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
Oct 2, 2021
One rationale people give for male newborn genital cutting (aka circumcision) is “do it, he won’t remember it.” This is a bogus claim. First, it presumes circumcision is a better-do-it-now-rather-than-later birth imperative. The second rationale, a fallacy which follows closely on the first, is that the boy’s still-developing brain is incapable of creating long-term memories. But this is not entirely true. Research has shown that the more traumatic an early experience is, the more likely it will be remembered.
Over the years I’ve had a lot of conversations with men about circumcision. Out of curiosity—and because of my own night terrors I associate with my own newborn circumcision—I asked them if they have an early recollection that they think may be related to their newborn circumcision. What surprised me was that about one out of five said yes.
In 2010, I surveyed men to determine if experiencing newborn circumcision, could lead to acquiring alexithymia, the inability to identify and express emotions. It does. Out of curiosity, I asked them if they have an early recollection, a “snapshot,” or night terror that they associate with their circumcision. Of the men in the study who were cut as newborns, 20.3 percent answered yes or maybe. Recently, I conducted a survey regarding Adverse Childhood Experiences (ACEs) and 23.4 percent of the men also answered yes or maybe to the same question.
Granted, it is impossible to verify if an early memory is true. But before you pooh-pooh these early memories, consider that the large and consistent percentages across these surveys strongly suggest that they are true. Regardless, listening and acknowledging these stories should be part of the circumcision debate.
By Dan Bollinger
Jul 30, 2021
Men circumcised as babies are 4.5 times more likely to experience erectile dysfunction than intact men. Learn more.
#fridayforeskinfacts #circumcision #erectiledysfunction #ED
Feb 11, 2018
Georganne Chapin, MPhil, JD
Increasingly, new parents are questioning the peculiarly American practice of “routine” infant circumcision. They’re heeding their own instincts, doing their research, and choosing to protect their sons’ bodies and right to keep the genitals nature gave them.
Unfortunately, many of these parents and their sons now face a new worry – an iatrogenic[1] epidemic of forced foreskin retraction, the result of ignorance and bias among U.S. healthcare professionals.
A new lawsuit shines a bright light on this insidious practice. On January 10, 2018, Atlanta attorney David Llewellyn filed a Complaint against a major pediatric hospital in that city, describing its disregard for current pediatric care guidelines, and its nursing staff’s systematic violation of patient rights.
Alleging battery; nursing malpractice; intentional infliction of emotional distress; willful, wanton and reckless misconduct; and negligent failure to protect the patient, Park v. Children’s Healthcare of Atlanta catalogs the actions by a nurse who – without conversation or warning – ripped away the foreskin of an intact 2-month old baby named Jude Parks, causing him severe pain, bleeding and emotional anguish. The Complaint also describes the defiant attitude taken by the nursing supervisor and other hospital staff, who insisted – contrary to fact – that the hospital’s protocol calling for the forced retraction of all intact boys’ foreskins was derived from current established medical recommendations.
Some Background
Starting in the late 1800s, Victorian-era doctors began promoting foreskin-removal as a way to make boys stop pleasuring themselves. (It didn’t work) By the mid-20th century, routine medical (i.e., non-religious) amputation of baby boys’ foreskins had become a peculiarly American phenomenon – fueled, no doubt, by the fact that health insurers paid for it. Today, an estimated 80 million adult American men are missing a palm-sized area from their penises. Even with increased parental awareness – still, over half of all baby boys born in the U.S. are victims of a medical system that makes money from the procedure. But with the voices of aggrieved men becoming louder, and parents questioning the bogus medical claims that there’s something inherently unhealthy about the natural penis, circumcision rates continue to fall.
Most Americans, though, remain surprisingly unfamiliar with the intact penis. Parents who choose to keep their sons intact get little or – worse – the wrong information about how to care for their sons’ genitals. They don’t know that a tight or adherent foreskin (called physiologic phimosis) is normal in babies and boys, and that over time, the foreskin will loosen and separate naturally from the head of the penis. They don’t know that the average age of spontaneous foreskin retraction is actually around ten years of age, and that nobody should but the boy himself should try to hasten this process along.
Though ignorance and misinformation are widespread, the pediatric literature itself (including guidelines from the American Academy of Pediatrics) actually is clear: a baby’s foreskin should NEVER be forcibly retracted. Using force to pull back a boy’s foreskin is painful, and can cause swelling, bleeding and infection.
What Happened to Baby Jude?
According to the above-mentioned lawsuit, Jude Parks was referred by his primary doctor to Children’s Healthcare “because he had been vomiting often and the vomit was of a disturbing color.” He was accompanied by his mother Ms. Parks and his maternal grandmother. The Children’s Healthcare physician who examined Jude ordered tests for blood and urine. Nurse Sorrells (a named Defendant in the lawsuit) “took off Jude’s diaper, apparently to obtain a urine specimen, and, without comment and without asking permission to do so, forcibly tore and retracted his foreskin all the way back off of his glans, to which it was naturally attached… caus[ing] the end of Jude’s penis to become bloody. Jude started screaming. Neither his mother nor [his grandmother] had ever hear him scream like that before. Neither has heard him scream that way since.”
When Jude’s mother told Defendant Sorrells that no one is supposed to retract and tear an intact boy’s foreskin, the nurse insisted that what she’d done was proper, and that Ms. Parks herself should be retracting Jude’s foreskin at every diaper change. A nursing supervisor subsequently appeared and told Ms. Parks it was hospital protocol to retract intact boys’ foreskins – that they did so in every case. She also said that Jude not being circumcised “leaves him open for infection.”
For weeks after the incident, the Complaint states, Jude manifested pain, and anxiety whenever his diaper was changed. The Complaint further alleges that Jude’s foreskin is scarred, and he may need surgery later on in order to be able to retract it.
The Complaint provides exhaustive evidence that the actions performed upon Jude, and the hospital protocol supporting those actions, violate current medical standards and guidelines, including those from the American Academy of Pediatrics. It further alleges that Children’s Healthcare was aware or should have been aware of these standards and guidelines. Finally, it provides a reference to a contemporary article by Adrienne Carmack, MD and Marilyln Milos, RN confirming that it is not necessary to retract a boy’s attached foreskin to insert a catheter.
While it’s too late to protect Baby Jude from this harm, it is possible to protect the thousands of intact boys like him.
If you are the parent of an intact boy:
- Do not allow a doctor, nurse or anybody else to forcibly retract your son’s foreskin. Make a point of telling your pediatrician this up-front, and providing this information in his medical chart. If you do take your intact boy to an emergency room, let the provider(s) know that foreskin retraction is off-limits.
If your baby has been subjected to forced retraction:
- The soreness and swelling will likely resolve on its own. Watchful waiting, and bathing him in plain warm water (no soap or bubble baths), are the best recourse for healing. If he does not improve, or if there is pus or smelly discharge, seek medical help – preferably from a foreskin-knowledgeable physician. Let the new doctor know that you will not tolerate further tampering with your son’s foreskin.
- You are entitled (and we encourage you) to complain in writing to the doctor who performed the retraction and the facility where this battery took place. At a minimum, you should provide them with factual information, such as the Carmack and Milos article referenced aboveand this information sheet. You may also file a complaint with your state’s medical board or office of professional discipline. Finally, you may wish to explore filing a lawsuit. Should you choose to do so, Intact America can help you or your attorney with the pertinent resources. Contact us at [email protected] or write to me directly at [email protected].
Over time, as the ranks of intact American men increase, medical professionals will learn the facts and foreskin bias will subside. Until that time, it’s not simply enough to keep your son intact. Ongoing education and vigilance will remain necessary until Americans realize that nature put the foreskin there for a reason – and that it’s something we should value, rather than fear.
[1] I.e., caused by the medical system. Iatrogenesis refers to any effect on a person, resulting from any activity of a person or persons acting as healthcare professionals or promoting products or services as beneficial to health that does not support a goal of the person affected.
