By Ronald Goldman
Mar 9, 2016
Marilyn Milos didn't know much about circumcision when she consented to have her three sons circumcised. She trusted her doctor who told her it did not hurt and "only took a moment." Several years later she watched a circumcision in nursing school. "We students filed into the newborn nursery to find a baby strapped spread-eagle to a plastic board on a counter top across the room." Then the doctor arrived. "The silence was soon broken by a piercing scream, the baby's reaction to having his foreskin pinched and crushed as the doctor attached the clamp to his penis. The shriek intensified when the doctor inserted an instrument between the foreskin and the glans (head of the penis), tearing the two [normally attached] structures apart. The baby started shaking his head back and forth, the only part of his body free to move, as the doctor used another clamp to crush the foreskin lengthwise. . . . The baby began to gasp and choke, breathless from his shrill continuous screams. . . . During the next stage of the surgery, the doctor crushed the foreskin against the circumcision instrument and then, finally, amputated it. The baby was limp, exhausted, spent."
Now she deeply regrets her sons' circumcisions and works tirelessly to educate others.
Most people still don't know much about circumcision. If you have ever read an article about circumcision, it probably focused on medical issues. Recently The New York Times reported that public health officials were considering promoting infant circumcision because of a controversial claim that it could help prevent disease.
A few relevant facts may surprise you. Circumcision is the only surgery in history ever advocated as a widespread means of preventing disease. When such claims are investigated by national medical organizations, they are found lacking. That's why no such organization in the world recommends circumcision. Over 80% of the world's males are not circumcised. Though many people associate circumcision with Jews, most circumcised males are Muslims. The United States has the highest rate of non-religious circumcisions of male infants in the world (32.5%). (The American rate peaked around 1965 at about 85%.) American circumcision rates vary widely depending on the region of the country.
In the continuous effort of certain American male investigators to seek a medical benefit, the potential adverse effects of circumcision have been ignored. Expanding the circumcision debate beyond medicine is overdue, and women have good reasons to be involved. Critically examining circumcision from psychological and sexual perspectives could show how this cultural practice may affect some mothers of circumcised sons, some women in relationships with men, and society. Before we consider these issues, let's review a few of the effects of circumcision on infants.
HOW PAINFUL IS CIRCUMCISION?
A variety of studies confirm that newborn infant responses to pain are similar to and greater than those in adult subjects. Robert Van Howe, M.D., a Michigan pediatrician who has authored numerous studies about circumcision, describes the infant's response. "Circumcision results in not only severe pain but also an increased risk of choking and difficulty breathing. Medical studies show significant increases in heart rate and level of blood stress hormone. Some infants do not cry because they go into shock from the overwhelming pain of the surgery." According to clinical definitions and researchers' reports, circumcision is traumatic. Even when pain medication is used (local injection, the best option tested), it relieves only some of the pain, the effect is inconsistent, and it wanes before the post-operative pain does. General anesthesia is not considered safe for newborn infants.
Increased awareness of extreme circumcision pain by Jewish mothers has contributed to growing questioning and forgoing of circumcision by some Jews, as reported in dozens of articles appearing in mainstream Jewish publications on the topic in recent years. Five rabbis endorse a book that questions Jewish circumcision.
EFFECTS ON MOTHER-INFANT RELATIONSHIPS
The trauma of circumcision raises questions about effects on mother-infant relationships. Based on more than twenty years of clinical observations using leading-edge techniques, psychiatrist Rima Laibow, M.D., reports,
When a child is subjected to intolerable, overwhelming pain, he conceptualizes mother as both participatory and responsible regardless of mother's intent. . . . The consequences for impaired bonding are significant. . . . Circumcision is an enormous obstacle to the development of basic trust between mother and child.
Even though the physician does the circumcising, and the father may have made the final decision to circumcise, the newborn infant connects the experience to the mother. Because the experience is repressed, the connection between the event and the mother is also repressed. (How this repressed connection affects men's feelings toward women is not known.)
Studies have shown that circumcision can adversely affect mother-infant bonding. Circumcised infants can be more irritable. Since infant irritability at two days has been connected with insecure bonding at fourteen months, the impact of circumcision on bonding may be more than temporary. The effect of circumcision on mother-infant bonding and interaction is evident in this account by Mary Milvich about her experience around the birth of her first child:
I shared a hospital room with a mother whose son was born within hours of my daughter. My roommate and I marveled at the identical personality traits exhibited by our newborn babies. Both were perfectly calm, never cried and gazed unwaveringly at our faces when we held them. We experienced that maternal closeness the mother feels when she realizes her baby knows her and accepts her as caretaker. . . . Delight in our new-found joys of motherhood was shattered the following morning. My roommate's baby had changed. He refused to nurse; he cried; he wouldn't be held. "He doesn't want me," my roommate pitifully told the nurse. "It's just the circumcision," the nurse told her comfortingly.
Investigators have confirmed that the trauma of circumcision may contribute to the failure of an infant to breast-feed. In addition, extended crying connected with circumcision may exceed the mother's tolerance level. She could become more interested in relieving her own distress (from hearing the crying) than that of her infant. If a mother believes she is not able to relieve her infant's distress, she may feel a lack of competence and respond less or not at all. She may also think her infant has a "difficult" temperament and use that belief as a reason not to respond.
Conversely, if an infant withdraws because of the trauma of circumcision, he may not communicate his needs, the mother could assume he is content, and his needs may not be met. Interaction between mother and child could be frustrating and less rewarding for the mother if she receives only a limited response from her child. Like all relationships, the mother-infant relationship is a two-way social relationship that depends on the responsiveness of both. If either the mother or the infant is unresponsive, the relationship may suffer, and emotional disturbances could occur. More research is needed.
MEN'S FEELINGS ABOUT CIRCUMCISION
To understand how circumcision may affect women in relationships with men, we need to know how circumcision can affect men. Current knowledge of male feelings about their circumcision is generally based on surveys published in medical journals, clinical experience, and reports from men who have contacted circumcision information organizations. These reports collectively include thousands of boys and men. Circumcision advocates dismiss these surveys and reports as "anecdotal."
In a medical journal survey of 546 self-selected men between the ages of 20 and 60 who reported circumcision harm, the following effects and feelings were noted.
- anger, rage, sense of loss, shame, sense of having been victimized and mutilated
- low self-esteem, fear, distrust, and grief
- relationship difficulties, sexual anxieties, and depression
- reduced emotional expression, avoidance of intimacy
Statements about circumcision from dissatisfied men include the following:
"I have felt a deep rage for a long time about this."
"Circumcision has given my life a much diminished and shameful flavor."
"I feel violated and abused."
Some of these circumcised men wish they had been given a choice at a later time rather than having it forced on them when they were too young to resist. Six medical societies in Australia and New Zealand and the British Medical Association recognize the long-term psychological risks of circumcision.
This survey does not suggest that all circumcised males have such feelings or how common the feelings are, only that they persist in some circumcised males, and more research is needed. There are various possible reasons why we don't hear more from circumcised men about how they truly feel.
- lack of awareness and understanding that circumcision could be associated with their symptoms
- emotional repression to defend against uncomfortable feelings
- fear of disclosure because they may be dismissed or ridiculed
EFFECTS ON MALE-FEMALE INTIMACY
Because research is limited, we can only speculate about how the potential psychological effects of circumcision on men could inhibit their relationships with women. For example, low male self-esteem, shame, fear, distrust, and sexual anxiety can adversely affect communication and limit the degree of intimacy. In addition, sexual intimacy is a major component of male-female bonding, and research has shown that male sexual activity increases when self-esteem is higher. If circumcision lowers both male self-esteem and sexual sensitivity (to be discussed later), it would tend to reduce male sexual activity and consequently weaken the pair bond.
Male-female relationships could also be restricted because some circumcised men may feel a nagging sense that passion, excitement, or sexual fulfillment is missing. If a man believes he cannot experience what he is missing with a woman, he may withhold commitment and continually seek new women to give him hope. In addition, the reduced emotional expression of circumcised men may dampen women's feelings. As a result, both men and women may feel something is missing from their relationships.
From a larger perspective, it would not be surprising if circumcision were found to have a negative effect on interpersonal relationships, since circumcision is a trauma, and trauma commonly impairs a person's relations with others. Harvard psychiatrist, professor, and author Judith Herman writes that after a traumatic event "a sense of alienation, of disconnection, pervades every relationship."
Research has also shown that men have a lower physiological tolerance to emotional stress than women do. Emotional numbing, a response to trauma, would tend to reduce a person's tolerance to emotional stress. This would account for the male tendency to avoid certain situations, such as marital conflict. One method men use to control their exposure to this emotional stress is to respond rationally rather than emotionally. Another tactic is to withdraw or stonewall during a conflict. Both behaviors can weaken the marital relationship by restricting communication and leaving conflicts unresolved. Does circumcision increase America's uniquely high divorce rate?
Emotional numbing also affects our sensitivity to others' pain because it is related to our sensitivity to our own pain. When an infant is subjected to the trauma of circumcision with nobody responding to his cries, he experiences our insensitivity to his pain. If we do not have empathy for infants, they may not have empathy for others. A male acquaintance, after reading about circumcision, remarked, "It hurts, and the baby screams. So what?" Circumcision may be an early experience that reduces male empathy.
It appears that there are a few reasons why circumcision could be a contributing factor to relationship difficulties between men and women. More research is needed.
EFFECTS ON SEXUAL RELATIONSHIPS
To understand how circumcision may impair women's sexual relationships with men, we need to learn about the foreskin. Christopher Cold, M.D., Chairman of Anatomical Pathology at the Marshfield Clinic in Marshfield, Wisconsin, has studied and written about the foreskin. "It has important functions. The foreskin protects the head of the penis throughout life from contamination, friction, drying, and injury. It is an integral, natural part of the penis, not 'extra.' On the average adult male it is about twelve square inches [some circumcised men guess less than one square inch], and it consists of a movable, double-layered sleeve. The foreskin enhances sexual pleasure. Detailed study shows that it is made up of unique zones with several kinds of specialized nerves that are important to natural sexual function and experiencing the full range of sexual sensations."
Loss of the foreskin results in thickening and progressive desensitization of the outer layer of the head of the penis, particularly in older men. Some men circumcised as adults report a significant loss of sensitivity and regret the change. Circumcision may be an unrecognized factor in the high rates of erectile dysfunction in American men, which would involve associated psychological effects. Of course, any sexual and associated psychological effects on men would affect women.
Women who have only had sex with circumcised men may not know what they are missing. According to surveys in the medical literature, women reported that they were significantly more likely to have vaginal dryness during intercourse with circumcised men than genitally intact men. A medical journal survey of women who had comparative sexual experience included 138 responses. Other things being equal, on a scale of ten, they rated genitally intact men 8.03 and circumcised men 1.81. With circumcised partners, women were less likely to have one or multiple vaginal orgasms, and their circumcised partners were more likely to have a premature ejaculation. Circumcision was also connected with vaginal discomfort. Women were less likely to "really get into it" and more likely to "want to get it over with" if their partner was circumcised.
The results can be explained. The foreskin, as previously mentioned, is a movable, double-layered sleeve. During intercourse, it glides up and down the penile shaft, reducing friction and retaining vaginal secretions. Without the foreskin, the skin on the penile shaft rubs against the vaginal wall, resulting in friction and increasing the need for artificial lubrication. The circumcised man has less sensitivity and requires deeper and harder thrusting to try to compensate, further increasing the friction.
With circumcised partners, surveyed women were more likely to feel unappreciated, distanced, disinterested, frustrated, and discontented. When their partners were not circumcised, women were more likely to feel intimate with their partners, relaxed, warmth, mutual satisfaction, and "complete as a woman," and the greater sexual satisfaction benefited the relationship. To be clear, this does not mean that women cannot have a satisfying emotional and sexual relationship with a circumcised man. Other things being equal, it means that such a relationship may be likely to be even more satisfying if the man were not circumcised.
MALE ABUSES TOWARD WOMEN
It is possible to compare circumcision rates by country to prevalence of male abuses toward women that include violence, repression, isolation, murder, rape, and forced marriage. The ten worst countries for women are Afghanistan, Democratic Republic of Congo, Iraq, Nepal, Sudan, Guatemala, Mali, Pakistan, Saudi Arabia and Somalia. Eight of these countries have a male circumcision rate that exceeds 80%. Two other countries have a rate between 20% and 80%.
In the United States, domestic violence is the single greatest cause of injury to women. Every fifteen seconds a man beats a women. Low self-esteem can contribute to this behavior. Men low in self-esteem are more prone to jealously in their relationships. Jealously is a precipitating factor in violence toward women. Predictably, low male self-esteem, a possible effect of circumcision, correlates with a high risk of domestic violence. It has also been documented that exposure to violence in childhood is linked to later spousal abuse. The child experiences circumcision as violent. Those who have been violated generally have a problem with anger and may direct it at others.
The association between circumcision rates and abuses toward women could be related to the long-term psychological effects of circumcision on men which, in addition to low self-esteem and anger, include disruption in the mother-male child relationship, post-traumatic stress disorder, weakened relationships with women, and low empathy. More research is needed.
UNNECESSARY FEMALE SURGERY
Let's examine if the long-term effects of circumcision could affect the surgical inclinations of circumcised doctors. For example, women are subjected to excessive risk for unnecessary surgery in the United States. Six of the top thirteen most frequently performed surgeries and procedures were performed exclusively on women. An episiotomy is routinely performed on a mother during birth. Some women view this obstetrical practice, which has no demonstrated benefit and only adverse effects, as female genital mutilation. About 569,000 hysterectomies a year lead to over 600 deaths annually. Critics claim that 98% of hysterectomies are unnecessary.
Is there any connection between unnecessary female sexual surgery and male circumcision? Virtually all cultures that widely practice unnecessary female sexual surgery also practice unnecessary male sexual surgery, and men control both practices. Such is the case in the United States. In Europe where circumcision is rare, the rate of unnecessary female sexual surgery is much lower. In addition, it seems that circumcised men who have been denied the full expression of their sexuality may unconsciously seek a way to deny others that pleasure, whether they use social custom, fear, ignorance, or sexual surgery. According to psychological clinical literature, such behavior is connected with the compulsion of those who are traumatized to repeat the trauma on others. As psychiatrist Karl Menninger said, "What's done to children, they will do to society." Finally, a study on the underlying reasons for female genital mutilation concluded that the motivation was psychosexual and included male fear of female sexuality. A potential long-term effect of circumcision is fear of female sexuality.
Addressing male circumcision may help dealing with female genital mutilation and other forms of unnecessary female sexual surgery. Research into this connection is important because these practices adversely affect hundreds of millions of people worldwide.
WHY WOMEN ARE GETTING INVOLVED
There is much more we could investigate. Do potential anger and rage associated with circumcision contribute to uniquely high American rates of female murder victims, rape, and domestic violence? We do not know. Because male motivation and money are steered toward seeking potential benefits for circumcision, we are not likely to know all the effects of circumcision any time soon. However, more than enough is now known (and not known) to question this cultural practice. Women are particularly encouraged to be involved in the circumcision decision for their son.
- Women are not subject to the personal psychological motivations of circumcised men to want their son circumcised (e.g., "I want him to look like me").
- Some women have experienced long-term regret ("deep wound of guilt" "my gravest parenting mistake") if they consented to circumcision.
- Women sign the majority of hospital circumcision consent forms.
Times are changing. More women are thinking about circumcision seriously, seeking independent sources of information, often long before giving birth, and not yielding to men who want it for their son.
Because of male psychological resistance to this issue and the maternal instinct to protect infants from harm, women are more likely to see through the cultural blinders and take action. Women are getting involved in educating others either personally, with the Internet, or through pertinent organizations. One who is speaking out is Melissa Morrison, who chose circumcision for her son because "it was something that was just done." She watched her son's surgery and now deeply regrets her decision. "People need to know what they are doing to their babies. I didn't know. I'm talking to my girlfriends; I'm talking to mothers. If it helps just to save one baby, then it's worth it."
References are available upon request. Please go to contact us page.
Ronald Goldman, Ph.D. is a psychological researcher, educator, and Executive Director of the Circumcision Resource Center in Boston, a nonprofit educational organization. Dr. Goldman is internationally known for his work on circumcision and is the author of Circumcision: The Hidden Trauma and Questioning Circumcision: A Jewish Perspective. He gives lectures on the psychosocial aspects of circumcision, counsels parents and circumcised men, and has participated in over two hundred interviews with broadcast and print media.