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.
Georganne Chapin, MPhil, JD
At a time when human dignity is under assault in our nation and institutionally sponsored racial violence is escalating, I want to say that Intact America stands with those fighting for justice. I also want to talk about how racist myths and stigma have been used to justify male genital cutting — male circumcision — both historically and today, in the United States and overseas.
We know that male and female child genital cutting has been a tradition in some cultures for thousands of years. But as a medical practice, it started in English-speaking countries relatively recently. Nineteenth century Victorian-era doctors believed that sex was dirty, and that the male foreskin was the cause of much disease and of out-of-control sexuality. They thought that removing the foreskin would keep boys from masturbating. Doctors also cut off girls’ and women’s clitorises to tame their sexual impulses and to “cure” hysteria and other maladies. No group was exempt, and poor immigrants and others at the bottom of the social scale came to be targeted as needing to be cut in the name of sexual control and “hygiene.”
Black people, especially black men, were (and still are) sexualized in the American imagination, with myths abounding regarding their sexual appetite, dangerousness, and the size of their genitals. Not surprisingly, then, these myths became justifications for making black men a specific target for circumcision by a medical establishment enthusiastic to carry out the practice. (Black women have also been victimized by the medical system for decades, subjected to medical experimentation, sterilization and other abuses.)
In 1891, a prominent physician named Peter Remondino began calling for “the wholesale circumcision of the Negro race.” Remondino described black men’s foreskins as combining “the extra vitality and proliferation of the preputial tissue with the strong animal vitality of the negro,” and proposed foreskin removal as “an efficient remedy in preventing the predisposition to discriminate raping” — in other words, the rape of white women — “so inherent in that race.”
Remondino was not an outlier. He had been a surgeon in the Union Army during the Civil War and was the first president of the San Diego Board of Public Health. His articles were published in prominent medical journals of the times. His book, “The History of Circumcision from the Earliest Times to the Present,” was published in 1900 and can be found today on Amazon.
And lest you think that circumcising black men as a means of keeping their sexuality under control has died out, look no further than the anti-HIV efforts largely funded by U.S. foundations and carried out by “reputable” American academics to circumcise millions of men in sub-Saharan Africa. (Keep in mind that U.S. cemeteries are full of circumcised men who have died of AIDS since the epidemic started here in the 1980s.) These African campaigns exploit and put at risk whole populations of men who are viewed as so driven by their sexual impulses that they cannot be relied upon to practice safe sex, and also threaten the health of their sex partners.
Most American men alive today were tied down and their foreskins brutally severed when they were babies and unable to resist. The fact that perpetrators of violence may themselves have suffered violence in the past makes our work as human rights advocates both complicated and extremely important. We must break the cycle and fight injustice in every corner, under every rock, of our society.
You cannot compartmentalize justice — you can’t fight to protect babies’ bodies from being placed in four-point restraints and genitally mutilated, but stay silent when you see unresisting men or women held to the ground, kicked and beaten or suffocated to death. You cannot compartmentalize equality. You can’t fight to protect girls and women from genital cutting and rape, but turn the other way when boys and men are assaulted because our social mythology tells us that males (and even more so, black males), cannot be victims or — even worse — that they deserve it.
I am proud to lead Intact America and represent a movement that fights for human rights, personhood, dignity, liberty, and a life free from violence. I hope you will join me in fighting for freedom, exercising compassion, and demanding an end to all forms of injustice and inequality.
Intact America defends the right of every person to bodily autonomy. We deplore all forms of violence inflicted upon people because of their age, their race, their color, their language or culture, their country of origin, their sex or sexual orientation, their mental or physical disabilities, their religion, or any other personal characteristic that makes them convenient targets of oppression.
In the face of the COVID-19 pandemic, the American College of Surgeons released an advisory recommending that that hospitals, health systems and surgeons “thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations… or other invasive procedures.” In addition, the ACS called on facilities to “minimize use of essential items needed to care for patients,” among these “personal protective equipment” (e.g., sterile gloves and masks) and cleaning supplies.
Echoing the guidance from the ACS, U.S. Surgeon General Jerome Adams warned that every elective surgery could spread coronavirus within the facility, [and] use up protective medical gear as public officials worry about shortages and burden a hospital workforce who “may be needed” to respond to COVID-19.
On March 16, the American College of Obstetricians (ACOG) joined several other medical societies in issuing a similar statement, endorsing the Surgeon General’s warning.
If we applied the advice of the ACS, ACOG and the Surgeon General every day — not just in times of crises or pandemics — the “routine,” elective genital cutting of children would simply end.
Just like in the United States, during the 1930s and ’40s circumcision took hold in Commonwealth countries. Then World War II caused economic collapse in England, leading to the creation of the British National Health Service — a system where every procedure and every treatment was scrutinized for its cost and potential benefit. That’s how male circumcision there went by the wayside. Cutting out the funding of the risky, harmful and unnecessary amputation of baby boys’ foreskins ended up benefitting British boys and men for the rest of their lives, while saving resources for people with true medical needs.
It’s estimated that more than a billion dollars are squandered each year in the United States on amputating baby boys’ foreskins and repairing the most immediately obvious functional and cosmetic blunders. (If you’re thinking “only a billion,” note that this sum could buy 31,400 high-acuity ventilators or pay for 378,000 ventilator-dependent patient days.) Long-term costs of circumcision, physical and psychological, are of course much greater.
Whether in times of abundance or of scarcity, no state Medicaid program and no private insurer should be spending taxpayer or premium dollars on gratuitous medical interventions. If there is any silver lining to the COVID-19 pandemic it will be relegation to history of the nation’s most common and utterly unnecessary pediatric surgery.
Not a week goes by without somebody asking me: “How did you get involved in this cause (intactivism)?” I tell them I cannot abide the injustice that allows doctors and parents to remove an important body part from their infant sons.
Similarly, not a week goes by without somebody saying to me, “I want to do everything I can to protect boys, but I can’t use my real name because ….” (the reasons vary). I think to myself: How do you expect to change things if you stay anonymous?
“An activist is someone who cannot help but fight for something. That person is not usually motivated by a need for power or money or fame, but in fact is driven slightly mad by some injustice, some cruelty, some unfairness so much so that he or she is compelled by some internal moral engine to act to make it better.”
— Eve Ensler
Last month, as I was marching with our Intact America contingent at NYC Pride, I marveled at how far one cause – equal right for people, no matter what their sexual orientation – had come. I realized this was only possible because people who had suffered in secrecy, shame and fear for so long decided to speak out, to come out with their real names, their real stories, and their demands for justice.
In my own lifetime, I’ve seen racial desegregation outlawed, and interracial couples become mainstream. I’ve seen same-sex couples, first having achieved the right to marry, adopt babies and create the families that would have been impossible only a few years before.
All social change movements began as unfamiliar or unpopular causes. To oppose slavery in the United States was once unthinkable. The injustice of enslaving other human beings is what motivated persons of conscience to speak out, to come out and demand the abolition of slavery.
When American women began demanding the right to vote (starting with the Seneca Falls convention in 1848), they were attacked as unladylike, ugly and unlovable – as man-haters, or unpatriotic threats to the American way of life. Women and men so motivated by the injustice of denying half the population the right to participate in the political system marched and wrote and spoke out, using their real names, incurring ridicule and for themselves and their families. (Not coincidentally, many also fought for women’s suffrage.)
Activists who oppose FGM in African and Muslim countries have been criticized, persecuted, and disowned by their families and cultures. But it hasn’t kept them from coming out –even, in many cases, fleeing their own countries in order to continue speaking out.
Granted, pockets of fear and hatred continue to exist, and we live at perpetual risk of backsliding. But progress on the human rights front continues, and the slow but growing acknowledgment by Americans that baby boys deserve justice is evidence of this progress.
Why are we making progress? Because people who believe in justice for all refuse to stay silent. They refuse to hide in the closet. They speak out. They march, they donate to the intactivist group(s) of their choice, and they spread the word to anyone who will listen.
Freed slave and abolitionist Frederick Douglass was encouraged by many of his friends to hide his identity. They feared – not without reason – that Douglass would be re-captured and either killed or returned to the plantation where he’d been enslaved. Douglass realized, though, that keeping his identity a secret diminished his credibility, and conveyed fear and weakness – the antithesis of activism.
Here is what I say when somebody tells me they are committed to intactivism, but need to remain anonymous: If you cannot use your own name, who will believe in you? Who can see you as an example to follow, if they don’t know who you are?
As social justice advocate DaShanne Stokes famously said: “Only by speaking out can we create lasting change. And that change begins with coming out.”
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 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.
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.
 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.
Slightly edited version of essay published in Huffington Post 05/03/2017 01:26 pm ET
By: Georganne Chapin, MPhil, JD, Executive Director, Intact America
On April 13th, a Detroit doctor was arrested and charged with the Federal offense of removing parts of the genitals of two young girls. Meanwhile, doctors across the United States remove part of the genitals of 3,000 baby boys every single day.
How is that different?
It’s not. Too many people who object to cutting little girls have no qualms about cutting baby boys. The simple truth is that no child born with healthy genitalia should have any part of them cut, permanently altered, or painfully removed—no matter what gender they are.
I remember the first time I heard about female genital mutilation, or FGM as it’s often labeled. I was in my 20s, and not yet married or a mother. I immediately thought, “But we do the same thing to boys…, and call it by its euphemism — ‘circumcision’.”
Maybe if we called it male genital mutilation, more people would understand what it actually entails—binding the arms and feet of a newborn boy, using a metal probe to forcibly tear his foreskin from his glans penis, clamping that foreskin, and then cutting it off with scissors or a scalpel. Sometimes doctors cut off too much (causing complications too gruesome to mention here); sometimes they cut unevenly. Follow-up surgeries to correct errors and functional impairments are common. That’s no surprise. Surely, it is hard to operate on the genitals of a bucking, screaming child.
‘I Heard the Most Terrible Cries.’
Read what Elise Carin Wicklund, a mother in Parrish, Florida, wrote after she was told by her baby’s pediatrician that her weeks-old son would feel only a few seconds of discomfort.
“I heard the most terrible cries. The nurse brought me my screaming baby. They hadn’t even been able to put his onesie on all the way. He wouldn’t look at me. He wouldn’t nurse. For a long time, when I changed his diaper, he screamed.”
Without a doubt, that doctor is still out there cutting little boys. Compare this to the case of Jumana Nagarwala, a Johns Hopkins-trained female physician, charged with genital cutting of minor girls.
“Despite her oath to care for her patients, [Dr. Nagarwala] is alleged to have performed horrifying acts of brutality on the most vulnerable victims,” said Acting Assistant Attorney General Kenneth A. Blanco in a news release announcing the arrest.
Nagarwala’s case, the first to be filed under 18 U.S.C. 116, the Federal law that criminalizes female genital mutilation, has opened the eyes of many Americans, who are shocked that FGM is practiced on our soil. Perhaps it’s time they think more about what doctors routinely do to little boys.
As for the alleged health benefits of male circumcision, suffice to say that Great Britain, Europe, Australia, and other Western countries do not circumcise their boys or men, and their rates of AIDS/HIV, cervical cancer and penile cancer are comparable to or lower than ours.
The truth is that Americans circumcise their boys for the same reason other cultures circumcise their girls. We need to recognize that only tradition, bias and politics make the one okay, and the other abhorrent. Let’s acknowledge that all children deserve equal justice.