Dec 4, 2022
Two recent surveys by Intact America have raised the question by some participants of why we asked the men if their penis looked like A (an intact penis) or B (a circumcised penis), which they found either distasteful or an invasion of privacy. This is the A or B image they were talking about.
The short answer is accuracy. Asking this question improves the quality of the survey results. A lot. The reason is that many men don’t know their penile status! A 2004 study of college-aged men found that 33% were mistaken or unsure of their penile status.[i] This is nothing new, a 1960 study found 14% of men were unsure; their status was confirmed by a physical examination.[ii]
More recently, in Intact America’s three, national random sample surveys (2017, 2018, & 2021) of 3298 Americans, 14% of men were mistaken or unsure of their penile status. See below for my decade-old methodology to determine whether men were mistaken or not. But first, here’s an entertaining anecdote to illustrate the problem.
You may have seen the episode of the Graham Norton Show on BBC in 2017 with guest actor Sir Patrick Stewart. He relayed the funny story about him mentioning in passing to his wife that he was circumcised. According to Stuart, in his 70s at the time, the conversation went something like this:
Stewart: I’m circumcised.
Wife: (laughs) You’re not circumcised.
Stewart: That’s ridiculous! I should know if I’m circumcised! End of conversation.
Stewart: The next day, I happened to be seeing my doctor for my annual physical. When the doc was ‘down there,’ I mentioned my disagreement with my wife, and asked, “I’m circumcised, right?”
Surprisingly, even men who call themselves intactivists, and who are presumably knowledgeable about circumcision and male sexual anatomy, aren’t sure. A survey of intactivists found that 13% of intactivist men are mistaken or unsure.
In 2011, I wanted to learn if newborn circumcision was associated with alexithymia. Alexithymia is the inability to identify and express emotions. It is thought that it is acquired at a very early age. Such people have difficulty in relationships, social interactions, and even in therapy. But I could not examine these men who live across the United States. So, I had to develop a viable validation alternative for that peer-reviewed alexithymia and circumcision study. My solution was to ask their penile status and then compare that with their answer to the A-B image question. Entries that did not match correctly were removed from the dataset.
As it turns out, and unknown to me at the time, I’m not the first researcher to realize that self-report is inaccurate when it comes to penises. In 1992, Schlossberger found that: “Use of visual aids to report circumcision status was more accurate (92%) than self-report (68%).[iii] Wow.
Granted, the best way to determine penile status would be a physical examination. But this is so problematic on so many levels that it would be all but impossible to survey. You’d have to pass certain standards using human subjects, hire medical staff, obtain liability insurance, and of course get permission from the men to disrobe. (By the way, the proper way to determine if a man is circumcised isn’t to look for the lack of a foreskin, but the presence of a circumcision scar.)
The solution that I came up with, and one I’ve used many times since, is a three-part survey-question method. The questioning goes something like this:
Are you circumcised or intact (not circumcised)?
Which one of these images most looks like your flaccid (not erect) penis?
Are you restoring your foreskin?
I don’t know what this is
As you can see, this method results in much more accurate answers, and provides trustworthy data. Nevertheless, some men are not comfortable answering these questions, even to an anonymous researcher. I can appreciate that. That’s why I’ve taken steps to avoid their discomfort: 1) I inform participants that they’ll be asked personal, sexual questions, 2) tell them they can opt out now, 3) tell them they can opt out at any time, 4) mention that this data will only be used in aggregate form, and that at no time will their identity be revealed, and 5) use the image shown above obtained from a medical illustration stock image source instead of using a photo of real penises.
A study I recently conducted, and now in-press, titled “Adverse Childhood Experiences, Dysfunctional Households, and Circumcision,” also employed this method. None of the journal reviewers mentioned a problem with using this image.
So, not using this tripartite image question would make the results skewed, if not unusable, and therefore unpublishable.
Sadly, many circumcision studies being published since I created this method continue to just ask the men if they are circumcised or not, leaving us unsure of what to make of their conclusions. As scientists like to say: “Junk in, junk out.” (no pun intended!)
[i] Risser JMH, Risser WL, Eissa MA, Cromwell PF, Barratt MS, Bortot A. Self-assessment of circumcision status by adolescents. Am J Epidemiol. 2004;159:1095–1097.
[ii] Wynder EL, Licklider, SD. The question of circumcision. Cancer. 1960;13(3):442 5. 14.
[iii] Schlossberger N, Turne R & Irwin C (1992) Early adolescent knowledge and attitudes about circumcision: methods and implications for research. J Adolesc Health 13(4): 293-297.
Nov 15, 2022
Intact America interviewed Dusty Drake (they/she) following her heartwarming and open TikTok account of their circumcision complications. A transcript of the interview and her video follows.
How did you discover Intact America and what does the intactivist movement mean to you?
I first discovered Intact America a few years ago on Instagram. Back in 2011 however was the first time that I heard the term intactivist. Without knowing the word though, it is something I advocated against within my social circle even before that because of my own experience. To me, the intactivist movement is about bodily autonomy more than anything else. It’s giving the right to make cosmetic decisions about one’s body to the individual themself. It seems to be a controversial opinion in North America, but I don’t think that parents should be allowed to alter their child’s body for cosmetic purposes just because it’s their child. That child is an autonomous human being and will grow into an adult who can consent to those procedures if they decide they want them.
What encouraged you to share your story, and why now?
I was encouraged to share my story when I saw a prompt posted on September 22nd to Instagram by Intact America. The prompt simply said “Robbed of your foreskin? Tell us your story.” Their email was written below and I thought to myself, “I should email them. I’m shut down so often when I bring up the problems with cosmetic infant circumcision so I’m terrified to share my story but at least they are willing to be a listening ear.” After composing the email though I had a spark of inspiration and decided that I wasn’t going to send it. I have a following on TikTok and though even though I’ve been harassed and shut down before while speaking against cosmetic infant circumcision, this is still something that people need to hear even if they aren’t ready. So I decided to record and post my story instead. I can’t begin to tell you how extremely nervous I was to talk about my own personal experience with having been circumcised as an infant and the issues I experienced during puberty because of it. While recording, it felt just as nerve wracking as if I was speaking to a room full of strangers who had no interest in what I had to say. But I continued, because if my voice can help one parent reconsider their entitlement over their child’s body and prevent them from taking away their child’s bodily autonomy then it was worth the temporary discomfort I felt while recording.
What are some of the reactions to your TikTok video and how do they make you feel?
A majority of the reactions from my TikTok on my own experience have been overwhelmingly positive which I was honestly surprised about. I have posted content against cosmetic infant circumcision in the past and have been met with a lot of hate, harassment, and even bullying. So I was understandably nervous to share my own story, but I am so glad I did. I think the biggest reward from posting about my own experience is the new and expecting parents posting that they are reconsidering doing this to their child, have now made the decision not to, or feel more reassured that they made the right decision by leaving the choice up to their child.
Would you consider sharing more about your experience, or discuss circumcision in future TikTok videos?
If the right inspiration strikes, I will continue to talk about my experience. I absolutely intend to continue making content against cosmetic infant circumcision because the right to bodily autonomy is a human rights issue.
Dusty’s TikTok Transcript:
When I was a baby, only a few days old, a doctor had convinced my parents that there was something wrong with my body and that immediate surgical intervention was needed. There was no infection, no birth defect, and there were no adverse effects that could come from leaving my body in its natural state. Yet despite this, my parents had been convinced that to be good parents and do what was best for their first born child, that immediate surgery was necessary. They hadn’t been properly educated on the surgery, and they had have been given information on the benefits of leaving my perfectly healthy body alone. So they followed through with the doctor’s recommendation.
When I began puberty at around 10 or 11-years-old, my body began to grow quickly, so quickly, in fact that the incision from the surgery that I was unnecessarily forced to undergo as an infant began to tear. The scar tissue began stretching beyond its limits. This increased tension led to years of bleeding and scabbing along the incision line from the scar, not to mention the pain that this caused me during this whole time. But I was scared and ashamed of what was happening to me. I had believed that I had done something wrong, or worse, that there was something intrinsically wrong with me and that this was a punishment for it, and this made sense to me. After all, I was a young closeted queer kid who was being bullied every single day by my peers. Heck, I didn’t even know what queer or gay or any of that was, but I knew that that was something I didn’t wanna be and that it was bad, because that’s what my peers and society had taught me.
So it made sense to me that on top of being bullied every day, that life would just punish me in this way, despite the fact that I hadn’t done anything except for show kindness to others. So I never told anybody what I was going through and I just suffered through it alone. But when I was an adult, I discovered that I wasn’t the only one who had gone through this. There were doctors all over convincing parents to perform these unnecessary surgeries on their children, their newborn children. After I realized that I wasn’t alone in this, I got the courage to speak to my parents about it. They didn’t know what to say at the time, and they were clearly processing the information I was giving them, but they did look really remorseful.
Just last month, I was hanging out with my mom and she came up to me on her own, she sat next to me on the couch and just gave me a big old hug. She looked me in the eyes and she said, “I am so sorry. I would never crop a dog’s ears or tail, but for some reason, I never gave a second thought to mutilating my own newborn baby. I wish I could go back and make an informed decision with the knowledge I have today. I’m so sorry that we circumcised you.”
Jul 21, 2022
Since Intact America’s founding in 2008, our organization’s stated goal has been to “change the way America thinks about circumcision.”
Our Vision statement says:
Intact America envisions a world where children are free
from medically unnecessary surgeries carried out on them without their consent
in the name of culture, religion, profit, parental preference, or false benefit.
The genital cutting of any child in the absence of life-threatening or seriously health-threatening pathology violates not only that child’s body, but also his/her/their autonomy over their own sexual future. This position is immutable. No parent or guardian has the right to waive a child’s right to be protected from any type of tortious interference, or physical or sexual assault, with regard to genital cutting. The right that governs is that of the child.
Intact America was founded in 2008 by a coalition of individuals and intactivist organizations who wished to see the intactivist movement grow into a mainstream human rights cause. The new organization, as well as its founders, were guided by widely-accepted secular bioethical principles adopted in Western human rights and political discourse in response to atrocities committed against persons of many religions, races, and cultures during World War II. Our position is also supported by common law and the objective fact that having normal genitals, including a foreskin, is not a condition requiring surgical intervention. Furthermore, intactivism places no inherent value in following a particular common or traditional practice nor in capitulating to the current (but always-evolving) status quo, if those traditions and practices compromise the physical integrity and sexual wellbeing of children and the adults they will become.
Thus, neither religion nor “culture” should ever be invoked to support child genital cutting. At the same time, opposition to child genital cutting is not rooted in anti-religious sentiments. To tie ourselves up in such accusations is to lose focus on the true intent of the intactivist movement, as expressed in the fundamental goal and vision of Intact America, restated from above: a world where children are free from medically unnecessary surgeries carried out on them without their consent.
As a human rights organization that respects all persons regardless of their race, religious or cultural affiliation, it is also our duty to refute expressions of bigotry when expressed by people outside or within the intactivist movement. To leave no doubt, in 2022 Intact America’s adopted a new position statement against bigotry and hate speech:
Intact America rejects all forms of ethnic, racial, and religious stereotypes and bigotry. We condemn any form of hate speech based on ethnicity, race, national origin, gender, sexual orientation, religion, or irreligion. The incorporation of anti-Semitic or anti-Muslim expressions into criticism of male (or female) circumcision only serves to undermine our movement and potentially derail our work to protect all children from genital cutting.
I fervently believe that adherence to the logic and principles outlined above will ensure our success in protecting future children and the adults they will become.
Dec 1, 2021
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
Oct 25, 2021
This letter to the editor was published in The New Yorker on October 25, 2021.
Kudos to Shteyngart for bravely exposing the harm that can be caused by circumcision. His heartbreaking personal struggle, while extreme, is more common among circumcised men than the public has been led to believe. Since 2008, when I co-founded Intact America, an organization that seeks to change the way people in this country think about circumcision, I have heard from thousands of men who have suffered lifelong physical and psychological damage from the procedure. According to a 2019 report published in the Journal of Pediatric Surgery, in the U.S., where nearly all circumcisions take place in medical settings, eleven per cent of pediatric-surgery malpractice cases involve circumcision. Yet American doctors and hospitals keep putting babies at risk with a medically unnecessary procedure that is not routinely performed on male children in any other Western country. We must ask why we allow doctors and hospitals to profit from cutting the genitals of male children even as we fight to outlaw female genital cutting, here and abroad.