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Resources

White Papers

Access in-depth analysis and research findings on circumcision data.

White Paper PDF Downloads

INTACT AMERICA: A Tipping Point Strategy

CGC as an ACE

Survey Data

Explore comprehensive data and statistics on public opinions, circumcision trends, and forcible foreskin retraction.

Survey Data PDF Downloads

2023 Newborn Circumcision Knowledge Survey

2023 Foreskin Appreciation Day Survey

2022 Terminology Survey

2022 Medical Complaint Survey

2021 Nurses Survey

2020 Solicitation Survey

2018-2021 Public Opinion Surveys

2018 FFR Survey

2015 Terminology Survey

2014 Public Opinion Survey

2023 DoNoHarm Surveys

The Circumcision Debate

For great, sharable information, check out our user-friendly site at the link below for newcomers to the circumcision question. If you are expecting a boy, it’s likely that people will ask you, “Are you going to have your baby circumcised?” Newborn circumcision continues to fall out of favor among Americans today, and with good reason. We think that the fact that you’ve come to Intact America means you’re considering keeping him natural and intact (not circumcised, uncircumcised). We hope the information provided here will make it easier for you to feel comfortable with that circumcision surgery decision.

Here Are 7 Things New Parents Should Know About Foreskin Removal

01There is no medical reason for “routine” circumcision of baby boys.

No professional medical association in the United States or the rest of the world recommends routine circumcision. People in Europe, Asia and Latin America—where 90% of men are intact (not circumcised) and suffer no negative consequences—are often shocked to hear that American doctors and hospitals remove part of a boy’s penis shortly after birth.

02Times and attitudes have changed.

The circumcision rate in the United States is down from more than 85% in 1981 to about 75% today (lower in some regions). This means that a quarter of all baby boys leave the hospital intact as more and more parents realize that circumcision is unnecessary. Many say it’s not a choice they should be making for their son.

03The foreskin provides protection and sexual pleasure.

The foreskin is a natural, functional part of the body. In baby boys, it’s attached to the head of the penis (glans), protects it from urine, feces, and irritation, and keeps contaminants from entering the urinary tract. The foreskin also plays an important role in sexual pleasure, due to its specialized, erogenous nerve endings and its natural gliding and lubricating functions.

04Caring for and cleaning the foreskin is easy.

Here are some tips on how to clean an uncircumcised newborn. A natural, normal intact penis requires no special care beyond gentle washing. The foreskin should never be forcibly retracted—just “clean what’s seen.” Once natural retraction has occurred (sometimes not until late adolescence), a young man simply needs to pull back his foreskin to wash his penis. (Most boys and men thoroughly enjoy this process!) Read our Foreskin Care flyer for more information.

05Circumcision is permanent, and your son might not appreciate it.

Circumcision permanently alters a boy’s genitals, removing healthy, protective, functional tissue from the penis and exposing him to unnecessary pain and medical risks over his lifetime. More and more men are voicing their displeasure over having lost a natural part of their sexual anatomy.

06Circumcision is painful, and there are risks to the surgery.

Both common sense and medical research confirm that babies are sensitive to pain. Even when analgesia is used, circumcision pain is not eliminated and the effects can be long-lasting. Also, complications can and do occur with this surgery. These include infection, abnormal bleeding, removal of too much skin, loss of part or all of the glans, urinary problems, and even death. All circumcisions result in the loss of the foreskin and its functions, and leave a scar on the penis.

07Circumcision does not prevent urinary tract infections (UTIs) or other diseases.

Over the years, the claims that circumcision prevents various diseases have repeatedly been proven to be exaggerated or outright false. UTIs occur more frequently in girls than in boys, and are treated with antibiotics. While most adult men in the United States are circumcised, our rates of sexually transmitted diseases (including HIV) are as high—or higher—than those in countries where circumcision is rare.

Fact Sheets

Advocate for intact penis care and equip yourself with compelling reasons against cutting the genitals of children.

Fact Sheet PDF Downloads

Foreskin Facts

Intact Care Guide

Talking Points

Foster informed dialogue and challenge societal acceptance of circumcision.

Talking Point One

Intact America’s position on infant and childhood genital cutting adheres to basic bioethical principles, including autonomy, nonmaleficence, beneficence, and justice.2

Individual Autonomy, Parental Rights, and Informed Consent
In health care decisions, respect for the autonomy of the patient implies that the patient has the capacity to act and decide intentionally, with understanding, and without coercion or influences that would mitigate against a free and voluntary act. This principle underlies the concept of informed consent in the physician/patient transaction. In the case of medical procedures offered to infants or children, because the child has no understanding or capacity to freely and voluntarily consent, the right to decide is given to the child’s parent or guardian in a form of consent known as proxy consent. However, the scope of proxy consent is, by necessity, limited to medical interventions undertaken on behalf of a minor child in their custody if and only if that intervention is necessary to save the life or the health of the child. Because the foreskin is a normal, healthy anatomical structure, and because “routine” CGC does not save the child’s life or health, the parent or guardian has no right to solicit or consent to circumcision on behalf of the child. Therefore, childhood circumcision, except in extremely rare cases where a pathological condition is present, violates the principles of informed consent and cannot ethically be performed by medical practitioners or in medical settings.

Nonmaleficence
The principle of nonmaleficence requires that medical practitioners not intentionally create or cause to occur a needless harm or injury to the patient, through acts of either commission or omission. Childhood genital cutting (CGC) involves the permanent surgical removal of healthy, protective, erogenous tissue. The harms of CGC are compounded by the fact that, often, no anesthetic or inadequate anesthetic is used for what is a prolonged and painful operation. Regardless of whether pain control is administered during the surgery, however, because it is not medically necessary, CGC circumcision violates the principle of nonmaleficience.

Beneficence
The principle of beneficence says that health care professionals have a duty to not only provide a benefit to a patient, but also to take positive steps to prevent harm to the patient. It does not include the felt needs, concerns or cultural beliefs of anyone other than the patient. Because “routine” CGC does not seek to remedy an ill and, indeed, exposes babies and children to unnecessary risk, trauma and pain, it violates the bioethical principle of beneficence and should not be a part of medical practice.

Justice
The principle of justice in health care implies fairness, equal treatment and – by extension – equal protection. In the United States, girls of all ages are protected by federal and state laws from unconsented-to genital surgery practiced in medical or non-medical settings because of the health beliefs or religious or cultural preferences of their parents. A consensus is also growing that children who are born intersex (i.e., those whose genitalia have both male and female characteristics) should not be “treated” with genital surgery until they are old enough to express their sexual identity. Boys are accorded no such protection. There is no acceptable rationale prohibiting genital cutting on some children, while tolerating (and even promoting) it for others. Male CGC violates the bioethical principle of justice.

Talking Point Two

Intact America’s principles agree with the American Medical Association’s position, which states: “Physicians should not provide, prescribe, or seek compensation for medical services that they know are unnecessary.”1 Child genital cutting conducted in the absence of pathology is a medically unnecessary surgical procedure whose sole purpose is to permanently remove healthy issue. Therefore, it is a violation of the AMA’s Code of Medical Ethics for physicians to solicit, provide or seek compensation for such surgery.

Talking Point Three

Intact America opposes the use of public and private health insurance funds for medically unnecessary surgery on children’s natural genitals.

Health care resources are finite. Whether funded by government-collected tax revenue (as for Medicaid and Medicare services) or by privately insurance premiums, health insurance funds are pooled to spread risk and maximize equitable distribution of benefit. Federal rules prohibit the expenditure of government funds for medically unnecessary services, but even for private insurance, it is generally accepted that only medically-necessary services shall be paid for by pooled funds; medically unnecessary procedures such as aesthetic enhancements (cosmetic surgery) performed in the absence of pathology or medical indication shall be the financial responsibility of the person requesting the service. (Bioethical rules of consent also apply, of course, whatever the payment source; thus, discretionary procedures may only be performed upon individuals who have the legal capacity to consent to them, and who have given such consent.)

Because there is no medical indication for removing a child’s natural, healthy foreskin, and because a child does not have the legal capacity to consent to this intervention, neither public nor private insurance funds should be used to pay for this procedure, or for the cosmetic alteration of any child’s genitals.

Individual Autonomy, Parental Rights, and Informed Consent
In health care decisions, respect for the autonomy of the patient implies that the patient has the capacity to act and decide intentionally, with understanding, and without coercion or influences that would mitigate against a free and voluntary act. This principle underlies the concept of informed consent in the physician/patient transaction. In the case of medical procedures offered to infants or children, because the child has no understanding or capacity to freely and voluntarily consent, the right to decide is given to the child’s parent or guardian in a form of consent known as proxy consent. However, the scope of proxy consent is, by necessity, limited to medical interventions undertaken on behalf of a minor child in their custody if and only if that intervention is necessary to save the life or the health of the child. Because the foreskin is a normal, healthy anatomical structure, and because “routine” CGC does not save the child’s life or health, the parent or guardian has no right to solicit or consent to circumcision on behalf of the child. Therefore, childhood circumcision, except in extremely rare cases where a pathological condition is present, violates the principles of informed consent and cannot ethically be performed by medical practitioners or in medical settings.

Nonmaleficence
The principle of nonmaleficence requires that medical practitioners not intentionally create or cause to occur a needless harm or injury to the patient, through acts of either commission or omission. Childhood genital cutting (CGC) involves the permanent surgical removal of healthy, protective, erogenous tissue. The harms of CGC are compounded by the fact that, often, no anesthetic or inadequate anesthetic is used for what is a prolonged and painful operation. Regardless of whether pain control is administered during the surgery, however, because it is not medically necessary, CGC circumcision violates the principle of nonmaleficience.

Beneficence
The principle of beneficence says that health care professionals have a duty to not only provide a benefit to a patient, but also to take positive steps to prevent harm to the patient. It does not include the felt needs, concerns or cultural beliefs of anyone other than the patient. Because “routine” CGC does not seek to remedy an ill and, indeed, exposes babies and children to unnecessary risk, trauma and pain, it violates the bioethical principle of beneficence and should not be a part of medical practice.

Justice
The principle of justice in health care implies fairness, equal treatment and – by extension – equal protection. In the United States, girls of all ages are protected by federal and state laws from unconsented-to genital surgery practiced in medical or non-medical settings because of the health beliefs or religious or cultural preferences of their parents. A consensus is also growing that children who are born intersex (i.e., those whose genitalia have both male and female characteristics) should not be “treated” with genital surgery until they are old enough to express their sexual identity. Boys are accorded no such protection. There is no acceptable rationale prohibiting genital cutting on some children, while tolerating (and even promoting) it for others. Male CGC violates the bioethical principle of justice.

Talking Point Four

It is the position of Intact America that all persons—male, female, and intersex—should be protected from coerced genital surgery. In cases of children born with anomalous genitalia, Intact America opposes gender assignment surgery on those too young to express their gender preference or to understand the risks, harms, and irreversibility of such surgery.

Individual Autonomy, Parental Rights, and Informed Consent
In health care decisions, respect for the autonomy of the patient implies that the patient has the capacity to act and decide intentionally, with understanding, and without coercion or influences that would mitigate against a free and voluntary act. This principle underlies the concept of informed consent in the physician/patient transaction. In the case of medical procedures offered to infants or children, because the child has no understanding or capacity to freely and voluntarily consent, the right to decide is given to the child’s parent or guardian in a form of consent known as proxy consent. However, the scope of proxy consent is, by necessity, limited to medical interventions undertaken on behalf of a minor child in their custody if and only if that intervention is necessary to save the life or the health of the child. Because the foreskin is a normal, healthy anatomical structure, and because “routine” CGC does not save the child’s life or health, the parent or guardian has no right to solicit or consent to circumcision on behalf of the child. Therefore, childhood circumcision, except in extremely rare cases where a pathological condition is present, violates the principles of informed consent and cannot ethically be performed by medical practitioners or in medical settings.

Nonmaleficence
The principle of nonmaleficence requires that medical practitioners not intentionally create or cause to occur a needless harm or injury to the patient, through acts of either commission or omission. Childhood genital cutting (CGC) involves the permanent surgical removal of healthy, protective, erogenous tissue. The harms of CGC are compounded by the fact that, often, no anesthetic or inadequate anesthetic is used for what is a prolonged and painful operation. Regardless of whether pain control is administered during the surgery, however, because it is not medically necessary, CGC circumcision violates the principle of nonmaleficience.

Beneficence
The principle of beneficence says that health care professionals have a duty to not only provide a benefit to a patient, but also to take positive steps to prevent harm to the patient. It does not include the felt needs, concerns or cultural beliefs of anyone other than the patient. Because “routine” CGC does not seek to remedy an ill and, indeed, exposes babies and children to unnecessary risk, trauma and pain, it violates the bioethical principle of beneficence and should not be a part of medical practice.

Justice
The principle of justice in health care implies fairness, equal treatment and – by extension – equal protection. In the United States, girls of all ages are protected by federal and state laws from unconsented-to genital surgery practiced in medical or non-medical settings because of the health beliefs or religious or cultural preferences of their parents. A consensus is also growing that children who are born intersex (i.e., those whose genitalia have both male and female characteristics) should not be “treated” with genital surgery until they are old enough to express their sexual identity. Boys are accorded no such protection. There is no acceptable rationale prohibiting genital cutting on some children, while tolerating (and even promoting) it for others. Male CGC violates the bioethical principle of justice.

Talking Point Five

Intact America opposes forced or coerced genital cutting on persons of any age or gender. Should an adult choose to be circumcised or to undergo any other genital modification surgery or surgery on that adult’s reproductive organs, Intact America acknowledges their right to choose such surgery, so long as they are fully informed of its risks, harms and permanent nature. In the case of a medically indicated circumcision, informed consent includes information as to all possible alternative treatments, including the option of non-intervention. If full, informed patient consent is not possible due to illness-related incompetence, proxy decision-makers must be provided with full information on all potential risks, harms, and options, including the option of non-intervention.

Talking Point Six

Intact America opposes all forms of coerced surgery involving the genitalia or reproductive organs, including abortion, cesarean section, tubal ligation, hysterectomy, vasectomy, castration, or any other such interventions forced on persons of any age or gender. Intact America takes no position on elective abortion performed upon the request of a fully informed, consenting woman.

Talking Point Seven

Intact America supports breastfeeding as a beneficial practice for both mothers and infants. Breastfeeding enhances the infant-mother emotional bond and provides the infant with optimal nutrition, while children who do not breastfeed are at greater risk for some illnesses. Many women have reported that following their baby’s circumcision, they were unable to latch on or nurse for many hours. To optimize the benefits offered by breastfeeding, it is prudent to avoid this medically unnecessary and traumatic procedure.

Talking Point Eight

Intact America opposes any forced cosmetic modification of the human body and holds that any medically unnecessary body modification that entails permanent disfigurement or decoration must never take place without the fully informed consent of the individual whose body would be permanently modified.

Talking Point Nine

ntact America stands for equal dignity and rights for all and is committed to advancing human rights for all people. Intact America holds that all children—boys, girls, and intersex—must be protected from bodily harm. Intact America thus endorses the principle of equal protection regarding forced genital surgery.

In the United States, federal and state laws prohibit any form of genital cutting upon girls by health care professionals or laypersons, while the genital cutting of boys and some intersex children is not only tolerated but is actually promoted in medical settings. Infant male genital cutting also is currently accepted as an expression of certain religious beliefs.

Proponents of female CGC use many of the same rationales put forth by cultures that practice male CGC. They say that genital cutting is traditional, culturally mandated, healthier, and cleaner; they say that the child will be more accepted by his or her peers and, as an adult, will be more marriageable (or attractive to the opposite sex).

Those who vociferously oppose female CGC often resist any comparison to male CGC on the basis that the former is more damaging and invasive than the latter. They contend that female CGC deprives girls of their sexual pleasure and puts girls at risk of death, while male CGC still allows men to achieve orgasm and is “less risky.” This reasoning is flawed because it implies that if female CGC could be modified—for example to leave the clitoris in place3—or could be made safer through the use of sterile instruments, it would be acceptable.

However, female, male and intersex CGC all involves the forced removal of healthy genital tissue from unconsenting children who are powerless to defend themselves and who will live permanently with the consequences. Therefore, any attempt to rationalize the practice for some children while condemning it for others reflects prejudice, ignorance, and cultural bias, and flies in the face of the universal truth that every child has the right to be protected, respected, and loved.

Talking Point Ten

Intact America opposes the promotion of male CGC as a method for preventing sexually transmitted infections, including HIV. It is socially irresponsible and dangerous to disseminate a message that the removal of normal genital tissue offers protection from sexually transmitted infections. Individuals can both contract and transmit sexually transmitted infections regardless of whether their genitals are intact or surgically altered. The only way to prevent such infections is through abstinence or “safe sex” practices.

Reading List

Gain insight into the historical and cultural context of male genital cutting through a curated selection of books dedicated to the topic of circumcision.

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Marilyn

Marilyn Fayre Milos, multiple award winner for her humanitarian work to end routine infant circumcision in the United States and advocating for the rights of infants and children to genital autonomy, has written a warm and compelling memoir of her path to becoming “the founding mother of the intactivist movement.” Needing to support her family as a single mother in the early sixties, Milos taught banjo—having learned to play from Jerry Garcia (later of The Grateful Dead)—and worked as an assistant to comedian and social critic Lenny Bruce, typing out the content of his shows and transcribing court proceedings of his trials for obscenity. After Lenny’s death, she found her voice as an activist as part of the counterculture revolution, living in Haight Ashbury in San Francisco during the 1967 Summer of Love, and honed her organizational skills by creating an alternative education open classroom (still operating) in Marin County. 

After witnessing the pain and trauma of the circumcision of a newborn baby boy when she was a nursing student at Marin College, Milos learned everything she could about why infants were subjected to such brutal surgery. The more she read and discovered, the more convinced she became that circumcision had no medical benefits. As a nurse on the obstetrical unit at Marin General Hospital, she committed to making sure parents understood what circumcision entailed before signing a consent form. Considered an agitator and forced to resign in 1985, she co-founded NOCIRC (National Organization of Circumcision Information Resource Centers) and began organizing international symposia on circumcision, genital autonomy, and human rights. Milos edited and published the proceedings from the above-mentioned symposia and has written numerous articles in her quest to end circumcision and protect children’s bodily integrity. She currently serves on the board of directors of Intact America.

Georganne

Georganne Chapin is a healthcare expert, attorney, social justice advocate, and founding executive director of Intact America, the nation’s most influential organization opposing the U.S. medical industry’s penchant for surgically altering the genitals of male children (“circumcision”). Under her leadership, Intact America has definitively documented tactics used by U.S. doctors and healthcare facilities to pathologize the male foreskin, pressure parents into circumcising their sons, and forcibly retract the foreskins of intact boys, creating potentially lifelong, iatrogenic harm. 

Chapin holds a BA in Anthropology from Barnard College, and a Master’s degree in Sociomedical Sciences from Columbia University. For 25 years, she served as president and chief executive officer of Hudson Health Plan, a nonprofit Medicaid insurer in New York’s Hudson Valley. Mid-career, she enrolled in an evening law program, where she explored the legal and ethical issues underlying routine male circumcision, a subject that had interested her since witnessing the aftermath of the surgery conducted on her younger brother. She received her Juris Doctor degree from Pace University School of Law in 2003, and was subsequently admitted to the New York Bar. As an adjunct professor, she taught Bioethics and Medicaid and Disability Law at Pace, and Bioethics in Dominican College’s doctoral program for advanced practice nurses.

In 2004, Chapin founded the nonprofit Hudson Center for Health Equity and Quality, a company that designs software and provides consulting services designed to reduce administrative complexities, streamline and integrate data collection and reporting, and enhance access to care for those in need. In 2008, she co-founded Intact America.

Chapin has published many articles and op-ed essays, and has been interviewed on local, national and international television, radio and podcasts about ways the U.S. healthcare system prioritizes profits over people’s basic needs. She cites routine (nontherapeutic) infant circumcision as a prime example of a practice that wastes money and harms boys and the men they will become. This Penis Business: A Memoir is her first book.