characterized by increasing opposition to non-therapeutic circumcision of boys by intactivists and increasing efforts by the circumcision industry to protect third-party payment for performance of non-therapeutic circumcision of non-consenting boys; and by increasing recognition that newborn boys intensely feel pain and that non-therapeutic male circumcision is a horribly traumatic experience.
The Congress of the United States created the Medicaid program in 1965. Medicaid is a joint federal/state program that pays the medical expenses of low-income Americans. Medicaid covers about 45 percent of births in the United States. Medicaid pays for medically-unnecessary, non-therapeutic circumcision in 32 states, although it appears to be a violation of law to do so.
W. K. C. Morgan, a Canadian medical doctor, then on the faculty of the University of Maryland School of Medicine, in a highly critcal letter pubished by JAMA (1965), slammed the practice of non-therapeutic circumcision of boys as it had developed in the United States.
Preston (1970) considered the matter of infant circumcision. He examined and debunked claims that male circumcision could prevent cancer of the cervix in women, cancer of the penis and cancer of the prostate in men. Preston concluded:
Routine circumcision of the newborn is an unnecessary procedure. It provides questionable benefits and is associated with a small but definite incidence of complications and hazards. These risks are preventable if the operation is not performed unless truly medically indicated. Circumcision of the newborn is a procedure that should no longer be considered routine.
Laumann et al. reported an incidence of newborn circumcision of 78 percent in 1971.
The American Academy of Pediatrics (AAP) is not an "academy" at all. It is a medical trade association that protects and advances the business and financial interests of its pediatrician "fellows". Influenced by Preston's paper, the AAP published a manual on the hospital care of newborn infants in 1971. The manual included the statement:
There are no valid medical indications for circumcision in the neonatal period.
The statement in the 1971 manual was good medical science, then and now, but it did not sit well with the membership of the AAP because it provided no basis on which to promote non-therapeutic circumcision for profit. A four-member "ad hoc" task force was formed to produce a new statement to fit the desires of the membership, which was published in Pediatrics in 1975. The new statement had not a single citation of any other document. While it recognized the validity of the 1971 statement, It claimed without any basis that parents had a right to circumcise a newborn infant boy for "traditional, cultural, and religious factors".
The statement expressed no concern for the pain of circumcision, nor did it provide information on the functions and value of the foreskin nor did it recognize the child as a person with domestic and international rights to self-determination and physical integrity. The statement carefully avoided recommending circumcision and placed the responsibility for the certain amputation injury on the parents rather than on the attending physician.
The 1975 statement served as the AAP's position statement until 1989.
The AAP supplemented the 1975 statement in 1977 by stating:
There are no medical indications for routine circumcisions, and the procedure cannot be considered an essential component of health care. If an infant is circumcised, the procedure must be delayed until the infant is at least 24 hours old and stable, without bleeding tendency or any other illness. Circumcision must never be done at time of delivery.
Infant circumcision traditionally had been carried out without any kind of anesthesia or analgesia because of the false belief that infants could not feel pain. Researchers started to investigate the pain of circumcision in the 1970s.
The American Cancer Society estimated that there are about 460 deaths per year in the United States from penile cancer. Sidney S. Gellis, M.D.[a 1] (1978) estimated that the number of deaths from infant circumcision exceeded the number of deaths from penile cancer.
- Irrational patient selection.
- Lack of information prior to consent.
- Pain and anesthesia management.
- Improper surgical objectives.
- Lack of cost-effectiveness.
However, until the benefits of routine circumcision of the neonate can be proved worth the risk and cost, medical resources probably should be allocated to measures of demonstrated value.
The American circumcision industry appears to have totally ignored Grimes' concerns.
It was at about this time that several small organizations that opposed non-therapeutic circumcision of boys started to appear. They were the first intactivists, although that word had not yet been coined. One such organization was the Remain Intact Organization of Larchwood, Iowa, which was lead by Rev. Russell George Zangger. From the 1970s to the 1990s Zangger sent out cards with New Testament quotations that said the outward sign of circumcision is of no value. Jeffrey R. Wood formed INTACT (Infants Need to Avoid Circumcision Trauma), founded in 1976 as a local resource serving Western Massachusetts, and "Dedicated to Preserving Freedom of Choice." The organization gained recognition and had members across the nation.
Boczko & Freed (1979) collected cases of penile cancer in circucised men and by so doing, disproved the false belief propagated since 1932 by Abraham L. Wolbarst that circumcision was protective against penile cancer.
Bollinger (2017) reported the incidence of infant non-therapeutic circumcision peaked at about 85 percent of all infant boys in 1982.
John A. Erickson (1982) started to work individually to advance genital integrity.
Professor Lowell R. King (1982), who had been a member of the "ad hoc" task force on circumcision of the AAP, felt compelled to defend the reasoning of the task force.
Marilyn Fayre Milos, RN[a 3], while a nursing student at Marin General Hospital, witnessed an unanesthetized circumcision of a newborn boy in 1979. Shocked by the extreme pain and horror of it, she became an opponent of infant circumcision and was forced to resign in 1985 from her nursing position at Marin General Hospital where infant non-therapeutic circumcision is a profit center and promoted to parents. She immediately created the National Organization of Circumcision Information Resource Centers (NOCIRC) in 1985.
Rosemary Romberg (1985) published Circumcision: The Painful Dilemma.
American lawyer William E. Brigman (1985) used new medical evidence to argue that circumcision is child abuse, and discussed possible legal remedies. Recent medical articles have documented the actual injury of circumcision, to make it possible for an attorney to win damages for wrongful circumcision, he said. Brigman suggested civil rights class action suits against hospitals.
Anand & Hickey (1987) published a paper in the New England Journal of Medicine that conclusively proved that newborn infants are capable of feeling pain. After publication of this landmark paper, no doubt about pain sensation in infants remained. The article stated:
Numerous lines of evidence suggest that even in the human fetus, pain pathways as well as cortical and subcortical centers necessary for pain perception are well developed late in gestation, and the neurochemical systems now known to be associated with pain transmission and modulation are intact and functional. Physiologic responses to painful stimuli have been well documented in neonates of various gestational ages and are reflected in hormonal, metabolic, and cardiorespiratory changes similar to but greater than those observed in adult subjects. Other responses in newborn infants are suggestive of integrated emotional and behavioral responses to pain and are retained in memory long enough to modify subsequent behavior patterns.
The July/August 1989 edition of The Truth Seeker was dedicated to circumcision. It featured the core proceedings from the First International Symposium.
The American Academy of Pediatrics' 1975 circumcision promotional statement was now getting long in the tooth so a newer statement was desired. The AAP appointed the late Edgar J. Schoen, M.D.[a 1], of Oakland, California, who had written a humorous poem about circumcision as the chairman of a new task force on circumcision. The task force had six members of whom five (83%), including Schoen, were believed to be Jewish, although Jews constitute only 1.9 percent of the population.
The statement, which was intended to promote the practice of non-therapeutic circumcision for the benefit of the fellows of the AAP, had a high degree of bias and had many serious deficiences. Some more notable deficiences included:
- failure to recognize the child as a person with legal rights to bodily integrity.
- failure to provide information on the nature and functions of the human foreskin.
- failure to call for analgesia to ease the intense pain of the amputation.
- inclusion of Thomas E. Wiswell's methodologically-flawed papers on urinary tract infection (UTI).
- failure to inform parents that UTI is properly treated with antibiotics.
- use of the misleading word potential to describe speculative medical benefits that do not actually exist.
- attempting to shift responsibility for the performance of an injurious and harmful amputation from the medical operator to the parents.
The advocacy of circumcision to prevent UTI spurred a debate in the medical literature until the AAP published a new statement in 1999 that softened the claims.
Professor Ronald Poland (1990), who had served on the task force with Edgar J. Schoen that produced the 1989 AAP Circumcision Policy Statement, strongly objected to the use of methodologically flawed UTI studies. Professor Poland concluded that infant non-therapeutic circumcision should not be "a part of routine medical care."
The Second International Symposium on Circumcision convened at the Hotel Kabuki in San Francisco, California, USA on April 30 through May 3, 1991.
Tim Hammond organized the National Organization to Halt the Abuse and Routine Mutilation of Males in 1992.
Lynn E. Lebit (1992) discussed issues with the substituted judgment doctrine.
Professor George C. Denniston, M.D.[a 1], M.P.H.[a 5], explained some functions of the foreskin, said circumcision was both unnecessary and harmful because of the deprivation of functions, so should not be performed.
The Third International Symposium on Circumcision convened at the University of Maryland, College Park, Maryland, USA on 23-25 May 1994.
Ross Povenmire (1998) questioned the authority of parents to grant consent for non-therapeutic circumcision of children.
Christopher Fletcher, M.D., (1998) conducted a survey of doctors in the United States who perform non-therapeutic circumcision of boys. Dr. Fletcher concluded his report in part:
This study reveals that, across the country, American specialties that perform circumcisions are ignorant of the medical facts regarding the penile foreskin and in conjunction with hospitals and misinformed patients, attempt to justify and rationalise newborn male circumcision. In many cases, despite personal beliefs that circumcision is more harmful than beneficial, some physicians are unwilling to give up their participation in this almost uniquely American custom which many of them have personally experienced as infants.
The American Academy of Pediatrics had been acutely embarrassed by the faults of Edgar J. Schoen's horrific circumcision policy statement, so a new task force was convened under the direction of Carole Marie Lannon, M.D.[a 1], M.P.H.[a 5], to produce a new, more appropriate, and less embarrassing policy statement on non-therapeutic child circumcision. The new task force produced the Fourth Circumcision Policy Statement. The 1999 circumcision statement advocated analgesia for pain relief of the extreme circumcision [pain], admitted that the foreskin contains nerves, softened the claims made for UTI prevention, recognized the effectiveness of breastfeeding at reducing UTI in infants and declared non-therapeutic infant circumcision to be an elective surgical procedure. Other than that, it shared the much the same faults as the 1989 statement.
Rhinehart (1999) was a practicing psychiatrist who described his patients later-life problems stemming from their neonatal circumcision.
Early twenty-first century
The twenty-first century has been characterized by greater opposition to non-therapeutic circumcision of boys in the general population, the utter failure of the circumcision industry's vaunted new circumcision policy, and much more attention to legal and ethical issues relating to non-therapeutic circumcision of boys.
Geoffrey P. Miller (2002) discussed the impact of American culture on the law of circumcision.
Thomas et al. (2004) studied the incidence of HIV in circumcision and intact men in a United States Navy population. A slightly higher incidence of HIV infection was found in circumcised men (84.9%) as compared with intact men (81.8%). The authors concluded:
Doctors Opposing Circumcision (D.O.C.) included this commentary on the law of circumcision of boys in their June 2008 Genital Integrity Statement. It has since been later amended by another party to include a reference to Adler (2013) that was not available at the time of writing.
Doctors Opposing Circumcision issued a Genital Integrity Policy in June 2008.
Van Howe & Svoboda (2008) said of the American practice of medically-unnecessary, non-therapeutic infant circumcision:
Once all factors are revealed, it is impossible to consider circumcision a minor issue, but rather circumcision comes to symbolize one of the greatest ongoing systemic ethical violations for which modern medicine has been responsible.
The British journal, The Lancet, published reports of two randomized controlled trials (RCTs) that were carried out in sub-Saharan Africa which purported to prove that male circumcision was protective against infection with HIV. The American Academy of Pediatrics consulted with the American College of Obstetricians and Gynecologists (ACOG) and the American College of Family Physicians (AAFP) (those being the medical trade associations that represent the specialties that perform most non-therapeutic infant circumcisions and make most of the money from the performance of the non-therapeutic amputation). The three associations determined to make common cause to produce a position statement that would promote male circumcision based on its alleged protection against HIV infection. The AAP was to take the lead, but ACOG and AAFP provided representatives to the new AAP task force, of which New York Jewess Susan Blank, M.D.[a 1], M.P.H.[a 5], was the chairwoman. This new task force did not publish a statement until 2012. The AAP declined to re-affirm the statement so it expired in August 2017.
Bollinger (2012) estimated that the total cost of non-therapeutic male circumcision, including hospital costs, repair of botched circumcisions, treatment of complications, and so on is more than $3 billion per year, of which the beneficiary is the American circumcision industry.
Doctors Opposing Circumcision (2013) provided evidence that the purpose of the 2012 AAP Circumcision Policy Statement was to get more money for doctors,
Van Howe & Svoboda (2013) criticized the 2012 AAP statement because it failed to include important points, inaccurately analyzed and interpreted current medical literature, and made unsupported conclusions.
Doctors Opposing Circumcision commissioned a new website in 2016.
J. Steven Svoboda argued against non-therapeutic circumcision. He stated that this decision should be considered in the context of benefit vs risk of harm, rather than simply risk-benefit due to the non-therapeutic nature of the procedure. He states that benefits do not outweigh the risks, and also claims that foreskin removal should be considered a sexual harm. He also went on to conclude that non-therapeutic circumcision largely violates the physician's duty to respect a patient's autonomy since many procedures take place before a patient is able to freely give consent himself.
Reis-Dennis & Reis (2017) asked if physicians should be blamed for harm resulting from unnecessary genital surgeries, including infant circumcision.
The ill-fated 2012 AAP Circumcision Policy Statement expired on August 31, 2017 in accordance with AAP policy, because it was not reaffirmed. The AAP has had no official circumcision policy since that time.
Adler & Daase (2020) reviewed the American debate on non-therapeutic child circumcision for a French-speaking audience.
Navia et al. (2020) surveyed the incidence of non-therapeutic neonatal circumcision in four states. The incidence of circumcision in 2016 was found to have declined to 54.5 percent, which translates to an increase in genital integrity and wholeness rate to 45.5 percent.
A study by Intact America (2020) reveals how hospitals pressure mothers into granting consent for unneeded and unwanted injurious non-therapeutic circumcision of a newborn boy. Infant circumcision is a profit center for many American hospitals so parents are pushed to circumcise.
Incidence of circumcision
Jacobson et al. (2021) collected circumcision statistics from the Kids' Inpatient Database from 2002 to 2016. They reported that the incidence of circumcision had "neonatal circumcision rates decreased significantly over time" with 55 percent being circumcised, which translates to a genital integrity (intact) rate of 45 percent. The previous intact rate for the nation had been reported to be 41.7 percent in 2010, so this represents an improvement of 7.9 percent in the number of intact boys. The incidence of circumcision for the entire United States had declined to 52.1 percent at the end of the study period (2016), which indicates that 47.9 percent of boys born in that year are intact.
In the Midwest, the incidence of circumcision had declined to 75 percent, which translates to a genital integrity rate increase to 25 percent or 1 in 4 boys having an intact foreskin. The previous report from 2010 was one boy in five being intact, and before that it was 1 in 10 boys being intact, so this in an increase of 25 percent in the rate of intactness for the Midwest.
The percentage of American boys being circumcised has been slowly declining for a long time, while the number of boys with intact foreskin has correspondingly increased. A state of parity has now been reached where the number of intact boys is about equal to the number of circumcised boys.
As the present trend continues, it is expected that being intact will shortly become the more usual, normal condition for young boys in America.
American genital integrity organizations
The United States of America now has numerous genital integrity (intactivist) organizations working to promote the genital integrity of American boys.
These documents by Dan Bollinger are included here because they contain significant information about the United States:
- Bollinger, Dan (19 May 2017).
Infant Male Genital Cutting Incidence Worldwide, Academia. Retrieved 21 October 2021.
- Bollinger D. Origins of the intactivist movement: A masculine foundation 17 November 2017; Retrieved 14 October 2021.
Doctor of Medicine, Wikipedia. Retrieved 14 June 2021.
Master of Arts, Wikipedia. Retrieved 14 June 2021.
Registered nurse, Wikipedia. Retrieved 11 January 2021.
Doctor of Philosophy, Wikipedia. Retrieved 16 June 2021. (Also abbreviated as D.Phil.)
Master of Public Health or Master of Philosophy in Public Health, Wikipedia. Retrieved 14 June 2021.
Juris Doctor, Wikipedia. Retrieved 13 October 2021. (Also known as Doctor of Law or Doctor of Jurisprudence.)
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Treatment for Self-Abuse and Its Effects, in: Plain Facts for Old and Young (archive URL). Project Gutenberg (ed.). Burlington, Iowa: F. Segner & Co. Retrieved 31 October 2021.
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