Clinical Anatomy 28:563–564 (2015)
Letter to the Editor An Undeniable Need for Change:
The Case for Redefining Human Penis Types: Intact, Circumcised, and Uncircumcised (All Three Forms Exist and All are Different) To the Editor, Clinical Anatomy: As times change, so too must the terms used to describe various processes and conditions. This fine tuning of lexicon occurs in scientific, geopolitical, and social arenas. For instance, in recent years we have seen the replacement of Global Warming with Climate Change to better capture the possible broader implications of increased CO2 emissions; we have successfully transitioned away from Undeveloped to Emerging when referring to countries whose per capita GDP is below a certain level to further bolster their efforts to build their economies; and we (as a society) have replaced many old and potentially offensive terms with new ones that convey respect. A clinical example of this evolution in terminology was the replacement of Mongolism with Down-syndrome (Allen et al., 1961). This change was initiated by forward-thinking researchers who realized that it was time for the old and perhaps offensive term to be replaced with a new one. Few could argue that this change, and others like it have not moved our society and its language in the right direction. It is time, yet again, for the medical community (and society) to universally replace an old, and potentially offensive term with a new, more clinical one so as to better capture the science, to eliminate the pejorative, and to avoid unintended offense: the term uncircumcised should be replaced with the term intact when referring to the natural, unaltered human penis (as in Hill, 2007). If one were to momentarily reflect on a possible hidden and antiquated subtext of the term uncircumcised, a buried and subconscious meaning could be something synonymous with unclean (or, at the extreme heathen or uncivilized [The Holy Bible, 1 Chronicles 10:4, Genesis 34:14, Isaiah 52:1 & Ephesians 2:11 (among others)]). Given this and a modern view of personal hygiene, and a greater acceptance of those who may be different, continued usage of the term uncircumcised would be unfair as it perpetuates a subliminal stigma upon those who are in the natural, unaltered state. Indeed, there is a healthy debate surrounding the risks verses benefits of removing the human male prepuce, and that discussion needs to unfold between experts in that field of study (e.g., El-Hout and Khauli, 2007; Hill, 2007), of which I am not. However, from an outsider’s perspective there appears to be inconsistent usage in the terminology describing a natural, unaltered human penis (both intact and uncircumcised can be found in the literature).
C V
2015 Wiley Periodicals, Inc.
Curiously, some publications1 that strongly advocate the unaltered state use the term uncircumcised rather than intact. This usage of uncircumcised (rather than intact) by these authors potentially relegates their research into the subordinate or one-down position (i.e., having surrendered the power in a relationship to another—in this case to the circumcised), as it suggests they have accepted (or, perhaps, have been pressured by the medical establishment to accept) that circumcised is the default state of human males (question: is unmastectomied the universally accepted default state of human females?). Until advocates of the natural, unaltered state consistently use the term intact in their research and publications and collectively request its adoption by the establishment (as in Allen et al., 1961), they may continue to walk (and work) in the shadows of the circumcised—having acquiesced to the fact that unaltered human males are just awaiting the removal of their foreskins. Furthermore, it could be argued that the continued usage of uncircumcised (instead of intact) by members of the medical community might seem: uninformed (as research shows that the male prepuce has a function [Hill, 2007]); unethical (as there are risks associated with removing healthy tissue [Hill, 2007]); and unenlightened (as a majority of the world’s males have their foreskins and should not be considered as being in an ungroup because of that fact [WHO, 2007])
1 Citing specific articles that advocate the natural state, yet use uncircumcised (rather than intact) could unfairly single out authors and journals. Instances of this usage are readily found in the literature.
*Correspondence to: William G. Wallace, Ph.D., Department of Biology, College of Staten Island/CUNY, Staten Island, NY 10314. E-mail: [email protected] Received 14 February 2015; Accepted 8 March 2015 Published online 16 April 2015 in Wiley Online (wileyonlinelibrary.com). DOI: 10.1002/ca.22541
Library
564
Letter to the Editor
Fig. 1. Flow chart describing three possible human penis types based on the presence (Intact), absence (Circumcised), or restoration (Uncircumcised) of a foreskin. Given the above, I strongly encourage those clinicians, researchers, and organizations who specialize in this area of study to seriously consider this suggested change in terminology (i.e., use of intact, rather than the potentially pejorative term, uncircumcised, when referring to the natural, unaltered human penis). Once the medical community makes this transition, society will likely follow; the term Mongolism has essentially vanished from the lexicon. The term, uncircumcised however, still may have a use— though this proposed change may complicate the issue further. The use of the prefix “un” in some cases can convey the idea that a previous condition had been reversed—as in unsubscribed. As such, uncircumcised may better describe a penis that had previously been in the circumcised state, but, as a result of either surgical or non-surgical foreskin restoration, is now in the uncircumcised (or reversed-circumcised) state (Anonymous, 1994). As a growing number of circumcised men become aware of the possibility of, and work towards regaining some of the functionality of a foreskin, this old term can be appropriately re-defined to describe their restored penis type. At present, no medical term clearly defines this condition and it most certainly exists. There would then be three useful, respectful, and scientifically sound terms to refer to the possible penis types that exist: intact (those in the natural state), circumcised (those with the prepuce removed), and uncircumcised (those with a restored prepuce or pseudo-prepuce) (as in
Figure 1). For the medical community to not change the vernacular describing penis types, given all of the above, would be UNCONSCIONABLE! And isn’t conscionable the preferred state?
William G. Wallace* Department of Biology College of Staten Island/CUNY New York, New York
REFERENCES Allen G, Benda CE, Book JA, Carter CO, Ford CE, Chu EHY, Hanhart E, Jervis G, Langdon-Down W, Lejeune J, Nishimura H, Oster J, Penrose LS, Polani PE, Potter EL, Stern C, Turpin R, Warkany J, Yannet, H. 1961. Mongolism. Lancet 1:426. [Anonymous]. 1994. The joy of uncircumcising. Br Med J 309:676– 77. El-Hout Y, Khauli RB. 2007. The case for circumcision. J Men’s Health Gender 4:300–305. Hill G. 2007. The case against circumcision. J Men’s Health Gender 4:318–323. World Health Organization, Department of Reproductive Health and Research and Joint United Nations Programme on HIV/AIDS (UNAIDS). 2007. Male circumcision: Global trends and determinants of prevalence, safety and acceptability. Geneva: WHO Press, World Health Organization. 44 p. (ISBN 978–92-9173-633-1).
Letter to the Editor An Undeniable Need for Change:
The Case for Redefining Human Penis Types: Intact, Circumcised, and Uncircumcised (All Three Forms Exist and All are Different) To the Editor, Clinical Anatomy: As times change, so too must the terms used to describe various processes and conditions. This fine tuning of lexicon occurs in scientific, geopolitical, and social arenas. For instance, in recent years we have seen the replacement of Global Warming with Climate Change to better capture the possible broader implications of increased CO2 emissions; we have successfully transitioned away from Undeveloped to Emerging when referring to countries whose per capita GDP is below a certain level to further bolster their efforts to build their economies; and we (as a society) have replaced many old and potentially offensive terms with new ones that convey respect. A clinical example of this evolution in terminology was the replacement of Mongolism with Down-syndrome (Allen et al., 1961). This change was initiated by forward-thinking researchers who realized that it was time for the old and perhaps offensive term to be replaced with a new one. Few could argue that this change, and others like it have not moved our society and its language in the right direction. It is time, yet again, for the medical community (and society) to universally replace an old, and potentially offensive term with a new, more clinical one so as to better capture the science, to eliminate the pejorative, and to avoid unintended offense: the term uncircumcised should be replaced with the term intact when referring to the natural, unaltered human penis (as in Hill, 2007). If one were to momentarily reflect on a possible hidden and antiquated subtext of the term uncircumcised, a buried and subconscious meaning could be something synonymous with unclean (or, at the extreme heathen or uncivilized [The Holy Bible, 1 Chronicles 10:4, Genesis 34:14, Isaiah 52:1 & Ephesians 2:11 (among others)]). Given this and a modern view of personal hygiene, and a greater acceptance of those who may be different, continued usage of the term uncircumcised would be unfair as it perpetuates a subliminal stigma upon those who are in the natural, unaltered state. Indeed, there is a healthy debate surrounding the risks verses benefits of removing the human male prepuce, and that discussion needs to unfold between experts in that field of study (e.g., El-Hout and Khauli, 2007; Hill, 2007), of which I am not. However, from an outsider’s perspective there appears to be inconsistent usage in the terminology describing a natural, unaltered human penis (both intact and uncircumcised can be found in the literature).
C V
2015 Wiley Periodicals, Inc.
Curiously, some publications1 that strongly advocate the unaltered state use the term uncircumcised rather than intact. This usage of uncircumcised (rather than intact) by these authors potentially relegates their research into the subordinate or one-down position (i.e., having surrendered the power in a relationship to another—in this case to the circumcised), as it suggests they have accepted (or, perhaps, have been pressured by the medical establishment to accept) that circumcised is the default state of human males (question: is unmastectomied the universally accepted default state of human females?). Until advocates of the natural, unaltered state consistently use the term intact in their research and publications and collectively request its adoption by the establishment (as in Allen et al., 1961), they may continue to walk (and work) in the shadows of the circumcised—having acquiesced to the fact that unaltered human males are just awaiting the removal of their foreskins. Furthermore, it could be argued that the continued usage of uncircumcised (instead of intact) by members of the medical community might seem: uninformed (as research shows that the male prepuce has a function [Hill, 2007]); unethical (as there are risks associated with removing healthy tissue [Hill, 2007]); and unenlightened (as a majority of the world’s males have their foreskins and should not be considered as being in an ungroup because of that fact [WHO, 2007])
1 Citing specific articles that advocate the natural state, yet use uncircumcised (rather than intact) could unfairly single out authors and journals. Instances of this usage are readily found in the literature.
*Correspondence to: William G. Wallace, Ph.D., Department of Biology, College of Staten Island/CUNY, Staten Island, NY 10314. E-mail: [email protected] Received 14 February 2015; Accepted 8 March 2015 Published online 16 April 2015 in Wiley Online (wileyonlinelibrary.com). DOI: 10.1002/ca.22541
Library
564
Letter to the Editor
Fig. 1. Flow chart describing three possible human penis types based on the presence (Intact), absence (Circumcised), or restoration (Uncircumcised) of a foreskin. Given the above, I strongly encourage those clinicians, researchers, and organizations who specialize in this area of study to seriously consider this suggested change in terminology (i.e., use of intact, rather than the potentially pejorative term, uncircumcised, when referring to the natural, unaltered human penis). Once the medical community makes this transition, society will likely follow; the term Mongolism has essentially vanished from the lexicon. The term, uncircumcised however, still may have a use— though this proposed change may complicate the issue further. The use of the prefix “un” in some cases can convey the idea that a previous condition had been reversed—as in unsubscribed. As such, uncircumcised may better describe a penis that had previously been in the circumcised state, but, as a result of either surgical or non-surgical foreskin restoration, is now in the uncircumcised (or reversed-circumcised) state (Anonymous, 1994). As a growing number of circumcised men become aware of the possibility of, and work towards regaining some of the functionality of a foreskin, this old term can be appropriately re-defined to describe their restored penis type. At present, no medical term clearly defines this condition and it most certainly exists. There would then be three useful, respectful, and scientifically sound terms to refer to the possible penis types that exist: intact (those in the natural state), circumcised (those with the prepuce removed), and uncircumcised (those with a restored prepuce or pseudo-prepuce) (as in
Figure 1). For the medical community to not change the vernacular describing penis types, given all of the above, would be UNCONSCIONABLE! And isn’t conscionable the preferred state?
William G. Wallace* Department of Biology College of Staten Island/CUNY New York, New York
REFERENCES Allen G, Benda CE, Book JA, Carter CO, Ford CE, Chu EHY, Hanhart E, Jervis G, Langdon-Down W, Lejeune J, Nishimura H, Oster J, Penrose LS, Polani PE, Potter EL, Stern C, Turpin R, Warkany J, Yannet, H. 1961. Mongolism. Lancet 1:426. [Anonymous]. 1994. The joy of uncircumcising. Br Med J 309:676– 77. El-Hout Y, Khauli RB. 2007. The case for circumcision. J Men’s Health Gender 4:300–305. Hill G. 2007. The case against circumcision. J Men’s Health Gender 4:318–323. World Health Organization, Department of Reproductive Health and Research and Joint United Nations Programme on HIV/AIDS (UNAIDS). 2007. Male circumcision: Global trends and determinants of prevalence, safety and acceptability. Geneva: WHO Press, World Health Organization. 44 p. (ISBN 978–92-9173-633-1).
