The cruellest cut of all

As the medical case for circumcision fades, angry campaigners are calling for a ban on a practice they claim violates human rights, says Jerome Burne

Every day for the past six months, John has been wearing two 6oz metal ball-bearings attached by straps to the end of his penis. He's not a fetishist; he's on a course of DIY plastic surgery to correctwhat was, in his view, a terrible wrong inflicted on him when he was a baby. John was circumcised and he wants his foreskin back.

Your first reaction might be that John is the sort of chap who could have featured in one of Graham Norton's trawls through the wackier shores of the web. But the organisation he belongs to, known as Norm-UK, boasts the art critic Brian Sewell as its patron and features a number of doctors on its board. Largely unnoticed by the wider public, the once uncontroversial topic of male circumcision has become hot. One campaigner claims that it violates at least seven human rights.

Forty or 50 years ago, circumcision was unremarkable - as many as half of newborn male babies in the UK were circumcised on the grounds that it was more hygienic and could protect them against conditions such as penile and prostate cancer as well as urinary tract infections. Such claims proved to be unfounded, and the number of circumcisions has plunged to between four and six per cent, most of which are said to be done for therapeutic reasons. (Figures are hard to come by, as records are based on medical, not religious, circumcisions.) Recent guidelines issued by Canadian surgeons declare that "circumcision performed on a healthy infant is now considered a non-therapeutic and medically unnecessary intervention", and UK doctors' associations agree.

The change is a triumph for evidence-based medicine, but it raises some tricky questions. If circumcision is medically unnecessary, is it right to subject small babies to it? At the moment, parents who want to have their child circumcised on the grounds of personal choice only need to find a doctor who is willing to do it privately. The aim of Norm-UK - which takes its name from the American National Organisation for Restoring Men - is to make this unacceptable.

A particularly delicate area of this debate is the issue of religious circumcision. Official bodies usually defend it on the grounds of religious freedom and cultural toleration, but some of the more hardline Norm members point out that such sensibilities have not prevented governments outlawing so-called female circumcision. "Circumcision is one of the very few non-therapeutic operations that can be done without the consent of the person being operated on," says David Smith, the manager of Norm-UK. "It's a scandal that young boys are mutilated unnecessarily."

But if most of the operations are done to cure a medical condition, what is wrong with that? The main reason for a therapeutic circumcision is to treat a condition called phimosis - a tight foreskin that won't retract. "Parents get worried and want something done even if it is not causing any problem," says Dr John Warren, a consultant physician at Princess Alexandra Hospital in Harlow, and founder of Norm-UK. "But research published as long ago as 1968 found that 90 per cent of tight foreskins resolved themselves by the age of four and 99 per cent were normal by 17." The charity also claims it is possible to treat most cases non-surgically.

Last month, Norm-UK delivered a letter to the British Association of Paediatric Surgeons (Baps) declaring that "most therapeutic circumcisions performed by the NHS are unnecessary" and backed it up with 109 journal references. Baps 2001 guidelines say: "...there is rarely a clinical indication for circumcision... Doctors should be aware of this and reassure parents accordingly."

The official position of the British Medical Association - "It is unethical to circumcise if research shows that less invasive techniques are available" - is equally general. It is dismissed as "meaningless" by Smith. "If you take your child to the GP and say you are worried about his non-retracting foreskin, the only solution you are likely to be offered is circumcision."

But debates about individual rights and medical judgements miss what is for many the central objection to circumcision - that it is an assault on male sexuality. The operation removes the prepuce that covers and protects the head, or glans, of the penis, which is made up of an outer skin and an inner mucosa. "Until the mid-Nineties, it was possible to claim that the foreskin was just a flap of skin," says Smith. "But then research showed that the inner mucosa contains up to 40,000 nerve endings that make a man more sensitive during sex."

For many circumcised men this is not a problem. Some even claim decreased sensitivity is a bonus because it allows them to "keep going" for longer. But Norm-UK claims that men experience a variety of negative feelings as a result losing their foreskins, including "low self-esteem over body image", "a sense of betrayal by parents, especially the mother" and "anger and hostility towards doctors".

The process of restoration can help resolve these problems. Although you can't re-create those lost nerve endings, you can recover the uncircumcised look and provide a covering for your glans which, ideally, responds by becoming thinner-skinned and more sensitive. All it takes is some straps, tapes and weights, and about three years.

There is no shortage of devices for sale on the internet with names like Pul-Man, TLC Tugger, Foreballs and Tug Ahoy. Foreballs, for instance, is a stainless steel barbell weighing up to 12oz and costing $130 (£72). You attach it with tape and let it hang. "Some men have got their foreskin back in six months," says Wayne Griffiths, founder of the American Norm. "But usually you have to wear something for two years."

One happy restorer is the Norm-UK member Alan Wood. "After years of dedicated stretching, taping and tugging," he exults, "I am finally released from the shackles of inhibition." His glans, he reports, is more moist and much more sensitive, while masturbating has new dimensions.

Sewell is listed as the patron of Norm-UK, but he is not the most wholehearted of supporters nor, he says, is he in need of restoration. Where Sewell does show solidarity with the organisation is on the human rights issue. "I do think it is something that people should be allowed to choose," he agrees. "Doctors are very lazy about such matters and far too likely to take a thoughtless snip."

FORESKINS: THE FACTS

Doctors began to promote circumcision in the 1850s as a cure for masturbation, then seen as a cause of insanity, epilepsy, hysteria, tuberculosis, short-sightedness and death.

In Finland, where no one is circumcised at birth, only one man in 16,667 has it done subsequently.

Foreskins removed from babies are in great demand by biomedical companies who use them in the manufacture of insulin and for producing artificial skin. A single foreskin is said to be able to grow 250,000 square feet of skin.

Last year, during the "circumcision season" in South Africa, when manhood rituals take place, there were five penis amputations and 12 deaths due to botched ceremonies.

In May this year David Reimer committed suicide aged 38. He first became famous as living proof that gender is decided socially. He was castrated very young after a circumcision went wrong and destroyed his penis. He was given hormone treatment and "successfully" bought up as a girl, Brenda (left). Later he rebelled and insisted on recovering his male identity.

There are websites devoted to what is known as "recreational or fetish circumcision". These contain erotic fantasies about forcefully circumcising a man and collecting foreskins. Members "share stories and pictures of circumcision". A woman who is only sexually aroused by circumcised males is called an "acucullophile".

Freelance circumciser Omunnakwe Amechi was charged last year in a London court with wounding two boys aged 14 and 19 months when he operated on them in their front rooms. The boys had to go to hospital and needed transfusions and corrective surgery. Amechi declared that he had been circumcising since 1995. He was acquitted.

JB