The First Cut

First published in Men’s Style, Summer 2005/06

WHEN SHAUN PETERS* was a few days old he underwent a routine operation on his penis. It was 1973 in Perth and, like many boys of his generation, Peters was never told about the surgery. By the time he reached puberty however, problems had begun to emerge. As his penis grew, Peters’ erections became increasingly tight and painful and a pronounced bend in the shaft developed. It was not until he reached university that he realised he had been the victim of an aggressive circumcision – not only had his foreskin been removed, but almost all the skin on the shaft of his penis had been cut away.

“Until then, I thought I’d been born deformed,” Peters says. “When I found out someone had intervened and damaged part of my body, I was very angry.”

By the age of 18, Peters was no longer able to achieve a full erection. He was suffering sexually and emotionally and became severely depressed. In 1992, he underwent surgery in an attempt to restore his penis with skin grafts taken from his thighs. The result was disappointing. Not only was the surgery highly invasive, it removed the last remaining areas of sensitive penile skin. A long, painful recovery followed.

“If I had known what I was in for, I never would have considered it,” Peters says. Six months later, he attempted suicide. “Apart from the despair I felt over my own situation, I didn’t want to live in a society that allowed this kind of thing to go on.”

But he survived the attempt and later began legal action against the family doctor who had botched his circumcision. In 1999, he accepted an out of court settlement of $360,000, as well as an admission of liability by the doctor.

Male circumcision, in which the loose tissue at the end of a boy’s penis is cut off, at birth or often puberty, has been carried out for thousands of years. Some argue that the procedure originated as a hygienic measure among tribal communities living in hot, dusty environments, where it was difficult to keep the penis clean.

However according to medical historian Robert Darby, author of A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain (University of Chicago Press, 2005), the removal of the foreskin was more likely a blood sacrifice, a mark of tribal identification or a rite of passage. “In the days before aseptic surgery, any cutting of flesh was the least hygienic thing anybody could do, carrying a high risk of bleeding, infection and death,” Darby says.

 

WHILE OTHER RITUALS from these ancient cultures, such cannibalism, human sacrifice and infanticide, have passed into history, circumcision has remained an important religious and cultural ritual, mainly because of its role in controlling male sexuality, Darby says.

Victorian England took to it with a vengeance. Nineteenth-century physicians, such as William Acton who labelled the foreskin “a source of serious mischief”, lauded its lopping-off as a cure for masturbation. So too, circumcision has been seen to cure or prevent epilepsy, paralysis, insanity, tuberculosis, penile cancer and urinary tract infections. By the end of the 19th century, circumcision had spread throughout the English-speaking empire, reaching its peak in the 1950 and ‘60s.

By the 1970s, however, routine circumcision of newborns began to fall out of favour in the developed world, out of concern for the wellbeing of babies, who were being forced to undergo painful and traumatic surgery without anaesthetic, based on a false notion that they were unable to feel or remember pain. The health benefits were seen as negligible and circumcision rates fell dramatically.

Today, around 60 per cent of boys in the US are circumcised, 30 per cent in Canada, 6 per cent in the UK (where it is no longer available on the government health scheme) and less than 2 per cent in Scandinavian countries. The rate in Australia has dropped from around 90 per cent in the 1960s, to less than 15 per cent today, although there is some evidence of a slight increase over the past few years.

Circumcision rates in Australia vary enormously from state to state. According the Health Insurance Commission, which records Medicare claims for the procedure, Queensland and NSW have the highest rates, at around 20 per cent and 17 per cent, whereas in Victoria only 6 per cent of boys are circumcised and in Tasmania the practise has almost completely died out. These variations may be due in part to the different ethnic make-up of populations.

Circumcision remains an important ritual for many Muslims and Jews, a sign of spiritual purification and initiation into the community. According to the Hebrew Bible, Abraham circumcised himself and his son Ishmael, at the behest of God, at the age of 99.

Most Jewish boys are still circumcised on the eighth day of life, as part of a ceremonial ritual known as the brit milah. Melbourne mother Monica Abrahams circumcised her two young sons to welcome them into her family and the Jewish community. “It means they are part of the group, if they choose,” she said. “They are marked, scarred, initiated, and in this way truly born and in their bodies.”

However, for many parents, the decision is based purely on aesthetics – “I want my son to look the same as me”. Queensland GP Dr Terry Russell, who circumcises more than 2000 boys a year (and more than 15,000 since 1993), says less than 10 per cent of his patients are being circumcised for religious reasons. “The majority are Caucasian boys, whose parents have done their research and decided it’s the best thing for their child,” Russell says.

The debate over the risks versus benefits of circumcision is a heated one, with both sides claiming science, sex and human rights in their court. Two strident voices in this debate are those of NSW paediatrician George Williams, who is head of the lobby group Circumcision Information Australia (CIA), and Brian Morris, professor of molecular medical sciences at the University of Sydney.

According to Dr Williams, circumcision is child abuse. “We’re talking about mutilating cosmetic surgery on babies and young children, in blatant violation of the UN Convention on the Rights of the Child,” says Williams, who has called for circumcision to be removed from the pharmaceutical benefits scheme, as it has been in the UK.

Morris, on the other hand, is all for bringing back the routine circumcision of newborns. “Done by a trained professional in a proper medical setting, it’s simple, painless and will reduce the incidence of all sorts of problems throughout the child’s life,” Morris says.

Recent studies have shown circumcised men are much less likely to be infected with sexually transmitted diseases, including HIV and the human papilloma virus, which is a major cause of cervical cancer in women – a finding that has been hailed by circumcision advocates as a public health breakthrough.

“There is overwhelming evidence that the foreskin is the vehicle for transmission of HIV into the male body,” says Morris. “Removing the foreskin is basic preventative medicine. We want to reduce the incidence of diseases before they happen.”

However, the jury is still out on the role of circumcision in HIV prevention. At the Third International Aids Society Conference in Brazil, in July, at which the results of a recent trial in South Africa were reported, the Joint United Nations Programme on HIV/Aids called for more research, but warned against undermining proven protective behaviours, in particular the use of condoms.

Despite the recent findings, the Paediatrics & Child Health Division of the Royal Australasian College of Physicians (RACP) says, “There is no medical reason for routine newborn male circumcision.” While the college acknowledges there are some health benefits to circumcision, it says they do not outweigh the risks of surgery. This point of view reflects similar statements by the Canadian Paediatric Society and the American Academy of Pediatrics.

Urinary tract infections, which circumcision can reduce in newborns, only affect up to 2 per cent of boys. Likewise, penile cancer, which is effectively prevented by circumcision, only affects about one in 100,000. The spread of HIV/Aids is limited to a very small section of the community in Australia – mainly homosexuals and injecting drug users – unlike Africa where it affects the wider community.

The RACP statement has caused outrage among advocates of circumcision, such as Professor Morris, who describes it as a “scandal”. “It’s certainly not the scientific point of view,” he says.

 

AT THE CENTRE OF ALL this brouhaha is the foreskin – a complex web of skin, mucous membrane and muscle fibres, containing more than one metre of arteries, veins and capillaries, about 70 metres of nerve fibres and more than 1,000 specialised erotogenic nerve endings. Foreskin advocates say removing this tissue damages a male’s sexual response. The glans of the penis, normally kept moist by the foreskin, eventually dries out and the skin thickens protectively, causing a loss of sensitivity.

Adelaide man John Aldous, who was circumcised as an adult, during surgery to correct a bend in his penis, describes this loss of sensitivity as “devastating” to his sex life. “On a scale of one to 10, having sex with an intact foreskin was a 10,” says Alder, “whereas sex after circumcision was a one-and-a-half to two. I had to fantasise about what it felt like before I was circumcised in order to climax.”

During penetration, instead of moving within it’s own lubricated sheath, the circumcised penis creates friction within the vagina, which can lead to dryness and discomfort. “Sex with a foreskin is more sensual, smooth and sensitive than the ramrod piston action of a circumcised penis,” says Alder, who has restored his foreskin using non-surgical methods.

However, “ramrod piston” sounds just fine to members of the pro-circumcision Circlist group, who are unanimous about the sexual and aesthetic benefits of the circumcised penis, which they say is “cleaner, longer and stronger”. Indeed, many women say they prefer the look of the exposed glans – a mark of manhood in some tribal cultures, including desert Aborigines from northern and western areas of Australia, where circumcision is part of an initiatory rite, done at puberty.

The risks of circumcision include bleeding, infection and damage to the organ itself. Serious complications such as heavy bleeding, septicaemia and meningitis may occasionally cause death. In 2002, a five-week-old Canadian boy bled to death after a routine hospital circumcision and a one-month-old Irish boy died after a “kitchen table” circumcision in 2003. Every year, several boys die in southern Africa alone, victims of botched tribal circumcisions.

Accidental amputation of the penis is rare but not unknown. There are cases in the medical literature in which the penis has been surgically reattached, with some success. However, in 1965, an American boy whose penis was burnt off with a cauterisation needle after a circumcision underwent “gender reassignment”, which technically turned him into a girl. After being told the truth about his gender at the age of 14, David Reimer had a series of surgeries to reconstruct his penis. He committed suicide last year.

Traditional techniques carry their own risks. Most religious circumcisers do not use any form of anaesthetic. “I don’t think all pain is negative,” says Monica Abrahams. “Life is harsh and tough and through sacrifice we grow. This might sound rough for an eight-day-old baby but the pain they experience is pretty minimal.” 

Last year, circumcision was back in the headlines in New York after a mohel – a Jewish religious circumciser – infected three babies with herpes after draining blood from their wounds with his mouth, an ancient technique said to aid healing. One of the boys died.

There are no regulations regarding circumcision in Australia: some children are circumcised by their mother’s obstetrician, some by their GP, some by a paediatric surgeon, and others by a mohel.

Techniques vary from the traditional freehand slice and suture, to devices such as the Plastibell, favoured by Russell, which he uses in combination with an anaesthetic cream. As with all infant circumcisions, the foreskin must first be torn from the glans, to which it is adhered in young children. The bell-shaped plastic device is then placed over the glans and the foreskin is tied tightly into the ridge of the bell using a floss-like ligature, then cut off using scissors. By the time the anaesthetic wears off, within a few hours, the ring of remaining tissue above the ligature has died and within days it turns black and falls off along with the Plastibell.

According to Dr Russell, who circumcises boys from newborn up to puberty, he has “never had a significant bleed, never required a transfusion, never had a systemic infection and never lost a penis”. Minor bleeds occur in less than 1 per cent of his patients and localised infections in 2 per cent.

Gold Coast triplets Jethro, Callum and Lucas Parker, were circumcised by Russell in September, the day before their seventh birthday. Their 50-year-old father Kevin, who suffered from a hereditary condition, which hardens the foreskin and makes retraction painful, underwent a traumatic circumcision last year. Kevin’s younger brother, who had the same condition, also required treatment after tearing his foreskin during intercourse.

The triplets mother Sarah said she wanted to avoid any future health problems for her sons. “What their father went through was a complete nightmare. He was debilitated for three weeks. During the night, when he had involuntary erections, he would wake up screaming.”

The triplets were given a shot of pethidine and Game Boys to take their minds off their genitals during the procedure, and apart from a morbid fear of urination for some days afterwards, their mother said the experience was trauma-free. “I’m very happy with the results but I still don’t think it’s something everybody should do,” she says. “If there wasn’t a health issue, I wouldn’t have put them through it.”

The 2,000 foreskins removed by Russell each year are donated to non-profit organisations, including the Queensland Institute of Medical Research, where they are used for cancer research. In the US however, anti-circumcision groups have raised fears that foreskins are being “harvested” for sale to bio-research laboratories and pharmaceutical companies. According to outspoken Jewish “intactivist”, Dr Paul Fleiss (father of Hollywood madam Heidi), “The marketing of purloined baby foreskins is a multimillion-dollar-a-year industry”.

Despite their differences, something lobbyists from both sides of the debate agree on is the need for some kind of regulation. “Some old-school doctors still do it without an anaesthetic – that’s just barbaric,” says Morris, who recommends parents seek out an experienced practitioner.

In 2000, Sydney GP Dr Aladdin Matter was convicted of professional misconduct and banned from medical practice for three years, after complaints involving 14 babies he circumcised in the late ‘90s, all without adequate anaesthesia. According to the Health Care Complaints Commission, one eight-month-old boy almost bled to death after Matter removed an excessive amount of skin from the boy’s penis.

Shaun Peters believes there is a need to regulate how much skin is amputated. “Over-zealous circumcisers often take 50 to 80 per cent of the existing penile skin, rather than the more traditional 20 per cent,” Peters says.

 

THERE IS A GROWING movement in the US, Europe and Australia in which men, angry at being robbed of part of their anatomy, are engaging in non-surgical “foreskin restoration”, which uses a variety of methods, including taping, weights and “tuggers” to expand their penile skin so that it eventually covers the head of the penis, as nature intended it.

Popularised by Jim Bigelow in his book, The Joy of Uncircumcising! (Hourglass, 1994), support groups for men interested in foreskin restoration have sprung up around the world – the National Organization of Restoring Men (NORM), which began in San Francisco in 1989, has more than 30 chapters worldwide, including several in Australia.

Non-surgical restoration, which can take several years, requires enormous commitment, but is well worth the effort, according to John Aldous, founder of the Adelaide branch of NORM. While the restored foreskin protects the glans, which eventually regains some of its lost sensitivity, the specialised nerve endings removed during a circumcision are irreplaceable. However, Aldous rates the sensitivity of his restored penis at five or six on a scale of one to 10 – a significant improvement. “As a sexually active adult both with and without a foreskin, I know which is better,” he says.

However, the issue of consent is a vital one and the reason many parents choose not to circumcise their sons. Perth father Brent Morrow said although he is circumcised, he would never consider surgically altering his child’s body, unless it was a medical necessity. “There is no way I would voluntarily offer my child up to a doctor to intervene with his body for no real reason. That’s a choice for him to make when he is able.”

Shaun Peters agrees. “If an adult man wants to sacrifice part of his body for his own cosmetic or religious gratification, then that is his right. But for parents to make that decision on behalf of a child – from a human rights point of view, that is completely unacceptable.”

 

*Names have been changed