A GLOSSARY OF CIRCUMCISION AND THE MOVEMENT TO END IT
Frequently Used Expressions
Ar. = Arabic; Fr. = French; Heb. = Hebrew; Gk = Greek; L. = Latin; pl. = plural; pr = pronounced
In Ar. words a capital letter means a consonant has a dot under it, a vowel has a macron over it.
LISTS: (Glossary of the intact penis: Penile Anatomy; Skinonyms)
- Surgical Circumcision
- Other Surgery
- Ritual Circumcision
- Restoration
- Intactivism
- Abbreviations
SURGICAL CIRCUMCISION
ablate
Remove. (ablation = removal) (L., = carry away)
Apligraf (TM)
Trade name (of Organogenesis Inc.) for a skin-tissue cultured from human foreskins. Others are Dermagraft (TM), OrCel (TM) and TranCyte (TM). Ethical issues involved in the trade in foreskins, especially their ownership, are commonly ignored. One foreskin generates a large amount of the tissue, but that would be no excuse if any other tissue were involved. Excellent substitutes are commonly used in non-circumcising countries. Both firms filed for bankrupcy protection late in 2002; Organogenesis seems to have recovered.
acucullophilia
A condition of being sexually aroused only by circumcised males.
assymetrical
an asymmetrical circumcision is one that leaves more skin hanging off one side than the other, as in the case of baby Flatt. A rarely-mentioned unaesthetic downside to circumcision. If done before puberty, it will become less prominent after.
"beauty cut"
Euphemism for a low, tight circumcision in which the maximum amount of mucosa is removed and the scar lies in the sulcus. Causes the greatest loss of erogenous tissue. The penis's owner may not agree that it is beautiful.
bone foreceps
Instrument used for haemostasis in freehand circumcision. They resemble double-acting bolt-cutters and can literally cut bone, so damage to the glans from this method was not uncommmon - especially since the glans could not be seen when they were applied.
Picture of Bone forceps
Brennemann's ulcers
Ulcers on the urethral meatus, caused by the ammonia burns to the unprotected tissue (the ammonia generated by the breakdown of urine). When the ulcers heal, the scar formation causes meatal stenosis.
circopath
Person with a compulsion to circumcise. Hence also circopathy, the compulsion to circumcise; and circopathology, the psychological basis of that compulsion. (coined by Gary Harryman on July 13, 2001)
CIRCUMCISION
A euphemism for MGM, but generally used to mean cutting off the whole of the foreskin. It may leave less or more of the inner mucosa and of the frenulum (see high, low, loose and tight.), at the whim of the circumcisor, to the greater or lesser detriment of the person circumcised.
Circumcision is not medicine. It is not "surgery" either, in the eyes of many. It is a "procedure" -- a broad term that encompasses things like removing a splinter, adjusting a spine, lysing a foreskin, or performing the Heimlich maneuver. What are the rules governing the safety, efficacy and necessity of "procedures"? Pretty vague.
If circumcision were surgery, or even real medicine, it would need a ton of guidelines, such as how much tissue to remove, what parts (like the frenulum) to preserve or excise, and how to achieve a "neat" cut. There doesn't even exist a real definition of what circumcision is, because there is no way to consistently identify the organ or tissue being removed. It's not like appendectomy or tonsillectomy, where the goal is clear. There is no dotted line indicating where the foreskin ends and the shaft skin begins.
Circumcisions are like snowflakes; no two are exactly alike. And those fathers who insist on having their sons circumcised to "look like them" don't realize the staggering odds against the circumcisions being anything like their own.
"Circumcision" is not a specific operation. It is not like a vasectomy or the extraction of a wisdom tooth. Circumcision is merely a vague term that says "someone went after the end of my child's penis with a probe, knife and/or clamp". Fathers aren't actually signing up for Junior's penis to match -- what do you tell the dad who has no clear scar to speak of, but the son has a thick, Gomco-induced racing stripe around his johnson? The dad with an all-American "high-'n-tight" job whose son is handed back to him with a loose, bunched cut (as happens more frequently today)? With 30 years between the procedures and changes in methods, how can a dad realistically expect the attack on his son's penis to be similar to the attack on his own?
Circumcision is nothing more than how a given doctor, on a given day, would hack away at the tissue of a normal, healthy penis. No two doctors do it exactly the same; no two boys have exactly the same anatomy to work on. Clamps and bells were introduced in an attempt to bring some consistency to the "procedure", but even they are not consistently applied. Doctors can still pull the skin tighter, can still slip and slice a glans, can still cause grievous hemorrhage.
Given that this is not a necessary surgery in any sense on healthy children, it is really not possible to do it "properly". There is no "properly" when it comes to circumcision in the absence of disease or deformity (from injury, etc.). We all just hack at the bits as best we can, trying to expose the glans, and then tell the parents that it's 'done'."
(L. circumcidere = to cut around. Because it is derived from "-cis-" meaning cut and not from "-ise" meaning cause-to-become, the spelling in "-ize" is not an option.)
circumincession, circuminsession
Not to be confused with the above: in theology, terms referring to the relationship between the three Persons of the Trinity (L. circum, around + in + sedere, to sit; or incedere, to move).
Circumstraint (TM)
Torture-board with straps to hold down a baby sensibly struggling against being circumcised.
Picture of Circumstraint (TM)
cornification
See keratinisation. (L. cornus = horn) A useful reminder that the circumcised glans hardens like a worker's hands (but beware of the double meaning of "horny").
deep dorsal vein
This vein terminates in the foreskin. After circumcision it must find such connections as it can. On erection it swells (becomes varicose) in a circumcised penis but rarely or less so in an intact one - indicating that circumcision dramatically alters the circulation of the penis.
Picture of erect intact penis - only superficial dorsal veins are visible
Picture of erect circumcised penis - swollen deep dorsal vein
dehiscence
Gaping open of a wound. A complication of circumcision, especially when done with a Gomco clamp. Click here for a first-hand account. (L. gaping apart)
Dermagraft (TM)
Trade name (of Advanced Tissue Sciences Inc. - in liquidation) for a skin-tissue cultured from human foreskins. See Apligraf (TM).
electrocautery
The use of electricity to cauterise (burn) cut tissues, seal blood vessels and so prevent bleeding. Electrocautery instruments may be bipolar (in which the electricity flows between two closely spaced electrodes) or unipolar, in which one electrode is placed on the body remote from the surgery. Unipolar electrocautery should never be used on an extremity such as the finger or penis because the heating effect takes place along its entire length. Several circumcisions performed this way have resulted in ablation of the penis. In the case of David Reimer, the use of an electrocautery instrument with a metal clamp in place contributed to the damage.
fistula
A tubular complication of circumcision, as when a skin bridge is open underneath, or an additional hole is cut in the urethra. (L. = pipe, flute, pl. fistulae)
foreskin regression
The re-covering of the glans by the foreskin remnant in older men who have had a low and/or loose circumcision, caused by the natural shrinking of the penis. In some cases and in cold conditions, this may lead to the appearance of intactness.
freehand
(circumcision) without a purpose-designed clamp. One is shown on another page.
Gomco clamp (TM)
A circumcision device invented in 1934 by Hiram S. ("Inch") Yellen, M.D. and Aaron A. Goldstein (and reportedly based on the tyre-lever used for Model T Fords, according to Julian Wan's sickeningly worshipful history of the device). It consists of a metal bell placed over the glans (requiring a slit in the foreskin first) and a flat plate with a hole in it placed over both, to define the position of the cut. They are brought together by a screw to apply circular crushing and fusing force (of 8000 to 20,000 pounds, according to Wan) at the position of excision. Leaves a characteristic dark line at the excision scar. Varney's Midwifery says its disadvantages are that "it involves more parts, requires more steps in the procedure, and it takes more time." Under that enormous pressure, a groove wears in the bell with prolonged use, making it ineffective. The clamp is made in a set with different-sized bells and rings and there is a danger of mixing parts of different sizes. In 2001, the FDA issued a warning against clamp injuries. (from GOldstein Manufacturing COmpany, later Gomco Surgical Manufacturing Co.)
Picture of Gomco clamp TM
h[a]emostasis
prevention of bleeding. (Gk., blood stopping)
h[a]emostat
lockable scissors-like clamp used in freehand circumcision. It crushes the foreskin distal to the glans, and the skin is cut with a scalpel distal to it. It may inadvertantly crush the tip of the glans as well, and by squeezing the cylindrical foreskin flat at only one end, can seldom ensure an even cut.
hairy shaft
A complication of too-tight circumcision in which hairy scrotal skin is drawn on to the penile shaft.
high
A circumcision is called "high" when more shaft-skin and less mucosa is removed. This leaves the scar relatively high up the flaccid penis when its owner is standing up. Compared to a low one, this has the advantage of leaving the penis' owner with more of his frenulum, though it is probably done to remove all folds. Methods that involve drawing the foreskin forward before cutting it, such as clamp methods, all produce a high result. The terms "high" and "low" describe a different variation from "loose" and "tight".
Picture of high circumcison Picture of low circumcison
hypertrophic
overgrown, of scarring that has thickened (Gk, excess growth)
Picture of hypertrophic scarring
iatrogenic
(Damage) caused by a doctor (or nurse or parent) eg, phimosis caused by premature attempt to retract the foreskin. (Gk. iatros = physician)
ischaemia, ischemia
Restriction of blood supply, a complication of circumcision. (Gk. isch- = restriction, haema = blood)
keloid
Of scars, pulling on the skin (Gk chele, a claw). The term also refers to extremes of hypertrophic scarring, a rare complication of circumcision.
keratinisation
Hardening of the mucosa of the glans after circumcision, leading to reduced sensitivity. (Gk. keras = horn)
Picture of Keratinisation
loose
A circumcision (whether "high" or "low") is called "loose" when the penis's owner is allowed to keep more of his skin and/or mucosa. A low and loose circumcision may resemble a naturally short foreskin, but even the loosest of conventional circumcisions will still remove all of the ridged band.
Picture of loose circumcison Picture of tight circumcison
low
A circumcision is called "low" when more mucosa and less shaft-skin is removed. This leaves the scar relatively low down the flaccid penis when its owner is standing up. In a very low circumcision, almost all the mucosa of the foreskin is removed and the scar is in the sulcus. Compared to a high one, this gives a smooth appearance, but it removes more of the frenulum. A low circumcision must be performed freehand, skinning the mucosa back and cutting it away, bringing the shaft-skin forward and aligning them. It is a highly skilled operation, and as always, the outcome to the adult is unpredictible in the baby. The terms "high" and "low" describe a different variation from "loose" and "tight".
Picture of low circumcison Picture of high circumcison
malapposition
Rotation of the shaft-skin with respect to the glans during circumcision, causing the raphe not to line up with the frenulum. A life-long aesthetic blemish, easily committed (when the shaft is covered in blood) by a doctor who may not even know that it is a possibility. (L. = bad placing together)
Picture of Malapposition
meatal stenosis
Narrowing of the meatus, a very common complication of circumcision.
meatal ulcer
Ulcer at the meatus, a very common complication of circumcision.
meatitis
Inflammation of the meatus, one of the possible consequences of circumcision.
meatotomy
Operation to correct meatal stenosis by enlarging the opening of the meatus.
Mogen(TM)? clamp
(Heb. = shield) One of a series of circumcision instruments made by this company, including probe, probe-tipped scissors, etc. Invented in 1954 by Rabbi Harry Bronstein, a Brooklyn mohel, consists of two flat blades brought together and held by a rotating cam. It opens no wider than 3mm in order not to admit the glans - but it is not possible to see whether this has in fact happened: Varney's Midwifery - in a chapter written by a mohalet - says
'Using the Mogen clamp has the distinct disadvantage of making the circumcision a "blind" procedure. The glans of the penis cannot be seen (so anomalies may not be discovered until after the circumcision) and is thus at risk of being cut.'
(This occurred in Florida in 2004, and the parents sued both the mohel and the Mogen company.)
It then closes to crush the foreskin before it is cut. Described as "the least painful method" though there is no reason this should be so, and "able to be used without previous experience."
Picture of a Mogen clamp
necrosis
Death of tissue. (adj. necrotic)
necrotizing fasciitis
"Galloping gangrene", a possible consequence of circumcision.
neonate
Newborn baby. (adj. neonatal)
nerve force theory
18th-19th Century theory whereby "nervous ether" radiating from the brain set the body in motion. "Nerve force" was believed to circulate in the body like the four humours, and a shortage or an excess, believed to cause disease. "Irritability" (i.e. sensitivity, but confused with inflammation) of the genitals led to an imbalance in nerve force. Thus masturbation was to be condemned and prevented on health as well as moral grounds. See also reflex theory.
- R. Darby, A Surgical Temptation, p 39
neuroma
Abnormal growth of a nerve, especially at a cut end, a complication of circumcision, causing confusion of sensations. (Gk neur- = nerve -oma = growth. pl neuromata, neuromas)
nosocomial
hospital-acquired (infection). (from Gk, nosokomeion, hospital) See also iatrogenic.
nociceptor
Nerve specialised for the detection of painful stimuli. (L. nocere, to hurt + [re]ceptor)
OrCel (TM)
Brand name of foreskin-derived tissue, like Apligraf (TM)
Peyronie's disease (Peyronie's fibroid)
A plaque of dense tissue in the penis causing painful erections and deformity, including a bent penis (in many cases a dog-leg or "J" shape, or twisting the penis around almost a full 360 degrees - a corkscrew) when erect. A man with Peyronie's "can pee around a tree". An image of Peyronies, from the AmericanAcademy of Family Physicians' website. (The penis shown is circumcised).
True Peyronie's is extremely rare and does not have any known relationship to circumcision. The condition may be inherited or the result of trauma, even minor. A simple curve of the penis, however, may well be the result of, or worsened by, a circumcision executed more poorly than usual.
PlastiBell(TM)
A grooved plastic dome (with a handle, designed to be broken off) placed under the foreskin (which must be slit and forcibly separated from the glans to allow entry). A ligature (thread) is tied tightly around the foreskin, crushing it into the groove, causing it to become necrotic (to die) and drop off. Varney's Midwifery, citing Gee and Ansell, says "the Plastibell has a higher incidence of infection." Mothers supporting circumcision in the Moms Online pages reported several complications of Plastibell circumcisions in January 2001, for example: UGH! So the plastibell is hanging on by one little piece of skin and my baby is SO uncomfortable. I couldn't figure out why he would NOT sleep. Finally we figured out he was only happy when his diaper was off. Apparently the diaper rubs up and pushes the plastibell up so it pulls on the part where it is still atatched. This damm thing is really starting to piss me off! Why won't it come off and leave my poor baby in peace. I started him back on his tylenol thank goodness now he is able to get some sleep (and me as well).
One study of 2000 PlastibellTM circumcisions found a complication rate of 1.8%, "the most frequent being minor infection and hemorrhage. Other complications included a tight Plastibell ring that can cause constriction of the glans penis, irregular skin margin, inadequate skin excision and migration proximally [up the penis] of the Plastibell ring as the glans swells with venous engorgement. There have been isolated cases of necrotizing fasciitis, ruptured bladder, retention of urine secondary to glandular prolapse, and retention of the Plastibell device.
Al-Samarrai AYI, Moifti AB, Crankson SJ, Jawad A, Haque K, al-Meshari A. A review of a Plastibell device in neonatal circumcision in 2,000 instances. Surg Gynecol Obstet 1988; 167 (4):341-3.[Medline]
Bliss DP Jr, Healey PJ, Waldhausen JH. Necrotizing fasciitis after Plastibell circumcision. J Pediatr 1997;131(3):59-62.[Medline]
Woodside JR. Necrotizing fascitis after neonatal circumcision. Am J Dis Child 1980;134(3):301-2.[Medline]
Jee LD, Millar AJ. Ruptured bladder following circumcision using the Plastibell device. Br J Urol 1990;65(2):216-7.[Medline]
Mihssin N, Moorthy K, Houghton PW. Retention of urine: an unusual complication of the Plastibell device. BJU Int 1999;84(6):745.[Medline]
Pearce I. Retention of urine: an unusual complication of the Plastibell device. BJU Int 2000; 85(4):560-1.[Medline]
DattaNS, Zinner NR. Complication from Plastibell circumcision ring. Urology 1977;9(1):57-8.[Medline]
Picture of Plastibell TM and its ligature
posthectomy
Medical Gk for circumcision (posthe = foreskin, -ectomy = cutting off)
redundant (foreskin)
More than someone (other than the owner) feels comfortable with. There is no rule about how much foreskin anyone should be blessed with. (Well, maybe if it trips him up when he walks...) Babies and small boys quite commonly have as much as 1cm (0.5 in) of overhang. This has been better categorised as "abundant foreskin". Parents who are concerned that their son has too much foreskin should be told, "Don't worry, he'll grow into it."