Do You Know: About Forced Foreskin Retraction? – Part 1

Unfortunately, parents who have taken a stand and said NO to the circumcision of their baby boys now have another worry: an iatrogenic* epidemic of Forced Foreskin Retraction (FFR), fueled by the same ignorance and phobias that have perpetrated the uniquely American infant circumcision industry. (I talked about forced foreskin retraction in Intact America’s October-November newsletter.) Preliminary results of a new national survey commissioned by Intact America, and conducted by the reputable polling firm Qualtrics, show that two out of five intact boys under the age of six years has had his foreskin forcibly retracted.

As part of our ongoing work, Intact America has been fighting this epidemic, publishing information about care of the intact penis, and answering personal inquiries from parents whose sons have been victims of over-zealous doctors or nurses. Another intactivist organization, Doctors Opposing Circumcision, has filed numerous official complaints on behalf of parents and their sons to state medical boards.

Now, the battle is escalating. In January 2018, Atlanta attorney David Llewellyn filed an important lawsuit against a major pediatric hospital in that city, describing that organization’s defiance of current pediatric care guidelines, and its nursing staff’s systematic violation of patients’ rights.

Alleging battery; nursing malpractice; intentional infliction of emotional distress; willful, wanton and reckless misconduct; and negligent failure to protect a patient, Park v. Children’s Healthcare of Atlanta details the actions of a nurse at Children’s, who – without conversation or warning – ripped away the foreskin of an intact toddler in order to insert a urinary catheter, causing him severe pain, bleeding and emotional distress. The complaint also describes the defiant attitude taken by other hospital staff, who insisted that the hospital’s protocol calling for nurses and doctors to forcibly retract all intact boys’ foreskins was derived from current established medical recommendations, erroneously claimed that the child’s foreskin put him at risk of disease, and shamed his parents for not having had their son circumcised.

The medical literature, including guidance from the American Academy of Pediatrics, is clear: An intact boy’s foreskin should NEVER be forcibly retracted.

If your son has been a victim of forced foreskin retraction at the hands of medical professionals, we encourage you to complain in writing to the doctor who performed the retraction and the facility where this took place. At a minimum, you should provide them with factual information, such as this article by Carmack and Milos and this information sheet. You should also file a complaint with your state’s medical board or office of professional discipline. Finally, you may wish to file 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 Georganne Chapin directly at [email protected]

* Caused by the medical system. Iatrogenesis refers to any effect on a person, resulting from any activity of one or more persons acting as healthcare professionals or promoting products or services as beneficial to health that does not support a goal of the person affected.

Do You Know: How to protect your son from forced foreskin retraction?

Congratulations! You gave birth to a baby boy, you protected him from circumcision, and you took him home whole, happy and peaceful!

So – we’re good! That should be the end of it, right?

Unfortunately, too often that’s NOT the end of it. Most North American health care professionals are woefully uninformed about the anatomy, functions, development, and care of the normal penis. And, also unfortunately, many of them are ready, willing – and even insistent – on trying to turn your boy’s healthy, normal foreskin into a problem.

Every few days, either via Facebook or email, Intact America hears from a parent who’s taken their baby to the doctor for a well-child visit, and encountered unexpected trouble.

Before I knew it, she grabbed my son’s penis and forced his foreskin back. It’s swollen and raw, and he’s been crying for hours. What do I do?

My son’s pediatrician has diagnosed our 2.5 year old with Phimosis and performed a retraction. I feel very uneasy about this…

We also hear from parents who have taken their baby to the Emergency Room with a fever and have faced a doctor or nurse who zeroed in on his foreskin as the culprit – insisting that it needs to be retracted to insert a catheter for a urine sample.

My son was at the ER and they wanted to cath him. [They told my wife] they couldn’t do a clean catch because he had foreskin and his foreskin cells would interfere and eventually threatened to call CPS [Child Protective Services] because she refused to forcibly retract him.

What you need to know:

  • A baby’s foreskin should NEVER be forcibly retracted! “Phimosis” (a tight or adherent foreskin) is normal in babies and boys, and the foreskin will loosen and separate naturally from the head of his penis over time. The average age of spontaneous foreskin retraction is actually around 10 years of age, which means that many boys’ foreskins separate sooner, and many separate later. Forcibly pulling back a boy’s foreskin is painful, and can cause swelling, bleeding and infection. Nobody but the boy himself should handle his foreskin.
  • “Catheterization is an intervention that carries risks…, [including] discomfort and introduction of bacteria into the urinary tract, which could actually lead to infection…,” as pointed out in this recent article by experts Adrienne Carmack, MD and Marilyn Milos,RN.
  • Absent other symptoms (smelly, bloody or cloudy urine; pain while urinating), suspecting a urinary tract infection (UTI) simply because a boy is intact and has a fever makes no sense. And even if the child has symptoms of a UTI, various methods exist to obtain a clean urine sample without inserting a catheter.
  • Finally, if catheterization is truly called for, it is NOT necessary to retract a boy’s attached foreskin to accomplish the insertion. (Again, see this article by Carmack and Milos detailing gentle methods for inserting a catheter without retracting the foreskin.)

You have the right as your child’s parent to refuse to allow a doctor, nurse or – of course – anybody else to forcibly retract your intact son’s foreskin. If you believe that your child is at risk of forcible retraction, state calmly and clearly that you do NOT give the clinician permission to handle your son’s penis and foreskin. Make a point of telling your pediatrician this up-front, and providing this information in his medical chart. If you do have to take your intact boy to an emergency room, let the provider(s) know that foreskin retraction is off-limits.

If your son’s foreskin has been forcibly retracted by a health care professional, here is what you can do.

For your baby: If his penis is swollen and sore, it is likely this will resolve on its own. Watchful waiting, and bathing him in plain warm water (no soap or bubble baths), are your best recourse for healing. If it does not improve, or if you see pus or smelly discharge, seek medical help – preferably from a foreskin-knowledgeable physician. At a minimum, let the new doctor know that you will not tolerate further tampering with his intact foreskin.

Official actions: You are entitled (and we encourage you) to complain in writing to the doctor who performed the retraction and the facility where this took place. At a minimum, you should provide them with factual information, such as the article by Carmack and Milos and this information sheet. You can also file a complaint with your state’s medical board or office of professional discipline.

Do You Know: About circumcision revision surgery?

We know the rate of neonatal circumcision in the United States is slowly falling. In the meantime, the rate of circumcision “re-do’s” — referred to in the medical literature as “circumcision revisions” — is rising. A lot.

Circumcision revision surgery is both highly unfortunate — and unsurprising.

Conversations about penises — how they function and what people think they should look like — were not commonplace just a decade ago. Now, as circumcision rates continue to decline, the practice is being widely discussed and debated. Almost daily, news articles, blogs, podcasts, YouTube videos, and the growth of new support and advocacy groups show the growing discussion and, in turn, contribute to growing awareness.

With all this penis talk, American parents are paying a lot of attention (sometimes, it seems, way too much attention) to their sons’ penises. On social media and in direct inquiries to Intact America, parents frequently write that their son’s circumcision “doesn’t look right,” and they want to know how to get it “fixed.” Our network of pediatric urologists report that the number of parents seeking circumcision “revisions” is growing, and the academic literature seems to support this.

The authors of a 2013 article published in Clinical Pediatrics reviewed five years of data from freestanding children’s hospitals affiliated with the Child Health Corporation of America. After excluding patients with other penile pathologies, they found that the rate of circumcision revision procedures increased significantly over the 5-year period when compared to the rate of neonatal circumcision, and suggest that the main reason for the increase was “changing standards of satisfaction” among parents of circumcised boys. In other words, parents take their sons for a second surgery — this one requiring risky general anesthesia — because they aren’t happy with the handiwork of the original circumcising doctor or mohel. Some of the complaints from parents seeking a “penile touch-up” (not to be confused with surgeries required to repair circumcision-related functional impairments) for their sons include too little foreskin removed; “uneven” appearance of the remaining foreskin; or the child’s penis pulling to one side. While the repair might make the parent feel better, it exposes the child to additional risks, both physical and psychological, and it can never restore the sensitive tissue removed in the circumcision.

The most unfortunate thing, though, about circumcision revision surgery in a child is that it is the result of a harmful procedure that was NOT necessary in the first place. And that just as the child was forced to endure a primal wound that he could neither consent to nor understand, he is now being forced to undergo a second surgery — more painful and more risky than the first.

Based on social change theory and examples of past movements for social equality and human rights, the United States is moving toward a tipping point — that point at which a critical mass of Americans will have come to believe that keeping boys intact is the normal, desirable thing to do. This means more and more baby boys will be kept intact, and babies who are kept intact will never need their penises to be “revised.”

Do You Know: That “smegma” means “soap” (in ancient Greek)

smegma (noun) – smeg-ma.  Smegma is a combination of shed skin cells, skin oils, and moisture. It occurs in both male and female. In female bodies, it collects around the clitoris and in the folds of the labia minora; in males, smegma collects under the foreskin. From Ancient Greek (smegma).

Yes! That’s right. Smegma was recognized by the Ancient Greeks (who had a sophisticated understanding of the body and abhorred circumcision) as a beneficial, cleansing substance. That white stuff that builds up in our genitals — under the foreskin in intact males, and around the clitoris in intact females — is as natural as the saliva in your mouth. And just as helpful!

Like saliva, smegma serves important functions. Fresh smegma is smooth and moist. In adult men, it helps to keep the foreskin and the head of the penis soft, and eases intromission (insertion) during sex. Understanding this makes it easy to see why men who are missing their foreskins need to use lubricants for both masturbation and sex. And it makes it easy to understand why partners of circumcised men sometimes complain of pain and dryness during intercourse.

Circumcision removes nature’s perfect lube — forever!

Smegma also keeps the penis and clitoris from adhering (sticking) to the adjacent skin. Of course, in baby boys, the foreskin is naturally attached to the head of the penis — that’s for protection, too. As the foreskin begins to separate from the glans, smegma sometimes appears in the form of pearl-like lumps (some people call them “smegma pearls”) underneath the foreskin, This is perfectly normal, and no intervention is required — in fact, nobody should forcibly retract a child’s foreskin for any reason; the pearls will dissolve as the foreskin completes its separation. Smegma will then take over to do its important work!

Just as no special care or attention is required for an intact baby, nothing special is needed to keep an adult’s genitals healthy. Again, nature’s best rinsing agent — plain old water (with a natural mild, unscented soap, if you wish) will take care of any build-up of smegma or any odor you might find offensive.

Here’s something else to think about. Scientific research has shown that bodily secretions popularly thought to be an unpleasant nuisance actually have disease-fighting properties. A study published in 2016 found that nasal mucous contains a natural antibiotic substance (called lugdunin), which is uniquely effective in fighting drug-resistant staph infections. Another natural substance that fights infection is Lysozyme, a crystalline, basic protein present — among other places — in human saliva and tears, where it functions as an antibacterial enzyme. Isn’t it likely that smegma also fights infection? Could this help to explain lower rates of STDs in Europe, where relatively few men are circumcised, compared to the United States, where 75-80 percent of adult men are missing their foreskins and the natural protection it offers? Let’s hope that future research will explore this question. Sometimes the facts are right under our noses — or under our foreskins!

(This article is a slightly revised version of an earlier “Do You Know…?” published in the Intact America newsletter in October 2016.)

Do You Know: Why Intact America loves Pride?

On Sunday, June 25, 2017, Intact America will have a BIG presence at NYC Pride — with a fabulous float traveling down 5th Avenue, and an informational booth at Pride Fest (the street fair), at the corner of Hudson and Bethune.

Intactivists have been welcomed in the NYC Pride March since we first asked to be included in 2006. We’re there to throw a big, informative party for the foreskin, and celebrate the right of every person — male, female or intersex — to keep and enjoy the whole body that nature gave them.

This year, in addition to “Foreskin Pride,” we’re unveiling a new theme: “The Foreskin is Out of the Closet!”

Successful human rights movements depend upon people willing to buck social norms, to risk embarrassment, to come out, and to speak out loudly and clearly against injustice.

Movements for social change and social equality depend upon people who care more about justice than about being popular among their peers.

LGBTQ people know that coming out is a political act. It’s also a profoundly personal act. Coming out says, “I am who I am. I’m ok. I’m out, and I’m proud!”

It’s the same for intactivism.

Parents who allowed their sons to be cut because they didn’t know any better are now coming out and saying, “We regret what we allowed to happen, and we are speaking out so other parents won’t make the same bad decision.”

Men whose foreskins were stolen from them when they were babies are coming out and saying, “I feel grief, I feel anger, and I am speaking out so that other boys and men won’t have to suffer the same fate.”

New parents are OUT and PROUD about keeping their sons intact.

Men with foreskins can say, “I am who I am. I am natural. I am proud.”

So — if you’re in or around New York City on June 25, please join Intact America on our March for justice. Or come by our booth at PrideFest, at the corner of Bethune and Hudson, to see the foreskin coming out of the closet!

Do You Know: About female genital mutilation?

Just as with male circumcision, there’s a lot of myth and misinformation about female circumcision (also called female genital mutilation, female genital cutting, etc.). Intactivists know that cutting the healthy genitals of ANY child is wrong. But even some intactivists feel pressured to “admit” that cutting a girl’s genitals is worse than cutting a boy’s. Here, we’d like to give some history and facts that will help you refute the argument that male and female genital cutting are totally different, and that cutting a boy is somehow less bad than cutting a girl.

Both female and male genital cutting are customs that go back thousands of years. Both are carried out for a host of stated reasons, including religious mandate, “hygiene,” aesthetics, and “health.”

Those who condemn female genital cutting (FGM) often distinguish it from male circumcision (MGM), citing MOTIVE, EXTENT OF PSYCHOLOGICAL/PHYSICAL HARM, ANATOMICAL NON-EQUIVALENCE, RELIGIOUS FREEDOM vs CULTURE, and HEALTH. They also claim that FGM discriminates against girls.

Some people argue that FGM is worse than MGM because FGM is done to control women’s sexuality, while MGM is carried out for health benefits. What most Americans do NOT know is that male circumcision also has roots in the desire to suppress male sexual pleasure.

In the 12th Century, Jewish philosopher and physician Maimonides said the real purpose of (male) circumcision was to cause “bodily pain to the organ in question,” and to weaken pleasure and sexual excitement. In late 19th century England and America, Victorians believed that masturbation threatened a person’s health and social wellbeing. Some doctors promoted circumcision (and clitorectomy) to keep boys (and girls) from pleasuring themselves. (The remedy didn’t work.)

Whatever the supposed motive of the culture, of parents, or of circumcisers, the child who experiences forced and painful removal of his or her private parts can neither comprehend nor appreciate the adults’ justifications. Shock, pain, feelings of betrayal and humiliation, depression and rage are common responses — and are reported by female, male and intersex victims of genital mutilation.

Extent of psychological and physical harm
Another common defense of male circumcision goes like this: “Men who have been circumcised can still have orgasms; women who’ve been cut cannot.” The truth is that cutting the genitals of any person takes away from their full potential for sexual pleasure. FGM practices vary a lot, from a slight “nick” with a needle or scalpel (intended to draw a bit of blood), to the removal of some tissue (such as the tip of the clitoris, the prepuce or clitoral hood, or part/all of the inner labia), to the most extreme type (infibulation), which involves removal of the clitoris and labia, and sewing the remaining tissue together (leaving just a small opening to pass urine and menstrual blood). The latter is horribly debilitating and, fortunately, relatively rare.

Just as many circumcised men report pleasurable and satisfying sex lives, many women who have undergone milder forms of FGM say that they do feel sexual pleasure and have orgasms, and that it doesn’t interfere with pregnancy or childbirth. (Of course, neither women nor men who are forcibly circumcised as children will ever know what they are missing.)

Anatomical non-equivalence
People anxious to distinguish male from female genital cutting often say things like, “It’s not the same; for it to be the same, the whole penis would have to be cut off.” Or “the foreskin is just a tiny flap of skin; in FGM, they remove everything.” These arguments are silly (would you ever say, “It’s ok to cut off a baby’s forefinger, but not his thumb”?) and also imply a lack of understanding about (1) the wide range of FGM techniques, and (2) the fact that the amount of tissue removed from a baby boy when he is circumcised amounts to 12-15 square inches of nerve- and blood vessel-laden skin in an adult man.

“Religion,” “culture,” and “health”
Male circumcision is often defended as a religious practice protected under our constitutional right to religious freedom, while female circumcision, is said to be “cultural.” The distinction is meaningless, for several reasons. First, American courts have regularly held that freedom of religion does not give me the right to harm somebody else (circumcision is harmful) or to deprive that person of his or her own religious freedom (we can never know what, if any, religion a child will choose once s/he becomes an adult). Second, all but a few thousand of the one million circumcisions carried out on boys in the U.S. each year take place in hospitals, and have absolutely no religious significance. Third, if under U.S. law, culture is no excuse for FGM, it should be no excuse for MGM.

As for “health,” the fact that doctors carry out the procedure does not give it medical or ethical legitimacy. Nearly all infant and child male circumcisions in the United States are performed by physicians, but virtually none of them treat any pathology, and other western countries where MGM is rare have similar or better health indicators (including rates of STDs) than we do.

In a Michigan case , it was a female American-trained doctor who allegedly removed parts of the little girls’ private parts. That doesn’t make it medical treatment.

Federal and state laws prohibiting FGM are seen by their supporters as addressing discrimination against girls. One might ask how a law that fails to protect the one million baby boys who are circumcised in the United States each year can be characterized as fair, just, or even constitutional.