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.
Aug 22, 2022
Dear Marilyn:
I’m looking forward to attending Intact 2022, the 16th International Symposium on Child Genital Cutting, in Atlanta this week. Can you tell me how child genital cutting symposia have impacted intactivism since you began organizing them in 1989?
—Larry, St. Louis, MO
Dear Larry:
I first witnessed a circumcision in 1979. I was horrified and immediately began researching the subject. Our local libraries, including those at the hospital and universities, had little or no relevant information. Then in 1980, Edward Wallerstein sent me a copy of his book, “Circumcision: An American Health Fallacy.” This book became the foundation of my work. I told everyone what I was learning and appeared on local radio and television shows. I was contacted by an attorney who wanted to file a lawsuit asking if parents have a right to consent to a child’s circumcision, or if the baby’s body belonged to the baby. I found a plaintiff, and our lawsuit got publicity.
The publicity likely prompted a couple of local doctors—urologist Aaron Fink and Edgar Schoen, a pediatrician—to join forces and begin their campaign to validate both cultural and religious circumcision, in the form of a pro-circumcision resolution that Fink introduced to the California Medical Association (CMA) and Schoen took to the American Academy of Pediatrics (AAP).
Fink introduced his resolution to the CMA at its yearly convention in 1987, but the Scientific Committee voted it down. Fink came back in 1988 with Arthur Dick, a urologist, who circumcised a banana in front of the CMA membership, and the resolution passed. This was followed by a counter-resolution from Dr. John Hardebeck, who planned to present it at the CMA convention the following year. I knew that meeting was being held at the Disneyland Hotel. So I booked a hotel across the street for our First International Symposium on Circumcision.
I invited Dr. Michel Odent, a French obstetrician and childbirth specialist, to give the keynote presentation. He asked if there would be other international presenters and, when I told him I didn’t have any, he said, “Well then, you need me.” I invited Fink and Schoen, but neither came or even responded to my invitation. But those who did were eager to share their work or their experiences. This was the first time that experts from various disciplines—religion, anthropology, psychology, medicine, law, and ethics—gathered around the subject of circumcision. We were all thrilled by what had transpired. Dr. Paul Fleiss, a popular Los Angeles pediatrician who was both a breastfeeding and anti-circumcision advocate, also attended, and—at the end of the symposium—declared: “Marilyn, now we need to take this show on the road.”
The second symposium was held in 1991 in San Francisco, and Dr. Ashley Montagu, anthropologist and humanist, gave the keynote address. Presenters and attendees alike were amazed at the quality, breadth, and depth of the presentations on this crucial human rights issue.
The joy of each symposium is the new material that has been presented, the medical research that has been done, and the focus on how we treat children at the beginning of life and how this affects society. Those who have attended our symposia have been enriched with important information about the issue and what’s being done to end an anachronistic blood ritual. By coming together, we learn from one another, and become secure in knowing we’re not alone. We have become Intactivists together and we have become a family.
In the following years, we held 13 more symposia around the world including Switzerland, England, Australia, Italy, and Finland; six books of the proceedings were published by Springer—the same company that published Wallerstein’s groundbreaking book decades earlier. Our books are now in universities worldwide and being used in classrooms.
The Atlanta symposium (August 2022) will be the first I will not attend in person. While I’m sorry for that, that’s life! And I’m thrilled to know these gatherings will continue—this time because of David Llewellyn and Georganne Chapin—as will the movement I initiated all those years ago just because I couldn’t keep my mouth shut. As you can see, I still can’t. Please, carry on…
—Marilyn Milos, RN
Jul 21, 2022
Since Intact America’s founding in 2008, our organization’s stated goal has been to “change the way America thinks about circumcision.”
Our Vision statement says:
Intact America envisions a world where children are free
from medically unnecessary surgeries carried out on them without their consent
in the name of culture, religion, profit, parental preference, or false benefit.
The genital cutting of any child in the absence of life-threatening or seriously health-threatening pathology violates not only that child’s body, but also his/her/their autonomy over their own sexual future. This position is immutable. No parent or guardian has the right to waive a child’s right to be protected from any type of tortious interference, or physical or sexual assault, with regard to genital cutting. The right that governs is that of the child.
Intact America was founded in 2008 by a coalition of individuals and intactivist organizations who wished to see the intactivist movement grow into a mainstream human rights cause. The new organization, as well as its founders, were guided by widely-accepted secular bioethical principles adopted in Western human rights and political discourse in response to atrocities committed against persons of many religions, races, and cultures during World War II. Our position is also supported by common law and the objective fact that having normal genitals, including a foreskin, is not a condition requiring surgical intervention. Furthermore, intactivism places no inherent value in following a particular common or traditional practice nor in capitulating to the current (but always-evolving) status quo, if those traditions and practices compromise the physical integrity and sexual wellbeing of children and the adults they will become.
Thus, neither religion nor “culture” should ever be invoked to support child genital cutting. At the same time, opposition to child genital cutting is not rooted in anti-religious sentiments. To tie ourselves up in such accusations is to lose focus on the true intent of the intactivist movement, as expressed in the fundamental goal and vision of Intact America, restated from above: a world where children are free from medically unnecessary surgeries carried out on them without their consent.
As a human rights organization that respects all persons regardless of their race, religious or cultural affiliation, it is also our duty to refute expressions of bigotry when expressed by people outside or within the intactivist movement. To leave no doubt, in 2022 Intact America’s adopted a new position statement against bigotry and hate speech:
Intact America rejects all forms of ethnic, racial, and religious stereotypes and bigotry. We condemn any form of hate speech based on ethnicity, race, national origin, gender, sexual orientation, religion, or irreligion. The incorporation of anti-Semitic or anti-Muslim expressions into criticism of male (or female) circumcision only serves to undermine our movement and potentially derail our work to protect all children from genital cutting.
I fervently believe that adherence to the logic and principles outlined above will ensure our success in protecting future children and the adults they will become.
–Georganne Chapin
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 29, 2021
Marilyn Milos, Regarded as ‘The Mother of the Intactivist Movement,’ Merges Her Organization, Genital Autonomy-America, with Intact America, the Nation’s Largest Professional Anti-Circumcision Advocacy Group
Says Milos: “It’s an auspicious time to join forces and further public awareness of the direct correlation between circumcision solicitation in hospitals and the high rate of medically unnecessary circumcision in the United States.”
(Tarrytown, New York—October 30, 2021) Georganne Chapin, MPhil, JD, founding executive director of Intact America, and Marilyn Milos, RN, founding executive director of Genital Autonomy-America, announced today that their two organizations have officially merged. Ms. Milos will continue her intactivist work at Intact America, the largest national, professional advocacy group that is changing the way America thinks about circumcision.
The newly merged entity, a 501(c)(3) not-for-profit organization, will retain the name Intact America. Ms. Milos will sit on Intact America’s Board of Directors and continue her intactivist work as Intact America’s clinical consultant.
“It’s a tremendous honor that Marilyn Milos and the Board of Directors of GA-America have entrusted their organization’s mission and vision to us,” said Ms. Chapin. “Thanks to her work, male genital cutting emerged from the shadows and became a human rights issue. I and many other intactivists consider Marilyn to be the mother of our movement.”
The Evolution of Organized Intactivism
It was a watershed event in intactivism when, in 1985, Marilyn Milos launched the National Organization of Circumcision Resource Centers (NOCIRC). (The organization was renamed Genital Autonomy-America [GA-America] in 2016.) The group was the first clearinghouse of circumcision information for doctors, nurses, parents, and the public. Over the years, NOCIRC succeeded in raising awareness among tens of thousands of people that male child genital cutting (circumcision) is physically painful and traumatic to a baby, medically unnecessary, and amputates the most erogenous part of the adult male genitalia.
Under Ms. Milos’ leadership, NOCIRC gained attention for organizing biennial International Symposia on Circumcision, beginning in 1989. Experts in medicine, academia, ethics, law, and other disciplines flocked to the symposia, whose proceedings were published and shared worldwide. These highly influential publications advanced the field of male and female genital cutting research and shed new light on the ill effects of routine male circumcision.
A Next Step for Intactivism
Although Ms. Milos broke the taboo about speaking publicly about circumcision, more work was needed to strategically change America’s systemic circumcision culture. In 2008, Ms. Milos and other leading intactivists helped to form Intact America, a professional advocacy group funded by philanthropist Dean Pisani and managed by the experienced health care executive and attorney Georganne Chapin. Intact America’s work includes conducting national research and generating public awareness by mounting campaigns against routine male child genital cutting and forced foreskin retraction of intact boys.
Ms. Chapin noted, “We’re shifting the public’s perception of circumcision. In our most recent opinion poll, conducted this year, we found that more than 22.5% of respondents favor keeping boys intact, up from 16.8% in 2019. That’s an increase of 25% in just two years. We’re making big progress.”
Ms. Milos said the merger comes at an auspicious time. “I’ve worked relentlessly to save baby boys from the horror of routine circumcision and help adults and families to overcome the physical and psychological consequences of unnecessary circumcisions,” Ms. Milos said. “Now, it’s time for me to step back from the day-to-day responsibility of running GA-America. Since it was founded, Intact America has taken intactivism to the next level. I feel that the movement’s future success could not be in better hands.”
About Intact America
Intact America is the largest national advocacy group working to end involuntary child genital cutting in America and to ensure healthy sexual futures for all people. It does this by challenging social and sexual norms and empowering supporters and volunteers through advocacy and education. To learn more about the issues involved in the current conversation about newborn male circumcision, visit IntactAmerica.org and CircumcisionDebate.org, and follow us on Facebook, Twitter, and Instagram.
