Psychological impacts of male circumcision

This menu page indexes and links articles relevant to an understanding of the psychological, neurological, and sociological sequelae and effects of male circumcision. The material within each category is arranged in order of publication.

Introduction

In medical circles, neonatal male circumcision was long assumed to be psychologically and emotionally benign. It was believed that newborn infants had "poorly developed" neurologic systems; that newborns could not feel pain; or, if they did feel the pain, they would not remember it. According to that orthodoxy, the experience of neonatal circumcision could never have any lasting effect on a child and could not traumatize a child.

The belief that infants cannot feel pain is now outmoded and discredited.

Pain of circumcision and pain control



It was also a common belief that the foreskin had no particular structure and no useful function; and that the patient would never later regret its loss.

The idea that the foreskin is a "useless flap of skin" is contradicted by a modern understanding of anatomy.

The penis and foreskin: Penile anatomy and sexual function

The assumption that no patient would ever regret being circumcised was not justified.

Awakenings (link to NOHARMM website)

Enough evidence now exists to say with confidence that male circumcision causes psychological changes. The trauma of the experience is injurious.24,47,47 It can have long-term deleterious effects later in life.24,47,48,51,56,57 However, the specific neurological, psychological, and behavioural changes resulting from early genital trauma have never been carefully investigated. Much more study is needed to further elaborate these changes.

The study of the psychology of circumcision can be divided into several interrelated areas:

The effects of pain and perinatal trauma on the child; Grieving the loss of a body part; Effects of early trauma and loss in the adult; The effects on the parent (parental-infant bonding); The effects on society; Factors influencing parents and doctors to request or perform circumcisions.

Although the literature on the psychological impacts of circumcision is far from complete, some information is available. New material is gradually appearing and will be added to these pages as it becomes available.

Perinatal trauma. Circumcision is a form of perinatal (birth) trauma.35 Cansever tested boys before and after circumcision and found that the trauma causes severe disturbance of normal function.6 Taddio and others have documented behavioral changes at six months of age, suggestive of PTSD in circumcised boys.37 Yilmaz et al. have demonstrated PTSD in boys in the phallic period who are undergoing circumcision for phimosis.56 Rhinehart has documented posttraumatic stress disorder resulting from the perinatal trauma of circumcision in middle-aged males.48 substantial evidence that perinatal trauma16,33,45,46,47,49,52,57 and/or deprivation of pleasure8,19 contribute to later aggressive, violent, and/or suicidal behaviour. Anand and Scalzo suggest that early trauma predisposes to altered pain sensitivity, stress disorders, ADD/hyperactivity, and self-destructive disorders.65 Van der Kolk identified a compulsion in traumatized persons to repeat the trauma.18 Goldman reports that the performance of circumcision by a circumcised male doctor may be a reenactment of one's own circumcision trauma.47

Denial of loss. Persons who have lost body parts must grieve their loss.41,42,43,45 The first stage of grief is denial of the loss.25 Fitzgerald and Parkes state that "Anything that seriously impairs sensory or cognitive function is bound to have profound psychological effects, not only on the person who is affected but also on family, friends, workmates, and caregivers."42 The thought of permanent loss of sensory function is so painful that persons deny their loss in order to avoid facing the painful feelings.42 Denial of loss causes a flight from reality. Parkes et al. state that persons in denial may minimize their loss.41-43 Circumcision causes the loss of a body part and all of its functions including a drastic loss of erogenous sensory function, so denial of loss is not uncommon in circumcised males. Circumcised males may experience the full range of distress and emotional dysfunction resulting from loss. This frequently results in circumcised fathers adamantly insisting that a son be circumcised.25,29, 57

Fathers are frequently unable to vocalize their feelings. They will say that "I want my son to look like me," even though the child may be different in eye color, hair color, and other aspects. In fact, what the father really may be feeling is, "I don't want a son with an intact penis to remind me of what I have lost."

Effects of denial on medical doctors. Goldman states that some circumcised male medical doctors misuse the medical literature to support, rationalize, and justify their own loss; and to defend the practice of circumcision.47 Denniston reports that doctors "who have been cut themselves may be unable to stop cutting others."29 LeBourdais reports that the likelihood of a baby being circumcised is determined by the circumcision status of the a father; the sex, age, and circumcision status of the physician; amongst other factors. Goldman reports that doctors who are older, male, and circumcised are more likely to condone circumcision.47 Members of medical societies may have emotional issues that may preclude the objective formulation of policy concerning non-therapeutic male circumcision.55

Summary

Parents need to be aware that circumcision is dangerous. It involves traumatic loss of a body part. There is a definite potential for long-lasting psychologic injury. However, children differ unpredictably in their resilience to pain, trauma, and loss. Some individuals will be affected more seriously than others. Much more research is needed before we can fully understand the psychologic and social consequences of this traumatic life event.

Highlights

See also The Birth Scene, a site having an excellent discussion of circumcision in four articles by leading writers.

Therapists

NOHARMM maintains a webpage listing therapists in various parts of the United States who are knowledgeable in helping men who have issues resulting from their circumcision.

Organizations

References

The psychology of male circumcision

The neurology of male circumcision

The study of neurological changes secondary to circumcision is in its infancy. Neurological changes have been demonstrated secondary to pain, stress, and trauma.22 Fitzgerald et al. report experimentation in animals.59,60 In addition, brain atrophy/dis-organization by sensory deprivation after removal of the pleasure sensors in the prepuce has been hypothesized by Immerman and Mackey.61,61

The next two documents are problematical.63,64 Immerman & Mackey (1998) set forth an informed hypothesis that removal of the sensors in the prepuce cause brain disorganization/atrophy. Thereafter they seek to justify circumcision by arguing that brain disorganization/atrophy has desirable social effects. This is not consistent with the principles of good medicine. Immerman and Mackey's defense of circumcision's maleficial effect on the brain in these articles may illustrate Goldman's revelation that some medical doctors may use 'Intellectual activity ...as an extremely clever apparatus precisely for the avoidance of facts, as an activity which distracts from reality' when they write about circumcision.46 This is a way in which many circumcised men deny the reality of their loss.38 This sometimes manifests itself in the scientific literature.46 Anand & Scalzo (2000) hypothesize that early abnormal stimulation of the nervous system (such as the pain of circumcision) affect the development of the nervous system and influence behavior.64

[See also The Anthropology and Sociology of Circumcision.]