12 INTACT Days of Christmas

12 INTACT Days of Christmas!
Words by Danelle Day

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On the First Day of Christmas my true love gave to me, 

A Happy, Healthy INTACT Baby!

On the Second Day of Christmas my true love gave to me, 

Two Info Packs
And a Happy, Healthy INTACT Baby!

On the Third Day of Christmas my true love gave to me, 

Three Baby Expos,
Two Info Packs
And a Happy, Healthy INTACT Baby!

On the Fourth Day of Christmas my true love gave to me, 

Four Parents Listening,
Three Baby Expos,
Two Info Packs
And a Happy, Healthy INTACT Baby!

On the Fifth Day of Christmas my true love gave to me, 

Five Restoration Devices!
Four Parents Listening, 
Three Baby Expos,
Two Info Packs
And a Happy, Healthy INTACT Baby!

On the Sixth Day of Christmas my true love gave to me, 

Six Men Taking Down Morris,
Five Restoration Devices!
Four Parents Listening, 
Three Baby Expos,
Two Info Packs
And a Happy, Healthy INTACT Baby!

On the Seventh Day of Christmas my true love gave to me, 

Seven GA Laws Passed,
Six Men Taking Down Morris,
Five Restoration Devices!
Four Parents Listening,
Three Baby Expos,
Two Info Packs
And a Happy, Healthy INTACT Baby!

On the Eighth Day of Christmas my true love gave to me, 

Eight AAP Changes,
Seven GA Laws Passed,
Six Men Taking Down Morris,
Five Restoration Devices!
Four Parents Listening,
Three Baby Expos, 
Two Info Packs
And a Happy, Healthy INTACT Baby! 

On the Ninth Day of Christmas my true love gave to me, 

Nine Stores to Card,
Eight AAP Changes,
Seven GA Laws Passed,
Six Men Taking Down Morris,
Five Restoration Devices!
Four Parents Listening,
Three Baby Expos,
Two Info Packs
And a Happy, Healthy INTACT Baby!

On the Tenth Day of Christmas my true love gave to me, 

Ten Foreskin-Friendly Docs,
Nine Stores to Card,
Eight AAP Changes,
Seven GA Laws Passed,
Six Men Taking Down Morris,
Five Restoration Devices!
Four Parents Listening,
Three Baby Expos,
Two Info Packs
And a Happy, Healthy INTACT Baby! 

On the Eleventh Day of Christmas my true love gave to me, 

Eleven Demonstrators,
Ten Foreskin-Friendly Docs,
Nine Stores to Card, 
Eight AAP Changes,
Seven GA Laws Passed,
Six Men Taking Down Morris,
Five Restoration Devices!
Four Parents Listening,
Three Baby Expos,
Two Info Packs
And a Happy, Healthy INTACT Baby! 

On the Twelfth Day of Christmas my true love gave to me, 

Twelve Sons Now Saved,
Eleven Demonstrators, 
Ten Foreskin-Friendly Docs,
Nine Stores to Card, 
Eight AAP Changes, 
Seven GA Laws Passed,
Six Men Taking Down Morris,
Five Restoration Devices!
Four Parents Listening,
Three Baby Expos,
Two Info Packs
And a Happy, Healthy INTACT Baby! 

"If boys were meant to have foreskin, we'd be born with it" onesie from Made By Momma

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Happy Holidays!

☃ Saving Our Sons began in 2008, and since that time our work has been led by a handful of volunteers, educators, and professionals striving to empower parents, raise awareness, and make life better for babies and children, and men they become.

While the online Saving Our Sons community has grown to over 90,000, and includes a wide and diverse audience, there is still a very small number handling everything here at 'home base' -- keeping the underlying foundation of SOS a positive, proactive, and pro-intact one.

We operate solely by volunteers and donation, and the past 9+ years are testimony of the baby-saving ripple effect that a small few can have with devotion, action, and a pooling of hearts and resources.

With this in mind, we *love* hearing from families who have found Saving Our Sons over the years and have had their lives touched by SOS in one way or another. It is a blessing to correspond with you, to work together in this global effort, as well as at the grassroots level, and we always look forward to hearing from you. If you are sending greetings at this time of year, we would love to hear from you. ❤

Saving Our Sons 
P.O. Box 1302 
Virginia Beach, VA 23451 

We will write back!

❄ Have a blessed holiday season. ❄ 

You Didn't Fail: Thank you for speaking up

By James Ketter © 2016

To all my intactivist friends who know what it is like to try with all your heart to educate expecting parents, to try and spare a child from genital cutting, only to learn later that his parents had him cut anyway...

I thank you. 

You should never, ever feel like YOU failed or did anything wrong.

Let me tell you, as a victim of genital cutting myself, what you did for that baby boy:

You were the only one who spoke for him at his most vulnerable.

Do you know how incredibly HUGE that is?

Do you know how important that will one day be to him?

What it will mean to him?

Let me answer that.

No one spoke out for me.
No one.
Not one single person in my entire family, group of family friends, or even my community spoke even one single word for my sake when I was vulnerable and needed protection.
Not one damn soul.
Not a syllable of protest.

YOU didn't stay silent.

YOU cared enough to make your feelings and facts known.

You were the person who put the needs of those babies ahead of your own.

You were the only one who truly granted them their humanity.

Do you know what I would give to have just one person in my life to have given me a gift like that? Just one single person in my family, or my community, who wasn't complicit, silent, or uninterested in my fate at as a human being. Do you know what it would mean to me to have just one single person in my life who actually TRIED to save me? It would mean the world.

I actually have tears in my eyes thinking about this. I have no one who even tried to speak for me. To everyone else I was nothing more than disposable property. I would kill to have someone like you in my life. Someone who cared. Even if she didn't succeed in saving me. Just to know one single person cared enough to try might be enough to change things for me immeasurably.

You didn't fail.

You are a HERO.

I love you for speaking out. I thank you from the bottom of my heart for trying so hard. You've given those poor boys a voice when they had none. And that means so much more than you can possibly imagine.

"Any time you speak up for those who cannot speak for themselves, you are heroically impacting lives and changing the world." -Danelle Day

Also by James Ketter:

Foreskin is Better: From a man who has experienced both

I Researched Circumcision! ...Did you REALLY?

Meatal Stenosis: Growing up with circumcision pain

Related Reading:

Why I Speak Up

You Made a Difference for That ONE

Example Letter for a Friend

Carding a Store: Tips for Effective Seed Planting

I tried (MGM Memorial)


Saving Our Sons Community:

Intact: Healthy, Happy, Whole:


Peaceful Intact Education:


My son committed suicide due to circumcision

By Caroline Lowbridge
For BBC News
Read more by Lowbridge

Alex sent his mother an email before committing suicide, to let her know his reasons in detail.

"It quickly became apparent that what had just happened was a catastrophe... I died in 2015, not now."

Lesley Roberts was stunned as she read the devastating final email from her beloved son Alex Hardy.

The email had been timed to arrive on 25 November 2017, 12 hours after he killed himself. Less than an hour before the email arrived, Lesley had opened her front door to find a police officer standing there, explaining her son was dead. Alex was an intelligent and popular 23-year-old with no history of mental illness. Lesley could not understand why he would have wanted to take his own life. His email explained how the foreskin of his penis had been surgically removed two years before. This is commonly known as circumcision, but Alex had come to believe it should be regarded as "male genital mutilation". He never mentioned this to his family or friends when he was alive. Lesley did not even know her son had been circumcised. In the following months, she tried to find out more about circumcision. Why had it affected Alex so badly, and why did he feel killing himself was his only option?

Lesley said her dreams came true when she became a mom to Alex in July 1994.

Alex was the eldest of Lesley's three sons and had been very much longed for, having been conceived after fertility treatment. Lesley says her "dreams came true" when she became a mother in July 1994. "He was everything I could have wished for," she says. "Gorgeous, easygoing, and adoring of his younger brother Thomas who arrived following more treatment almost three years later." He also adored his baby brother James, who was born when Alex was 13.

The walls and windowsills of Lesley's home in Cheshire are covered in photos of all of them. Alex sailed through his education and was particularly gifted at English, so much so that his old school established the Alex Hardy Creative Writing Award in his memory. "Alex was passionate about history but as his English teacher I saw in him a true talent for writing," says Jason Lowe, who is now head teacher at Tarporley High School.

Alex was an intelligent child and breezed through school.

It was while on a school skiing trip to Canada, aged 14, that Alex fell in love with the country. He had enjoyed skiing as a child and the trip reignited his passion. So, when Alex reached 18, he decided to defer university and live in Canada for a year. "He fell in love completely with Canada and made so many friends and got a promotion at work," says Lesley. "After one year he rang me and said 'Mum, I'm deferring my place for university'. The same thing happened after year two." Two years turned into three, then four, and by the time of his death Alex had been living in Canada for five years and had obtained residency. "He was known as the 'super-smart Brit' with impeccable manners," says his mother. "The super-intelligent guy from the UK who helped people with their Canadian residency applications."

Alex was an avid skier and snowboarder, but said he found physical activity painful after being circumcised.

Lesley visited her son several times, both alone and with his brothers and stepfather. They were a close family, but Alex did not tell any of them he was secretly suffering with a problem with his penis. "I had issues with a tight foreskin," he eventually wrote in his final email, "but from my late teens it created issues in the bedroom as it meant my foreskin would not retract over the glans as intended which caused some awkward moments."

In 2015, still silently suffering, Alex consulted a doctor in Canada. He was given steroid cream to stretch his foreskin, but went back to the doctor after just a few weeks because he did not think the treatment was working. The medical name for Alex's problem is phimosis. It simply means his foreskin was too tight to pull back from the head of his penis, or the "glans" as Alex referred to it in his email. This is perfectly normal for boys in the early years of their life. As boys get older, their foreskin usually starts to separate from the head of the penis.

Lesley says that Alex was "intuitive, empathetic, gentle, kind, witty, quirky, unassuming, and caring."

Phimosis does not always cause problems, but if it does, problems can include difficulty urinating and pain during sex. In England, the NHS advises topical steroids and stretching techniques - and circumcision as a last resort. Over in Canada, where circumcision is more common, Alex was referred to a urologist. "He immediately suggested circumcision," Alex wrote. "I asked about stretching and he completely lied to my face and said it would not work for me. "I was mostly trusting as I felt he was the expert who knew best in this regard so with a pinch of salt I accepted it."

Lesley has since read online reviews of this urologist which have made her question his competence. One patient said she had been unable to work since having surgery for kidney problems, and he had "destroyed" her quality of life. "I'm a mother of three young children who are scared every day I will die as they see me suffering in so much pain," she wrote. "I can see how he misdiagnosed others, botched surgeries, and ruined lives," said another review. "He's dangerously incompetent." Another review of Alex's urologist read: "They left a surgical instrument in my bladder but I only got notified three months later. Run away before you get hurt!"

Lesley says she misses Alex's "big sparkly eyes, his grin, his sense of humor, and his bear hugs."

Lesley, who was "horrified" by these reviews, has asked for the urologist to be investigated. She has been told an inquiry is ongoing. The College of Physicians and Surgeons of British Columbia told the BBC it "cannot disclose the existence of a complaint against a physician, and only may do so if the complaint leads to formal discipline". "I will wish with my last breath and with all of heart that my darling son had run away," says Lesley.

Much to his regret, Alex was not able to research the urologist - or circumcision - properly at the time because his laptop was broken. He had tried researching the topic in a public computer space but felt uncomfortable, and also felt it was "too much of a taboo" to discuss with friends. So Alex booked what he believed was a minor procedure and had the surgery in 2015, at the age of 21.

Alex adored his little brother.

In the email to his mother, Alex explained, in great detail, the physical problems he had suffered afterwards. He described experiencing constant stimulation from the head of his penis, which was no longer protected by his foreskin. "These ever-present stimulated sensations from clothing friction are torture within themselves; they have not subsided/normalized from years of exposure," he wrote. "Imagine what would happen to an eyeball if the eyelid was amputated?" "He was in so much pain that it hurt to do normal physical activity," says Lesley. "He was a keen skier and snowboarder so you can imagine the pain he was in."

What is lost to male circumcision.
Informational cards for distribution at Etsy.

Consultant urological surgeon Trevor Dorkin, who is a member of the British Association of Urological Surgeons, advises his patients that the head of their penis will be more sensitive after circumcision. However, this sensitivity usually reduces. "I always say to guys 'it's going to feel more sensitive to start with' because all of a sudden you haven't got this protection over the head of the penis and it will feel different," says Mr Dorkin, who has carried out more than 1,000 circumcisions. "But in the vast majority of the cases the man adjusts to that, the brain adjusts to that, it adjusts to the signals that are coming back through the nerves from the head of the penis."

Alex also wrote about experiencing erectile dysfunction, and burning and itching sensations, particularly from a scar which sat where his frenulum was removed. The frenulum is a band of tissue where the foreskin attaches to the under surface of the penis. Some men refer to it as their "banjo string". "It's one of the more erogenous zones so it's thought to be important in sexual function," says Mr Dorkin. "The foreskin, the head of the penis and the frenulum is a very, very sensitive area. "But again when you do circumcision sometimes the frenulum is not preserved and it doesn't necessarily have an effect on overall sexual function and enjoyment."

Men take part in the Silent Survivors Stand during Genital Integrity Awareness Week in Washington D.C.

But Alex felt his frenulum had been important. "Through its absence I can certainly verify it is the most erogenously sensitive area of the penis and male body overall," he wrote. "If someone were to amputate your clitoris you may begin to be able to understand how this feels." He wrote about experiencing cramps and contractions in his muscles and "uncomfortable" sensations which extended deep into his abdomen. Lesley does not know whether or not Alex had sex after his circumcision. "Where I once had a sexual organ I have now been left with a numb, botched stick," he wrote. "My sexuality has been left in tatters." He asked: "Nature knows best - how can chopping off a section of healthy tissue improve nature's evolved design?"

Lesley did not know her son had been circumcised until after he died.

Like many people, Lesley admits she knew very little about the foreskin or circumcision before her son died. "I didn't know anything apart from I believed it was a very routine surgery," she says. The foreskin is sometimes dismissed as a "useless flap of skin", but Mr Dorkin says it does have a purpose. "It covers the head of the penis," he says. "In terms of what's it for, it provides a bit of protection to the head of the penis. It's thought to have some sort of immunological function perhaps." Circumcision rates vary a lot depending on where you are in the world and which culture you grew up in. According to the World Health Organization, 95% of men are circumcised in Nigeria but only 8.5% of men in the UK are.

Who in the world is circumcised? Figures from the World Health Organization.
Learn more at Medical Professionals for Genital Autonomy.

Most of the men circumcised in the UK are either Muslim or Jewish, as circumcision is regarded as an important part of their religions. According to the 2011 census, Muslims accounted for 4.8% of the population in England and Wales, while 0.5% were Jewish. People who question circumcision are sometimes accused of being anti-Semitic or Islamophobic, but Lesley stresses her son was neither. "For me, this has nothing to do with religion at all. I respect all people of faith or indeed no faith, as Alex did," she says. In Canada, where Alex had moved to, an estimated 32% of men are circumcised. Alex felt male circumcision has been normalized to the extent that most people do not question it, while female circumcision has become known as female genital mutilation (FGM) and is now illegal in many countries.

The most common forms of male and female genital cutting.

He felt male circumcision should be known as "male genital mutilation" - a view shared by a growing anti-circumcision movement. "If I were a female (in Western nations) this would have been illegal, the surgeon would be a criminal and this would never have been considered as an option by doctors," Alex wrote. "I do not believe in championing one gender over another but I feel strongly that gender equality should be achieved for all." Campaigners for "genital autonomy" believe it is wrong to circumcise a baby or child - whether they are male or female - because the patient cannot give consent, and these campaigners regard circumcision as a human rights issue.

Alex was the oldest of Lesley's three sons.

Having lived with an intact penis for 21 years, Alex believed men circumcised as babies or young children would "tragically never be able to fully comprehend what has been taken away". He estimated he had been stripped of 75% of the sensitivity of his penis. However, experiences of men circumcised as adults differ dramatically. Some report a significant loss in sensitivity and greatly reduced sexual pleasure. Some report being less sensitive but say there is no change in their overall enjoyment of sex. Some are happy with their decision to get circumcised. Some, like Alex, deeply regret having it done.

Alex celebrated his 21st birthday whale watching with his mom.

Alex sought further medical help following the circumcision as well as psychological help, but never shared his problems with his family or friends. "I was with him during those two years and I think I would be lying if I said I didn't think something wasn't right," says Lesley. "I did say 'Is something bothering you? Are you OK?' and he would absolutely reassure me that he was." Lesley, who used to be a teacher, now hopes to go into schools and speak to young men about sharing their problems, even if they are very personal. "I think we all know that men don't particularly tend to talk about their problems in the same way that girls do but I think circumcision is very much a taboo subject," she says. "Alex was reserved. He certainly wouldn't have said 'I've got a tight foreskin and it really hurts'. And he didn't. And I didn't know." Only a week after Alex died, a friend opened up to Lesley about his own circumcision. "He told me he wouldn't normally have mentioned it but he had a circumcision as an older man, 10 years ago, and he was in constant daily pain," says Lesley. "It just seems it's more common than you think."

Dr. Trevor Dorkin, urologist and member of the British Association of Urological Surgeons, warns his patients of the risks before he will perform circumcision surgery.

Mr Dorkin says serious problems following a circumcision are rare, but not unheard of. "You do hear of horror stories where a circumcision has been done poorly and there's damage done to the head of the penis itself," he says. Sometimes too much skin is taken and this can result in what's known as "burying" or shortening of the penis, where it gets pulled back into the body. "Surgeons at the end of the day are human and there is potential for human error and technical error during any operation," he says. "One of my mentors told me every case is a tricky case, that's got to be your approach to surgery. You never take anything for granted in surgery."

Circumcision always has risk, but it is especially great when performed upon an infant. Adult circumcision has real and lasting consequences, but when done to a fully informed (which Alex was not) consenting adult, it is not as life-threatening as infant circumcision.

There have been cases of children and men dying after being circumcised. Four-week-old Goodluck Caubergs bled to death after a nurse circumcised him at his home in Manchester, while one-month-old Angelo Ofori-Mintah bled to death after being circumcised. Since 1995 at least 1,100 boys have died in South Africa after ritual circumcisions. Some penises fall off after becoming infected and rotten, while some have to be amputated. In Canada, where Alex was living, newborn baby Ryan Heydari bled to death after being circumcised by a doctor in Ontario. Recently there have been reports of two babies dying within weeks of each other after home circumcisions in Italy, and a two-year-old boy died after being circumcised at a migrant centre in Italy.

Complications of infant circumcision, via Stanford University School of Medicine.
See Also: Death from Circumcision

"I'm not qualified to say that circumcision is always bad, because it isn't," says Lesley. "It certainly was in my son's case and I think we need more research. We need to look into the risks, what can really go wrong, and we need to be more aware of them." If circumcision is necessary, Mr Dorkin says it is important to tell patients about potential complications. "Particularly when you are doing the operation in a guy who is in his late teenage years or early adulthood, it's a very sensitive area and sexual function is important, so you have to explain the risks to them," he says.

As a child, Lesley says Alex was "gorgeous, easy going, and adoring of his younger brother, Thomas."

"Alex said he was not made aware of all the risks," says Lesley. "If he had, I feel sure he would not have had the surgery. "Alex wasn't alone. I now know he wasn't the only one that this has happened to. And that can't be right." The UK charity 15 Square, which tries to educate people about circumcision, says Alex is not the only man to have killed himself after being circumcised. "It happens more frequently than people realise," says chairman David Smith. There are no statistics on men who have killed themselves after being circumcised.

Alex died over a year ago but his story has not been told until now. An inquest into his death was held in the UK but it was not reported by the media. Lesley, who is normally private and reserved like her son, only agreed to share Alex's story because it was his dying wish. "If the following information can benefit anybody then it has served its purpose," he wrote. "I did not feel comfortable raising the issue when I had a choice, so if my story can raise awareness to break this taboo within society regarding men's health then I am happy for release of my words. "Alex said in his letter 'We stand on the shoulders of those who came before us'," says Lesley. "This is the last thing I'm doing for my precious son."

Alex asked his mother to share his story after he left this earth.


If you were cut against your wishes at birth, or misled to believe the amputation of your prepuce would benefit you as an adult, there is hope through restoration, and support in many men's groups today. MenMatterToo.org/men

Related Resources:


Saving Our Sons Community 




The Intact Network

Restoration resources and reasons circumcised men are restoring today.
Informational cards for distribution at Etsy.
What was so difficult in keeping my son intact was not that my son would feel different in a locker room, but that I would feel different from him. I would then have to accept that I'm an amputee from the wars of a past generation. - father in "Circumcision: The Hidden Trauma"

Please Help With Domain Transfers

2021 UPDATE: All domains acquired 3 years ago are in need of renewal. We operate solely on a volunteer and donation basis, and need to cover these domains for the next time frame. Please help with your gift below so that each one continues to redirect to a pro-intact site for the next 3 years. THANK YOU for being a part of this important work!

We have the amazing opportunity to purchase a number* of popular domains that previously led to pro-cutting information, and ensure that in the future they lead to pro-intact information. In order to make this happen, we need to raise $70 per domain to keep these sites intact and not have them bought out for further infant cutting propaganda.

If you are able to help with this endeavor in any way, big or small, please give via PayPal Friends/Family to TheIntactNetwork@gmail.com or at the button below. Even a $2 donation is useful, and will pool with others for the acquisition of a domain. We'll share the domains with donors as they are able to be acquired and re-directed to pro-intact info. If you'd like to select one from the top of the list (most urgent) email SavingSons@gmail.com or message the SOS or TIN Facebook pages.


To give via Zelle: SavingSons@gmail.com 

*Domains will be purchased for redirection to pro-intact sites in an order of priority. We will not be attempting to purchase sites that are being sold for over $70 per 36 months, because this is outside the range of our fundraising limitations. We will be focused on the current top 25 that otherwise point to pro-cutting materials online. We will add to this list as others come available, or as we are able to raise funding to do so. There are currently a total 45 'in queue' (potential domains that match this description). We will need to repeat fundraising efforts to maintain these domains and their intact re-directs every 3 years.

Those who have given toward this need (2020-2021):
(to include your business link/name, add a note with your donation or drop an email to SavingSons@gmail.com)

Kirk C. ~ 7 full domains

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Those who gave toward this effort (2017-2018):

★ Marc R.  ~ 1 full domain

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Intact Australia

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If you believe what nature creates is natural and normal, keep him intact.
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A Father's Regret

By Ryan B.

I am full of regret.

I am a father, and I allowed my son to go through the same trauma I experienced.

I had a natural and loving hesitation -- I asked the doctor, "Does it have to be done?"

His answer should have been, "NO!"

Instead it was an explanation of how it was "simple, painless, and healthy."

I consented, and I saw the raw, bleeding, open wound on my son.

He had adhesions for many years that would tear, bleed, and become infected. He almost constantly had pain, discomfort, and infections...

Please, research the benefits of keeping your children intact and don't risk walking down this road we were forced to travel.




Further stories from parents who are Keeping Future Sons Intact:

How to put a condom on an intact penis

Most of the world's sexually active men are happily intact for a lifetime. And because the majority of today's parents in the United States are also keeping their sons intact, future generations of men in the U.S. will come into maturity with all they were meant to have as well -- making the following useful information to know.

How to put a condom on an intact penis:

Catheterization Without Retraction

By Adrienne Carmack, M.D. board-certified urologist, in practice in Texas, and author of The Good Mommy's Guide to Her Little Boy's Penis and Marilyn Fayre Milos, R.N. Executive Director of Genital Autonomy America, California.

Catheterization Without Retraction
Canadian Family Physician. 2017 Mar; 63(3): 218–220.

Over the past century, numerous boys born in Canada and the United States have been circumcised. (1) However, this trend is changing, with neonatal circumcision being performed less commonly than in years past. (2,3) Because of these historical practices, many physicians and nurses have limited experience treating patients with intact foreskins and engage in ill-advised procedures such as premature foreskin retraction for purposes of “hygiene” or catheterization. Premature retraction of the foreskin can lead to tearing of healthy tissue, which is painful and increases the risk of preputial scarring and infection. (4–6) We describe a method for catheterization in which premature retraction of the foreskin is not necessary.


The foreskin should first be gently manipulated to determine if the meatus can be easily visualized. Pressure used for this should be gentle to avoid tearing of tissues, similar to the amount of pressure that would be used when spreading the labia to visualize the meatus of a girl. If the natural attachments of the foreskin to the glans (head of the penis) remain, the foreskin should not be forced back to expose the meatus.

If the foreskin can be gently moved such that the glans and meatus can be seen, catheterization can be performed under direct vision using a sterile technique. The foreskin should never be retracted past the point where it has already naturally separated. (7)

If the meatus cannot be seen, the genitals can be prepared and draped in a sterile manner without retraction. The catheter can then be lubricated and gently inserted through the foreskin opening and guided into the meatus, much like an intravenous catheter is guided into a vein by feel. Gentle pressure with the thumb along the dorsal aspect and the fingers along the ventral surface of the penis can keep the catheter from slipping between the glans and inner lining of the foreskin into the preputial space (Figure 1).

When catheterization is being performed for the purpose of collecting a urine specimen, the foreskin should also not be forcibly retracted. In both boys with an intact prepuce and girls, the initial urine obtained during catheterization should be discarded, as this will contain preputial and periurethral flora. The latter urine should be saved for culture. (8)


An understanding of the normal anatomy and development of the foreskin illustrates why the technique of catheterization without retraction is an important skill for health care practitioners. Physiologic phimosis is the normal state of young boys. (9) This finding is characterized by a closed preputial outlet with the inner mucosa of the foreskin beginning to evert through the preputial opening, which is healthy with no scarring. The glans cannot be seen without retraction. This is in contrast to pathologic phimosis, in which the glans and meatus can often be seen, as the scarred ring of the preputial orifice is held open and no mucosa is visible at the preputial outlet. (10)

In a Danish study, 8% of healthy boys aged 6 to 7 still had complete physiologic phimosis preventing visualization of the meatus, and only 23% of boys this age had fully retractable foreskins. (11) In a Japanese study, 84.3% of boys aged 6 months to 1 year had a tight ring preventing any retraction, and this decreased gradually with time to 40% at ages 1 to 2 years, 28% at ages 3 to 4 years, 20% at ages 5 to 7 years, 16% at ages 8 to 10 years, and 8.6% at ages 11 to 15 years. (12)

The term phimosis is Greek and means “a muzzling.” Physiologic phimosis simply means the foreskin cannot be retracted and the glans is “muzzled.” Ballooning during urination is a common finding and part of the normal developmental process of foreskin separation. (10) It occurs because the opening of the immature foreskin is not yet lax enough to accommodate a full urine stream or passage of the glans through it. The foreskin and glans separate naturally as the child develops, has erections, and manipulates his foreskin. When a young boy manipulates his foreskin naturally, he tends to pull his foreskin away from his body, not toward it, as is done with retraction. As he gets older and more curious, he begins to pull his foreskin toward his body as well. (10) In most boys, physiologic phimosis resolves naturally by the end of puberty. (11)

The foreskin and glans are connected by the balanopreputial lamina, a membrane similar to the synechial membrane that connects the nail bed and the fingernail. The balanopreputial lamina is sometimes called the synechia. This membrane and the small preputial opening prevent retraction in boys with normal physiologic phimosis. The attachment might be forcefully disrupted, just as the fingernail can be torn from the nail bed, but this causes pain, is unnecessary, and can lead to infection, scarring, adhesion formation, or iatrogenic phimosis. There is no functional need for the glans to be exposed, and there is a protective effect of having the foreskin attached to and covering the glans.

Because the foreskin protects the glans penis and urethral meatus, premature exposure of the glans, as occurs after circumcision, commonly leads to meatal stenosis, in which a substantial part of the circulatory system in the glans penis is damaged (the frenular artery), and the glans tissue is exposed, denuded, and inflamed, which can lead to ulceration and subsequent scarring of the urethral opening. This inflammation and ulceration are caused by disruption of the normal attachment between the glans and foreskin, the absence of the protective foreskin, interruption in the normal circulatory system, or blisters from ammonia burns. (13–15) The blisters and ulceration at the opening of the urethra are caused by contact of urine-soaked diapers with the urethral meatus, which is no longer protected by the foreskin.

Retracting the foreskin of a prepubescent boy with physiologic phimosis, although still a common recommendation by many health care practitioners, has been shown to increase problems such as scarring and infection. These might result in iatrogenic pathologic phimosis and lead to a higher likelihood of circumcision being performed at a later date. (16)  If the prepuce is unable to retract, there is nothing to clean under. The foreskin should not be retracted for cleaning until the foreskin has naturally separated and the child can do this himself. In fact, the owner of the foreskin should be the first person to retract his foreskin. Forceful retraction causes microtears that can lead to pathologic phimosis. (10)

An additional danger of premature retraction is paraphimosis, a condition in which the retracted foreskin becomes stuck behind the glans penis, cutting off circulation and leading to ischemia and possibly penile gangrene if not treated promptly. Retracting the foreskin and cleansing with soap, commonly believed to be important for proper hygiene, not only exposes the child to the risks of premature foreskin retraction, but also to the risks of infection such as balanitis, which has been shown to be associated with the use of soap on the delicate mucosal tissues of the male genitalia. (17) Soap dries out mucosal tissue and should never be used on the glans or inner foreskin. The foreskin should be left alone until it demonstrates the ability to retract. (10) Once this is possible, foreskin care is simple: retract (gently and only to the extent possible), rinse, replace. Warm water and fingertips adequately clean the tissue.

Besides false beliefs about hygiene, one of the main reasons boys are subject to premature foreskin retraction is that many health care professionals believe that the foreskin must be retracted to obtain a clean specimen for urine culture. Fortunately, this is not the case. With proper technique, as described above, urine specimens can be obtained from boys with intact foreskins without exposing these patients to the risks of premature foreskin retraction. Although the focus of this article is on a technique for catheterization, it must be remembered that catheterization is an intervention that carries risks. The risks of catheterization include discomfort and introduction of bacteria into the urinary tract, which could lead to infection. Indications for catheterization include the need to monitor urine output for medical management, emptying the bladder in patients who are unable to do so, introducing contrast material for imaging procedures such as a voiding cystourethrogram, and obtaining a urine specimen for analysis in patients who are unable to provide one.

If a patient can reliably void into a collection container, catheterization for monitoring urine output can be avoided. Patients who cannot empty their bladders have the options of clean intermittent catheterization, indwelling urethral catheterization, and suprapubic catheter placement. Other options for collection of a urine specimen for analysis and culture include a midstream voided sample and suprapubic aspiration, and these should be considered when determining the optimal approach for specimen collection.8 Suprapubic aspiration is significantly more painful than urethral catheterization in premature male infants (P < .001). (18) Contamination is possible with catheterized samples as it is with voided samples.19 This suggests that catheterization for urine specimen culture should be reserved for those patients who are unable to provide a voided specimen into a clean container, and suprapubic catheterization should only be used if previous efforts to obtain a specimen have resulted in contamination.


In boys with intact prepuces and physiologic phimosis, catheterization without retraction minimizes potential long-term problems and is an effective technique. Understanding how to catheterize without direct vision of the meatus and discarding the initial urine if culture is desired allow this procedure to be performed with high validity and minimal risk of iatrogenic problems for the child.


1. Weiss H, Polonsky J, Bailey R, Hankins C, Halperin D, Schmid G. Male circumcision. Global trends and determinants of prevalence, safety and acceptability. Geneva, Switz: World Health Organization, Joint United Nations Programme on HIV/AIDS; 2007.

2. Maeda JL, Chari R, Elixhauser A. Circumcisions performed in U.S. community hospitals, 2009. Rockville, MD: Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality; 2012. Available from: www.hcup-us.ahrq.gov/reports/statbriefs/sb126.jsp. Accessed 2015 Jun 15.

3. Fetus and Newborn Committee, Canadian Paediatric Society Neonatal circumcision revisited. CMAJ. 1996;154(6):769–80. [PMC free article] [PubMed]

4. Kaplan GW, McAleer . Structural abnormalities of the genitourinary tract. In: Mac-Donald MG, Mullett MD, Seshia MMK, editors. Avery’s neonatology. Pathophysiology and management of the newborn. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005. p. 1088.

5. Roberton NRC. Care of the normal term newborn baby. In: Rennie JM, Roberton NRC, editors. Textbook of neonatology. 3rd ed. Edinburgh, UK: Churchill Livingstone; 1999. pp. 378–9.

6. American Academy of Pediatrics . Newborns: care of the uncircumcised penis. Guidelines for parents [pamphlet] Elk Grove Village, IL: American Academy of Pediatrics; 1984.

7. Lacroix LE, Vunda A, Bajwa NM, Galetto-Lacour A, Gervaix A. Catheterization of the urethra in male children [video] N Engl J Med. 2010;363(14):e19. [PubMed]

8. Schaeffer AJ, Schaeffer EM. Infections of the urinary tract. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walshurology. 9th ed. Philadelphia, PA: Saunders-Elsevier; 2007. pp. 238–9.

9. Smeulders N, Wilcox DT. Urology. Disorders of the kidney and urinary tract. In: Rennie J, editor. Rennie & Roberton’s textbook of neonatology. 5th ed. London, UK: Churchill Livingstone–Elsevier; 2012. p. 949.

10. McGregor TB, Pike JG, Leonard MP. Pathologic and physiologic phimosis. Approach to the phimotic foreskin. Can Fam Physician. 2007;53:445–8. [PMC free article] [PubMed]

11. Oster J. Further fate of the foreskin. Incidence of preputial adhesions, phimosis, and smegma among Danish schoolboys. Arch Dis Child. 1968;43(228):200–3. [PMC free article] [PubMed]

12. Kayaba H, Tamura H, Kitajima S, Fujiwara Y, Kato T, Kato T. Analysis of shape and retractability of the prepuce in 603 Japanese boys. J Urol. 1996;156(5):1813–5. [PubMed]

13. Canning DA, Nguyen MT. Evaluation of the pediatric urology patient. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia, PA: Saunders-Elsevier; 2007. p. 3215.

14. Elder JS. Abnormalities of the genitalia in boys and their surgical management. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia, PA: Saunders-Elsevier; 2007. p. 3749.

15. McGrath K. The frenular delta. A new preputial structure. In: Denniston GC, Hodges FM, Milos MF, editors. Understanding circumcision. A multi-disciplinary approach to a multidimensional problem. New York, NY: Springer; 2001. pp. 199–206.

16. Metcalfe PD, Elyas R. Foreskin management. Survey of Canadian pediatric urologists. Can Fam Physician. 2010;56:e290–5. Available from: www.cfp.ca/content/56/8/e290.full.pdf+html. Accessed 2017 Feb 2. [PMC free article] [PubMed]

17. Birley HD, Walker MM, Luzzi GA, Bell R, Taylor-Robinson D, Byrne M, et al. Clinical features and management of recurrent balanitis; association with atopy and genital washing. Genitourin Med. 1993;69(5):400–3. [PMC free article] [PubMed]

18. Badiee Z, Sadeghnia A, Zarean N. Suprapubic bladder aspiration or urethral catheterization: which is more painful in uncircumcised male newborns? Int J Prev Med. 2014;5(9):1125–30. [PMC free article] [PubMed]

19. Lau AY, Wong SN, Yip KT, Fong KW, Li SP, Que TL. A comparative study on bacterial cultures of urine samples obtained by clean-void technique versus urethral catheterization. Acta Paediatr. 2007;96(3):432–6. [PubMed]

Related Reading

Urine Samples and Catheter Insertion for Intact Boys: http://www.drmomma.org/2011/12/urine-samples-and-catheter-insertion.html

Using a Catheter Without Retraction: My Nurse Did It, and So Can Yours! http://www.savingsons.org/2013/01/using-catheter-without-retraction-my.html

How the Foreskin Protects Against UTIs: http://www.drmomma.org/2009/12/how-foreskin-protects-against-uti.html

UTI and Circumcision Resources: http://www.savingsons.org/2014/11/uti-resource-page.html

Circumstraint Patent and Origin

By Brian Brown © 2016

Is the Olympic Circumstraint a medieval torture device or piece of modern medical equipment? It is difficult to tell, but one thing is for certain: the grave horrors this board has witnessed pale most other traumas that are needlessly inflicted upon the bodies of newborn babies in North America.

Pictured above is the original blueprint of the circumstraint - a retraining board used most often for forced genital cutting of infants. Although the design has changed since its inception in 1953, the intent has not - it is an effective way to immobilize a small infant. 

The patents reads (in part): 
An infant immobilizing device particularly suited to the performance of circumcision and other operations upon small infants for which general anesthesia is not necessary or advisable.  
...substantially complete immobility is achieved.  
[The size is ideal.] This is true since operations of this type are usually performed in the first two weeks of life but not until the infants weight has increased to about seven pounds. It is found, therefore, that a retaining depression 10b cupped approximately to fit an average eight-pound infant will do well for the majority of cases. 
While fairly close conformity of the depression walls to the body contour is desirable to minimize freedom of movement of the child, nevertheless a small amount of clearance from the infants body along the depression walls is not objectionable in that regard and is actually preferred to an excessively tight fit creating discomfiture for lack of air circulation around the skin. The walls of the depression should extend well up around the sides of the body members to furnish lateral restraint against physical movement, but should otherwise leave the body exposed as much as possible for access by the surgeon.

Interestingly, the patent makes no mention of the sex of the child that this device is appropriate for. In post-war America, it was perfectly legal to immobilize any infant for the purpose of cutting their genitals – male, female, or intersex. Females finally gained legal protection in 1997 from this medieval practice in the United States. Isn’t it time we extend the basic right of genital autonomy to all? 

Related reading: 

Author and genital cutting survivor, Patricia Robinett, speaks about her own forced circumcision: youtube.com/watch?v=50BaM7H2GLI 

An anonymous nurse describes the horror of genital cutting upon the circumstraint: SavingSons.org/2012/06/if-this-stained-circumstraint-could.html

FGM Bill of the United States: DrMomma.org/2016/03/female-genital-mutilation-fgm-bill-of.html

Olympic Circumstraint patent: google.com/patents/US2751268

Also by Brown: 

Circumstraint Product Description

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