“We justify male infant circumcision by pretending that the babies don’t feel it because they’re too young and it will have no consequences when they are older. This is not true. Women who experience memories of abuse in childhood know how deeply and painfully early experiences leave their marks in the body. Why wouldn’t the same thing apply to boys?”
Christiane Northrup, M.D

The Psychological Impact of Circumcision


The psychological effects of circumcision on the child – and the man he will become – are an often overlooked harm of the practice, with serious implications for mental health, emotional and relational well-being, and the health of society.

Psychological effects

Evidence indicates that the ability to learn and remember is present from before birth [1,2] and that newborn infants have fully functioning pain pathways.[3] Therefore, one would expect to find psychological effects associated with genital cutting of newborns.

Changes in infant-maternal interaction have been observed after circumcision, including disrupted feeding and weaker attachment between the infant and mother.[4,5] The American Academy of Pediatrics Task Force on Circumcision (1989) noted behavioral changes resulting from circumcision in their report.[6] The behavior of nearly 90 percent of circumcised infants has been found to be significantly changed after the circumcision.[7] Differences in sleep patterns and more irritability – both signs of stress – have been observed among circumcised infants [8,9,10].

Post-traumatic stress disorder (PTSD) is a normal response to an event in which a person’s physical integrity has been threatened or violated. Forced genital cutting is a direct experience of sexual violence, so it fulfills the criteria as a psychogenic cause for PTSD.[11] Taddio et al. studied the behavior of babies at first vaccination. They found that circumcised boys have a much stronger reaction to the pain of vaccination than do girls and intact (non-circumcised) boys, which the authors suggested is an “infant analogue” of PTSD.[12] Other authors also have reported PTSD in circumcised males.[13] Rhinehart reported on four cases of PTSD connected with neonatal circumcision in middle-aged men that he encountered in his psychiatric practice.[14] Ramos and Boyle reported PTSD in 70 percent of Filipino boys who experienced ritual circumcision and 51 percent of Filipino boys who experienced medical circumcision.[15]

Cansever tested young boys before and after ritual circumcision and reported that these children had a tendency to seek safety afterwards through emotional withdrawal.[16] Based on relevant literature, clinical experience, and statements from circumcised men, Goldman suggests that reduced emotional expression is the primary potential long-term psychological effect of circumcision.[17] A subsequent study found that circumcised men had significantly increased alexithymia (difficulty identifying and expressing feelings) compared to intact men.[18]

A large Danish study found that circumcised boys may have a greater risk of developing autism spectrum disorder before age ten and a higher risk for infantile autism before age five. Circumcised boys were also more likely to develop hyperactivity disorder.[19] While, causally, autism is considered to be a multifactorial disorder,[20] the link with circumcision may in part explain why the incidence of autism is almost five times more common in boys in the United States.[21] Hyperactivity disorder (attention deficit disorder) is about three times more common in boys.[22] More research is needed to replicate and better understand the Danish findings.

Based on growing reports from circumcised men, other potential long-term psychological effects of circumcision include excessive or inappropriate anger, shame, shyness, fear, powerlessness, distrust, low self-esteem, and decreased ability for emotional intimacy.[14,17,13-25] Because circumcision is generally performed shortly after birth, it is a perinatal trauma, and several authors report that perinatal trauma may contribute to self-destructive behavior in adult life.[26-30] Lack of awareness and understanding of circumcision, emotional repression, fear of disclosure, and nonverbal expression explain why we do not hear from more circumcised men about how they truly feel.[17,31,32]

Van der Kolk reports that trauma often results in a compulsion to reenact or repeat the trauma on others.[26] For example, a circumcised father often irrationally insists that a son undergo circumcision, even against a spouse’s wishes and knowing that there is no medical necessity.[33] As another example of the compulsion, a survey of randomly selected physicians showed that circumcision was more often supported by doctors who were older, male, and circumcised.[34,35] In addition, some American doctors have apparently tried to coerce parents to circumcise their sons.[36,37] Circumcision status and its associated psychological and social factors may also bias circumcision studies and circumcision policy statements in favor of circumcision.[38]

With increased awareness of the psychological effects of circumcision, there is a growing need for some circumcised men to seek professional psychological help. Clinicians who are themselves circumcised, deny their own harm and associated effects, and/or have chosen circumcision for their sons may be less likely to be empathetic to men in distress about circumcision harm, in order to avoid the discomfort of cognitive dissonance.[39] Clinicians should regard circumcision-related feelings and behaviors seriously and refer clients as appropriate.[40]

Broader social implications

Laumann reported that 77 percent of the American adult males in the 1992 National Health and Social Life Survey were circumcised.[41] The effects of this sexual wounding – both neonatal and lifelong, intra- and interpersonal – have been discussed above. Goldman argues that having so many emotionally and sexually injured males in a culture could potentially produce undesirable social outcomes.[17] Despite many disquieting indications,[17,23,42,43] there has been but limited longitudinal research – and remarkably little professional concern – about the potential social effects of circumcision.

“What’s done to children, they will do to society.”
Karl A. Menninger, M.D.

References

1. Hepper PG. Fetal memory: Does it exist? What does it do? Acta Pædiatr (Stockholm). 1996;416:16-20.
2. James DK. Fetal learning: a critical review. Infant Child Dev. 2010;19(1):45-54.
3 Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. New Engl J Med 1987;317(21):1321-9.
4. Marshall RE, Porter FL, Rogers AG, Moore J, Anderson B, Boxerman SB. Circumcision: II. effects upon mother-infant interaction. Early Hum Dev. 1982:7(4):367-374.
5. Dixon S, Snyder J, Holve R, Bromberger P. Behavioral effects of circumcision with and
without anesthesia. J Dev Behav Peds. 1984;5:246-250.
6. American Academy of Pediatrics Task Force on Circumcision. Report of the Task Force on Circumcision. Pediatrics. 1989;84(2):388-391.
7. Marshall RE, Stratton WC, Moore JA, Boxerman SB. Circumcision I: effects upon newborn behavior. Infant Behav Dev. 1980;3:1-14.
8. Brackbill Y. Continuous stimulation and arousal level in infancy: effects of stimulus
intensity and stress. Child Dev. 1975;46:364-9.
9. Emde RN, Harmon RJ, Metcalf D, Koenig KL, Wagonfeld S. Stress and neonatal sleep. Psychosom Med. 1971;33:491-7.
10. Anders TF, Chalemian RJ. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med. 1974;36:174-9.
11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, Fifth edition. Arlington, VA: American Psychiatric Association; 2013. p. 272
12. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1997;349(9052):599-603.
13. Boyle G, Goldman R, Svoboda S, and Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychol. 2002;7:329-343.
14. Rhinehart J. Neonatal circumcision reconsidered. Transactional Anal J. 1999;29(3):215-21.
15. Ramos S, Boyle GJ. Ritual and medical circumcision among Filipino boys: evidence of post-traumatic stress disorder. Humanities and Social Science Papers. 2000; Paper 114. Available at: http://epublications.bond.edu.au/hss_pubs/114
16. Cansever G. Psychological effects of circumcision. Brit J Med Psychol. 1965;38:321-31.
17. Goldman R. Circumcision: the hidden trauma. Boston: Vanguard Publications; 1997.
18. Van Howe R, Bollinger, D. Alexithymia and circumcision trauma: a preliminary investigation. Int J Mens Health. 2011;10(2):184-195.
19. Frisch M, Simonsen J. Ritual circumcision and risk of autism spectrum disorder in 0- to 9-year-old boys: national cohort study in Denmark. J R Soc Med. 2015;108(7):266-79.
20. Amaral D, Dawson G, Geschwind D, editors. Austism spectrum disorders. New York: Oxford University Press; 2011.
21. CDC. Prevalence of autism spectrum disorder among children aged 8 years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010. MMWR Surveill Summ. 2014;63(SS02);1-21.
22. Singh, I. Beyond polemics: science and ethics of ADHD. Nat Rev Neurosci. 2008;9(12):957-64.
23. Hammond T. A preliminary poll of men circumcised in infancy or childhood. BJU Int. 1999; 83(Suppl 1):85-92. See also: http://circumcisionharm.org/ and https://www.youtube.com/watch?v=v_ht2CRTdbo.
24. Gemmell T, Boyle GJ. Neonatal circumcision: its long-term harmful effects. In: Denniston GC, Hodges FM, Milos MF, editors. Understanding circumcision: a multi-disciplinary approach to a multi-dimensional problem. New York: Kluwer/Plenum; 2001. p. 241-252
25. Watson, LR. Unspeakable mutilations: circumcised men speak out. CreateSpace Independent Publishing Platform; 2014.
26. van der Kolk BA. The compulsion to repeat the trauma: re-enactment, revictimization, and masochism. Psychiatr Clin North Am. 1989;12(2):389-411.
27. Salk L, Lipsitt LP, Sturner WQ, Reilly BM, Levat RH. Relationship of maternal and perinatal conditions to eventual adolescent suicide. Lancet 1985;1(8429):624-7.
28. Jacobson B, Eklund G, Hamberger L, Linnarsson D, Sedvall G, Valverius M. Perinatal origin of adult self-destructive behavior. Acta Psychiatr Scand. 1987;76(4):364-71.
29. Jacobson B, Bygdeman M. Obstetric care and proneness of offspring to suicide. BMJ. 1998;317:1346-9.
30. Miller A. Appendix: The newly recognized, shattering effects of child abuse. In: The untouched key: tracing childhood trauma in creativity and destructiveness. New York: Anchor Books (Doubleday); 1991.
31. Ritter TJ, Denniston GC. Say no to circumcision: 40 compelling reasons. Marketscope Books; 1996.
32. Goldman R. The psychological impact of circumcision. BJU Int. 1999;83(Suppl 1):93-103.
33. Rediger C, Muller AJ. Parents’ rationale for male circumcision. Can Fam Physician. 2013;59(2):e110-5.
34. Stein MT Marx M, Taggert SL, Bass RA. Routine neonatal circumcision: the gap between contemporary policy and practice. J Fam Pract. 1982;15:47-53.
35. Muller, A. To cut or not to cut? Personal factors influence primary care physicians’ position on elective circumcision. Am J Mens Health. 2010;7(3):227-232.
36. AAP Task Force on Circumcision. Circumcision policy statement. Pediatrics. 1999;103(3):686-693.
37. Coercion to circumcise. The Intactivism Pages website. Last updated 2015 Nov 5.
38. Goldman, R. Circumcision policy: a psychosocial perspective. Paediatr Child Healt . 2004;9:630-3.
39. Cooper J. Cognitive dissonance: 50 years of a classic theory. London: Sage Publications; 2007.
40. The Circumcision Resource Center (Boston, MA) offers psychological support to circumcised men. See: http://www.circumcision.org
41. Laumann EO, Masi CM, Zuckerman EW. Circumcision in the United States. JAMA. 1997;277(13):1052-7.
42. Laibow, R. Circumcision and its relationship to attachment impairment. In: Syllabus of abstracts, Second International Symposium on Circumcision, San Francisco (CA); 1991. Available from info@nocirc.org.
43. Main M, Hesse E, Kaplan N. Predictability of attachment behavior and representational processes at 1, 6, and 19 years of age – The Berkeley Longitudinal Study. In: Grossmann KE, Grossman K, Waters E, editors. Attachment from infancy to adulthood: the major longitudinal studies. New York: Guilford Press; 2005. p. 245-304

Revised January 2016, by Ronald Goldman, Ph.D.