An Open Letter to Professor Robert W. Block, MD, FAAP, 2011-2012 President of the American Academy of Pediatrics
Dear Professor Block,
I understand that you may be considering making recommendations that may be harmful to baby boys, because of studies that found that cutting off men's foreskins can reduce the heterosexual transmission of AIDS in sub-Saharan Africa.
I first became aware of the suggestion that cutting off men's foreskins might reduce the heterosexual transmission of AIDS in sub-Saharan Africa in an article, "The African AIDS Epidemic," by John C. Caldwell and Pat Caldwell, in the March 1996 Scientific American, pages 62 - 68, or pages 40 - 46 in the UK edition. This article reported that there is a strong correlation between the heterosexual transmission of AIDS, and having sex while afflicted with chancroid, which is a sexually transmitted disease characterized by large soft sores on the genitals. Chancroid disappeared in North America and Western Europe around the beginning of the twentieth century, due to improvements in hygiene, and can be controlled by washing the genitals with soap and water following exposure.
The article also reported that in poor areas where maintaining personal cleanliness was difficult, men whose foreskins had been cut off were less likely to be infected with AIDS, and subsequent randomized trials found that in areas with high levels of AIDS and chancroid, men whose foreskins had been cut off were roughly half as likely to become infected by HIV through sex with women as men with foreskins. But since cutting off a man's foreskin removes about half the skin of the penis, this shows that in areas with high levels of chancroid, all parts of the skin of the penis are equally likely to be afflicted by chancroid sores, through which the AIDS virus can pass.
Thus efforts to stop the spread of AIDS in sub-Saharan Africa should focus on the eradication of chancroid, by publicizing the dangers of having sex while afflicted with chancroid, and the importance of washing the genitals with soap and water after exposure to chancroid, and determined efforts should be made to provide adequate clean running water to all communities where this is currently lacking. The provision of clean running water is a fundamental requirement for improving people's lives, and will have numerous benefits beyond stopping the spread of AIDS.
Furthermore, since chancroid disappeared in North America and Western Europe more than a century ago, and heterosexual transmission of AIDS is rare in North America and Western Europe, the studies in areas with high levels of chancroid infection have no relevance to North America and Western Europe.
When I was about four years old, I liked to walk along the road with my hand down the front of my trousers, feeling my foreskin, because it felt nice. This was a delicious, soft, blissful feeling. Then my mother had my foreskin cut off, to stop me from feeling it.
When I was about six years old, my parents complained that I was standing in an unnatural posture, with my bottom stuck out. With the benefit of hindsight, I now believe that I was standing like that, in a subconscious attempt to reduce pain from the exposed glans of my penis snagging and scraping on my underwear.
I first became consciously aware of pain from the exposed glans of my penis snagging or scraping on my clothing when I was about ten years old, and running in a race at primary school. I was winning the race, when I was suddenly hit by a searing stab of pain as my urinary meatus snagged against my running shorts. I dropped back and lost the race.
From around that time onwards, up until I began foreskin restoration by the skin stretching method in 1995, I was troubled by severe discomfort or pain when the exposed glans of my penis scraped or rubbed against my underwear, a horrible nerve-jarring sensation. And I would be hit by a searing stab of pain if my urinary meatus snagged against my underwear. This once nearly killed me in the early nineties when it happened while I was riding my motorbike, nearly causing me to lose control of the bike.
To try to avoid these problems, I tried to prevent my penis moving around in my underwear, by pulling it downwards and folding it under my scrotum, then pulling my underpants up tightly to try to keep it in this position. This caused little bother while I was working at a desk, and was able to go to the toilet if need be to put my penis back in position if it became dislodged.
However in 1990 I began working in a factory, and the job required me to be in constant physical motion, in order to dislodge window parts when they became stuck while moving round a large machine that processed them. I was constantly on edge for fear that my penis would become dislodged from its safe position, causing severe and uncontrollable pain, because I could not go to the toilet to put it back in position until my next break.
The fact that my foreskin had been cut off also caused other problems, in particular the region around the scar was unbearable to touch, and the skin on the distal part of the shaft of my penis became taut and shiny when I had an erection, which made it physically unpleasant to have an erection.
I therefore decided to seek a surgical foreskin restoration, and after making enquiries, I was contacted by a surgeon who had carried out two surgical foreskin restorations. The proposed operation involved removing a lot of skin from my scrotum. One time when I had pulled my underpants up too tight in the factory, it had caused extreme pain in my testicles after a while, and I realized that the operation could cause me to have this pain in my testicles all the time, so I decided not to have the operation.
Around 1993 I learned from a magazine of the existence of organizations NOCIRC and UNCIRC in America, and after finding the phone number of one of them I spoke to Dr Jim Bigelow, a psychologist who pioneered the skin stretching method of foreskin restoration in America. He told me that the skin stretching method of foreskin restoration was available in England from Dr John Warren, and gave me Dr Warren's contact details, but I did not contact Dr Warren at that time, because I did not know what the skin stretching method involved, and I was sceptical about it.
Around March 1995 I was experiencing very severe pain from the exposed glans of my penis snagging and scraping on my clothing, due to squatting down continually to sandpaper window parts in a factory, which made it impossible to keep my penis in a fixed position. In desperation I phoned Dr Warren, who explained that the principle of the skin stretching method is that if tension is applied to skin over a long period of time, new skin cells gradually grow to relieve the tension.
Dr Warren told me to pull skin from the shaft of my penis up over the glans and tape it there with surgical tape, which can be bought at drug stores, so as to create a surrogate foreskin. This immediately brought relief from the pain, and I used this method to get through the day without pain, for the next eight years. After about six years it became necessary also to put a tab of surgical tape directly on my glans across my urinary meatus, to stop my urinary meatus from being dragged open by the shaft skin dragging backwards, which would cause severe pain after a while if not corrected.
Not long after I spoke to him, Dr Warren formed NORM-UK, a self-help group for men restoring their foreskins by the skin stretching method, named after similar organizations in America. NORM stands for National Organization of Restoring Men. NORM-UK is now a registered charity, with a large website and a full-time professional manager.
Around 2000 I attended a NORM-UK foreskin restoration seminar, where Dr Peter Ball described a number of restoration devices, including the Tug Ahoy tapeless restoration device, manufactured by Dr Jim Haughey in America. In 2003 I purchased a Tug Ahoy and used it for a year, making rapid progress with foreskin restoration. In 2005, on the recommendation of Dr Ball, I purchased a TLC Tugger tapeless restoration device, and used it for two years. The result is that I now have a completely restored foreskin, and life is incomparably better than it was before I started restoration in 1995.
But I have never recovered the delicious, soft, blissful feeling, that I remember from before my proper foreskin was cut off.
The legal consequences
I would draw your attention to the fact that if you make any recommendations that result in an increase in the number of baby boys who are sexually molested and mutilated by someone cutting off their foreskin, you might become criminally liable under Section 373 of Title 18 of the United States Code, 18USC373, for incitement to commit a crime of violence.
You might also become liable for civil damages, whose combined value could exceed the total wealth of the United States of America.
Mr Chris Austin.
33 Collins Terrace, Maryport, Cumbria, CA15 8DL, England.