Dec 4, 2022
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?”
Doctor: Not!
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)?
Circumcised
Intact
Don’t know
Which one of these images most looks like your flaccid (not erect) penis?
A
B
Unsure
Are you restoring your foreskin?
Yes
No
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!)
—Dan Bollinger
[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.
Jul 11, 2022
Dear Marilyn:
Everything about my son’s birth was great. Except for one thing that keeps bugging me. Even though we knew early on that we’d keep him intact, people kept asking us if we wanted to circumcise him. I told my OB/GYN we didn’t want to, but on the next visit she asked. In the hospital, just about every nurse asked me even though our choice was written on my chart. This happened over and over before and after the birth. I was so angry I wanted to scream. Why do they keep asking? It made me begin to question our decision. Don’t get me wrong, I’m glad we didn’t, but geez, why weren’t they listening?
—Alice, Fort Myers, FL
Dear Alice:
Congratulations for having the strength to protect your son’s right to his own body and withstanding the pressure of those who tried to coerced you to cut off the most sensitive part of his genitals. Circumcision is BIG business—a $2 billion-dollar-a-year industry for an unnecessary and harmful amputation, which is why doctors and nurses “sell” it so hard.
Doctors and nurses won’t admit it, but they know that circumcision is excruciatingly painful and traumatic. That’s why they do their genital cutting behind closed doors and prevent parents from hearing the screams or watching their babies suffer.
By keeping parents in the dark, health professionals can convince vulnerable and exhausted parents, right after their child is born, to circumcise their baby. If more parents knew what circumcision involves, they could stand strong and resist the pressure.
For example, a colleague and I videotaped a circumcision at the hospital where we worked. A childbirth educator showed the circumcision video to her class, and not one of the mothers circumcised their sons as a result. The educator showed it again to a second class of mothers. They didn’t circumcise their babies either—except for one doctor who was taking the class. Even worse, the doctor insisted that our video be censored. That’s how much doctors dread letting the truth slip out.
Fortunately, several anti-circumcision movies are available now that include actual circumcisions. I suggest watching The Circumcision Movie. Not only will you see that you and your husband were correct to protect your son, you’ll also learn that you are not alone in denouncing this anachronistic blood ritual.
—Marilyn
May 16, 2022
Dear Marilyn:
I was circumcised without my consent as a baby and I wish I could experience sex as an intact man would. I’ve heard about foreskin restoration, but I know it can’t restore the sensitivity of the natural foreskin on a normal penis. Is there any benefit to be gained by trying to restore my foreskin?
—Confused in Seattle
Dear Confused:
I am sorry that your foreskin was taken from you. You can regain some sensitivity with foreskin restoration (gentle stretching techniques) to cover the glans, making it more sensitive and providing the gliding mechanism that will improve sex for you and your partner. Although foreskin restoration is a tedious, time-consuming endeavor that takes several years to complete, every man who has succeeded has been pleased with the results.
Do an internet search for ‘foreskin restoration’ to learn more about it, find support groups, and see the current devices that have been developed. Good luck!
—Marilyn
Dec 1, 2021
On October 11, 2021, the New Yorker magazine published an essay by popular writer Gary Shteyngart, recounting how being circumcised when he was seven years old resulted in decades of misery and complications. On November 1, the magazine published three comments in response, mine, one from a rabbi, and one from a urologist. The post below is the follow-up letter I wrote to the urologist, Dr. Michael Mooreville.
Dear Dr. Mooreville:
I am writing about your letter to the New Yorker, which appeared after my own among the responses to Gary Shteyngart’s essay about his decades of suffering because of a botched circumcision. Thank you, in advance, for taking the time to read my comments below.
First, you suggest that Shteyngart’s problems occurred because he was circumcised too late, and then say that it’s easier (somehow) for a physician to know how much foreskin to remove from a baby than from an older male. My decades of working to end unconsented-to, medically unnecessary circumcision suggest this is not true. Men who have spoken or written to me, or who have spoken out publicly about their circumcision-induced penile deformities, overwhelmingly were circumcised as newborns by doctors in American hospitals. Some of them have undergone one or more additional surgeries to correct cosmetic or functional problems; others, out of parental ignorance or shame, instead have learned to live with the harm just as Shteyngart did. In none of these cases did any of these surgeries result in a better, healthier penis than the penises of men who were fortunate enough to have grown up with their natural, unaltered genitalia. As a practicing American urologist, your caseload is likely similar to that of other urologists who have told me that more than one-quarter of their medical practice involves addressing circumcision-related damage, including meatal stenosis (which occurs nearly exclusively in circumcised males), skin bridges (such as Shteyngart’s), and degloved penile shafts.
Second, I am curious about your comment that amputating a baby’s foreskin will allow his penis to “grow into a fully mature look…” (emphasis mine). Are you suggesting that the penises of men with foreskins (comprising around 75% of the world’s males) are somehow “immature”; this makes no sense. How can a penis shorn of its natural protective covering, with its nerves, muscles and blood supply be superior to the natural, unaltered penis that evolved over hundreds of thousands of years? Frankly, I’m astonished that the New Yorker’s rigorous fact-checking protocol didn’t eliminate this nonsensical statement from your letter.
Finally, I wonder if there are other healthy body parts you would suggest removing from babies or children because they “can be the source of multiple (?) medical problems in older men” (or women). The appendix (1.1 cases of appendicitis per 1000)? Teeth (prone to infection-causing decay)? Breasts (1 case per 1000 of breast cancer among American women aged 40, increasing over time), while the rate of penile cancer (which occurs in both intact and circumcised men) in the United States is 1 per 100,000. I might add here that genital hygiene is not complicated. If a boy can learn to become a teacher or chef or woodworker or tennis player or truck driver or urologist, he should be able to learn how to wash his penis.
I hope you will think about my questions, and dare to think in a more common-sense way about a forced bodily alteration that does nothing to make American boys or men healthier than their counterparts in countries where males retain the genitals they are born with.
Sincerely,
Georganne Chapin, MPhil, JD
Executive Director
Oct 25, 2021
This letter to the editor was published in The New Yorker on October 25, 2021.
Kudos to Shteyngart for bravely exposing the harm that can be caused by circumcision. His heartbreaking personal struggle, while extreme, is more common among circumcised men than the public has been led to believe. Since 2008, when I co-founded Intact America, an organization that seeks to change the way people in this country think about circumcision, I have heard from thousands of men who have suffered lifelong physical and psychological damage from the procedure. According to a 2019 report published in the Journal of Pediatric Surgery, in the U.S., where nearly all circumcisions take place in medical settings, eleven per cent of pediatric-surgery malpractice cases involve circumcision. Yet American doctors and hospitals keep putting babies at risk with a medically unnecessary procedure that is not routinely performed on male children in any other Western country. We must ask why we allow doctors and hospitals to profit from cutting the genitals of male children even as we fight to outlaw female genital cutting, here and abroad.
Georganne Chapin
