Friday, January 05, 2007

Circumcision Studies

The following is a sampling of peer reviewed medical studies pertaining to circumcision and the prepuce (foreskin) that has been published and is accessible in full or part online. List compiled in part by the Circumcision Resource Center at Circumcision.org. To add a study to this list, write to DrMomma.org@gmail.com

Additional related resources (books, websites, articles) available at Are You Fully Informed?


Circumcision Information and Resource Pages - CIRP.org - houses a significant amount of published literature and journal articles available for online viewing.

The International Symposia on Law, Genital Autonomy and Children's Rights (Symposia details here) publishes scholarly articles from the symposia. The first through the eleventh symposia curriculum are linked from the National Organization of Circumcision Information Resource Centers here.

Publications include:

Genital Autonomy: Protecting Personal Choice (2010)

Circumcision and Human Rights (2009)

Bodily Integrity and the Politics of Circumcision: Culture, Controversy and Change (2006)

Flesh and Blood: Perspectives on the Problem of Circumcision in Contemporary Society (2003)

Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimentional Problem (2001)

Male and Female Circumcision: Medical, Legal and Ethical Considerations in Pediatric Practice (1999)

Sexual Mutilations: A Human Tragedy (1997)


Journal Articles

Circumcision is Associated with Adult Difficulty in Identifying and Expressing Feelings 

This preliminary study investigates what role early trauma might have in alexithymia (difficulty in identifying and expressing feelings) acquisition for adults by controlling for male circumcision. Three hundred self-selected men were administered the Toronto Twenty-Item Alexithymia Scale checklist and a personal history questionnaire. The circumcised men had age-adjusted alexithymia scores 19.9 percent higher than the intact men; were 1.57 times more likely to have high alexithymia scores; were 2.30 times less likely to have low alexithymia scores; had higher prevalence of two of the three alexithymia factors (difficulty identifying feelings and difficulty describing feelings); and were 4.53 times more likely to use an erectile dysfunction drug. Alexithymia in this population of adult men is statistically significant for having experienced circumcision trauma and for erectile dysfunction drug use. http://mensstudies.metapress.com/content/2772r13175400432/

Bollinger, D. and Van Howe, R. , "Alexithymia and Circumcision Trauma: A Preliminary Investigation," International Journal of Men's Health (2011);184-195.

Circumcision Associated with Sexual Difficulties in Men and Women 

A new national survey in Denmark, where about 5% of men are circumcised, examined associations of circumcision with a range of sexual measures in both sexes. Circumcised men were more likely to report frequent orgasm difficulties, and women with circumcised spouses more often reported incomplete sexual needs fulfillment and frequent sexual function difficulties overall, notably orgasm difficulties, and painful sexual intercourse. Thorough examination of these matters in areas where male circumcision is more common is warranted. http://ije.oxfordjournals.org/content/early/2011/06/13/ije.dyr104.short?rss=1

Frisch, M., Lindholm, M., and Grønbæk, M., "Male Circumcision and Sexual Function in Men and Women: A Survey-based, Cross-sectional Study in Denmark," International Journal of Epidemiology (2011);1–15.

Circumcision is Associated with Premature Ejaculation

Premature ejaculation (PE) is common. However, it has been under-reported and under-treated. The aim of the study was to determine the prevalence of PE and to investigate possible associated factors of PE. This cross-sectional study was conducted at a primary care clinic over a 3-month period in 2008. Men aged 18-70 years attending the clinic were recruited, and they completed self-administered questionnaires. A total of 207 men were recruited with a response rate of 93.2%. Their mean age was 46.0 years. The prevalence of PE was 40.6%. No significant association was found between age and PE. Multivariate analysis showed that erectile dysfunction, circumcision, and sexual intercourse =5 times in 4 weeks were predictors of PE. These associations need further confirmation. http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2011.02280.x/full

Tang, W. and Khoo, E. "Prevalence and Correlates of Premature Ejaculation in a Primary Care Setting: A Preliminary Cross-Sectional Study," Journal of Sexual Medicine (2011) Apr 14.

Claim of Circumcision Benefit is Overstated and Premature

Further research is required to assess the feasibility, desirability and cost-effectiveness of circumcision to reduce the acquisition of HIV. This paper endorses the need for such research and suggests that, in its absence, it is premature to promote circumcision as a reliable strategy for combating HIV. Since articles in leading medical journals as well as the popular press continue to do so, scientific researchers should think carefully about how their conclusions may be translated both to policy makers and to a more general audience. The importance of addressing ethico-legal concerns that such trials may raise is highlighted. The understandable haste to find a solution to the HIV pandemic means that the promise offered by preliminary and specific research studies may be overstated. This may mean that ethical concerns are marginalized. Such haste may also obscure the need to be attentive to local cultural sensitivities, which vary from one African region to another, in formulating policy concerning circumcision. http://jme.bmj.com/content/36/12/798.abstract

Fox, M. and Thomson, M., "HIV/AIDS and Circumcision : Lost in Translation," Journal of Medical Ethics 36 (2010):798-801.

Circumcision/HIV Claims are Based on Insufficient Evidence

An article endorsed by thirty-two professionals questions the results of three highly publicized African circumcision studies. The studies claim that circumcision reduces HIV transmission, and they are being used to promote circumcisions. Substantial evidence in this article refutes the claim of the studies. Examples in the article include the following: Circumcision is associated with increased transmission of HIV to women. Conditions for the studies were unlike conditions found in real-world settings. Other studies show that male circumcision is not associated with reduced HIV transmission. The U.S. has a high rate of HIV infection and a high rate of circumcision. Other countries have low rates of circumcision and low rates of HIV infection. Condoms are 95 times more cost effective in preventing HIV transmission. Circumcision removes healthy, functioning, unique tissue, raising ethical considerations. http://www.ncbi.nlm.nih.gov/pubmed/20965388

Green, L. et al., "Male Circumcision and HIV Prevention: Insufficient Evidence and Neglected External Validity," American Journal of Preventive Medicine 39 (2010): 479-82.

In National Survey Circumcision Had No Protective Effect 

A survey of South African men showed that circumcision had no protective effect in the prevention of HIV transmission. This is a concern, and has implications for the possible adoption of mass male circumcision strategy both as a public health policy and an HIV prevention strategy. http://www.ajol.info/index.php/samj/article/view/14003

Connolly, C. et al., South African Medical Journal 98(2008): 789-794.

Circumcision is Not Cost Effective

The findings suggest that behavior change programs are more efficient and cost effective than circumcision. Providing free condoms is estimated to be significantly less costly, more effective in comparison to circumcising, and at least 95 times more cost effective at stopping the spread of HIV in Sub-Saharan Africa. In addition, condom usage provides protection for women as well as men. This is significant in an area where almost 61% of adults living with AIDS are women. http://www.ajol.info/index.php/samj/article/viewFile/14003/2617

McAllister, R. et al., "The Cost to Circumcise Africa," American Journal of Men's Health 7(2008): 307-316.

Circumcision/HIV Have Incomplete Evaluation

The push to institute mass circumcision in Africa, following the three randomized clinical trials (RCTs) conducted in Africa, is based on an incomplete evaluation of real-world preventive effects over the long-term – effects that may be quite different outside the research setting and circumstances, with their access to resources, sanitary standards and intensive counseling. Moreover, proposals for mass circumcision lack a thorough and objective consideration of costs in relation to hoped-for benefits. No field-test has been performed to evaluate the effectiveness, complications, personnel requirements, costs and practicality of proposed approaches in real-life conditions. These are the classic distinctions between efficacy and effectiveness trials, and between internal validity and external validity.

Campaigns to promote safe-sex behaviors have been shown to accomplish a high rate of infection reduction, without the surgical risks and complications of circumcision, and at a much lower cost. For the health community to rush to recommend a program based on incomplete evidence is both premature and ill-advised. It misleads the public by promoting false hope from uncertain conclusions and might ultimately aggravate the problem by altering people’s behavioral patterns and exposing them and their partners to new or expanded risks. Given these problems, circumcision of adults, and especially of children, by coercion or by false hope, raises human rights concerns. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2801441/?tool=pmcentrez&render

Green, L. et al., "Male Circumcision is Not the HIV ‘Vaccine’ We Have Been Waiting For!" Future Medicine 2 (2008): 193-199, DOI 10.2217/17469600.2.3.193.

Circumcision Decreases Sexual Pleasure

A questionnaire was used to study the sexuality of men circumcised as adults compared to uncircumcised men, and to compare their sex lives before and after circumcision. The study included 373 sexually active men, of whom 255 were circumcised and 118 were not. Of the 255 circumcised men, 138 had been sexually active before circumcision, and all were circumcised at >20 years of age. Masturbatory pleasure decreased after circumcision in 48% of the respondents, while 8% reported increased pleasure. Masturbatory difficulty increased after circumcision in 63% of the respondents but was easier in 37%. About 6% answered that their sex lives improved, while 20% reported a worse sex life after circumcision. There was a decrease in masturbatory pleasure and sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings. http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2006.06646.x/abstract

Kim, D. and Pang, M., "The Effect of Male Circumcision on Sexuality," BJU International 99 (2007): 619-22.

Circumcision Removes the Most Sensitive Parts of the Penis

A sensitivity study of the adult penis in circumcised and uncircumcised men shows that the uncircumcised penis is significantly more sensitive. The most sensitive location on the circumcised penis is the circumcision scar on the ventral surface. Five locations on the uncircumcised penis that are routinely removed at circumcision are significantly more sensitive than the most sensitive location on the circumcised penis.

In addition, the glans (head) of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The tip of the foreskin is the most sensitive region of the uncircumcised penis, and it is significantly more sensitive than the most sensitive area of the circumcised penis. Circumcision removes the most sensitive parts of the penis.

This study presents the first extensive testing of fine touch pressure thresholds of the adult penis. The monofiliment testing instruments are calibrated and have been used to test female genital sensitivity. http://www.ncbi.nlm.nih.gov/pubmed/17378847

Sorrells, M. et al., “Fine-Touch Pressure Thresholds in the Adult Penis,” BJU International 99 (2007): 864-869.

Circumcision Policy Influenced by Psychosocial Factors

The debate about the advisability of circumcision in English-speaking countries typically has focused on potential health factors. The position statements of committees from national medical organisations are expected to be evidence-based; however, the contentiousness of the ongoing debate suggests that other factors are involved. Various potential factors related to psychology, sociology, religion, and culture may also underlie policy decisions. These factors could affect the values and attitudes of medical committee members, the process of evaluating the medical literature, and the medical literature itself. Although medical professionals highly value rationality, it can be difficult to conduct a rational and objective evaluation of an emotional and controversial topic such as circumcision. A negotiated compromise between polarized committee factions could introduce additional psychosocial factors. These possibilities are speculative, not conclusive. It is recommended that an open discussion of psychosocial factors take place and that the potential biases of committee members be recognized. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2724127/

Goldman, R., “Circumcision Policy: A Psychosocial Perspective,” Paediatrics & Child Health 9 (2004): 630-633.

Circumcision is Not Good Health Policy

A cost-utility analysis, based on published data from multiple observational studies, comparing boys circumcised at birth and those not circumcised was undertaken using the Quality of Well-being Scale, a Markov analysis, the standard reference case, and a societal perspective. Neonatal circumcision increased incremental costs by $828.42 per patient and resulted in an incremental 15.30 well-years lost per 1000 males. If neonatal circumcision was cost-free, pain-free, and had no immediate complications, it was still more costly than not circumcising. Using sensitivity analysis, it was impossible to arrange a scenario that made neonatal circumcision cost-effective. Neonatal circumcision is not good health policy, and support for it as a medical procedure cannot be justified financially or medically. http://www.mendeley.com/research/costutility-analysis-neonatal-circumcision/

Van Howe, R., “A Cost-Utility Analysis of Neonatal Circumcision,” Medical Decision Making 24 (2004):584-601.

Pain, Trauma, Sexual, and Psychological Effects of Circumcision

Infant male circumcision continues despite growing questions about its medical justification. As usually performed without analgesia or anaesthetic, circumcision is observably painful. It is likely that genital cutting has physical, sexual and psychological consequences, too. Some studies link involuntary male circumcision with a range of negative emotions and even post-traumatic stress disorder (PTSD). Some circumcised men have described their current feelings in the language of violation, torture, mutilation and sexual assault. In view of the acute as well as long-term risks from circumcision and the legal liabilities that might arise, it is timely for health professionals and scientists to re-examine the evidence on this issue and participate in the debate about the advisability of this surgical procedure on unconsenting minors. http://epublications.bond.edu.au/hss_pubs/36/

Boyle G. et al., "Male Circumcision: Pain, Trauma and Psychosexual Sequelae," Journal of Health Psychology (2002): 329-343.

Circumcision Results in Significant Loss of Erogenous Tissue

A report published in the British Journal of Urology assessed the type and amount of tissue missing from the adult circumcised penis by examining adult foreskins obtained at autopsy. Investigators found that circumcision removes about one-half of the erogenous tissue on the penile shaft. The foreskin, according to the study, protects the head of the penis and is comprised of unique zones with several kinds of specialized nerves that are important to optimum sexual sensitivity. http://www.ncbi.nlm.nih.gov/pubmed/8800902

Taylor, J. et al., "The Prepuce: Specialized Mucosa of the Penis and Its Loss to Circumcision," BJU 77 (1996): 291–295.

Circumcision Affects Sexual Behavior

A study published in the Journal of the American Medical Association found that circumcision provided no significant prophylactic benefit and that circumcised men were more likely to engage in various sexual practices. Specifically, circumcised men were significantly more likely to masturbate and to participate in heterosexual oral sex than uncircumcised men. http://jama.ama-assn.org/content/277/13/1052
Laumann, E. et al., "Circumcision in the U.S.: Prevalence, Prophylactic Effects, and Sexual Practice,"

JAMA 277 (1997): 1052–1057.

Researchers Demonstrate Traumatic Effects of Circumcision

A team of Canadian researchers produced new evidence that circumcision has long-lasting traumatic effects. An article published in the international medical journal The Lancet reported the effect of infant circumcision on pain response during subsequent routine vaccination. The researchers tested 87 infants at 4 months or 6 months of age. The boys who had been circumcised were more sensitive to pain than the uncircumcised boys. Differences between groups were significant regarding facial action, crying time, and assessments of pain.

The authors believe that "neonatal circumcision may induce long-lasting changes in infant pain behavior because of alterations in the infant’s central neural processing of painful stimuli." They also write that "the long-term consequences of surgery done without anaesthesia are likely to include post-traumatic stress as well as pain. It is therefore possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an infant analogue of a post-traumatic stress disorder triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination." http://www.ncbi.nlm.nih.gov/pubmed/9057731

Taddio, A. et al., "Effect of Neonatal Circumcision on Pain Response during Subsequent Routine Vaccination," The Lancet 349 (1997): 599–603.

Circumcision Study Halted Due to Trauma

Researchers found circumcision so traumatic that they ended the study early rather than subject any more infants to the operation without anesthesia. Those infants circumcised without anesthesia experienced not only severe pain, but also an increased risk of choking and difficulty breathing. The findings were published in the Journal of the American Medical Association. Up to 96% of infants in some areas of the United States receive no anesthesia during circumcision. No anesthetic currently in use for circumcisions is effective during the most painful parts of the procedure. http://jama.ama-assn.org/content/278/24/2157.short?cited-by=yes&legid=jama;278/24/2157

Lander, J. et al., "Comparison of Ring Block, Dorsal Penile Nerve Block, and Topical Anesthesia for Neonatal Circumcision," JAMA 278 (1997): 2157–2162.

Circumcised Penis Requires More Care in Young Boys

The circumcised penis requires more care than the natural penis during the first three years of life, according to a report in the British Journal of Urology. The clinical findings of an American pediatrician showed that circumcised boys were significantly more likely to have skin adhesions, trapped debris, irritated urinary opening, and inflammation of the glans (head of the penis) than were boys with a foreskin. Furthermore, because there are large variations of appearance in circumcised boys, circumcision for cosmetic reasons should be discouraged. http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410X.1997.00467.x/pdf

Van Howe, R., "Variability in Penile Appearance and Penile Findings: A Prospective Study," BJU 80 (1997): 776–782.

Poll of Circumcised Men Reveals Harm

A poll of circumcised men published in the British Journal of Urology describes adverse outcomes on men’s health and well-being. Findings showed wide-ranging physical, sexual, and psychological consequences. Some respondents reported prominent scarring and excessive skin loss. Sexual consequences included progressive loss of sensitivity and sexual dysfunction. Emotional distress followed the realization that they were missing a functioning part of their penis. Low-self esteem, resentment, avoidance of intimacy, and depression were also noted. http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410x.1999.0830s1085.x/pdf

Hammond, T., "A Preliminary Poll of Men Circumcised in Infancy or Childhood," BJU 83 (1999): suppl. 1: 85–92

Psychological Effects of Circumcision Studied

An article titled "The Psychological Impact of Circumcision" reports that circumcision results in behavioral changes in infants and long-term unrecognized psychological effects on men. The piece reviews the medical literature on infants’ responses to circumcision and concludes, "there is strong evidence that circumcision is overwhelmingly painful and traumatic." The article notes that infants exhibit behavioral changes after circumcision, and some men have strong feelings of anger, shame, distrust, and grief about having been circumcised. In addition, circumcision has been shown to disrupt the mother-infant bond, and some mothers report significant distress after allowing their son to be circumcised. Psychological factors perpetuate circumcision. According to the author, "defending circumcision requires minimizing or dismissing the harm and producing overstated medical claims about protection from future harm. The ongoing denial requires the acceptance of false beliefs and misunderstanding of facts. These psychological factors affect professionals, members of religious groups, and parents involved in the practice."

Expressions from circumcised men are generally lacking because most circumcised men do not understand what circumcision is, emotional repression keeps feelings from awareness, or men may be aware of these feelings but afraid of disclosure. http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410x.1999.0830s1093.x/abstract

Goldman, R., "The Psychological Impact of Circumcision," BJU 83 (1999): suppl. 1: 93–102

Serious Consequences of Circumcision Trauma in Adult Men Clinically Observed

Using four case examples that are typical among his clients, a practicing psychiatrist presents clinical findings regarding the serious and sometimes disabling long-term somatic, emotional, and psychological consequences of infant circumcision in adult men. These consequences resemble complex post-traumatic stress disorder and emerge during psychotherapy focused on the resolution of perinatal and developmental trauma. Adult symptoms associated with circumcision trauma include shyness, anger, fear, powerlessness, distrust, low self-esteem, relationship difficulties, and sexual shame. Long-term psychotherapy dealing with early trauma resolution appears to be effective in healing these consequences. http://www.cmaj.ca/content/154/6/769.abstract

Rhinehart, J., "Neonatal Circumcision Revistited," Transactional Analysis Journal 29 (1999): 215-221

Anatomy and Function of the Foreskin Documented

A new article describes the foreskin (prepuce) as an integral, normal part of the genitals of mammals. It is specialized, protective, erogenous tissue. A description of the complex nerve structure of the penis explains why anesthetics provide incomplete pain relief during circumcision. Cutting off the foreskin removes many fine-touch receptors from the penis and results in thickening and desensitization of the glans outer layer. The complex anatomy and function of the foreskin dictate that circumcision should be avoided or deferred until the person can make an informed decision as an adult. http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410x.1999.0830s1034.x/pdf

Cold, C. and Taylor, J., "The Prepuce," BJU 83 (1999): suppl. 1: 34–44.

Male Circumcision Affects Female Sexual Enjoyment

A survey of women who have had sexual experience with circumcised and anatomically complete partners showed that the anatomically complete penis was preferred over the circumcised penis. Without the foreskin to provide a movable sleeve of skin, intercourse with a circumcised penis resulted in female discomfort from increased friction, abrasion, and loss of natural secretions. Respondents overwhelmingly concurred that the mechanics of coitus were different for the two groups of men. Unaltered men tended to thrust more gently with shorter strokes. http://onlinelibrary.wiley.com/doi/10.1046/j.1464-410x.1999.0830s1079.x/pdf

O’Hara, K. and O’Hara, J., "The Effect of Male Circumcision on the Sexual Enjoyment of the Female Partner," BJU 83 (1999): suppl. 1: 79–84

Male Circumcision and Psychosexual Effects Investigated

Infant male circumcision continues despite growing questions about its medical justification. As usually performed without analgesia or anesthetic, circumcision is observably painful. It is likely that genital cutting has physical, sexual, and psychological consequences, too. Some studies link involuntary male circumcision with a range of negative emotions and even post-traumatic stress disorder (PTSD). Some circumcised men have described their current feelings in the language of violation, torture, mutilation, and sexual assault. In view of the acute as well as long-term risks from circumcision and the legal liabilities that might arise, it is timely for health professionals and scientists to re-examine the evidence on this issue and participate in the debate about the advisability of this surgical procedure on unconsenting minors. http://epublications.bond.edu.au/cgi/viewcontent.cgi?article=1036&context=hss_pubs

Boyle, G., Goldman, R., Svoboda, J.S., and Fernandez, E., "Male Circumcision: Pain, Trauma, and Psychosexual Sequelae," Journal of Health Psychology 7 (2002): 329-343.

Surveys Reveal Adverse Sexual and Psychological Effects of Circumcision

A survey of the 35 female and 42 gay sexual partners of circumcised and genitally intact men, and a separate survey of 53 circumcised and genitally intact men, and a separate survey of 30 genitally intact men themselves indicated that circumcised men experienced significantly reduced sexual sensation along with associated long-lasting negative emotional consequences. http://www.amsciepub.com/doi/abs/10.2466/pr0.2001.88.3c.1105

Boyle, G. and Bensley, G., "Adverse Sexual and Psychological Effects of Male Infant Circumcision,". Psychological Reports 88 (2001): 1105-1106.

Foreskin Reduces the Force Required for Penetration and Increases Comfort

Masters and Johnson observed that the foreskin unrolled with intercourse. However, they overlooked a prior observation that intromission (i.e., penetration) was thereby made easier. To evaluate this observation an artificial introitus was mounted on scales. Repeated measurements showed a 10-fold reduction of force on entry with an initially unretracted foreskin as compared to entry with a retracted foreskin. For the foreskin to reduce the force required it must cover most of the glans when the penis is erect. http://www.ncbi.nlm.nih.gov/pubmed/12208206

Taves, D., "The Intromission Function of the Foreskin," Med Hypotheses 59 (2002): 180.

Survey of Men Circumcised as Adults Shows Mixed Results

Men circumcised as adults were surveyed to assess erectile function, penile sensitivity, sexual activity and overall satisfaction. Over 80% of these men were circumcised to treat a medical problem. The response rate was 44% among potential responders. Mean age of responders was 42 years at circumcision and 46 years at survey. Adult circumcision appears to result in worsened erectile function, decreased penile sensitivity, no change in sexual activity, and improved satisfaction. Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised. Note: Results may be affected by the fact that there was no sample of normal, healthy, genitally intact men for comparison. http://www.ncbi.nlm.nih.gov/pubmed/11956453

Fink, K., Carson, C., DeVellis, R., "Adult Circumcision Outcomes Study: Effect on Erectile Function, Penile Sensitivity, Sexual Activity and Satisfaction," J Urol 167 (2002): 2113-2116.

Survey Finds Circumcision Contributes to Vaginal Dryness

The impact of male circumcision on vaginal dryness during coitus was investigated. We conducted a survey of 35 female sexual partners aged 18 to 69 years who had experienced sexual intercourse with both circumcised and genitally intact men. Women reported they were significantly more likely to have experienced vaginal dryness during intercourse with circumcised than with genitally intact men. http://journal.nzma.org.nz/journal/116-1181/595/

Bensley, G. and Boyle, G., "Effects of Male Circumcision on Female Arousal and Orgasm," N Z Med J 116 (2003): 595-596.

Early Adverse Experiences May Lead to Abnormal Brain Development and Behavior

Self-destructive behavior in current society promotes a search for psychobiological factors underlying this epidemic. The brain of the newborn infant is particularly vulnerability to early adverse experiences, leading to abnormal development and behavior. Although several investigations have correlated newborn complications with abnormal adult behavior, our understanding of the underlying mechanisms remains rudimentary. Models of early experience, such as repetitive pain, sepsis, or maternal separation in rodents and other species have noted multiple alterations in the adult brain, correlated with specific behavioral types depending on the timing and nature of the adverse experience. The mechanisms mediating such changes in the newborn brain have remained largely unexplored. Maternal separation, sensory isolation (understimulation), and exposure to extreme or repetitive pain (overstimulation) may cause altered brain development (Circumcision is described as an intervention with long-term neurobehavioral effects.) These changes promote two distinct behavioral types characterized by increased anxiety, altered pain sensitivity, stress disorders, hyperactivity/attention deficit disorder, leading to impaired social skills and patterns of self-destructive behavior. The clinical importance of these mechanisms lies in the prevention of early adverse experiences and effective treatment of newborn pain and stress. http://www.ncbi.nlm.nih.gov/pubmed/10657682

Anand, K. and Scalzo, F., "Can Adverse Neonatal Experiences Alter Brain Development and Subsequent Behavior? Biol Neonate 77 (2000): 69-82

Repeat Circumcision on the Rise 

American Academy of Pediatrics. Kokorowski PJ, et al. "Is circumcision revision becoming more common?" AAP 2011; Abstract 13760.


Request a circumcision and intact care information pack here.
Includes research and materials for those expecting a son or beginning an exploration of intact subjects.

Information cards available via Saving Our Sons here.

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Thursday, January 04, 2007

Circumcision Websites

The following is a list of websites that deal with the subject of circumcision. We strive to add additional sites as they come along, yet not all sites remain active and updated. A full list of websites, blogs, news, YouTube channels and online activity pertaining to circumcision can be found at The Intact Network.

Additional resources (books, articles, medical studies) found at Are You Fully Informed?



Websites in Alphabetical Order


As Nature Intended

Attorneys for the Rights of the Child

Beyond the Bris

Circumcision Decision Maker

Catholics Against Circumcision

Circumcision Information and Resource Pages

Circumcision Information Australia

Circumcision Information Resource Center of Colorado

Circumcision Resource Center

Doctors Opposing Circumcision

DrMomma.org

End Routine Infant Circumcision

Foregen

Genital Autonomy

Historical Medical Quotes on Circumcision

History of Circumcision

In Memory of the Sexually Mutilated Child

Intact America
The Intact Network
The Intactivism Pages

International Coalition for Genital Integrity

Jewish Circumcision Resource Center

Jews Against Circumcision

Male Circumcision and HIV

The Male Circumcision Information Site

MGM Bill: A Bill to End Male Genital Mutilation in the United States

Mothering Magazine

Mothers Against Circumcision

National Organization of Circumcision Information Resource Centers

National Organization of Restoring Men

National Organization to Halt the Abuse and Routine Mutilation of Males

Not Just Skin

Nurses For the Rights of the Child

Peaceful Parenting

Quran Circumcision [Islam]

Quranic Path [Islam]

Restoring Tally

Ridged Band

Saving Our Sons
Stop The Cut

Stop Infant Circumcision Society

Students for Genital Integrity

TLC Tugger

Udonet - Circumcision

Whole Baby Revolution

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Wednesday, January 03, 2007

Circumcision Books

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View a full library of books pertaining to circumcision here on Amazon. 

Additional resources (websites, articles, medical studies) found at Are You Fully Informed?



What Your Doctor May Not Tell You About Circumcision

Circumcision: What Every Parent Should Know

Marked in Your Flesh: Circumcision from Ancient Judea to Modern America

Circumcision: The Hidden Trauma

Circumcision: The Rest of the Story

Doctors Re-examine Circumcision

Circumcision: An American Health Fallacy

Circumcision: The Painful Dilemma

A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain

Circumcision: A History of the World's Most Controversial Surgery

Questioning Circumcision: A Jewish Perspective

Covenant of Blood: Circumcision and Gender in Rabbinic Judaism

Circumcision Exposed: Rethinking a Medical and Cultural Tradition

In the Name of Humanity: Speaking Out Against Circumcision

40 Compelling Reasons Why You Should Respect His Birthright and Keep Your Son Whole


Children's Genitals Under the Knife

As Nature Made Him: The Boy Who Was Raised As A Girl [1 detailed example of the consequences of botched circumcision]

Sex as Nature Intended It

A Mind of Its Own: A Cultural History of the Penis

The Joy of Uncircumcising *also found as downloadable book here

Crystallized Pathology: The Clitoris, the Penis and Women's Sexual Health *currently limited and available upon request at DrMomma.org@gmail.com

Circumcision *Mothering reprint of articles


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Tuesday, January 02, 2007

Foreskin Friendly Physicians


With increasingly large numbers of parents keeping their sons intact today, proper intact care both at home and at the doctor's office is vital. Unfortunately, very few U.S. physicians are trained on the prepuce organ and proper intact care in medical schools across the nation, and as a result, this impacts care during family visits today.

Forced retraction is an epidemic in the United States and some parts of Canada today. This should not be the case. There is ample research currently available for physicians to become fully informed on intact care, and the many myths that surround retraction and circumcision.

We encourage you, as parents, to read up on intact care, retraction, and circumcision. Be well versed in red flags you may see or hear when visiting your local clinic or hospital, and take proactive measures to protect your son.

What is a 'foreskin friendly' physician? This is a medical professional who has taken the time to review current literature on the prepuce, natural male development from infancy to adulthood, and proper care of the penis in its normal state. S/he will not forcibly retract your child or encourage you to do so. S/he knows that the average age of retraction is 10 1/2 years of age, and that some boys do not retract until after puberty. S/he is well aware that the prepuce and glans are organs fused tightly together at birth, and they may or may not loosen in toddlerhood and early childhood on their own. S/he will not tell you to retract or clean, because this physician knows the prepuce is a self-sustaining organ (much like your eyelids, organs that also do not need special 'cleaning'). If issues do arise, the least invasive measure of care will be taken. For example, in the case of a yeast infection, nystatin or a similar ointment would be recommended, not circumcision. In the case of a urinary tract infection, antibiotics would be prescribed, not amputative surgery. Overall, these are physicians who appreciate that the prepuce is not a flawed organ by design, but rather a purposeful and functional one. They are men and women who adhere to a method of practice that benefits even their smallest patient.

An asterisk ( * ) next to a physician's name means that in addition to being a foreskin-friendly care provider, this doctor will not perform circumcision surgery on any healthy infant. This facet of practice is not known of all the physicians on this list.

If you are a 'foreskin friendly' physician, or are a parent who knows of a physician who fits these criteria, drop us an email with contact information at DrMomma.org@gmail.com or leave a comment below to have your practice added. Other parents in your area will thank you!


UNITED STATES


ALABAMA


ALASKA


ARIZONA


ARKANSAS


CALIFORNIA


COLORADO


CONNECTICUT


DELAWARE


DISTRICT OF COLUMBIA


FLORIDA


GEORGIA


GUAM


HAWAII


IDAHO







IOWA


KANSAS


KENTUCKY


LOUISIANA


MAINE


MARYLAND


MASSACHUSETTS


MICHIGAN


MINNESOTA


MISSISSIPPI


MISSOURI


MONTANA


NEBRASKA


NEVADA


NEW HAMPSHIRE


NEW JERSEY


NEW MEXICO


NEW YORK


NORTH CAROLINA


NORTH DAKOTA


OHIO


OKLAHOMA


OREGON


PENNSYLVANIA


PUERTO RICO


RHODE ISLAND


SOUTH CAROLINA


SOUTH DAKOTA


TENNESSEE


TEXAS


UTAH


VERMONT


VIRGINIA




WEST VIRGINIA


WISCONSIN


WYOMING



CANADA


ALBERTA


MANITOBA 


ONTARIO



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Monday, January 01, 2007

Effective Carding




What is carding

Carding is a term first coined in 2005 by Danelle Frisbie to represent leaving small, professionally made info cards (or magnets, stickers, brochures, bookmarks) of baby-friendly information with expecting mothers, new parents, clients, students, and out in public locations where these same individuals would stumble into information (many for the very first time), and be curious enough to look a little further into the subject at hand. Carding is what Frisbie called 'seed planting' - leaving tidbits of information that, when planted in the right place, and sowed by gentle advocates, grows into positive, proactive empowerment for those who reap the harvest.

Carding includes wide assortment of baby, child and family health information - breastfeeding, babywearing, baby sleep, gentle parenting and discipline, informed vaccination, car seat safety, circumcision and intact information, among others. Intact information cards, specifically, are geared toward diverse demographics to meet people where they are in their genital autonomy journey. This is especially important in the United States and Canada, as a wide group of people from many backgrounds benefit from accurate and complete information on genital cutting as it exists in 21st century North America. Intact info cards are varied in their message and geared toward expecting mothers, new fathers to be, those who already have children, those who are not yet looking to become parents (teens, college students), cards specific to men, women, grandparents, cards for people of different faiths, and interests. Holiday themed cards are made to be especially fitting to leave among the decor that floods stores and public venues throughout the seasons, and in the process, plants seeds of intact information to new audiences that would otherwise not be reached with traditional pregnancy/birth/baby media.

What does carding look like? 

Carding can take many forms. There are advocates whose passion it is to stand on street corners, or in front of hospitals, and hand material to passerbys. Some participate in marches, rallies, vigils, and demonstrations, where information is handed to those in attendance. Others incorporate carding into their professional work - shop owners who include an info card with items they sell and ship; photographers with an info card or brochure in their studio pack; doulas, midwives, and physicians with an info card in their new client papers; teachers and professors who include an info card in their syllabus, etc. The possibilities are endless.

Another form of carding becoming more popular - one that can be done by anyone, anywhere - and one that has the potential to reach multiple thousands, is a sort of grassroots, 'gorilla,' carding: leaving info cards in the places we pass each day, and specifically targeting those locations and items that expecting and new parents-to-be frequent. Examples include the maternity and newborn baby items in stores and garage sales; pregnancy, birth and baby books at bookstores, second hand stores, garage sales and libraries; public and community bulletin boards and information tables; stores devoted to pregnant and new mothers; parks, playgrounds, malls, zoos, and family entertainment venues; public restrooms, changing rooms, and family rooms, among other public areas with heavy traffic.

One key thing to remember when participating is that there is a difference between carding vs. littering. It is vital to remain respectful and responsible in the manner in which we share information. The primary goal is to get information into the hands of those people who would benefit, and potentially never receive it elsewhere, while at the same time not disrupting others' property in the process.

This means we card discretely and respectfully. Cards are not left laying all over store shelves. They are most often placed into items that will go home with new parents. One may be left in the open, 'on display' in an aisle for shoppers, but more than one per aisle only serves to cause headache and hassle for store personnel, and reflects poorly on the organizations listed on materials. Stickers are not ever used on surfaces they would need to be scraped from. They can instead be placed on throw-away packaging, tags, sticky-notes, and window-cling material. Business card size magnets are also excellent items to use when the opportunity arrises (you'd be surprised how many people simply love finding a free magnet and take it home to stick on their fridge!).

Above all, when carding, ask a few questions:

1) Am I placing this item in a location it is likely to reach someone who will be positively impacted?
2) Am I placing this item in such a way that it is likely to go home with one person, or be seen by many?
3) Am I placing it in a manner that it will not do damage to anyone's property?

If the answer is 'YES' to all three of these questions, then it is likely an effective carding choice.

The more often an individual cards, the more casual, quick and effective they become. You'll find your own favorite spots, and discover new ones along the way.

If you are comfortable handing cards to new and expecting parents you see, go for it! This is by far the best way to card. When you see someone who may benefit, simply smile and say, "Someone gave this site/information to me when I had my first baby, and it really helped out. Thought you may like it." Hand card, smile, and continue on your way. This is non-threatening, does not take up anyone's time, provides information in a friendly but non-intrusive manner, and they can take it or leave it. This process is almost always met with a grateful, "Thank you!"

Because we often do not know where someone is in their pregnancy or parenting journey, sometimes a simple card that will lead them to more information on key issues is best when handing directly. With the exception of giving "Thank You for Breastfeeding" cards to nursing mothers, and "Thank You for Babywearing" cards to babywearing parents, below is the info card we use most often when handing directly to strangers passing by. It involves what Frisbie calls, "stumble upon" advocacy. New and expecting parents visit DrMomma.org and stumble into information from a wide variety of contributors to intact issues, breastfeeding, healthy infant sleep, babywearing, immunization options, discipline, birth choices, and more. We've received a grand volume of letters from parents who say they visited curious about birth, and decided to breastfeed as a result; or came over because they were interested in VBAC, and elected to forgo 'sleep training' this time around; or checked out the site because they wanted to learn more about discipline with their older boys, and decided to keep #4 intact... and countless similar stories. Sometimes, it takes more than a breastfeeding site to reach new moms with breastfeeding information. It takes more than an intact site to reach new parents about genital integrity. It takes additional information and community to draw people back to gentle parenting. So if you are reading this, and your only interest is reducing the rate of genital cutting in the U.S. (for example), don't pass by the opportunity to give a nursing mother or babywearing dad an info card that meets them in the moment they are at. It may be the one thing that leads to that next baby saved... Use their current location or interest, and provide that chance to stumble into more.

Key Tips for Effective Carding:

1) Be respectful of property: do not damage or alter anything that does not belong to you. For example, use a magnet or card instead of a sticker. If you are using stickers, only place them on things that will be discarded (exterior wrapping, price tag, etc.) or can be removed (window cling material, a sticky-note).

2) Do not go overboard: Dumping cards all over a store is not effective. The cards will be gathered up by staff and thrown into the trash. They do not reach expecting parents who need the information, it wastes money spent on materials, and it reflects poorly on organizations listed on the cards. Don't do this.

3) Place cards where parents will either take them home or see them, and be able to read privately if they so choose. This may be in a pregnancy book, baby magazine, newborn item, bathroom stall, OB/GYN office, Labor & Delivery ward floor, maternity pants' pocket, under the windshield wiper of a car in the 'expecting mom' parking space, etc.

4) When making cards yourself, always check and double check for grammatical errors before printing. Have someone else look things over before ordering. Simple mistakes distract from the overall value and integrity of the message, and again, reflect poorly on the organizations listed.

5) When making cards yourself check for professional and well organized use of space for both graphics and text. Having a sentence unevenly positioned, or 8 words on one line and 1 word on the next, distracts from the message. Manage your layout wisely.

6) When making cards yourself, be sure to list at least one website that people can go to for further information if they so choose. One of the biggest mistakes of advertising is to leave people hanging. They may get the message, but have no where to turn - nothing to DO with this message.
  • Don't assume that everyone knows which key words to Google for more. 
  • Don't assume everyone has immediate computer access, or will remember to do a search when they get home. 
  • Don't assume everyone knows how spell words like 'circumcision,' 'breastfeeding' or 'babywearing'.  
  • Don't assume people understand messages you may find commonplace - 'Bring Your Whole Baby Home'  'Thank You for NIP' and 'His Body: His Choice' may mean nothing to them. 
Sparking interest, and then providing a website (or two, or three) is key.

7) When listing the websites drop the 'www' - this is unnecessary to include and only clutters the card. Use the shortest, cleanest web address possible. Use CAPS to your advantage for easy reading. Make the web addresses prominent. If someone only sees and remembers one thing on the card, you want it to be the web address. For example:

DrMomma.org
SavingSons.org
Mothering.com
Ezzo.info
IntactNetwork.org

If you'd like to join with advocates across the U.S. and Canada, the next Card North America weekend can be found by visiting Saving Our Sons or peaceful parenting events on Facebook. We know many of you never leave the house without cards in tow to plant seeds wherever you go. This is a great thing! Let's always be sure to spread the word with respect for everyone around us, ourselves, and the world we live in.

You can view others' photos and obtain ideas for carding in the Card North America galleries on Facebook:
If you'd like to have your photos added to the albums, drop us an email at DrMomma.org@gmail.com, or upload images to the Facebook page walls.

Professionally produced info cards can be obtained upon request from Saving Our Sons (intact related items): http://www.savingsons.org/p/info-cards-etc.html or peaceful parenting: https://www.facebook.com/media/set/?set=a.409331317670.191616.202794322670

Have additional tips to make carding successful? A favorite place to plant a seed? We'd love to hear from you! Drop us an email, or comment below.

~ HAPPY CARDING! ~



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