Two recent surveys by Intact America have raised the question by some participants of why we asked the men if their penis looked like A (an intact penis) or B (a circumcised penis), which they found either distasteful or an invasion of privacy. This is the A or B image they were talking about.
The short answer is accuracy. Asking this question improves the quality of the survey results. A lot. The reason is that many men don’t know their penile status! A 2004 study of college-aged men found that 33% were mistaken or unsure of their penile status.[i] This is nothing new, a 1960 study found 14% of men were unsure; their status was confirmed by a physical examination.[ii]
More recently, in Intact America’s three, national random sample surveys (2017, 2018, & 2021) of 3298 Americans, 14% of men were mistaken or unsure of their penile status. See below for my decade-old methodology to determine whether men were mistaken or not. But first, here’s an entertaining anecdote to illustrate the problem.
You may have seen the episode of the Graham Norton Show on BBC in 2017 with guest actor Sir Patrick Stewart. He relayed the funny story about him mentioning in passing to his wife that he was circumcised. According to Stuart, in his 70s at the time, the conversation went something like this:
Stewart: I’m circumcised.
Wife: (laughs) You’re not circumcised.
Stewart: That’s ridiculous! I should know if I’m circumcised! End of conversation.
Stewart: The next day, I happened to be seeing my doctor for my annual physical. When the doc was ‘down there,’ I mentioned my disagreement with my wife, and asked, “I’m circumcised, right?”
Surprisingly, even men who call themselves intactivists, and who are presumably knowledgeable about circumcision and male sexual anatomy, aren’t sure. A survey of intactivists found that 13% of intactivist men are mistaken or unsure.
In 2011, I wanted to learn if newborn circumcision was associated with alexithymia. Alexithymia is the inability to identify and express emotions. It is thought that it is acquired at a very early age. Such people have difficulty in relationships, social interactions, and even in therapy. But I could not examine these men who live across the United States. So, I had to develop a viable validation alternative for that peer-reviewed alexithymia and circumcision study. My solution was to ask their penile status and then compare that with their answer to the A-B image question. Entries that did not match correctly were removed from the dataset.
As it turns out, and unknown to me at the time, I’m not the first researcher to realize that self-report is inaccurate when it comes to penises. In 1992, Schlossberger found that: “Use of visual aids to report circumcision status was more accurate (92%) than self-report (68%).[iii] Wow.
Granted, the best way to determine penile status would be a physical examination. But this is so problematic on so many levels that it would be all but impossible to survey. You’d have to pass certain standards using human subjects, hire medical staff, obtain liability insurance, and of course get permission from the men to disrobe. (By the way, the proper way to determine if a man is circumcised isn’t to look for the lack of a foreskin, but the presence of a circumcision scar.)
The solution that I came up with, and one I’ve used many times since, is a three-part survey-question method. The questioning goes something like this:
Are you circumcised or intact (not circumcised)?
Which one of these images most looks like your flaccid (not erect) penis?
Are you restoring your foreskin?
I don’t know what this is
As you can see, this method results in much more accurate answers, and provides trustworthy data. Nevertheless, some men are not comfortable answering these questions, even to an anonymous researcher. I can appreciate that. That’s why I’ve taken steps to avoid their discomfort: 1) I inform participants that they’ll be asked personal, sexual questions, 2) tell them they can opt out now, 3) tell them they can opt out at any time, 4) mention that this data will only be used in aggregate form, and that at no time will their identity be revealed, and 5) use the image shown above obtained from a medical illustration stock image source instead of using a photo of real penises.
A study I recently conducted, and now in-press, titled “Adverse Childhood Experiences, Dysfunctional Households, and Circumcision,” also employed this method. None of the journal reviewers mentioned a problem with using this image.
So, not using this tripartite image question would make the results skewed, if not unusable, and therefore unpublishable.
Sadly, many circumcision studies being published since I created this method continue to just ask the men if they are circumcised or not, leaving us unsure of what to make of their conclusions. As scientists like to say: “Junk in, junk out.” (no pun intended!)
[i] Risser JMH, Risser WL, Eissa MA, Cromwell PF, Barratt MS, Bortot A. Self-assessment of circumcision status by adolescents. Am J Epidemiol. 2004;159:1095–1097.
[ii] Wynder EL, Licklider, SD. The question of circumcision. Cancer. 1960;13(3):442 5. 14.
[iii] Schlossberger N, Turne R & Irwin C (1992) Early adolescent knowledge and attitudes about circumcision: methods and implications for research. J Adolesc Health 13(4): 293-297.
Intact America interviewed Dusty Drake (they/she) following her heartwarming and open TikTok account of their circumcision complications. A transcript of the interview and her video follows.
How did you discover Intact America and what does the intactivist movement mean to you?
I first discovered Intact America a few years ago on Instagram. Back in 2011 however was the first time that I heard the term intactivist. Without knowing the word though, it is something I advocated against within my social circle even before that because of my own experience. To me, the intactivist movement is about bodily autonomy more than anything else. It’s giving the right to make cosmetic decisions about one’s body to the individual themself. It seems to be a controversial opinion in North America, but I don’t think that parents should be allowed to alter their child’s body for cosmetic purposes just because it’s their child. That child is an autonomous human being and will grow into an adult who can consent to those procedures if they decide they want them.
What encouraged you to share your story, and why now?
I was encouraged to share my story when I saw a prompt posted on September 22nd to Instagram by Intact America. The prompt simply said “Robbed of your foreskin? Tell us your story.” Their email was written below and I thought to myself, “I should email them. I’m shut down so often when I bring up the problems with cosmetic infant circumcision so I’m terrified to share my story but at least they are willing to be a listening ear.” After composing the email though I had a spark of inspiration and decided that I wasn’t going to send it. I have a following on TikTok and though even though I’ve been harassed and shut down before while speaking against cosmetic infant circumcision, this is still something that people need to hear even if they aren’t ready. So I decided to record and post my story instead. I can’t begin to tell you how extremely nervous I was to talk about my own personal experience with having been circumcised as an infant and the issues I experienced during puberty because of it. While recording, it felt just as nerve wracking as if I was speaking to a room full of strangers who had no interest in what I had to say. But I continued, because if my voice can help one parent reconsider their entitlement over their child’s body and prevent them from taking away their child’s bodily autonomy then it was worth the temporary discomfort I felt while recording.
What are some of the reactions to your TikTok video and how do they make you feel?
A majority of the reactions from my TikTok on my own experience have been overwhelmingly positive which I was honestly surprised about. I have posted content against cosmetic infant circumcision in the past and have been met with a lot of hate, harassment, and even bullying. So I was understandably nervous to share my own story, but I am so glad I did. I think the biggest reward from posting about my own experience is the new and expecting parents posting that they are reconsidering doing this to their child, have now made the decision not to, or feel more reassured that they made the right decision by leaving the choice up to their child.
Would you consider sharing more about your experience, or discuss circumcision in future TikTok videos?
If the right inspiration strikes, I will continue to talk about my experience. I absolutely intend to continue making content against cosmetic infant circumcision because the right to bodily autonomy is a human rights issue.
Dusty’s TikTok Transcript:
When I was a baby, only a few days old, a doctor had convinced my parents that there was something wrong with my body and that immediate surgical intervention was needed. There was no infection, no birth defect, and there were no adverse effects that could come from leaving my body in its natural state. Yet despite this, my parents had been convinced that to be good parents and do what was best for their first born child, that immediate surgery was necessary. They hadn’t been properly educated on the surgery, and they had have been given information on the benefits of leaving my perfectly healthy body alone. So they followed through with the doctor’s recommendation.
When I began puberty at around 10 or 11-years-old, my body began to grow quickly, so quickly, in fact that the incision from the surgery that I was unnecessarily forced to undergo as an infant began to tear. The scar tissue began stretching beyond its limits. This increased tension led to years of bleeding and scabbing along the incision line from the scar, not to mention the pain that this caused me during this whole time. But I was scared and ashamed of what was happening to me. I had believed that I had done something wrong, or worse, that there was something intrinsically wrong with me and that this was a punishment for it, and this made sense to me. After all, I was a young closeted queer kid who was being bullied every single day by my peers. Heck, I didn’t even know what queer or gay or any of that was, but I knew that that was something I didn’t wanna be and that it was bad, because that’s what my peers and society had taught me.
So it made sense to me that on top of being bullied every day, that life would just punish me in this way, despite the fact that I hadn’t done anything except for show kindness to others. So I never told anybody what I was going through and I just suffered through it alone. But when I was an adult, I discovered that I wasn’t the only one who had gone through this. There were doctors all over convincing parents to perform these unnecessary surgeries on their children, their newborn children. After I realized that I wasn’t alone in this, I got the courage to speak to my parents about it. They didn’t know what to say at the time, and they were clearly processing the information I was giving them, but they did look really remorseful.
Just last month, I was hanging out with my mom and she came up to me on her own, she sat next to me on the couch and just gave me a big old hug. She looked me in the eyes and she said, “I am so sorry. I would never crop a dog’s ears or tail, but for some reason, I never gave a second thought to mutilating my own newborn baby. I wish I could go back and make an informed decision with the knowledge I have today. I’m so sorry that we circumcised you.”
I have read that the foreskin produces anti-microbial agents, including Langerhans cells. Is that true? What are Langerhans cells?
—Richard in Virginia
Yes, Richard, Langerhans cells have important immunological properties.
Langerhans cells reside in the epidermis of the foreskin, the body’s outermost and thinnest layer of skin and the layer responsible for protecting you from the outside world. Langerhans cells determine the appropriate adaptive immune response (inflammation or tolerance) by interpreting the microenvironmental context in which they encounter foreign substances. In a normal physiological, “non-dangerous” situation, Langerhans cells coordinate a continuous state of immune tolerance, preventing unnecessary and harmful immune activation. But when they sense a danger signal, for example during infection or when the physical integrity of skin has been compromised as a result of a trauma, they instruct T lymphocytes of the adaptive immune system to mount efficient responses against the danger.
Thus, Langerhans cells in the foreskin play an important role in fighting infections and protecting the rest of the penis.
—Marilyn Milos, RN
Richard Schwartzman, a psychiatrist who wrote and spoke about child rearing, including the harm of infant circumcision, passed away on July 20, 2022. He was 83 and is survived by an immediate family that includes Rebecca Wald, her husband, and their children.
For close to 50 years, Dr. Schwartzman practiced medical orgone therapy, a unique approach to restoring emotional health pioneered by Wilhelm Reich (1897-1957). Reich was a widely misrepresented physician and natural scientist who attempted to demonstrate a Western scientific basis for life energy, an animating force that he maintained flows through all living things and permeates the cosmos.
“The pain and terror of circumcision is NOT ‘forgotten’ as is said, even though it cannot be consciously recalled. I am a physician and psychiatrist who has had patients relive their circumcision in the course of Wilhelm Reich’ s body-oriented, emotional release treatment,” Dr. Schwartzman once told Ronald Goldman, Ph.D., in a personal email.
Dr. Schwartzman went on to say that he had seen at least 15 individuals who sought treatment because they felt they had been emotionally damaged by their circumcision and/or were in the process of regrowing their foreskin, noting that all but one (who terminated treatment very early) had improved their function and satisfaction with life.
Dr. Schwartzman became aware of Marilyn Milos’s important work around 1989 when one of his associates, James DeMeo, Ph.D., spoke at Marilyn’s first symposium and then several after. Dr. Schwarzman is mentioned in Goldman’s 1997 book, Circumcision: The Hidden Trauma. Dr. Schwartzman was also a friend of Intact America, and had the opportunity to speak in Boulder in 2015 at the Genital Autonomy symposium. There he explained how early infant traumas are physically locked within us at a bio-energetic level. He also showed a clip from Room for Happiness, a documentary he produced about medical orgone therapy.
Dr. Schwartzman received his Bachelor of Science degree from Philadelphia’s rigorous Central High School and thereafter matriculated directly to Temple University School of Pharmacy, graduating in 1963. After becoming a pharmacist, he attended the Philadelphia College of Osteopathic Medicine. He undertook two medical internships, the first at Zeiger Osteopathic Hospital (1967) and the second at Philadelphia General Hospital (1970). The second internship allowed him to pursue a residency in psychiatry and neurology at Hahnemann Medical College and Hospital, which was an M.D. program.
Dr. Schwartzman was the first osteopathic physician in the United States to complete an M.D. residency, paving the way for many others to do the same. He lobbied for this opportunity and chose the burden of repeating the grueling internship year because he felt the M.D. residency would best prepare him as a psychiatrist. Dr. Schwartzman was never one to take a linear or expected path in life for its own sake, or to let established rules prevent him from doing what he felt was right.
In the practice of medical orgone therapy, Dr. Schwartzman was trained by physicians Morton Herskowitz, D.O. (1918-2018) and Elsworth F. Baker, M.D. (1903-1985) who had both been Reich’s students and were directly trained by Reich. This lineage allowed Dr. Schwartzman to practice orgone therapy as Reich had conceived it. Over the years, Dr. Schwartzman was disheartened by the emergence of many various self-taught “energy workers,” claiming to practice orgone therapy or calling themselves Reichians. He felt such offshoot approaches could be harmful to the recipient and also greatly contributed to the already misunderstood Reich.
Dr. Schwartzman maintained a private medical orgone therapy practice in Center City Philadelphia and then in Solebury, PA, from 1974 until his retirement in February of 2021. He positively impacted the lives of countless grateful patients. He also trained many physicians in the practice of orgone therapy (not just in the U.S. but also in Greece, Italy, and Germany); he wrote journal articles; he was an early blogger; and he lectured on topics related to Reich’s work.
In addition, Dr. Schwartzman was also a fellowship-trained forensic psychiatrist, serving as Medical Director of Psychiatric Services to the Philadelphia Prisons and Assistant Clinical Professor of Psychiatry at Hahnemann University (1978-2000). In this role he saw firsthand how criminal behavior stemmed from childhood trauma. Dr. Schwartzman had the opportunity to train many of Hahnemann University’s medical students who would rotate through the prison hospital. He also regularly testified in court, sometimes in high-profile cases, regarding competency to stand trial and post-conviction recommendations.
Dr. Schwartzman was full of energy, and full of love for his family and his work. He had an incredibly generous spirit. He also had an inquisitive and open scientific mind. Using his skills as a pharmacist, he was known to putter in his kitchen compounding medications with a mortar and pestle that weren’t available in the pharmacy. He liked to point out that many great thinkers, scientists, and artists were laughed at and scorned by the establishment during their lifetimes, only to be accepted as geniuses centuries later.
Like his mother, Beatrice, Dr. Schwartzman was an optimist who always saw his cup in life as half full. He felt extremely fortunate throughout his life, pointing out on the occasion of his 83rd birthday that he had enjoyed good health until old age had recently taken its toll. He expressed how very lucky he was to have had meaningful work that he enjoyed for so many years. He took great joy and pride in his immediate family.
Dr. Schwartzman’s message was to enjoy life whenever possible, often encouraging his family to have more fun. He very much liked Goethe’s quote: “Enjoy when you can, and endure when you must.” His recipe for a successful life: Try to lead a simpler life by limiting unnecessary obligations and responsibilities. Find big work that you find meaningful and enjoy. Take pleasure in giving generously to your family and others you love. Do not strive to be “happy.”
As founding board member emeritus, Dr. Schwartzman also played an important role in founding Bruchim, a nonprofit that supports non-circumcising Jewish families. He was delighted by Bruchim and always enjoyed hearing the latest Bruchim news, frequently sharing insights with his daughter Rebecca that have helped shape the direction of the organization. Bruchim will be a lesser organization for his absence.
If you have memories of Dr. Schwartzman that you would like to share with the Wald family, or any other thoughts related to his life and work, you may send them to [email protected] The family is requesting that memorial contributions be made to Intact America, Bruchim, or the charity of your choice that benefits infants and children.
By Marilyn Milos, RN
Sometimes the retractable foreskin of an adult male will close down; this condition is called “pathological phimosis.” Too often, when men who have developed pathological phimosis consult with a urologist or other physician, they are told that the only cure is circumcision. This is incorrect in most cases.
The word phimosis means muzzling, to indicate that the glans (head of the penis) is muzzled by the foreskin. At birth, most babies have “physiological phimosis,” a normal condition because the glans and foreskin have not yet separated. The foreskin separates from the glans over time, usually by adolescence.
But even after the foreskin becomes mobile and retractable, it is possible that a man will one day begin to have trouble retracting it, and be diagnosed with pathological phimosis.
Here are a few possible causes for pathological phimosis, along with cures that you can pursue in order to avoid the loss of your foreskin.
1. Yeast imbalance. Exposure to soap, shampoos, and chlorinated water in swimming pools or hot tubs can kill normal, beneficial bacteria on the foreskin. This can result in yeast overgrowth, inflammation, itching, and stinging with urination; it can also make the foreskin close down. A yeast imbalance can be corrected by eliminating soap and shampoo, or by using a barrier cream on the foreskin before swimming. To help the healing process. Liquid Acidophilus culture purchased from the health food store or pharmacy can also be applied to the foreskin by pouring some of the liquid into the palm of the hand, dipping the foreskin into the solution, and letting it drip dry; do this six times a day for 3 or 4 days.
2. Vigorous sexual activity. Sometimes the foreskin will close down if a male has been too vigorous sexually, which can cause small tears in the foreskin. The opening will become tight while the tissue heals. Time and gentleness are the cure for this.
3. “Lichen sclerosus” (formerly called “BXO”), is another condition that can cause the foreskin to become too tight. Lichen sclerosus is characterized by the presence of small, shiny, and smooth white patches on the foreskin. These patches may become larger, and the skin may become itchy, thin, and wrinkled, and may tear easily and bleed. A dermatologist can diagnose lichen sclerosus, which is commonly treated with two creams, Clotrimazole and hydrocortisone, both available over the counter at your local pharmacy, or by prescription, depending upon the desired strength.
If none of these conditions is present, and your foreskin is simply too tight for comfortable retraction, before considering circumcision, ask your urologist about a Y-V- or Z-plasty. These are surgical techniques in which small slits are cut in the foreskin, and then sewn together in a way that widens the opening. This surgery saves the foreskin and its specialized nerve endings that allow for full sexual sensations and enjoyment.
As you can see, finding the reason for your phimosis is a critical step to solving the problem and avoiding the loss of your foreskin.
If you have questions not covered here about problems with your foreskin, you may write to us at: [email protected].
During my Obstetrics and Gynecology Residency, I had the opportunity to learn newborn circumcision. Because of the frequency of the procedure, I agreed to the training. Yes, the Siren on the rocks of “cultural normalcy” called me.
Immediately prior to the training, I remember a blond-haired resident giddy with excitement at being able to learn the procedure, and vividly recall her saying: “Have the nursing staff line the boys up. Go Chop! Chop! Chop! Think of all the RVUs you can make??” RVU stands for Relative Value Unit, which is a figure used for compensation. Obviously, her main concern was the amount of money that could be generated by sexually maiming newborn boys in the name of profit.
The white Circumstraint board was on a procedure table. The baby was brought into the room. The mother’s written “consent” had been verified.
There were three of us. My assigned job was to put the safety pin through the foreskin.
The naked baby was then placed in four-point restraint and immediately began crying uncontrollably. Someone prepped the skin. Another Resident placed the local anesthetic which resulted in further crying. Those who have children or work with newborns know that babies do “talk” in their own ways. There are cries of hunger. Cries of frustration, and cries of absolute fear and pain. Perhaps I am blocking out the other parts of the procedure that the other two doctor trainees performed.
It came time for me to place the safety pin, so I was standing directly over the baby. The screaming was just awful. I can remember starting to place the safety pin in the foreskin and small dot of blood appeared where the pin would be placed. At this point, I almost walked out of the room. Seeing a naked restrained human screaming in pain, with his head rocking back, spittle flying from his little mouth was too much. I wondered, “Now why are we doing this? Why are we violating this human being? I finished my part and stepped aside. As the shrieks of the restrained baby intensified, the third resident severed the baby’s foreskin along the edge of the clamp and placed the circular bloody specimen on side of the Circumstraint.
I will never forget the shrieks of that baby.
The episode left me with the knowledge that I had violated my own morals as well as the code of medical ethics. Indisputably, we had done harm to the baby that day. The baby’s normal genital anatomy at birth had been forever changed, leaving him physically altered as well as neurologically ruined. Unquestionably, it is impossible for a newborn baby to give consent for such a procedure. I still hear the screams from time-to-time.
And we call ourselves healers?
I have never performed or taken part in another circumcision.
— James F. Verrees, M.D., FACOG
Las Vegas, Nevada
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