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Normal versus Cut - Final Psychological score 100-0

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Abstract

The thought came to me like the proverbial thunderclap: No psychological study has ever concluded that circumcision is beneficial to a boy's psyche. But was my sudden hypothesis true? What I discovered after an exhaustive search of the literature was that more than one hundred scientific studies found circumcision painful, traumatic, or psychologically harmful to men and boys, but not one peer-reviewed study has shown it benefits the male psyche.
By Dan Bollinger, 2014
The thought came to me like the proverbial thunderclap: No psychological study has ever concluded that
circumcision is beneficial to a boy’s psyche. But was my sudden hypothesis true? What I discovered after
an exhaustive search of the literature was that more than one hundred scientific studies found
circumcision painful, traumatic, or psychologically harmful to men and boys, but not one peer-reviewed
study has shown it benefits the male psyche.
Included in my comprehensive search were articles dealing with the short- and long-term psycho-sexual
consequences of circumcision, early trauma, or early sexual abuse. Also included were articles on
neonatal circumcision pain control, and the effect of early pain on the brain and its development.
Background
The pros and cons of other aspects of circumcision are well-discussed in the literature including
medicine, ethics, law, religion and ethics. However, in psychology the discussion is decidedly one-sided
in favor of avoiding the trauma.
Psychology’s study of circumcision began in earnest in 1965 when Gocke Cansever tested children
before and after circumcision with a battery of standard psychological tests and concluded that
circumcision is perceived by the child as an assault.
i
Since then many other studies have researched
circumcision. Bertil Jacobson and Marc Bygdeman found circumcised men are more likely to commit
suicide.
ii
My study with co-author Robert Van Howe found circumcised men were more likely to test
high for alexithymia (inability to identify and express one’s emotions).
iii
Sure there are some op-eds that claim circumcision is the greatest thing since sliced bread. And online
discussions are full of comments from people who are staunch believers in the religio/cultural/sexual
power of cut penises. But opinion and anecdotes are not science.
A seven-part series in Psychology Today on circumcision did not reveal any improvement to a boy’s
psyche. An essay by Kurt Johmann in 2003 listed a plethora of negative consequences, but no positive
ones.
The topic often comes up for discussion in online forums such as Yahoo! Answers. For instance, one
person asked, “Is circumcision beneficial to men’s health?” The best answer, chosen by readers, was:
“There is also the psychological trauma when teens are rejected because their female partners did not
want to engage in sexual activity with an uncircumcised male. The author did not provide any
references for this claim. Of course the opposite could be claimed as well, especially since the U.S.
intact-to-cut ratio is nearing 50/50.
A comprehensive online survey of 901 men investigated the psychological consequences of
circumcision. The vast majority of the men reported negative consequences with about one-tenth
reporting no negative consequences, but no man reported any positive psychological outcomes.
Is circumcision beneficial?
Now, back to the count. Like I mentioned, I didn’t know offhand of any studies concluding circumcision
is psychologically beneficial, and I have a large library on the topic. However, my claim requires an
extraordinary due diligence for proof. A search of online journal indexes including Pubmed, PsycINFO,
and Google Scholar found no candidates. So, I searched further afield.
A review of the large bibliography in the pro-circumcision website CircInfo.net found only anecdotal
evidence of benefit. They had no peer-reviewed study making the same claim. I suspect that if such an
article existed, this site would be sure to include it.
I did find that in 1947 Herman Nunberg espoused his hypothesis that circumcision may have a favorable
impact on the psychology of the child.
iv
However no one, not even Nunberg, followed up to see if his
hypothesis was true.
What are the harms?
Negative psychological consequences as a result of amputation and mutilation are well reported in the
literature and there is no reason to believe that loss or partial loss of the penis is exempt. Potential
effects of loss of body parts are: grief for altered body image or function, anxiety, depression, denial,
sexual problems, and obsessive preoccupation with the loss.
v
vi
vii
John Rhinehart reported that adults circumcised in childhood displayed feelings of terror, anger, and
dissociation when confronted with dangerous situations in adulthood. He went on to suggest that
preventing circumcision in the first place would be ideal.
viii
Cultural relativism and norming have an effect upon sociology and societal acceptance, but not
necessarily psychology. Three studies found that intact boys raised in a circumcising culture felt more
ashamed of their bodies.
ix
x
xi
At first glance this might seem to show psychological benefit, but this
effect is also likely true of intact girls where female circumcision is practiced, even though it is generally
accepted that all forms of female circumcision are detrimental to their psyche. Presumably, the counter-
argument holds true, too. Circumcised boys and girls would likely feel uncomfortable if they were raised
in a non-circumcising culture. Therefore, it is not circumcision that is the culprit, but living in a dissonant
culture.
Other findings
Reading the literature you often come across a statement similar to this one: “Circumcision may be
carried out for varying reasons in different societies. The reasons may be classified as: medical-
therapeutic, preventive-hygienic, religious and cultural.”
xii
Conspicuously absent from such statements is
any mention of a psychological reason.
Two common reason parents give for circumcising is that he’ll be teased in the locker room and that
he’ll look like his dad (if his dad is circumcised, that is). They both could conceivably have negative
psychological factors, too, yet I could find no scientific studies to back up these popular claims.
In a bizarre and ironic twist, a man who attempted to surgically reconstruct his foreskin was initially
thought to be psychotic, but upon further examination was deemed mentally healthy.
xiii
Even with a
clean bill of health they called his act “self-mutilation” instead of calling it “self-reconstructive surgery.
This is doubly strange since he was attempting to reverse a previous mutilation.
1
No thought was given
to the psychological status of his circumcisers.
In a similar case history, but with a different result, an Indian man suffering from ED chopped off his
penis.
xiv
This story illustrates the psychological importance men give to their body image (and
particularly their penis), their sexuality, and how amputation is sometimes a perceived solution.
Looking over the list I observe that a large amount of research has gone into circumcision pain relief,
including an ongoing study in Cincinnati.
xv
This is a silent acknowledgement that the procedure is overly
traumatic for the child. But it begs the question; What if the procedure was pain free? Many of the
articles listed below show that even if pain free, circumcision is still traumatic, debilitating, and sexually
maiming, and therefore has a detrimental effect on the boy’s psyche.
Conclusion
I stopped looking for articles concluding circumcision was psychologically harmful when exceeded one
hundred. I’m sure the list would have been much longer if I had been as diligent in trying to find even
just one article that showed a positive psychological result.
The Articles
1. Anand KJS, for the International Evidence- Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the
newborn. Arch Pediatr Adolesc Med. 2001;155:173-80.
2. Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. New Engl J Med. 1987;317(21):1321-9.
3. Anand KJS, Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behavior? Biol Neonate. 2000;77( 2):69-82.
4. Aust S, Härtwig EA, Heuser I, Bajbouj M. The role of early emotional neglect in alexithymia. Psychological Trauma: Theory, Research, Practice, and
Policy. 2013;5(3):225-232.
5. Bensley AG & Boyle GJ. Physical, sexual and psychological effects of male infant circumcision: an exploratory survey. In Understanding circumcision: a
multidisciplinary approach to a multidimensional problem. Eds: Denniston GC, Hodges FM & Milos MF. New York: Kluwer Academic/Pluwer Publishing.
2000;207-231.
6. Berenbaum H, James T. Correlates and retrospectively reported antecedents of alexithymia. Psychosom Med. 1994;56:353-359.
7. Bigelow J, Griffiths RW. Increasing awareness of iatrogenic damage consequent to male circumcision. . In Bodily integrity and the politics of
circumcision: Culture, controversy, and change. Eds: Denniston GC, Gallo PG, Hodges FM, Milos MF & Viviani F. New York: Springer. 2006;165-176.
8. Bigelow J. The joy of uncircumcising! Exploring circu mcision :History, myths, psychology, restoration, sexual pleasure, and human rights. Aptos CA:
Hourglass Book Pub., 2nd Edition 1995.
9. Bollinger D, Van Howe, RS. Alexithymia and circumcision trauma: A preliminary investigation. Int J Men’s Health . 2011;10(2):184-95.
1
The American Heritage Medical Dictionary definition of mutilate is; "Disfigurement or injury by removal or
destruction of a conspicuous or essential part of the body.” And the McGraw-Hill Concise Dictionary of Modern
Medicine gives genital mutilation as an example.
10. Bronselaer GA, Schober J, Meyer-Bahlburg HF, T'Sjoen G, Vlietinck R, Hoebeke PB. Male circumcision decreases penile sensitivity as measured in a large
cohort. BJU Int. 2013;111(5):820-827.
11. Cansever G. Psychological effects of circumcision. Br J Med Psychol,1965;38: 321-331.
12. Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. (Review). Cochrane Database Syst Rev 2006: art. no. CD004843.
13. Chamberlain DB, Babies remember pain. Pre - and Perinatal Psych. J. 1989;3:297-310.
14. Chamberlain DB. Delusional psychologies of circumcision and civilization. In Circumcisi on and Human Rights. Eds: Denniston GC, Hodges FM & Milos
MF. New York: Springer. 2009;1-14.
15. Committee on Fetus and Newborn, Committee on Drugs, Section on Anesthesiology, Section on Surgery, American Academy of Pediat rics. Prevention
and management of pain and stress in the neonate. Pediatrics. 2000;105(2):454-61.
16. Committee on Psychosocial Aspects of Child and Family Health, American Academy of Pediatrics; Task Force on Pain in Infants, C hildren, and
Adolescents, American Pain Society. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793-
7.
17. Cregin R, Rappaport AS, Montagnino G, Sabogal G, Moreau H, Abularrage JJ. Improving pain management for pediatric patients undergoing nonurgent
painful procedures. Am J Health Syst Pharm. 2008;65:723-727.
18. Dekkers W, Hoffer C, Wils JP. Scientific contribution, bodily integrity and male and female circumcision. Med Health Care Philos. 2005;8(2):179-191.
19. Denniston GC. An analysis of circumcision advocacy. In Male and Female Circumcision, Medical, Legal and Ethical Considerations in Pediatric Pract ice.
Eds: Denniston GC., Hodges FM & Milos MF. New York: Kluwer Academic/Plenum Publishers. 1999;221-240.
20. Denniston GC. Circumcision and sexual pleasure. In Flesh and Blood: Perspectives on the p roblem of circumcision in contemporary society. Eds:
Denniston GC, Hodges FM & Milos MF. New York: Kluwer Academic/Plenum Publishers. 2004;45-54.
21. Diamond D. Sexual identity and sexual orientation in children with traumatized or ambiguous genitalia. J Sex R es. 1997;34(2):199-211.
22. Diamond, D. Sexual identity and sexual orientation in children with traumatized or ambiguous genitalia. Journal of Sex Research. 1997;34(2):199-211.
23. Dias J, Freitas R, Amorim R, Espiridião P, Xambre L, Ferraz L. Adult circumcision and male sexual health: A retrospective analysis. Andrologia . 2013.
[Epub ahead of print]
24. Emde RN, Harmon RJ, Metcalf D, Koenig KL, Wagonfeld S. Stress and neonatal sleep. Psychosom Med. 1971;33(6):491-7.
25. Fitzgerald M. The birth of pain. MRC News (London). Summer 1998:20-3.
26. Friedman RM. The role of the testicles in male psychological development. J Am Psychoanal Assoc. 1996;44(1): 201 -253.
27. Frisch M, Lindholm M, Grønbæk M. Male circumcision and sexual function in men and women: A survey -based, cross-sectional study in Denmark. Int J
Epidemiol, 2011;115.
28. Gaensbauer TJ. Trauma in the preverbal period. Symptoms, memories, and developmental impact. Psychoanal Study Child. 1995;50:122-49.
29. Gallo PG, Araldi L, Viviani R, Gaddini R. Epidemiological, medical, legal, and psychological aspects of mutilated/at-risk girls in Italy: A bioethical review.
In Male and Female Circumcision, Medical, Legal and Ethical Considerat ions in Pediatric Practice. Eds: Denniston GC, Hodges FM & Milos MF. New York:
Kluwer Academic/Plenum Publishers. 1999;241-258.
30. Garry DJ, Swoboda E, Elimian A, Figueroa R. A video study of pain relief during newborn male circumcision. J Perinatol. 2006; 26:106-110.
31. Gavranidou M, Rosner R. The weaker sex? Gender and post-traumatic stress disorder. Depress Anxiety. 2003;17:130-139.
32. Gemmel T, Boyle GJ. Neonatal circumcision: Its long-term harmful effects. . In Unders tanding circumcision: a multidisciplinary approach to a
multidimensional problem. Eds: Denniston GC, Hodges F M & Milos MF. New York: Kluwer Academic/Pluwer Publishing. 2000;241-252.
33. Goldman R. Circumcision policy: A psychosocial perspective. Paediatr Child Health. 2004;9(9):630 -633.
34. Goubet N, Rattaz C, Pierrat V, Bullinger A, Lequien P. Olfactory experience mediates re sponse to pain in preterm newborns. Dev Psychobiol .
2003;42:171-180.
35. Goulding FJ. Penile block for postoperative pain relief in penile surgery. J Urol. 1981;126:337.
36. Green EJ, Crenshaw DA, Kolos AC. Counseling children with preverbal trauma. International Journal of Play Therapy. 2010;19(2):95-105.
37. Griffiths RW. Current practices in foreskin restoration. In Male and Female Circumcision, Medica l, Legal and Ethical Considerations in Pediatric Practice.
Eds: Denniston GC, Hodges FM & Milos MF. New York: Kluwer Academic/Plenum Publishers. 1999;295 -302.
38. Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psycho neuroendocrinol ogy. 1981;6(3):269-
75.
39. Hammond T. Long-term consequences of neonatal circumcision. In Sexual Mutilations : Medical, cultural, psychological, legal and sexual aspects of
genital mutilation explored. Eds: Denniston GC & Milos MF. New York: Kluwer Academic/Plenum Publishers. 1997;125 -129.
40. Hepper PG, Fetal memory: Does it exist? What does it do? Acta Pædiatr. (Stockholm) 1996;Suppl.416:16-20.
41. Hermann C, Hohmeister J, Demirakca S, Zohsel K, Flor H. Longterm alteration of pain sensitivity in school -aged children with early pain experiences.
Pain. 2006;125:278285.
42. Herschel M, Khoshnood B, Ellman C, May dew N, Mittendorf R. Neonatal circumcision. Randomized trial of a sucrose pacifier for pain control. Arch
Pediatr Adolesc Med. 1998;152:279-284.
43. Holman JR, Stuessi K. Adult Circumcision. A merican Family Physician. 1999;67(6):1514 -1520.
44. Howard C, Howard F, Garfunkel L, de B, Weitzman M. Neonatal circumcision and pain relief: Current training practices. Pediatrics. 1998;101:423-8.
45. Howard CR, Howard FM, and Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pe diatrics. 1994;93(4):641-6.
46. Howard CR, Howard FM, Fortune K, Generalli P, Zolnoun D, ten Hoopen C, de Blieck E. A randomized, controlled trial of a eutectic mixture of local
anesthetic cream (lidocaine and prilocaine) versus penile nerve block for pain relief during circircumcision. A m J Obstet Gynecol. 1999;181:1506-1511.
47. Irwin MG, Cheng W. Comparison of subcutaneous ring block of the penis with caudal epidural block for post -circumcision analgesia in children. Anaesth
Intensive Care. 1996;24(3):365-7.
48. Jacobson B, Bygdeman, M. Obstetric care and proneness of offspring to suicide as adults: Case -control study. BMJ. 1998;317:1346-1349.
49. Jeannine Parvati Baker. Ending circumcision: Where sex and violence first meet. Primal Renaissance: The Journal of Primal Psychology. 1996;2(1):54-58.
50. Jepsen EKK, Langeland W, Sexton H, Heir T. Inpatient treatment for early sexually abused adults: A naturalistic 12-month follow- up study. Psychological
Trauma: Theory, Research, Practice, and Policy. 2014;6(2):142 -151.
51. Kass FC, Holman. Oral glucose solution for analgesia in infant circumcision. J Fam Pract. 2001;50(9):785 -8.
52. Kaufman GE, Cimo S, Miller LW, Blass EM. An evaluation of the effects of sucrose on neonatal pain with 2 commonly used circumcision methods. Am J
Obstet Gynecol. 2002;186:564-568.
53. Kim S, Pang M. The effect of male circumcision on sexuality. BJU Int. 2006; 99(3):61922.
54. Kirya C, Werthmann M. Neonatal circumcision and penile dorsal nerve block: a painless procedure. J Pediatr. 1978;92:998-1000.
55. Kizilhan JI. Impact of psychological disorders after female genital mutilation among Kurdish girls in Northern Iraq. Eur J Psychiat. 2011;25(2):92 100.
56. Krugman S. Male development and the transformation of shame. In A new psycholog y of men. Eds: Levant RF & Pollack WS. New York: Basic
Books,1995:91-126.
57. Kurtis PS, DeSilva HN, Bernstein BA, Malakh L, Schechter NL. A comparison of the Mogen and Gomco clamps in combination with dorsal penile nerve
block in minimizing the pain of neonatal circumcision. Pediatrics. 1999;103;e23.
58. Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal
circumcision. JAMA. 1997;278:2158-62.
59. LaPrairie JL, Murphy AZ. Neonatal injury alters adult pain sensitivity by increasing opioid tone in the periaqueductal gray. Front Behav Neurosci.
2009;3(31):111.
60. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States. JAMA. 1997;277:1052 -7.
61. Leahy T, Pretty Grace, Tenenbaum G. Childhood sexual abuse narratives in clinically and nonclinically distressed adult survivors. Professional
Psychology: Research and Practice. 2003;34(6):657-665.
62. Lisak D. Beszterczey S. The cycle of violence: The life histories of 43 death row inmates. Psychology of Men & Masculinity. 2007;8(2):118-128.
63. Maguire P & Parkes CM. Coping with loss: Surgery and loss of body parts. BMJ. 1998;316:1086-1088.
64. Mancuso T, Burns J. Ethical concerns in the management of pain in the neonate. Paediatr Anaesth . 2009;19:953-957.
65. McIntosh N. Pain in the newborn, a possible new starting point. Eur J Pediatr. 1997;156:173-177.
66. McNally RJ, Perlman CA, Ristuccia CS, Clancy SA. Clinical characteristics of adults reporting repressed, recovered, or continuous memories of childhood
sexual abuse. Journal of Consulting and Clinical Psychology. 2006;74(2):237-242.
67. Meislahn HS, Taylor JR. The importance of the foreskin to male sexual reflexes. In Fles h and Blood: Perspectives on the problem of circumcision in
contemporary society. Eds: Denniston GC, Hodges FM & Milos MF. New York: Kluwer Academic/Plenum Publishers. 2004;27-44.
68. Menage J. Post-traumatic stress disorder after genital medical procedures. In Male an d Female Circumcision, Medical, Legal and Ethical Considerations
in Pediatric Practice. Eds: Denniston GC, Hodges FM & Milos MF. New York: Kluwer Academic/Plenum Publishers. 1999;215-220.
69. Mordeniz C, Verit A. Is circumcision a modified ritual of castration? Urol Int. 2009;82(4):399 -403. Epub 2009 Jun 8.
70. O’Hara K, O’Hara J. The effect of male circu mcision on the sexual enjoyment of the female partner. BJU Int. 1999;83 (Suppl.1):79-84.
71. Odent M. Neonatal circumcision from a primal health research perspective. In Male a nd Female Circumcision, Medical, Legal and Ethical Considerations
in Pediatric Practice. Eds: Denniston GC, Hodges FM & Milos MFs. New York: Kluwer Academic/Plenum Publishers. 1999;275-278.
72. Page GG. Are There Long-Term Consequences of Pain in Newborn or Very Young Infants? J Perinat Educ. 2004;13(3):10-17.
73. Paley J, Alpert J. Memory of infant trauma. Psychoanalytic Psychology. 2003;20(2):329-347.
74. Payne K, Thaler L, Kukkonen T, Carrier S, & Binik Y. Sensation and sexual arousal in circumcised and uncircumcise d men. J Sex Med. 2007;4:667674.
75. Porter FL, Wolf CM, Miller JP. Procedural pain in newborn infants: The influence of intensity and development. Pediatrics. 1999; 104: e13.
76. Pretorius IM. Repeating and recalling preverbal memories through play: the psychoanalysis of a six -year-old boy who suffered trauma as an infant.
Psychoanal Study Child. 2007;62:239-62.
77. Rai BP, Qureshi A, Kadi N, Donat R. How pa inful is adult circumcision? A prospective, observational cohort study. J Urol. 2013;189(6):2237-42.
78. Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis Journal. 1999;29(3):215-221.
79. Richards MPM, Bernal JF, Brackbill Y. Early behavioral differences: gender or circumcision? Dev Psychobiol . 1976;9(1):8995.
80. Richters J, Smith AMA, de Visser RO, et al. Circumcision in Australia: prevalence and effects on sexual health. Int J STD AIDS. 2006;17:547-54.
81. Sahin F, Beyazova U, Aktürk A. Attitudes and practices regarding circumcision in Turkey. Child Care Health Dev. 2003 Jul;29(4):275-80.
82. Schiavenato M, Butler-O’Hara M, Scovanner P. Exploring the association between pain intensity and facial display in term newborns. Pain Res Manag.
2011;16(1):102.
83. Schlossberger N, Turne R, Irwin C. Early adolescent knowledge and attitudes about circumcision: methods and implications for research. J Adolesc
Health. 1992;13(4):293-297.
84. Schober JM, Meyer-Bahlburg HF, Dolezal C. Self-ratings of genital anatomy, sexual sensitivity and function in men using the 'Self-Assessment of Genital
Anatomy and Sexual Function, Male' questionnaire. BJU Int. 2009;103(8):1096-1103.
85. Shockley RA, Rickett K. What’s the best way to control circumcision pain in newborns? J Fam Pract. 2011;60(4):233a-233b.
86. South MM, Strauss RA, South AP, Boggess JF, Thorp JM. The use of non-nutritive sucking to decrease the physiologic pain response during neonatal
circumcision: a randomized controlled trial. Am J Obstet Gynecol. 2005;193:537-542.
87. Sternberg WF, Scorr L, Smith LD, Ridgway CG, Stout M. Long-term effects of neonatal surgery on adulthood pain behavior. Pain. 2005;113:347-353.
88. Taddio A, Chambers CT, Halperin SA, Ipp M, Lockett D, Rieder MJ, Shah V. Inadequate pain management during routine childhood immunizations: the
nerve of it. Clin Ther. 2009;31(Suppl 2):S152-S67.
89. Taddio A, Goldbach M, Ipp M, Stevens B, Koren G. Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet. 1995;345:291-
2.
90. Taddio A, Gurguis MG, Koren G. Lidocaine-prilocaine cream versus tetracaine gel for procedural pain in children. Ann Pharmacother 2002;36:687 -692.
91. Taddio A, Katz J, Herisch AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1997a;349:599-
603.
92. Taddio A, Ohlsson A, Einarson TR, Stevens B, Koren G. A systematic review of lidocaine-prilocaine cream (EMLA) in the treatment of acute pain in
neonates. Pediatrics. 1998;101;1-.
93. Taddio A, Pollock N, Gilbert-Macleod C, Ohlsson K, Koren G. Combined analgesia and local anesthesia to minimize pain during circumcision. Arch Pediatr
Adolesc Med. 2000;154:620-623.
94. Taddio A, Stevens B, Craig K, Rastogi P, Bendavid S, Shennan A, Mulligan P, Koren G. Efficacy and safety of lidocaine-prilocaine cream for pain during
circumcision. N Engl J Med. 1997b;336:1197-1201.
95. Taeusch HW, Martinez AM, Partridge JC, Sniderman S, Armstrong-Wells J, Fuentes-Afflick E. Pain during Mogen or PlastiBell circumcision. J Perinatol.
2002;22(3):214-8.
96. Tan PH, Cheng JT, Kuo CH, Tseng FJ, Chung HC, Wu JI, Hsiao HT, Yang LC. Preincisional subcutaneous infiltration of ketamine suppresses postoperative
pain after circumcision surgery. Clin J Pain. 2007;23:214-218.
97. Thorup J, Thorup SC, Ifaoui1IBR. Complication rate after circumcision in a paediatric surgical setting should not be neglected. Dan Med J. 2013;60(8):1
3.
98. Tractenberg M. Psychoanalysis of circumcision. In Male and Female Circumcision, Medical, Legal and Ethical Considerations in Pediatric Practice. Eds:
Denniston GC., Hodges FM & Milos MF. New York: Kluwer Academic/Plenum Publishers. 1999;209-214.
99. Travis JW. Circumcision as a component of the normative abuse of children. . In Understanding circumcision: a multidisciplinary approach to a
multidimensional problem. Eds: Denniston GC, Hodges FM & Milos MF. New York: Kluwer Academic/Pluwer Publishing. 2000;367-376.
100. Tsao JC, Evans S, Meldrum M, Altman T, Zeltzer LK. A review of CAM for procedural pain in infancy: Part I. Sucrose and non-nutritive sucking. Evid Based
Complement Alternat Med. 2008;5:371-381.
101. van Dijk M, de Boer JB, Koot H, Duivenvoorden HJ, Passchier J, Boowmeester N, Tibboel D. The association between physiological and behavioral pain
measures in 0- to 3-year-old infants after major surgery. J Pain Symptom Mgt. 2001;22:600-609.
102. Walco GA, Cassidy RC, Schechter NL. The ethics of pain control in infants and children. N Engl J Med. 1994;331(8):541 -4.
103. Williamson PS, Williamson ML. Physiologic stress reduction by a local anesthetic during newborn circumcision. Pediatrics. 1983;71(1):36-40.
104. Yawman D, Howard CR, Auinger P, Garfunkel LC, Allan M, Weitzman M. Pain relief for neonatal circumcision: a follow-up of residency training practices.
Ambul Pediatr. 2006; 6: 210-214.
105. Yilmaz E. Batislam E, Basar MM, Basar H. Psychological trauma of circumcision in the phallic period could be avoided by using topical steroids. Int J Urol.
2003;10(12):651-6.
106. Zoske J. Male circumcision: A gender perspective. The Journal of Men’s Studies. 1998;6(2),189-208.
References
i
Cansever G. Psychological effects of circumcision. Br J Med Psychol. 1965;38: 321-331.
ii
Jacobson B, Bygdeman, M. Obstetric care and proneness of offspring to suicide as adults: Case-control study. BMJ
1998;317:1346-1349.
iii
Bollinger D, Van Howe, RS. Alexithymia and circumcision trauma: A preliminary investigation. Int J Men’s Health.
2011;10(2):184-95.
iv
Nunberg H. Circumcision and the problems of bisexuality. Int J PsychoAnal. 1947;145-179.
v
Bensley AG. Boyle GJ. Physical, sexual and psychological effects of male infant circumcision: an exploratory
survey. In Understanding circumcision: a multidisciplinary approach to a multidimensional problem. Eds: Denniston
GC, Hodges FM & Milos MF. New York: Kluwer Academic/Pluwer Publishing. 2000;207-231.
vi
Dekkers W, Hoffer C. Wils JP. Scientific contribution, bodily integrity and male and female circumcision. Med
Health Care Philos. 2005;8(2):179-191.
vii
Maguire P. Parkes CM. Coping with loss: Surgery and loss of body parts. BMJ. 316: 1086-1088.
viii
Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis Journal. 1998;29(3): 215-221.
ix
Ozturk O. Ritual circumcision and castration anxiety. Psychiatry. 1973;36(1): 4959.
x
Sahin F, Beyazova U. Akturk A. Attitudes and practices regarding circumcision in Turkey. Child Care Health Dev.
2003;29(4): 275-280.
xi
Kirimli Y. Yetişkinliğe ilk adım: Sünnet. İğdiş, Sünnet, Bedene Şiddet Kitabı. Eds: Naskali-Gursoy E, Koc A. 2009;
151-163.
xii
Yavuz M, Demir T, Dogangun B. The effect of circumcision on the mental health of children: A review. Turkish
Journal of Psychiatry, 2012; 23(1): 63-70.
xiii
Streimer WG. Genital self-mutilation: attempted foreskin reconstruction. Br J Psychiatry. 1991;56: 125-7.
xiv
Sudarshan CY, Nagaraja Rao K, Santosh SV. (2006). Genital self-mutilation in erectile disorder. Indian J
Psychiatry. 48(1): 6465.
xv
Available online at: http://clinicaltrials.gov/ct2/show/NCT01726036
... A literature review of more than a hundred psychological studies shows that early traumas have a detrimental effect on a boy's psyche, and about half of those specifically mentioned circumcision. 13 Whether the child consciously remembers a negative experience is irrelevant to its impact and categorization as an ACE. It is not the recollection of a trauma that is harmful, rather the body's and mind's response to it, both immediately and over time. ...
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This white paper presents compelling evidence that child genital cutting (CGC)-in its myriad forms performed on males, females, and intersex children-is a known early trauma. As such it is also an Adverse Childhood Experience (ACE). More than a million children in the United States continue to suffer from CGC annually; many go on to experience repercussions, some lasting for years or even decades. Yet CGC is not included in the ACE questionnaire, while less frequent and possibly less traumatic experiences are. Consequently, victims of CGC are being ignored by the ACEs' community. To solve this, we have created this paper and AdverseChildhoodExperiences.net, which together alert health authorities and researchers to this omission and propose a minor addition to the popular ACE questionnaire.
... As Bollinger (2014) has pointed out, "No psychological study has ever concluded that circumcision is beneficial to a boy's psyche [whereas] more than one hundred scientific studies [have] found circumcision [to be] painful, traumatic, or psychologically harmful to men and boys." [177] Men who are constitutionally predisposed toward higher levels of emotionality [105] are more likely to suffer various degrees of sadness and unhappiness due to ongoing unresolvable sexual frustration and the realization of irreversible, circumcision-induced sexual deficits (in sensation, performance, and satisfaction), leading to chronic elevations in negative mood states. However, it should be noted that the emotional pain that some circumcised men experience must not be equated with psychological illness. ...
Article
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Non-therapeutic infant male circumcision is a permanent surgical alteration to the penis that may cause significant physical, sexual and psychological harm. Physical harms include unintended adverse effects of the surgery itself (e.g., complications such as bleeding, infection, excessive removal of foreskin leaving insufficient shaft skin to accommodate erections, etc.), as well as the inherent loss of healthy, functional tissue. Sexual harms that necessarily follow from circumcision include the loss of all sensation in the foreskin itself, and the loss of all sexual functions that involve the physical manipulation of the foreskin. Additional sexual harms that may follow cir-cumcision include reduced sexual sensation in the remaining penile structures, difficulty with masturbation, increased chafing in both the circumcised man and his sexual partner, as well as reduced overall psychosexual/psychological tension relief and subjective satisfaction. Psychological harms include short-term trauma as well as the potential for long-term emotional disturbances , including sadness, frustration, distress, and anger—akin to post-traumatic stress disorder (PTSD). In this paper, the extent and severity of these various harms are considered and it is argued that they are more serious and more widespread than is commonly believed.
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The idea that routine infant circumcision is a benign or even beneficial procedure persists in some sections of Australian society despite a widely accepted range of consequences occurring as a result of most types of surgery. These outcomes relate to changes in how patients perceive their body and changes in actual bodily function. Current knowledge on the longterm consequences of neonatal circumcision relies mostly on reports from self-selected men of the physical, sexual and psychological harm attributed to being circumcised.
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This preliminary study investigates what role early trauma might have in alexithymia acquisition for adults by controlling for male circumcision. Three hundred self-selected men were administered the Toronto Twenty-Item Alexithymia Scale checklist and a personal history questionnaire. The circumcised men had age-adjusted alexithymia scores 19.9 percent higher than the intact men; were 1.57 times more likely to have high alexithymia scores; were 2.30 times less likely to have low alexithymia scores; had higher prevalence of two of the three alexithymia factors (difficulty identifying feelings and difficulty describing feelings); and were 4.53 times more likely to use an erectile dysfunction drug. Alexithymia in this population of adult men is statistically significant for having experienced circumcision trauma and for erectile dysfunction drug use.
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Background and Objectives: This study investigated the mental health status of young girls after genital mutilation in Northern Iraq. Although experts assume that circumcised girls are more prone to psychiatric illnesses than non-circumcised girls, little research has been conducted to confirm this claim. For the purpose of this study, it was assumed that female genital mutilation is connected with a high rate of posttraumatic stress disorders (PTSD). Methods: The psychological impact of female genital mutilation was assessed in Northern Iraq with 79 circumcised Kurdish girls who were between 8 and 14 years of age. Thirty uncircumcised girls from the above area and thirty-one uncircumcised girls from other areas of Iraq served as comparison subjects. A psychological interview and further questionnaires were used to assess traumatization and psychiatric illnesses. Results: The circumcised girls showed a significantly higher prevalence of PTSD (44.3%), depression disorder (33.6%), anxiety disorder (45.6%) and somatic disturbance (36.7%) than the uncircumcised girls. We could not find any significant differences between the two control groups. Conclusions: Within the circumcised group, a mental health problem can be diagnosed that may constitute the first evidence for the severe psychological consequences of juvenile girls´ genital mutilation.
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To date, most of the inpatient outcome studies among early traumatized individuals lack data on dissociative disorders. More research is needed to evaluate whether severely dissociative patients can improve following specialized inpatient treatment for chronic childhood abuse. The objectives of this study were to investigate symptomatic change in patients attending a 3-month specialized inpatient treatment program for adults with a history of childhood sexual abuse (CSA) and mixed trauma-related disorders. In particular, symptomatic changes in those with and without a complex dissociative disorder I + II (CDD) were contrasted. Fifty-six patients with CSA and trauma-related disorders (including 23 patients with CDD) completed the treatment program and a test battery at precare evaluation, admission, discharge, and at 1-year follow-up. There was an overall symptom reduction in dimensional measures maintained at the 1-year follow-up. Patients with CDD consistently had significantly higher symptom levels than the patients without these disorders. Both patient subgroups showed parallel improvement from admission to follow-up, although those high in dissociation (CDD patients) needed more time to show improvement and were still clinically worse at the end of treatment and at follow-up. The findings were matched by clinically significant changes. The results suggest that adults with reported childhood sexual abuse and mixed trauma-related disorders can improve in symptom severity following a trauma-based 3-month inpatient program regardless of CDD status. The high distress level in CDD patients indicates that patients with CDD need treatment that is in part different from the more general treatment of polysymptomatic CSA survivors, addressing the pathological aspects of dissociation more vigorously. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
Book
Who owns your sex organs? Different cultures today and in different epochs have given a variety of answers to this question. It may seem self­ evident that every individual owns and has sovereignty over his or her own body parts, such as the head, legs, nose, stomach, pancreas, and other body parts. The sex organs, however, seem to be an exception. Even though they are as much an integral part of the individual as a leg or a liver, the sex organs are unique in that many cultures have established laws and taboos over the use and even the mere display of the sex organs. Thus, certain cultures have placed constraints over the individual's ownership of his or her sex organs and actively regulate and restrict the individual's access and use of those organs. In other cultures, the question of ownership of the sex organs is more decisively answered. In any culture where circumcision to any degree of either the male or female is practiced, permitted, encouraged, or even merely tolerated, it is clear that the individual is not considered to own his own sex organs. In the United States today, the medical establishment has created an is considered acceptable and desirable that anyone for environment where it any reason can authorize or execute the amputation of the foreskin from a male child's penis.
Chapter
The authors propose that the foreskin is the primary sensory tissue of the penis and that the foreskin’s ridged band is built to trigger ejaculation as part of a functional whole that also includes the frenulum, glans, and urethra. The study evolved from research which demonstrated specialized nerve end-organs in the ridged band, and from pre-tests showing that intact subjects are more likely than circumcised subjects to experience reflexes triggered by traction on penile skin, namely, erection of the penis and contraction of the bulbocavernosal muscle. The authors then developed a website which describes the foreskin’s anatomy and function and asks intact males whether, in their opinion, the foreskin and its ridged band play an important role in sexual intercourse. The overwhelming majority has firmly agreed, and, for every nine who found the foreskin more important than the glans to sexual intercourse, only five found the glans more important.
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The practice of routine medical circumcision of newborn male infants remains the norm in the United States, occurring to more than one million baby boys annually. This article examines the history and continuing debate surrounding this surgery, and places it within the context of gender identity. The rise of the activist anti-circumcision movement is described, as medical, moral, psychological, and legal issues surrounding this controversy are identified. The continuing practice of male circumcision is framed as an abusive wounding of males, which holds lifelong implications. A differentiation is made between the conventional medical amputation of the foreskin, from that which is solely ritual, religious-based. Further, a societal double standard is noted between the moral outcry against female circumcision and the relative silence toward male circumcision.
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This article discusses the present status of neonatal circumcision in the United States and presents clinical findings regarding the long-term somatic, emotional, and psychological consequences of this procedure in adult men. These consequences are seen as typical of complex posttraumatic stress disorder. They emerged during psychotherapy focused on the resolution of prenatal, perinatal, and developmental trauma and shock experiences. Their relationship to phenomena such as trauma, shock, somatic decisions, discounting, and scripting is described.