Circumcision: The Disease That Moved

An Essay on the Surgery That Outlived Every Reason for Its Existence

In 1870, circumcision cured paralysis. By 1900, it prevented syphilis. By 1932, it prevented cancer. By 1985, it prevented urinary tract infections. By 2005, it prevented HIV.

The foreskin didn’t change. The operation didn’t change. Only the reason changed.

No other surgery in the history of medicine has survived the serial demolition of every rationale offered for its existence. Tonsillectomy thrived for decades on weak evidence, but when the evidence collapsed, the surgery declined. Routine episiotomy was once standard obstetric care; when studies showed it caused more harm than it prevented, rates dropped. The self-correcting mechanisms of medicine, imperfect as they are, eventually retire procedures that cannot justify themselves.

Circumcision is the exception. Each time the reigning justification has been dismantled—by new science, by changing disease paradigms, by the simple passage of time—the medical establishment has not abandoned the procedure. It has found a new disease. The operation is the constant. The diseases orbit around it.

That pattern, exposed in full, tells us something the medical literature never will: the purpose of the research was never to evaluate the surgery. It was to protect it.

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I. The Cure for Paralysis (1870s)

The story begins in a New York operating theater in 1870, with a five-year-old boy chloroformed on a marble table.

Lewis Sayre, one of the most prominent orthopedic surgeons in America—future president of the American Medical Association—had been asked to examine the child for paralysis in both legs. Standard treatments had failed. When Sayre examined the boy’s genitals, he found the foreskin adhered to the glans, inflamed and painful. On an intuition he would later describe as a flash of inspiration, Sayre drew the foreskin forward with scissors and cut it away.¹

The result, as he reported it, was miraculous. Within weeks, the boy could walk. Sayre had, he believed, discovered the hidden cause of childhood paralysis.

The theoretical framework that made this plausible was called reflex neurosis—the Victorian-era conviction that the body was a web of nervous affinity, and that irritation in one organ could manifest as disease in a seemingly unrelated part of the body.² Within this framework, an irritated foreskin could plausibly cause paralysis, epilepsy, insanity, or any other condition doctors could not otherwise explain. And there were many conditions Victorian doctors could not explain. Sayre soon tried circumcision on boys suffering from hip-joint disease, hernia, epilepsy, and spinal curvature. He traveled to the Manhattan State Hospital’s Idiot Asylum on Randall’s Island and circumcised dozens of institutionalized boys, attempting to cure imbecility.³ The results were, predictably, inconclusive—but by then it didn’t matter. The profession had already absorbed his message.

For three decades, until his death in 1900, Sayre promoted circumcision in hundreds of speeches and papers, touting a wider and wider array of benefits.⁴ His prominence gave the idea authority. Reprints circulated at medical society meetings across the country. Doctors who admired his orthopedic brilliance were prepared to take his genital theories seriously. Soon, adherent foreskins were being discovered all over America and their removal was being credited with alleviating a remarkable variety of childhood complaints. One doctor reported a case of “brass poisoning completely cured.”⁵

There is an irony worth noting. Sayre himself grew alarmed at what he had set in motion. In an 1887 paper, he warned that other physicians had taken his recommendations too far, performing radical amputations of the foreskin where he had merely freed adhesions. He wished, he wrote, “to raise my voice in protest against this unjustifiable mutilation.”⁶ The word mutilation may appear here for the first time in the circumcision literature—introduced by the very physician whose name heads the roster of American advocates.

His warning was ignored. By the turn of the twentieth century, circumcision had become standard practice for well-trained doctors.⁷ The operation had detached from its original rationale and begun to float free.

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II. The Shield Against Syphilis (1890s–1930s)

As reflex neurosis theory collapsed under the weight of germ theory in the early 1900s, the justification shifted seamlessly. The same foreskin that had supposedly caused paralysis through nervous irritation now caused disease through bacterial contamination. Circumcision was reborn as a hygienic measure.

Jonathan Hutchinson, an English surgeon, had been promoting circumcision since the 1850s for its supposed protection against syphilis.⁸ By 1900, he was issuing “A Plea for Circumcision” in which the foreskin was a “harbour for filth, and a constant source of irritation. It conduces to masturbation and adds to the difficulties of sexual continence. It increases the risk of syphilis in early life, and of cancer in the aged.”⁹

Hutchinson and his contemporaries were remarkably candid about something that later advocates would learn to conceal: they valued circumcision precisely because it reduced sexual sensation. Hutchinson conceded that removing the foreskin “in all likelihood did rob a man of tactility,” but considered this a feature, not a bug.¹⁰ In 1935, a physician named C.W. Cockshut explained the logic with startling directness:

Nature intends that the adolescent male shall copulate as often and as promiscuously as possible, and to that end covers the sensitive glans so that it shall be ever ready to receive stimuli. Civilization, on the contrary, requires chastity, and the glans of the circumcised rapidly assumes a leathery texture less sensitive than skin. Thus the adolescent has his attention drawn to his penis much less often.¹¹

This was not a dissident position. This was the mainstream medical rationale, stated plainly: circumcision worked by damaging sexual function, and that damage was desirable.

By 1914, Abraham Wolbarst, a New York urologist, was calling for “universal circumcision as a sanitary measure” in the Journal of the American Medical Association, estimating that millions of children had already undergone the procedure.¹² The profession no longer debated whether to circumcise. It debated only how to do it properly.

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III. The Weapon Against Cancer (1930s–1970s)

The hygiene rationale peaked just as antibiotics arrived to make syphilis and gonorrhea treatable conditions. Circumcision needed a new disease. It found one in 1926.

Wolbarst published a paper in the journal Cancer announcing that infant circumcision prevented penile cancer. His evidence was observational: Jewish men, who were circumcised, rarely presented with the disease. Therefore, circumcision must be the protective factor.¹³ The logical structure was simple, the confounders uncontrolled, and the conclusion exactly what circumcision advocates needed. Penile cancer replaced syphilis as the banner disease.

Wolbarst’s successor was Abraham Ravich, another New York urologist, who extended the cancer theory to extraordinary lengths. In 1942, Ravich published data showing that prostate cancer was far less common among his Jewish patients than among Gentiles, and concluded that circumcision must be responsible.¹⁴ By 1950, he had gone further, claiming circumcision prevented cancer of the penis, prostate, and cervix—the last based on the observation that Jewish women rarely developed cervical cancer, which Ravich attributed to their husbands’ circumcised penises.¹⁵ His proposed mechanism was a virus lurking in smegma, the natural lubricant secreted by the foreskin.

Every attempt to demonstrate that smegma was carcinogenic failed.¹⁶ The one study that appeared to support the theory had injected horse smegma under the skin of mice—a methodology with no clinical relevance to human sexual contact.¹⁷ The cervical cancer theory collapsed when a follow-up study in 1960 revealed that a large percentage of the men in the original dataset had been wrong about their own circumcision status—circumcised men reported being intact, intact men reported being circumcised—rendering the entire statistical basis meaningless.¹⁸ The follow-up was ignored. The original study continued to be cited.

Ravich, meanwhile, compared his own achievements to those of Moses.¹⁹ He spent the 1960s traveling to Japan, England, and the Soviet Union to advocate for compulsory circumcision. Every country he visited rejected the proposal.²⁰ He died in 1984, convinced that opposition to circumcision was attributable to “false pride, distorted phallic veneration, anti-semitism, ignorance, or surrender to misleading propaganda.”²¹

The cancer justification lingered for decades despite being thoroughly dismantled. As late as 2001, the Centers for Disease Control still cited circumcision as reducing the incidence of penile cancer.²² One urologist calculated that to prevent a single case of this already vanishingly rare disease, a surgeon would need to perform one circumcision every ten minutes, eight hours a day, five days a week, for between six and twenty-nine years.²³

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IV. The Prevention of Urinary Tract Infections (1980s–2000s)

By the late 1970s and early 1980s, the intellectual winds had shifted. Baby-boom parents, steeped in the 1960s suspicion of professional authority, were declining the procedure. Younger doctors acknowledged the science was equivocal. The 1975 American Academy of Pediatrics Task Force on Circumcision declared that no medical indication existed for routine operations.²⁴ The circumcision rate began to decline.

Then, with the precision of a replacement arriving before the departing worker has left, a new rationale materialized: prevention of urinary tract infections.

The apostle was Thomas Wiswell, a U.S. Army pediatrician at Fort Sam Houston in Texas. Wiswell had initially opposed routine circumcision. But reviewing military hospital records, he noticed that as circumcision rates declined in the late 1970s, UTI rates in infant boys appeared to rise. His largest study, involving 209,399 children born in Army hospitals between 1985 and 1990, reported a tenfold greater incidence of UTI in uncircumcised boys.²⁵

Questions about the data were immediate. Circumcision status was abstracted from military hospital records where there was no financial incentive to document it, meaning it was likely underreported—and underreporting would systematically inflate the apparent UTI rate among the uncircumcised.²⁶ The studies were retrospective, not randomized. Confounding factors—breastfeeding status, prematurity, maternal infection, hygiene practices—were not controlled.²⁷

Even accepting Wiswell’s numbers at face value, the clinical significance was marginal. Advocates acknowledged that only about 2.2 percent of intact boys would develop a UTI in the first year of life. Of every 1,000 circumcised infants, approximately 980 received no preventive benefit.²⁸ The few who did develop UTIs responded promptly to antibiotic treatment—the same treatment given to girls, who develop UTIs at far higher rates and for whom no one proposes genital surgery.²⁹

None of this mattered to the trajectory of the practice. Edgar Schoen, chairman of the AAP’s Task Force on Circumcision, called the UTI evidence “conclusive” and likened circumcision to immunization.³⁰ Wiswell presented himself as a reluctant convert, a skeptic persuaded by data—a narrative structure that echoed Lewis Sayre’s self-presentation a century earlier.³¹ The pattern held: a physician claims an unexpected discovery, publishes prolifically, attracts institutional support, and frames the new rationale as compelling enough to override objections.

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V. The Answer to AIDS (2000s–Present)

The UTI justification was still being debated when the next disease arrived.

In 1986, a California physician named Aaron Fink wrote a letter to the New England Journal of Medicine proposing that circumcision could prevent AIDS.³² The hypothesis was based on the observation that certain African populations with high HIV rates also had low circumcision rates. Three randomized controlled trials in sub-Saharan Africa, conducted between 2002 and 2006 in South Africa, Kenya, and Uganda, reported relative risk reductions for HIV acquisition of 51 to 60 percent in circumcised men.³³

These trials became the basis for a WHO/UNAIDS endorsement of circumcision for HIV prevention in 2007, and for mass circumcision campaigns across eastern and southern Africa.³⁴

The trials were not without serious methodological concerns. All three were stopped early, a practice known to inflate treatment effects. The absolute risk reduction was approximately 1.3 percent—from roughly 2.5 percent to 1.2 percent over the trial periods—a figure far less dramatic than the relative risk reduction presented in the published conclusions.³⁵ The circumcised men received weeks of post-surgical counseling about safe sex practices; the control group received a single counseling session. In every trial, researchers failed to trace the sexual partners who infected study participants, making it impossible to determine whether the reduced HIV incidence was attributable to the surgery, the behavioral counseling, the weeks of post-surgical abstinence, or some combination.³⁶ No study team made their data available for independent analysis.³⁷

Observational evidence from the developed world offered no support. The United States, with a historically high circumcision rate, had higher HIV prevalence than Western European nations, nearly all of which had intact male populations.³⁸ A monogamous-couple study in Uganda found that circumcision status was not a significant factor in HIV transmission.³⁹

The HIV justification followed the established sequence: a genuine public health crisis provided the emotional urgency, observational data provided the initial correlation, institutional endorsement provided the appearance of scientific consensus, and the procedure was promoted before the evidence could be fully evaluated—or the critique fully heard.

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VI. The Rest of the World Responds

In 2012, the AAP issued a policy statement declaring that the preventive health benefits of circumcision outweighed the risks, though the benefits were “not great enough to recommend universal newborn circumcision.”⁴⁰ The careful reader could see both impulses in the same document: the compulsion to endorse, and the inability to actually recommend.

The response from outside the United States was swift and unambiguous. In 2013, a group of thirty-eight physicians and ethicists representing seventeen European medical organizations—from Denmark, Finland, Norway, Sweden, Germany, the Netherlands, Belgium, the United Kingdom, and others—published a formal rebuttal in Pediatrics, the AAP’s own journal. The paper was titled “Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision.”⁴¹

Their central charge was that the AAP had reached its conclusions by operating within a culturally biased framework. Circumcision is practiced routinely in the United States and virtually nowhere else in the developed world. The European physicians noted that the claimed benefits—reduced UTI risk, reduced STI risk, reduced penile cancer risk—did not manifest as actual health differences between American men and European men, nearly all of whom are intact.⁴² The benefits existed in the statistical models. They did not exist in the comparative health outcomes of real populations.

The Frisch paper identified another telling asymmetry. American medical literature treated the foreskin as a risk factor—a source of potential disease to be weighed against the risks of its removal. European medical literature treated it as a normal, functional body part whose removal required justification. The difference was not scientific. It was cultural. And the AAP’s framework assumed the American cultural position as the neutral starting point.⁴³

With the exception of Israel, the United States remains the only developed country where a majority of male infants are circumcised outside a religious context.⁴⁴ Every other Western nation reviewed the same evidence and reached the opposite conclusion.

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VII. The Pattern

Five justifications in 150 years. Paralysis, syphilis, cancer, urinary tract infections, HIV. Each presented with institutional authority. Each absorbed into the medical literature as if it were the definitive case. Each eventually undermined by the weight of counter-evidence. And each replaced—before the previous rationale had fully collapsed—by a new disease that arrived just in time to keep the procedure alive.

If the reasons keep changing but the practice never stops, the reasons are not what is sustaining the practice.

So what is?

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VIII. What Was Actually Removed

The answer begins with what is actually being removed.

The foreskin is not, as generations of medical literature implied, a vestigial flap of skin. The Canadian pathologists John Taylor, A.P. Lockwood, and A.J. Taylor demonstrated in 1996 that the prepuce is a complex structure containing specialized mucosal tissue, smooth muscle, and a high density of fine-touch neuroreceptors.⁴⁵ The inner surface of the foreskin is a type of tissue found in only a few places in human anatomy—variably-keratinized squamous epithelium similar to the frictional mucosa of the mouth, vagina, and esophagus. It contains Meissner’s corpuscles, Merkel’s disks, Pacinian corpuscles, Ruffini corpuscles, and genital end bulbs—nerve endings that detect light touch, pressure, temperature, and vibration.⁴⁶

In 2007, Sorrells and colleagues published the first quantitative mapping of penile fine-touch sensitivity, testing 159 men using calibrated Semmes-Weinstein monofilaments at nineteen locations on the penis.⁴⁷ The findings were definitive. The most sensitive location on the circumcised penis was the circumcision scar on the ventral surface. Five locations on the intact penis that are routinely removed by circumcision were more sensitive than the most sensitive point on the circumcised penis.⁴⁸ The glans of the circumcised penis was less sensitive to fine touch than the glans of the intact penis—a consequence of keratinization, the thickening of exposed tissue that occurs when the foreskin’s protective covering is removed.⁴⁹

The foreskin is, in other words, the most sensitive part of the penis. Circumcision removes it and damages the sensitivity of what remains.

The intact penis is also a mechanically different organ. The foreskin’s double-layered sheath enables the penile skin to glide over the shaft during sexual activity. This gliding mechanism reduces friction, provides stimulation to both partners, and constitutes the organ’s primary mode of erotic function.⁵⁰ Circumcision eliminates this mechanism entirely, replacing it with a scarred, immobile shaft that relies on friction alone.

None of this anatomy was investigated by the physicians who spent 150 years recommending the organ’s removal. Sayre did not study it. Wolbarst did not study it. Ravich did not study it. Wiswell did not study it. The AAP’s 2012 technical report did not include a section on the anatomy and function of the tissue being removed.⁵¹ For a century and a half, the medical establishment debated the benefits of amputating a structure it had never bothered to understand.

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IX. Why the Pattern Repeats

The second part of the answer is psychological, and it explains something the historical record alone cannot: why the pattern perpetuates across generations.

Ronald Goldman’s research on the psychological impact of circumcision documented a consistent cluster of responses among men who become aware of what was done to them: anger, grief, a sense of violation, shame, confusion, and a profound feeling of having been betrayed by the people who were supposed to protect them.⁵² These responses are consistent with the symptom pattern of post-traumatic stress disorder—not because every circumcised man is diagnosably traumatized, but because the underlying experience shares the core features of trauma: an overwhelming event, inflicted without consent, involving pain, loss, and helplessness.⁵³

The more significant finding is what happens in the absence of awareness. Goldman documented that circumcised men who knew less about the impact of circumcision were more likely to report satisfaction with their status.⁵⁴ The mechanism is straightforward: a man who has never known the sensation of a foreskin has no experiential basis for understanding what was lost. He can only compare his experience to itself. This is not consent. It is the absence of information necessary to form a grievance.

The psychological defense that sustains the practice is denial—not as a moral accusation but as a clinical description. A circumcised father who allows his son to be circumcised is, in many cases, replicating his own experience without the conscious ability to recognize it as harmful.⁵⁵ To question the practice is to confront a loss in himself that he may not be equipped to process. The psychiatrist John Rhinehart observed that when a man represses an emotion connected to his own circumcision, he often becomes unable to recognize the expression of that same emotion in someone else—including his own son.⁵⁶

This is the engine of intergenerational repetition. It does not require malice. It requires only the normal human tendency to defend against unbearable knowledge.

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X. The Institution Protects Itself

The medical institution, meanwhile, has its own reasons for continuity. In the American system, circumcision generates revenue. It is a simple procedure that can be taught to residents, performed quickly, and billed to insurance. The foreskins themselves have commercial value: a single neonatal foreskin can be cultured to produce bioengineered skin replacement products.⁵⁷ The economic incentive is modest per procedure but substantial in aggregate across more than a million annual births.

More consequential than the economics is the institutional inertia. A profession that has performed a procedure on millions of patients for over a century cannot easily reverse itself. To acknowledge that routine circumcision was never medically justified would be to acknowledge that the profession inflicted unnecessary surgery on generations of children. The legal, ethical, and psychological implications of that admission are considerable. It is far easier to find a new disease.

Denniston identified this cycle with precision: circumcisers begin with the conclusion that circumcision is beneficial, produce studies that appear to confirm it, and by the time the current justification is debunked, they have already migrated to the next one. The presumption is that their claims are true unless later disproven—a reversal of the scientific method, in which a proposed intervention must demonstrate efficacy before being adopted.⁵⁸

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XI. What Does Not Grow Back

The foreskin contains the densest concentration of fine-touch nerve receptors on the male body. It includes specialized structures—the ridged band, the frenulum, the mucocutaneous junction—that exist nowhere else in human anatomy.⁵⁹ It provides mechanical function during intercourse, immunological protection through Langerhans cells and antibacterial secretions, and a self-lubricating environment that maintains the glans as a moist internal organ.⁶⁰

Every year, roughly 1.2 million American newborns lose this tissue in a procedure that no national medical organization in the world unequivocally recommends.

The justification offered for this practice has been replaced five times since 1870. The current one—HIV prevention, based on African trials whose methodology and generalizability remain contested—rests on the same evidentiary standards as the ones that came before. There is no structural reason to believe it will be the last.

The disease will move again. It always does. But the operation remains, and the tissue it removes—tissue whose function was never studied by the people who insisted on cutting it away—does not grow back.

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References

1. Sayre, L.A. “Partial Paralysis from Reflex Irritation, Caused by Congenital Phimosis and Adherent Prepuce.” Transactions of the American Medical Association 21 (1870): 205–11; Gollaher, D. Circumcision: A History of the World’s Most Controversial Surgery (New York: Basic Books, 2000), 73–76; Glick, L.B. Marked in Your Flesh (Oxford University Press, 2006), 155–59.

2. Gollaher, 80–81; Darby, R. A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain (University of Chicago Press, 2005), 220–21.

3. Sayre, L.A. “Paralysis from Peripheral Irritation, So-Called ‘Spinal Anaemia.’” Medical and Surgical Reporter (Philadelphia) 35 (1876): 305–8; Gollaher, 79.

4. Gollaher, 78–79; Glick, 159.

5. Darby, 220–22.

6. Sayre, L.A. “On the Deleterious Results of a Narrow Prepuce and Preputial Adhesions.” Transactions of the Ninth International Medical Congress vol. 3 (1887); Glick, 159–60.

7. Gollaher, 106.

8. Darby, 74–76.

9. Hutchinson, J. “A Plea for Circumcision.” Archives of Surgery 2 (1890); Darby, 76.

10. Gollaher, 105.

11. Cockshut, C.W. Quoted in Gollaher, 176.

12. Wolbarst, A.L. “Universal Circumcision as a Sanitary Measure.” JAMA 62, no. 2 (1914): 92–97; Gollaher, 106.

13. Wolbarst, A.L. “Circumcision and Penile Cancer.” Lancet 1, no. 5655 (1932): 150–53; Glick, 186–87; Fleiss, P.M. What Your Doctor May Not Tell You About Circumcision (New York: Warner Books, 2002).

14. Ravich, A. “The Relationship of Circumcision to Cancer of the Prostate.” Journal of Urology 48, no. 3 (1942): 298–99; Glick, 189–90.

15. Ravich, A. and Ravich, R.A. “Prophylaxis of Cancer of the Prostate, Penis, and Cervix by Circumcision.” NY State Journal of Medicine 51, no. 12 (1951): 1519–20; Glick, 190–91.

16. Reddy, G. and Baruah, I.K.S.M. “Carcinogenic Action of Human Smegma.” Archives of Pathology 75, no. 4 (1963): 414–20; Fleiss.

17. Plaut, A. and Kohn-Speyer, A.C. “The Carcinogenic Effect of Smegma.” Science 105 (1947): 391–92; Glick, 191.

18. Wynder, E.L. et al. “A Study of Environmental Factors in Cancer of the Cervix.” American Journal of Obstetrics and Gynecology 68 (1954): 1046; Wynder, E.L. and Licklider, S.D. “The Question of Circumcision.” Cancer 13 (1960): 442–45; Fleiss.

19. Ravich, A. Preventing V.D. and Cancer by Circumcision (New York: Philosophical Library, 1973), 104; Glick, 192.

20. Fleiss.

21. Ravich, Preventing, 129–30; Glick, 191.

22. Centers for Disease Control and Prevention. “Trends in Circumcisions Among Newborns.” (2001); Glick, 189.

23. Marshall, V. Cited in Glick, 188 n.36.

24. Gollaher, 153.

25. Wiswell, T.E. et al. “Declining Frequency of Circumcision: Implications for Changes in the Absolute Incidence and Male to Female Sex Ratio of Urinary Tract Infections in Early Infancy.” Pediatrics 79 (1987): 338–42; Gollaher, 153–54.

26. Gollaher, 154.

27. Fleiss; Glick, 274–75.

28. Glick, 275.

29. Glick, 275; Fleiss.

30. Schoen, E.J. Cited in Gollaher, 152.

31. Gollaher, 154; Glick, 208–9.

32. Fink, A.J. “A Possible Explanation for Heterosexual Male Infection with AIDS.” New England Journal of Medicine 315 (1986): 1167; Glick, 205–7.

33. Auvert, B. et al. “Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk.” PLoS Med 2 (2005): e298; Bailey, R.C. et al. Lancet 369 (2007): 643–56; Gray, R.H. et al. Lancet 369 (2007): 657–66.

34. WHO/UNAIDS. “New Data on Male Circumcision and HIV Prevention.” (2007).

35. Gisselquist, D. “Randomized Controlled Trials for HIV/AIDS Prevention Among Men in Africa: Untraced Infections, Unasked Questions, and Unreported Data.” In Denniston, G.C. et al., eds., Genital Cutting: Protecting Children from Medical, Cultural, and Religious Infringements (Springer, 2013), 243–70.

36. Gisselquist, 243–70; Boyle, G.J. “Issues with the Circumcision/HIV RCTs and Their Interpretation.” In Denniston et al., Genital Cutting.

37. Gisselquist, 245.

38. Van Howe, R.S. and Storms, M.R. “How the Circumcision Solution in Africa Will Increase HIV Infections.” Journal of Public Health in Africa 2 (2011): e4.

39. Glick, 274.

40. American Academy of Pediatrics Task Force on Circumcision. “Male Circumcision.” Pediatrics 130, no. 3 (2012): e585–e610.

41. Frisch, M. et al. “Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision.” Pediatrics 131 (2013): 796–800.

42. Frisch et al.

43. Frisch et al.

44. Glick, 276; Gollaher, 126–27.

45. Taylor, J.R., Lockwood, A.P., and Taylor, A.J. “The Prepuce: Specialized Mucosa of the Penis and Its Loss to Circumcision.” British Journal of Urology 77 (1996): 291–95; Gollaher, 120–23.

46. Fleiss; Cold, C.J. and Taylor, J.R. “The Prepuce.” BJU International 83, Suppl. 1 (1999): 34–44.

47. Sorrells, M.L. et al. “Fine-Touch Pressure Thresholds in the Adult Penis.” BJU International 99 (2007): 864–69.

48. Sorrells et al.

49. Fleiss; Gollaher, 121.

50. Fleiss.

51. Frisch et al.

52. Goldman, R. Circumcision: The Hidden Trauma (Boston: Vanguard Publications, 1997), 104–11.

53. Goldman, 117–22.

54. Goldman, 104–5.

55. Goldman, 151; Denniston, G.C. “The Psychological and Physical Harms of Male Circumcision.” In Denniston et al., Genital Cutting, 63–64.

56. Rhinehart, J. Cited in Denniston, 64.

57. Gollaher, 123.

58. Denniston, G.C. “Unnecessary Circumcision.” In Denniston et al., Genital Cutting, 59–72.

59. Taylor et al.; Sorrells et al.; Cold and Taylor.

60. Fleiss; Gollaher, 121–23.

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