In 1987 Harry Meislahn was a man with too much time on his hands. Settling into an easy chair for an afternoon of pleasure reading, he picked up the latest copy of the New England Journal of Medicine, where he saw an article about pain response in newborns. In an attempt to prove that newborns have feelings too, the authors, K.J.S. Anand and P.R. Hickey, had referenced over 200 observations of pain, biochemical changes and heart rate among them. Crying, a simple response, was included. All babies cry, but how loud, and in response to what? Anand and Hickey listed a study of crying response during circumcision.
There are two kinds of men in the world, and the majority have foreskins. But not here in the U.S. According to NOCIRC estimates, by 1920 50 percent of American males were being circumcised at birth, and the percentage climbs from there. By 1950 70 percent were cut, but the peak year was 1980, when the estimate reached 85 percent of boys born in the United States. No actual head count was done until 1990, and that year the number was down to 59 percent. The country with the next highest rate is Canada, estimated at 25 percent and falling. Excluding the Islamic countries, and Israel, where circumcisions are performed for religious or cultural reasons, no other country in the world comes close.
The medical reasons doctors recommend circumcision are based on the possibility that it prevents cancers of the penis and cervix, urinary tract infections, sexually transmitted diseases, phimosis (when the foreskin is stuck over the head and can’t be retracted), and paraphimosis (when it’s stuck down on the shaft and can’t be pulled over the head).
Circumcision probably reduces the risk of infection of the urinary tract, and it definitely prevents phimosis and paraphimosis, which can affect as many as one in ten. As for preventing sexually transmitted diseases, the AAP reports that the evidence is, again, “inconclusive” as well as “conflicting.” STD rates in the United States are extremely high, and so is the percentage of sexually active circumcised males.
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There were reasons other than medical ones for the operation. People liked the look. People thought that boys would feel out of place or weird about their penises if they looked different from their friends and fathers. People don’t like smegma. And the problems caused by circumcision itself were rare. It’s a small thing, why not just go ahead and have it done?
A variety of clamps have been used through the years to protect the unsheathed glans from accidental cuts–since 1935 the most popular has been the Gomco. It looks a lot like the clamps used in shop class, only smaller. On the bottom arm of the clamp is a bell-shaped plunger and a small hole, through which the glans is inserted. The bell-shaped plunger is placed over the metal-capped glans, and the prepuce is stretched over the top of the bell, which is then attached to the top arm. The clamp is screwed tight, slowly, which releases a small blade concealed in the ring of the hole. The foreskin is crushed at the line of the blade, and a knife is used to make the final, circular cut. The clamp is left in place for at least five minutes to allow clotting, and a thermocautery unit is sometimes used to complete the clotting. The whole operation takes about 20 minutes.
And the chances of being cut too close are significant, according to Meislahn. “You’re dealing with a tiny piece of skin, and a tiny error can get bigger as the guy gets bigger. The average adult penis is 17 times larger than it was in infancy [his estimate], so a millimeter mistake is magnified in an adult. Many of the nurses in the movement got into it because they felt doctors were cutting off too much.” He also mentions the occasional devastating accident.
