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Do You Know: The causes of tight foreskin and what to do about it?

Marilyn MilosBy 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].

Do You Know: Why Lawsuits Won’t End MGC?

It seems so clear, right? Cutting a boy’s genitals violates the U.S. Constitution, state and federal laws against sex-based discrimination, and statutes and regulations regarding the use of government funding for medically unnecessary services. It also meets definitions of assault and battery — because the child cannot consent — and the surgery serves no therapeutic purpose. And, as we know, both short- and long-term consequences are not uncommon, and some are severe.

So… Sue the bastards!! Right? Over recent months, I have reached out to personal injury attorneys from nearly a dozen states, including those with laws that most liberally favor malpractice cases. I told them that Intact America (as well as other intactivist organizations) are receiving more and more complaints from parents of boys with significant injuries that occurred either during circumcision, as a result of forcible foreskin retraction, or that appeared later. It was our hope, given the limited bandwidth (and resources) of our fellow intactivist who are lawyers, that we could identify a larger group of practitioners who would be willing to review and take on lawsuits from individuals wanting to sue.

Unfortunately, it’s not that simple My conversations were uniformly sobering. Here are some of the comments from the lawyers I spoke with:

    • The standard for evaluating a case is whether any other doctor would have done the same thing. Circumcision is so common, it’s almost impossible to find a situation that’s so unusual as to make one stand out.
    • If we think the dollar value of the recovery is under $250,000, we can’t even consider taking it on. The expenses of preparing a case include research, hiring experts, taking depositions… It can take up to two years. And even though most cases settle, it’s the night before trial, so you’ve already invested all this money.
    • Circumcision is considered normal in this country. It’s unremarkable. And a certain number of complications is normal. So…, you rarely have the facts needed for a lawsuit. [This same attorney let me know he is personally opposed to circumcision.]

But what about bodily autonomy and the child’s consent? When I asked about cases involving aggressive “selling” of the procedure to parents, misleading claims as to its benefits, and lack of informed consent, the lawyers brushed these facts aside with the same explanation. Ultimately, if nearly every hospital is circumcising, and if the parent signs a consent form, then there is no cause of action egregious enough to mount a lawsuit.

So, what now? At this point, as painful as it is to hear this message, counting on the courts to punish the participants in the circumcision machine is wishful thinking.

This doesn’t mean, of course, that we need to sit still as American boys are systematically violated. No, in fact, we need to document every case that comes to us and help the parties who were harmed by filing complaints with the physicians themselves, the hospital or other facility where the event took place (I call this “the scene of the crime”) and the professional (mis)conduct board of the state where it occurred. This is a massive task, but if we are able to amass and track enough cases, physicians will find it increasingly uncomfortable to continue to violate children by cutting off their foreskins and the promiscuous promotion of circumcision will decline.

If you would like to volunteer to help Intact America with this project, please write to us at [email protected]. Tell us what state you live in, and what (if any) experience you have with legal issues, customer service, or other activities that would help you to help us do this work.

In advance, thank you.

Georganne Chapin
Executive Director
Intact America

Do You Know: Why Some Men Have “Bent” Penises?

By James Snyder, MD

As a preface, I should mention that Routine Infant Circumcision (RIC) is the reason/cause of some penile curvature in adult men (which is distinct from Peyronie’s Disease or Chordee — see below). The operators in this procedure may be medical students, nurses/midwives, obstetricians, pediatricians, or anyone who is being taught to do a “simple” infant circumcision. The fact is this procedure is often underestimated in terms of risk, and it is delegated to the least experienced operator. Removal of skin from the penis to reveal the Glans Penis is the primary goal, but the results/complications/mistakes of the operator may become evident only after years have passed and the subject is unable to obtain redress of grievances. The most careful RIC removes up to 1/3 to 2/3 of the skin of the normal penis. This skin does not regenerate as the child becomes an adult; the results can be tragic when the removal of skin leaves behind shortening, unequal and asymmetric coverage, curvature, and sexual crippling. Now I will proceed to a discussion of two well-known natural causes of penile deformities – Peyronie’s Disease and Chordee.

Peyronie’s Disease or the “Bent Spike Syndrome” begins as a thickening of the fibrous sheaths which surround the two erectile bodies of the penis. These erectile bodies are attached to the bony pelvis and continue through the length of the penis to attach to the Glans Penis. During sexual arousal, these bodies fill with blood to the limits of the fibrous sheaths which define the size and shape of the penis. At the same time, the urethra, a tube which conducts urine and semen from the bladder and prostate, also engorges with blood. These structures and their various functions are most easily understood by consulting books of Anatomy, such as Grey’s Anatomy or Grant’s Atlas of Anatomy, found in most libraries.

Peyronie’s affects the erectile bodies of middle-aged men, causing painful erections with curvature and distortions of the shape of the penis, which may prevent normal sexual intercourse. The condition is sometimes associated with Dupuytren’s contracture of the tendons on the palm of the hand. The cause of these conditions is poorly understood, and various treatments have resulted in incomplete cure of the disease which usually worsens over time.

Urologic specialists at the Mayo Clinic see about 700 patients yearly with this condition and have developed appropriate medical and surgical treatments which may include injections, traction, and surgery.

Chordee (pronounced Cor-DEE) is a curvature of the penis toward the feet (ventral or ventrally). This is a normal condition after conception when the embryo develops all the essential organs to support life and becomes a fetus. Early in this process, the sexual organs begin to develop and differentiate between males and females. At first, the phallus is curved ventrally in both sexes. The secretion of the male sex hormone, testosterone, by the fetal gonads causes the male phallus to enlarge, unwind, and take a more nearly straight form. Later, the skin which will become the scrotum folds to the midline and encloses the testicles, continuing this process and forming the tube which conducts urine, the urethra, similar to the action of a zipper until the distal end of the penis is reached.

The condition known as Hypospadias is a failure of this process to complete any or all of these described formations. In the most severe forms, the Chordee fails to resolve, and the distal penis remains close to its original form. More commonly, the penis is completely formed except for the ventral curvature, which may be more or less severe. In the milder forms, the curvature can be surgically corrected when the Urologic Surgeon makes a skin incision along the length of the penis on the dorsal or upper surface and removes or cuts out a series of wedges from the fibrous sheath of the erectile bodies. This may improve the shape or curvature of the penis to allow normal sexual function.

This is an abbreviated discussion of these conditions, which, fortunately for humanity, are not common. In my experience as a Urologic Surgeon, I have encountered these conditions only a few times. The best treatment options are available from experienced surgeons working at university medical centers.

James L Snyder, MD
Fellow, American College of Surgeons
Diplomate, American Board of Urology

Persons interested in learning more about Peyronie’s Disease and its treatment, including surgery and the use of injectable medication, may consult the Mayo Clinic website.

Do You Know: About Brit Shalom

by Lisa Braver Moss & Rebecca Wald
In many cases, Jewish families who opt out of circumcision make a decision of omission — circumcision is simply skipped. But more and more parents are choosing an alternative ceremony known as brit shalom (“covenant of peace” in Hebrew) as opposed to brit milah (“covenant of circumcision”).

Brit shalom is an uplifting, celebratory baby-naming ceremony specifically designed for non-circumcising families. It’s an affirmation that despite what may be seen by others as a radical choice, the family still considers themselves to be Jewish. And it’s a beautiful symbolic acknowledgment of the ancient Abrahamic covenant.

Brit shalom ceremonies can be tailored to what’s meaningful to the family. Its liturgy may be modeled after that of brit milah, with the circumcision being replaced by a symbolic act such as the cutting of a pomegranate.

Throughout Jewish history, there have been those who didn’t circumcise, but alternative ceremonies for traditional brit milah are relatively new. We believe one of the earliest such ceremonies was officiated by Rabbi Nathan Segal (1949-2019) in the mid-1980s. The movement grew from there.

Various naming ceremonies for intact babies came into being—for example, “brit ben” (covenant for a boy) and “brit b’lee milah” (covenant without circumcision). The ceremony known as brit shalom has become the most common. Since the etymological root of “shalom” in Hebrew can mean both “peace” and “wholeness,” there is perhaps no better name.

At first, it was difficult to find officiants to lead brit shalom ceremonies, and families often created and led their own, culling liturgy from various Jewish sources (or borrowing from Jewish naming ceremonies for girls). Over time, an underground grass-roots movement evolved, with names of willing officiants shared informally and photocopied pages of newly-created ceremonies stapled together and distributed as needed. Until our book Celebrating Brit Shalom came out in 2015, there was no published resource specifically designed for these families.

Thanks to Dr. Mark Reiss, who, over a period of years, painstakingly amassed a list of officiants willing to lead brit shaloms, more non-circumcising families began to hold ceremonies. In more recent times, many progressive rabbis, such as those from the Reform movement, will also officiate if asked.

Brit shalom is an expression of pride in both being Jewish, and deciding not to circumcise. We hope more and more families will choose this option.

Lisa Braver Moss and Rebecca Wald are the authors of Celebrating Brit Shalom and the co-founders of Bruchim, a new Jewish nonprofit advocating for the open inclusion of non-circumcising families in Jewish spaces.

Do You Know: About Smegma?

Smeg​ma  \ ˈsmeg-mə \ : the secretion of a sebaceous gland, specifically: the cheesy matter that collects between the glans penis and the foreskin or around the clitoris and labia minora

Yes! That’s right. Smegma was recognized by the Ancient Greeks (who had a sophisticated understanding of the body and abhorred circumcision) as a beneficial and cleansing substance. That white stuff that builds up in our genitals – under the foreskin in intact males, and around the clitoris in intact females – is as natural as the saliva in your mouth. And just as helpful!

Smegma serves important functions. Fresh smegma is smooth and moist. In adult men, it helps to keep the foreskin and the head of the penis soft, and eases intromission (insertion) during sex. Understanding this makes it easy to see why men who are missing their foreskins need to use lubricants for both masturbation and sex. And it makes it easy to understand why partners of circumcised men sometimes complain of pain and dryness during intercourse.

Circumcision removes nature’s perfect lube — forever!–

Smegma also keeps the penis and clitoris from adhering (sticking) to the adjacent skin in a mature adult. Of course, in baby boys, the foreskin is naturally attached to the head of the penis – that’s for protection, too. As the boy grows and the foreskin begins to separate from the glans, smegma sometimes appears in the form of small white lumps (some people call them “smegma pearls”) underneath the foreskin. This is perfectly normal, and no intervention is required. The pearls will be discarded once the foreskin separates from the glans. Smegma will then take over to do its important work!

And remember: Nobody – not a parent or a doctor or a nurse or a babysitter – should EVER forcibly retract a child’s foreskin!

Just as no special care or attention is required for an intact baby, nothing special is needed to keep an adult’s genitals healthy. Again, nature’s best rinsing agent – plain warm water (with a mild unscented soap, if you wish) will take care of any build-up of smegma or any odor you might find offensive.

Here’s something else to think about. A study published in 2016 found that nasal mucous contains a natural antibiotic substance (called lugdunin), which is uniquely effective in fighting drug-resistant staph infections. Another natural substance that fights infection is Lysozyme, a crystalline, basic protein present in human saliva and tears, where it functions as an antibacterial enzyme. Isn’t it likely that smegma also fights infection? Could this help to explain lower rates of STDs in Europe, where relatively few men are circumcised, compared to the United States, where three-quarters of adult men are missing their foreskins and the natural protection this body part offers? Let’s hope that future research will explore this question. Sometimes the facts are right under our noses — or under our foreskins!

By Marilyn Milos, RN and Georganne Chapin, IA Executive Director

Do You Know: About Planned Giving?

By Georganne Chapin, IA Executive Director

This past year has made me acutely aware of the fragility of life, all that I’m grateful for — and the type of world I want to secure for the future. In that world, no child will ever be subjected to medically unnecessary surgery without their consent.

Perhaps not surprisingly, a growing number of Intact America donors are asking how they can continue to support Intact America’s mission beyond their own lifetimes.

One of these donors was Gene Burkett, a man I came to know well.

Gene’s journey with Intact America began in 2015 when he came upon us while researching circumcision. As Gene later wrote to me, “While other websites had useful information, it appeared that Intact America was the only one that had an active advocacy component. It also was one with the most educational material on the story of circumcision, especially in the United States.”

Over the years as our friendship evolved, I much appreciated the counsel that Gene, who was a finance professional, gave me. He understood Intact America’s challenges and saw his way clear to support us.

In January 2021, a few weeks before he passed away, Gene informed me he had made Intact America the sole beneficiary of two IRA accounts, representing the bulk of his assets.

Here is what he said:

“I am 100% confident that I am doing the right thing with these funds. My willingness to do this, with no strings attached, is the direct result of my faith in your integrity, abilities, and dedication to this cause. I trust that you, or whoever succeeds you, will use this money wisely to be able to fulfill my hopes and dreams.”

I was, and continue to be, overwhelmed by both Gene’s gift – the largest Intact America has ever received – and his faith in us. To honor Gene, his values, and his dreams, we’ve created the Gene Burkett Legacy Circle for supporters who include IA in their estate planning.

If, like Gene, you would like to build a legacy that protects every child’s right to bodily integrity, I would welcome a conversation. You can contact me at 914.400.1909 or [email protected]. If you have already included Intact America in your estate plans, I would love to know that so I can personally thank you and welcome you into the Gene Burkett Legacy Circle.

Below is some information about legacy giving.
Gift options include:

Bequests
Making a gift through your will is the simplest way to create a legacy of protecting children’s rights. To do so, add this sentence to your existing will: “I give and bequeath (dollar amount, or percentage of residuary estate, etc.) to: Intact America (Tax ID #81-2887457), located at 303 South Broadway, Suite 420 (PO Box 8516), Tarrytown, NY 10591.” To create your will in 20 minutes, free of charge, visit our partner FreeWill.com. (Please consult your attorney and/or tax advisor before adding this language to your will to determine the best method for including Intact America in your estate planning.)

Gifts by Beneficiary Designation
Naming Intact America as a beneficiary of your retirement account, life insurance plan, bank account, donor advised fund, real estate, or other assets is another convenient way to give. It doesn’t require an estate plan or lawyer, and you can change your beneficiary choice at any time. You can note Intact America’s Tax ID number (81-2887457) on the beneficiary designation form.

Retirement Plan Gifts
There are excellent tax benefits to reap from donating retirement plan assets in an IRA, 401(K), 403(B), or qualified pension to Intact America. IA will receive the full value of the distributions tax-free. The assets designated to use this way will not be a part of your taxable estate, potentially lowering estate taxes owed. As noted above, you can note Intact America’s Tax ID number (81-2887457) on the form provided to you by your financial institution or pension fund.

By including Intact America in your estate planning, you will become a member of the Gene Burkett Legacy Circle in recognition of your visionary generosity. In addition to knowing that you are protecting future boys and men from harm, as a member you will receive:

– Recognition in select Intact America publications and on our website.
– Exclusive “State of the Organization” Zoom calls or webinars with Intact America leadership.
– Personal invitations to Intact America events.

For more information about legacy giving, contact Georganne Chapin, Founding Executive Director, Intact America, at [email protected] or 914.400.1909.