By John Warren | 27 November 2012
Church and State
The foreskin (also known as the prepuce) is a fold of specialised skin that covers the head (the glans) of the penis. All mammals have a foreskin. The female equivalent of the penis is the clitoris, and it too is equipped with a foreskin. The foreskin has been little studied by scientists, and there have been those who stated it was a vestigial structure of no use. But Nature does not make mistakes, especially not with the reproductive organs. Humans have evolved over millions of years, and in the struggle for survival, any body part that was not doing a useful job would have disappeared or been modified.
So, what is it there for? In the newborn baby boy, the foreskin is usually joined onto the head of the penis, and the opening appears very narrow, so that the glans is often out of sight. But this opening is quite sufficient for urine to escape freely, and that is all that a baby needs. And meanwhile, the foreskin protects the glans from the irritant effects of decomposing urine and faeces.
As a boy grows, so, gradually, his foreskin separates from the glans, so that it can move backwards and forwards. It is quite normal for toddlers to pull their foreskin whenever they get the opportunity, and this helps its mobility. In due course, and the timing is very variable, the foreskin becomes fully retractable, so that it can fold back behind the rim of the glans, and be moved forward again. Sometimes this will happen in the first 5 years, but in other individuals it may be delayed until puberty is complete.
In circumcised males the glans loses its moist glistening surface, and becomes tough and hard and insensitive. In any case, the glans, even in its normal condition, is not as sensitive as the foreskin. Studies by the late John Taylor, a Pathologist practising in Canada, published in the British Journal of Urology in 1996, showed that the inner foreskin is highly specialised as a sense organ. The type of cells making up the surface is similar to the lining of the mouth. The inner foreskin is equipped with ridged bands circumferentially, rather like the finger tips. In these bands there are a great many specialised nerve endings called Meissner corpuscles. He reported: “Meissner’s corpuscles were more plentiful in some subjects than in others but perhaps significantly, they were only seen in the crests of ridges, occasionally in small clumps that expanded the tips of corial papillae (Fig. 8). End-organs were not seen in sulci between ridges in this material. S100 staining (Fig. 9) showed additional end-organs and myelinated nerve fibres within papillae and confirmed the richly innervated nature of the ‘ridged band’.”
Morris Sorrels and others published a study of penile sensitivity in the British Journal of Urology International in 2007 which concluded: “The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.”
The inner foreskin is kept out of sight and protected when the penis is not in use. But during sexual arousal, as erection occurs, so the foreskin rolls back and the inner foreskin is exposed. Then during sexual activity, whether it be intercourse with a partner or masturbation, the inner foreskin is stimulated by gliding over the tissues with which it comes into contact. The mobility of the entire foreskin structure enables it to function as a lubricant. Circumcised men often find they need to apply lubricant jelly in order to achieve satisfactory masturbation or intercourse.
The Origin of Circumcision
Circumcision appears to have originated in prehistoric times in the Middle East. It is also practised traditionally in other parts of the world, such as Australia and Polynesia. We can never know why it was carried out in these early times. It has often been stated that it was practised in Ancient Egypt. The evidence for this is supposedly tomb paintings. But, in the best known of these, the Mastaba of Ankhmahor, the image is badly damaged, and one cannot be certain what procedure is being carried out in the genital region of a male. It may merely be pubic shaving. Most of the nude male statues from Egypt show intact penises, while one from 2230 BCE shows another penile mutilation, a dorsal slit. Of the male mummies that have been examined, none has been found to be circumcised.
The earliest Biblical reference to circumcision appears in Exodus 4, 24-26, which tells of Moses’ infant son being circumcised by his mother, Zipporah, using a flint knife. The use of a stone tool suggests that the origin of this story is certainly before iron was used c 1000 BCE, and possibly before the use of bronze c 1800 BCE.
The Book of Genesis chapter 17 relates the well-known story of Abraham, the patriarch, who made a pact (covenant) with God, that in return for being the father of a multitude of nations, he would be circumcised, and all his male descendants after him on the eighth day of life. Three of the world’s great monotheistic religions claim Abraham as a patriarch. The oldest is the Jewish religion, Judaism, which is about 3000-4000 years old. Christianity followed, at 2000 years of age, and the youngest is Islam, 1400 years old. Of course we can never know for certain whether Abraham was a historic figure; there is no evidence for his existence outside the scriptures, which were set down centuries after his supposed life. If he was a historical figure, there is uncertainty about his dates, scholars placing him somewhere between 3000 and 1000 BCE. But followers of the three Abrahamic religions mostly believe that he was more than a myth.
Judaism and Islam still generally practise circumcision to this day. In Judaism it is a sacred rite carried out with great ceremony on the eighth day of life. Up to about 140 CE Jewish circumcision consisted only in the removal of the tip of the foreskin (milah), but then a more radical operation removing the entire foreskin (periah) was introduced.
In Islam circumcision may be carried out at any time during childhood, and there is no religious ceremony associated with it. The Quran does not mention circumcision.
Christianity, however, abandoned circumcision as it branched off from Judaism. There was a dispute among the early Christians and a debate was held in Jerusalem on this topic (See Acts 15). St Paul became the Apostle of the uncircumcised, while St Peter was the Apostle of the circumcised. The question had revolved around the necessity or otherwise of gentile converts to Christianity being circumcised. In modern times most Christians do not practise circumcision on religious grounds, but the Coptic Church and a few other sects are exceptions to this.
Medical Attitudes to Circumcision
During the 19th century many doctors became obsessed with a strange notion that masturbation (female as well as male) was the cause of a whole range of dangerous diseases, such as epilepsy, consumption (now better known as tuberculosis), insanity, rheumatism, cancer etc. All sorts of devices were developed to discourage young people from touching their genitals. It was in this climate that Sir Jonathan Hutchinson (1828-1913), President of the Royal College of Surgeons of England, in 1891 published a paper on ‘Circumcision as Preventive of Masturbation’. In it he not only advocated circumcision for the treatment of this ‘shameful habit’, but proposed that “…if public opinion permitted their adoption…measures more radical than circumcision….would be a true kindness.” The lead given by such a prominent doctor was of course taken up by many others, both in Britain and in North America. These notions, firstly that masturbation causes disease and secondly that circumcision prevents it, though both totally unfounded, lingered on well into the middle of the 20th century.
In Britain the first doctor to shed any light on this appalling misconception was perhaps Douglas Gairdner, a Cambridge paediatrician, who, in 1949, published a paper in the British Medical Journal, ‘Fate of the Foreskin’ in which he showed that the newborn foreskin is normally attached to the glans, and that this is not a disease, but that natural development results in separation occurring spontaneously. Before moving to Cambridge Gairdner studied in Newcastle-upon-Tyne with Sir James Spence, who was instrumental in setting up children’s services in the new British National Health Service, which came into existence in 1948. Neonatal circumcision was not included in the NHS.
Although Spence never published on circumcision, a letter of his to a general practitioner has been recorded for posterity to enjoy. It reads as follows:
My Dear C.,
Your patient, C.D. aet 7 months, has the prepuce with which he was born. You ask me, with a note of persuasion in your question, if it should be excised. Am I to make this decision on scientific grounds, or am I to acquiesce in a ritual which took its origin at the behest of that arch-sanitarian Moses?
If you can show good reason why a ritual designed to ease the penalties of concupiscence amidst the sand and flies of the Syrian deserts should be continued in this England of clean bed-linen and lesser opportunity, I shall listen to your argument: but if you base your argument on anatomical faults, then I must refute it. The anatomists have never studied the form and evolution of the preputial orifice. They do not understand that Nature does not intend it to be stretched and retracted in the Temples of the Welfare Centres or ritually removed in the precincts of the operating theatres. Retract the prepuce and you see a pin point opening, but draw it forward and you can see a channel wide enough for all the purposes for which the infant needs the organ at that early age. What looks like a pin point opening at 7 months will become a wide channel of communication at 17.
Nature is a possessive mistress, and whatever mistakes she makes about the structure of the less essential organs such as the brain and stomach, in which she is not much interested, you can be sure that she knows best about the genital organs…
Unfortunately Gairdner and Spence failed to sweep away medical circumcision entirely, and it lingered on, particularly in private clinics almost to the present day. And their revisionism had no impact on the other side of the Atlantic, where routine neonatal circumcision became almost universal in the USA by the 1970’s. In Britain immigration has led to a significant proportion of the population having roots in parts of the world where boys are expected to be circumcised. Doctors are requested to carry this out, and it will generally be done for a fee, although a few cities have now established free of charge circumcision clinics. Unfortunately misconceptions about the foreskin persist in the medical profession; many believe that a boy must have a retractile foreskin by the time he starts school. But he doesn’t need to retract at 5 years old, and if you simply wait it is almost certain that it will become retractile by itself. This misunderstanding still results in a great many unnecessary circumcisions. Ballooning of the foreskin during urination also is liable to cause alarm, but it is often a transient phase during the natural maturation of the penis.
Doctors who recommend infant circumcision claim that it is protective against diseases such as sexually transmitted infections, including HIV, cancer of the penis, urinary tract infection in infants and cancer of the cervix in future female sexual partners. In the next essay I will examine these claims in more detail, and discuss the harmful effects and possible complications of circumcision.
Dr John Warren was educated at Charterhouse School and studied medicine at Cambridge and the London Hospital Medical College. He was a consultant physician at the Princess Alexandra hospital in Harlow, Essex from 1975 to 2005 and has now retired. Dr Warren founded NORM-UK in 1994 and is its current chairman.
Dr John Warren: Awakening to the Damage of Circumcision and the Value of Foreskin
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