Chapter 18

THE INTACT PENIS

People who live in parts of the world where circumcision is not practiced would find our attitudes quite curious, but many American parents who have chosen to leave their infant sons intact have felt that they were doing something “brave,” “daring,” or “radical.” Often such parents worry about whether they have made the right choice, or think that their baby’s penis looks “strange.” Perhaps they have never before seen an intact penis.

Parents giving birth in American hospitals have often had to be quite insistent and militant about their choice against circumcision. Sometimes they have faced criticism and lectures from doctors and nurses. Some parents who have planned to leave their sons intact have allowed their doctors to talk them into the operation.

Misinformation in books on infant care and in medical textbooks has led parents and physicians alike to believe that care of the intact infant is quite complicated and painstaking, and that the penis with its foreskin will be fraught with innumerable problems. Unfortunately this misinformation often results in excessive attention to the infant’s foreskin which is what causes most of these problems.

The movement to do away with routine infant circumcision has followed in the footsteps of the natural childbirth movement, the growing popularity of breastfeeding, and the awakening public interest in other natural health related issues. There are many similarities especially between mothers’ struggle to “relearn” breastfeeding, and new parents’ endeavor to leave their infant sons intact.

Mother and intact son

© Suzanne Arms


“Many American parents who have chosen to leave their infant sons intact have felt that they were doing something ‘brave,’ ‘daring,’ or ‘radical.’ “


Within recent years the mother who chose to breastfeed her infant has faced curiosity, criticisms, and immense misinformation in our bottle feeding‑oriented society. Similarly, the parent of an intact son has encountered criticism, curious remarks and misinformation about his “natural” penis.

Opponents to routine infant circumcision, like many of those involved with other wholistic health related issues, have often seemed “vehement,” “fanatical,” and “angry.” This anger has often resulted from the outright absurdity that people should have to work so hard, and face so much misinformation, opposition, and apathy, over something so incredibly simple!!

The Care of the intact Penis

Mother and intact son

© Suzanne Arms


“The parent of an intact son in our society has often encountered criticism, curious remarks and misinformation about his ‘natural’ penis.”


Correct care of the intact penis, based on knowledge of the development of the foreskin and glans during fetal life, infancy, and childhood, should be an essential part of medical training, especially for doctors who will specialize in pediatrics or general practice. Unfortunately, most American doctors lack this information. They know little or nothing about the function of the foreskin, or its development or correct care. Usually they also know very little about the reasons for circumcision. When asked about the advisability of the operation they often cite non‑medical arguments such as conformity or “social” reasons. Most American doctors’ only “knowledge” about foreskins is how to cut them off.

The most informative and helpful sources of information concerning the development and correct care of the infant’s foreskin have come from Great Britain. In 1949, Gairdner, a British physician, conducted a detailed study. According to his findings:

“The prepuce appears in the fetus at 8 weeks as a ring of thickened epidermis which grows forwards over the base of the glans penis. It grows more rapidly on the upper surface than the lower, and so leaves the inferior aspect of the shaft of the penis and the terminal part of the urethra that has yet to be constructed….

“From the inferior aspect of the glans a pair of outgrowths are pushed out and meet (the sulcus on the upper aspect of the glans marks their fusion) so enclosing a tube which becoming continuous with the existing urethra advances the meatus to its final site. These outgrowths from the glans carry with them the prepuce on each side, thus completing the prepuce inferiorly and forming the frenulum.

“By 16 weeks the prepuce has grown forwards to the tip of the glans. At this stage the epidermis of the deep surface of the prepuce is continuous with the epidermis covering the glans, both consisting of squamous epithelium. By a process of desquamation the preputial space is now formed in the following manner. In places the squamous cells arrange themselves in whorls, forming epithelial cell nests. The centres of these degenerate, so forming a series of spaces; these, as they increase in size, link up until finally a continuous preputial space is formed.

“The stage of development which has been reached by the time the child is born varies greatly….

“The prepuce is still in the course of developing at the time of birth, and the fact that its separation is usually still incomplete renders the normal prepuce of the newborn non‑retractable [emphasis mine].

Development of the Prepuce (After Spalding, Deibert and Hunter)

Development of the Prepuce (After Spalding, Deibert and Hunter)

“The age at which complete separation of the prepuce with full retractability spontaneously occurs is shown … [in a] study of 100 newborns and 200 boys up to age 5…. Of the newborns, 4% had a fully retractable prepuce, in 54% the glans could be uncovered enough to reveal the external meatus, and in the remaining 42 % even the tip of the glans could not be uncovered…. The prepuce is non‑retractable in four out of five normal males of 6 months and in half of normal males of 1 year. By 2 years about 20% and by 3 years about 10% of boys still have a non‑retractable prepuce…. Nonretractability depends on incomplete separation of the prepuce….

Cross Section

Cross section of infantile penis showing adherence of the prepuce to the glans penis. The urethra is on the right.

Cross section epithelial cells

Cross section between the adherent glans and penis showing nests of epithelial cells that ultimately degenerate and bring about a separation of the two surfaces.

“Among 200 intact boys aged 5‑13 years, 6% had non‑retractable prepuces; and 14% could only be partially retracted. Often this involved only a few strands of tissue between the prepuce and glans so that minimal force is required to achieve retractability.” 1

Development of prepuce

Development of prepuce. (a) Eights weeks; (b) sagittal section and ( c ) coronal section, 12 weeks; (d) 16 weeks; (e) at about term

Percentage of boys with retractable prepuce‑ Proportion of boys of varying ages from birth to 5 years, in whom the prepuce has spontaneously become retractable. Note that it is uncommon for this to occur in the first six months.

From: Gairdner, Douglas, D.M., M.R.C.P., ‑The Fate of the Foreskin: A Study of Circumcision,” British Medical Journal, Dec. 24, 1949, p. 1433, 1434.

Incidence of peputial adhesions

‑ Incidence of preputial adhesions in various age‑groups. ‑ Total material (9200 observations); ‑‑‑ 173 boys observed through 7 years (1160 observations); … 1086 boys observed in 1964‑65 (1052 observations).

From: Oster, Jakob, “Further Fate of the Foreskin; Incidence of Preputial Adhesions, Phimosis, and Smegma among Danish Schoolboys,” Archives of Disease in Childhood (British Medical Association), April 1968, p. 200.

Fetal penis cross section

Cross section of a penis from a 120 mm. fetus. Note the lack of cleavage between the prepuce and glans.

Reichelderfer and Fraga, in a chapter in a British‑based textbook on infant care, relate similar findings:

   “Our studies have shown that less than 1% of newly born infants could retract the prepuce. We examined 495 children up to 12 years of age. 25% could retract the prepuce at less than 6 months, 61% at 6‑12 months, 63% at I year, 79% at 2 years, 86% at 3 years, 85% at 4 years, 86% at 5 years, 90% at 6‑8 years and 100% at 9‑12 years. 2

   They include the following important information, of which parents and doctors must be aware:

   “If an attempt is made to separate the prepuce from the glans at birth by running a probe around the potential preputial space, numerous raw bleeding areas are encountered where the connecting tissues have been torn. Healing then takes place by fibrosis, leaving an adherent foreskin .

    This information is essential because frequently parents and doctors have believed that the infant’s foreskin should be forcefully retracted, either shortly after birth or during the first few months of his life before it has separated of its own accord. Sometimes new parents of intact sons have been instructed to retract and wash under their baby’s foreskin every day. In a society that is only familiar with circumcised penises, people have been led to believe that care of the intact penis is quite difficult and complicated, and therefore have proceeded to make it so.

   Forcible retraction of the infant’s or young boy’s foreskin before it has loosened naturally is extremely painful to the child and can create future difficulties which would not have occurred had it been left alone. While innumerable parents of circumcised infants have expressed remorse over having allowed their babies to undergo the painful operation, parents of intact sons often express just as much anger and dismay because their child had his foreskin forcefully torn back from his glans. Since the infant’s foreskin is normally adherent to his glans, artificially breaking these adhesions literally involves tearing one layer of skin away from another. Some observers have believed that this step of the circumcision procedure appears to be more painful to the baby than the actual clamping and cutting. Since forceful retraction of the foreskin often is done to the baby more than once, the intact baby in our unenlightened society has frequently experienced much more pain and trauma to his penis than the circumcised baby!

  Unfortunately, although British sources have clearly described the correct development and care of the foreskin, American medical sources have been replete with misinformation. For example, Taber’s Medical Dictionary, which is widely used in the United States by all branches of the medical profession, advises the following:

   “The foreskin is often tight after birth. It should be pulled back gently at birth to see that the meatus is clear, and then left alone for 8 days. After this, if still tight, it should be picked up in the thumb and finger and gently coaxed backwards twice a day. If it is inclined to bleed, smear it with an antiseptic ointment. Care must be taken not to strip it backwards too far or constriction of the glans (paraphimosis) may occur. If tightness still persists or there is any difficulty passing urine, a doctor should be consulted. Often the gentle [?] passage of a probe by the doctor, underneath the skin of the prepuce will obviate any need to circumcise.” 3

Even though extensive studies have shown that only 14% of all newborns’ foreskins are retractable, a leading medical text tells doctors and nurses that the tight foreskin of the newborn is abnormal and must be forcefully loosened! I have even known of parents who have wished to leave their infant sons intact, only to have the doctor advise them shortly after birth that circumcision must be done because the baby’s foreskin does not retract! This is reminiscent of new mothers who have been advised by doctors or nurses that they should not breastfeed because they “obviously don’t have any milk” ‑‑ both parties unaware that a new mother only secretes colostrum for the first few days!

What About the Problems that the Intact Male May Encounter?

Expectant and new parents frequently express concern that their son may have “problems” if he keeps his foreskin. However, most parents would not be able to define what those “problems” might be. Sometimes people have known an intact male or parents with an intact son who did experience a problem with his foreskin, or has been circumcised during childhood or adulthood, and have understandably wondered if the easiest solution would be to have the foreskin cut off at birth.

The two major problems that intact males encounter are phimosis‑the condition in which the foreskin is either tight or adherent to the glans and cannot be easily retracted, and infection of the foreskin. A thorough analysis of both of these conditions, how and why they occur, and how they can be prevented or remedied, is necessary. Weighed against the risks of the operation itself, and the advantages of having one’s foreskin, is circumcision justified as a preventive measure against either phimosis or infection? If either condition occurs, is circumcision the only, or the most advisable cure? Or can the problem be resolved by simpler, less drastic means?

Phimosis

There are three categories of phimosis. The first is the frequently misunderstood, normal developmental condition in the infant or young boy in which the foreskin is not yet ready to retract. This condition is not true phimosis because it is normal.

Secondly there is “congenital phimosis.” This is the condition in which a foreskin which is left alone during infancy and early childhood never does loosen or retract naturally. Some authorities, aware of the non‑retractability of the prepuce at birth and during early childhood, still label the remaining small percentage of boys with non‑retractable foreskins at age 4 or 5 as having “congenital phimosis.” However, since other studies have revealed cases of foreskins first becoming retractable during late childhood or teenage years, the use of this term is highly questionable. “Congenital” implies that the condition is a birth defect, and therefore an abnormality. Some tight foreskins are actually not adherent to the glans, but simply have small openings making retraction difficult. True congenital phimosis appears to be extremely rare.

Thirdly, there is “acquired phimosis.” This is the unfortunate, troublesome complication brought about by the forceful retraction of the normally adherent foreskin of the infant or young child. When two adjacent surfaces of skin are forced apart, this causes tearing, bleeding, and exposure of raw skin surfaces, the same as if a layer of skin were pulled off of any other body surface. Then, when the two fresh, raw, bleeding skin surfaces are placed back together, such as when the infant’s foreskin is replaced over the glans, these two surfaces heal together creating scar tissue, leading to a troublesome, abnormal attachment of the prepuce to the glans. This is why it is extremely important that the foreskin NOT be retracted until it has loosened of its own accord.

Occasionally parents of intact sons have been frantic with worry that their son will develop acquired phimosis after one episode with forcible retraction by an unknowledgeable doctor. Consultation with medical authorities about this has indicated that if this happens, the foreskin should subsequently be left alone. A single incident of forceful retraction appears not to lead to significant build‑up of scar tissue or adhesions. A small amount of petroleum jelly or other ointment applied between the glans and the prepuce may help prevent the two surfaces from healing together. Usually the unfortunate child is in considerable pain from this event and is quite resistant to having his foreskin retracted again.

Parents of intact sons may have to take the responsibility of educating their doctors about this matter. And since doctors have been known to forcefully retract babies’ foreskins without any warning or discussion, parents should discuss the matter with their doctor prior to the baby’s examination. Also, since some doctors retract the foreskins of newborn infants in hospitals, parents wishing to leave their sons intact should, during prenatal care, instruct the doctor not to retract the baby’s foreskin if they have a boy.

Gairdner states the following in regard to phimosis:

“Since in the newborn infant the prepuce is nearly always non‑retractable, remaining so generally for much of the first year at least, and since this normal non‑retractability is not due to tightness of the prepuce relative to the glans but to incomplete separation of these two structures, it follows that phimosis (which implies a pathological constriction of the prepuce) cannot properly be applied to the infant. Further the commonly performed manipulation known as ‘stretching the foreskin’by forcibly opening sinus forceps inserted in the preputial orifice cannot be justified on anatomical grounds besides being painful and traumatizing. In spite of the fact that the preputial orifice often appears minute‑the so‑called pinhole meatus‑its effective lumen, when tested by noting whether or not a good stream of urine is passed, is almost invariably found to be adequate.” 4

In Denmark a study was made on the eventual outcome in a population group in which intact foreskins are left alone until total retractability occurs spontaneously.
“Oster conducted 9,545 observations on the state of the prepuce in 1,968 schoolboys aged 6‑17 years. The boys were examined annually for up to 8 years between 1957 and 1965. 4% of these boys had phimosis; 2% had tight prepuces; and 5% had smegma. Incidence of phimosis decreased with age ranging from 8% among the 6‑7 age group to 1 % among the 14‑17 age group. Smegma increased slightly, ranging from 1 % among the 6‑9 age group to 8 % among the 14‑17 age group. Preputial adhesions which did not constitute phimosis ranged from 63 % among the 6‑7 age group to 3 % among the 16‑17 age group.

The author concludes:
“Physiological (congenital) phimosis is a rare condition in schoolboys, and it has a tendency to regress spontaneously; operation is rarely indicated. Clumsy attempts at retraction probably cause secondary (acquired) phimosis, which then requires operation.
“Preputial non‑separation (‘adhesion’) occurs frequently, but separation of the epithelium takes place gradually and spontaneously as a normal biological process in the course of school life and is concluded about the age of 17.
“Production of smegma increases from the age of about 12‑13 years. Neither this nor the hygiene of the prepuce present any problems if the boys are regularly instructed.” 5
Paraphimosis is another problem which is caused by forceful, premature retraction of the infant’s tight foreskin. In this condition the tight foreskin has been pushed back, exposing the glans, and then constricts so that it cannot be replaced. Swelling ensues and the helpless infant is in considerable pain. Some doctors will perform an immediate circumcision to remedy the situation, although others have found that simply soaking the penis in warm bath water will ease the swelling so that the foreskin will go back over the glans.

Gairdner discusses this:
“Through ignorance of the anatomy of the prepuce in infancy, mothers and nurses are often instructed to draw the child’s foreskin back regularly, on the supposition that stretching of the foreskin is what is required. I have on three occasions seen young boys with a paraphimosis caused by mothers or nurses who have obediently carried out such instruction: for although the size of the prepuce does allow the glans to be delivered, the fit is often a close one and slight swelling of the glans, such as may result from forceful efforts at retraction may make its reduction difficult.” 4

It is clear that the prepuce of the infant and young boy should be left alone. But what about the still‑tight foreskin of the older child, teenager, or adult? Some doctors, even those who know that the infant’s foreskin is normally tight, still recommend circumcision for the small percentage of boys whose foreskins do not retract after ages 4 or 5. Are there other, simpler alternatives In the United States, any parent of an intact son, and the intact male as he grows older, is likely at one time or another to encounter a doctor who recommends circumcision. As long as our society is circumcision‑oriented and regards the intact penis as an oddity, there will always be some medical authorities who think that foreskins should be cut off at the slightest indication of a problem. (This is not unlike bottle‑feeding oriented doctors who recommend weaning rather than resolution for any problem with breastfeeding.) Parents of intact sons, and intact individuals must be knowledgeable and ready to consult other physicians or sources of information when and if cutting off the foreskin is recommended.Many intact individuals have found that gradual stretching of one’s own foreskin usually can loosen it if it is tight or adherent. Most little boys handle their own penises. During early childhood this is rarely true masturbation. It is merely curiosity about one’s own body parts, similar to exploring one’s toes. Many little boys have unintentionally helped their own foreskins to loosen by doing this.

Jeffrey R. Wood, Founder and President of INTACT Educational Foundation gives the following advice:

…”Sadly, many American doctors are trained to think of circumcision as the only alternative to any problem involving the foreskin‑when, in fact, there are many other choices which may be more advantageous to the patient.
“…Anyone who doesn’t want to be circumcised [or allow their son to be circumcised‑RR] doesn’t have to be‑except in the rarest cases….

The prescribed time for the foreskin to loosen varies greatly with the individual –
“…It may be before birth or after puberty! … Normally it occurs before the age of four, [although] some men are not fully mature until around 25. In some cases [of late failure of the foreskin to separate into older childhood or teens], stretching exercise seems advisable to facilitate the loosening process. (Usually this can be done by the individual in private.)

“…Difficulties with the foreskin can be among the many signs that one is not eating properly and an improved standard of nutrition provides benefits to the entire body not just the foreskin…. There is a theory, as yet undocumented, that continued heavy dependence on milk into early adulthood in certain individuals somehow prevents the foreskin from getting its genetic message to loosen up. Unfortunately, the average American diet is built around milk and dairy products as one of its key ingredients so that it is somewhat of a challenge for anyone in this country to maintain a nutritionally adequate diet that avoids these staples. But it is possible, and when refined carbohydrates and other ‘junk foods’are eliminated as well, the results are incredible. One of the most notable benefits is a greater resistance to colds and all types of infections. Some uncircumcised men have even noticed that smegma has ceased to accumulate. As for the foreskin loosening up, this requires time and patience, and since it might have happened anyway, the significance of improved nutrition in this regard is difficult to establish. But it’s certainly worth a try‑for the other benefits alone!

“In the rare cases where surgery is required, there are two alternatives to … complete circumcision…. The simplest operation is known as the dorsal slit, in which nothing is actually removed, and the effect of which is to make the foreskin more easily retractable…. [The other alternative is] partial circumcision‑in which only the contractile tip of the foreskin is removed‑the part which in phimosis has failed to acquire the ability to expand. What remains of the foreskin continues to protect the glans in the flaccid state…” 6

Infection of the Foreskin

 When I first made plans to write this book I intended to devote an entire chapter to the problem of infected foreskins. I had so frequently heard about infection being a common, troublesome problem among males with foreskins that I expected to uncover a great deal of information about this. Surprisingly I have found very few resources that even discuss the matter.

Nonetheless, expectant and new parents are frequently told about the “danger of infections” if their baby is not circumcised. Is this argument justified when balanced against the very common problem of meatal ulceration and other problems that are exclusive to circumcised males?

If the foreskin does become infected, is immediate circumcision the best or the only appropriate remedy for the condition.

Three medical terms refer to infections of the foreskin and/or glans. Balanitis refers to an inflammation of the glans penis and mucous membrane beneath it. Posthitis refers to the inflamed condition of the foreskin. Balanoposthitis refers to both.

As was thoroughly discussed in the chapter covering complications, the reddened, swollen prepuce of the infant still in diapers is actually protecting the more delicate glans from the much more painful, troublesome problem of meatal ulceration.

Gairdner discusses this:

“Inflammation of the glans is uncommon in childhood when the prepuce is performing its protective function. Posthitis‑inflammation of the prepuce‑is commoner, and it occurs in two forms. One form is a cellulitis of the prepuce. This responds well to chemotherapy and does not seem to have any tendency to recur. Hence it is questionable whether circumcision is indicated. More often inflammation of the prepuce is part of an ammonia dermatitis affecting the napkin (diaper) area…. The urea‑splitting Bact. ammoniagenes (derived from fecal flora) acts upon the urea in the urine and liberates ammonia. This irritates the skin which becomes peculiarly thickened, while superficial desquamation produces a silvery sheen on the skin as if it were covered with a film of tissue paper. Such appearances are diagnostic of ammonia dermatitis, and inquiry will confirm that the napkins, particularly those left on through the longer night interval, smell powerfully of ammonia….

“When involved in an ammonia dermatitis the prepuce shows the characteristic thickening of the skin, and this is often labeled a ‘redundant prepuce’‑another misnomer which may serve as a reason for circumcision. The importance of recognizing ammonia dermatitis lies in the danger that if circumcision is performed, the delicate glans, deprived of its proper protection, is particularly apt to share in the inflammation and to develop a meatal ulcer. Once formed, a meatal ulcer is often most difficult to cure. ” 7

As the individual matures and his foreskin loosens, virtually all potential problems with foreskin irritation or infection can be prevented by simple, regular washing. Some problems with foreskin infection can result from the individual’s not knowing how to properly clean this part of his body. Although retracting one’s foreskin while bathing is extremely simple, in our society, where the intact male has been an oddity, he may grow up never knowing that his foreskin should be retracted. Another factor is that circumcision has sometimes followed social class patterns in our society, so that in past decades the upper and middle classes have been more likely to choose circumcision for their sons, while the lower classes have been more likely to leave their sons intact. (Sometimes the “choice” was made for financial reasons – hence, unfortunately associating foreskins with poverty.) This has contributed to people’s prejudice against foreskins. Also, sometimes people at lower income levels may have had less access to bathing facilities, general healthcare or nutritious foods, while many have worked at jobs requiring hard physical labor and/or contact with dirt, thus possibly predisposing them to infections regardless of their circumcision status.

Family with newborn

© Suzanne Arms


“After hearing descriptions of tying the child down or holding him forcibly and how most of the scream as no anesthetic is used, I began to question the practice. We were searching for a positive birth experience with a loving atmosphere and caring attendants. A circumcision would be a less than positive event and certainly not peaceful.”


Sylvia Topp comments:

“It seems to be true that a person who is not circumcised can develop infections of the foreskin, obviously a problem that would be unknown to a circumcised man. However, these infections are usually not serious and not one of the uncircumcised men I interviewed mentioned having such problems. A few said they had had warts which had been removed but one said he knew a circumcised man who also got warts. Now, although an infection can be annoying, is it really a good enough reason to perform an operation on every male baby? Other parts of the body get infected all the time, but this as far as I know is the only case where surgery instead of cure is preferred as treatment…

“Unfortunately, few of the (intact) men I talked to had been trained in the care of the foreskin, since this knowledge is not easily available to this minority of American boys and men. Two of the men hadn’t pulled back their foreskins until they were adults because there was no one around to explain anything to them. Another had his foreskin attached in a thin line at the back of the penis head and had asssumed that everyone’s was since he had no one to compare himself with. He lived with the difficulty of cleaning in the corners that this attachment formed until intercourse ripped the skin loose, and of course frightened him.” 8

Some types of irritations can occur as a result of too much attention to cleaning. One doctor relates:

I have never seen any penile condition that could be attributed to smegma. Many irritations are due to excessive cleansing ‑ especially soap.” 9

Much of the need to inform the public about the correct care of the intact penis is similar to the need to enlighten and educate the public about breastfeeding. The doctor who advises that all infant males should be circumcised because “He might develop an infection of the foreskin” is very much like the doctor who advises that all mothers should bottle‑feed because otherwise “She might develop sore nipples or a breast infection.” Some doctors, upon treating breastfeeding problems (which can be much more troublesome than foreskin problems!) conclude that “Breastfeeding is too fraught with difficulties for today’s mother.” Those of us who seek the benefits of more natural choices for our children prefer positive alternatives rather than such a defeatist attitude.

The Intactivism Movement

Ever since man first decided that foreskins should be cut off, other people have been objecting to the practice. Tribes that left the penis alone often criticized or sneered at other tribes who practiced circumcision. Since circumcision has only rarely been the choice of the individual, complaints and protests have often come from the victims themselves. Their laments were usually unheard. Years later they would be circumcising their own sons.

As soon as circumcision first became a medical practice during the late 1800’s, the operation had its share of critics. Yet the operation’s popularity grew throughout the early decades of this century, as birth became “assembly line processed” in hospitals. Circumcision has always had its dissenters, but during recent decades when the rate of neonatal circumcision approached 98% in many parts of the United States, these individuals have been “voices crying in the wilderness.”

Most circumcision critics have been men who have been victims of complications of the operation, or who have simply resented their lack of foreskin. Some were born during the earlier part of this century and now feel dismayed to find that nearly all boys today are deprived of their foreskins. Usually their efforts have ended in burn-out and frustration. They have had few listeners and rarely did their efforts reach the people that need to be educated – prospective parents! Out of their frustration, or due to poor methods of dealing with people their cries were usually extremely vehement and bitter. Most were dismissed as angry fanatics. One of the most vitriolic of the anti-circumcision crusaders was Joseph Lewis, a Jewish man who in the 1950’s wrote In The Name of Humanity, an angry tirade against infant circumcision, especially the Jewish ritual. Lewis was an atheist and wrote many treatises on atheistic causes. Therefore, his efforts were bound to alienate anyone with religious beliefs. Lewis had few listeners.

Many intactivists have condemned doctors who perform the operation as evil, money-hungry butchers, and label parents who choose circumcision as sadistic child abusers! Others rant and rave about the mutilated, sexually deficient circumcised organ. As one of the “pioneers” in modern day intactivism I understand and empathize fully with their ardor, especially since after so many years and so much effort infant circumcision continues to happen. I call their expression justifiable, righteous anger. Unfortunately, too many people fail to understand that an angry, condemning approach is only a detriment to the cause. Most people will not listen or learn from such epithets. Some may actually feel driven to have their sons circumcised so that they will not be like “those angry fanatics.” For parents do not choose circumcision out of conscious intent to harm their child. Nor do most doctors perform the operation out of sadism. People have simply been misinformed. No one wants to believe that they have done something wrong. Nor does any man want to believe that there is something wrong with his penis. Many doctors are resistant to learning from lay people. Even when the circumcision issue is presented calmly, factually, and gently some people find the subject too difficult to handle. (So fellow intactivists, let’s keep our angry rants to our selves in our closed groups and try to be kind and understanding, although informative, when dealing with the general public. I remember how I once felt as a naive new mother.)

In order for our intactivism to have a significant impact on the American public, the message must reach expectant parents and the professionals who work with them. The childbirth education movement has had to emerge and develop as a powerful force before the two concerns could join.

During previous ages there was little need for organized childbirth education. Such knowledge was passed down and shared from woman to woman in a direct, informal way. Most babies were born at home with female friends and relatives in assistance. Families were large and girls grew up with knowledge about birth and infant care. During this century families have become smaller and more fragmented. Birth was transferred to the domain of male medical professionals and became centralized within hospitals. Parents were left knowing virtually nothing about birth or infant care. Usually they placed their trust in the medical profession, but the support received therein was often woefully lacking. Organized classes in childbirth education have, in part, been an effort to fill this gap.

The childbirth education movement began as an effort to develop and introduce methods of giving birth comfortably without medication, thus providing psychological and physiological benefits to mother and baby. Psychoprophylaxis and conditioned response were first studied in Russia during the late 1800’s by Pavlov. These techniques were subsequently applied to women in labor for dealing with contractions. Dr. Fernand Lamaze, a French doctor, learned these methods during the 1920’s and further developed them. During the 1950’s an American woman, Marjorie Karmel, gave birth in France under Dr. Lamaze’s direction. She subsequently introduced the Lamaze method in the United States. Concurrently, during the 1920’s and ’30s Dr. Grantly Dick‑Read developed the Read method which is based on relaxation, deep breathing, and spirituality. During the 1940’s and ’50s Dr. Robert Bradley, using Read’s philosophy, plus his own observations of animals giving birth, introduced the Bradley method. His most important contribution was the introduction of the husband as labor‑coach and active participant during birth.

Until the late 1960’s classes in childbirth education were often difficult to find. Doctors tended to be skeptical if not adamantly opposed to childbirth classes. Many resisted the idea of allowing fathers into delivery rooms. Frequently doctors and nurses did not want their patients to be informed or knowledgeable because that made them “ask too many questions.” Expectant parents often had to search far and wide simply to find doctors and hospitals willing to allow the father to be present during birth or agree to let the mother deliver without medication.

The popularity of childbirth education classes has burgeoned during the past few years due to increasing interest in natural health and consumer awareness. Consumer pressure has contributed to acceptance of childbirth education by most doctors and hospitals. Today, classes in prepared childbirth are available in virtually all communities in the United States and most developed countries.

During the latter half of the 1970’s some factions within childbirth education have become increasingly critical of standard procedures within hospitals, such as episiotomies, pubic shaves, enemas, heart monitors, and separation of mothers and babies. The childbirth education movement has produced a plethora of books and publications. The first books centered on basic issues such as father participation during birth and the advantages of giving birth without medication. Many books published more recently have been increasingly openly critical of dehumanizing hospital procedures and doctor control of birth. Within childbirth education the home‑birth movement has emerged, as many parents, desperate for a humane and meaningful birth experience have chosen to stay home to give birth. As an alternative to both hospital and home birth, alternative birthing centers have provided a comfortable choice for many.

Throughout all of this, infant circumcision has received very little attention. There have simply been too many other important issues to bring light and question. Questioning circumcision is still just beginning to emerge as a worthy issue to be covered in childbirth education classes. Unfortunately, too many childbirth educators still provide only vague, neutral advice to prospective parents.

Dr. Frederick Leboyer’s book and philosophy about Birth Without Violence became popular during the mid‑1970s. Being French, it never occurred to Dr. Leboyer to mention circumcision. However, he introduced the concept that newborn babies have feelings! Never before had we thought about the baby’s perception of birth! Some new parents began trying the Leboyer method when giving birth. But we were typical Americans who had never thought to question the cutting off of baby boys’ foreskins. Those of us who gave birth to sons found ourselves shocked with the painful reality!!

During this time, in 1976, Jeffrey R. Wood established INTACT Educational Foundation in Wilbraham, Massachusetts. He promoted the adjective “intact” to define the state of the penis that has its foreskin. Whenever possible we use this term as a more positive sounding alternative to “uncircumcised.”

Some of Mr. Wood’s letters to his followers relate this organization’s history and purpose:

“As we begin to understand something of the complex psychosexual processes that underlie this barbaric assault against masculine integrity, there is a link being established between the violence inflicted upon helpless infants, and the unrest which they may in turn manifest when older. We are discovering that emotionally as well as physically, the results of circumcision are unpredictable and often disastrous. Only in a religious context does there seem to be any less potential for lifelong psychological consequences, yet even progressive elements within the Jewish culture are calling for reform on this vital issue. What has been taken for centuries to symbolize a covenant of faith now increasingly appears to be symbolic of the same contempt for nature that has brought mankind to the very brink of self‑destruction. Today’s trend toward more natural living is not merely another fad, it is an expression of humanity’s deepening concern for its ultimate survival.” 9

“Inspired by the work of Roger and Peggy Saquet, whose Non‑Circumcision Information Center offered free material to readers of Boston’s alternative newspapers, I established INTACT in the fall of 1976 to serve Western Massachusetts in much the same capacity. Both N‑CIC* and INTACT work harmoniously together, each sharing its ideas and reprints with the other, and in recent months, each has received some degree of national publicity. The name INTACT came about in the following manner. The alternative newspaper here in the Pioneer Valley, the Valley Advocate was my initial advertising medium, and it charges by the word for classified ads. “NonCircumcision Information Center of Western Massachusetts” would come to seven words, running up the advertising bill considerably. Not wanting to use a mysterious, unpronouncable bunch of initials, I hit upon INTACT as a good code word. The name stuck, actually, it’s our entire message condensed into just one word! Incidentally I’ve always thought that the letters in our name should all stand for something, as in ‘Immediate need to Abolish Circumcision Totally’‑but that particular choice sounds too extreme for good public relations    [He later came upon “Infants Need to Avoid Circumcision Trauma.]” 10

Most books and publications about childbirth education or infant care say nothing or only give vague advice about circumcision. However, within the latter half of the 1970s and early 1980s a few books and publications have given more attention to the circumcision question. The Home Birth Book by Charlotte and Fred Ward includes a chapter on Primal Therapy by Patricia Nicholas which mentions circumcision trauma. (Inscape, c. 1976.) Labor and Delivery, An Observer’s Diary by Constance A. Bean (Doubleday c. 1977) includes a poignant, eye opening chapter entitled “The Circ Room” which describes infant circumcision in detail. (This chapter, entitled “The Circ Room” is now included on Peaceful Beginnings’ website. Magical Child by Joseph Chilton Pearce (Dutton c. 1977) strongly denounces circumcision. Mothering magazine has included a number of articles, including some written by me, opposing circumcision. In the winter of 1980, ICEA News (the newsletter of the International Childbirth Education Association) published a brief article opposing infant circumcision. Paul Zimmer, a pioneer intactivist in Pennsylvania, was listed as a resource and was deluged with requests for information. Right From the Start (Rodale Press c. 1981) by Gail Sforza Brewer and Janice Presser Greene includes a highly informative chapter about circumcision. The December 1981 issue of The Saturday Evening Post included two informative articles and an eye opening picture display of a baby being circumcised. (The Saturday Evening Post later sold the slide series used for this article to me. I reprinted them and for several years sold them to childbirth educators and others for use in informing the public. They are now printed on Peaceful Beginnings’ website as the feature entitled “One Baby’s Experience.” Some have also been reprinted and used widely in intactivist literature.)

My concern about infant circumcision dawned in 1977 following my third son’s home birth and subsequent circumcision. In 1979 I began selling copies of my circumcision slides and information sheets to childbirth instructors. In 1980 Jeffrey Wood appointed me as Vice President of INTACT Educational Foundation. Shortly thereafter I wrote out INTACT’s Philosophy and Policy and made several of our information sheets available singly and in bulk to the public. Two sets of informational slide series’ on circumcision were also made available. (Many of these information sheets now appear on my website.) Numerous ads and references in various childbirth education related newsletters and magazines have kept the public informed of our cause.

In 1979 Nicholas Carter’s book Routine Circumcision: The Tragic Myth was published by Noontide Press. His book was well researched, but is somewhat dated as he wrote it during the 1960s and searched 10 years for a publisher. The tone is quite angry and vehement and it has not been well received.

In 1980 Edward Wallerstein, a Jewish man, published Circumcision: An American Health Fallacy through Springer Publications. It is well documented and factual, with a calmer, more academic tone than many other works on the subject. It gained some respect among medical professionals.

In October of 1981 NBC Magazine did a feature on infant circumcision showing several infants actually undergoing the operation. I was on that program as was Edward Wallerstein and several doctors including Dr. Paul Fleiss whose interview appears in this book.

In 1983 Mr. Wood and I mutually decided to split forces due to personal, philosophical differences. Since my writings also cover a number of other babies and birth related topics in addition to circumcision I renamed my efforts Peaceful Beginnings’ and continued mailing out materials as before. Today Peaceful Beginnings’ exists as a website which is readily available to the online public.

Jeffrey Wood has retired from his efforts but his work will always be remembered as having played an essential role in the pioneering efforts of modern day intactivism. Roger Saquet’s “Non-Circumcision Information Center” has been inoperative for many years.

Intact boy

© Suzanne Arms


“It is an absurdity that something as simple as not cutting off part of the body should be considered ‘radical.’ “


What type of people are involved in this cause? Many, like myself, are parents of circumcised sons who regret our decision and have seen a desperate need for more information to be made available about circumcision. Others are parents of intact sons who have been uncertain or put on the defensive about their less conventional decision. Some activists are circumcised men who resent the fact that they lack their foreskins. Others are intact men, resentful about the absurdity of being “unusual” for having a natural penis. Many concerned individuals come from Jewish backgrounds. Some are childbirth instructors wanting to share this information with their students. Some are doctors and nurses who seem to be as frustrated with the medical establishment as the rest of us.

Like all causes, intactivism has had its critics. No matter how gently or factually we present our information, some people find our information too upsetting to accept. Some publications have been approached with articles about circumcision and have flatly turned it down. It is an absurdity that something as simple as not cutting off part of the body should be considered “radical.”

One of the major goals of intactivism is that our information become an accepted, vital concern within all programs of childbirth education. We urge that our materials and information be included in childbirth preparation classes, classes in infant care, and during prenatal care.

We have experienced immense concern and participation from childbirth educators and groups throughout the United States and elsewhere. We have also experienced our share of dissension and apathy. Like most major endeavors, the field of childbirth education has many factions and conflicts. Some classes are offered through specific hospitals and merely prepare the expectant parents to accept and cooperate with all of the hospital’s routines. Some instructors merely teach exercises and breathing techniques for labor and birth, and even consider such basic issues as nutrition or breastfeeding inappropriate to cover in class. Independent instructors are more likely to be true parent advocates, raising challenging questions and issues and urging parents to actively make choices and seek changes that will better their birth experiences.

Not all childbirth educators agree with intactivism’s total opposition to all genital cutting of non-consenting infants and children. Some advise in favor of circumcision. Many do not cover the topic at all. Others basically agree with us but are afraid to discuss it in their classes for fear of getting others upset if they present this vital information. Some feel that it is not right for the childbirth educator to influence people’s thinking on such a “personal” decision. This is just a cop-out, for virtually all parents have had so little information about circumcision that their “decision” scarcely deserves to be called such. And while the childbirth educator may not have thought the issue through, a neutral stance on infant circumcision is taking the position that only the needs and feelings of the parents are important, and that the babies’ rights and well-being have no significance. This approach may be easier and “safer” from the childbirth instructor’s perspective. However, growing awareness and true concern for the best interests of the helpless infants involved should hopefully inspire more and more childbirth educators to come out opposing the painful and unnecessary operation.

Making changes in society and inspiring people to think about something that they have never before considered is immensely challenging, frustrating, and rewarding. Fortunately, within childbirth education changes do take place relatively fast. Many issues that have been considered “radical” and “controversial” have become widely accepted and commonplace within a few years. During the early 1970s delivering without medication and fathers participation in the delivery room were “hot” issues, ”causes” for which we had to fight. Most childbirth educators considered other issues such as immediate contact with the baby, total rooming in, and home birth too “radical” to cover in their classes. Alternative birth centers, “birth rooms” in hospitals, or Leboyer births were unheard of. Today these practices have become commonplace in most parts of the country. In the years since, however, especially with the advent of widespread information available on the internet, our information soundly opposing infant circumcision continues to reach more expectant parents and increasing numbers of expectant parents have been leaving their baby boys intact.

Leaving ones child intact does have one major advantage. It is a far simpler matter than most other issues concerning infants and children. Similar causes such as alternative education for one’s children, specific diets, or even natural childbirth and breastfeeding require their followers to learn and do many things. Some choices require considerable expense and sacrifice. In contrast, leaving one’s son intact (as long as parents know to leave their child’s foreskin entirely alone) usually requires very little commitment or action (save for fending off critical relatives – especially in the United States.)

Next Section 18B
Section 18C     Timeline (18D)

References:

  1. Gairdner, Douglas, D.M. “The Fate of the Foreskin” British Medical Journal, Dec. 24, 1949, p. 1433‑1434.
  2. Reichelderfer, Thomas, M.D. and Fraga, Juan R., M.D. “Circumcision” Reprinted from Care of the Well Baby, 2nd Ed., @1968, J.B. Lippincott Co., by Kenneth S. Shepard, M.D., p. 297‑298.
  3. Thomas, Clayton L., M.D. ‑ editor Taber’s Cyclopedic Medical Dictionary F.A. Davis Company, Philadelphia, @1977, p. C‑75.
  4. Gairdner, p. 1435. 5. Oster, Jakob “Further Fate of the Foreskin” Archives of Diseases of Children, Vol. 43, 1968, p. 200‑203.
  5. Oster, Jakob “Further Fate of the Foreskin” Archives of Diseases of Children, Vol. 43, 1968, p. 200‑203.
  6. Wood, Jeffrey R. “Alternatives to Circumcision in the Treatment of Phimosis” INTACT Educational Foundation ‑ Informational Material
  7. Gairdner, p. 1435‑1436.
  8. Topp, Sylvia “Why Not to Circumcise Your Baby Boy” Mothering, Vol. 6, January 1978, p. 73.
  9. Wood, Jeffrey R. General Letter ‑ INTACT Educational Foundation
  10. Wood, Jeffrey R. “Notes from Jeff Wood” ‑ INTACT Educational Foundation