Chapter 18 (Circumcision: The Painful Dilemma)

From Peaceful Beginnings

Chapter Eighteen: Humane Alternatives in Infant Circumcision?

This book was originally intended to be an investigation, rather than a denunciation of infant circumcision. I began my research with a neutral stance on the subject. My only concern was the pain experienced by the infant. I imagined that the operation conferred many benefits. This is what the American middle class has been led to believe. I had originally planned that this book would simply guide parents to either decision, rather than specifically influence them against circumcision. And in my original plans it was very important that I discuss humane alternatives for those who did choose circumcision, so as to help alleviate the infant's pain.

Today I have found myself on a soapbox crusading against infant circumcision. But in the early stages of my research I was uncertain over whether I had made the right decision for my sons and undecided over whether or not I would ever have another son circumcised. I often became angry and bewildered to find so many people adamantly opposed to the operation! Even though this book has turned out to be a polemic, strongly opposing infant circumcision, I was actually several months into my research before the overwhelming facts and heartrending personal experiences convinced me that babies should not have their foreskins cut off.

It is ironic that today some people label me as "dogmatic" or "biased" about this issue, and are unaware of my neutral beginnings. When I hear other people's uncertain or noncommittal viewpoints about circumcision, all I am hearing are my own views before I became deeply involved in this research.

Shortly after my son Ryan was born, when my concerns about circumcision were first dawning, I had a friend who gave birth to a baby boy who was born with a naturally short foreskin which appeared as if he had been circumcised. At the time, this event seemed to me the "ideal solution" -‑ to have a baby boy whose penis looked like our culturally accepted norm without having to undergo the pain of circumcision. I believed that if there was some way that the pain of circumcision could be eliminated or greatly minimized for the infant, then the "problem" would be solved. I had no comprehension that foreskins were of any value to the individual. I had absolutely no concern over which "style" of penis males happened to have. I had never imagined that any man had ever been dissatisfied over his lack of foreskin. Nor did I have any awareness that the presence or absence of the foreskin could make any difference sexually. Women rarely have had any knowledge of such things. However, these issues are of crucial, central importance to most of the men who are concerned about circumcision.

When I was originally collecting information and working on this book my three circumcised sons were my only children. Eric was 5, Jason – 3, and Ryan just a few months old when I first decided to write my book. They were still little guys, in a constant state of small child immodesty and continual need of mother’s attention in dressing, bathing, etc. Therefore, I was continually reminded of my own little sons’ circumcised states while researching a continued stream of literature and communications repeatedly informing me, too late, of the operation’s cruelty and non-necessity. (I conducted some of the interviews in this book while holding my baby Ryan in my arms!) I believe that I have been a caring, sensitive mother in almost every other respect. Obviously if any mother in the world has ever wanted to believe that what was done to her own children was something beneficial and positive, it would have been me! I probably battled internally with what I was learning far more than most people who have researched this subject. But the overwhelming facts have won out over my initial determination to be “impartial.” Some of my childbirth education peers have tried to insist upon “neutrality” on this (and other emotional issues surrounding birth.) My answer: It is easy to be “neutral” about something if one does not know very much about it. I simply have heard and learned too much. “Neutrality” for me would mean shutting down my brain and closing my heart. I am incapable of reverting back to my previous state of ignorance.

Although the issue of pain experienced by infants has been of primary importance to me as a mother, it is of secondary importance to the overall anti‑circumcision concern. The central issue is that the infant's penis should be left in its natural state regardless of the pain. One cannot improve on the body by cutting any part off. The other chapters in this book have uncovered some disastrous consequences of circumcision. But even if cutting off the foreskin conferred minor benefits, or made absolutely no difference to the well‑being of the individual, the operation, when performed on an infant is a violation of essential human rights because the infant does not have a choice over whether or not he should have his foreskin. Circumcision of an infant is taking away something that belongs to that individual ‑- painful or not!

Nonetheless, fair coverage should be given to the use of anesthetics and efforts to minimize the pain felt by infants undergoing circumcision.

Ever since people first began cutting off the foreskins of infants, many have insisted that the baby feels little or no pain. Usually this is simply a means of placating one's own conscience about the matter! Others, while not thinking to question the loss of a useful piece of body tissue, have been conscious and aware enough to have heartfelt concern for the baby's distress, and have sought measures to alleviate the infant's pain.

Dr. Weiss, a Jewish physician who has written many articles expressing concern over the pain experienced by infants undergoing circumcision comments:

"The suffering of circumcised infants is referred to in the classical literature. Recent investigations indicate that they go through a period of stress, since they are irritable and show oozing and edema of their wounds for several days. "Throughout the ages attempts were made to decrease the pain of this operation. Some offered up special prayers in their behalf; others drowned out their cries by loud songs. During the nineteenth century the French physician du Havre pleaded for the use of an anesthetic -‑ a plea subsequently repeated by medical men in the United States, New Zealand, and Germany." 1.

Frequently during the Jewish ritual the infant is given a small amount of wine from a spoon or to suck from a small piece of cloth. It is doubtful that the infant ingests enough wine for the alcohol to have an anesthetic effect. If an infant were actually given enough alcohol to make him drunk this would be dangerous to his system. But the sucking action may have some value in helping the infant cope with the stress of the operation.

Older children and adults are usually given general anesthesia if they are to undergo circumcision. Could this method be employed for newborns? Newborn infants are usually given general anesthesia if they have to have serious, necessary surgery.

General anesthesia requires the use of an operating room and an anesthesiologist on duty. If all male neonates undergoing routine circumcision were being given general anesthesia, this would "tie up" the use of valuable hospital facilities and personnel, making them unavailable for more important and life‑saving procedures. General anesthesia would add greatly to the expense of the operation, as well as lengthen the baby's hospital stay after birth. If general anesthesia were deemed necessary for infant circumcision, this would force most parents and medical practitioners to think about the necessity of the operation. People would have to realize that circumcision is surgery. Probably most parents would decide against infant circumcision. Insurance companies would be reluctant to cover the operation. Most doctors would actively advise parents against it.

But, most importantly, use of general anesthesia can result in complications. Its use is riskier when administered to a tiny baby. There is no question that if the millions of newborn male infants who undergo circumcision each year were all given general anesthesia, a number of these would experience dangerous complications and a few would die from the effects of the anesthesia. For this reason alone, few people would wish to adopt this procedure.

For many, the most common "solution" has been to simply disregard the infant's distress from circumcision by insisting that the baby feels little or nothing. For many others, the most simple "solution" is to leave the baby as nature made him.

There is one other alternative that some doctors have tried. In June 1978 The Journal of Pediatrics published an article describing the use of a penile dorsal nerve block for infant circumcision.

The penis has two main nerves called dorsal nerves because they are situated along the upper surface of the penile shaft. In the procedure described, two injections of lidocaine are administered into the infant's penis at the site of these two nerves, prior to circumcision.

"Stabilizing the organ with gentle traction of the skin of the penis at an angle of about 20 to 25 degrees, the skin is pierced at one of the dorsolateral positions and the needle advanced posteromedially into the subcutaneous tissue. The depth of the needle need not be more than 0.25 to 0.5 cm. There should be no further resistance felt after the skin is penetrated, the top of the needle remaining freely movable. At this point infiltration of 0.2 to 0.4 ml. of 1% lidocaine is made, taking great care to avoid accidental vascular injection. Under no circumstance should the infiltration be made as the needle is being advanced or withdrawn. The same procedure is repeated at the other dorsolateral position. 2.

The authors conclude that this technique renders the operation painless and non traumatic for the infant.

Had I come across this article early in my research, before I was aware of the many other issues surrounding circumcision, I may have pronounced this the "ideal solution." However, this technique demands many considerations. The authors do exhibit a certain amount of humanitarianism for their concern about the feelings of the infant. But it is questionable that this method renders circumcision totally painfree and non‑traumatic for the baby. And, as previously stated, pain is certainly not the only consideration surrounding circumcision. It appears that in response to the concern that has been expressed over the infant's pain from circumcision, some medical professionals have simply sought less painful methods of operating, rather than taken the time to question the wisdom of cutting off part of someone's body.

When the dorsal nerve block is used, the infant is still strapped down to a Circumstraint board. Being forcibly restrained, strapped to a plastic board, and worked over by a giant adult, may be a more significant element in circumcision trauma than the actual pain. In Leslie Pam's primal therapy experience (see interview) the feelings of fear, total helplessness, and being "numb" with terror at the time of the actual cutting, were more crucial than the pain itself.

Additionally, two injections into the penis are certainly not without pain. Would an adult or child be nonchalant about needles being stuck into his penis? This brings us back to the "babies don't feel pain" hoax.

Certainly complications can result from this method, either from adverse reaction to the lidocaine or from mistakes in administering the injection. A newborn infant's penis is quite tiny and the procedure does require great care and skill. Dr. Call mentions that a local injection presents a problem with swelling of tissues and resultant difficulty in making an even cut. (See interview.)

Finally, the effects of lidocaine wear off completely in a short time. However, it is well known that the soreness, swelling, pain upon urination, and general discomfort in healing of the infant's penis last for several days. The surface of the freshly circumcised infant's glans is raw, newly‑exposed tissue from which the foreskin has literally been torn away. This cannot be disregarded.

Perhaps the most significant function of the dorsal nerve block is that it alleviates the consciences of the adults involved.

I find it difficult to believe that anyone after reading this book in its entirety would still wish to have their infant son circumcised. Even if a method could be devised that would render neonatal circumcision totally painless and non-traumatic, a consideration of the horrendous complications that have resulted, the sexual advantages of possessing one's foreskin, the ethics of altering another person's body without his permission, and the simple, common-sense value ofleaving the body in its natural state should certainly convince most people that the operation should not be done.

However, there are some parents who still decide, after reading all the literature and arguments opposing the operation, that their sons must be circumcised. Parents who already have one or more circumcised sons sometimes find it extremely difficult to make the decision not to have it done to a subsequent son. I have also seen parents in strong disagreement over the decision. Usually it has been the mother who wants with all her heart to protect her baby from any harm while the father callously insists that his son must "match" him. (This is why I am especially angered when some people try to blame mothers for perpetuating the practice!) Parents who cannot make the decision to leave their sons as nature made them should consider alerting their doctor to the dorsal nerve block procedure, in the hopes that this will at least partly alleviate some of the baby's pain.

Jewish parents who believe that circumcision of their newborn sons is an expression of their "covenant with God" may wish to consider incorporating the dorsal nerve block procedure into the Jewish ritual. Different mohelim will undoubtedly have varying feelings about using this technique. However, I know of no stipulation in Jewish law that would prohibit this. The procedure definitely involves administering medication. Therefore a mohel would probably not be qualified to perform this part of the operation. If the parents believe that a mohel must perform the circumcision, they may have to employ a doctor to administer the anesthetic beforehand. This method may involve some additional expense, but some parents will consider it worth it if it will alleviate some of the baby's pain.

Jeffrey R. Wood has suggested yet another alternative to "conventional" routine circumcision. Some parents have chosen to have only the tip of their baby's foreskin severed without separating the remaining foreskin from the glans. If this is done with an extremely sharp blade this should be no more painful than an injection and would not involve any accompanying risks of anesthesia. The operator would have to employ unusual skill and caution, however, not to damage the glans, since no protective "bell" device would be used. 3.

This option, or other variations of the "mini" circumcision, would afford the individual the opportunity to stretch his remaining foreskin over his glans should he later decide that he prefers the intact appearance.

It must be emphasized, however, that cutting off even a tiny amount of foreskin still involves strapping the baby down in the conventional manner. It still involves hurting his penis and exposing him to trauma and risk of complications.

There have been parents who have read our literature and have agonized over the circumcision decision, and have finally opted for a "partial" circumcision such as this as a "compromise." Most anti‑circumcision activists have difficulty understanding such people. Why can't they be motivated to simply leave the baby's penis alone?!

Yet just as in other countries where female circumcision is common, many people today are opting for less radical variations of the operation' because the custom is too culturally ingrained to be totally abandoned, there are some American parents who can not be persuaded to leave their sons totally intact, but can be persuaded to accept partial circumcision for their sons. It will probably take many years for American parents and doctors to totally do away with routine infant circumcision. However, perhaps many of the "partially" circumcised baby boys of today, born to parents who cannot let go of the circumcision concept, will some day, as fathers, be more willing to leave their own sons intact.

References:

Weiss, Charles, Ph.D., M.D. "Does Circumcision of the Newborn Require an Anaesthetic?" Clinical Pediatrics, Vol. 7, No. 3, March 1968, p. 128‑129.

Kirya, Christopher, M.B., & Werthmann, Milton W., Jr., M.D. “Neonatal Circumcision and Penile Dorsal Nerve Block -‑ A Painless Procedure” The Journal of Pediatrics, Vol. 92, No. 6, June 1978, p. 998‑1,000.

3. Wood, Jeffrey R., (personal correspondence).

GLOSSARY

amputation ‑ The permanent loss of a normal body structure, resulting from accident, surgical intervention due to irreparable injury or disease, or as religious ritual or medical routine. Circumcision involves the surgical amputation of the foreskin of the penis.

balanitis ‑ Inflammation and infection of the glans penis and mucous membrane immediately behind it.

balanoposthitis ‑ Inflammation and infection of the glans penis and prepuce, caused by ammonia irritation during the diaper‑wearing period, or by very poor hygiene in the older individual. Usually this can be resolved by simple measures and need not be treated by amputation of the foreskin (circumcision).

brith ‑ A Hebrew word meaning "covenant" or promise (with God). Alternate spellings: "bris," "brit," "berith," or "briss." Pertains to the Jewish ritual circumcision ceremony which is normally performed on the eighth day of the male baby's life.

carcinoma ‑ Cancer. A growth of malignant cells which may affect almost any part of the body.

carcinogen ‑ A substance which is known to cause or stimulate the growth of cancer.

chordee ‑ Downward curvature of the penis on erection, which is sometimes painful. This can occur as a result of a congenital anomaly, a urethral infection such as gonorrhea, or as a complication of circumcision due to excessive removal of foreskin.

circumcision ‑ (Latin derivatives ‑ "circum" ‑ "around" or "in a circle"; "cisio" ‑ "cutting")

male circumcision ‑ The surgical amputation of the prepuce (foreskin), which normally covers the glans penis.

female circumcision ‑ The surgical amputation of the prepuce ("hood") of the clitoris, so that the glans of the clitoris is exposed. Variations include amputation of the clitoris and labia minora (clitorectomy). Female circumcision is rarely performed in the United States or done to infants.

voluntary circumcision ‑ The personal decision of an adult to have his or her foreskin cut off. Usually performed under anesthesia by a doctor.

enforced circumcision ‑ The cutting off of an individual's foreskin against his or her will. Examples: Forcible circumcision of war captives by conquering armies as an act of subjugation and humiliation; forcible circumcision of slaves as a means of identification; forcible circumcision of mental incompetents, infants, and small children. Forcible circumcision is usually performed without anesthesia.

Almost all cases of amputation of the foreskin, throughout history and today, have not been the personal choice of the individual.

Circumstraint ‑ A plastic tray molded to fit the shape of an infant's body, in which he is placed on his back with his arms and legs secured with straps for the circumcision operation. Manufactured by the Olympic Medical Company, Seattle, WA. (See picture display.)

corona ‑ (From the Greek word "korone" meaning "crown.") A structure resembling a crown. Corona glandis ‑ The circular border of the glans penis.

coronal sulcus ‑ The circular indented area or groove beneath the corona of the glans penis.

covenant ‑ A promise or pledge. A sacred religious agreement to perform a certain act. In the case of Jewish ritual circumcision, an agreement for the Jews to mark the body in a certain way to show that they are God's "chosen people."

dorsal nerve block ‑ A technique of injecting a local anesthetic (lidocaine) into the dorsal nerve of the penis prior to circumcision.

dorsal slit ‑ A procedure in which a hemostat is applied to the foreskin, effectively crushing the blood vessels, after which a slit is made at that site to enlarge the opening of the foreskin. The dorsal slit can be an effective alternative to circumcision for the purpose of enlarging and loosening a tight, non‑retractable prepuce. The dorsal slit is the first step in some methods of infant circumcision. When the Plasti-bell and Gomco Clamp devices are used, the normally tiny opening of the infant's foreskin must first be enlarged before the "bell" can be inserted under the foreskin and over the glans. The dorsal slit should not be performed on intact infants or small boys for the purpose of loosening the foreskin, as it is painful and unnecessary. The foreskin normally loosens and enlarges spontaneously during the first few years of the child's life.

episiotomy ‑ An incision made in the female perineum at the time of giving birth, for the purpose of enlarging the vaginal opening and enabling the baby to be born more quickly. After delivery this incision is repaired with stitches. Episiotomy is not necessary for the majority of vaginal births, although many doctors perform it routinely.

fistula ‑ An abnormal, tube like passage between two parts of the body, or between one part of the body to an outside surface. A fistula may be a congenital defect due to incomplete closure of parts during development, or may result from an injury, abscess, or inflammatory process. A fistula occurring between the urethra and the outside of the shaft of the penis is a rare complication of circumcision.

foreskin ‑ The skin which normally covers the glans penis or the clitoris. Technical term ‑ prepuce. (Originally "foreskin" referred only to the portion of penile skin extending beyond the tip of the glans in the infant which usually later "disappears" as the penis grows to fill it.)

frenulum ‑ A fold of membrane which connects two parts of the body, one part being moveable, and serves to control the movement of that part.

frenulum preputii ‑ The membrane which unites the prepuce to the glans along the underside of the penis. A frenulum develops along the line where two halves of an organ began separately and later joined during prenatal development.

glans ‑ (Derived from the Latin word for "acorn" due to physical resemblance.) In the male ‑ the "head" of the penis. In the female ‑ the clitoris. Normally the glans is covered by the prepuce and is essentially an internal organ.

Gomco clamp ‑ A modern circumcision device, invented in 1934 by Aaron Goldstein, and manufactured by the Gomco Surgical Manufacturing Corp., Buffalo, N.Y. ("Gomco" is derived from "GOldstein Medical Company"). Also known as the Yellen clamp, after Hiram S. Yellen, M.D., who developed a precursor to this device during the 1800s. The device consists of a metal "bell" which is inserted under the foreskin and over the glans, and a large metal clamp which is then screwed over the foreskin and bell to crush the foreskin. The Gomco clamp is left in place for five minutes, the foreskin is then cut off and the clamp removed. (See picture display.)

hemorrhage ‑ Excessive bleeding from an injury, surgical incision, tooth extraction, childbirth, abortion, menstruation‑any event which causes rupture of blood vessels. Excessive blood loss can result in anemia (insufficient red blood cells). Severe hemorrhage may be treated by blood transfusion. Death can result from hemorrhage. Hemorrhage is an occasional complication of circumcision.

hemostat ‑ A scissors‑like clamp frequently used during surgical procedures to pinch off blood vessels or pieces of skin or to hold body tissue out of the way. One method of infant circumcision involves pulling the foreskin up beyond the glans, crushing it straight across with a hemostat, and cutting off the foreskin at that site. The dorsal slit procedure involves inserting a hemostat into the opening of the foreskin to crush the skin and blood vessels, so that it then may be enlarged without undue bleeding.

hypospadias ‑ An abnormal opening of the male urethra onto the undersurface of the penile shaft, caused by incomplete closure during prenatal development. An infant born with hypospadias should not be routinely circumcised as the prepuce provides an effective skin graft to correct the defect.

iatrogenic ‑ Induced by a doctor or medical practitioner, medical procedure, medication, or condition within a medical establishment. Particularly used to describe an injury, disease, or ailment (usually inadvertently) caused by the above.

infibulation (female) ‑ A form of genital mutilation, usually accompanied by primitive forms of female circumcision (clitorectomy) in which the vaginal opening is stitched closed as a method of preserving virginity. A second operation to open the vagina is required at the time of marriage.

infibulation (male) ‑ The stitching or otherwise fastening of the foreskin together in front of the glans as a means of preventing masturbation.

intact ‑ Untouched, especially by anything that harms or diminishes. Having no relevant component removed or destroyed. The adjective "intact" is currently being used to describe the individual who has his foreskin.

meatal stenosis ‑ A condition in which the urinary opening of the glans penis becomes constricted due to repeated irritation from ammonia in urine‑soaked diapers. This condition does not occur in the child with a foreskin which covers the glans, as this protects the glans from irritation. This condition only occurs in the circumcised male child whose glans is exposed.

meatal ulceration ‑ "Burns" consisting of sores and blisters on the sensitive glans penis, especially around the urethral opening, of the circumcised child. Caused by ammonia irritation from urine as it collects in the diaper. Both male and female children may develop similar "burns" in other parts of the diaper area. The male child with a foreskin may develop similar ulcerations on the less sensitive outside of the foreskin. Urine burns are treated by frequent diaper changing, warm baths, ointments, and use of diaper liners or disposal diapers (which help draw urine away from the skin), but can be a persistent and troublesome problem. Meatal ulceration does not occur in the female child, or the intact male child, as the outer skin protects the more sensitive glans.

meatotomy ‑ An operation to enlarge the urinary opening, done to correct severe cases of meatal stenosis, in which the irritated meatus has become so small that it is difficult to pass urine.

meatus ‑ male ‑ The opening in the glans of the penis, from which urine and semen are discharged. Female ‑ the passage for urine, located between the clitoris and the vaginal opening.

mezizah ‑ Hebrew term for the third step of the Jewish circumcision ritual, in which the mohel applies his mouth to the freshly circumcised infant's penis and sucks up the first drops of blood. In more recent times this procedure has been carried out via a tube, as infections, venereal disease, and tuberculosis, sometimes resulting in the death of the infant, have occurred due to contamination of the wound. Most Jewish circumcisors today have eliminated this step from the circumcision ritual. Critics have attributed sadistic and homosexual implications to this practice, while defenders claim that this was simply all that was known during ancient times to stop the bleeding.

micturition ‑ The voiding of urine

milah ‑ Hebrew term for the amputation of the prepuce which is the first step of the circumcision ceremony. In ancient times this was done with a sharp stone or knife. In modern times, most mohelim use the same clamps and devices that are used by the medical profession. (Orthodox Jews, however, prohibit the use of clamps, as they believe that not enough blood is shed with these devices.)

mitzvah ‑ A Hebrew term meaning "religious duty." Also interpreted as "good deed" or "blessed occasion." The term "mitzvah" is used to describe the circumcision ritual.

mohel (pl. "mohelim') ‑ A Jewish ritual circumcisor, usually a rabbi, who has special training and certification to do this operation. In former times mohelim learned from each other. In modern times, mohelim usually train in hospitals and learn from doctors who do routine (non‑religious) circumcisions on newborn babies. Mohelim are licensed by their state to perform ritual circumcision on Jewish babies.

mutilate ‑ To cut off or permanently destroy a limb or part of; to cut up or alter radically so as to make imperfect.

nachas ‑ A Hebrew term for "parental bliss," which Jewish parents are expected to feel when their newborn infant son undergoes the circumcision ritual.

neonate ‑ A newborn baby during the first four weeks of life.

neonatal ‑ Of or pertaining to babies during the first four weeks of life.

non‑REM sleep ‑ A state of deep sleep without rapid eye movements, described as a "low point on an arousal continuum." Prolonged sleep beginning with a lengthy, behaviorally inactive sleep period without rapid eye movements is not normally characteristic in the sleeping patterns of newborn infants but is observed as a response following the circumcision operation. This behavior is consistent with a theory of conservation‑withdrawal in response to stressful stimulation.

paraphimosis ‑ A condition in which the infant's normally tight foreskin is forcefully retracted beyond the glans, constricts and becomes stuck. The glans then swells and the foreskin cannot be easily replaced. The condition is extremely painful for the baby. Some doctors will immediately amputate the foreskin of a baby with this condition, although in most cases it can be corrected with warm water to ease the swelling and gentle easing back of the foreskin. If the parents or caretaker know to leave the foreskin alone during infancy this problem will not occur.

periah ‑ A Hebrew term for the second step of the Jewish circumcision ritual, in which after the foreskin is amputated, the inner membrane is then torn away from the glans and pushed back with the mohel's thumbnail. (This step was devised to prevent the individual from later undergoing an operation to become "uncircumcised" ‑drawing his remaining foreskin forward to make it appear that he had never been circumcised, thereby concealing his identity as a Jew.) Modern clamp devices for circumcision eliminate the need for this step as the membranes are first separated before the insertion of the clamp and "bell."

perineum ‑ The external region between the vulva and the anus in the female or between the scrotum and the anus in the male. This is the area that is cut when a woman has an episiotomy.

phimosis ‑ A condition in which the foreskin is either adhered to the glans penis or tightly constricted over the glans and cannot be retracted.

neonatal tightness of the foreskin ‑ In the newborn infant the foreskin is normally adhered to the glans and has a very tiny opening. "Phimosis" is an incorrect term for this condition. The opening does not enlarge and the prepuce and glans usually do not separate until months or years later in life. The parent or medical practitioner should not attempt to loosen or retract the foreskin during infancy.

acquired phimosis ‑ A complication caused by forceful retraction of the infant's foreskin before it has separated naturally. Forcefully retracting the naturally tight foreskin of the infant will break adhesions and cause it to bleed. The foreskin and glans may heal together when the foreskin is replaced (much as two fingers, with the skin injured, would join together if bandaged together). With acquired phimosis, scar tissue develops between the foreskin and glans and the foreskin cannot be retracted. This condition can usually be corrected by gradual easing back of the foreskin over time, applying petroleum jelly or similar ointments to prevent the two surfaces from rejoining, or warm baths. However, some doctors prescribe amputation of the foreskin to correct this condition.

congenital or "true" phimosis ‑ A rare condition in which the naturally tight foreskin, left alone from infancy, still cannot be retracted during late childhood or teenage years. Like acquired phimosis, this can usually be corrected by gradual easing back of the foreskin and warm baths, although some doctors will prescribe circumcision.

Plasti-bell ‑ A circumcision device manufactured by Hollister Corporation, Chicago, IL. The device consists of a plastic "bell" which is placed over the glans and under the foreskin. A string is then tied over the foreskin and the bell, part of the foreskin is cut off, the handle of the bell removed, and the ring of plastic stays in place. Within ten days the remaining foreskin dries up and the plastic ring normally falls off. (See picture display.)

posthitis ‑Inflamed condition of the foreskin.

prepuce ‑ male ‑ The skin which normally covers the glans of the penis, commonly known as the "foreskin." This piece of skin is what is cut off during circumcision.

female ‑ The skin that covers the clitoris, sometimes called the "hood" of the clitoris. This piece of skin is cut off during female circumcision.

priapism ‑ Abnormal, painful and continued erection of the penis due to disease and usually without sexual desire.

pseudo ‑ False. Used in this book to describe the modern medical establishment as a “pseudo‑religion.”

raphe ‑ A seam or ridge originating in embryonic development in which two halves of an organ that begin separately are later joined. The raphe of the penis and scrotum is a ridge which extends along the posterior surface of the penis and extends through the midline of the scrotum.

retraction (of foreskin) ‑ The pulling back of the foreskin to expose the glans. Usually this is only necessary when washing. Normally in the young boy or adult this procedure is simple. This should not be done to an infant until the foreskin has naturally loosened from the glans and can be retracted easily.

routine ‑ A procedure that is done automatically, without question, especially by a system or organization. Pertaining to hospitals -‑ a procedure that is done automatically to all patients in a given situation. For example: all patients admitted to a hospital will probably have a routine blood sample taken. Routine procedures are usually not essential life‑saving procedures, but are often done as precautionary measures, or simply because that hospital staff always does things in that particular way. Therefore a mother giving birth in a hospital may have a routine enema, routine pubic shave, routine medication, or a routine separation from her baby for several hours after birth.

routine neonatal circumcision ‑ All or nearly all newborn male infants born in a hospital have their foreskins amputated, for non‑religious reasons, shortly after birth. While at least one parent is usually asked to sign a consent form, parents are usually inclined to cooperate with hospital procedures and therefore sign it "routinely."

sandek ‑ A Hebrew term meaning "Godfather." A man who holds the infant during the Jewish circumcision ritual. This is considered to be a position of high honor.

Sheldon clamp ‑ A circumcision device manufactured by the Olympic Medical Supplies Company, Seattle, WA. With this method, the infant's foreskin is stretched up over the glans, smashed by this clamp, and cut off. No protective "bell" is used to cover the glans. (See picture display.) (Author’s update – this device was taken off the market during the 1980’s, probably due to the greater risk of damage to the glans.)

smegma ‑ The naturally occurring substance that collects beneath the foreskin of the penis and around the clitoris and labia. It is mainly composed of dead skin cells. Smegma is easily washed away while bathing. If the individual does not bathe for several days, smegma will develop an unpleasant odor (as will feet, mouths, underarms, and all parts of the body). Smegma has not been proven to be carcinogenic despite repeated tests with laboratory animals.

trauma ‑ An event which causes great physical pain and/or psychological upset to the individual, which may have lasting repercussions affecting that person's future and/or nature. Intense fear, anger, shame, or remorse may be emotional reactions to trauma. Amputation of the foreskin (circumcision) is a trauma to a newborn baby. The procedure is also frequently an emotional trauma to new parents.

References: Some of these definitions were found with the help of the following:

1. "Taber's CYCLOPEDIC MEDICAL DICTIONARY" Edition 13, c. 1977.

2. "Webster's Seventh New Collegiate Dictionary" C. & C. Merriam Company, Springfield, Ma., c. 1967.