Urinary Tract Infections Higher Among Circumcised Men in Australia

Prevalence of urinary symptoms in urban Australian men aged 40-69
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/11434500

J Epidemiol Biostat 2001;6(2):211-8 (ISSN: 1359-5229) McCredie M; Staples M; Johnson W; English DR; Giles GG. Department of Preventive and Social Medicine, Dunedin Medical School, University of Otago, New Zealand.


BACKGROUND: This study was devised to determine the prevalence of urinary symptoms among men living in the Australian cities of Melbourne, Sydney or Perth, and to identify factors associated with the presence of moderate-to-severe urinary symptoms.

METHODS: The study comprised a population-based sample of 1,216 men, aged 40-69 years, whose names were obtained through electoral rolls and who participated as controls in a case-control study of risk factors for prostate cancer. As part of a structured face-to-face interview, the men completed the International Prostate Symptom Score (IPSS). Men with moderate (IPSS = 8-19) or severe (IPSS > or = 20) urinary symptoms were compared with those with mild or no symptoms (IPSS < 8) using unconditional logistic regression.

RESULTS: The age-specific prevalence of moderate-to-severe urinary symptoms (IPSS > or = 8) in men aged 40-49, 50-59, 60-69 years was 16%, 23% and 28%, respectively. Compared with men with no or mild urinary symptoms (IPSS < 8), men with moderate-to-severe symptoms were more likely to report not currently living as married [odds ratio (OR) = 1.5; 95% confidence interval (CI) 1.1-2.0] and being circumcised (OR = 1.5; 95% Cl 1.2-2.0).

The increased likelihood associated with drinking an average of > 60g per day of alcohol in the 2 years before interview was of marginal statistical significance (OR = 1.6; 1.0-2.6). There were no significant differences between men with IPSS > or = 8 and those with IPSS < 8 with respect to body mass index, education level, having had a vasectomy, or cigarette smoking.

CONCLUSION: Among Australian men, being circumcised, or not currently living as married, were associated with increased prevalence of urinary symptoms.

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No comments:

The Effects of Circumcision on Breastfeeding

Review of research between The National Organization of Circumcision Information Resource Centers and La Leache League International


It is the human right of every baby
to have the opportunity to be breast or breastmilk fed.
~ Australian Breastfeeding Association


Advantages of Breastfeeding
Medical societies in Australia,1 Canada,2 and the United States3 concur that breastmilk is the optimum food for infants. The National Organization of Circumcision Information Resource Centers agrees with this conclusion. Breastfeeding provides nutritional, emotional, developmental, immunological, and economic benefits that are not equaled by any substitute.3 Studies show that breastfed babies exhibit improved neurodevelopment and greater cognitive ability.1,4-6 Breastfeeding may contribute to improved mother-infant bonding and to lessened tendency for violence in adult life.6 One study finds that breastfeeding protects against childhood asthma.7 Another study finds that breastfeeding reduces infant mortality.8 Early initiation of breastfeeding reduces the incidence of diarrhea.3,9 Breastfeeding protects against otitis media (middle ear infection)3,10 and urinary tract infection (see below).
Breastfeeding also improves the mother's health because it provides increased levels of oxytocin with several important benefits, including reduced post-partum bleeding, more rapid return to pre-pregnant weight, improved bone remineralization with fewer hip fractures, and reduced risk of ovarian and breast cancer.3 Moreover, a recent study suggests that breastfeeding protects mothers from postpartum stress.11 Only mothers who breastfeed enjoy these benefits.

How Breastfeeding Replaces Circumcision as a Prophylactic Measure Against UTI
Breastfeeding now is documented to dramatically reduce the incidence of urinary tract infection (UTI).
In the early 1980s, Thomas E. Wiswell, M.D., a vociferous advocate for routine circumcision, opined that lack of male circumcision might be the cause of UTI, and he set out to prove it with two retrospective studies that were published in 1985 and 1986.12,13 The studies, carried out by searching through old medical records maintained by the United States Army on children of Army personnel, failed to examine an existing clinical population. The study purported to show that the incidence of UTI in circumcised and intact infants were 1.4 and 0.14, respectively. The difference of 1.26 percent is not clinically significant. Wiswell's studies suffered severe methodological flaws, including lack of control for confounding factors,14 such as maternal infection, perinatal anoxia, low or high birthweight,15 breastfeeding, socio-economic status, urogenital deformities, and the nature of infant hygienic care.
Escherichia coli, bacteria present in feces, is the most frequent etiologic agent of acute uncomplicated urinary tract infection (UTI) in infants and children, accounting for 85 to 90% of all pathogens recovered from urine cultures.16
After Wiswell's studies were published, Coppa et al. discovered that human milk contains oligosaccharides that are excreted in infant urine and inhibit the adhesion of E. coli to the tissue of the urinary tract.17 This protective effect was quickly confirmed in a preliminary report in 1990 by another group of Italian scientists, headed by Pisacane,18 and further confirmed by Swedish researchers.19 The Pisacane group then produced a prospective case-control study, published in 1992,20 that found breastfed infants have only 38% as many UTIs as non-breastfed infants.20
A recent study that tried to correct for some of the deficiencies in Wiswell's studies found that 195 circumcisions would be necessary to prevent one hospitalization for UTI.21
Wiswell could not have known about the significant effect of breastfeeding protection against UTI because these studies17-20 had not been published at the time he conducted his studies,12,13 which do not control for breastfeeding. The number of breastfed infants in his studies is unknown. Consequently, his data is inconclusive and inaccurate.
Even if one were to accept Wiswell's data, breastfeeding has an additional advantage that male circumcision could never provide: breastfeeding reduces UTI in both male and female infants.3,22 Females have a four times greater incidence of UTI than males,16 which may be because females lack the protective effect of the preputial sphincter (see box). Breastfeeding actually delivers the protection against UTI infection that has been touted for circumcision.3,18,19,20 Circumcision is an inappropriate and ineffective way to reduce the risk of UTI in infants.

Postoperative Pain, Stress, and Exhaustion
Human milk is the best food for babies.1,3 Babies who are breastfed are more likely to experience optimum health and well-being throughout life than babies who are given a substitute for mother's milk. It is imperative, therefore, that nothing be done that would interfere with successful initiation and completion of breastfeeding during, at least, the first year of life. Mothers need full information, well in advance of birth, so that they may avoid the pitfalls and snares that prevent success in breastfeeding.
We now know that newborn babies are born with fully functioning pain pathways.23 Infants exhibit greater physiologic responses to pain than do adult subjects.23 Male neonatal circumcision has been documented to be an extremely painful, distressing, traumatic, and exhausting experience for a newborn male infant.24-28 Circumcision disrupts the baby's normal sleep patterns.25,27 Post-operatively, the circumcised infant is in pain and is in an exhausted, weakened, and debilitated condition.28 Most importantly, the circumcision procedure frequently causes the newborn to withdraw from his environment,25 thus interfering with his process of bonding and breastfeeding.28
La Leche League International (LLLI) first reported problems with breastfeeding by circumcised male infants in 1981.30 Circumcision has long-lasting postoperative pain that continues for days after the surgical event.29 Howard et al. found that some male babies are unable to suckle the mother's breast after circumcision,29 thus confirming the LLLI report.30
The Workgroup on Breastfeeding of the American Academy of Pediatrics (AAP) recommends that stressful procedures that interfere with breastfeeding be avoided.3
Breastfeeding problems among circumcised male infants have been verified by lactation consultants.31,32 Parents may avoid creating this problem simply by refusing to consent to the circumcision of their baby boy. In doing so, they would also be adopting the recommendations of the AAP and LLLI to avoid stressful procedures.3,30 Mothers who protect their new baby from circumcision are more likely, therefore, to be successful in breastfeeding and less likely to have to resort to providing breast milk substitute.3,29,30

The Relative Value of Breastfeeding and Circumcision
When it comes time for parents to make decisions about circumcision and breastfeeding, the choice is clear. Medical societies agree that no medical benefit from circumcision exists and "potential [alleged] benefits" cannot be proven. The Canadian Paediatric Society says that male neonatal circumcision should not routinely (i.e., in the absence of medical indication) be performed.33 The American Medical Association calls male neonatal circumcision a non-therapeutic procedure.34 The American Academy of Family Physicians equates male neonatal circumcision to a "cosmetic procedure."35 Male neonatal circumcision now is regarded as a non-therapeutic procedure that is totally unnecessary for a child's health and well-being. Furthermore, male neonatal non-therapeutic circumcision has significant risks and complications.36 Circumcision increases infant mortality because some babies die from complications of circumcision.37 Studies show that intact boys have better penile health during the first three years of life.39,40 Other drawbacks and disadvantages include psychological and sexual problems in adult life.40 Non-therapeutic circumcision, therefore, provides no discernible health benefit to the child, while there are numerous documented significant risks, complications, and adverse sexual and psychological sequellae. Chessare found that non-circumcision produced the highest "utility" (or, in other words, the highest state of health).41
Pain in young babies presently is believed to permanently affect development of the immature nervous system.40 The AAP and the Evidence Based Group for Neonatal Pain now emphasize prevention of pain by avoidance of painful procedures in infancy in preference to the use of anesthesia.42,43 Neonatal circumcision is the most common painful procedure to which young children are subjected. Neonatal circumcision, therefore, should be avoided.
Breastfeeding, on the other hand, offers all of the benefits described above without any significant risk, complication, disadvantage, or drawback. Certainly, responsible parents will favor breastfeeding over circumcision for male infants. If parents are adamantly insistent on a circumcision of their male infant, the circumcision should be deferred until after breastfeeding is well established.
Breastfeeding, like non-circumcision or "intactness," is natural and healthy. Bottlefeeding, like circumcision, is unnatural and unhealthy. Male neonatal circumcision should never be allowed to compromise the successful initiation of breastfeeding.

Conclusion
Breastfeeding contributes significantly to the health and well-being of both baby and mother. We recommend that babies be breastfed, except in those few rare circumstances when a particular mother may have a medical condition that contraindicates breastfeeding.1-3
Studies have proven that circumcision impairs the health and well-being of the child.24,33,36-41 Doctors and parents should protect children from the complications, risks, and unavoidable surgical trauma inherent in circumcision.44
Psychological studies show that some circumcised fathers adamantly insist on having a child circumcised in opposition to current informed medical opinion.45 In that case, it is the mother’s job to protect the baby. When she does so. she is teaching her husband to protect the child, not to wound him. In any event, the operation should be deferred until breastfeeding is well established. Furthermore, the Section on Urology of the AAP recommends that no genital surgery should be performed during the first six weeks of life while the bonding process is occuring.46 The Australasian Association of Paediatric Surgeons recommends, if a circumcision is to be performed, then it should be deferred until the child is at least six months of age when general anesthesia may be used.47 If a circumcision is performed, it should be carried out by a skillful surgeon in a setting that provides all necessary emergency equipment to handle possible complications and emergencies. Ring block anesthesia (the most effective available type of local anesthesia for infant circumcision24) should be used to reduce the pain. No local anesthesia can totally protect an infant from the pain of circumcision. While more dangerous, after six months, general anesthesia can be used. Circumcised babies should be given post-operative analgesia for the post-operative pain for seven to ten days.33,48 ”
The information provided to parents prior to obtaining permission for circumcision must include all material and relevant information about circumcision, the known risks, and the benefits of non-circumcision necessary for a parent to make an informed decision.49 Breastfeeding failure is a known and documented risk of circumcision. Doctors who perform circumcision, therefore, have a responsibility and a legal obligation to inform parents about the adverse effects of circumcision and the beneficial effects of non-circumcision upon breastfeeding.
Breastfeeding educational material for mothers should include information about the adverse effects of male circumcision on breastfeeding. Mothers need to learn "how the choices parents make about the birth experience can affect breastfeeding in the early days."50 Organizations that promote breastfeeding have an ethical and moral responsibility to provide this information to parents well in advance of delivery so that they can make a truly informed decision about circumcision.1,3

For more information on circumcision and breastfeeding see:

References
  1. Health Policy Unit. Breastfeeding. Sydney: Royal Australasian College of Physicians, 2001.
  2. Anonymous. Breastfeeding. Ottawa: Canadian Paediatric Society, 1998.
  3. Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 1997;100(6):1035-39.
  4. Horwood J, Fergusson DM. Breastfeeding and Later Cognitive and Academic Outcomes. Pediatrics 1998;101(1):e9.
  5. Angelsen NK, Vik T, Jacobsen G, Bakke L S. Breast feeding and cognitive development at age 1 and 5 years. Arch Dis Child 2001;85:183-188.
  6. Prescott JW. Brain nutrients in brain development for human love and peace. Touch the Future Newsletter, Spring 1997.
  7. Oddy WH, Holt PG, Sly PD, et al. Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ 1999;319:815-819.
  8. Betrán AP, de Onís M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant mortality in Latin America. BMJ 2001;323:303.
  9. Clemens J, Elyazeed RA, Rao M, et al. Early Initiation of Breastfeeding and the Risk of Infant Diarrhea in Rural Egypt. Pediatrics 1999;104(1):e3.
  10. Duffy LC, Faden H, Wasielewski R, et al. Exclusive Breastfeeding Protects Against Bacterial Colonization and Day Care Exposure to Otitis Media. Pediatrics 1997;100(4):e7.
  11. Groer MR, Davis MW, Hemphill J. Postpartum stress: Current concepts and the possible protective role of breastfeeding. JOGNN 2002:31;411-417.
  12. Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1985, 75: 901-903.
  13. Wiswell TE, Roscelli JD. Corroborative evidence for the decreased incidence of urinary tract infection in circumcised male infants. Pediatrics 1986;78:96-99.
  14. Altschul MS. The circumcision controversy (editorial). Am Fam Physician 1990;41:817-820.
  15. Littlewood JM. 66 infants with urinary tract infection in first month of life Arch Dis Child 1972;47(252):218-2.
  16. McCracken G. Options in antimicrobial management of urinary tract infections in infants and children. Pediatr Infect Dis J 1989;8(8):552-555.
  17. Coppa GV, Gabrielli O, Giorgi P, et al. Preliminary study of breastfeeding and bacterial adhesion to uroepithelial cells. Lancet 1990; 335:569-571.
  18. Pisacane A, Graziano L, Zona G. Breastfeeding and urinary-tract infection (Letter). Lancet 1990;336:50.
  19. Maarild S, Jodal U, Hansen AL. Breastfeeding and urinary tract infection. Lancet 1990;336:942.
  20. Pisacane A, Graziano L, Mazzarella G, et al. Breast-feeding and urinary tract infection. J Pediatr 1992;120:87-89.
  21. To T, Agha M, Dick PT, Feldman W. Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection. Lancet 1998;352(9143):1813-16.
  22. Outerbridge EW. Decreasing the risk of urinary tract infections (Letter). Paediatr Child Health 1998; 3(1):19.
  23. Anand KJS, Hickey PR, Pain and its effects in the human neonate and fetus. New Engl J Med 1987; 317 (21):1321-9.
  24. Lander J, Brady-Freyer B, Metcalfe JB, et al. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA 1997; 278:2158-62.
  25. Emde RN, Harmon RJ, Metcalf D, et al. Stress and neonatal sleep. Psychosom Med 1971;33(6):491-7.
  26. Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981; 6(3)269-275.
  27. Anders TF, Chalemian RJ. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med 1974;36(2):174-179.
  28. Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Hum Dev 1982; 7(4):367-374.
  29. Howard CR, Howard FM, and Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics 1994;93(4):641-646.
  30. Anonymous. Elective Surgery for You or Baby. In: The Womanly Art of Breastfeeding, 3rd ed. Franklin Park, IL: La Leche League International, 1981: 92-93. (ISBN 0-912500-10-7)
  31. Lee N. Circumcision and Breastfeeding [Letter]. J Hum Lact 2000;16(4):295.
  32. Caplan L. Circumcision and breastfeeding: a response to Nikki Lee's letter [Letter]. J Hum Lact 2001;17(1):7.
  33. Fetus and Newborn Committee, Canadian Paediatric Society. Neonatal circumcision revisited. (CPS) Can Med Assoc J 1996; 154(6): 769-780.
  34. Council on Scientific Affairs, American Medical Association. Report 10: Neonatal circumcision. Chicago: American Medical Association, 1999.
  35. AAFP Commission on Clinical Policies and Research. Position Paper on Neonatal Circumcision. Leawood, Kansas: American Academy of Family Physicians, 2002.
  36. Williams N, Kapila L. Complications of circumcision. Brit J Surg 1993; 80: 1231-1236.
  37. Baker RL. Newborn male circumcision: needless and dangerous. Sexual Medicine Today 1979;3(11):35-36.
  38. Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 1988;81(4):537-541.
  39. Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Brit J Urol 1997;80:776-782.
  40. Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychology 2002;7(3):329-43.
  41. Chessare JB. Circumcision: Is the risk of urinary tract infection really the pivotal issue? Clinical Pediatrics 1992;31(2):100-4.
  42. American Academy of Pediatrics. Committee on Fetus and Newborn, Committee on Drugs, Section on Anesthesiology, Section on Surgery. Prevention and Management of Pain and Stress in the Neonate. Pediatrics 2000;105(2):454-461.
  43. Anand KJS, International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001;155:173-180.
  44. Kendel DA. Caution Against Routine Circumcision of Newborn Male Infants (Memorandum to physicians and surgeons of Saskatchewan). Saskatoon: College of Physicians and Surgeons of Saskatchewan, February 20, 2002. Photocopy.
  45. Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychology 2002;7(3):329-43.
  46. Section on Urology, American Academy of Pediatrics. Timing of Elective Surgery on the Genitalia of Male Children With Particular Reference to the Risks, Benefits, and Psychological Effects of Surgery and Anesthesia (RE9610). Pediatrics 1996;97(4):590-4.
  47. J. Fred Leditsche. Guidelines for Circumcision. Australasian Association of Paediatric Surgeons. Herston, QLD: 1996
  48. Geyer J, Ellbury D, Kleiber C, et al. An Evidence-Based Multidisciplinary Protocol for Neonatal Circumcision Pain Management. JOGNN 2002 31, 403-410.
  49. Hill G. Informed consent for circumcision. South Med J 2002;95(8):946.
  50. La Leche League. [Breastfeeding problems after circumcision]. Leaven 1994; September-October:78.

2 comments:

How the Foreskin Protects Against UTI (urinary tract infection)

research cataloged by the National Organization of Circumcision Information Resource Centers


the human urinary tract

Male and female urinary tracts are similar except for the shorter urethra in females, which leads to a higher rate of UTI (urinary tract infection) among baby girls, female children, and adult women. Intact boys and men contract UTIs to a much lesser degree than girls and women. All UTIs are treated quickly and easily with a round of antibiotics.



The foreskin contains muscle fibers arranged in a whorl to form a sphincter at the tip of the foreskin.1,2 The sphincter holds the foreskin protectively closed2 except when the child urinates and the pressure of the urine stream forces the sphincter to open, allowing outflow of the urine. Then the sphincter closes again and prevents entry of foreign matter, such as fecal material that contains bacteria. The sphincter of the foreskin keeps contaminants away from the urethra and is added protection against UTI.3

Breastfeeding adds yet another level of protection. Breastfed babies have oligosaccharides in their urine. The oligosaccharides prevent adhesion of E. coli, the fecal bacteria that causes most UTI, to the epithelium of the urinary tract.4 Bacterial adhesion is a prerequisite for infection. Intact babies who are also breastfed have doubled protection against UTI.

Parents and other caregivers should never attempt to retract the foreskin.5,6 Retraction of the foreskin opens the sphincter and allows contaminants to enter. This is especially true at bath time because baby's bathwater may very well contain E. coli from the baby's intestinal tract. The first person to retract the foreskin of a child should be the child himself.5-7

Unfortunately, hospitals in the 1980s instructed parents to retract the foreskin to wash—a procedure that has been abandoned because of the danger of contamination by E. coli.8 This may have allowed E. coli to enter the urinary tract and caused the slight increased incidence of UTI reported by Wiswell.

The foreskin has many other protective functions, including immunological properties and its own antivirals and antibacterials, that help to prevent disease and contribute to good health throughout life.3,9

E-coli bacteria during a urinary tract infection.

E-coli are transferred to the urinary tract as a result of fecal matter getting around the urethra. In intact infants, the urethra is protected by the prepuce in boys and girls, and the labia in girls. In circumcised boys (or girls), the urethra is exposed and prepuce antibodies are not present, leading to higher rate of infection. This is especially the case among diaper wearing babies during the first 12 months of life. The inset of this photo shows a cell peeling off from the urinary tract during an e-coli induced urinary tract infection. The main panel shows e-coli on the bladder wall. Photo by Harry Mobley, U of MI Medical School


ARTICLE: BENEFICIAL FUNCTIONS OF THE FORESKIN (PREPUCE)


For more information on circumcision and breastfeeding see:

  1. Jefferson G. The peripenic muscle; some observations on the anatomy of phimosis. Surgery, Gynecology, and Obstetrics (Chicago) 1916; 23(2):177-181.
  2. Lakshmanan, S. Prakash S. Human prepuce: some aspects of structure and function. Indian J Surg 1980;44:134-137.
  3. Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Inf 1998;74:364-367.
  4. Coppa GV, Gabrielli O, Giorgi P, et al. Preliminary study of breastfeeding and bacterial adhesion to uroepithelial cells Lancet 1990; 335:569-571.
  5. Answers to your questions about your young son's intact penis. San Anselmo CA: National Organization of Circumcision Information Resource Centers, 1997.
  6. Fleiss PM. Hodges F. What your Doctor May Not Tell you about Circumcision: Untold Facts on America's Most Widely Performed - and most Unnecessary Surgery. New York: Warner Books, 2002. (ISBN: 0-446-67880-5)
  7. Wright JE. Further to the "Further Fate of the Foreskin". Med J Aust 1994; 160: 134-135.
  8. Wiswell TE. Prepuce care. (letter) Pediatrics 1986;7(2):265.
  9. Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 Suppl. 1:34-44.
6 comments:

My Story of Ritual Abuse

By Leland Traiman © 1994

My earliest memories are of terror, pain and helplessness. At first, these feelings were never attached to any particular time or event. Between the ages of four and five I had nightmares and daytime fantasies which somehow were related to these feelings. Between the ages of six and eight I had a recurring nightmare of a long bearded goat eating its way through the wall of the bedroom I shared with my older brother. I somehow knew I was the ultimate target of this bearded beast and that he was coming to take bites out of my flesh. Images of this goat followed me into the daylight hours. Although I felt close to my parents, especially my mother, I never felt I could or should talk to them of these terrors. I imagined them saying that these images were only from my imagination and had no basis in reality. So, I kept silent for a long time. Finally these images became so disturbing that at about the age of nine I told my mother about the goat. Although she was very sweet about it, she only confirmed my fear, telling me that it was "only" out of my imagination.
I was standing in the middle of the party terrified - in pain - and screaming.
But nobody seemed to notice me. 

It was during this time that these feelings of terror, pain and helplessness took on a social context. One evening my parents hosted a party for a social club they belonged to. My brother and I were sent to our room early and told that the party was for adults only. Of course, we were curious and sometime during the evening we sneaked out of our room, into the hall and peered around the corner into the living room. We saw a group of nicely dressed adults snacking, drinking and engaged in conversation. Of course, we were spotted by one of the guests and our parents were alerted. My father came over and, to our surprise, was not angry. With warmth and good nature he firmly ordered us back to bed, for it was way past our bedtime. That night I dreamt of the party. However, in my dream I was standing in the middle of the party terrified - in pain - and screaming. But nobody seemed to notice me. Everyone went on as if I was not there. Finally, one of the women turned to my mother and said, "I think your son is having a little problem." My mother answered, "Don't worry, it's nothing really. He'll get over it soon." That recurring nightmare haunted my nights and daytime fantasies for 12 years.

My maternal grandmother, Celia, was the acknowledged matriarch of our family. She had seen her first two children die in "Russia" (now known as the Ukraine). One died of starvation and the other she accidentally smothered to death trying to keep the infant quiet while the family was hiding during a pogrom(1). My mother was born a year after my grandparents arrived in New York City. My mother, the first child born in their new, free country was bathed in milk as soon as they brought her home from the hospital. The believed this would give the new baby beautiful skin, and no doubt was a symbol of the new relative wealth they enjoyed in their new home, where they did not have to fear for their lives simply because they were Jews.

During Passover(2) the young children in our family were given grape juice instead of wine to drink. From the time I was nine years old my grandmother would try to sneak some wine into my grape juice. My brother and my cousins welcomed the wine as a symbol of maturity, but not me. I would cough and spit out the wine and sometimes loudly complain how disgusting alcohol was.

"I remember your bris...I was so worried because you would not stop crying."

When I was 21 my grandmother Celia died. After the funeral, family and friends gathered at her home for food and remembrances. She had shared my aunt and uncle's house during the last 14 years of her life. In keeping with Jewish custom, no alcohol was served. But for the first time in my life I wanted a drink. I got into my uncle's liquor cabinet, found some gin, and got drunk.

The gathering went on for hours and when I was finally sobering up I found myself sitting next to my great-aunt Sara, my paternal grandmother's sister. She sat crocheting, not looking up from her work, talking at me, not to me. She was comparing this occasion to other family gatherings. I was not really listening until I heard her say,

"I remember your bris(3)."
On hearing this I sat up and leaned toward the old lady. She did not seem to notice my change in posture but kept crocheting. Without looking up she continued,

"Oh yes, that was some family occasion. Your grandmother, Celia, had insisted that the ceremony be done in her house and not your parents' home, which was customary. Of course, it was only eight days after you were born and your mother had felt ill for a few days and was not really up to leaving the house. Nonetheless, she bundled you up and readied your brother and father and dragged all of you across town on the subway to her mother's house. When you got there Celia was trying to have the bris done quickly. Her brother, your great-uncle Isaac, was still in the hospital and Celia wanted to visit him as soon as possible. He had had a cancer operation the night you were born and he wasn't expected to live." (Isaac died over three decades later.)

"And then you began to cry. They put the wine-soaked cloth in your mouth as it usually knocks the baby out, you know, like a sedative. But not you. You kept on crying, and of course, your other grandmother, my sister, was no help at all. She was never any good with crying babies or blood. So she was getting sick in the next room. Then Celia started saying, 'Why is the baby crying? It did not hurt him!' So I started arguing with her. 'Of course it hurt him,' I said, 'If you cut your finger doesn't it hurt?' We kept arguing until she left to see Isaac. Everyone was crowding around you. They wanted to see the new baby. You kept crying so I took you and put you in one of the bedrooms alone and I said, 'No one can see the baby now, he just had an operation.'"

"I could see that your mother wasn't feeling so well so I went to her and told her to go home and take care of your father and your brother and I would take care of you and I would bring you to her the next day. So your parents took your brother and left. I was so worried because you would not stop crying. You cried for 18 hours, through the night. You know," my great-aunt emphasized, "a new baby is supposed to sleep 18 hours a day, not cry for 18 hours. I remember because you were circumcised around noon and you finally fell asleep at 6 the next morning. I was so grateful when you finally slept."
My great-aunt told me this with hardly a glance in my direction, concentrating mainly on her crocheting.

I was finally able to recognize the actual event responsible for the nightmares
that had haunted my entire life. 


The effect on me was immediate. I was finally able to recognize the actual event responsible for the nightmares that had haunted my entire life. My fear of the bearded goat who wanted to bite off my flesh was the mohel(4) who, like all orthodox Jews, must have had a beard. It was the mohel who cut off a part of my body.

They never asked my permission to do this; what right did they have?

I realized my revulsion of alcohol was related to the wine forced on me as an unsuccessful sedative. I saw how ironic it was that I had gotten drunk only after my grandmother's death. I associated my grandmother with alcohol all my life and now I knew that this association had begun with the ritual abuse that took place in her home. Other things started making sense for the first time. I had always remembered at age three or four, long before I began nursery school, trying to pull the skin on the shaft of my penis over the glans at the end. I never knew why I had done this. I also came to realize why at my Bar Mitzvah(5), when I was again the center of attention in a Jewish ceremony, I was upset, angry and fearful that whole day even though all I had to do was read from the Torah(6) in Hebrew. This was totally out of character with the verbose joker I had become. I usually enjoyed being the center of attention. In my late teenage years I began to feel very badly about the fact that part of my genitals was missing. This, despite the fact that almost all the other boys in the locker room were also circumcised. I began to ask myself, "Why did they do this to me? They never asked my permission to do this; what right did they have?" And I also asked myself, "Am I a self-hating Jew because I ask these questions?"

Questioning barbaric acts on one's self and on innocent babies is valid.
It is an inherent act of self-love.

It took a lot of struggle and over 20 years to answer these questions, but I finally have. They did this to me out of ignorance. As an oppressed and ancient people struggling to keep its identity, most Jews falsely believe that continuing the tradition of male genital mutilation will help Jewish culture and beliefs survive.

The only "right" they had to do this to me was a legal one, not a moral or ethical one. A legal right based on the notion that children are more like property, cattle to be branded, rather than human beings with their own inalienable human rights. And finally, the question of identity and self-loathing or self-love. My questioning the authority of previous generations does not mean I hate them, nor that part of myself that comes from them. Rather, it is the appropriate task of every person to examine, question and change. Questioning barbaric acts on one's self and on innocent babies is valid. It is an inherent act of self-love.

This ritual abuse not only scars children physically and emotionally, but some children die as a result. How many have died over the centuries is unknown. This is one of the facts obscured by those who practice it. I know that the pain and the deaths were unnecessary. As more people openly question circumcision, more information is coming to light about the pain and death it has caused.

I want to be very clear, I am not equating Naziism and circumcision.
...I am saying that there are lessons we should have learned from the Holocaust.
And one lesson is that using the excuse "I was just following orders" is no excuse.

In my history classes at school and at home, when I was a child, I was nurtured on the lessons learned from the Nazi atrocities and the Nuremberg trials that followed. I was taught that "I was just following orders" is no excuse for committing crimes against individuals and against humanity. I want to be very clear, I am not equating Naziism and circumcision. That would be a silly comparison. I am saying that there are lessons we should have learned from the Holocaust. And one lesson is that using the excuse "I was just following orders" is no excuse. It does not matter if the orders come from a president, a pope, a prime minister, a Muslim cleric or a Rabbi. Some people claim God commands them to harm, mutilate or kill. Many people have killed Jews in the name of their God. Yigal Amir, a Jewish Israeli law student, assassinated Israeli Prime Minister Yitzhak Rabin because, he claimed, God told him to do it.

In light of this, everyone must question what I heard one rabbi say at a forum on male infant circumcision, "We do it because we have been commanded to do it." How can we, as Jews, condemn the harm that others wish to do to us in the name of their God and not condemn the harm that we do to our own children in the name of our own God?

Amir did not have the right to kill Yitzhak because "God commanded him" to do it. Abraham did not have the right to sacrifice Isaac(7), nor any part of Isaac's body(8), because he was commanded to do it. Jews have paid a very high price in the 20th century to understand the value of human rights. It is sad we still have so much of the lesson yet to learn. All children should be welcomed into our world bathed in the milk of human kindness, not in their own blood.



Source: NOHARMM Progress Report 3, August 1994



13 comments:

Jewish Father's Letter to His Son


To my dear son Elijah,

I write this letter to explain to you and my family and community why I choose not to perform a circumcision upon you. On your 8th day of life, I choose to have a Brit Shalom ceremony instead of a Brit Milah. The Brit Shalom ceremony is a ceremony acknowledging one's covenant with God without performing the ritual circumcision.

As a Jewish boy I was circumcised according to tradition when I was 8 days old, but not by my choice. I am choosing not to circumcise you my son because after studying this important issue, I can find no compelling reason to do it, and in my heart I will not do it simply because tradition dictates it.

The essence of the bris ceremony to me is that I want to make a covenant with God and you in my heart. The covenant I make with God is to commit myself to a spiritual life, to develop myself as a spiritual being, and that I will walk on this planet with a good heart. I am a Jew and I am proud of who I am. My son, I commit to raising you up as a spiritual being, and as a Jew. I will guide you to develop values of loving kindness. I will encourage you to develop as a spiritual being, and I will teach you about the importance of being considerate and respectful of all living beings. I will also encourage you to be self-reflective, and to explore the deeper meanings and mysteries of life, the hidden truths behind the veil. I believe you have come to this earth with a big mission for healing and touching others through your service.

To fulfill this covenant, I do not need to perform a circumcision and mark you as a sign of this covenant. The covenant stands with or without the sign that by tradition mandates it. The sign is a sign and not the covenant itself.

I intend to give you the opportunity to bar mitzvah when you are 13, and we will celebrate and honor the Shabbat, as well as other sacred Jewish rituals in our lives. We will learn about the power of restriction and extending help to others. We will learn about being a mensch.

Let me tell you my reasoning behind making this choice. There are many practices of olden days that were sanctioned by the Torah that are no longer permitted today because we are more enlightened, such as: human sacrifice, animal sacrifice, and slavery. Other acts that were punishable by death include fornicating if you are female (yes, only the females), homosexuality, and insulting one's parents. These traditions no longer exist.

I suspect something has been misunderstood in the transmission of the circumcision ritual through the ages. I have read that in earlier times, only a sliver of the foreskin was removed. It was not completely cut as common practice until the second century CE. I do not know this for sure, but nothing is known for sure about this. Apparently the earliest versions of the Torah tell the entire story of Abraham except the part about the covenant being sealed with circumcision. That comes later. There is mention that it was done for health reasons. I have heard that when the Jewish people lived in the desert long ago there was not much water, and that created a danger with regards to cleanliness. In this day and age that is not a compelling reason to circumcise you. I have also read that the circumcision is a mark upon us that marks us as different. Today in the United States, circumcision is the norm for all males, Jews and gentiles alike. Today, it is not a mark as a Jew.

I believe that the act of circumcision would be a traumatic event for you my child. I believe that it would form an early record in your body of the trauma and would color and distort your perceptions throughout your life. I have heard it said that the pain is brief and easily recovered from. I don't believe this. I believe the circumcision will be a deep trauma for you, as you are such a highly sensitive being. I believe that you would begin experiencing life through the eyes of the trauma, feeling defended and contracted, moving with fear and distrust. I do believe that experiencing trauma is a part of life, and healing through trauma is a part of how we evolve as a species. I am choosing not to voluntarily offer this trauma to you when you are so young, so vulnerable and so trusting as you form the matrix of your life. I want you to experience life in these early days as trusting and feeling protected and safe. Traumas will come to you later and beyond my control, but I intend this to be after you have already experienced that you can trust your parents not to hurt you on purpose.
I have come into this life charged to question the deeper purpose behind what I do. I will not circumcise you my son only because it is tradition. The reasons that I have been given supporting circumcision do not move me, they do not compel me to perform this ritual. Rather my concern for your well being is much greater.

Modern medical science says that a circumcised male is more healthy than a male with an intact foreskin. Modern medical science also told us the tonsils were not important and took mine out. Now I understand the tonsils to be a very important part of my immune system, that I no longer have. The appendix is still considered a useless organ. I don't believe the creator gave us an appendix without reason. My understanding of today is that the appendix aids in finer digestion of our food. As regards to the foreskin, we have been told that it has no purpose. As I have read about the anatomy and physiology of the foreskin, actually it has many important functions. The foreskin is the most sensitive area of the penis, akin to the clitoris of a woman, and it also functions as a protective lubricating sheath for the penis.

When I examined my own penis once I began studying this issue, I found that the area where I have a scar where the foreskin was, is still the most sensitive area of my penis, yet I know that scar tissue does not have the same sensation capacity as original tissue, nor the elasticity of the original. I have wondered what I would have been like without a circumcision, and I think I would have been better off without it. I want to give you the gift of choice.

Many Jewish people today make choices about which Jewish laws and rituals they will follow or not follow. There is much discussion about these choices that we make- whether we will eat pork or not, will we keep separate dishes for dairy and meat dishes as we should not mix meat and dairy. Shall we keep kosher? Do we observe Shabbat? How closely do we follow the customs of observing all the restriction on certain holidays such as Yom Kippur. Of the many customs that are not adhered to in our times, the one that seems to be sacrosanct and unquestioned is the circumcision. Why is this ritual so primary to the Jewish identity?

I forgo pork, I do not mix meat and cheese, I celebrate and honor Shabbat as a very special holiday each week where we light the candles each week and acknowledge our connection with spirit as a family. I especially revel in the New Year of Rosh Hashanah as a time of inner reflection, and I embrace the restrictions on Yom Kippur and the insights I gain through this process of fasting, forgiving and letting go of the past. At the time of Passover, I am fascinated by the meaning and relevancy of the story as it applies to my life today. I celebrate my spirituality in these ways and share them with my family. I declare that I identify myself proudly as a Jew and yet I am choosing to not circumcise you, my son. I will look into my heart and follow my gut.

A passage I read by Ronald Goldman resonated with me, "A central purpose of Judaism is tikkun olam: repairing the world. Much of the pain in the world is a result of repeating old harmful patterns of behaviors. By breaking a chain of pain, forgoing circumcision contributes to our healing. As we heal from this pain, we will be better able to heal others and reach our ethical and spiritual potential."

So my son, you can choose for yourself to be circumcised when you come of age if it is important to you. I believe the psychological damage and painful trauma done to you at 8 days old would be much worse than anything endured at 13, when it may be done on your own accord, if you so choose.

With love,

Your Father, Gabriel




~~~~
27 comments:

A Heartfelt Christmas Gift: Apologizing to our Sons



by Jeanice Barcelo
with guest, Marilyn Milos


Today, Marilyn Milos was the guest on my radio show. As the mother of three boys -- all of whom were circumcised -- Marilyn understands first-hand how a mother could unconsciously make the choice to hand her baby over to be brutalized and sexually violated.

Yet, when she witnessed an infant being circumcised first-hand (during her nursing training), she experienced a harsh wake-up call, and her life has never been the same.

Marilyn is a leading voice for the human rights of babies and has worked tirelessly to educate people about the horrors of circumcision. She is the founder and executive director of the National Organization of Circumcision Information Resource Centers and has been credited with initiating the International Genital Integrity Movement.

When I asked Marilyn what she did to help heal the damage that was done to her sons, she shared a letter that she wrote to her boys. I found the letter very touching, and wanted to share it with all of you.

This Christmas, may all mothers and fathers of circumcised sons awaken to the violence they have subjected their babies to. And may we heartfully apologize for the unconscious harm we have done, thereby healing a great deal of the damage.

Here is Marilyn's letter to her sons:


For [my sons],

You know that, if I could take one thing back in my life of many mistakes, it would be the circumcision of my sons--the gravest mistake of all! It is the pain and trauma inflicted upon you because I didn't know enough to protect you that will save untold numbers of other babies from the same suffering. It will never be enough because it won't be you and your brothers that are spared. Still, I hope, as witness to your betrayal and trauma, it will help you to heal your most profound wound. And, I know you, too, will help protect the next generation.

With my deepest apologies and my greatest love,

Mom


No mother should ever have to write such a letter to her son and no son should ever have to read it. Still, every mother does the best she can with the information she has at the time, so this work of apologizing for our actions is important to our sons and to us as well.

And, I now have four intact grandsons...so we can make a difference in our own lives, in our own families, and in our world!

Blessings,

Marilyn



More with Jeanice Barcelo on her site Ecstatic Birth Maui and radio show


For more information:
Mothers speak of son's circumcision
Dealing with Regret
Restoration - The Uncircumcising of men
Protect your Intact Son
Raising Intact Sons
For Fathers: Matching Penises

If you circumcised your first son, and would like to keep future sons intact, or make a difference in the lives of your grandsons or boys born around you, please join other parents in our Facebook discussion.
2 comments:

Bye-Bye Baby: Bebé Glotón SOLD OUT Worldwide


We first posted this story back in June 2009 when Bebé Glotón was just released in Spain.

However, as the doll entered the North American market this fall, and sales skyrocketed (20,000 sold in the U.S. in September alone), Bebé Glotón was wiped off the shelves and is virtually impossible to find. The last shipment into the States happened in November. They are long gone. And the manufacture (Berjuan in Spain) says more dolls will not be available till February due to the lengthy process of constructing the sucking mechanism. Unless you get lucky on eBay - where the dolls are selling for $100+ - the little ones in your house are going to have to suffice with nursing their other teddy bears and dolls and Costco receipts till 2010 rolls around.

There exist many mixed feelings on this doll. Some great. Some not-so-great. We'd love to hear what you think and welcome a report from lactivist parent whose child actually has this doll as well.

Photo of the Bebe Gloton doll inside its product box.

Some people like the idea - a baby doll who eats as normal human babies eat - at the breast. And yet, it comes with a pacifier (a common deterrent to a healthy breastfeeding relationship and milk supply, especially in the early months). Some La Leche League leaders are not too sure it is such a good thing. After all, we can just give our sons and daughters 'regular' dolls and they can nurse them any way they wish. Do we really need the "glurp glurp" sound effects and the pretty petaled bra? Yet, others feel it is a fun way to imagine you are nursing a real baby. And this encouragement - this life-like imitation of Mom - may just serve to normalize human milk for human babies. Something that could put a small crack in our hardcore nipplephobic state in North America.

So, what do you think?


~~~~

Bebé Glotón is a baby doll made by Berjuan, a toy maker in Spain, for the express purpose of promoting breastfeeding. The idea is to impress upon youngsters that breastfeeding is the natural, normal way to feed a human baby. It would be wonderful if they already see Mom nursing (not to mention aunts, relatives, strangers at the park, etc.) but maybe this wishful thinking of a ubiquitously breastfeeding-friendly world is not yet reality.

Children can wear the colorful bra-like top adorned with small flowers over their chest. When the doll is placed at the flowers, s/he makes a nursing motion and suckling sound.

The doll is available as either a girl or boy infant (both intact of course).

Bebé Glotón (which translates as 'Baby Glutton' or, in more common American English slang, the little 'Piggy Baby') sells for 44 Euro or about $65 U.S. dollars. Although you will be hard pressed to find one here at this time, unless you are ready to search online and pay international shipping fees.

See Bebé Glotón in action:




Two photos showing the flowery nursing bra being tied on a girl and then the girl pretend nursing her baby doll.

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