'Circumstraint' board: used for infants. Photo: James Loewen.
This past April, Vancouver resident Dr. Paul Tinari became the first Canadian man to have a heath-care-funded foreskin restoration. When he was eight years old, doctors at his school performed an operation without his consent. After years of painful erections, and frequent infections, Dr. Tinari -- with the support of his doctor and psychiatrist -- successfully sued, and as a result, the B.C. Ministry of Health paid for 90 per cent of the $12,000 operation. Dr. Tinari says he hopes that it will set a precedent for legal action that will eventually end the practice of infant circumcision all together.
Dr. Tinari, an engineer, considers himself uniquely authorized to discuss the subject of circumcision. "I was uncircumcised until I was eight, then circumcised until I was 48, and am now again uncircumcised, so I really have seen all sides of this issue." Tinari, a Metis, describes being held down and circumcised as a young boy in what he says was "a routine form of punishment" for masturbation at residential schools. He claims that thousands of young native and Metis boys were circumcised during their stays in the residential school system.
Dr. Tinari's case and his efforts to bring awareness to the issue are the most recent instalments in a movement against what the medical establishment calls routine, non-therapeutic male circumcision. North America has the highest rates in the world for this procedure, but currently, no regional, national or international medical body in the western world advocates its practice. In fact, many, like the College of Physicians and Surgeons of B.C., recommend against it. Historically, many doctors performed circumcisions believing there were psychological and medical benefits, but anti-circumcision advocates say that since these medical benefits have now been disproved, the issue is one of cruelty.
Dr. Tinari says his intention is to rectify what he sees as "human rights abuse" and a "gross violation" of a small child's body.
A brief history of the hoody
The history of circumcision in North America is tied to attitudes towards masturbation. In the late 1800s, for example, Dr. John Harvey Kellogg (who invented Kellogg's Corn Flakes and believed that bland foods curb passions) was considered the leading circumcision authority.
"A remedy for masturbation which is almost always successful in small boys is circumcision," Kellogg wrote in his 1888 book, Treatment for Self Abuse and its Effects. "The operation should be performed by a surgeon without administering an anesthetic as the pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment."
Many doctors followed his advice, performing circumcisions without anesthetic on male and female babies.
At the time, doctors performed female circumcision by dripping carbolic acid on the genitalia. Unlike male circumcision, this practice did not endure to the present day. By the turn of the century, medical journals regularly directly listed male circumcision as a cure or prevention for many illnesses and even criminality.
In 1928, the American Medical Association published a journal article in which renowned British doctor R.W. Cockshut wrote: "I suggest all male children be circumcised. I am convinced that masturbation is much less common in the circumcised."
From dirty to clean
The sexual revolution may have brought a greater acceptance of masturbation, but by 1970, 90 per cent of all North American boys were being routinely circumcised. Now, many parents who opt to have their sons circumcised say they do so for reasons of cleanliness.
Dennis Harrison, another Vancouver resident, is one of the main spokespeople for the Association for Genital Integrity, a Canadian group committed to raising public awareness of the issues surrounding infant male circumcision. His group applied for funding to start a legal process to end what he describes as unjust genital mutilation. The group was turned down and is now appealing the process.
"I think the whole thing hinges on the cultural perception of the foreskin as being just a problem waiting to happen. The 'circumcision decision' is then framed as 'Do we get rid of it at birth, or expose the kid to the risk of urinary tract infections, cancer and God knows what else?' On the surface, this seems like a rational approach but it's analogous to 'Do we chop off the little finger at birth, or wait for it to get caught in the car door or develop cancer?' You could use this logical framework to justify cutting off practically anything, because what body part never causes problems?" he says.
The medical profession has undergone a radical change of opinion regarding circumcision over the past few years. The College of Physicians and Surgeons of British Columbia published a paper in 2004 stating that due to insufficient proof of its benefits, "routine infant male circumcision, i.e. routine removal of normal tissue in a healthy infant, is not recommended."
The snip in Saskatchewan
In February 2002, the College of Physicians in Saskatchewan issued a much more strongly worded memo on the subject that states:
In spite of the fact that the Canadian Pediatric Society (CPS) has for two and a half decades explicitly cautioned against routine circumcision of newborn male infants, 27.6 per cent of newborn males were circumcised in the province in 2000-2001.
Since August 1996, infant circumcision has not been a publicly insured service in Saskatchewan. The decision to de-insure the service was based partly on the lack of valid medical indications for the procedure.
Even though citizens must now personally pay for this service, the incidence of routine male circumcision has dropped only moderately over the past five years.
It is difficult to identify any other domain of medicine in which physicians would feel comfortable playing such a passive role in a decision pathway culminating in surgery. It is also difficult to identify any other domain of medicine in which practice patterns stand in such stark contrast to research evidence.
At present, no regional, national or international public health authority in the western world advocates the routine circumcision of children, either male or female. However, several studies have found some medical advantages for the practice. One study found that "male circumcision is associated with a significantly reduced risk of HIV infection among men in sub-Saharan Africa, particularly those at high risk of HIV," but the study does point out that circumcision does not prevent HIV infection. Others found little or no difference in HIV rates for circumcised men. Still, many non-medical people assume there is a sound medical basis for circumcising infant boys.
"I find the anatomical aspect very interesting," continues Harrison. "When medicalized circumcision first took off, 100 years ago or so, the foreskin could [supposedly] potentially cause everything from curvature of the spine to insanity. Then for a while the foreskin became nothing -- a mere 'fold of skin.' Now it's something again, but it 'causes' AIDS. So the anatomy keeps changing, as required to support circumcision. Suggestions that the foreskin has useful functions are ignored or downplayed."
It was another Canadian, Dr. John Taylor, who first started doing research into just what those useful functions might be. While the dense collection of nerve endings in female genitalia (the so-called "g-spot") had been a focus of research and discussion for some decades already, it wasn't until the mid-'90s that Dr. Taylor published his first study in what he has called the "ridged band." The ridged band is a ring of deeply corrugated or ridged mucous membrane lining the tip of the foreskin.
Initially, Dr. Taylor was interested in studying the tissue in order to help him make an informed decision about circumcising his own children. What he found was that the foreskin is actually a highly specialized tissue that is comparable to an eyelid; foreskins are actually used in eyelid replacement surgery. Dr. Taylor says that when you remove the foreskin you are removing "half of the skin of the penis," and large amounts of specialized mucosa, which has in it specialized nerve endings called genital nerve endings. In simple language, according to Dr. Taylor's research, it is the man's foreskin that is analogous to the clitoris -- not the glans or head as is widely believed.
In an interview by Intact, an organization that seeks to end non-therapeutic male infant circumcision, Dr. Taylor was quoted as stating, "I think if you remove the vast bulk of the software from your penis, then you're going to suffer. If you lose all your specialized sensory nerve endings, and then the mechanism, the skin, and the rest of the penis that makes these nerve endings work, during sexual intercourse, or whatever, then you'll suffer. Obviously people who are circumcised don't miss what they've never had. It's like someone who was born blind, I guess. Now whether that's because they compensate, or do it in some different way, I don't know. No one knows."
While most people think of the foreskin as a fairly small section of skin, Dr. Taylor's research indicates that the proportion is relatively large for a baby. In a female, the equivalent would be about the same as removing the clitoral hood and labia, a practice that most of the westernized world openly abhors.
What's good for the goose
Several doctors and lawyers told The Tyee that Canadian doctors are increasingly being asked to circumcise girls. By law, doctors cannot perform the surgery since even though male circumcision is still legal in North America, female circumcision has been banned through protective legislation in both Canada and the U.S. But doctors are being asked to do the operation anyway in order to respect the religious and cultural beliefs of the families. Anti-circumcision advocates say this begs the question: when there is no medical reason to perform the surgery for either sex, why do most Canadians consider the practice to be mutilation for women, and not for men?
"While a doctor would never perform a vasectomy on a baby -- which is reversible," Tinari states, "you can get a circumcision done, which is not. Male circumcision is a feminist issue: as long as the door is open to male circumcision, then it is also open to female."
'Conspiracy of silence'
Tinari argues that "there is a conspiracy of silence around circumcision. First of all, the men who have been circumcised don't want to admit that there might be anything wrong with them, and they certainly wouldn't want to face that they had made a bad decision for their sons."
Tinari claims that "circumcision is also a multi-billion-dollar industry in Canada and the U.S." and that one doctor in the Lower Mainland of B.C. claims to have performed 20,000 circumcisions over the past decade, charging around $250 per procedure.
"There is the resale value," says Tinari. He is referring to the fact that human foreskins are a highly valuable tissue that can be grown in a lab to the size of a football field.
The foreskin has more blood cells and nerve endings than almost any other skin on the body. Most baby foreskins are used in insulin production, breathable bandages, and in the cosmetics industry. People like Tinari wonder why the sale of all other human tissue is considered illegal, or is highly regulated, yet doctors are allowed to remove healthy tissue without the patient's consent and against all medical recommendations, then sell it for profit in a for-profit industry.
Dr. Tinari estimates that between the surgery and the foreskin's resale value, each foreskin is worth approximately $100,000. His intention is to launch a legal battle, which he will call "The Head Tax" in which he aims to restore at least 10 per cent of that figure to the portion of the 10 million men in Canada who had the procedure non-consensually. But while Tinari says the issue is a moral one, he aims to fight it on the financial front. "When the cost of lawsuits exceeds the money that they are making from the surgery, that is when it's going to end. It won't end before that. Some people will join the class action lawsuit for the money, and although I would hope they did for moral reasons.... I don't care why they join."
As for his surgery? Tinari says he is very happy, "in every way," with his new skin.
Amanda Euringer is a Vancouver writer.
Related Tyee stories: Danielle Egan interviewed "the genitailor," a Vancouver plastic surgeon who creates "designer vaginas."