cadeuceus

Foreskin Curriculum

for everyone studying the healing arts

cadeuceus  


Anatomy - A new structure

The Ridged Band


Here is the description of the recent discovery, at least to the anatomical literature, of the ridged band, which makes the human prepuce much more than just a 'piece of skin'.


"When retracted, the inner surface of the prepuce displays two zones, 'ridged' and 'smooth'. The first, a transversely-ridged band of mucosa 10-15 mm wide, lies against the true skin edge forming the outer surface of the tip of the prepuce. In the dorsal midline, the 'ridged band' lies above the level of the adjacent 'smooth' mucosa and merges smoothly, on either side, with the frenulum of the prepuce. When magnified, the ridged mucosa has a pebbled or coral-like appearance. Unretracted, the adult 'ridged band' usually lies flat against the glans; retracted, the'ridged band' is everted on the shaft of the penis. The remainder of the preputial lining between the'ridged band' and the glans is smooth and lax. There is considerable variation in the degeee of ridging: older subjects showed less and younger subjects more marked ridging. Some ridging was seen in all the prepuces examined."1


Complex touch-sensitive nerve endings, called Meissner's corpuscles, were found in these ridges. The ridged band is primarily sensory tissue, and rolling over the corona of the glans, provides primary sexual stimulation.


Amount of normal tissue removed.


The amount of normal tissue removed in a 'modern medical circumcision' is approximately 50% of the covering of the adult penis.1 This can best be illustrated by pointing out that, if an intact male grasps his foreskin at the base of the glans penis, and slides it toward his body, the foreskin will unfold to cover the entire shaft of the penis.

Do not forget, the 6 pound infant becomes at least 32 times larger as an adult, as does the foreskin.


Physiology - What are the functions of the prepuce?


Protection

The foreskin, in almost all newborn infants (96%), is still attached to the glans as its skin.2 It is there to protect the glans and urethra from infections.3 It should be left alone. It should never be forcibly retracted. Later in life, the foreskin can fully retract in almost all individuals (age 17 years and up), but it still acts as a protection to the glans, keeping it soft and moist as nature intended it. The foreskin also keeps the glans warm.


Erection

During an erection, the shaft of the penis becomes fifty percent (50%) longer. Where does the skin come from to cover that longer shaft? From the foreskin of course. And there is still some left to move loosely over the body of the penis, reducing friction during sexual intercourse, as nature intended.


Sexual sensitivity

The foreskin, with its ridged bands, plays a primary role in the sexual sensitivity of an individual.4 5 How does anyone, especially a doctor, have the right to tamper with and remove part of another person's normal sexual apparatus, without his permission?


Embryology


Process of Separation - prepuce from glans

In utero, the fetus develops a penis that is completely covered by attached skin. This skin is attached to the glans penis just as tightly as skin on the tip of the finger.6 The process of creating the separated foreskin begins slowly at approximately 17 weeks gestation. Cells in the area of separation between the future foreskin and the glans initiate the process of creating the preputial space (ie, the space between the glans penis and the intact foreskin). They begin to form microscopic balls comprising multiple layers of cells. As these whorls of cells enlarge, those at the center are cut off from nutrients; they die, and create a space. These minute spaces coalesce, eventually becoming the preputial space.7


Timing

The process of creating the preputial space is completed by 3 years of age in 90% of boys, but it may take as long as 17 years for some boys to have a fully retractable foreskin.8 After that age, gentle stretching may sometimes be indicated,9but circumcision is still contra-indicated.


Care of the Intact Penis - 3 simple rules


1. Leave the foreskin alone!


2. Never permit anyone to retract the foreskin.


3. When the child can fully retract his own foreskin comfortably, he may begin to do so in the tub or shower.


History

World

The first known drawing of a circumcision is on the wall of a 6th Dynasty tomb at Sakkara, Egypt, about 2400 BC, or 4400 years ago. Presumably, the practice began long before that. It is therefore a primitive blood ritual, and has no place in modern medicine.

United States

The United States is the only country in the world that circumcises a majority of its sons without religious reason.


Not one national health organization in the world recommends non-therapeutic infant circumcision.


Circumcision was virtually unknown in the United States during the early years of the Republic Doctors began to promote it, beginning in the 1850's, as a cure for masturbation. When it was discovered that masturbation could not be prevented in this manner, they sought something else to prevent. In the 1950's it was cancer. Now it is AIDS. All of these alleged "medical reasons" are simply excuses. There are virtually no medical reasons to perform circumcision. The evidence: In Finland, where foreskins are valued, the risk of losing one at birth is 0 and the risk of needing a circumcision later is one in sixteen thousand, six hundred sixty-seven (1/16,667), a very rare event indeed.


Alleged medical reasons for circumcision


Cancer of the penis

The risk of cancer of the penis is one in one hundred thousand (1/100,000). If circumcision could prevent cancer of the penis (which is not likely - Madden presented a study recently with 37 cases of cancer of the penis in circumcised men);10 performing 100,000 circumcisions on normal infants to possibly prevent one cancer of the penis in an elderly man is unethical. A number of infants will die in the process, and many (200) will sustain significant, serious complications. Nowhere else in medicine is this type of prevention practiced.


Urinary Tract Infection

The risk of urinary tract infection in intact boys is alleged to be 1/100. How can anyone suggest that 100 boys have their normal foreskins removed to possibly prevent one UTI, easily and correctly treated with antibiotics?


Hygiene


Most Americans imagine that the foreskin of the adult male looks like the foreskin of the infant, pulled tightly over the glans, protruding out in front. They do not know, because they seldom see a normal intact male, that the foreskin becomes very loose, and may be easily retracted so that the intact male looks as if he were circumcised. It is as easy to clean this intact penis as a circumcised one. Hygiene is an absurd and tragic reason to circumcise.


Complications


Williams and Kapila report: "Although haemorrhage and sepsis are the main causes of morbidity, the variety of complications is enormous. The literature abounds with reports of morbidity and even death as a result of circumcision."11


Complications of every male circumcised


Loss of sexual sensitivity - 15+/- cell layer increase in thickness of surface of glans penis.

Loss of the foreskin

Loss of the frenulum

Progressive loss of glans sensitivity

a scar on the penis

changes in urethral orifice


Complications - common

Hemorrhage

Infections

Meatitis

Meatal stenosis - constriction of the urethral opening.

Bridging - adhering of the cut edge to the glans creates tunnels.

tight scar on shaft.

curving of penis, due to removal of too much skin. often not apparent until an erection.

pubic hair on penile shaft, pulled onto shaft after removal of too much foreskin.

bleeding during sexual intercourse

pain with erection

concealed, or hidden penis - cut surface of remaining skin adheres to itself, burying glans.

removal of too much skin

wound separation

urinary retention

 
Complications - serious

Hemorrhage

Infection

Cutting off all or part of the glans

Harming or destroying all or part of the penis

electrocautery has destroyed entire penises, necessitating surgery to change the infants' genitals to those of a female.

inadvertently putting hemostat in urethra and crushing glans.

Tetanus

Tuberculosis - via Mezizah, the practice of sucking the blood from the circumcision wound. the mohel gives the disease to infant.

lacerated scrotum

severe iron deficiency anemia (following hemorrhage)

blistering and peeling of glans with intromission (described by Masters and Johnson)

neonatal sepsis (twice as common in males as females) ie. scalded skin syndrome,

meningitis, necrotising entero-colitis, necrotizing fasciitis, gangrene.

Shock

Death


The following complications are derived from statements by circumcised men.

low self esteem over body image

sense of body violation

sense of denial of human rights

difficulties with intimate relations

sense of betrayal by parents, especially the mother

feelings of anger and violence toward women

addictions and dependencies (chemical and sexual)

extreme anger and hostility toward doctors


Broader Implications of Harm


A recent book, Circumcision, the Hidden Trauma by Ronald Goldman, Ph.D., discusses many subjects that may be associated with circumcision. These include:


"What's done to children, they will do to society."

—Karl Menninger MD, Menninger Clinic

The Bottom Line - Human Rights


The following rights were enumerated at the Second International Conference on Health and Human Rights, Harvard University, October 1996. Tim Hammond declared that each one of these is violated when a circumcision is performed:

Circumcision is also a violation of:

The Convention on the Rights of the Child

Article 24.3 calls for abolition of "traditional practices prejudicial to the health of children."


Myths

Please check to see how these myths have been refuted by the above information.


"Just a piece of skin."

"It does not hurt."

"Circumcision is not an important issue."

"It is necessary for hygienic purposes."

"Necessary to prevent cancer of penis."

  "Necessary to prevent urinary tract infection."

"It's important that he looks like his father."

(actually, his father wants to look like him)

"He may not be comfortable looking different."

(Half are intact today. He does need to be told that he is OK, that he is normal, and that he should treat his circumcised friends gently.)


Female Genital Mutilation

Most everyone in America is horrified at the idea of female genital mutilation (FGM). Everyone agrees it should stop. There are many parallels between FGM and MGM (euphemistically called male circumcision). We quote directly from the American College of Obstetrics and Gynecology Committee Opinion (Committee on Gynecologic Practice, and the Committee on International Affairs) Number 151 - January 1995. Try substituting "male" wherever the word "female" occurs.


"Female genital mutilation is a practice based on cultural and traditional patterns dating back at least 2000 years. According to the World Health Organization, approximately 80 million women [now living] have undergone these procedures. While the rationale for these procedures is lost in antiquity, the practice is still widespread in Africa, the Middle East, and Southeast Asia. The procedure is performed rarely in the United States, Canada, and western Europe; however, women who have undergone the procedure often immigrate to these countries.

"There are many forms of female genital mutilation but the procedures performed most often are 1) removal of the clitoral prepuce, 2) excision of the clitoris, and 3) removal of the clitoris and labia minora and occasionally much of the labia majora, suturing the two sides together to occlude the vagina (infibulation). These procedures usually are performed prior to adolescence (between the ages of 1 week and 14 years old) by untrained individuals without benefit of sterile conditions or anesthesia.

"The immediate physical effects of female genital mutilation can include infection, tetanus, shock, hemorrhage, and even death. In addition, there are long-term physical and mental disabilities, such as chronic pelvic infection, keloids, vulvar abscesses, sterility, incontinence, depression, anxiety, sexual dysfunction, and obstetric complications.

"There is no scientific basis for the female genital mutilation procedure. Physicians are reminded, however, that patients who have undergone the procedure should be treated with sensitivity and compassion. The American College of Obstetricians and Gynecologists joins many other major organizations (World Health Organization, United Nations International Children's Emergency Fund, International Federation of Gynecology and Obstetrics, and the American Medical Association) in opposing all forms of medically unnecessary surgical modification of the female genitalia. Furthermore, it is recommended that the issue be addressed by promoting awareness among the public and health care workers and by developing methods for educating physicians regarding the gynecologic and obstetric care of women who have undergone this procedure."


This is the basic information you need to know so that you can make the decision not to participate in circumcisions.

References

  1. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-5.
  2. Gairdner D. The fate of the foreskin: a study of circumcision. Br Med J 1949;2:1433-7.
  3. Fleiss P, Hodges F, Van Howe RS. Immunological functions of the human prepuce. Sex Trans Inf 1998;74(5):364-7.
  4. Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 Suppl. 1:34-44.
  5. Denniston GC, Hill G. Circumcision in adults: effect on sexual function. Urology 2004;64(6);1267.
  6. Hunter RH. Notes on the development of the prepuce. J Anat 1935;70(1):68-75.
  7. Deibert GA. The separation of the prepuce in the human penis. Anat Rec 1933;57:387-399.
  8. Øster J. Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child 1968;43:200-3.
  9. Beaugé M. The causes of adolescent phimosis. Br J Sex Med 1997; Sept/Oct: 26.
  10. Maden C, Sherman KJ, Beckmann AM, et al. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst 1993;85(1):19-24.
  11. Williams N, Kapila L. Complications of circumcision. Brit J Surg 1993;80:1231-6.

See



uparrow


D.O.C. Home