Francelle Wax is the producer of a film called American Secret: The Circumcision Agenda which takes a close look at the problems with male circumcision. More broadly speaking, it addresses the ideas of how ideas spread, why we believe in rituals that serve relatively little or no benefit, and what it would take to change our beliefs.

Francelle was kind enough to answer my own questions as well as those solicited from friends:

Hemant: I was raised with the understanding that it was cleaner and healthier to be circumcised. Is there any truth to that?

Francelle: For those with access to soap and water, hygiene is not a concern. If you were to take an intact child and a circumcised child and abandon each in the wild without the means to bathe, the circumcised child might fare better than the intact child. Obviously, such a hypothetical ought not serve as a basis for how we should do things in the United States in 2013.

This contention about health benefits never fails to elicit laughter from our European and Australian friends. The notion that it’s rocket science to keep oneself clean seems to cement our reputation as an extremely gullible nation that appeals to local authorities too often.

A little boy’s genitals require no maintenance beyond washing. Foreskin should NOT be retracted in young boys. Many American physicians don’t know this and forcibly retract at early pediatric visits, which can lead to complications that prompt the doctors to berate parents for not having circumcised their sons. In 80% of boys the foreskin does not fully retract before age ten. This is not a pathology, it is normal development.

Hemant: How did the religious ritual of circumcision come about? Do most parents circumcise kids for religious or cultural reasons?

Francelle: In the United States, the vast majority of circumcisions are done in secular settings for non-religious reasons. Reasons cited [include] that a father wants his son to look like him or concerns about hygiene fueled by the fear-mongering around that. Often times hospitals and doctors and nurses really hard-sell circumcision. Sometimes the circumcisions elected for religious reasons are done in clinical settings because parents do not prioritize the ritual. The secularization is the focus of my film, so I know more about that area of it. That said, while I describe myself as a practicing atheist, I was born and raised a Reconstructionist Jew, so I’ve been to my fair share of cousins’ brises and know what we were taught in Hebrew School, that God instructed Abraham to circumcise himself and his sons, both Ishmael and Isaac, and that this is why both the Jews and the Muslims circumcise.

There are different claims as to the derivations. I am not qualified to say which have merit, or which is the most plausible. I have heard it said that one likely explanation is that this was done to Jews by their captors, and that the Jews subsequently sort of took on the sign almost Stockholm Syndrome-style, after living with it for generations. But again, this is well outside my realm of knowledge.

Hemant: Do circumcisions (done by a professional in a hospital at a young age) really harm men in the future? What am I missing out on by not having foreskin?

Francelle: Circumcision can be harmful to men, boys, and their partners throughout life.

Skin bridges are a common result of circumcision. As the wound heals, a portion of remaining foreskin adheres to the penis and ultimately results in painful erections. Skin bridges can be difficult to correct later in life, and the corrective surgeries are not typically covered by insurance. Meatal stenosis — a narrowed urethra — is another common side effect. This too can require surgery.

And these are frequently the outcomes of circumcisions deemed “successful.” Severe and immediate complications include:

(1) Plummeting blood pressure.

(2) Allergic reaction to anesthetics. Most anesthetics aren’t approved for children under six months, so they’re used off label. Their efficacy is questionable, as well. Adequately anesthetizing the region requires 8 injections around the penis, a painful experience in its own right. Hurried clinicians often proceed before the anesthetic takes effect.

(3) Hemorrhaging.

(4) Infection.

(5) Death. While deaths are rare, the complications cited above are often recorded as the official cause of death, and the preceding circumcision is left off the books. Consequently, assessing the overall risk of death from the surgery itself is difficult.

Although most circumcised men feel like their sexual functioning is just fine — barring severe dysfunction, it doesn’t come naturally to people to miss what they’ve never had, particularly when it could lead to the belief that there’s something irreversibly “wrong” with them — there’s no getting around the fact that the procedure removes much of the most sensitive tissue.

Hemant: Is it true that male circumcision reduces men’s sexual pleasure? (I would think most men, including circumcised ones, would argue their sex lives are just fine.)

Francelle: Touch sensitivity tests have identified the most sensitive regions of the male genitalia; in intact participants, these are all on the foreskin. Circumcision removes approximately 50% of the nerve endings on the penis, among these, fine touch nerve receptors called the Meissner Corpuscles. We all have Meissner Corpuscles in our fingertips; in the penis, they are only present on the foreskin. These are unique nerve endings which provide very nuanced feedback. Partners of intact men report that they have a better ability to pace themselves and greater control than do circumcised men, and this is almost certainly due in part to the presence of Meissner Corpuscles.

Most men become interested in the issue in middle age after noticing a loss in sensitivity. This is typically written off as “normal aging” by the American medical community. In fact, a decline in sensitivity is often the result of a mucous membrane being stripped of its protective coverage and left to dry and callous over decades. The lack of moisture can also contribute to unpleasant dryness during sex, which may help explain the fact that the United States has a higher demand for products designed to combat vaginal dryness than most comparable countries.

To check for motivated skepticism, consider the following hypothetical:

Imagine that a new group is gaining cultural traction in the U.S. They perform a procedure called “Supercision” on their male infants, which removes more tissue than is removed during a circumcision. They prefer the look of the “supercised” penis, and there is some evidence that the procedure reduces the risk of some STIs (although certainly not enough to render condoms obsolete). Suppose that the “supercised” men swear up and down that they enjoy sex immensely, yet touch sensitivity tests show that the most sensitive region on their penises is only the sixth most sensitive region on a circumcised man’s penis. How many circumcised American men would line up to get the new procedure?

I don’t mean to make the point that all default natural states are optimal — but all surgery carries risks, and circumcision in particular has long-term consequences for a person’s sexuality.

Hemant: Do you think we can really convince parents that what they’re doing is wrong? Is the trend reversing direction?

Francelle: As long as parents or doctors have to admit to wrong-doing, I don’t think we will. It’s unfortunately far too stigmatizing for people to be associated with wrong decisions and actions, especially irreversible ones.

I expect that the decline will come in a very non-dramatic fashion: insurance companies will cease to cover the procedure, which means that doctors will broach the subject differently from how they currently do. Some parents will continue to pay out of pocket and push for it, but over time, the social pressure of needing to look like peers will be a non-issue.

With respect to trends, the numbers dip and rise. There is a fair amount of variation across the nation, with numbers as high as 80% in the midwest and as low as 30% on the west coast. Nationwide, 54.5% of all newborn males are circumcised.

Hemant: How should we deal with the cultural taboo against uncircumcised men? Don’t most porn movies feature men without foreskin?

Francelle: Only American porn.

The squeamishness factor is NOT an intractable problem. There isn’t something in the American water supply that causes little girls to mysteriously develop into adult women who pathologize the natural male body. American women think of foreskins as “unclean” and “unhealthy” because as little girls somebody told them to think that circumcision was a way to make men more clean and to improve their health. Australian girls don’t grow up to think that intact men are unclean or unhealthy, nor do little Norwegian girls or Irish girls or Canadian girls or Polish girls. And there is a very simple reason for that: because no one in a position of authority ever told them that they should.

The same is true in gay culture: boys who are told that they were circumcised for the sake of their health grow into men who are primed to view intact penises as maladies.

We are pretending that this is more difficult than it is. Don’t instruct children to have a warped view of the natural body and this problem goes away in a generation. Problem solved.

Hemant: Are there *any* benefits to male circumcision?

Francelle: There is a reduction in the likelihood of UTIs and penile cancer such that your risk drops from already-infinitesimal to slightly-less-than-infinitesimal. If we’re going to employ that line of reasoning, then there are a number of body parts that we must preemptively strike down before we rid ourselves of foreskins. Risk of penile cancer: 1 in 1000. Risk of breast cancer: 1 in 8. And yet I hear no one advocating for the forced removal of breast buds in children who have the abnormal genes that indicate a very high risk of breast cancer.

Sex feels great in part because of our sensitive skin and mucous membranes. Forcing the hardening of a mucous membrane can accord some protections, but it comes at a cost. The question at hand is whether that cost should be imposed on a person before he is able to consent to it.

Hemant: Male circumcision is not considered as big of a deal as female circumcision, which we know is a major problem in other countries… so why focus on the men in this movie?

Francelle: When meant in earnest, this protest is as valid as any other “we can’t walk and chew gum at the same time” defense — which is to say, not very. You don’t have to ignore female genital cutting in order to be against male genital cutting. Nobody is attempting to recruit those hard at work trying to prevent FGM to abandon their efforts and work exclusively on male circumcision.

There is also a huge accessibility factor. The United States faces resentment from female-circumcising cultures for “barging in” and asserting its views about how they should look. Tackling our homegrown issue of male genital cutting gives us more credibility when we make recommendations to other cultures regarding their children’s right to bodily integrity.

I aspire to be an “early adopter” regarding ethics. I try to be vigilant for potentially-harmful social norms that aren’t adequately justified by the available evidence. I’m also fascinated by why two groups — in many respects similar in culture — diverge on a particular point. That’s what first interested me in circumcision: I attended University in the UK and watched the jaws drop on my English classmates when I casually mentioned that in America, circumcision is routine.

In learning more about the issue — the anti-masturbation agenda which catalyzed the practice, the present day profit incentives, the stories of circumcised men who actually reflected on what had been done to them and chose to leave their sons intact, the parents who circumcised one son but went on to regret the choice, the doctors who at one time circumcised patients but went on to recognize the harm and abandoned this practice — I saw a complete story arc for an ethical issue that is largely neglected. And I saw an interesting way to present it; a way which I think will give people the objectivity needed to make them aware of our national bias around this issue.

Hemant: Finally, just as a point of curiosity, was it weird being a woman, making a movie about the male anatomy?

Francelle: Men and women in the movement are generally happy whenever there’s positive press on their activism. The reel for my film has been incredibly well-received by both men and women in the movement, and no one seems to care about my gender. If anything, a few men have appreciated that a woman would care about the issue enough to make a film about it.

I was privileged to be permitted to film an approximation of a multi-chapter NORM meeting (NORM being the National Organization of Restoring Men). This is where men discuss and get advice on the different techniques and devices used for skin-stretching, and sometimes show the improvement that they are making in their restoration. (Restoring is painless and, if performed regularly for 1 to 4 years, can accord men full coverage of their non-erect penis and recreate some of the benefits of a foreskin.) A number of men shared their experiences and progress very openly with me.