Circumcision Injuries Include More Than ‘Botches’

This week Israeli news outlets reported on a particularly bad circumcision injury. The infant has undergone multiple surgeries in an attempt to correct severe damage to his penis and the outcome remains unknown. While the skill of the circumciser has come into question, even properly performed circumcisions have complications. 

According to an American Academy of Pediatrics brief, 3.9% of circumcisions tracked in two New York hospitals resulted in hemorrhage as an immediate complication. Meatal stenosis (an abnormal narrowing of the urethral opening) is a late complication found to occur in 5%-20% of males circumcised during infancy and childhood. Some operative and post-operative pain probably occurs close to 100% of the time. Loss of healthy, sexually sensitive tissue and scarring occurs 100% of the time, as does loss of the circumcised person’s freedom to decide for themselves about an irreversible body modification. 

Risk and Harm 

The American medical establishment staunchly defends infant circumcision and maintains that its complications are relatively rare compared to other surgeries. But rare complications can also be devastating, as the most recent case in Israel illustrates. Moreover, given that circumcision is so common in the United States, Israel, and in Muslim countries, even a small relative risk has the practical consequence of resulting in harm to many. 

It seems doctors in Israel may be more forthright than their American counterparts when it comes to acknowledging this risk. Dr. Akram Assadi, a senior urologist at Haifa’s Rambam Health Care Campus (where the victim of the recent circumcision injury is being treated) told the press: “We see many incomplete circumcisions and children suffering bleeding after circumcision, abrasions and injuries of one kind or another. Lots of damage.” 

Surgery as a treatment for disease or injury has clear parameters. The goal is to restore function, with the diseased area removed or the injured area repaired. There is no dotted line on an infant’s penis instructing a circumciser as to how much healthy tissue to remove. 

Unrecognized Consequences

Removing the foreskin of an infant can result in consequences that may not be appreciated until adulthood. These include painfully tight erections for the sexually mature male, curvature of the erect penis, or pubic hair growing uncomfortably on the penile shaft. Infant circumcision can also result in adhesions, which may be painful, cosmetically undesirable, or both. These outcomes are frequently discussed in online groups by men who suffer from them, but there is often little validation from medical professionals. In countries where most men are circumcised, doctors consider many of these conditions to be perfectly normal, fallaciously confusing “common” with “normal.” 

Unsurprisingly, such outcomes have not been the subject of much medical inquiry. Embarrassment prevents many men from bringing up such issues with their health care providers unless they are driven to do so by extreme discomfort. Moreover, why would doctors from circumcising countries endeavor to study conditions they have deemed normal? Why would doctors from non-circumcising countries study conditions not present in their own populations? 

Diminished Sensitivity? 

Some adult men circumcised as infants also feel they have diminished sexual sensitivitiy, a perception that’s difficult to quantify but is nevertheless reported. Russian Jews circumcised as children and adults sometimes regret the procedure, having had the opportunity to experience both the natural and the circumcised state. But even in the absence of robust medical literature, it’s common sense that circumcision brings with it some change in sexual sensitivity. The foreskin is erogenous tissue measuring roughly the size of an index card in an adult male. Removing that much skin surely has some impact! Additionally, men with foreskins possess a mobile sheath of skin that glides back and forth during sexual activity. The foreskin also protects the sensitive head of the penis. Deprived of this covering, the glans converts from moist, mucosal tissue to perpetually dry, keratinized skin. 

Worthy of Consideration  

In reading about the catastrophic circumcision injury that recently occurred, it’s easy to dismiss this as a rare complication of a routine procedure. But there is a much larger range of potential adverse consequences from circumcision that demand more serious consideration. 

While I don’t personally advocate for banning brit milah, I do encourage all Jews to consider whether circumcision is necessary and beneficial for their child. Non-milah brit ceremonies are gaining traction and circumcision need not be the defining Jewish act some consider it to be. Many of my non-circumcising Jewish contemporaries choose instead to engage in other mitzvot that are personally meaningful to them, such as observing Shabbat, studying Torah, giving their children a Jewish education, and so forth. 

Here in the United States, Jews choosing not to follow the circumcision tradition are often left to guess whether this decision and their feelings will be respected within the broader Jewish community. A new nonprofit Bruchim (which I co-founded) works to allay their concerns, in part by connecting them to welcoming clergy and institutions. Bruchim’s rabbinic advisory council includes leaders of various Jewish backgrounds and denominations, all of whom feel that circumcision status should not present a barrier to Jewish engagement.