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Williamson, Marvel L., Ph.D., R.N. and Williamson, Paul S., M.D. Women's preference for penile circumcision in sexual partners. Journal of Sex Education and Therapy, Vol. 14, No. 2 (Fall/Winter 1988): pp. 8-12.

[This paper is a fairly typical example of pro-circumcision bias in a supposedly scientific paper.]

Women's Preferences for Penile Circumcision In Sexual Partners

[Its very title reflects its bias: a more accurate title would have been "Women's preference for penile intactness vs circumcision in sexual partners: a small, local survey"]

Marvel L. Williamson, Ph.D., R.N.
Assistant Professor, College of Nursing
The University of Iowa
Iowa City, IA 52242

Paul S. Williamson, M.D.
Associate Professor, College of Medicine
The University of Iowa
Iowa City, IA

[Interleaved comments by HY]

Abstract

Regardless of pediatricians' attempts to negate routine newborn circumcision, U.S. circumcision rates remain constant. [No, the rates vary widely across the US but have fallen slowly over last two decades. It is doubtful that many paediatricians make any serious attempts to "negate" RIC.] This study hypothesized that, because circumcision is usually a maternal choice and the circumcised penises are perceived by young women as more attractive, most women prefer circumcision for sexual reasons.

Of 145 new mothers of sons responding to this survey, 71-83% preferred circumcised penises for each sexual activity listed.

Visual appeal and sexual hygiene were predominant reasons for favoring circumcised sexual partners. Even among women having sexual experience only with uncircumcised partners, only half preferred uncircumcised penises for sexual partners. Eighty-nine percent of the sample had had their sons circumcised. This study furthers debate over whether circumcision decisions should be based solely on medical considerations limited to the newborn period.

In spite of recent attempt by the American Academy of Pediatrics and other organizations to persuade the public to abandon the practice of routine newborn circumcision (e.g., Thompson, King & Knox, 1975; American Academy of Pediatrics, 1984) [What attempt? The AAP's last three reports - the latest in 1999 - have been ambivalent, to say the least], new parents have continued to request the procedure at the same high rates (Metcalf, Osborn, & Mariani, 1983). In the United States, approximately 75-90% of newborn males are circumcised, compared to only 10% of Europeans [the figure for newborn Europeans is far lower] and 20% of males in general worldwide (Jones, 1985; Wallerstein, 1985) [the great majority of them Muslims circumcised in boyhood].

One survey of 200 women concerning their maternal attitudes [towards] circumcision revealed that mothers were not giving medically valid reasons for having their sons circumcised, and the authors concluded that health care providers needed to do a better job of educating parents about the medical risks and benefits of the procedure (Lovell & Cox, 1979).

Even after other researchers launched extensive programs to inform prospective parents about the lack of "absolute medical indication" for circumcision, no significant change in the rate of newborn circumcisions could be observed in targeted samples (Herrera, Hsu, Salcedo, & Ruiz, 1982; Herrera, Cochran, Herrera, & Wallace, 1983; Land & Policastro, 1983; Rand, Emmons, & Johnson, 1983; Stein, Marx, Taggart, & Bass, 1982). Parents within the United States who do not have their sons circumcised report the main reason is cultural. That is, most are a part of a subgroup, often Hispanic, that traditionally does not circumcise (Ernst, Philip, & Orman, 1987). [Who needs a reason not to cut off part of their baby's genitals? This article completely fails to mention - let alone give any serious consideration to - any of the many good reasons not to, such as risks, complications, loss of the foreskin's functions, etc. etc.]

Only 10% of the subjects who choose to leave their sons uncircumcised cite being convinced on the basis of reading or on physician's advice (Kreuger & Osborn, 1986; Stein et al., 1982).

It has been demonstrated that mothers more than fathers usually decide whether to have their sons circumcised (Bean & Egelhoff, 1984; Williamson & Williamson, 1984). [Or do they, as the person on the spot, just register the joint decision?] Although informed consent for circumcision now includes information on how easy it can be to give proper penile hygiene to an uncircumcised baby, [It does? Some "informed" consent forms give no information at all.] mothers persist in their desire to have their male infants circumcised. This trend is particularly noteworthy within the current financial context in which many third party payers deny coverage for newborn circumcisions (Medical World News, 1986. [But the majority still do.]

Review of the Literature and Conceptual Framework

Controversy characterized the history of circumcision.

Circumcision has existed since the Stone Age for unknown reasons (Jacobs, 1943). In earliest written records documenting its use, religious beliefs required that the male foreskin be removed as an outward display of faith and membership in the group.

In some cultures, circumcision signified a boy's entrance into manhood. In whatever setting, the uncircumcised were looked down upon for being pagan or unmasculine.

Later, the European elite class made circumcision exclusive privilege in the Victorian era (Jones, 1985). This notion persisted even into the early twentieth century as evidence that a man had been born into a situation where the luxury of circumcision could be afforded. [Circumcision is now right out of favour among all classes in Britain and Europe.]

Circumcision has not solely been a status symbol, however. Within certain circumstances it was a necessity. Entire armies found themselves immobilized by balanitis, a painful inflammation under the foreskin [Balanitis, inflammation of the glans, also occurs in the circumcised] due primarily to lack of access to bathing facilities. (King, 1979) [The publication is obscure - does King document this this extraordinary claim, or just repeat gossip? There are first-hand accounts of military doctors with a circumcision compulsion who invented such epidemics.] Societies that live in arid, sandy environments where water is precious learned long ago about the merits of circumcision. [This is a myth: various desert tribes do not circumcise.]

Even today, hygiene can be so difficult within some segments of the health care system, such as in institutions for the elderly or the mentally handicapped where patients may resist personal hygiene care, that circumcision eventually has to be performed to prevent infections or other complications of the foreskin (Harris, 1986). [What do they do to the women in their care?]

Inadequate penile hygiene, which is more likely in uncircumcised men, is resurfacing again as a predictor of carcinoma of the penis (Jussawalla, Yeole, & Natekar, 1985). [Yet cancer of the penis is rarer in some countries where circumcision is almost unknown, such as Denmark, than the US.] After the proclamation by the American Academy of Pediatrics against circumcision, studies have since begun reporting a relationship between uncircumcision and the incidence of urinary tract infection in male children (Ginsburg & McCracken, 1982; Shapiro, 1984; Wiswell et al, 1987). [Yes, when one "reason" for circumcision is disposed of, another arises, and another.]

Other complications, especially balanitis, bring about significantly more medical visits for uncircumcised boys than for penile problems in circumcised boys (Herzog & Alverez, 1986). Good hygiene, which itself can be difficult for even the best intentioned parents, does not entirely eliminate these problems (Krueger & Osborn, 1986).

[For the penis, as for every other part of the body, it is trivially true that because it is there it can give trouble. For no other part of the body is routine surgical removal recommended as a preventative.]

It is argued, therefore, that pediatricians have an incomplete perspective in the current debate over whether circumcision for newborns is necessary. Furthermore, medical indications and contradictions aside, insight into the cultural and sexual rationale for why the American public and American women in particular prefer circumcision is missing. Social reasons for circumcision, when conceded at all, are dismissed by medical personnel as being unjustifiable vis-a-vis existing "scientific" proof.

In addition, arguments that cite historical fallacies about circumcision fail tests of logic when posing as premises for concluding that circumcision for any reason is wrong (Grossman & Posner, 1984).

[True, if anyone had made such a deduction. The historical fallacies help to explain why circumcision became customary. It now continues largely under the momentum of that custom - which the authors seem to be at extraordinary pains to defend.]

The debate on medical grounds seems to miss a major portion of the reasoning, though. In the face of the current campaign against circumcision, why is it still requested at such high rates? What motivations do American women have for wanting American males to be circumcised?

In a study by Bean and Egelhoff of 277 new mothers of sons, 78% reported favoring circumcision even before becoming pregnant and having to make a conscious choice affecting a son, and 91% ultimately decide to have their newborn son circumcised (1984). [The question arises what pressures they were under in the hospitals.] Even those woman whose husbands were uncircumcised overwhelmingly opted for circumcision. [So much for "A boy should look like his father" - unless his father is circumcised.]

The reason must seem important enough to woman for them to withstand pressure from physicians and others who oppose circumcision. [This begs the question that there is any such pressure. There is ample anecdotal evidence that the vast bulk of the pressure is in the other direction.] Brown & Brown go as far as to say that "the circumcision decision of the United States is emerging as a cultural ritual rather than the result of medical misunderstanding among parents" (1987). [It has been for most of the 20th century.]

One idea that has been overlooked is that the penis is a sexual instrument, not just a passageway for urination. [The authors fail to follow through on this idea, that it is a sexual instrument that belongs to a particular person, or that its foreskin is integral to its sexual function. Their entire focus is on what his mother, who has - we may hope - no sexual interest in it, thinks about its sexual function.] For example, circumcision at puberty in nonliterate cultures is in some ways a sexual recognition of the emerging man (Bettelheim, 1954; Money, Cawte, Bianchi, & Nurcombe, 1970; Kitahara, 1976). The permanent exposure of the glans of the penis renders it a sexual tool.

[An accurate observation. And is it not extraordinary that in a literate society, people might seriously consider surgically modifying the penis of a baby in order to render it, full-time and life-long, a more visibly "sexual tool"? Many men might not want their penis looking like a "sexual tool" whenever it is exposed - in the shower with other men, for example.]

Most research conducted previously on the reasons newborn males are circumcised fails to include a reference to the perceived sexual appeal of a circumcised penis over an uncircumcised one.

Typical lists of reasons from which the subjects could choose offered only hygiene, religion, father's or sibling's circumcision status, and other traditional explanations. At the most, an "Other" category included in some surveys caught untold thoughts on the perceived advantage of circumcision. Without the inclusion of sexual attitudes toward penis type on such a list, respondents would typically hesitate to spontaneously present sexual rationale favoring circumcision, particularly in reference to a newborn penis.

Admitting to sexual desires and preferences is difficult enough for subjects even in straightforward studies. Without the researcher conceding the possibility, it is not likely a mother would volunteer information about her hopes for her son's future sexual attractiveness.

It was not until a study on cultural values associated with the decision to circumcise, in which Harris used unstructured interviews, that the sexual overtones of newborn circumcision were explicitly reported (1986). One of her findings was that a circumcised penis has a certain "cosmetic appeal," that in America the exposed glans is more pleasing aesthetically.

She concluded that circumcision could be an acceptable practice based on cultural values, and that the health care delivery system could be a more "perceptive cultural broker" with regard to honoring a society's view of beauty.

[Yes, this is a most extraordinary conclusion. In what other realm might a health care delivery system even dream of "honoring a society's view of beauty" by performing surgery on a healthy baby, quite regardless of that person's view of beauty?]

In asking various groups about why circumcision may be indicated, a few surveys have included a response category labeled "cultural," which may have been construed by some subjects to include sexual attitudes.

One such study found that significantly more obstetricians than pediatricians believed that the culture was a valid reason for neonatal circumcision (Herrera & Macaraeg, 1984).

What the concept of culture means, though, is that to many Americans circumcision seems to be normal because that is what they are accustomed to seeing. This could certainly be true, in that what people are used to is what they prefer.

This cultural perspective brings circumcision into a new arena, one in which the rigidity by some health professionals fosters alienation and resistance (Gellis, 1978). Some go so far as to say that opting for circumcision indicates an emotional response that is not based on rational decision making (Brown & Brown, 1987).

[Most Intactivists would heartily agree with that. Where we differ from the authors is in their assumption that health professionals have any role in cooperating with irrational decision-making involving life-altering surgery on a healthy, non-consenting third party.]

A study of female preference for certain male body parts showed that 89% of woman students at a southern college preferred pictures of circumcised penises over uncircumcised ones (Wildman, Wildman, Brown & Trice, 1976).

This is as close as the literature comes to facing the persistent preference by American women for circumcision, as best displayed by new mothers of male infants. To date, no study has explored the possible sexual motivations behind circumcision, however.

It was the purpose of this investigation, therefore, to determine if women, particularly mothers who recently made a decision about circumcision of their newborn sons, do indeed prefer circumcised sexual partners, and if so, for what reasons. This study hypothesized that most American woman prefer circumcised penises in their sexual relations, a factor unrelated to the purported ["purported"? demonstrated] lack of medical indications for the procedure.

Methods

Women 18 years of age and older who delivered full-term healthy sons within the previous month at a major midwest medical center comprised the targeted sample. [The midwest in general, and Iowa in particular, are areas of the highest infant circumcision rates in the US, which itself has the second-highest rate in the world.] Candidates for the study were chosen during a 6-month period based upon their willingness to participate in an earlier study that dealt with who and what influenced their decisions to circumcise or not circumcise their babies. [This willingness may not be randomly distributed. It might well be that women who bucked the trend to circumcise also resisted an inquiry into their sexual preferences.] The sample had been randomly selected and 85% made up the group to whom questionnaires were mailed for this study.

vicki ekwall (divinefate) wrote on NPR on August 25,2010

AND by the way that study of 145 iowa mothers: I was one of those mothers! I was 19 they chose young ignorant mothers with no worldly experience and I had a girl child. At the time I knew nothing of circumcision dangers or benefits! They asked me if my child had been born [a boy] would I have circumcised and absentmindedly I said yes it had no relevance to me! ONLY then did they ask me to fill out the survey! So that too was a skewed sample!

Of the 269 women who received the questionnaire, 148 returned their forms yielding a response rate of 55%. Three were unusable, yielding a final sample of 145. Due to the explicit sexual nature of the questions, this rate compares favorably to the other research studies investigating such personal sexual issues. [It still introduces a 46% inaccuracy into the outcome.]

Because there had been no previous data collection tool seeking this type of information, it is necessary to first confirm the content validity through its review by several experts. The survey instrument was tested on a pilot group of women who gave subsequent feedback about its clarity and the completeness of the response options available from which to choose. By comparing the outcome of this questionnaire to certain items on the previously conducted study on the group of 269, it was also possible to establish the reliability of the individual subject's responses over a period of time.

The survey was highly personal, asking the women about their own sexual experiences with men and about their preferences for circumcised or uncircumcised penises for various sexual activities. No reference was made to the women's decision to circumcise their own sons or not.

This survey dealt entirely with adult sexual experiences and preferences in order to distinguish the two issues and allow for correlational tests between their choices as parents and their attitudes as sexual adult women.

Each subject had received a thorough review of circumcision at the hospital when deciding about their son's candidacy for the procedure. Each was also shown drawings of both uncircumcised and circumcised penises. It was assumed, therefore, that the subjects knew what circumcision meant and what types of penises their sexual partners had. Lay terminology was used in each question. Prior to implementation of the study, all procedures and tools received approval by a human research subjects' rights board. Confidentiality was guaranteed to the subjects and was maintained throughout the study.

Results

Most of the newborn sons of mothers in the sample had been circumcised (89%). This percent is similar to the circumcision rate prevailing in the geographic area at the time of data collection.

Of the women in the sample, 83.7% were married, 12.8% were single, and 3.5% were separated, divorced, or widowed.

By race, 97.9% were Caucasian, 1.4% were black, and 0.7% were Hispanic. Another characteristic consistent with the midwest population generally was religion: 46.1% were Protestant, 21.3% were Catholic, 29.1% claimed no religion, 0.7% were Jewish, and the remaining 2.8% listed other religions.

The group was well educated. All but 12.7% had finished high school and 25.3% had at least some higher education. Fourteen percent had finished college. There was a weak correlation between higher education and the choice to circumcise the newborn (rpb = 0.27).

In response to the question "With which penis types have you had sexual experience?", 16.5% [of the 145 women who gave usable answers, that is, 24 women, or 8.9% of the total number asked] revealed that they had had sexual contract with both circumcised and uncircumcised men. Only 5.5% [8]had sexual experience exclusively with uncircumcised sexual partners, and the remainder of the sample [78%, 113]was sexually experienced only with circumcised men. [This may be usefully contrasted with the study by O'Hara and O'Hara, where all the women had experience of both kinds, and, while the sample was admittedly self-selected, those who preferred intact men explained why they did, in terms of actual differences in sexual sensation and performance.]

The responses to "If you could choose anyone for your ideal male sex partner, which circumcision type would you prefer he have for the following activities?" as shown in Table 1. There was a strong correlation between the circumcision status of her newborn son and a woman's ideal male partner's status for the purpose of intercourse (phi = 0.86)m, and a moderate correlation for visual appeal (phi = 0.50).

To investigate any possible relationship between the circumcision status of one's father or brothers and the preferred type of ideal sexual partner, correlational tests were made on those subjects who knew whether these family members were circumcised. No similarities were found that could be attributed to childhood exposed to penises of either type (phi = 0.12 for fathers and 0.06 for brothers).

It was interesting to note that 22% of the sample did not know whether their fathers were circumcised and of those who had brothers, 9% did not know whether they were circumcised.

TABLE ONE

ActivityPenis Type
 Circumcised (%)Uncircumcised (%) Either (%)
Sexual Intercourse716 23

Looking at to achieve sexual arousal

76 4 20

Giving manual
penile stimulation

75 520

Giving Fellatio

832 15


It could be surmised that some women prefer circumcised penises because that is their sole experience in sexual contacts.

[78% of the responding women were in that position of ignorance. Yet for the first three activities, fewer than that figure preferred circumcised men. Clearly, at least a few did not prefer circumcised men for those activities, even though they had experienced no other kind!]

However, of the group with dual experience (N = 24), two-thirds favored circumcision exclusively and a significantly greater proportion preferred circumcised partners for all the sexual activities listed in Table 1 (p < 0.01).

[It is inappropriate to apply statistical methods such as the chi-squared test to such a small sample, itself a small subset of the total, with a 46% non-response rate. "A significantly greater proportion" appearently means "significantly more than half" of the 24 women. The question arises whether they were expressing loyalty to their present (circumcised) partners or indicating some other such individual preference.]

Among those women who had sexual experience only with uncircumcised partners (N = 8), their past was more clearly correlated to their preferences. For each of the sexual activities presented, approximately half of this sub-group desired an uncircumcised penis and the other half said that penis type did not matter.

[How "approximately" can you divide eight people in half? Notice that the "don't cares" are only counted when that contrasts with preference for intactness.]

Evidently, almost any sexual exposure to a circumcised [penis] swayed women to sexually prefer circumcision. That is only 1% of the entire sample consistently preferred uncircumcised partners for all sexual activities, and those subjects came entirely from the group which had had sexual experience only with uncircumcised penises.

[This is a faulty conclusion. The authors reach it by lumping women who say either kind of penis is acceptable - the "don't cares" - in with those who "sexually prefer circumcision". One could equally conclude that "almost any sexual exposure to an intact penis swayed women to sexually prefer intactness." - as Maimonides said.

"The entire sample" is heavily loaded towards women who have never experienced an intact penis, so the 1% figure is unsurprising.
]

When asked "Why do you prefer one penis type over another for sex?", subjects were instructed to mark all options that applied to them.

Among those preferring a circumcised penis, the reasons they indicated appeared in the following ranked order from most frequent to least:

Stays cleaner (92 %)
Looks sexier (90%)
Feels nicer to touch (85%)
Seems more natural (77%)    [ ! ! ! ]
Smells more pleasant (55%)
Stays softer(54%)


It was fascinating to find that so many women thought a circumcised penis seemed more natural, probably meaning to them "familiar" within the American cultural context. [Or that they have little idea what circumcision entails, and hence just how "unnatural" it is.

The 54% figure for "stays softer" is a useful indicator of the "noise-level" of this survey, since "stays softer" is

  • factually inaccurate
  • seldom if ever cited as an advantage of circumcision
  • of no value - especially if circumcision is seen as enhancing sexual attractiveness.]

    Among those preferring an uncircumcised penis, most also stated that to them it looked more natural, but no one in the entire study thought that an uncircumcised penis looked sexier.

    [Just another effect of the unfamiliarity of the great majority of the women with an intact penis.]

    Overall, the factor correlating most strongly with whether the newborn son was circumcised was the subject's favorite penis type for sexual intercourse. There was little or no correlation between the newborn circumcision decision and demographic factors including race, upbringing, or sexual experiences.

    [Other studies indicate that the father's circumcision status is a strong predictor.]

    Conclusions

    This study clearly support the hypothesis that American women prefer circumcision for sexual reasons. The preference for circumcision does not necessarily come out of ignorance nor from lack of exposure to uncircumcised men.

    [This does not follow from the information presented.]

    Even when women grow up with uncircumcised fathers and brothers, or have uncircumcised sexual partners, the majority of such a group still prefer circumcised sexual partners.

    Women state a preference for circumcised penises particularly for sexual activities like fellatio, but also for intercourse, manual stimulation, and visual appeal.

    They say that this is primarily due to circumcised penises being cleaner and looking sexier.

    The cleanliness of circumcised penises within the sexual context means something different from cleanliness as a hygiene factor to prevent balanitis and other complications.

    To a sexual partner, cleanliness is important because the penis tastes, smells, and looks more appealing. [Or rather, the respondents think it does.] Spontaneous sexual activity is more likely to be enjoyable with a man who is circumcised, because bathing efforts last for longer periods of time. [This is the unsupported opinion of the researchers.] For the uncircumcised, washing under the foreskin must be attended to frequently to prevent the accumulation of any smegma, whereas in the circumcised male, the constant exposure or the coronal ring and the glans to air prevents the build up of odors and secretions. [And so is this.]

    Of almost equal importance to cleanliness of the penis for sexual activities is the visual attractiveness of a circumcised penis. What is sexier about a circumcised penis?

    Perhaps visualizing the glans, the urinary meatus, and the corona without them being hidden under a foreskin is arousing. After all, such is the appearance of an erect penis, and sexual imagery of the erect penis involves exposure of the glans. [Indeed this is possibly true, reflecting the ancient history of circumcision as sympathetic magic. Conversely it could be argued that circumcision destroys the visual appeal of the glans emerging from cover on erection.]

    While the foreskin of an uncircumcised penis can be retracted, the circumcised penis exists in exposed beauty whether flaccid or erect. [This is a scientific study?] Furthermore, in some uncircumcised men the foreskin can actually detract from the visual appeal of the penis. [And circumcision can detract from the visual appeal of the penis. See the botched galleries.] American producer of erotic films and publishers of photographic literature are careful, for example, on those rare occasions when uncircumcised models or actors are used, [Not as rare as they used to be] to select penises with foreskins that are smooth and free from extra wrinkled skin. [It would be fascinating to learn where and how they established this.] Particularly to the unaccustomed eye, a puckered or wrinkled foreskin can lack sexual appeal. [One solution to that would be to make the eye less unaccustomed, by abandoning routine infant circumcision altogether.]

    These findings suggest that the decision to have a new-born son circumcised may not be significantly affected by increasing the already rigorous efforts to explain the supposed lack of medical indications. ["Rigorous"?] While many mothers may not consciously view their sons as sexual beings, many may opt for circumcision with the belief that the son will be more sexually attractive to his future sexual partners, based on how they themselves feel. Future research can address this issue within a different cultural setting where most males are uncircumcised.

    [This is most unlikely to happen, since in countries where circumcision is not desperately defended as a custom, there is little demand for such research.]

    Newborn circumcision need no longer be performed without local anesthesia (Kirya & Werthman, 1978; Williamson & Williamson, 1983), silencing the outcry against circumcision as a form of "barbarism" (Foley, 1966). [An extraordinary claim! It is not only the pain of the operation itself that makes circumcision barbaric: there is the post-operative pain, the risks, and the loss of protective and erogenous tissue, but most of all, the human rights abuse.] Removal of the foreskin may be viewed as preventive care, not unlike procedures done in other areas of health care (such as the extraction of asymptomatic wisdom teeth). [Asymptomatic wisdom teeth are only ever removed from people who have reached an "age of wisdom" and then ethically only when symptoms may confidently be predicted.

    Somehow we are back to medical excuses, even though the authors have failed to present any.
    ]

    The opponents of circumcision argue in return against the imposition of such a decision without the affected newborn male's consent. In response, those favoring circumcision point out that the many men who later want or need to be circumcised face a major surgical procedure that would have presented only a minor inconvenience if done as an infant.

    [This is no answer at all. The proportion who actually need to be circumcised later is not "many" - perhaps 1% in countries where it has never been customary. A high proportion of those adults who want circumcision do so to conform to societal pressure. When fewer of their peers are circumcised, this pressure will vanish. A further significant proportion has a sexual investment in the act of circumcision itself. All of those who want it done have the benefit of freedom of choice - if they were left intact in infancy. For the remainder, the vast majority, cutting off part of their penises in infancy remains a human rights abuse.]

    Circumcision has, therefore, now become a much broader issue than one that can be dismissed on such narrow grounds as those proposed by the American Academy of Pediatrics. Not least among the considerations is the worth of sexual preference for male circumcision within the American culture as a valid reason for continuing the practice.

    [Excluded from this discussion is any reference to medical ethics, to any erogenous qualities residing in the foreskin itself - and hence to the sexuality of the person most directly concerned - or to the human rights of the person whose penis it is. As mentioned, there is no consideration of risks, complications or any other negative consequences of circumcision.

    It seems clear the authors have their own cultural investment in circumcision, which they are desperately attempting to rationalise here.

    For an adult to even
    touch a child's genitals in order to satisfy the adult's sexual agenda satisfies most definitions of child sexual abuse. Imagine the above study for a moment - but asking the fathers of girl babies.]

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    References

    American Academy of Pediatrics (1984). Care of the uncircumcised penis. Elk Grove Village, IL: Author.

    Bean, G., & Egelhoff, C. (1984) Neonatal Circumcision: When is the decision made? The Journal of Family Practice, 18, 883-887.

    Bettelheim, B, (1954) Symbolic wounds: Puberty rites and the envious male. New York: Free Press.

    Brown, M., and Brown C. (1987) Circumcision decision: prominence of social concerns. Pediatrics, 80, 215-219.

    Ernst, T., Philip, M., & Orman, R. (1987). Neonatal circumcision rates in a multiethnic hospital population. Family Medicine, 19, 227-228.

    Foley, J, (1966). The practice of medicine - a reevaluation. New York: Materia Medica.

    Gellis, S. (1978). Circumcision. American Journal of Diseases in Children, 132, 1168-1169.

    Ginsberg, C., & McCracken, G. (1982). Urinary tract infections in young infants. Pediatrics, 69, 409.

    Grossman, E., & Posner, N. 1984. The circumcision controversy: An update. Obstetrics and Gynecology Annual, 13, 181-195.

    Harris, C. (1986). Cultural values and the decision to circumcise. Image: Journal of Nursing Scholarship, 18, 98-104.

    Herrera, A., Hsu, A., Salcedo, U., & Ruiz, M. (1982)The role of parental information in the incidence of circumcision. Pediatrics, 70, 597-598.

    Herrera, A., Cochran, B., Herrera, A. & Wallace, B. (1983). Parental information and circumcision in highly motivated couples with higher education. Pediatrics, 71, 233-234.

    Herrera, A., & Macaraeg, A. (1984) Physicians attitudes toward circumcision. American Journal of Obstetrics and Gynecology, 145, 825-826.

    Herzog, L., & Alvarez, S. (1986). The frequency of foreskin problems in uncircumcised children. American Journal of Obstetrics and Gynecology, 140, 254-256.

    Jacobs, S. (1943). Ritual circumcision. Urologic and Cutaneous Review, 47, 679.

    Jones, S. (1985). Infant circumcision: Procedures complications, and indications. Continuing Education, 833-845.

    Jussawalla, D., Yeole, B. Cancer in Indian Moslems, Cancer, 55, 1149-1158.

    King, L. (1979) The pros and cons of neonatal circumcision. Surgical Rounds, 2, 29.

    Kirya, C., & Werthman, M. (1978). Neonatal circumcision and penile dorsal nerve block - a painless procedure. Journal of Pediatrics, 92, 998-1000.

    Kitahara, M. (1976). A cross-cultural test of the Freudian theory of circumcision. International Journal of Psychoanalytic Psychotherapy, 5, 535-546.

    Kreuger, M. & Osborn, L. (1986). Effects of hygiene among the uncircumcised. The Journal of Family Practice, 22, 353-355.

    Land, J., & Policastro, A. (1983). Parental Information and circumcision: Another look, Pediatrics, 72, 142-143.

    Metcalf, T., Osborn, L., & Mariani, E. (1983). Circumcision: A study of current practices. Clinical Pediatrics, 22, 575-579.

    Money, J., Cawte, J. Bianchi, G., & Nurcombe, B. (1970). Sex training and traditions in Arnhemland. British Journal of Medical Psychology, 43, 383-399.

    More insurers ending circumcision coverage. (1986). Medical World News, 27, 34.

    Rand, C., Emmons, C., & Johnson, J. (1983). The effect of an educational intervention on the rate of neonatal circumcision. Obstetrics and Gynecology, 62, 64-68.

    Shapiro, S. (1984). UTI in uncircumcised infants Report presented at the Symposium on Pediatric Infectious Diseases, University of California, Davis, School of Medicine and the Sacremento Pediatric Society.

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    Thompson, H., King L., & Knox, E. (1975) Report of the ad hoc task force on circumcision. Pediatrics, 56, 610-611.

    Wallerstein, E. (1985). Circumcision: The uniquely American medical dilemma. Urologic Clinics of North America, 12, 123-132.

    Wildman, R., Wildman II, R., Brown, A., & Trice, C. (1976) Note on males' and females' preferences for opposite sex body parts, bust sizes, and bust-revealing clothing. Psychologic Reports, 38, 485-486.

    Williamson, P., & Williamson, M. (1983). Physiologic stress reduction by a local anesthetic during newborn circumcision. Pediatrics, 76, 36-40.

    Williamson, P. & Williamson, M. (1984). The circumcision decision: Influences that determine newborn penile status. Unpublished manuscript.

    Wiswell, T, Enzenauer, R., Holton M., et al. (1987) Declining frequency of circumcision: Implications for changes in the absolute incidence and male to female ratio of urinary tract infections in early infancy. Pediatrics, 79, 338-342.

     

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