Manhood: The Rise and Fall of the Penis (40 page)

As described previously the glans is the end of the
corpus spongiosum
, the erectile tissue compartment surrounding the urethra. In erection the glans swells, but the internal pressure remains lower than that in the
corpora cavernosa
. The glans is lined with a sensitive mucous membrane and is normally sheathed with foreskin, which consists on the inside of mucous membrane and on the outside of skin. Since the vagina is also lined with mucous membrane, the penis can easily slide back and forth. Both the glans and the foreskin contain numerous fine nerve endings, which heighten sexual pleasure. This means that the foreskin is also an important sexual organ, the simple rubbing of which can lead to an ejaculation. If it is removed, a sexually significant part of the penis is lost, and continuous friction causes a layer of callus to form.

Any Jewish man may carry out a circumcision, but the ritual (
brit
milah
) is mostly performed by the
mohel
. It is a religious obligation, and should normally take place on the eighth day after birth. General principles of treatment if there are medical problems are laid down in the Shulchan Aruch. Circumcision is, for instance, forbidden if there are The ‘Spanish

collar’.

m a n h o o d

any indications for haemophilia; if in any family two sons have died or if two sisters of the mother have each lost a child from bleeding after circumcision, the following son must not be circumcised. This rule is regarded as the very first indication of haemophilia, a disease that we know today is inherited through the maternal line.

The
sandak
, a kind of godfather, holds the child on his lap during the ceremony. The
mohel
pulls the whole foreskin up to the glans and pushes the skin into the slot of a protective plate, after which the foreskin is cut along the line of the slot without anaesthetic. Formerly the wound was sucked clean orally by the
mohel
(
mezizah
), but when it was found that syphilis, tuberculosis and diphtheria (and nowadays aids too) could be passed on in this way, a suction instrument was introduced for the purpose. The wound used to be treated with
mohel
flour, a powder made of ground oakwood; nowadays it is bandaged.

Incidentally, last century it was the custom among the Falaches, a Jewish sect in what was then Abyssinia, to circumcise even still-born male babies before they were put in their coffins, so that when they were resurrected they would be immediately recognized as Jews.

For both Jews and Muslims circumcision is surrounded by prayers and rituals. Among Indonesian Muslims circumcision is called
sunat
.

Sometimes a
dukun
(village doctor) or
bong
(imman) performs the ceremony, but usually the procedure is carried out by a layman. In Java the foreskin is sometimes cut only lengthways: a flat piece of bamboo is pushed between the glans and the foreskin, after which the foreskin is severed. Because the glans is initially uncomfortably sensitive after circumcision, the boys are put under cold running water. To protect the glans from grazing they wear half a coconut shell over their penis which hangs from a string round their waist.

The television film
The Winds of War
showed how after the invasion of Poland in 1939 foreigners, including Americans, travelled back to Berlin through the German lines. Jews and people with Jewish-looking faces and Jewish names were singled out. In cases of doubt the Nazis looked to see whether the men were circumcised or not. In the film an American minister travelling with the group protested: ‘All Americans are circumcised, me too.’ Under the Nazi threat many foreskin-restorations were carried out in this period. In fact, these are age-old practices: as long ago as the second century bc there were Jewish apostates who were anxious to imitate the ways of their Hellenistic overlords and to participate in sporting events in the athletics school in Jerusalem.

In ancient Rome too there were Jews who because of sanctions against them wished to undo their circumcision. Obviously there were successful methods even at that time, since, when the law banning 210

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circumcision was repealed, the requirements that a circumcision had to meet were further tightened by the rabbis. The foreskin must be completely removed, so that no tissue remained for possible experiments.

Then there is the well-known discussion about King David’s

‘marble foreskin’, since Michelangelo’s celebrated statue of this Jewish patriarch shows him apparently uncircumcised. Scholars had a field day with this and finally declared that Michelangelo knew exactly what he was doing: King David lived around 1000 bc, and it was not until after 300 bc that the circumcision laws were tightened. Before that time only a small fringe of the foreskin was removed, which is exactly what one sees in Michelangelo’s sculpture, where the foreskin does not completely cover the glans . . .

Religious circumcision confronts many surgeons, urologists or plastic surgeons with a dilemma. On the one hand there is the right to physical and intellectual integrity, and the individual’s right to self -

determination, and on the other there is freedom of religion. And religions sometimes have archaic rules. A recent Dutch government proved pro-active on this point and removed ritual circumcision from the standard health insurance package.

Health circumcision

In 1870 an American orthopaedic surgeon launched the notion that a whole range of ailments, rheumatism, asthma, kidney infections, bed-wetting, alcoholism, sterility and venereal disease, could be cured by circumcision. Sayre, the surgeon concerned, was acclaimed as the

‘Columbus of the foreskin’.

At the beginning of the twentieth century an American magazine hypothesized that the low incidence of cervical cancer in Jewish women might be a result of Jewish men being circumcised. Although this hypo -

thesis was not confirmed by scientific research, there was a massive overreaction: since then virtually all American male babies have been circumcised, mostly in hospital. In 1900 a quarter of male Americans had been circumcised. This so-called health circumcision, on medical grounds, was used in Europe in the Victorian period, but at that time to prevent masturbation.

When the army medical service published reports to the effect that uncircumcised soldiers were much more susceptible to venereal disease than their circumcised colleagues, circumcision was recommended as a preventative health measure. The result of this was that by the late 1960s some 90 per cent of the male population was circumcised. In 1969 there were the first stirrings of resistance, but it was not until 211

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David’s private

parts.

1990 that there was a real sea change in America. A lobby group for circumcised men was set up and there were direct appeals to the media:

‘We don’t cut babies’ ears off because they need washing behind them, do we?’ Members could not only commiserate with each other, but could also swap experiences about all kinds of methods of restoring the foreskin. These included obtaining ‘new’ tissue by careful stretching of the remains of the foreskin, involving the use of clamps, plasters and elastic bands. Homosexuals, as so often with these kinds of problems, were the trailblazers. From San Anselmo in the United States the anti-circumcision lobby distributes its newsletter
No-circ
, which reports on successes achieved, like a ban on female circumcision, which is regarded as a first step in the struggle against male circumcision. In a statement the movement argues that doctors who perform a ritual circumcision are infringing the ancient medical adage
primum non
nocere
, do not inflict harm. Even the un charter on human rights is invoked: no one shall be subjected to torture, or inhuman or humiliating treatment.

In early 2007, as a result of publications in the authoritative journal
The Lancet
, there were unexpected developments. A study in Kenya 212

a i l m e n t s o f t h e p e n i s

headed by scientists from Johns Hopkins University (Baltimore) involved 2,784 hiv-negative men aged between eighteen and 24. The men were either circumcised or their circumcision had been postponed for two years. After two years 4.2 per cent of the second group had become infected with the hiv virus, whereas in the group of immediately circumcised men the percentage was 2.1!

In Uganda a comparable study was conducted by a team from the University of Illinois, only this time with 4,996 hiv-negative men between fifteen and 49. This study also showed a halving of the risk of hiv infection. The tenor of the various reactions was more or less unanimous: because of the enormous potential of circumcision, within Southern Africa alone a reduction of 3.7 million hiv infections and 2.7

million deaths from aids, the procedure had to be seen as a preventative measure. This marked a return to ‘health circumcision’.

213

chapter eight

Voluntary and Involuntary

Sterility

Forced sterilization

The controversial history of sterilization in men, vasectomy, begins with Cooper’s publication of 1832 on the severing of the seminal duct in dogs. The first sterilization was carried out in the United States at the end of the nineteenth century in order to prevent the spread of crime.

There was a fear that the usa would be inundated by mentally and socially inferior people. The procedure was also carried out in the United Kingdom, but in this case on eugenic grounds, to protect the race from self-destruction by its own descendants. At the beginning of the twentieth century Sharp reported on 450 sterilizations he had carried out in the state of Indiana on members of the Reformed Church.

In their case vasectomy was intended to suppress masturbation. It was performed without anaesthetic and took no longer than three minutes.

The severed end of the duct on the testicle side was left open so that the sperm cells could drain away freely and be absorbed by the body. In 1907 a law was introduced in Indiana that permitted the sterilization of ‘mental defectives’ and the ‘insane and feeble-minded’ for eugenic reasons. In the following decades similar laws were passed by 32 states, while twelve also legalized the forced sterilization of criminals. Up to 1960 over 60,000 sterilizations were carried out for the above

-

mentioned reasons.

In Germany in 1933 vasectomy was made to serve eugenics, based on ‘modern racial hygiene’. In the first year after its introduction 28,000 sterilizations were carried out. In 1936 Adolf Hitler discussed sterilization with the German cardinal Faulhaber, the Archbishop of Munich. Hitler had argued for the sterilization of those with hereditary defects, and is reported as saying the following: ‘The operation is simple and does not make the man unsuitable for an occupation or marriage, and now we are being thwarted by the church.’ Cardinal Faulhaber is supposed to have said: ‘Chancellor, the state is not being 214

vo l u n ta ry a n d i n vo l u n ta ry s t e r i l i t y forbidden by the church to remove these harmful individuals from the community within the framework of the laws on public decency and given a genuine emergency. But instead of physical mutilation other methods must be tried, and such a means exists: the internment of people with hereditary defects.’

Internment camps amounted to concentration camps; such an institution fell within the laws on public decency and sterilization did not. Sterilization led to sexual pleasure without reproduction and that in the view of Catholic moral theologians could not possibly be permitted. For the ordinary Catholic sexual intercourse had repercussions, as Uta Ranke describes in her book
Eunuchs for the Kingdom of
Heaven.

In 1935 a question came from Aachen to the Holy See as to whether a forcibly sterilized man could be admitted to a church marriage. On 16 February the reply was received that the man’s marriage must not be forbidden, since it involved an unjust coercive measure by the state.

In Sweden it has been possible since 1935, with the approval of a committee, to sterilize those whom ‘the law has declared
non compos
mentis
’, or who because of a psychiatric condition are deemed unsuitable for parenthood. In 1948 a law was promulgated to control sterilization on eugenic grounds; in practice many sterilizations were actually performed for socio-economic reasons. Between 1948 and 1962 14,000

sterilizations were carried out in Japan, and the number of illegal sterilizations was estimated at four times that figure.

A large proportion of people with a mental handicap are not able to give informed consent with regard to sterilization. In those cases the carer should fulfil his/her obligations towards the parents or guardian and, with those who are of age, towards those charged with the pe r -

son’s welfare. If the handicapped person is capable of informed consent and is over the age of twelve but not yet sixteen, the permission of parent or guardian is also required. Everything seems perfectly regulated, but in practice the picture is different. When the parents of a strapping lad of fourteen with Down’s syndrome asked me to have him sterilized, since their son had already made a spontaneous attempt at intercourse, I acceded to their request without hesitation. Some readers might think that a Down’s syndrome male with his 47 chromosomes cannot father children, but in certain circumstances that is perfectly possible.