July 29, 2023
This article (except for the final two paragraphs) was published on the Circumcision Facts and Science Facebook page on November 22, 2016. Reprinted by permission.
We excerpt a previous in-depth but succinct explanation published recently in a medical journal. The brief explanation is that Biblical circumcision involved a different technique (seen today in Mogen circumcisions), but the amount of foreskin removed was the same.
by Guy Cox, Brian Morris, & John N. Krieger
22 May 2013
Journal of Medical Ethics, 39(7):429-431.
A recent Commentary piece by Lang [1] contains a substantial historical error. He writes “Milah is merely a token clip of the very tip (the overhang flap or akroposthion) of the prepuce, which leaves most of the organ system (including all its essential functions) intact.” No reference is cited, but the source appears to be Wallerstein. [2]
Medical considerations make this unlikely, and the available historical evidence contradicts it. From the medical perspective, if the circumcision scar can migrate in front of the corona glandis it tends to shrink and create a secondary phimosis or a trapped penis. If treated early this can be remedied without further operation [3] but re-circumcision may be necessary. [4] Leaving it untreated can have serious consequences. [5] Successful outcomes, with or without further surgery, result in a fully exposed glans. Deliberate removal of only the excess foreskin, without subsequent retraction and exposure of the glans, therefore poses a serious risk of creating an intractable secondary phimosis.
All available evidence suggests that Jewish circumcision did expose the glans. There is no pre-Hellenic representation of Jewish circumcision - there is almost no surviving early Jewish iconography, and the Jewish prohibition of exposing the genitals [6] means that in any case, penises would not be depicted. However, Egyptian circumcision long predates Jewish circumcision, and there is good reason to believe that the Jewish practice was derived from the Egyptian. [7] Iconography of circumcised Egyptians is abundant, and detailed. [7] One can see from these that the glans was completely exposed, though there could be a ‘cuff’ of residual inner foreskin behind the glans. This is exactly what would be expected from descriptions of the chituch operation (described by Lang [1] as milah). The foreskin is forcefully stretched forward and severed in front of the glans. The outer layer springs back behind the glans and the residual inner foreskin is pushed back to meet it. [7] There is a 5,000 year old Egyptian illustration of the technique, [7] and the same technique is still used today in both medical and ritual circumcisions. There is also much textual evidence that Jewish circumcision exposed the glans. It is recorded that Jewish athletes competing in Graeco-Roman games wore a cap to cover the glans. [8]
The chituch type of circumcision does leave sufficient loose skin for foreskin reconstruction by stretching to be possible, and there is Biblical evidence that this did occur. [9] Roman surgeons wrote about techniques for foreskin restoration to re-cover the glans after circumcision. [8] Many Jews became Hellenised and wished to compete in athletic events, [9] for which a reconstructed foreskin was a more seemly solution than a cap (especially since the cap could be lost in the heat of competition.) [8] It has long been accepted that periah - ablation of the inner foreskin - was a later introduction into Jewish ritual circumcision. [10] This technique is also still currently used in both ritual and medical circumcision. [7] Foreskin restoration would have been virtually impossible after the introduction of periah so periah could not have been part of the operation before the Hellenistic period, and it was a prescribed part of the rite in the Talmudic period three of four centuries later. It is therefore hard to escape the idea that periah was introduced to hinder circumcision reversal. [1][2][7] Following the destruction of Palestinian Jewish culture in AD 70 Jewish populations were dispersed. Since new ideas would not be adopted everywhere at the same time, it would be unlikely that periah was adopted by all Jewish communities at the same time. Circumcision reversal was still a topic of discussion late in the first century AD. [11] The important point is that periah did not affect the exposure of the glans penis, it just made circumcision reversal more difficult.
We would also add, as a postscript, that Lang’s use of the sale of Viagra as a metric of erectile dysfunction [1] seems curious when many studies in the developed and developing countries have actually investigated the topic directly. Large-scale studies in the U.S., [12] Australia, [13] and Africa [14] have shown that circumcised men are significantly less likely to suffer from erectile dysfunction. Sales of Viagra in the richest country of the world reflect nothing more than the ability to pay for it.
A story in the 34th chapter of the Book of Genesis suggests that circumcision during the biblical period involved removal of a significant portion of the foreskin, far more than a token snip. Following the rape of Dinah, the Shechemites agreed to circumcise themselves. Three days later they were still in great pain such that two of Dinah's brothers were able to overpower and slaughter all of the men of the city. It is difficult to conceive that a token snip would have incapacitated all of the men for three days. [15]
Some intactivists say that circumcision as practiced today is unbiblical based on the assertion that the amount of skin removed is more than that during biblical times. However the Torah commandment simply states that the Jews are to circumcise their sons. [16] Nowhere in the Torah does it specify how much foreskin to remove. The specific amount is left up to religious authorities to determine.
[1] David P. Lang; "Circumcision, sexual dysfunction and the child’s best interests: why the anatomical details matter"; Journal of Medical Ethics; 2013. (Epub ahead of print May 28. doi 10.1136/medethics-2013-101520).
[2] Edward Wallerstein; "Circumcision - An American Health Fallacy"; New York: Springer, 1980
[3] Jason Blalock et al; "Outpatient management of phimosis following newborn circumcision"; Journal of Urology; 2003;169:2332-4.
[4] Patel H; "The problem of routine infant circumcision"; CAMJ 1966;95:576-581.
[5] Ahmet Ali Sancaktutar et al' "Severe phimosis leading to obstructive uropathy in a boy with lichen sclerosus"; Scandinavian Journal of Urology and Nephrology; 2012;46:371-4.
[6] Genesis 9:20-24
[7] Guy Cox, Brian Morris; "Why circumcision, from prehistory to the 21st century" In: Bolnick DA, Koyle M, Yosha A (eds), Surgical Guide to Circumcision London: Springer. 2012:243-59.
[8] Rogers BO; "History of external genital surgery" In: Horton CE (ed). Plastic and Reconstructive Surgery of the Genital Area. Boston: Little Brown & Co. 1993:3-15.
[9] 1 Maccabees 1:15-16
[10] Bryk F.; "Circumcision in Man and Woman"; (tr. Felix Berger). New York: American Ethnological Press, 1934:342 pp. (Facsimile reprint New York: AMS Press, 1974)
[11] 1 Corinthians 7, verse 18
[12] Edward O. Laumann et al; "Circumcision in the United States. Prevalence, prophylactic effects, and sexual practice"; Journal of the American Medical Association; 1997; 277:1052-7.
[13] Juliet Richters et al; "Circumcision in Australia: prevalence and effects on sexual health"; International Journal of STD and AIDS; 2006;17:547-554
[14] Krieger, JN; "Circumcision, sexual function and sexual satisfaction"; In: Bolnick DA, Koyle M, Yosha A (eds), Surgical Guide to Circumcision; London: Springer 2012:233-239
[15] Genesis 34:25
[16] Genesis 17:9-14