(Genaro Castro-Vázquez (Auth.) ) Male Circumcision

Male Circumcision in Japan
Male Circumcision in Japan
Genaro Castro-Vzquez
MALE CIRCUMCISION IN JAPAN
Copyright Genaro Castro-Vzquez, 2015.
Softcover reprint of the hardcover 1st edition 2015 978-1-137-51875-0
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ISBN 978-1-349-56555-9 ISBN 978-1-137-51876-7 (eBook)
DOI 10.1057/9781137518767
Library of Congress Cataloging-in-Publication Data
Castro-Vzquez, Genaro, 1966

Male circumcision in japan / Genaro Castro-Vzquez.
p. cm.
Includes bibliographical references and index.
1. CircumcisionJapan. I. Title.
GN484.C38 2015
392.10952dc23 2015012228
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Contents
Acknowledgments vii
Introduction 1
1 Researching Circumcision 17
2 A Cosmetic Surgery 43
3 Mens Views 65
4 Womens Views 95
5 Urologists and Cosmetic Surgeons 121
6 Mothers Views 149
Conclusion 173
Notes 183
References 185
Index 199
Acknowledgments
I owe debts of gratitude to a number of people who provided help

and support during the writing of this book. Thanks to Midori Iijima,
a friend and professor at Rikkyo University who has always been a
source of inspiration and positive energy. My deepest gratitude to
Dr. Shinya Iwamuro, Dr. Eiji Ishikawa, Professor Takashi Kazama,
Dr. Akitomo Shingae, Professor Kentaro Azuma, Mrs. Yuka Bessho,
and Mr. Takahiro Watanabe for their support in finding and introduc-
ing participants for the research this book reports. Thanks also to Pro-
fessor Joy Hendry and the Editorial Board of the Japan Anthropology
Workshop Series for their critical and constructive feedback, which
helped improve the proposal underpinning this book. Many thanks
to Dr. Chee Han Lim who read and edited some of the papers this
research is based on. I am also grateful to Dr. Sally McLaren who read
and edited the entire manuscript. Thanks to all the participants in the
study for sharing part of their lives with me. Finally, my thanks as ever
to my family and friendsin particular to Toshi Takanewho have all
provided warmth and encouragement that help me keep going.
Part of the ethnographic data included in this book has been pub-
lished previously in some papers, which have been totally rewritten
and updated. Some of the data included in Chapter 2 was originally
published in Sociology 47 (4); data presented in Chapter 3 draws on
some of the material contained in Culture, Health & Sexuality 15 (1),
some of the data in Chapter 4 initially appeared in International Jour-
nal of Sexual Health 25 (3), some of the data included in Chapter 5
were included in Critical Public Health 23 (4), finally, some of the data
included in Chapter 6 were originally published in Anthropology &
Medicine 20 (3). I am grateful to the publishers for permission to
revisit this previously published material. The research this book
reports was funded by Nanyang Technological University through a
HSSUG grant.
4
Introduction
Sayre recommended circumcision, maintaining that even if it

didnt work, the procedure was unlikely to harm the lad.
(Gollaher 2000, 75)
S ayre was a prominent physician and a leading figure in the intro-

duction of medical circumcision1 in the United States during the
nineteenth century. He was confronted with one of the most difficult
medical conundrums: deciding when and how the removal of the pre-
puce2 ought to be recommended. Insufficient medical knowledge was
his major obstacle. The functionality and anatomy of the prepuce was
not fully understood and a number of illnesses, syphilis included, were
attributed to being uncircumcised. Sayre could not establish a ratio-
nal explanation based on a cause-effect relationship; he thus adopted
a pragmatic approach that could let him deal with the matter in a
workable way. He basically assumed that if removing the foreskin did
not cure any ailment, at least the procedure would not hurt the indi-
vidual involved.
Sayres approach was not only limited by medical knowledge, how-
ever. His standpoint was strongly influenced by prevailing social and
moral concerns, in particular those related to male sexuality, which
unlashed a debate of irreconcilable positions. While contenders main-
tained that removing the prepuce was medically unjustifiable and
harmful, supporters claimed that ailments such as venereal disease and
the vice of masturbation could be cured.
Astonishing as it may sound, Sayres situation is not unique, and
twenty-first-century medics still grapple with the perplexing problem
of having to justify the removal of the foreskin. Sociomedical history
2 Male Circumcision in Japan
indicates that advocating circumcision has always caused controversy

due to a lack of consensus of opinion. This is closely related to the
lack of absolute empirical evidence to prove the health benefits of the
surgery. Furthermore, social, ethical, and political factors have always
affected decision-making processes, so circumcision has never been a
pure medical concern.
Anc ient Ritual s

Examining the cultural intricacies underlying circumcision reveals that
the procedure has always been deeply imbued with social meanings
and symbolism, which cannot be collapsed into a simple medical defi-
nition. Cutting off the foreskin has always been a strongly political
act, enacted upon others by those with power, in the broader inter-
ests of a public good but with profound individual and social conse-
quences (Aggleton 2007, 15).
The most ancient graphic representation of circumcision dates
from 2400 BC. It is an Egyptian inscription in the royal tomb of
Ankhmahor, located on the west bank of the Nile. The inscription
represents two young noblemen whose foreskins are being removed
by temple priests. Historians believe that getting circumcised was
most likely a test for young men to demonstrate their ability to con-
trol bodily pain. However, an explanation grounded in religion
alone is insufficient to explain the significance of circumcision in the
ancient civilization. Egyptians excessive concerns with purity could
be directly linked to the importance of removing the foreskin. Such
preoccupation with the bodys secretions and excretions could have
been a major reason for circumcising males. The space between the
penile glans and the prepuce presents a potential risk of developing
disorders and putrefaction, especially in hot climates. If the penis is
not cleaned regularly, the cheesy sebaceous matter known as smegma
accumulates between the glans and the foreskin. Smegma, aside from
being malodorous, could obstruct the natural flow of urine and
semen (Friedman 2001; Gollaher 2000).
The salience of circumcision in antiquity can be equally traced
through Jewish accounts depicting the practice: Circumcision [is]
an indispensable rite of male initiation, not only into Judaism in the
formal religious sense but into the Jewish communitythe only com-
munity in which a Jew could survive as a socially recognized person
(Glick 2005, 56). Academics who investigate the historical roots of
Israel have made an effort to demonstrate the uniqueness of their the-
ology and rituals and to keep a distance from archaic, bloody rites of
Introduction 3
passage in primitive societies. Judaic circumcision as well as bloody

rites that have taken place in Aboriginal Australia, the Philippines,
Eastern Indonesia, and Melanesia since time immemorial present a
wide variation in procedures (Bell 2005). Yet all these rituals might
have a common origin. Ethnographic and anthropological research
indicates that the so-called blood-bridegroom, which refers to the
premarital ritual of cutting off the prepuce in preparation for pro-
creation, could underpin Jewish circumcision as well as any form of
practice that implies the removal of the prepuce (Gollaher 2000).
The influence of Islam in the preservation and promotion of cir-
cumcision deserves special attention because of the geographical
dimensions and populations that the Muslim world involves. A his-
torical reading of the development of Islamic circumcision suggests
that the practice that was initially a premarital rite that conferred pre-
rogative powers to men in society has turned into a regular procedure
for boys before they reach maturity (Smith 1927). In this light, Kim-
mel (2001) points out that what accounts for the cutting-off of the
prepuce is genderedthat is, circumcision means the reproduction of
patriarchy, and this might also be a shared characteristic to any form
of circumcision regardless of variation of the procedure, historical
time, or geographical location: In the penises of infant sons resides a
fathers dearest aspirations: for grandsons, great-grandsons, patrilin-
eal continuity (Glick 2005, 18, emphasis added).
Medic al iz atio n
3
The medicalization of circumcision can be tracked down through
the debates of European Jews who, during the age of Enlightenment,
tried to challenge religious justifications and looked for modern and
rational explanations to removing the prepuce. By the mid-nineteenth
century, Jews moving to the Americas had brought with them their
religion. It was not unusual that parents wanted to have their sons
circumcised because it would help maintain a tradition that enlarged
their sense of community in the new land. Nevertheless, the practice
acquired a different meaning when non-Jewish migrants in the Ameri-
cas started to adopt circumcision as a prophylactic measure (Glick
2005). Such a prophylactic viewpoint ought to be framed within the
medical, cultural, and moral tendencies that influenced worldviews
between the mid-eighteenth and the late nineteenth centuries. This
eventually resulted in what Darby (2005) calls the demonization of
the foreskin and the medical endorsement of the surgical procedure.
The discovery of germs, which were identified as the leading cause of
illness, revolutionized the medical world. The so-called germ theory

of disease replaced paradigms such as the miasma theory and pro-
voked irrational fears of germs. The foreskin was seen as a source of
ailment and attributed to the propagation of syphilis.
Nonetheless, Efron (2001) affirms that despite the emphasis on
its antiseptic properties, circumcision had a political meaning, as it
was implicated in the production of a modernized view of Jewishness
grounded in the notion of bourgeois respectability. A major cultural
tendency in the nineteenth century has been identified as the civiliz-
ing process that was directed to foster conventional respectability and
to promote values pertaining to the burgeoning bourgeois societies
on both sides of the Atlantic. Elias (1994) masterfully describes this
process that included the colonization of the human body through
the promotion of manners, habits, and behaviors that aimed to con-
ceal body fluids. Except for the salty liquid secreted from the eyes
known as tears, all body fluids were considered unsanitary. Smegma
that accumulates between the penile glans and the prepuce was one of
these undesired secretions that could be easily eliminated by cutting
off the foreskin.
For the first time the emergent professional elite of European and
American medical doctors agreed that the circumcised penis was
more sanitary than the uncircumcised (Gollaher 2000, 86). Such
agreement was partly a response to Victorian moral anxieties concern-
ing masturbation. This was one of the first and clearest exercises of
medicalization that made circumcision a remedy for two patho-
logical conditionsnamely, congenital phimosis and spermatorrhea4
(Darby 2005, 8). In addition, the promotion of adult circumcision
was supported by the idea that Jewish men had lower rates of syphilis.
Medic al Ro utines
Medical knowledge effectively transformed the view of circumcision
from a preventive to a curative procedure. This is clear when look-
ing at the way clitoridectomythe excision of the clitoriswas con-
ceptualized. It became a socially condemned practice and a medically
inadmissible and abhorrent crime because it entails the mutilation of
female genitalia. Cutting off the prepuce, conversely, did not require
the consent of the male involved in most cases because it turned into
a medical procedure, which was not seen as a mutilation of the male
body.
During the mid-nineteenth century, circumcision was broadly
endorsed as a preventive measure against a wide range of ailments
Introduction 5
that included phimosis, onanism, and spermatorrhea. Likewise,

removing the foreskin was recommended for treating diseases that
originated in the nervous systemnamely, epilepsy and paralysis
and to solve digestive problems in newborn baby boys. Circumcision
supposedly eliminated the irritation that the prepuce caused in the
nervous system and facilitated food digestion and thus improved
newborn babys survival chances. The truth was that the procedure
was profusely recommended without a clear idea about its positive
effects: should it be the case that circumcision didnt work, the pro-
cedure was unlikely to harm the lad (Gollaher 2000, 75, emphasis
added).
The routinization of pediatric circumcision did not only stem from
medicalization and parental concerns about childrens health and
well-being. Routine circumcision was influenced by the prevailing
medicalization of childbirth as well as the increasing visibility of medi-
cal authority over lay people (Darby 2005). The social aspirations of
non-Jewish households could have strongly impacted on the decision
to have a newborn circumcised as well. Similar to some Jewish families
who looked for bourgeois respectability through the medicalization
of circumcision, a circumcised baby boy in a non-Jewish household
progressively became a symbol of class distinction, as it implied that
labor and birth as well as postpartum care occurred at a hospital under
the supervision of qualified medical personnel. This was meant to
oppose the tradition of midwifery. The services of a midwife were
most likely for parents who had a poor education background and/or
who were unable to pay for hospital bills: As white middle-class Gen-
tiles adopted circumcision, those left behind were recent immigrants,
people of color, the poor, and others at the margins of respectable
society (Gollaher 2000, 108, emphasis added).
The acceptance of routinized pediatric circumcision was also linked
to the idea that the procedure did not entail a traumatic experience
because the penis of the newborn was seen as physically insensitive.
If removing the prepuce could cause some pain, the baby would be
unable to remember the experience anyway (Goldman 1997).
C a nc er, H I V, and the P repuce

A rather convincing argument to promote infant circumcision has
been, however, that the procedure could help prevent genital and oral
cancers. During the 1930s, smegma was directly implicated in the
occurrence of cancer in the genitals (Wolbarst 1932). Epidemiolo-
gists had usually drawn on the relative lower incidence of syphilis and
gonorrhea and cervical cancer on Jewish men and women, respec-

tively, to explain why smegma had carcinogenic properties.
In 1963, the hypothesis that human smegma was a form of carcin-
ogen was discredited (Reddy and Baruah 1963). Preston and Leitchs
investigation showed that thinking of the uncircumcised penis as a
major factor leading to cancer in the genitals was yet to be scientifi-
cally proven (Preston 1970; Leitch 1970) because circumcised men
can develop cancer of the penis too (Boczko and Freed 1979). Com-
parative studies between nations that have and have not enforced
routine pediatric circumcision indicated no significant difference in
terms of the occurrence of carcinoma of the penis (Wallerstein 1980).
Recently, carcinoma of the cervix, although a complex illness, has
been associated with the occurrence of the human papillomavirus
(HPV) infection. Oncological investigation has linked sexual inter-
course with uncircumcised men as a risk factor for women in acquiring
HPV during coitus, which might result in a form of cervical cancer
(Martnez 1969; Rotkin 1967). However, despite the presence of
HPV being strongly implicated in cervical and penile cancer, the rela-
tionship between the uncircumcised penis and HPV infection remains
empirically unsupported.
The introduction of circumcision into the AIDS industry (Patton
1990) is a reminder that circumcision is the worlds most controver-
sial surgery (Gollaher 2000), reigniting an endless debate between
two diametrically opposed positions concerning the benefits of
removing the prepuce. Proponents demonize the foreskin (Darby
2005) and see in circumcision a new opportunity and an effective (as
well as a valid) medical intervention in the battle against AIDS. Being
circumcised reduces the risk of acquiring HIV in men by approximately
60 percent in the context of heterosexual intercourse. Uncircumcised
men, on the other hand, are at a heightened risk of contracting HIV
because of genital sores, minilesions, ulcerations, and a high density of
cells that increase the risk of acquiring sexually transmitted infections
(STIs; Szabo and Short 2000). The uncircumcised penis is meant to
be at higher risk of acquiring HIV because the inner mucosal surface
of the foreskin is not keratinized. Keratinization renders into a form of
protection because, after circumcision, a layer of keratin is deposited
in the cells of the peniss skin that makes it horny, as in nails and hair.
In the context of heterosexual intercourse, the nonkeratinized fore-
skin of the uncircumcised man gets pulled back down and this results
in a larger surface where HIV transmission could occur. The vulner-
ability of the frenulum to trauma during intercourse, which connects
the penis with the prepuce, entails a potential risk of HIV infection in
Introduction 7
uncircumcised men as well. Circumcision has thus been presented as

the newest weapon in the arsenal (Dowsett and Couch 2007) and a
biomedical imperative for the 21st century [because] circumcision of
males represents a surgical vaccine (Morris 2007, original emphasis).
Opponents, however, insist that promoting the circumcision of
adult men is just another good example of medicalization that entails
a practice of exercising control over supposed medical phenomena-
disease, illness, injuries and bodily malfunction (Clarke et al. 2003, 2).
Medicalizing the prepuce is a process that enlarges medical jurisdic-
tion, authority and practice (Zola 1972) into the male body and his
sexuality. Medicalizing the prepuce tends to sideline the relevance of
penile hygiene to avoid disease (Hankins 2007), in general, and con-
dom use to prevent the transmission of HIV, in particular.
A P ro f itabl e Bio medic al Proj ect

Circumcision in Japan presents an additional challenge. The Japanese
number of HIV infected peoplealthough increasingis still com-
paratively lower in relation to other industrialized nations. In 2012,
Japan had 14,706 HIV-infected people and 6,719 AIDS patients
(Kseirdsh Eizu dk iinkai 2012), and the majority of Japanese
men are uncircumcised. In addition, the reality of circumcision in
Japan shows that this minor surgery is more than a snip. It is an
intriguing social phenomenon that deserves international attention
because adult circumcision in Japan is a practice largely dissociated
from any salutogenic benefit and underpinned by gender and sexual
scripts (Gagnon and Simon 2005).
It is unlikely that the National Health Insurance (NHI; Koku-
min Kenk Hoken) can cover the surgery because, as will be further
discussed in Chapter 2, adult circumcision is considered a cosmetic
procedure, which is chiefly commercialized by cosmetic surgeons as
a package of beauty products that provide penile improvements. By
these means, the prepuce has been biomedicalized,5 which means
that adult circumcision in Japan has become part of the new biopo-
litical economy of medicine, health, illness, living, and dying which
forms an increasingly dense and elaborate arena in which biomedical
knowledges, technologies, services, and capital are ever more co-
constituted (Clarke et al. 2010, 1).
Through a biomedicalizing process, this minor surgery is traded as
a procedure that transforms the bodies of Japanese men to include
new properties and the production of new individual and collective
technoscientific identities (Clarke et al. 2003, 163). The so-called
circumcised adult implies the identity of a man that is grounded in

the politico-economic constitution of the Biomedical TechnoService
Complex, Inc (Clarke et al. 2003, 163).
The identity of the circumcised adult entails a financially profit-
able biomedical project. A circumcised man refers to an individual
whose life has been dramatically transformed and improved through
the removal of his penile foreskin. Circumcision in Japan is over-
whelmingly advertised in mens fashion magazines, pornographic
materials, and the Internet as a method to cope with issues concern-
ing self-confidence, emasculation, and sexual prowess because, as one
advertisement puts it, [T]he pride of a man is in the lower half of his
body (Kahanshin ha otoko no puraido da!; Hills Tower Clinic).
The impact of advertising has not been academically investigated.
Yet the surgery appears rather popular as indicated by the number
of new clinics opening up with this as speciality (Miller 2004, 94).
Advertisements locate circumcision within a narrative that effectively
recreates the male sexual script that brings together the psychol-
ogy and symbolism of male genitalia. The minor surgery becomes, by
these means, a medical procedure for Japanese men in pursuit of the
perfect penis (Tiefer 1986).
Cosmetic surgeons offer circumcision as a procedure that works
on the body and psyche of heterosexual men. The script often harps
on three positive outcomes of circumcision: sexual organs that look
better or larger, improved self-confidence, and enhanced sexual per-
formance, which stems from both self-confidence and insensitivity
in the penis glans. An insensitive penile glans supposedly produces
harder and longer-lasting erections, which are apparently preferred
by Japanese women. The effect of such advertisements cannot be
underestimated, however. Reports from hotlines serving family-
planning clinics and the Japan Family Planning Association indicate
that requests for information concerning circumcision usually come
from young men and male teenagers concerned about the size and
shape of their genitals (The Yomiuri Shimbun 1989).
Even if Japanese men have decided to undergo circumcision, they
have to face two main issues: abusive pricing and medical malprac-
tice (The Yomiuri Shimbun 2006). Prices are unregulated because the
minor surgery is regarded as a cosmetic procedure. Newspaper reports
point out that having the prepuce removed could cost between 10,000
and 30,000 JPY (about 99 and 297 USD) at a government hospital.
However, it can cost as much as 600,000 JPY (about 5,934 USD) at a
beauty clinic (Mainichi Shimbun 2006a). Officials from the Ministry
of Health, Labour and Welfare (MHLW) who have investigated the
Introduction 9
implications of circumcision have realized that some clinics advertise

the surgery at 63,000 JPY (about 622 USD), but when including
expenses related to medical treatment (chiry), the cost becomes
1,000,000 JPY (about 9,877 USD). It is very difficult to decide,
therefore, whether there is injurious falsehood involved in the appar-
ent mismatch between advertisements and practice (Ministry of
Health, Labour and Welfare 2011a).
Miller suggests that clinics take advantage of the embarrassment
of their clients to inflate fees and overcharge. For instance, one
clinic claimed that expensive collagen injections were needed before
the removal of the foreskin, raising the usual cost of the procedure
(Miller 2004, 94). Concerning malpractice, media reports include
cases of men suffering from genital malfunction and/or disfiguration
as well as experiencing great disappointment because the surgery did
not transform the sexual organ as expected (Tokyo Chkan 2003).
G enital H ygiene
Removing the prepuce has undoubtedly become a new form of the
Biomedical TechnoService Complex, Inc (Clarke et al. 2003),
which has created a new niche market for those interested in commer-
cializing adult circumcision in Japan. This, however, does not mean
that the opinions of medical doctors concerning the minor surgery are
unanimous. The international debate of polar extremes concerning
the medical validity of circumcision also occurs in Japan.
Ishikawa (2008) and Hinami, Iwamuro, and Yamamoto (2003),
as well as Iwamuro (2009), contend that the surgery is completely
unnecessary and make an effort to discredit mass media and Inter-
net advertisements that persuade Japanese men to have the foreskin
removed. Through the use of anecdotes and plain language, they
emphasize that in medical terms, the prepuce per se can never be
a source of ailment as long as proper genital hygiene is observed.
Certainly, there are conditions that require medical intervention:
paraphimosis (kanton hkei), for example, needs immediate attention
because the retracted foreskin of the penis cannot return to the origi-
nal position and causes inflammation and severe pain. Nonetheless,
even in cases like this, nonsurgical methods can be used to loosen
a foreskin that could become a medical problem (Yanagisawa et al.
2000; Hayashi et al. 2010; Iwamuro et al. 1998; Iwamuro et al. 1997).
The absence of accurate records makes it difficult to determine
the actual number of circumcised newborn babies as well. Although
expenses concerning pediatric circumcision can be claimed under
the code J068 of the NHI (Ministry of Health, Labour and Welfare
2008), doctors are not particularly obliged to report on the number
of foreskins removed when the parents of the newborn involved did
not use their insurance. A urologist can recommend surgery when the
foreskin is deemed to be a cause of illness and those supporting the
medical practice assert that circumcision is a valid procedure to treat
boys at risk of urinary infections because of an overly tight foreskin
covering the penis glans (Hiraoka et al. 2002). Japanese plastic sur-
geons and urologists tend to have a clear disagreement of opinion.
This does not imply, however, that the viewpoints of urologists are
uniform, as some of them do support the removal of the foreskin.
A New Binary
It is clear that adult circumcision in Japan is a procedure chiefly under-
pinned by gender and sexual scripts. Thus the minor surgery ought to
be contextualized within the master narrative of the theories of the
Japanese (nihonjinron). The narrative depicts the sexual and gen-
dered self of Japanese women and men within a binary that implies
the roles of the good wife and wise mother (rysai kenbo; Koyama
2012) and the household central pillar (daikoku bashira; Dasgupta
2013) for women and men, respectively. This implies a perfect
complementary (Hidaka 2010) of opposites whose collusion largely
helps (re)produce heterogender: The material conditions of capi-
talist patriarchal societies are more centrally linked to institutionalised
heterosexuality than to gender and, moreover, that gender (under
the patriarchal arrangements prevailing now) is inextricably bound
up with heterosexuality. [Thus,] gender, or what I would call het-
erogenders, is the asymmetrical stratification of the sexes in relation
to the historically varying institutions of patriarchal heterosexuality
(Ingraham 1996, 169). Men are to be the breadwinners that provide
for and protect the household. In opposition, women who have a
reproductive role in the family face restricted access to the labor mar-
ket because they are expected to devote themselves to childrearing
and homemaking. The master narrative tends to restrict the sexual self
of the couple to the preservation of kinship and lineage and confers a
leading role to men in sexual intercourse.
Current gender dynamics, however, indicate that the narrative
is ineffective in explaining the gendered and sexual self of Japanese
people nowadays. Academics and journalists have put in an effort to
challenge the homogenizing view of the masculine self by suggest-
ing the plurality of men and masculinities (Roberson and Suzuki
Introduction 11
2003, 9, emphasis added). Mens studies (Taga 2005) has opened up

an area of research that has helped investigate how gender issues are
entangled in discrimination and inequality in labor policies. However,
the gendered self of younger men has turned into a serious issue that
entails part of the gender panic in twentieth-century Japan (Kin-
sella 2012, 72, original emphasis), which largely refers to younger
men who break down masculinity (Fujimura 2006) and tend to dis-
tance themselves from their expected productive roles. They fail to
become regular employees (Mathews 2004, 132, emphasis added)
and choose temporary/casual jobs, which makes them unlikely
to become breadwinners. Likewise, they fail to keep up a manly
appearance and look weak and feminized (Demetriou 2008). Even
more problematic is, however, that they tend to turn into herbivo-
rous boys (sshokukei danshi) and fail to become sexualized beings
because of their lack of interest in sex (sekkusu ni kanshin ga nai;
Kitamura 2011).
The gender panic involves younger Japanese women as well
because they tend to neglect their expected reproductive role. Against
the homogenizing view underpinning the master narrative, journalists
and academics contend that interpretations of womens lives are as
diverse as their lives themselves (Okano 2009, 5, emphasis added).
Younger women postpone marriage, have few children, remain single
or childless, and are rather tolerant toward divorce and premarital sex
(Muta 2008). Media and academic surveys claim that younger women
have become sexualized beings and are even more sexually active than
the previous generation (Kinsella 2012). This of course does not mean
that marriage and childrearing have lost social relevance. Women used
to remain single because they were unable to find a man who satisfied
their demands. During the 1980s and 1990s, women were mainly
looking for men with a proper educational background and income
(Nemoto 2008) that allowed the household to have a middle-class
standard of life. Nowadays, women postpone marriage until they find
the appropriate person (Ogura 2003).
In this light, the current master narrative implies the notions of
failing men and sexually active women, which appear to be the
new binary supporting the gendered and sexual self of contemporary
Japanese heterosexual people. Intriguingly, such a narrative appears to
be (re)created by plastic surgeons in the commercialization of adult
circumcision, which encompasses a procedure for men who fail to
satisfy the supposed sexual demands of Japanese women.
Daily I nter ac tio n s

The apparent lack of medical knowledge to justify adult circumcision
in Japan suggests that the symbolism attached to the foreskin is key
to understanding the seemingly growing popularity of the medical
procedure. It is most likely through daily social relations that the bio-
medicalization of the foreskin becomes real and that the foreskin
turns into a token of masculinity and circumcision into a tech-
nology of the self (Foucault 1988). The power of such symbolism
largely relies on the daily interactions of Japanese men and women,
who accept the biomedicalization of the foreskin, believe in the ben-
efits of the medical procedure, and let it dictate their gendered and
sexual selves accordingly.
In disentangling the social processes underpinning the biomedical-
ization of the prepuce and the creation of a profitable niche market for
cosmetic surgeons, the relevance of symbolic interactionism becomes
apparent. This is because symbolic interactionism implies a theoriz-
ing grounded in the ordinary lives of Japanese people (Jackson
and Scott 2010b, 2223), which permits an analysis of circumcision
through three interrelated dimensions of scripting: the intrapsychic,
the interpersonal, and the cultural (Gagnon and Simon 2005).
The intrapsychic dimension is concerned with the ways Japanese
men make sense of their own bodies in relation to their genitals and
also in relation to circumcision. The beauty and cosmetic industry
offers the removal of the prepuce as a technology of the self (Fou-
cault 1988) that helps men transform their bodies, souls, thoughts,
conduct and way of being [and such change permits them] to attain a
certain state of happiness, purity, wisdom, perfection or immortality
(Foucault 1988, 18). Circumcision is thus a technology that appar-
ently leads to the transformation of the gendered and sexual self of
Japanese men.
Looking at the implications of such a transformation is grounded
in a reading of the interpersonal dimension. On the one hand, the
medical practice elicits the existence of power relations among men
through a hierarchical order that places circumcised men higher in
the ranking. On the other, taking circumcision into the context of
heterosexual intercourse reveals a transformation of the female body
as well. Through sexual intercourse with circumcised men, women
are meant to attain a sense of fulfillment and a state of happiness
that they are unable to attain with uncircumcised men. Circumcision
is thus a technology that entails the change of the sexual and gendered
self of Japanese women too. Categorically, circumcision is supposed to
Introduction 13
be a medical intervention that implies a form of embodiment for het-

erosexual couples. As Jeffrey Weeks puts it, Embodiment describes
an active process in which the body is shaped and changed by human
practice. Through body-reflexive practices masculinities and femi-
ninities, sexual desires and sexual identities are shaped, drawing on
the multiple possibilities of the body but transforming them into
active elements of individual lives and social worlds (Weeks 2011,
21). The salience of the cultural dimension becomes apparent when
acknowledging that sexual intercourse with a circumcised man does
not occur in a vacuum. The cultural dimension helps contextualize
circumcision through the master narratives concerning the sexual and
gendered self in Japan that offer a range of scripts (Gagnon and Simon
2005, 13).
Exploring the ways the male bodythe prepuce, in particularand
circumcision have been scripted and are produced in everyday interac-
tions reveals how practice and subjectivity relates to wider social and
cultural contexts. This, in addition, suggests a reading of embodiment
and human agency without reaching a level of unexplained volun-
tarism (Jackson and Scott 2010a, 821), which means that agency and
embodiment for heterosexual couples in relation to circumcision are
located in social context. Circumcision in Japan is commercialized as
a technology of the self that allegedly conveys a method to regain
control over the male body and, by extension, to dominate the female
one.
The cultural and interpersonal dimensions, in addition, dem-
onstrate the relevance of gender as a construct that further helps
understand the scripts underpinning circumcision. Contemporary
gender relations are hierarchically constructed as power relations that
permeate the everyday life of Japanese men and women. Nevertheless,
masculinity and femininity are opposites in coalition (Holland et al.
1998). They both conflate to produce a regime of normality, which
validates the power of patriarchy. Liberation and oppression are, in
this light, not uniform or contradictory processes, but their implica-
tions become apparent through the actual contradictions of womens
[and mens] lives (Ramazanoglu 1989, 4). As such, justice involves
not only the distribution of goods alone but also the decision-making
process and the social divisions of labor and culture (Young 1990).
Th e Struc ture o f This Book

This book represents a conscientious effort to rehabilitate symbolic
interactionism (Jackson and Scott 2010a) for an understanding of
circumcision within Japanese gender and sexuality frames of reference.

The main objective is to provide some empirical evidence that chal-
lenges current globalizing campaigns to promote the circumcision of
newborns, children, and adult men. I draw on the Japanese case to
demonstrate that removing the prepuce is mostly a practice grounded
in cultural and social concerns rather than medical knowledge. In con-
crete, I want to answer the following question: How can the Japanese
case help contest the common understanding that circumcision is a
prophylactic measure?
Chapter 1 presents the groundings of research on circumci-
sion in Japan. The chapter describes the relevance of sexual scripts
in understanding the male body as well as the sexual and gendered
self. Particular emphasis is placed on the social construction of geni-
talia to shed light on the symbolism attached to the penis and the
social intricacies underpinning the prepuce. The chapter reviews the
master narratives supporting the gendered and sexual self in Japan
because the biomedicalizing processes underlying adult circumcision
make removing the prepuce a cosmetic procedure for men grappling
with gender and sexual issues. The constructs of failing men and
sexually active women are underscored as they cast some critical
light on the relevance of circumcision in contemporary Japan. To fin-
ish, the chapter introduces a methodological stance on ethnographic
research that is conducted to provide empirical evidence of the social
interactions that allow the biomedicalization of the prepuce and the
commercialization of circumcision at Japanese beauty clinics.
Chapter 2 goes deeper into the cultural dimension that helps jus-
tify the surgical removal of the foreskin of adult men in Japan. The
chapter offers an iconographic and textual analysis of mass media and
Internet publicity that suggests that the prepuce is a hindrance in the
construction of the sexual and gendered self. Knowledge, gender,
and sexuality encompass three major axes to analyzing advertise-
ments that entail the core strategy of beauty and aesthetic clinics to
sell the minor surgery. The chapter discusses the implications of adult
circumcision presented in the publicity to highlight that having the
foreskin removed entails a medical procedure that inadvertently
enlarges a patriarchal gender regime. It is a medical technology that
helps repair the gendered and sexual self of Japanese heterosexual
couples as well as the social system.
In order to approach the intrapsychic and interpersonal dimen-
sions concerning the surgical removal of the prepuce, Chapter 3
presents my outcomes of interviews with a group of Japanese men
that aim at exploring their viewpoints and experiences in relation to
Introduction 15
adult circumcision. The encounters with the group of men reveal the
salience of knowledge and language availability as two major issues in
talking about the medical procedure. The chapter highlights the ways
male genitalia, in general, and the prepuce, in particular, have been
culturally scripted in Japan. Circumcision is not a topic of conversa-
tion that involves medical knowledge alone. It is a harsh topic that
entails the gendered and sexual male body. An open discussion is thus
unlikely to occur because circumcision is most likely part of a play-
ful conversation full of innuendos and dirty jokes (shimoneta). The
chapter discusses the relevance of communal baths to understanding
what the male body entails and highlights how the group of men is
able to challenge the master narrative underpinning circumcision.
Given the assumption that women prefer sexual intercourse with
circumcised men, Chapter 4 revolves around my outcomes of inter-
views with a group of Japanese women. This chapter further explores
the intrapsychic and interpersonal dimensions embedded in the pro-
cedure through a set of interviews that aim at providing empirical
evidence of the ways circumcision impacts the gendered and sexual
self of Japanese women. Linguistic barriers become apparent again,
and the chapter underscores the serious difficulties in trying to dis-
cuss the procedure with young women. From a cultural dimension,
the language to refer to and knowledge on circumcision is gendered
and the intent to know is unfeminine. Nevertheless, the relevance of
homosocial daily interactions becomes apparent and conversations
with peers or girls talk encompass an option for women to discuss
circumcision. This does not imply a discussion of medical technol-
ogy and its health benefits. Innuendos and jokes permeate girls
talk, which seems to confirm that a conversation about circumcision
is effectively opposite to femininity. To conclude, the chapter shows
how the young women are able to use verbal references to circumci-
sion to express sexual demands and needs.
Chapter 5 revolves around the opinions and experiences of a
group of Japanese urologists and cosmetic surgeons who I inter-
viewed to provide a deeper insight into the biomedicalization of
the prepuce. I analyzed the outcomes of the interviews through
three axesknowledge, gender, and sexualityin order to present
an understanding of the ways the intrapsychic, interpersonal, and
cultural dimensions intertwine to produce a surgery for adult hetero-
sexual men. The chapter further discusses the implications of adult
circumcision for the sexual and gendered self of heterosexual Japanese
couples in line with the cultural and social dispositions that allow for
the creation of a profitable biomedical niche market. To finish, the
chapter establishes that urologists and cosmetic surgeons share the

opinion that the genitals are absolutely relevant in the construction
of the gendered and sexual self of men. They also seem to agree that
heterosexual intercourse is an act that requires vaginal penetration.
However, urologists insist that parents could help stop the commer-
cialization of circumcision by promoting accurate information and
penile hygiene.
Since parents are meant to have a decisive role in enforcing penile
hygiene among young boys to prevent the biomedicalization of the
foreskin, and because women still bear the major responsibility for
childrearing and early training (shitsuke) of children in Japan, the
viewpoints and concerns of a group of Japanese mothers in relation
to circumcision and penile hygiene are presented in Chapter 6. The
chapter adds a different perspective on the cultural dimension under-
pinning male genitalia and the difficulties of enforcing penile hygiene.
Within a medical frame of reference, the promotion of penile hygiene
appears to be a phenomenon unrelated to broader social relations.
Parents and children are seen as if they were acting in a vacuum and
objectively assessing the benefits and consequences of maintaining
proper penile hygiene. Nonetheless, the experiences of this group of
mothers show that promoting genital cleanliness is a social issue
and that circumcision is not required even to prevent penile infections
among newborn babies.
4
Chapter 1
Researching Circumcision
Circumcision is a minor surgery on a major organ.

(African representative of WHO at the XVIII
International AIDS Conference)
W e are at the eighteenth International AIDS Conference and ready

to listen to some presentations on adult circumcision as a method
to prevent the transmission of HIV. The first thing that catches my
attention is that most of the presenters and people in the audience
have black skin, and the majority seems to be from Africa. The chair-
person is a black woman who represents the WHO and leads a coali-
tion to promote adult circumcision in the Sub-Saharan region. It is
really intriguing that mostly black people from Africa appear as the
main actors in the promotion of the surgical procedure. Some mem-
bers of the audience try to raise concerns about a HIV preventive
strategy that appears to be entirely localized in a particular region of
the world. To some extent, insisting on circumcising black African
men could have a tinge of racism. Nevertheless, the chair and the
presenters appear largely unwilling to engage in any form of dialogue.
They were there basically to talk about a medical procedure and
to inform about improvements in attaining the cheapest and most
effective methods to promote en masse adult circumcision. The
lack of dialogue is disheartening, and certainly disappointing is the
fact that there is not much to learn about the social aspects under-
pinning adult circumcision. Nevertheless, the closing remarks of the
chairperson, highlighting that circumcision is a minor surgery that
occurs on a major organ, sheds some light on the symbolism attached
to the procedure and the social implications of being circumcised.
This reference to the symbolic meaning of the practice made me

think of the relevance of sociological inquiry on circumcision in
Japan, especially because the surgery has never been medically rou-
tine, and it is adult Japanese males who want to be circumcised.
As such, this chapter establishes a framework for conducting research
on circumcision in Japanese settings. First, a succinct review of sym-
bolic interactionism is presented along with the theories of Gagnon
and Simon (2005). In order to develop a theory of circumcision in
Japan, I underscore the salience of the notion of sexual script and fully
explain the constructs of the interpersonal, intrapsychic, and cultural
dimensions, as well as the relevance of daily social interactions.
As circumcision is meant to be an intervention occurring on a
major organ, this chapter discusses the social construction of the male
body and stresses the relevance of the anatomic confirmation, which
helps identify a newborn as a baby boy. Analyzing the implications
of such a confirmation casts some critical light on how and when the
genital area acquires social significance and helps sustain a reading of
the sociality underpinning the male body. In order to continue with
the investigation of circumcision in Japan, the chapter reviews the
master narrative underlying gender and sexuality matters in Japanese
society. The contrast between traditional and contemporary views on
the gendered and sexual self are explored to point out that gender and
sexual relationships are currently expressed in terms of the binary of
failing men versus sexually active women in Japan. The ways in
which the Japanese male body has been investigated is also included.
To conclude, the chapter shows the methodology used in the ethno-
graphic research conducted with a group of men, women, urologists,
cosmetic surgeons, and mothers in Japan.
S ex ual S c r ipts
Disentangling the symbolism attached to circumcision in Japan and
its effects on society entails a process of theorizing (Jackson and
Scott 2010b) that helps illuminate how the surgical procedure has
come to be an integral part of everyday gender and sexual patterns of
sociality. This is not an attempt at establishing a definite social theory
of the surgical procedure but aims to engage in a theorizing process to
attend to the multiple dimensions underpinning the surgery: struc-
ture, meaning, practice and subjectivity (Jackson and Scott 2010b).
Looking at the social structures that support circumcision permits
a reading of the institutions that produce inequality and social order
based on the removal of the prepuce. This refers to the institutional
Researching Circumcision 19
and structural power to differentiate the circumcised penis from the

uncircumcised one and to decide when and how a foreskin becomes
problematic, as well as to normalize the consequences of removing the
foreskin for both the male and the female body. However, structural
power does not operate alone, it works in tandem with the mean-
ings embedded in the surgical procedure and the forms of knowledge
it implies. Circumcision becomes meaningful because it is largely
connected to the social significance of male genitalia and the penile
prepuce in particular, as well as the expected benefits and conse-
quences of removing the foreskin for the individual and the social
body. Meanings thus intersect the macro- and micro-aspects underly-
ing circumcision.
Circumcision has rendered an active element of a master narrative
that has made the surgery subject to normative regulation through
specific discourses in circulation at any historical moment (Jackson
and Scott 2010b, 90). These discourses have largely served to institu-
tionalize patriarchy and establish the meaning of appropriate sexual
behavior. Nonetheless, looking at institutions, structures, and mean-
ings appears insufficient without taking into consideration how the
surgical procedure finds its place within daily social interactions and
practices, which enable or limit structural power to become real. It
is then crucially important to take into consideration the ways that
circumcision impacts the subjectivities of men and women and elic-
its patterns of sociality to rule the lives of concrete gendered and
sexual selves.
Against this background, a theorizing of circumcision entails three
aims: (1) to question tendencies to remedicalize and/or biomedical-
ize the surgery; (2) to draw attention to the relevance of the surgery
in producing particular gendered and sexual selves, as well as helping
maintain specific gender and sexual regimes; and (3) to shed light
on daily interactions as the means to perpetuate and/or contest such
regimes. This elicits the significance of symbolic interactionism for
a sociology of sexuality (Jackson and Scott 2010a), as it helps attain
the three objectives by locating the surgical procedure within broader
cultural and social contexts.
The theories of Gagnon and Simon (2005) have largely inspired
the pragmatist/interactionist approach to sexuality. Their theories
revolutionized studies on sexuality, as they were the first to contest
psychoanalytic notions of repression, as well as biological deter-
minism, and to propose a social and cultural explanation to sexual
conduct instead (Weeks, Holland, and Waites 2003, Jackson and
Scott 2010b). Their approach certainly paved the way for a social
constructivist understanding to sexuality because they were truly the

first sociologists to radically question the biologism, the naturalism
and the essentialism that pervaded most existing research and study
(Plummer 2001, 131). A keystone of their theorizing is the construct
of sexual scripts [which] are involved in learning the meaning of
internal states, organizing the sequences of specifically sexual acts,
decoding novel situations, setting the limits on sexual responses, and
linking meanings from nonsexual aspects of life to specifically sexual
experience (Gagnon and Simon 2005, 13, emphasis added). The
salience of the construct revolves around the understanding that
human sexual conduct is the result of learning processes rather than a
response to presocial, innate, and thus inevitable sexual drives. As
such, body partsincluding the genitals, feelings, and actionsare
not sexual per se; they all become sexual through an active process of
learning scripts, which takes place at the heart of social interaction.
Nevertheless, sexual scripts are not established and unchangeable
patterns of conduct; they are fluid improvisations involving ongo-
ing processes of interpretation and negotiation (Jackson and Scott
2010a, 815) because the same sequence of acts may have different
meanings for both different pairs of actors or the participants in the
same act. This is the world where sexual activity can be expressive of
love or rage, the will to power of the will to self-degradation, where
the behavioral is experienced through the symbolic (Gagnon and
Simon 2005, 14). In order to explain how sexual scripting originates,
develops, and stays in existence, scripts are to be understood as hav-
ing three major dimensions: the interpersonal, the intrapsychic, and
the cultural. The interpersonal revolves around conventions, which
are mutually shared by two or more actors and which permit them
to engage in a complex act that involves mutual dependence. The
intrapsychic refers to internal and motivational elements that produce
arousal (Gagnon and Simon 2005). As individuals do not exist in a
vacuum, the interpersonal and the intrapsychic dimensions ought to
be read in line with cultural scenarios, which include, for instance,
large class of gestures, both verbal and nonverbal, that are mutually
accessible. Routinized language, the sequence of petting behaviors
among adolescents and adults, the conventional styles establishing
sexual willingness are all parts of culturally shared, external routines.
These are the strategies involved in the doing of sex, concrete and
continuous elements of what culture agrees is sexual (Gagnon and
Simon 2005, 14, emphasis added). Scripts constitute flexible cultural
scenarios (Laumann and Gagnon 1995) that entail an institu-
tional semiotic system (Gagnon 2004, 276) and supply collective
behavioral instructions around which individuals improvise to pro-

duce and change the meanings attached to current representations
of sexual life (Laumann and Gagnon 1995). Scripts depict these
representations and frame what individuals tell themselves (the intra-
psychic dimension) and others (the interpersonal dimension) about
the representations.
Through social interaction, individuals turn into active actors that
help transform representations that, for instance, the mass media,
religious leaders, educators and researchers have created (Laumann
et al. 1994, 6). In this light, social interaction allows for the exercise
of agency and variation but without assuming voluntarism (Jack-
son and Scott 2010a, 815), which means that individuals are not
constantly evaluating situations and freely making choices: Individu-
als are constrained by a script that they learned from those around
them (Laumann et al. 1994, 29). Although scripts provide a range
of meanings that permit an understanding of what the sexual is,
they do not govern sexual conduct. Scripts are not rigid programs
but rather rough guides (Laumann et al. 1994, 30) that provide
cultural resources that allow everyday interaction. Furthermore, as
we need intrapsychic scripting (Gagnon 2004, 276), scripts lie at
the substratum of the individual mind. However, different from the
psychoanalytic construct of psyche (which largely implies desires and
thoughts originating in the unconscious and thus unavailable to intro-
spection), the intrapsychic is a socially based form of mental life
(Gagnon 2004, 276).
Sexual desires, thoughts, and conduct are therefore not presocial.
They are deeply rooted in society and fully integrated into everyday
life. This challenges theories concerning sex drive because the sexual
is not at the center of human concerns, beginning in infancy, an
essential to normal human development (Gagnon and Simon 2005,
8). The sexual is actually just an ordinary element of wider patterns of
sociality. The sexual can be triggered by non-sexual motives . . . occurs
in the context of ordinary lives and . . . it is shaped by wider social
institutions (Jackson and Scott 2010a, 81516, emphasis added).
Understanding how the sexual self appears and develops, therefore,
does not imply entering the unexplored world of the unconscious
mind to dig up childhood memories. It is rather a process of under-
standing how we reconstruct our biographies to bring them into
greater congruence with our current identities, roles, situations and
available vocabularies [because] the present significantly reshapes the
past (Gagnon and Simon 2005, 9, emphasis added).
S c r ipts and the Bo dy

Particularly relevant in unveiling the sociality beneath circumcision
is the epistemological function of scripts that set the limits of what is
meant to be a gendered and sexual body. Such meanings are largely
grounded in the so-called anatomic confirmation (Gagnon and Simon
2005, 22) of a child as a baby boy or girl, which appears at the bed-
rock of the social understanding of the body. In line with the psycho-
analytic tradition, this is may be what the maxim Anatomy is destiny
means. An anatomic confirmation underpins the parental decision to
educate a child as a boy or a girl: It may seem only natural to those
who equate gender with biology that the presence of a penis [or a
vagina] would confirm that the boy [or the girl] who has it is male [or
female] (Bordo 1999, 23).
Anatomy and social attribution (Gagnon and Simon 2005, 22)
conflate to produce the meaning of a gendered and sexual body. Ana-
tomic confirmation leads to a social understanding of genitalia that
translates into cultural scenarios and behavioral expectations for
boys and girls. Scripts of the body grounded in such a confirmation
amalgamate into a master narrative that has three major implications.
First, the accurate identification of the infant as either a boy or a girl
is vital as it has permanent consequences for the adequate devel-
opment of the gendered and sexual self of the child. Second, the sexual
has its origin in and is largely concerned with the genital area. Third,
the genitals encompass the almost most important part of the body.
Anatomic confirmation is largely connected to parental efforts to
rear a child in line with his or her genitals to avoid what might be
called gender dissonance, which elicits a mismatch between a con-
firmed anatomy and its expected demeanor. As Butler (1990, 173)
underscores, [C]oherence is desired, wished for, idealized [because]
this idealization is an effect of corporeal signification [and] the orga-
nizing principle of identity. Hence the salience of the vigor of play,
the frequency of father-child as opposed to mother-child interaction,
and the tolerance for aggression in the boy as opposed to the girl
infant . . . all contribute to development of the self defined as mascu-
line or feminine (Gagnon and Simon 2005, 23).
The assumption that the sexual is particularly located in the geni-
tals is most likely reflected in the parental anxiety about children
touching their genitals, which appears chiefly connected to masturba-
tion. Although touching the genital area might imply an enjoyable
activity for the infant, it could not be possibly similar to masturbat-
ing. Parental distress largely shows how sexual scripts concerning the
body and adult experience are applied to childrens early attempts to

learning about their own bodies because the complexity of adult
masturbation as an act is enormous, requiring the close coordination
of physical, psychological, and social resources, all of which change
dynamically after the puberty (Gagnon and Simon 2005, 10).
Scripts concerning the genital area make it appear as if the area were
truly the almost most important part of the human body. Through
adults guidance, children learn very early in their lives the allure of
mystery and the symbolism of unnamed qualities embedded in the
genitals, which is chiefly expressed in moral rather than sexual terms.
Any expression of interest or any act involving the genitals is utterly
described as dirty, bad, good boys and girls dont, and the like
(Gagnon and Simon 2005, 27). Despite some parents willing to
engage in a form of sex education, the mystery concerning the gen-
itals becomes larger and the attraction to the genitals rather intense.
This is due to the vagueness and quality of the instruction provided to
support reactions and warnings against what, in the eyes of adults,
has the look of childrens sexual interest and activity. As such, children
are usually left without a system of naming that will adequately con-
trol [their] nascent interest in [their] own or other bodies (Gagnon
and Simon 2005, 29). This nourishes their imagination, and it is not
unusual for children to assume that girls have been castrated or that
women have a penis behind the pubic hair, for instance.
The training to enforce childrens voiding and bowel control tends
to reinforce the moral view surrounding genitalia as well as the view
that the genital area is dirty. No other part of the body receives
as much attention as the genitalsthe unspeakable and untouch-
able area. Parental attempts to divert childrens attention from the
genitals and to hinder any incipient sexual activity largely result in
the development of guilty knowledge, [and] the capacity and need to
keep sexuality secretespecially from those one loves (Gagnon and
Simon 2005, 30). Silence, secrecy, and/or the use of euphemisms to
refer to the genitals, in particular, and the sexual, in general, becomes
natural and the reliance on the peer group to get sexual information
appears normal.
Th e G e ndered and S ex ual S elf i n Japan

Given that circumcision implies a gendered and sexual body, theoriz-
ing circumcision requires a review of the master narrative concern-
ing gender and sexuality in Japan. This helps highlight the ways the
bodies of Japanese men and women have been specifically scripted;
explores how the surgical procedure finds its place within the inter-
personal, intrapsychic, and cultural dimensions; and sheds light on
how removing the prepuce might impinge on the ordinary lives of
Japanese men and women.
The so-called theories on the Japanese (nihonjinron) have been
traditionally deployed to describe gender and sexual regimes in the
country: Although some analysts have challenged the validity of
Nihonjinron assertions on methodological, empirical, and ideological
grounds, the discourse has retained its popular appeal, attracting many
readers and maintaining a commercially viable publication industry
(Sugimoto 2002, 4). The theories coalesce into a master narrative
underpinned by a binary that places men and women as opposites,
which is similar to the relationship between genital confirmation and
expected demeanor expressed earlier. While girls ought to be edu-
cated to become good wives and wise mothers (rysai kenbo), the
education of boys should emphasize that men are to develop into the
house master pillar (daikoku bashira) that upholds and protects the
household, the family system, and by extension, the entire nation.
The master narrative has been profusely used to create archetypes
(Mackie 2002) that supposedly regulate gender and sexual relation-
ships and to elicit that Japanese industrialization largely hinged on
gender relationships (Ueno 2009). The relationship between gen-
der and industrialization lies on a patriarchal division of labor that
facilitated and promoted the postwar rapid economic growth (kdo
keizai seich; Kimura 2006).
The salaryman is the quintessential epitome of the Japanese
hegemonic masculinity (Connell 1995) that has transcended
domestic discussions to the point that some academic studies have
also attempted to generalize about Japanese society on the basis
of observations of its male elite sector, and have thereby helped to
reinforce this sampling bias (Sugimoto 2002, 2, emphasis added).
Despite any individual receiving a salary being, by definition, a sal-
aryman, the term within the Japanese context most likely refers to
corporate white-collar employees of private-sector organizations with
a lifetime employment and seniority-based salary.
This implies that the roles of men and women have been scripted
in line with the breadwinner salaryman and his perfect comple-
mentary (Hidaka 2010) the full-time housewife, which is a gender
relationship meant to symbolize the Japanese familial and national
level of material comfort in terms of goods and services available to
the middle class. While men are to perform the productive role in the
household, women are to execute the reproductive one. Furthermore,
the sexual has been scripted as being chiefly concerned with procre-
ation and the production of a male offspring, the eldest son (chnan)
who will be the next head of the household and who can help per-
petuate the patriarchal order.
One aspect that shows how the master narrative has become tan-
gible reality is that Japanese men are still almost completely alienated
from the home, and womens participation in society is mostly con-
fined to homemaking with restricted access to paid work. Statistical
analyses suggest that in the 1990s, an increasing number of married
women started working outside the home, but they were still almost
fully in charge of homemaking and childrearing because Japanese
men spent only twenty minutes a day on housework even when their
wives worked (Tipton 2008, 227). Recent surveys show that the
imbalance has not changed. Japanese men and women who work full
time spend 30 minutes and 3 hours doing housework, respectively
(The Economist 2011). Most recently, the Ministry of Health, Labour
and Welfare (MHLW; 2013) acknowledges that less than 2 percent of
working men take child-care leave.
C u r re nt G ender and S ex ual Dynami cs

The master narrative is insufficient for explaining current gender
and sexual dynamics that have been dubbed as the gender panic in
twentieth-century Japan (Kinsella 2012, 72, original emphasis). The
regime based on the dyad breadwinnerfull-time-housewife does
not fully represent contemporary gender relationships. An increasing
number of women having access to tertiary education and full-time
jobs are meant to be a major factor that has triggered changes in the
gender regime: While the proportion of men channeled into irregu-
lar employment increased steadily in the 1990s, reaching 14.8 per-
cent by 2002, women fully absorbed a greater part of the growing
demand for cheap and flexible irregular employment50.7 percent
of all female employment was irregular by 2002 (Kinsella 2013, 5).
Such gender dynamics seem to have exacerbated the negative impact
of the so-called Lost Decade that has persisted for more than twenty
years and refers to a sense of collective sociocultural uncertainty and
anxiety combined with a stage of financial crises, corporate restricting,
and increasing unemployment rates (Shimokawa 2006). Following
Dasgupta (2009, 90), the Lost Decade of the 1990s . . . represents
a socio-economic and cultural watershed in Japans contemporary his-
tory and has a bearing on any discussion of masculinity and mens lives
in Japan today.
Increasing rates of singleness, divorce, postponed or refused mar-

riage, and childlessness indicate as well that the master narrative does
not reflect accurately shifting gender relationships in Japan that could
place social, political, and economic stability at risk (Rebick and
Takenaka 2006). Overwhelming feelings of anxiety have been trig-
gered by a crisis of ultra-low fertility rates (Jones, Straughan, and
Chan 2009), which might represent a financial collapse in the 2040s
because the working-age population in 2050 could be 17 percent less
than that in 2005 (Japan Centre for Economic Research 2007). Con-
servatives insist that the crisis is largely caused by unpatriotic and
selfish women who opt for a career and neglect childrearing as well
as homemaking (Holloway 2010).
Younger women delaying marriage and having fewer children, or
staying away from these two activities altogether, does not necessarily
imply that marriage has lost social significance, however. Ethnographic
and sociological research make it evident that during the 1970s and
1980s, women postponed or rejected marriage because they could
not find a husband with the three Hs: high income, high education,
height (kgakureki, kshyny, kshinch). Nowadays, women wait
for the appropriate person while working (Nakano 2011). Such an
appropriate person is a man with the three Cs: comfortable income,
communicative, and cooperative with housework and childcare (kai-
teki na, rikai shiaeru, kychteki na; Ogura 2003). Against the script
that encloses the sexual within the bounds of reproduction, waiting for
the appropriate man does not entail womens celibacy and/or sexual
abstinence. Media and academic surveys have successfully produced
the image of the so-called sexually liberated women (Kinsella 2012).
Young women tend to distance themselves from the script associated
with ladylike cultivation (McVeigh 1997), which is deeply rooted in
the ideal of the good wife and wise mother. Young women appear
closer to the image of the sexually unrestrained bad girls (Miller and
Bardsley 2005), who are rather tolerant of divorce and premarital sex
(Muta 2008; Okano 2009) and even more sexually active than their
mothers and grandmothers.
The master narrative is equally insufficient for explaining gender
and sexuality issues of Japanese men nowadays. Against the homog-
enizing view of masculinity centered on the figure of the male elite
sector alone, academics and activists have put in effort to dislocate
the salaryman doxa (Roberson and Suzuki 2003) and highlight
how issues of diversity and hegemony exert influence on the ways
Japanese men perform their gender and sexual identities. Taga (2005)
presents a succinct historical review of the debates involving maleness
in Japanese mass media and academic reports in which he identifies

three main areas of concern. First, the so-called mens studies revolves
around issues of masculinity and femininity in relation to the divi-
sion of labor and underscores that the gender regime, which was
instrumental in bringing about development, financial stability, and
economic growth after the Second World War, has been singled out
as a leading cause of inequality and discrimination in labor policies.
The second area of concern lies with the identities of retired men
who, after devoting their lives to the corporate world, realize that
they are almost like strangers at home. They are most likely the
breadwinners who provided for the household but whose dedication
to their companies deprived them of daily interactions with their fami-
lies. These men are late to middle aged and are grappling with their
second life and what their family members think of them as heavy
wet leaves (nure ochiba) or large-size refuse (sodai gomi) (Alexy
2007, 171). As It (2005, 151) puts it, [T]he loneliness faced by
male seniors living on their own points to the fact that men, having
thought of themselves as working beings (shigoto ningen) are unable
to function effectively as lifestyle beings (seikatsujin).
The third and most worrying area pertains to issues related to
the younger generation of men that the mass media in particular has
depicted as failures. Different from their grandparents who rebuilt
the nation after the war and their parents who conducted the country
to rapid economic expansion, younger Japanese men have failed to
cope with the current recession in the economy as well as the political
and demographic conundrum.
The mass media has produced the iconography of failing Japanese
men as a completely devastated samurai who is pushed around by a
little woman (see Munoz 2010). Fujimura (2006) holds that younger
Japanese men are dismantling masculinity, which has brought about
societal despair and uncertainty about the future. This is because the
master narrative and ideology concerning the salaryman has become
obsolete.
The future looks particularly uncertain when considering that
young Japanese men fail to fulfill their expected roles in terms of
labor, gender, and sexuality. There is some gender dissonance because
traditional scripts do very little to explain the behavior of young
men who fail to become regular employees (Mathews 2004, 132,
emphasis added) and remain as freeters (furt) or temporary and/
or casual employees. This employment situation prevents them from
turning into the so-called master pillar and to provide for and support
the household, as well as the social, political, and financial system. As

Cook (2013, 40, emphasis added) puts it,
The desire to marry was, however, a critical part of freeters decisions

as to just how far, and how long, they would pursue their personal
aspirations before resigning themselves to giving up and pursuing a
more stable path. Most of the men I knew clearly ascribed to the ideol-
ogy of being the provider and they sought to achieve, or felt that they
needed or were expected to at least strive to achieve a stable job with a
stable salary. Many felt that marriage would be impossible without such
financial stability and the women/girlfriends in their lives concurred:
women wanted and expected their future husbands to be providers,
as a result of both their own precarity in the labour market and their
continuing expectations related to marriage and motherhood. This sig-
nificantly contributed to a freeter-failure dilemma where men expected
to fail.
Furthermore, younger Japanese men have become bodies that mat-

ter (Butler 1993) as they fail to keep a manly appearance and the fri-
volity of cosmetics and fashion that adorn their bodies make them look
fragile and girlie (Demetriou 2008; The Yomiuri Shimbun 2010).
Contrary to traditional views on Japanese masculinity, the male body
has become an area of concern: Terms such as herbivorous boys,
bento boys, sweets boyswhich are far from traditional images of
how men should behave taken firm root in the Japanese language.
They have attracted attention of foreign media as well as businesses,
which have scrambled to develop products that appeal to this expand-
ing demographic of young men cultivating their softer sides (Saito
and Shima 2009). Finally, another issue revolves around sexuality. It
is a rather serious concern in times of low birthrates because the term
herbivorous boys (sshokukei danshi) is also used to ridicule and dismiss
their lack of carnal desires and appetites (Kitamura 2011). This is
taken as an indicator of their failures as sexualized beings.
Th e Bo dy and the New Bi nary

Despite true masculinity [being] almost always thought to proceed
from mens bodies (Connell 1995, 45), the legacy of the salaryman
doxa has made the male body socially almost unnoticeable. A salaryman
largely embodies an academic achiever whose position in society mir-
rors his intelligence and efforts to attain good grades at schoolthat
is, an educated citizen (Castro-Vzquez 2013d) whose position in
society and whose quality of life, in general, depends on his academic

certificates. Studies on the male body in Japan are still rare because
the salaryman most likely pertains to an ideal of masculinity repre-
sented by mental work, academic achievement, and disembodiment.
Moreover, the idea that the average Japanese man has an appetite for
work (nihon no heikinteki na dansei wa shigoto nesshin desu; Shibuya
2009, 43) has resulted in a male body that has been scripted in line
with the salaryman ideal and a research agenda that has been chiefly
concerned with the sedentary lifestyle and mental exhaustion entailed
in an environment of office work and mind-oriented labor conditions.
The male body in Japan has been profusely identified as a medical
concern. The body of the salaryman entails an example of medi-
calized masculinity (Rosenfeld and Faircloth 2006) that places the
body within a medical definition and regulation. This includes a litany
of conditions affecting Japanese men: [H]eadaches from hangovers
and a weakened liver from drinking too much, hemorrhoids and stiff
shoulders from sitting at his desk for too long, stomach ulcers from
irregular diet and stress (Dasgupta 2013, 2). As Kawanishi (2009,
3839) contends, the most stereotypical reading of the Japanese male
body represents an individual constantly deprived of sleep because he
was on call around-the-clock and/or who literally works himself to
deatha death that has been technically classified as karshi and is
caused by overwork or job-related exhaustion. More recently, obesity
and being overweight have entered the list of body conditions and, in
2006, the MHLW reported that of men aged between 40 and 74, one
out of two suffer from the so-called metabolic syndrome (visceral fat
syndrome; Ministry of Health, Labour and Welfare 2011c).
An investigation of bald Japanese men offers a reading of body
image and identity that does not challenge the medical view. Mens
shame over loosing hair and their attempts to hide bald spots are
linked to middle-age crisis. The medical and beauty industries offer a
range of solutions and make Japanese men believe that their gen-
der identity and chances to be liked depend on their hair. This of
course helps reproduce stereotypical images of what a masculine man
is (Sunaga 1999). Shibuya (2009) presents a compelling view of issues
that worry Japanese men nowadays. Particularly relevant to this book
is her argument on the commercialization of circumcision and the
influence of the Japanese beauty industry in creating a niche mar-
ket that anchors the gender identity of young men to their genitals.
This could be located within current tendencies among young men
to enhance their status as objects of aesthetic and sexual appraisal
(Miller 2006, 126). Different from the traditional view that tends to
medicalize the male body, the recent emphasis on externalization

of personal or social identity has given birth to new business that sell
beauty products and services to those wanting to change or upgrade
their appearance [ . . . ] These efforts at body and beauty transforma-
tion suggest that the ideological sphere of reference of masculinity
has widened to include a greater diversity of physical styles. In other
words . . . male beauty practices [are not seen] as a type of feminiza-
tion of men, but rather as a shift to beautification as a component of
masculinity (Miller 2006, 126, emphasis added). This idea of body
change and improvement is crucial in understanding the biomedical-
ization of the prepuce in Japan.
The relationship between sexuality and masculinity has been
chiefly explored from the vantage point of homosexuality (see, for
instance, Lunsing 2005; McLelland 2005). However, the literature
also includes a historical assessment of the meaning of male virginity
in Japan (Shibuya 2003). In retrospect, looking at the ways attitudes
toward virginity have changed suggests that while the male body has
been desexualized, the female body has been sexualized. During the
1920s, virginity before marriage was equally important for men and
women. Nevertheless, during the 1960s when the idea of the sexu-
ally active woman became apparent, the number of virgin men and
women, increased and decreased, respectively. By the 1970s, male vir-
ginity as synonymous with failed masculinity was conspicuous.
More recent inventories on sex behavior seem to confirm that
women have turned into sexual beings. Young women appear
equally or more sexually active than young men (Nihon seikyiku
kykai 2007). Nowadays there is a perverse and even voyeuristic
interest in the seeming increase in young Japanese women who are
popularly and collectively referred to as girls (gyaru) and who insist
on becoming sexually and financially independent (Kinsella 2013).
Young women tend to contest the master narrative by neglecting
and/or delaying becoming the good wife and wise mother that the
society needs to support the development of the Japanese economy.
This has led to a new master narrative grounded in the gender binary
failing men versus sexually active women. While failing men
eat grass and have an asexual body, sexually active women eat
meat and have a sexualized body:
The panic in Japan over the emergence of grass-eating or herbivorous

men (sshokukei danshi) . . . suggests that young men may be rebel-
ling. . . . The term was coined to indicate the opposite of carnivo-
rous women (nikushokukei joshi), women who actively seek adventure
and career success. Viewed as single men in their twenties and thir-
ties who may live with their parents, enjoy homemaking, and do not
smoke, drink, or maintain the slovenly rooms associated with bachelors,
they exhibit little interest in sex, romance, or corporate advancement.
(Bardsley 2011, 133, emphasis added)
This new binary is important to understanding how circumcision has

been socially and medically defined and commercialized in Japanese
settings.
M e a nings and Representati ons

Against this background, the research I present here on circumcision
in Japan started by exploring the cultural dimension underpinning
the practice through media as well as medical and academic reports
because these are the main sources of information for those consid-
ering the procedure. Pediatric circumcision has never been medical
routine, and thus it is still uncommon; however, adult circumcision
is largely a cosmetic intervention that commonly occurs at beauty
clinics.
The social semiotics of gender (Connell 1995) is an effective
heuristic device to analyze the ways circumcision is presented on Japa-
nese websites, in newspapers, and magazines, as well as in medical,
sociological, and anthropological accounts in the English and Japanese
languages from 2000 to 2012. Although the social semiotics of gen-
der help challenge biological determinism by providing the endless
play of signification, the multiplicity of discourses and the diversity of
subject positions (Connell 1995, 165), this does not lead to unex-
plained voluntarism. I see iconographies as forming and formed by
structures that have historical roots, thus the importance of looking
at representations through a specific Japanese cultural dimension. In
this light, pragmatism in semiotics (Jensen 1995) is instrumental to
theorizing the social meanings attached to circumcision in order to
explore how gender and sex-related scripts are a fundamental element
in the perception and cognition of circumcision in Japan.
A pragmatic view of semiosis implies that signs are always an inte-
gral element of all human perception and cognition. I see signs always
intertwined in all thinking processes that involve social life, cultural
production, and material practice. I thus understand signification as
an incessant process that brings a sense of direction to human cogni-
tion and action, which means that signs are always the basis of any
form of interaction between human beings and their natural as well as
cultural environments. Nevertheless, signs that represent circumcision

are only supposed to be a kind of social action, because [r]epresen-
tation, then, may be neither a privileged nor a bankrupt attempt at
contemplating truth, but an act for a purpose in a context. Pragmatism
further holds that signs, whether representations or other communi-
cative forms, do not provoke a response in any behaviorist sense, but
may produce a predisposition to act. Signs present potential courses
of action (Jensen 1995, 11, emphasis added). In this light, I did not
see representations of circumcision as predisposing Japanese men and
women to any form of action. Representations are symptoms, not
portraits (Goffman 1976, 8). They are an element of the cultural
scenarios that allow a reading of the implications of being circum-
cised for the male and the female bodies. Representations offer broad
epistemological guidance to knowing the advantages and disadvan-
tages of having the prepuce removed, which might have an effect and
ignite a course of action. However, such action is always negotiated
through social interaction and evaluated in line with a cultural sce-
nario or institutionalized forms of semiosis that are designated as
suchritual, religion, and cultureand through which societies think
about themselves (Jensen 1995, 12).
Although a cultural scenario exists, I do not see meanings attached
to circumcision as ontologically fixed. The circumcised penis is a dif-
ference that makes a difference (Jensen 1995, 12), and such difference
can be understood only in relation to the meaning embedded in the
uncircumcised penis. Meanings unmistakably lead to questions pertain-
ing to the social construction of circumcisionthat is, knowing how far
representations make reality and how far they reflect a reality people
already assume, and into the complex interplay between the real and
the fictive (Goffman 1976, viii). In this light, the core assumption
was that representations of circumcision in Japan become real as long
as Japanese men and women define representations as real because
they are real in their consequences (Jensen 1995, 12, emphasis added).
Ta l king abo ut Circ umci s i on

In investigating the consequences that make representations of cir-
cumcision real, my research has drawn on the viewpoints of a group
of Japanese men and women, urologists, plastic surgeons, and moth-
ers through a series of semistructured interviews. Finding Japanese
men and women willing to talk about circumcision, however, was an
issue due to the ingenuous assumption that we were going to dis-
cuss a medical procedure and its implications in terms of health
and disease. The truth is that, outside a hospital environment, daily

conversations about male genitalia are rather infrequent except for
jokes and dirty talk (shimoneta). It largely became evident that a con-
versation that involves the genital area was problematic because, as
previously discussed, the area has been socially and culturally scripted
to mark the gender and sexual categories underpinning the differ-
ence between women and men (Jackson 1999). Different from an
online consultation that facilitates anonymous communication (see,
for instance, Chiebokuro 2012), a face-to-face conversation about
circumcision was an issue that challenged conventions of modesty,
decorum and morality (Jackson and Scott 2010b, 115).
Historical research suggests that a code of civilized morality per-
vades any form of conversation related to the sexual in Japan. Such
a code implies that any form of sexual behavior outside the bounds
of male-female marriage should be dealt with silence or euphemism
(Pflugfelder 1999, 8, emphasis added): In the civilizing process,
sexuality . . . is increasingly removed behind the scenes of social life
and enclosed in a particular enclave, the nuclear family. Likewise, the
relations between the sexes are isolated, placed behind walls in con-
sciousness. An aura of embarrassment . . . surrounds this sphere of life.
Even among adults it is referred to officially only with caution and
circumlocutions. And with children, particularly girls, such things are,
as far as possible, not referred to at all (Elias 1994, 148). A civilizing
process involves the promotion of bourgeois values and a culture of
pretense that brings about a sense of conventional respectability and
contributes to the colonization of the human body. Colonizing the
body implies the construction of a wall between people (Elias 1994,
138); a wall that creates a sense of privacy and an idea of an inviolable
self surrounding the human body. It is a frontier between one body
and another that becomes larger with age, is particularly relevant for
women and children, and has three major implications. First, the geni-
tals are a central element to construct a barrier between individuals;
second, sexual acts require greater privacy [; and third,] the sexual
realm [can no] longer be discussed so openly in polite society (Jackson
and Scott 2010b, 53, emphasis added).
It is difficult to understand why and how notions of guilt and dirti-
ness might influence the ways Japanese people learn and talk about the
sexual in general, because social imagery shows that Japanese society
is sexually unrestrained due to four major factors. First, the well-
known and huge Japanese pornographic and prostitution industries;
second, the sexual expressions during the Edo period (16031867),
such as shunga (erotic art expressed in woodblock print format); third,
festivals such as Hnen Matsuri (one of the fertility festivals where

there is plenty of visual evidence of penises); and fourth, the legacy
of the Foucauldian notion of ars erotica (the oriental knowledge of
sensual pleasure; Foucault 1990).
Allison (1996) presents a historical gaze to acknowledge how a
civilizing process was incorporated into the daily interactions of
Japanese people. A key element in her analysis is the notion of the
western perception of Japanese primitiveness (Allison 1996, 163,
emphasis added), which can be seen in dramatic traditions and reli-
gious art works exhibited, for instance, at shrines. Such primitiveness
entails fertility gods and images with exaggerated genitalia, sexual
characteristics, and breasts that make Japan appear as a paradise of
nudity, rudity and crudity (Dore 1958, 159).
Against this background, and in an almost palpable effort to erase
the uncivilized portrait that would help promote Japans identity as
a credible and modern nation,
the Japanese state outlawed bodily exposures (i.e., nursing in pub-

lic, mixed public bathing). In part, acquiring such an identity meant
adopting western standards for corporeal deportment. In part as well,
it meant developing a notion of the public as a terrain that is monitored
and administered by the state. Thus the behavior of the Japanese, as
state subjects, in this terrain is regulated and surveilled. Stemming from
both these impulses, a concept of public morals was formulated, and
based on such rulings as that in 1900 banning any subject matter con-
sidered injurious to public morals regardless of the intent of the artist
or author. (Allison 1996, 163)
Censorship is still enforced and mirrored in contemporary laws on

obscenity that forbid any display of the genital area. The use of the
mosaic censor (mozaiku) is mandatory in movies and any form of
artistic work to hide any bodily and sex expressions that might be
against public morals. Civilized morality is also reflected in sex-
ual scripts for women and children, in particular. Expressing an open
desire to know about and/or to discuss sex and genitalia in public
is utterly problematic because it contradicts the charm, mystery, and
immaculacy expected from feminine women and innocent children.
As Jackson (1999, 78) elaborates,
[P]art of the allure of femininity is sexual unattainability, which depends

on women projecting themselves as attractive but not available. Here
there may again be a connection between women and children. Both
are seen as requiring protection from the sexual. Both, of course, are
vulnerable to sexual coercion, but it is not this, but sex itself, which
is seen as potentially damaging to them, as somehow degrading and
defiling them. In maturing to adulthood, men are expected to become
sexually active, women to become sexually attractive. To be too active
would destroy the allure and mystery of femininity and the childlike
innocence which is paradoxically part of it. But while children are not
supposed to be sexual women are expected to express their sexuality
only within certain boundaries.
It is not difficult to identify such mystery of femininity in the Japanese

master narrative as it largely refers to attitudes and the lifestyle embed-
ded in ladylike cultivation (McVeigh 1997) or the Cinderella-like
ideal that Japanese women are supposed to draw on to lead their
lives. Popular dramas such as Last Cinderella (Rasuto Shinderera;
Tanaka, Hirano, and Sekino 2013), which was screened in 2013,
masterfully illustrates how social imagery remains alive and well. The
drama suggests that the narrative of the sexually attractive woman is
still a lifestyle guide for some Japanese women, in opposition to the
infamous bad girls [who] create and consume the sexually explicit
(Miller and Bardsley 2005, 7) and the girls (gyaru) who challenge
notions of girlhood, sexuality and independence (Kinsella 2012,
70).
Childrens innocence, on the other hand, could be nicely expressed
by the saying nemureroko o okosu mono dearu, literally meaning an
issue that wakes up sleeping children (a close expression in English
is the proverb Let sleeping dogs lie). Although the saying under-
pinned former purity education (junketsu kyiku; see, for instance,
Motegi 2013), it still appears as the tenet of current school- and home-
based sex education: It is better not to make a big hassle, because
children, as innocent beings, will learn about sex when they wake
up . . . it is better to keep them quiet to avoid unwanted troubles
(Castro-Vzquez 2007, 33). The most recent official surveys suggest
that sex- and genitalia-related conversations are unlikely to occur at
home or school, which means that young Japanese people most likely
rely on the Internet, mass media, and their peer group to gain infor-
mation about sexuality (Nihon seikyiku kykai 2013). Similar to the
theorizing of Gagnon and Simon (2005, 2930), Japanese children
develop guilty knowledge very early in their lives, create a secret
society to keep their sexuality secret, especially from parents, and
get most sexual information through peer relationships.
Contrary to any form of biological essentialism, Japanese men

and women tend to learn that desires and pleasure are at all times
embodied and presuppose interpretative social interaction. This
means that sexual embodiment can neither be thought of as an
abstract potentiality outside the social spaces where it is lived, nor as a
mere assemblage of organs, orifices and orgasms (Jackson and Scott
2007). Furthermore, despite the so-called sexual revolution and our
supposedly permissive society, Japanese men and women still learn
taboos associated with genitalia and sexuality before they are made
aware of the scripts within which they operate (Jackson 1999, 53,
original emphasis).
P ro c edures
Despite the difficulties I had in finding participants, a snowball tech-
nique generated a sample of 26 adult Japanese men who voluntarily
agreed to participate in the research. I did not have particular criteria
for selection: any Japanese man willing to join the project was accepted
and approached through e-mail or personally introduced. Although I
did not directly ask about circumcision-status and sexual preferences,
three men acknowledged being circumcised, eight reported that they
were homosexual, and one, bisexual. A total of 12 were undergrad-
uate or graduate students at universities in Ibaraki or Nagoya, and
14 were either blue- or white-collar workers based in Tokyo. Eight
were married and the rest were single. Their ages ranged from 18 to
45 years. A circumcised Japanese man who is my acquaintance intro-
duced the first participant. Finding Japanese women to participate in
the study was even more problematic, but again, a snowball technique
generated a sample of 13 Japanese women who voluntarily agreed to
participate. As in the case of the men, any Japanese woman willing to
join the project was accepted. Aged from 18 to 26 years old, partici-
pants were single, undergraduate or graduate students at universities
in Tokyo, Ibaraki, or Nagoya. All participants had started their sexual
lives and seven of them had boyfriends (tsukiatte iru hito). One of my
Japanese acquaintances introduced the first participant.
I also interviewed 14 Japanese male physicians to explore how
medical knowledge was related to gender and sexuality in their points
of view concerning circumcision. Four of the doctors were urologists
working at public hospitals, and ten were cosmetic surgeons at pri-
vate clinics in Tokyo. While urologists were contacted through their
electronic address available on the Internet, cosmetic surgeons were
recruited through a snowball sampling process. A male acquaintance
of mine, who is circumcised, introduced the first cosmetic surgeon.

Although the urologists were eager to offer their opposing views on
the matter, finding cosmetic surgeons was a problem due to their
hectic schedules. Finally, to investigate issues concerning pediatric cir-
cumcision, twenty Japanese mothers who had given birth to at least
one baby boy voluntarily agreed to participate in the project. They
were also acquired through a snowball technique. A Japanese mother
who is a friend of mine introduced the first participant. Aged between
30 and 47, they were married mothers in Tokyo, all of whom, despite
introducing themselves as full-time housewives, have done, or cur-
rently do, part-time jobs to support the family income. Eleven of
them hold a university degree, and nine graduated from two- or
three-year colleges (tanki daigaku). Their sons ages ranged between
4 and 15 years old, and none of the mothers reported having had
them circumcised. However, seven of the mothers have grappled with
their sons penile infections.
I collected data through 26 individual, semistructured, in-depth
interviews with the male participants that lasted approximately
120 minutes each. I interviewed each participant once because some
of them could not accommodate a second appointment. In the case
of the young women, urologists, plastic surgeons, and mothers,
I interviewed each participant twice. I collected data through a set
of two, individual, semistructured, in-depth interviews that lasted
approximately 60 minutes each. With the agreement of the partici-
pants, interviews were fully recorded and conducted in Japanese.
In case I interviewed the participant twice, I explored the contents
of each interview twice. After listening to the recordings of the first
interview, I scheduled a second encounter to expand on insufficient
and/or unclear responses in the first interview. In line with the Ethics
Approval granted by Nanyang Technological Universitys Division of
Sociology ethics committee, participants received a complete expla-
nation of research objectives and methods as well as the assurance
that all information granted would be treated confidentially and only
included as data in published academic manuscripts. To protect their
privacy, all information that could cause personal identification was
deleted or changed. In this book, I use pseudonyms to identify the
participants. All the interviews were conducted by myself, a midfor-
ties, Mexican, male scholar.
Each participant received 1,000 JPY (about 10 USD) as financial
incentive. This, of course, did not compromise the right to terminate
participation at any stage or to skip any question that could create
discomfort. Interviews took place in an isolated area of a coffee shop
or university classroom to prevent incomplete or biased informa-

tion due to the presence of people around who could listen to the
conversations. When the meeting took place in a coffee house, the
interviewer paid for the refreshments. I interviewed the urologists and
cosmetic surgeons at their place of work and they did not accept any
remuneration.
In every case, the interviews largely revolved around three main
areas concerning circumcision: knowledge, gender, and sexuality.
Particular emphasis was placed on the implications of the surgical pro-
cedures for the male and the female body. Nonetheless, topics were
not presented in a fixed order; rather, they were introduced when
appropriate in the course of conversation. To support the partici-
pants and to keep the conversation going in the event the interviews
themselves became highly disquieting and emotionally charged, the
respondent was allowed to define how far certain experiences should
be talked about, and alternative sources of information and support
were suggested when they appeared appropriate.
I started the analysis by transcribing the interviews with pauses,
interruptions, and hesitations marked but not measured. Next, data
were evaluated to confirm initial assumptions and concepts to explain
the interview contents. This generated a series of major ideas and
themes that were classified by using key and subsidiary code. The
Ethnograph (Coffey and Atkinson 1996) computer program was
instrumental in the process, as it permitted assigning codes to the
transcripts and identifying every segment of script that had the same
code while still being able to know the origin of each segment. Fol-
lowing that, systemic networks (see Halliday 1975; Bliss, Monk, and
Ogborn 1983; Kress 1976) were used to examine the data. Networks
are a linguistic technique useful for organizing and categorizing quali-
tative data. This permitted me to preserve and represent some of the
original quality of the data and to translate the language of the inter-
view transcripts into the language of the theory through an interactive
process of induction and deduction.
In line with the iconographic analysis of circumcision, I did not
regard interview transcripts as straightforward representations of
reality. I saw transcripts as accounts of life or an element of the
life history (Plummer 1995) of the interviewee involved, which
implies life story actions around lives, events and happenings [to be
analyzed] neither on the solitary individual life (which is in principle
unknown and unknowable), nor on the text (which means nothing
standing on its own), but on the interactions which emerge around
story telling (Plummer 1995, 2021, original emphasis). In this light,
the meanings taken from each account were clearly disclosed because
[t]he meanings of stories are never fixed but emerge out of a cease-
lessly changing stream of interaction between producers and readers
in shifting contexts. They may, of course, become habitualized and
stable; but always and everywhere the meanings of stories shift and
sway in the contexts to which they are linked. [Moreover] stories do
not float around abstractly but are grounded in historically evolving
communities of memory, structured through age, class, race, gender
and sexual preference (Plummer 1995, 22, original emphasis). In
addition, my theorizing of circumcision was largely supported by the
framework of a feminist social theory to help create knowledge useful
for transforming gendered injustice and subordination (Ramazano-
glu and Holland 2002, 147). Although I had a clear intention to offer
a gendered view of circumcision, I did not attempt excluding, silenc-
ing or marginalizing significant divisions between women [and men
and/or privileging] gender over other differences . . . [such as] racial-
ized power, heterosexism, the effects of capitalism or disability . . .
[because] gender relations are difficult to separate in practice from
other power relations (Ramazanoglu and Holland 2002, 147). I saw
the consequences of circumcision on the lives of Japanese men and
women presented in the interview transcripts through the intersec-
tions of three major sources of power relations: knowledge, gender,
and sexuality. Thus my data analysis largely revolved around the inter-
section among the three sources of power relations and the surgical
procedure.
Against this background, I understood current gender relations in
Japan as hierarchically constructed power relations that influence the
daily interactions of men and women. Therefore, gender relations were
critical to understanding the social implications of circumcision. Such
relations have been constructed through history, within and between
cultures, and in entanglements with knowledge and sexuality (which
are other forms of power). I regarded sexuality-concerned power rela-
tions and sexual beliefs and practices, specifically those involving male
genitalia, as cultural constructions. They entail scripts that largely help
sustain the conventions of heterosexuality. Sexual beliefs and practices
are an integral component of the regime of normality (Segal 2001)
that has contributed to the unequal distribution of power that largely
results in the subordination of women and the supremacy of men.
However, I saw masculinity and femininity as opposites in coalition
[as they both conflate to produce an] understanding of contemporary
heterosexuality as inherently and unnaturally masculine (Holland et
al. 1998, 29, original emphasis). The power of heterosexuality thus,
together with the patriarchal regime it sustains, revolves around its

integration into the interpersonal, intrapsychic, and cultural dimen-
sions that result in a master narrative where heterosexuality appears as
normal or obvious (Epstein and Sears 1999).
Following Weeks (1986), I read the sexual as a private and public
phenomenon that is intimately personal but at the same time regu-
lated by laws of the biological and cultural. The sexual is also socially
constructed but organized and institutionalized; it is indeed the prod-
uct of fantasy, individual agency, and resistance. Furthermore, to make
aims, assumptions, politics and ethics clear and justifiable (Ramaza-
noglu and Holland 2002, 148), my research of circumcision in Japan
revolved around a notion of justice that, rather than focusing on
distribution, a conception of justice should begin with the concepts of
domination and oppression. Such a shift brings out issues of decision-
making, division of labour, and culture that bear on social justice but
are often ignored in philosophical discussions concerning justice
(Young 1990, 3).
Co nc lusio n
In attempting to theorize circumcision, the relevance of the construct
of sexual script becomes apparent. Understanding circumcision in
Japan revolves around an investigation of the interpersonal, intrapsy-
chic, and cultural dimensions that allow for a reading of the symbol-
ism and social implications of a minor surgery performed in a major
organ. Looking at the scripts underpinning circumcision sheds light
on the social processes that make the surgery an integral element of
everyday interactions and learning processes involving the sexual and
gendered body.
Disentangling the symbolism embedded in circumcision required a
thorough consideration of what the anatomic confirmation of a child
as boy or girl entails because it turns into the earliest reading of the
body as a sexual and gendered self. Anatomic confirmation results
in different cultural scenarios and behavioral assumptions that largely
translate into parental guidelines of how to rear a child. A major
implication for an investigation of circumcision is that such anatomic
confirmation makes the genital area appear as if it were almost the
most important part of the body and the genitals as the origin of the
sexual.
These implications are largely mirrored in the preoccupation about
how to divert childrens attention away from their genitals to avoid
any form of precocious sexual activity. It is not unusual then that
the earliest forms of sex education encompass an assortment of moral

warnings that leave children unable to understand their curiosity
about their own and other bodies. Such warnings, together with the
efforts to train childrens sphincter control, make the genital area
seem dirty, unspeakable, and untouchable, as well as cause remorse
and guilt in those willing to know about it. Any form of information
concerning the genitals has to be kept in secret or referred to by using
innuendos and euphemisms.
This research, to explore the particularities of circumcision in
Japan, required a review of the ways in which the gendered and sexual
self has been constructed in Japanese society. Traditional views about
gender and sexuality are nicely depicted in the theories on the Japa-
nese that present men and women as opposites. The theories entail
a master narrative that elicits a regime of gender underpinned by men
performing the role of breadwinners and production in opposition to
women, whose main role revolves around homemaking and reproduc-
tion. The gender regime has usually been expressed in terms of the
salaryman and full-time housewife relationship. In this light, the
sexual has been largely concerned with reproduction and the preser-
vation of the household through patrilineal relationships.
Nevertheless, the traditional master narrative proves inefficient for
explaining current gender dynamics in Japan. The idea of becoming
a salaryman and the main breadwinner for the household appears
unappealing to young Japanese. Social imagery suggests that they
are failures unable to perform their expected roles. Women, on the
other hand, are not complying with their reproductive roles and are
not willing to become full-time housewives either. They are girls
looking for financial independence and sexual freedom. Current gen-
der dynamics are depicted thus in terms of the binary failing men
versus sexually active women. Such a binary is particularly relevant
in understanding the ways circumcision is promoted and commercial-
ized in Japanese settings.
A close inspection of the ways the sexual has been scripted and inte-
grated in daily interactions is relevant to investigating circumcision
in Japan. Contrary to the idea of a sexually unrestrained and liberal
society that is conveyed by Japanese popular festivals, pornography,
prostitution, religion, and artworks, civilized morality pervades com-
mon sense and, in line with Gagnon and Simons theories (Gagnon and
Simon 2005), Japanese people are unable and/or unwilling to engage
in conversations that involve the genital area. Guilty knowledge and
censorship concerning the sexual are so ingrained in daily social inter-
actions that talking about circumcision becomes challenging.
Nevertheless, ethnographic research to explore the viewpoints of

Japanese men and women was possible, and the rest of the book pres-
ents various aspects concerning the ways the surgical procedure has
been integrated into the intrapsychic and interpersonal dimensions
of a group of men, women, cosmetic surgeons, urologists, and moth-
ers in Japan. An accurate reading of the ethnographic data requires,
however, a comprehensive understanding of the cultural dimension
underlying circumcision. The next chapter helps uncover this cultural
dimension by providing an iconographic and textual analysis of the
information available on the Internet and in academic and mass media
reports for those willing to have the prepuce removed.
4
Chapter 2
A Cosmetic Surgery
There is a concern that men cannot mention to anyone.

(Ueno Clinic 2010)
M edics and academics who have conducted research on circumci-

sion might find this statement, which was taken from an advertise-
ment to promote a surgical procedure, rather awkward. What is the
concern that men do not want to talk about? Certainly, bringing
up the condition of ones foreskin as a topic of conversation could
be a bit unusual if it is not within a religious or medical context.
Removing the foreskin has been chiefly considered as a deed of faith
or as a prophylactic measure. Thus it is rather intriguing and there-
fore requires academic investigation into the social processes that have
made circumcision a concern that cannot be mentioned to anyone.
In understanding the mystery and secrecy underpinning circum-
cision in Japan, it is important to highlight that Japanese circumci-
sion is largely concerned with adults and is most likely undertaken by
cosmetic surgeons. Despite circumcising adults being internationally
endorsed as preventive action against the transmission of HIV among
heterosexual couples, this is certainly not the case of Japan, where the
procedure is considered cosmetic surgery.
Against this background, the aim of this chapter is twofold: first,
to shed light on the cultural and structural dimension supporting cir-
cumcision in Japan and second, to disentangle the master narrative
the beauty and aesthetic industry deploys to commercialize the surgi-
cal procedure. At a structural level, it is relevant to underscore that
pediatric circumcision has never been routinized, which has two major
consequences. As will be discussed in this chapter, it is unlikely that
the NHI can be used to pay for the surgery, and no accurate records
of circumcised males exist. Being a cosmetic procedure, prices are
unregulated and the minor surgery becomes expensive.
As Japanese men are largely circumcised at beauty and aesthetic
clinics, this chapter offers an iconographic and textual analysis of the
information that Japanese men can access to decide whether they want
to be circumcised. The analysis is grounded in four axes: knowledge,
the body, gender, and sexuality. In approaching knowledge, a major
issue revolves around language availability, as linguistic nuances and
inaccuracy make it difficult to understand what circumcision entails
and when and how the prepuce should be removed. Although the
procedure has largely become a niche market for cosmetic surgeons,
urologists tend to oppose the practice and suggest nonsurgical proce-
dures when the prepuce might turn into a source of disease.
The success of the marketing concerning circumcision strongly
relies on the script that the gender and sexual identity of Japanese
men lies in the genitals. The medicalization of the procedure lies in
the psychological trauma, which is caused by mens dissatisfaction
with the size and shape of the penis. Removing the foreskin could be
an effective method to cope with two diseases affecting men: erectile
dysfunction (ED; bokki shgai) and premature ejaculation (PE; sr).
Circumcision becomes biomedicalized, as it represents a promise of
sexual enhancement.
A D ebate o f Po l ar E x tremes
Historical records indicating when exactly the knowledge and practice
of circumcision entered Japan are practically unknown. A religious
origin of the practice, however, is unsustainable because Judaism and
Islam are not particularly conspicuous in the archipelago. Religion
in Japan largely entails an amalgam of Shintoism, Buddhism, and
Christianity as a number of Japanese families have both a house-
hold Shinto shrine and a Buddhist altar. Most Japanese find it quite
acceptable to visit Shinto shrines on festive days, have a marriage cer-
emony in a Christian church, and worship the souls of their ances-
tors at a Buddhist temple. In this sense, the Japanese religious system
is non-exclusivist, eclectic and syncretic (Sugimoto 2002, 25556).
Circumcision has never been a real marker of faith for Christian
believers. Also Shintoism and Buddhism have never incorporated cir-
cumcision into the religious doctrine. Although a number of Shinto
rites and festivals related to fertility include the genital area, none of
them involve the removal of the prepuce in any form. Circumcision in
A Cosmetic Surgery 45
Japan, therefore, does not have any ritual or religious background that
could be traced back in history.
Shibuya (2009) and Ishikawa (2008) try to challenge common
sense and debunk the assumption that the yearning for a circumcised
penis is deeply rooted in Japanese society. In order to justify that
since the old days having a long foreskin (hkei)1 was a matter of
embarrassment (Shibuya 2009, 171) for Japanese men, references
to the intellectual Atsune Hirata (17761843) and his reflections on
Western learning written during the Edo Era (16031868) are not
unusual:
As everybody knows who has seen one, the Dutch, are taller than other
people and have fair complexions, big noses, and white stars in their
eyes. By nature they are lighthearted and often laugh. They are sel-
dom angry, a fact that does not accord with their appearance and is a
seeming sign of weakness. They shave their beards, cut their nails, and
are not dirty like Chinese. Their clothing is extremely beautiful and
ornamented with gold and silver. Their eyes are really just like those of
a dog. They are long from the waist downwards, and the slenderness
of their legs also makes them resemble animals. When they urinate they
lift one leg, the way dogs do. Moreover, apparently because the backs
of their feet do not reach the ground, they fasten wooden heels to their
shoes, which makes them look all the more like dogs. This may explain
also why a Dutchmans penis appears to be cut short at the end, just like
a dogs. Thought this may sound like a joke, it is quite true, not only
of Dutchmen but of Russians, Kday, a ships captain from Shirako in
Ise, who some years ago visited Russia, recorded in the account of his
travels that when he saw Russians in a bathhouse, the end was cut short,
just like dogs . . . This may be a reason the Dutch are as lascivious as
dogs and spend their entire nights at erotic practices . . . Because they
are thus addicted to sexual excesses and to drink, none of them lives
very long. (Keene 1969, 170, emphasis added)
It is clear that Hiratas reflection was not to eulogize the genitals of

Dutch and Russian men. He was actually mocking and ridiculing the
size and shape of their penises that made them look like dogs and
most likely provoked their animalistic sexual behavior. During the
Edo Era, having the exposed penile glans did not entail an ideal of
genitalia for Japanese men in any way; it was in reality seen as quite
bizarre (Miller 2004, 94).
From the vantage point of medicine, concrete data on the first
cases of newborn and/or adult circumcised males in medical settings
are unknown. Nevertheless, the practice has never been officially
medicalized because routine pediatric circumcision has never been

endorsed. Circumcision is most likely a phenomenon of postmod-
ern Japan that involves adults as well as the beauty and cosmetic
industry. As the Ministry of Health, Labour and Welfare (MHLW)
acknowledges, [R]itual circumcision (katsurei) does not exist in
Japan, but if we consider the existence of the so-called operation on
a phimotic penis (hkei no shujutsu), there is in reality a considerable
number of prepuces that are being cut off (Ksei rdsh 2013).
Newspaper reports and some beauty clinics websites suggest that
about 70 percent of Japanese men have a long foreskin (The Yomi-
uri Shimbun 1989). The website of a beauty clinic states that [f]or
some reason, about 60 to 70 percent of Japanese men have a long pre-
puce (hkei) even if they are adults. One explanation is the influence
of eating habits and hormone-disrupting chemicals (kanky horumon)
that have affected the development of the penile glans, making it
comparatively smaller. The number of men worrying about having
a long prepuce is extremely large (Estclinic-mens 2013). Academics
imply that 1.5 percent of Japanese men are circumcised (Van Howe
2004). The truth is that circumcision is largely classified as cosmetic
surgery and thus the exact number of circumcised males is difficult
to know. NHI hardly covers the medical procedure, thus the MHLW
does not provide accurate records on the number of circumcised
males. However, the popularity of circumcision among young men is
apparent by the number of new [beauty] clinics opening up with this
as a speciality (Miller 2004, 94). In Tokyo alone, for instance, there
are about 35 facilities that offer adult circumcision (Hkei chiry
kurinikku 2014).
The expenses of pediatric circumcision are reimbursable under the
NHI code J068 (Ksei rdsh hokenkyoku iryka 2008) in the case
that the surgery is used to cure paraphimosis (kanton hkei): Also
known as capistration, [paraphimosis] is an uncommon condition in
which the foreskin, once pulled back behind the glans penis, cannot
be brought down to its original position, thus constituting one of the
few urologic emergencies encountered in general practice (Dono-
hoe 2012). However, what is problematic are inconsistencies in the
medical understanding and treatment of pediatric paraphimosis or
phimosis among Japanese urologists. The debates of polar extremes
are a tangible reality in Japan as well. The MHLW does not provide
guidelines to assess infant paraphimosis (Iwamuro et al. 1997) and
Kayaba et al. (1996, 1814) hold that despite the incidence of highly
unretractable prepuce among Japanese newborns is approximately
70% by age 6 months, and 50% by 12 months . . . preputial separation
progresses until school age, [therefore] it is difficult to determine

the neonate who will ultimately require circumcision. This notwith-
standing, Hiraoka et al. (2002) contend that a pediatrician should
recommend surgery when the foreskin could be a cause of disease.
Cutting off the prepuce is a valid preventive measure to reduce boys
risk of urinary infections due to an overly tight foreskin covering the
penis glans.
Urologists that strongly oppose circumcision advocate nonsurgical
methods to treat severe cases of infant paraphimosis. Yanagisawa et al.
(2000) point out that the most recurrent treatment for paraphimosis
is either circumcision or the so-called dorsal slit, which consists of
making a single cut along the upper length of the prepuce to release
the trapped glans. Nonetheless, as with any surgical procedure, there
is always a risk of hemorrhage, wound infections, and cosmetic imper-
fections, which afterwards might imply the consequences of using
either local or general anesthesia when trying to correct such imper-
fections. A Japanese clinical report highlights that 3.1% of the boys
who had undergone surgery for phimosis . . . have reported anesthetic
complications including convulsions, bronchospasm, arrhythmia and
vomiting (Yanagisawa et al. 2000, 2).
A study involving Japanese mothers indicates that any form of
surgical intervention could become redundant. The mothers of 372
newborn babies with different degrees of phimosis were taught how
to do manual retraction of the foreskin to enforce the penile hygiene
of their sons. Within a range of time between 2.32 and 1.78 months,
the children obtained full retractability of the prepuce without seri-
ous complications (Iwamuro et al. 1997; Iwamuro et al. 1998). This
is a form of behavioral intervention that could certainly help dila-
tion, ease retraction of the foreskin, and avoid complications and
discomfort caused by any form of surgical procedure. Nevertheless,
manual retraction of the newborn foreskin could cause secondary phi-
mosis due to recurrent adhesion between the foreskin and the glans
(Wright 1994). Empirical evidence, on the other hand, shows that
applying conjugated equine estrogen ointmenta steroidentails
a topical effective method to deal with pediatric phimosis and thus
avoids any form of surgery or behavioral intervention. However, the
use of equine estrogen should be stopped with patients having a poor
response in order to prevent side effects (Yanagisawa et al. 2000).
Matters are complicated further and become bitterly controver-
sial when considering how adult circumcision is performed in Japan.
The advocacy of adult circumcision as a preventive measure against
the transmission of HIV is practically unsustainable. The majority of
Japanese men are uncircumcised, but the rates of HIV/AIDS in the

country remain comparatively lower in relation to other industrialized
nations. In November 2013, the total cumulative cases of Japanese
males infected with HIV and AIDS patients are 11,940 and 5,572,
respectively (AIDS Prevention Information Network 2013). Debates
of polar extremes concerning the circumcision of adults largely involve
urologists at one end, who are intent on stopping the promotion of
the practice, and cosmetic surgeons at the other end, trying to create a
niche market for a surgery that is meant to be a valid procedure help-
ing with gender and sexual issues of Japanese men.
Ishikawas book Dont Cut! (Kitte ha ikemasen!) nicely depicts the
position of urologists against removing the prepuce (Ishikawa 2008).
The lack of compelling and reliable scientific studies on the prepuce
and circumcision among Japanese men largely results in misconcep-
tions and speculations that cosmetic surgeons take advantage of to
commercialize the surgical intervention. There is an assumption that
a prepuce covering the penile glans (hi kaburi) has been a major
concern for Japanese men from the past, and thus it is not unusual
for men nowadays to believe that their penis is not normal because
the foreskin covers the penile glans (Ishikawa 2008, 66). Evidence
of this could be reflected in the large number of young men and teen-
agers anonymously requesting information about the prepuce at
call centers (denwa sdan). The Japan Family Planning Association
(2002) reports that the majority of adolescents and young men who
use the call centers look for information related to the prepuce. This
could be linked to the accepted idea in Japan that a penis with the
glans exposed is better than a penis with the glans unexposed (hi ga
muketa penisu ha hi ga kaburi no penisu yori jt da; Ishikawa 2008,
10).
A lack of basic knowledge or information concerning male geni-
talia facilitates the commercialization of adult circumcision. Hinami,
Iwamuro, and Yamamoto (2003) edited Knowledge about Phimosis
Thats Full of Mistakes (Machigaidarake no hkei chishiki), a volume
dedicated to challenging prevalent ideas transmitted by the mass
media about the benefits of having the prepuce removed. The book
includes Hinami and Iwamuross reflections about their urological
practice and highlights negative experiences of some young Japanese
men who were circumcised. Due to unfulfilled expectations, there are
cases of teenagers that faced an identity crisis after realizing that their
circumcised penis did not change in the way they wanted and that
the effects of the surgery are irreversible. Their medical reflection is
presented to insist that a large prepuce that covers the glans is not the
cause of disease or a physical defect in any way. Yamamoto is a senior

sex educator whose viewpoint relies on a form of sex education where
young men and teenagers can learn generally about the male body
and, in particular, the male genitals. Sex education then incorporates
a strategy to stop adult circumcision in Japan.
Iwamuro (2009), in his book The Willie (Ochinchin), insists that
misconceptions should be tackled as early as possible in the life of the
young boy in order to be effective. The Willie provides guidance for
parents to train their children how to keep the genitals clean. In using
a very didactic approach, the book offers concrete graphic explana-
tions to convey a simple message: being uncircumcised is not an issue
and should not be a reason for keeping the penis unclean. To remove
any trace of dirt that might cause penile diseases, the advice should
be delivered straightforwardly: [I]f the foreskin is covering up [the
penis glans], roll it back! (Kabureba hkei, mukereba ok! desu;
Iwamuro 2003, 66).
Although the influence of the mass media could be staggering, a
lack of official data and longitudinal research makes it difficult to con-
duct a thorough evaluation of the impact of the cosmetic industry
on circumcision trends. However, newspapers report that Japanese
men can be easy prey for cosmetic surgeons due to inaccurate and/
or incomplete information, which could lead to abusive pricing and
medical malpractice. Issues concerning information closely relate to
the range of age of the person involved: Especially, information
concerning the size and shape of the penis that is displayed in maga-
zines and the Internet has a bad influence on teenagers. They are
convinced that their penis is deformed. There are not a few serious
cases of young men who are convinced that their penis is deformed,
and are linked to the psychosomatic diseases known as body dysmor-
phic disorder (shintai shkei shgai; Mainichi Shimbun 2003). Older
men link smegma to cancer and look to circumcision as a preventive
method against penile cancer (The Yomiuri Shimbun 1989). Never-
theless, a major issue that causes much dissatisfaction among Japanese
men revolves around prices. If regulating prices for cosmetic surger-
ies is almost impossible, at least consumers should be fully informed
about the actual cost of the cosmetic procedure. Officials from the
MHLW have discussed the need to regulate the ways the surgery is
advertised. Information provided could be misleading and create great
disappointment because the procedures price on a clinic homepage is
63,000 JPY (about 615 USD), but in reality, it can become as expen-
sive as 1,000,000 JPY (about 9,770 USD; Ministry of Health, Labour
and Welfare 2011b). The problem lies in items that are not disclosed
on the homepage. Circumcised men have to pay for expenses related

to anesthesia, medication, taxes, and so on, which makes the minor
surgery ridiculously expensive (Mainichi Shimbun 2006b).
Language Mat ter s

Linguistic nuances complicate matters further. In the Japanese lan-
guage, the word circumcision (katsurei) rarely appears in daily conver-
sations because it only refers to the tradition of removing the foreskin
for ritual or religious purposes. The term hkei literally translates into
English as the medical condition identified as phimosis, but it could
colloquially be used to refer to someone who has a long prepuce cov-
ering the penile glans or someone who is uncircumcised. Expressions
like hkei yar, literally translated as phimotic asshole and obviously
used to offend the person involved, make the Japanese social and cul-
tural understanding of circumcision richer but definitively difficult to
enclose within the boundaries of medical knowledge. Uncircumcised
men can also be disrespected by being called komokaburi, which liter-
ally translates as a sake cask wrapped in a rush mat.
The verb mukeru (peel off) could be colloquially used to indicate
that the prepuce is retractablethat is, the glans can be seen but also
that the foreskin has been removed. This could elicit the idiomatic use
of the verbs cut and uncut to refer to circumcised and uncircum-
cised, respectively, in the English language. Nevertheless, the term
hkei does not translate as uncut and neither does muke as cut
in the strict sense. Technical jargon such as foreskin removal (hhi
setsudan) or an operation on a phimotic penis (hkei no shujutsu)
imply circumcision, but they are both barely heard in daily conversa-
tions; the latter is conspicuously seen in advertisements that promote
the surgery. Moreover, the availability of three terms to point out
how retractable the prepuce is complicates matters further. The condi-
tion of a foreskin can be classified as pseudo- or false phimosis (kasei
hkei), true phimosis (shinsei hkei), and paraphimosis (kanton hkei).
In theory, neither false nor true phimosis represents a risk to health
as long as the penis glans can be exposed to clean it. As expressed
earlier, only when the penis glans gets uncovered and the prepuce
cannot return to the original position could medical intervention be
required because this is considered a case of paraphimosis or glans
penis strangulation. Nevertheless, the classification is equivocal and
no clear medical consensus exists on how to differentiate true from
false phimosis. Deciding when medical intervention is required always
implies controversy. Urologists such as Iwamuro (2003) or Ishikawa
(2008) utterly refuse circumcision and would suggest nonsurgical

methods to be used even in cases of paraphimosis.
In an effort to disseminate accurate information, the MHLH has
included in his website the pamphlet titled Do You Know? Mens Body
Issues, Womens Body Issues (Shittemasuka? Dansei no karada no koto,
josei no karada no koto) that Yamagata et al. (2012) produced. Con-
cerning circumcision, the pamphlet simplifies issues and gives the
following advice:
If after rolling back the prepuce with your hand, you cannot see the
penile glans completely, this is true-phimosis. Consult with a urologist
because the National Health Insurance can cover its treatment. On the
other hand, if the prepuce normally covers the glans but you can roll it
back with your hand and see the glans, this is false-phimosis. If you have
an erection and the foreskin gets trapped behind the glans and becomes
a hindrance to intercourse, consult with a urologist. It is good if men
with false-phimosis roll back the prepuce to clean the remains of urine
in the glans. You should not pull out the prepuce harshly and injure it.
(Yamagata et al. 2012, 7)
Clearly, the MHLHs recommendation relies on consultations with a

medical doctor, which is certainly the most rational way in dealing
with any disease. This could be unrealistic, however, as it tends to
neglect the sociality and symbolism embedded in the genital area. The
literature does not include any specific study dealing with the relation-
ship between physicians and men when discussing sex-related matters
in Japanese settings. In his now classic study on family planning in
Japanese society, Coleman (1983) contends that mens embarrass-
ment in talking about sexual issues and physicians lack of formal med-
ical education in human sexuality largely makes an open conversation
about male sexual organs unattainable and elaborates that [w]here
the specialists have fallen short, the commercial media have carved
out a niche, however, in an attempt to fill an information vacuum that
excites their profit motive. Magazine articles and television programs
on sexual topics appeal strongly to their Japanese audience, not only
because of intrinsic interest and a dearth of alternate sources of infor-
mation; in a society where there are few channels of communication
on sexual topics, individuals can look at television programs and read
magazine articles in privacy and anonymity (Coleman 1983, 182).
Colemans assertions might still have a degree of validity when look-
ing at the most recent statistics from the Japan Association for Sex
Education (Nihon seikyiku kykai). The core source of information
concerning sexuality for young Japanese men is currently either their

peer group or the Internet (Nihon seikyiku kykai 2013). The geni-
tals appear as the unspeakable and untouchable area of the body. In
this respect, advertisements for circumcision in the mass media and on
the Internet seem to be correct when they highlight that there is a
concern that men cannot mention to anyone (otoko ni ha, dare ni mo
ienai nayami ga aru; Ueno Clinic 2010). In other words, circumci-
sion is not really a topic of conversation for Japanese men.
These debates raise a key question: if the procedure is not under-
pinned by sound medical justification, if circumcision has never been
mandatory, and if Japanese men opting for it are likely to bear expen-
sive costs and sometimes face medical malpractice, why do they still
want to be circumcised? The reasons must be diverse and ignorance
about the male body might be a leading cause. Nevertheless, urolo-
gists who disapprove of the practice tend to blame the Internet and
mass media for the current trends of adult circumcision. Thus there
is a necessity for an iconographic analysis of the advertisements pro-
duced to sell the surgery.
A Mat ter o f Fac e

A major selling point of the marketing of circumcision revolves
around the interplay between representation and knowledge of the
male body. Publicity heavily relies on the script that the genitals are
one of the most important parts of the body. In line with the so-called
anatomic confirmation, advertising is largely grounded in the symbol-
ism attached to the penis as the part of the body that helps construct
a sexual and gendered self. As Friedman (2001, 6) contends, [f]rom
the beginnings of . . . civilization the penis was more than a body part.
It was an idea, a conceptual but flesh-and-blood gauge of mans place
in the world. That men have a penis is a scientific fact; how they think
about it, feel about it, and use it is not.
Paraphrasing Bordo (1999, 168), the Japanese cosmetic industry
(re)discovers the male body and offers a new reading of the pre-
puce. Plastic surgeons have produced a master narrative that entangles
social and medical knowledge and is chiefly underpinned by sexual
scripts. The narrative contends that a tiny piece of flesh is crucial in
the construction of a gendered and sexual male body. Having a large
prepuce covering the glans is thus a matter of face because the penis
is the face of a man (penisu ha otoko no kao desu; Yoshizawa Clinic
2004). This is nicely conveyed by one of the most publicized images
in printed media and the Internet to promote the surgery: a young
man wearing a turtleneck sweater (to view the image discussed, please
see Ueno Kurinikku 2008). In the representation, the neck of the
sweater covers half of the mans face, exactly as if it were the prepuce
enclosing the glans. The entire male body thus turns into a sexual
organ, and the penis glans represents the mans face.
This is supposedly where the yearning for circumcision originates.
Such yearning elicits a process of differentiation and pathologiza-
tion, which means that [t]he Others physical features, from skin
color to sexual structures such as the shape of the genitalia, are always
the antitheses of the idealized selfs (Gilman 1985, 25). The nar-
rative sustains that Japanese men should get circumcised to attain
such an ideal self. This indeed becomes a good reason to justify
the biomedicalization of circumcision. In drawing on psychological
jargon, the narrative insists that uncircumcised men grapple with a
psychological complex that is largely manifested by their unwilling-
ness to take baths at hot springs (onsen) or difficulties in approaching
women (josei ni sekkyokuteki ni narenai). The most serious issue arises
when men want to have sex because they fear rejection if their female
partners discover their condition or treatment with contempt if they
disclose it. Results from a survey displayed on the Internet show that
44.7 percent of men who have a long prepuce sometimes experi-
ence a psychological complex (Hkei chiry kurinikku 2014).
In helping cope with this psychological conundrum, beauty clinics
include on their websites a section to explain what phimosis entails
and the difference between true and false phimosis, as well as warn-
ings about paraphimosis, as shown in Tokyo Norst Clinics advertising
(Tokyo Norst Clinic 2010). The foreskin is depicted as a piece of
skin that bothers and entails a demerit (demeritto) of the male
body, as shown in Chuoh Clinics advertising (Chuoh Clinic 2008).
Furthermore, in medicalizing the prepuce, the narrative draws on the
notion of smegma (chik) to emphasize how being uncircumcised
negatively affects the male body. Smegma is associated with a bad
smell, urinary infections, penile and womb cancer, glans inflamma-
tion, and STIs, for example (Hkei chiry kurinikku 2014). Needless
to say, information that might render the surgery redundant tends to
be ignored. However, some clinics suggest that proper penile hygiene
could be a reasonable and efficient method to avoid infection or dis-
ease. For instance, men can help prevent cancer of the womb in their
partners by cleaning up and removing any trace of smegma in the
penis before intercourse (Anzen na chisiki de erabu hkei kurinikku
2013).
Within the biomedicalizing process, the psychological distress of

having a long prepuce is connected to ED. The narrative implies that
although ED is a complex matter, there are psychological issues, such
as self-confidence, that might prevent an erection. Men who think
that their penis is small because it is covered by the prepuce might lose
confidence and suffer ED. Circumcision could therefore be used as a
treatment for ED (Ednonayami 2005).
In view of the psychological impact of being uncircumcised, beauty
clinics offer anonymous and free consultation (mury kaunseringu)
through their sites on the Internet. Since talking about the genitals is
embarrassing, there is a strong emphasis that the identity of men look-
ing for consultation will never be disclosed. After being circumcised,
men receive counseling too. This is a form of postoperative care that
guarantees total satisfaction. To show how effective circumcision can
be, Internet sites display quotes and comments from men whose lives
have radically changed. Two clients on the Ueno Clinic site (Ueno
Kurinikku 2008) stated:
I worried alone about the small size [of my penis] because the head
looked like it was tapering off. It was rather embarrassing getting naked
in a hot spring in front of my friends; I had a [psychological] complex.
To change, I decided to get circumcised. At first, I was hesitant about
going to a clinic but stopped thinking and went for the surgery. It is
very good; I am different from before and became a positive person.
(Mr. S., aged 24, employee from Tokyo)
I am regular at brothels (fzoku). Once I caught a venereal disease.

[My penis] was swollen, the same symptom repeated several times. I
had it checked and after being diagnosed with gonorrhea and inflam-
mation of the urethra and the foreskin, I got circumcised because the
cause was having a long foreskin. Thanks to the surgery the venereal
disease got under control, I am not worried about venereal diseases and
enjoy going to brothels. Surprisingly, the feeling of safeness is different.
(Mr. O., aged 29, employee from Osaka)
The power of the surgery becomes apparent when acknowledging that

circumcised men overcome the psychological trauma and are able to
enjoy life and sex. In this light, Foucaults construct of technologies
of the self can be nicely applied to explaining adult circumcision. The
surgical procedure allows Japanese men to effect by their own means
[ . . . ] a certain number of operations on their own bodies and souls,
thoughts, conduct, and way of being, so as to transform themselves in
order to attain a certain state of happiness, purity, wisdom, perfection,
or immortality (Foucault 1988, 18). Removing the foreskin is a

practice that acts on the body and the soul of the male involved. More
important, the prepuce is indeed such a crucial factor in the life of
men and their identity that even those who were not circumcised can
experience emotional release and reassurance when they realize that
the condition of their foreskin is normal: My penis, when it gets
erect the glans can be seen clearly, normally there is a surplus of skin. I
was concerned asking myself Am I phimotic? Should I get treated?
I had unpleasant and gloomy days. I knew that there was free consul-
tation and went for some counseling . . . the surgery was not needed
because it was false-phimosis, a mild symptom . . . I should have got-
ten a consultation earlier (Mr. A., aged 36, employee from Osaka;
Ueno Kurinikku 2008). This narrative deploys anecdotal evidence to
reaffirm the idea that the prepuce entails a major concern for men. It
implies the idea that circumcision is a matter of face. In terms of the
intrapsychic dimension, having the prepuce removed means a great
boost in the self-esteem of Japanese men; although the surgery could
help prevent disease, having a larger-looking penis makes men gain
confidence.
Th e H ier arc hic al Order of M en

The marketization of circumcision strongly relies on interlinks
between gender and power. This is in fact another major reason for
Japanese men to undergo the surgery. Most of the publicity draws
on representations of humanized penises in explaining what prepuce
retractability entails and why the surgery is required. The narrative
presents cartoons of the penilized image of the male body to imply
power relations among men. Circumcised men definitively enjoy a
position of superiority over uncircumcised men.
Power relations among men based on the genitals, however, are
not particular to Japan. Historical evidence suggests that the size of
the penis has been profusely used to justify relations of power among
men. The supposed supremacy and superiority of the white over the
black man is good example of this. Black men are allegedly less civi-
lized because of their uncontrollable sexual urges that are linked to
their larger sexual organs. However, we need to realize that what
Whites have been saying about Black men, they have also been say-
ing about Scotsmen, about Gypsies, and about Jews. In each case,
the group that thinks itself superior suspects their inferiors of having
abnormally large sexual organs (Schmitt 1992, 43).
In the same vein, Zuerns dissertation about the future of the

phallus is a reminder of the current relevance of the penis in think-
ing about the male body and the struggles of men against masculine
hegemony (Zuern 1992, 56). Evidence of this, as Bordo (1999, 81)
holds, is the fascination of men with the penis dimensions: In the
showers in mens locker rooms, men routinely size up each others
endowment.
Japanese beauty clinics deploy a narrative that heavily relies on the
symbolism embedded in the genitals and the assumption that male
hierarchy and ascendency still lies in the size of the sexual organ. In
particular, to promote circumcision, male hierarchical order is under-
pinned by the retractability and shape of the prepuce. The humanized
representation of the penis could be effectively used to explain what
Connell (1995, 77) calls hegemonic masculinity or the accepted
answer to the problem of legitimacy of patriarchy which guarantees
(or is taken to guarantee) the dominant position of men and the sub-
ordination of women.
In understating what hegemonic masculinity entails and the pat-
terns that sustain the current gender order, Connell (1995) proposes
the constructs of subordinated, marginalized, and complicit mascu-
linities. In the iconographies of circumcision, hegemonic masculinity
is represented by the well-endowed man at the top of the ranking.
His penis glans is always exposed (tsune ni kit ga roshutsu shiteiru)
and thus circumcision is not required (to view the image discussed,
please see Yoshizawa Clinic 2004). This is supposedly the normal
penis (seij na penisu). In reality, it represents a cultural ideal invested
with symbolism and cultural power because, as Connell (1995, 79)
holds, the number of men rigorously practicing the hegemonic pat-
tern in its entirety may be quite small. In normal conditions, no
penis glans gets fully exposed without medical intervention. A circum-
cised man thus embodies a new form of hegemonic masculinity.
Subordinated masculinity refers to men who are unable to fulfill
the hegemonic ideal. They are located behind the leading position
and lower in the hierarchy. Men who struggle with false phimosis are
a nice iconographic example of subordinated masculinity. The long
prepuce covering the penile glans places them in a minor position.
Their subordination, however, does not pertain only to cultural stig-
matization. The narrative suggests that they suffer from psychological
trauma, feel embarrassment if they have to get naked, and might
endure mockery, abuse, and rejection. They could equally grapple
with economic discrimination when they look for circumcision to
correct the problem. Expensive surgeries and medical malpractice

could be the price for those willing to get closer to the hegemonic
ideal.
Marginalized masculinity refers to men who are unable to reach a
leading position but whose possibility of moving forward toward the
hegemonic ideal is almost zero. In this narrative, mens marginaliza-
tion is largely due to their unretractable foreskin, which is graphically
depicted by men with true phimosis. Men with false phimosis can at
least manually retract the prepuce and thus get closer to the hege-
monic ideal. Men suffering from true phimosis represent a real
form of marginalized masculinity. It is a serious hindrance, a major
obstacle, that prevents men from attaining a dominant position and
requires medical intervention. Finally, the construct of complicit
masculinity revolves around the idea that few men can possibly cope
with the standards embedded in hegemonic masculinity. This does
not preclude them from taking advantage of the general effect of this
hegemony.
Overall, men benefit from what Connell (1995) refers to as the
patriarchal dividend, which confers the power to the subordinate
and marginalizes women and men who are far removed from the
hegemonic ideal: Men gain a dividend from patriarchy in terms of
honour, prestige and the right to command. They also gain a material
dividend. In the rich capitalist countries, mens average incomes are
approximately double womens average incomes (Connell 1987, 82,
original emphasis).
Through cartoons and graphic displays, the cosmetic industry con-
veys the idea that the power of men effectively lies in the penis (to
view the image discussed, please see Ishikura 2014). The sexual organ
grants all men great potential to attain a dominant position, and cir-
cumcision helps remove the nasty foreskin that prevents them from
securing such a position. Clearly, the narrative revolves around the
so-called sociobiology, which is the revive attempt at an evolutionary
explanation of human society (Connell 1995, 46)that is, the penis
naturally qualifies men for reaping the patriarchal dividend.
The narrative insists in presenting male identity as rigidly con-
structed and strongly tied up with biology, which entails a new
form of biological essentialism grounded in the dichotomy of circum-
cised versus uncircumcised men. It is relevant to highlight, however,
that hegemony, domination/subordination and complicity . . . pro-
vide a framework in which we can analyze specific masculinities . . .
[the] terms . . . named not fixed character types but configurations
of practice generated in particular situations in a changing structure
of relationships. Any theory of masculinity worth having must give

an account of this process of change (Connell 1995, 81, emphasis
added). The relational character embedded in hegemony, marginal-
ization, and subordination (in terms of circumcision) thus has to be
theorized in line with the experiences and daily interactions of Japa-
nese men. Investigating the interpersonal dimension underpinning
the surgical procedure allows for a comprehensive understanding of
hegemony and how it concerns circumcised and uncircumcised men
in Japan.
Wo men and the P repuce

The third salient point stressed in the marketing of circumcision
revolves around Japanese women. Some Internet sites emphasize that
rather than men, women are concerned about a penis with a long
prepuce (hkei ha dansei jishin yori josei no h ga kinishite shimai;
Anzen na chisiki de erabu hkei kurinikku 2013). In line with the
hegemonic ideal, the domination of women lies in their preference
to have sexual intercourse with circumcised men. It is not unusual,
therefore, that cosmetic clinics display on their websites the results of
surveys that mirror the true feelings (honne) of women concern-
ing the foreskin. The validity of the information presented might be
questionable because it is not clear how the samples were acquired
and how data were analyzed. However, these surveys are meant to
represent the opinion of Japanese women.
An Internet site presents the results of a survey with 185 women
in their twenties: 40 percent of them did not know the difference
between true and false phimosis, and 31 percent did not care about
a penis with a long prepuce. It seems, however, that women prefer
circumcised men. One hundred women who have rich sexual experi-
ence with men (dansei keiken ga hfu na josei) were surveyed, and
63 percent of them implied that they would rather have sex with a
circumcised man because a penis with a long prepuce stinks (kusai;
Kabushikigaisha aieienu 2008). Certainly, what this rich sexual expe-
rience entails is not defined, and this makes the reading of the data
additionally problematic.
Some clinics provide quotes to illustrate womens viewpoints and
make the argument rather convincing. For instance, a young woman
in her twenties, who has a boyfriend and an active sexual life, said, I
felt like killing him, because [his penis] was smelly. A teenager who
did not have a boyfriend at the time she was surveyed but had started
her sexual life said that [she] broke up with her boyfriend because his
penis had a long prepuce (Hills Tower Clinic).
A major reason to prefer circumcised men is, however, that the
surgical intervention appears effective against PE, which seems to be
a serious ailment affecting Japanese men. The narrative presents
PE as one of the main demerits of uncircumcised men, which is
in line with the common assumption that a man whose penis has a
long prepuce most likely suffers from PE because [if] the prepuce
always covers the penile glans, the development of the glans becomes
insufficient and the penis renders shoddy (binjaku). Also, the glans
[becomes] oversensitive (kabin) which causes premature ejaculation,
[uncircumcised men] cannot enjoy a complete (jjitsu) sex life (Kita-
mura Clinic 2003). One hundred women who have had a rich sex
experience with men were surveyed and 71 percent of them said that
men whose penis has a long prepuce tend to have PE (Kabushiki-
gaisha aieienu 2008). The narrative connects PE to circumcision in
order to highlight that having a long prepuce compromises womens
sexual satisfaction and therefore uncircumcised men are not a good
match: [M]en whose penis has a long prepuce . . . ejaculate too fast
[and] cannot really satisfy women (Kabushikigaisha aieienu 2008).
After circumcision, the penile glans is less sensitive, which makes
men able to control ejaculation better and have longer-lasting sexual
intercourse. This permits women enjoy sex plentifully. A young
woman recommends men get treated [circumcised] soon and have
a good sex life, because there is only one life (jinsei ichido shikanai
node, hayaku naoshite yoi sex raifu wo; Hills Tower Clinic).
Furthermore, the narrative demonstrates that womens sexual sat-
isfaction might depend on the size of the male organ. Common sense
says that if the foreskin covers up the penile glans, it is because the
penis involved is undersized. In a sample of 100 women who have
had a rich sexual experience with men, 69 percent of them state that,
in their experience, men whose penis has a long prepuce also have a
small penis (Kabushikigaisha aieienu 2008), which might have a nega-
tive impact on womens sexual satisfaction. In line with the current
gender panic occurring in Japan, aesthetic clinics draw on the idea
that Japanese women are becoming sexually assertive and rather
demanding. The cartoon of a couple that is in bed masterfully depicts
the situation. The illustration is intended to warn men that women
nowadays are well informed and might reject them, which of course,
emphasizes the value of circumcision. The surgery implies not only
hygiene but also womens sexual pleasure (to view the image dis-
cussed, please see Yoshizawa Clinic 2004).
Circumcision thus renders into a medical technology that

enhances sexual performance and allows for the supposed womens
sexual satisfaction, which means a move from a medicalized to a
biomedicalized practice. As Clarke et al. (2010, 2) elaborate, [m]edi-
calization practices typically emphasize exercising control over medical
phenomenadisease, illness, injuries, bodily malfunctions. In contrast,
biomedicalization practices emphasize transformation of such medical
phenomena and of bodies, largely through sooner-rather-than-later
technoscientific interventions not only for treatment but also increas-
ingly for enhancement. In disentangling how circumcision becomes
biomedicalized, the salience of the gendered character of sexual desire
embedded in the construct of cathexis becomes apparent. Con-
nell (1987, 112) defines cathexis as the construction of emotionally
charged social relations with objects (i.e., other people) in the real
world. The narrative conveys the idea that the male body becomes
emotionally charged because of his penis. Humanized penises that
are lined up illustrate this. While at one extreme, the ugly, true
phimotic penis appears, the beautiful circumcised penis is placed at
the other extreme. A lovely penis unmistakably has the glans fully
exposed (to view the image discussed, please see Estclinic-mens 2013)
and women could become emotionally attached to the circumcised
penis because it is meant to be larger and guaranties longer-lasting
sexual intercourse.
In addition, the gendered character of emotions attached to the
circumcised penis elicits that women collaborate in the reproduc-
tion of patriarchy. In accepting that a beautiful penis is circumcised,
Japanese women become complicit of . . . their [own] sexual sub-
ordination, at least at the level of [representation] (Hockey, Meah,
and Robinson 2007, 110). Interestingly, it is also how the prepuce
conflates in the sexualization of the male body that might result in
womens sexual agency. Connell (1987)s theorizing underscores how
the sexualization of the female body has been an active component
in the construction of patriarchy through the so-called male gaze,
which chiefly refers to the demands on women to become subjects
who should actively attract and keep their men (Hollway 1998). Nev-
ertheless, sexualizing the male body through the prepuce does not
necessarily imply womens agency and liberation. Circumcision largely
helps justify womens subordination.
The narrative clearly presents men as doing sex and women as
having sex done to them (Holland et al. 1998). Such a dichotomy
largely mirrors what Wight (1996, 15456) identifies as the preda-
tory male discourse that
involves the stereotype of masculine sexuality, in which men gain esteem

from their male peers by having as many sexual partners as possible
[ . . . ] Within this discourse heterosexual intercourse is fundamental in
asserting ones masculinity, and physical sexual pleasure is of less impor-
tance that the opinions of ones male peers . . . A boys interest is to do
with gender not sex . . . The challenge is to seduce a woman, and the
less accessible she is the greater ones esteem if successful [ . . . ] Within
the predatory discourse, the woman is sexually passive, relationships
generally do not last long enough to develop much physical intimacy
and trust and there is an overwhelming focus on penetrative sex. Con-
sequently mens sexual repertoires are often limited.
The predatory discourse could also reinforce the idea that the sexual
originates in the genitals.
On the other hand, women seem to reproduce the master narra-
tive when they become mothers and want to have their male offspring
circumcised. Although most electronic and printed information on
circumcision is concerned with adult males, there are some clinics
that display some data on pediatric circumcision. The circumcision
of young boys is chiefly introduced as a matter for Japanese mothers.
The Internet site Womens True Feelings about a Long Prepuce (Hkei
to josei no honne; Kabushikigaisha aieienu 2008), for instance, includes
the worries of a mother who wants to know if having a long prepuce
is also a problem for newborn babies, because the prepuce entirely
covers the penis of her ten-month-old baby boy. Another mother nar-
rates how her five-year-old son felt embarrassed and did not let her
retract his prepuce. She wants to know whether it is good or not to
force the retraction of the prepuce and when it is good to retract it. A
third mother expresses her ignorance about the foreskin because she
is a woman and does not know if there is a right way to retract it. In
responding to these queries, cosmetic surgeons do not discourage cir-
cumcision. Rather, they ask mothers to wait until boys are old enough
to have them evaluated and decide if the prepuce can be retracted or
not (Kabushikigaisha aieienu 2008).
Asahi Shimbun, a top-ranking circulation Japanese newspaper, took
up mothers concerns and dedicated an article in its weekly magazine
Shkan Asahi to clarify doubts and to dissuade them from having their
sons circumcised. In the article, Japanese women are presented as the
stereotypical professional mother (kyiku mama) who is obviously
utterly involved in every single aspect pertaining to the education of
her children, as well as early training and the body of their young
boys. There seems to be a trend among Japanese mothers who want

to have their sons circumcised before they start primary education.
The Internet has become an important forum for discussing issues
concerning pediatric circumcision and the bodies of young boys.
For instance, a mother of a nine-month boy said: I thought that
true-phimosis required surgery and was extremely worried about it.
Pulling the foreskin back caused him urethritis and a bad fever of 39.5
degrees (Matsumoto 2002). The same newspaper article explains
that Japanese people in general are misinformed and do not want to
talk about circumcision because of prejudice against men whose penis
has a long prepuce, the so-called komokaburi. It appears to be a seri-
ous issue for teenagers, but since circumcision does not encompass
a matter of life and death, it has never been taken as serious medical
concern. Mothers might want to have their sons circumcised because
they have fewer children and tend to be overconcerned about them.
Also, most Japanese households have turned into nuclear families,
thus mothers cannot count on grandparents advice. Medical doctors
do not seem to offer concrete and effective explanations about the
penis of a newborn, but mothers are overwhelmed with information
about phimosis and the psychological complex it causes. Some moth-
ers might indeed want to have their sons circumcised because they do
not want them to look different from their peers (Matsumoto 2002).
Against this background, two lines of research become apparent. It is
relevant to explore the intrapsychic and interpersonal dimensions of
Japanese women and mothers in relation to circumcision.
Co nc lusio n
Exploring the cultural dimension of circumcision in Japan presents a
fascinating case study for medical sociologists and academics doing
sexuality and gender studies. Japanese circumcision is a phenomenon
far removed from any religious or ritualistic act of worship. Although
the earliest antecedents of the procedure cannot be fully identified,
making it difficult to know when and how circumcision entered Japan,
historical evidence suggests that having the penile glans exposed was
not an ideal of beauty for men during the Edo Era.
A medical frame of reference, however, cannot be fully applied to
explaining the practice because neonates and childrens routine cir-
cumcision has never been endorsed, thus the surgery has not been
fully understood as a preventive measure against disease. Japanese cir-
cumcision is most likely a phenomenon pertaining to a postmodern
society. It is largely a surgical procedure for adult males and involves

the cosmetic and beauty industries.
Circumcision has turned into a pricey minor surgery that has been
medicalized through a master narrative that chiefly revolves around
the psychological traumas of Japanese men. Cosmetic surgeons
offer the procedure to cope with self-esteem and confidence rather
than to prevent disease. The idea that ED and PE are largely psycho-
logical problems leads to the biomedicalization of circumcision, which
is also sustained by linguistic nuances that make it difficult to know
when exactly the foreskin is a real medical problem. This of course
does not mean that all medical doctors share the same opinion and
support the biomedicalization of the practice. Japanese urologists, in
particular, tend to present a very critical viewpoint in opposing the
commercialization of the surgical intervention at beauty clinics.
The master narrative to commercialize the procedure cleverly plays
with the idea that the genitals are the almost most important part of
the body, that the sexual and gendered self is grounded in the geni-
tals, and that the sexual also originates in the genital area. Although
the suggestion that the male gender identity largely depends on the
penis has been argued before, the Japanese cosmetic industry implies
that it is actually in the prepuce where the male gender identity is
anchored. Not only does the prepuce allow for a new reading of
the male body, but it also helps understand gender relations among
men through the binary of circumcised versus uncircumcised men.
The former is closer to what Connell (1995) names the hegemonic
ideal; the latter most likely represents subordinated and marginalized
masculinities.
In understanding how the prepuce is entwined with the sexual
self of Japanese men, the biomedicalization of circumcision becomes
apparent. Removing the prepuce entails a surgical procedure that
enhances sexual performance as it permits longer lasting sexual inter-
course, which makes the role of women crucial in reproducing the
master narrative. While Japanese mothers might help support pedi-
atric circumcision, the biomedicalization of the surgical procedure is
sustained by women who are particularly concerned about having sex-
ual intercourse with circumcised men. A circumcised penis is meant to
be a guarantee of sexual satisfaction.
Unmistakably, the cultural and structural dimensions underpin-
ning circumcision have strong links to the current gender and sexual
conundrum in Japan. Uncircumcised men can equally be identified as
sexual failures, and as women have become demanding and sexually
active, they want to have sex with circumcised men. Overall, Kimmel
(2001) seems to be correct: circumcision is always concerned with the

reproduction of patriarchy, and the Japanese case is not an exception.
How this occurs requires a reading of the intrapsychic and interper-
sonal dimensions of Japanese men and women, which are explored in
the rest of this book.
4
Chapter 3
Mens Views
Somehow, the penis, in particular, becomes a very important part

of your body . . . I think.
(Akabene-san, aged 19, single, student, circumcision
status undisclosed, sexual preference undisclosed)
Most Japanese men have a long foreskin (hkei) but dont want
guys to know that.
(Takane-san, aged 18, single, blue-collar worker, circumcision
status undisclosed, sexual preference undisclosed)
T he centrality of the penis in the construction of the male self

becomes apparent in the iconographic analysis of circumcision in
Japan. Unmistakably, cosmetic surgeons advertising revolves around
a phallocentric culture underpinned by the construct of the penil-
ized male self, which suggests that the gendered and sexual self of
Japanese men hinges on the genital area. Therefore, having the pre-
puce removed could be seen as a technology of the selfthat is, as
a medical procedure that has the potential to transform the male self.
Although the relationship between the cultural dimension and the
interpersonal and intrapsychic dimensions is rather complex and not
straightforward, the preceding quotes indicate that the phallocentric
culture could certainly be echoed in the actual gendered and sexual
self of men in Japan. As such, this chapter explores the interpersonal
and intrapsychic dimensions underpinning circumcision through the
viewpoints of a group of Japanese men.
This chapter draws on a set of interviews with a group of Japa-
nese men reflecting on the male body and circumcision. Due to the
apparent relevance of the penis in understanding what a male body

entails, my conversations with the interviewees were not an easy task
because of language availability and a culture of silence and pretense
that tends to prevent open discussions about the genitals. Neverthe-
less, the conversations with these men show how phallocentrism could
be reproduced through daily interpersonal interactions. The tradition
of taking baths with other men conspicuously revealed how, through
homosocial interactions, they have learned taboos related to the body
before they realize the scripts within which they operate.
Exploring the intrapsychic dimension, however, uncovers how
some of the men could effectively oppose ideas about the penilized
male self. In the interviewees explanation, young men most likely
look at circumcision as a way to reshape their identity because they
construct self-esteem and confidence based on their genitals. Sexual
self-exploration becomes an experience of embodiment that helps
men understand the importance of the prepuce. Adult men construct
their male identity based not on the genitals but on job achievement
and intellectual work, for instance.
The chapter finishes by highlighting the relevance of sexual inter-
course as a practice that allows self-reflection and permits some of the
men to form a clearer relationship between sexual satisfaction and the
prepuce. Different from a biomedical viewpoint, circumcision does
not necessarily enhance sexual performance and could be detrimental
to genital hygiene. Finally, my interview transcripts imply that circum-
cision has been socially constructed as a procedure for heterosexual
Japanese men, but homosexual men could also be rather concerned
about the condition of the prepuce.
G e nital ia and the Mal e Body

In approaching the interpersonal and intrapsychic dimensions under-
pinning circumcision, part of my interviews with this group of Japa-
nese men centered on the male body and its connections to the genital
area as lived experience because [s]ociologists may argue, for
example, that [medical science and cosmetic surgeons] construct the
[male body] as an objective of scientific inquiry, but it tells us nothing
about the phenomenology of [having the prepuce removed] (Turner
2008, 12).
Following the discussion on the ways the male body has been cul-
turally represented and socially constructed in Japan, talking to these
men helps move onto an analysis of the phenomenology of the male
body through their everyday experiences. My focus was to explore
Mens Views 67
how they made sense of their own bodies in relation to the social con-
struction of the male body, which is included in the master narrative
in explaining the gendered and sexual self in Japanese society, as well
as the narrative produced by cosmetic surgeons to turn circumcision
into a profitable niche market.
Asking the interviewees to think about the male body, however, was
not an easy task. The immediate reaction of most of these men was,
in line with genital confirmation, to elicit the centrality of the genital
area in understanding what the male body entails. Explaining such cen-
trality was, however, challenging because of knowledge and language
availability. Some of the men drew on their school experiences: a series
of disconnected and blurred images of anatomical and physiological
descriptions included in textbooks. Hidaka-san (aged 32, single, blue-
collar worker, circumcised, undisclosed sexual preference) explained:
Hmm . . . I believe that what makes you a man is, like other animals,
your penis . . . I guess.
Why is it so?
I am not sure, but I think that at school, we have gotten some
information.
What kind of information was that?

. . . it was usually boring stuff . . .
Boring?
Yes, a lot of names written in Chinese characters (kanji), difficult to
memorize because they are not usually used in daily conversations . . .
Despite the apparent relevance of the genital area, most of the inter-
viewees did not report a serious discussion on the matter before the
interviews. It always provoked curiosity, but the genitals were never
an active component in their education experiences at school and/or
home. Most of the men mentioned words such as the prepuce (hhi)
or the penis glans (kit) as a form of evidence that they knew what the
male body was. The terms were part of their vocabulary indeed, but
they were unable to state clearly where and how they learned them.
As Arai-san (aged 20, single, student, circumcision status undisclosed,
homosexual) put it:
Yes, yes, I am old enough to tell you that I know what the foreskin
(hhi) or the penis glans (kit) is . . . I mean, I know the meaning . . .
I cannot tell when I heard of them the first time . . . It could be one of
those science classes in secondary school.
What about conversations at home?

No, that I am very sure, you dont talk about that at home . . . Talking
about this with your parents is a bit odd . . .
Why is that so?

I dont know . . . hmm . . . I really dont know. Could it be me only?
Hmm . . . I dont know . . . I dont think so . . . I think you dont talk
about this to your parents . . . at least not me.
Maybe you talked about this when you learn how to clean the area?
I dont think so . . . no . . . not really . . . I mean . . . when I take a
bath, it is just like cleaning any other part of my body. I dont think
that someone ever taught me how clean there . . . Not a big fuss . . .
Does it have to be cleaned in a particular way? Do people teach how
to clean there?
In line with Hendry (2003, 69) who points out that hot spring resorts
(onsen) and public baths (sent) have a social function as well as a
hygienic one, some of the men in the sample indicated that the tradi-
tion of taking communal baths could help understand why the geni-
tals are so important. This was reflected in the insistence of carrying
a small towel as a symbol of good manners to hide the genital
area. In talking about his experiences at baths, Matsudo-san (aged 26,
single, student, circumcision status undisclosed, sexual preference
undisclosed) uttered:
Let me think, please . . . I do not really know . . . but . . . this thing

that you dont talk about your willie (ochinchin) or you dont show
it . . . hmm . . . could be related to the habit of going to an onsen or a
sent . . .
What do you mean?

I mean, there you can see men taking baths together . . . almost
naked . . . almost naked because they always bring with them a towel to
cover their willie . . . I dont know if this makes sense, but it is maybe
related.
Has ever someone told you that you have to cover it up?
I dont think so . . . it is something that you learn by looking at other
men . . .
Mens Views 69
Why do they want to do that?

Some people might say that it is because of good manners . . . I
guess . . . but . . . the fact that you cover up only that part means some-
thing maybe . . .
Good manners? What do you mean?

Some people say that you cover your willie up to show good manners . . .
What is good manners?

Hmm . . . I dont really know what that means.
In clarifying the meaning of good manners, some of the men sug-

gested that hiding the genitals could be connected to anxiety caused
by physical maturation at puberty and the ways young men patrol
each other rather than any behavior that is considered to be polite in
Japanese society or culture. Similar to findings in Hidakas research,
some of the men said that embarrassment and fear of their peers
opinions about pubic hair and penis sizes could have made them hide
their genital area, which helped emphasize that the genitals are impor-
tant to understanding what the male body is as well (Hidaka 2010).
Akabene-san (aged 19, single, student, circumcision status undis-
closed, sexual preference undisclosed) stated:
You know that in Japan, it is very common that we take baths together
with other boys, especially when we do school trips . . . They can see
if you have hair there and if the thing is getting bigger or not . . . You
feel uneasy . . .
Why?
Hmm . . . I dont know . . . but it is not unusual that they start picking
on you because you started growing hair before the rest of the mem-
bers of the group . . . or if your willie looks shorter or larger . . .
Is that why you started wearing a towel?

Maybe . . . I think that most guys start wearing a towel when they
become teenagers . . .
Why?
Hmm . . . it is maybe because it is very easy to get embarrassed, and
guys can very easily bully each other . . . Somehow, the penis, in par-
ticular, becomes a very important part of your body . . . I think.
Taking baths with their father was educational for some of the men.
Especially the older men in the group implied that their fathers might
have instructed them how to clean the penis. They, however, high-
lighted that things could have changed. Their reflections coincided
with Kawanishis description of the Japanese family today, where the
father is an absent figure from home: [A] good husband is healthy
and stays away from home (teishu genki de rusu ga yoi) (Kawanishi
2009, 71). The younger generation of men might not have taken
bathes with their fathers at all, as Takamatsu-san (aged 45, married,
white-collar worker, circumcision status undisclosed, heterosexual)
elaborated:
I dont think you can teach how to clean your willie . . .
Why is that so?

Hmm . . . I dont know . . . but when I was a boy, I remember my father
asking me whether I had cleaned it or not, though.
Did he actually teach you?

Taught me? I dont think so. You somehow learn how to do it.
How come?
This was because we used to take baths together . . . that was a common
thing . . . I still remember going to public baths (sent) . . . These days,
there are not many public baths in town . . . anyway, I dont think that
many fathers take baths together with their sons either . . . Things could
be different, though.
What makes you think so?

I dont know . . . I guess fathers are barely at home . . . They are fully
committed to work . . . I think it is difficult for a father to find the time
to take baths with their sons . . . Anyway, I dont think my father really
taught me how to clean there . . .
Is it maybe because you saw him cleaning it?

I am not sure about that . . .
Some of the men expressed that they actually received instructions about
how to clean their penis. Nevertheless, all the interviewees concurred
that the learning experience was a bit awkward. Similar to the research
reported by Sharpe (1994, 77), fathers . . . had very little role to play in
whatever sex education . . . their role was more confined to defining the
familys moral position. The group of men tended to agree that their
Mens Views 71
fathers warned them against touching or exposing their penis. As such,

fathers contribute to sex education not by providing instruction, but
through their silence by a shared understanding of what topics cannot
be mentioned in front of them (Holland et al. 1998, 61). Although
they were unable to remember when exactly this started, they tended
to agree that this could have been related to the fact that they grew up;
as you become older, you realized that the genitals are the unspeakable
and untouchable area, which becomes evident by using innuendos to
refer to it. Morita-san (aged 30, married, student, circumcision status
undisclosed, heterosexual) said:
Now that you are asking me this . . . I think that learning how to clean
my penis was somehow strange . . .
Why strange?
My father used to ask me, Did you clean there? . . . Did you roll it
back?
And that was strange?

Yes, I think so . . . It was strange because there is something we all
know . . . You dont touch or talk about your willie . . . or if you do,
you dont want your parents to know about it . . . I dont really know
how to explain it, but I got that impression.
How did you learn that you should not touch or talk?
You are asking me something difficult . . . I cant tell you exactly how I
learn . . . It is like a matter of common sense (jshiki) . . . I guess.
This form of common sense elicits, as Gagnon and Simon (2005)

put it, that these men have learned taboos linked to the body and
sexuality before they realized the scripts within which they operate.
Through self-reflection, some of the men in the group made it evi-
dent. As Tsuda-san (aged 18, single, student, circumcision status
undisclosed, homosexual) explained:
That is the thing . . . you dont really think about it, things become
somehow invisible, you dont know why but it is like this . . . you just
dont pay attention, and if you do, you dont say it . . . It could be also
because talking about your willie is taboo in Japan . . .
Really?
Maybe . . . I think it is taboo, but . . . hmm . . . it was maybe my father
who taught me how to clean it.
How did he teach you?

When we took baths together, he used to say roll back the skin and
clean it with soap and water . . . Anyway, it was bit odd because I still
remember warnings (chi) . . . Dont touch there . . .
Why those warnings?

I really dont know, but you somehow understand that your willie is a
place where you shouldnt lay your hands on, . . . and of course, you do
not talk about it either . . . It is a private thing, I guess.
References to privacy were common in my transcripts of interviews

too. Most of the men suggested that you do not talk about the geni-
tals because it is a private matter. Thus ideas concerning good man-
ners and privacy elicited what is described as civilized morality.
Some of the men implied that talking about the genitals, in particular,
and the sexual, in general, was most likely indecent or vulgar
(yarashii, gehin) if it was not done by using the right language,
which was a close reference to what Foucault (1990) identifies as
scientia sexualis. A scientific (kagakuteki) way to talk about the
genitals and the sexual involves the accurate and appropriate use of
a Japanese language that, in its written form, is expressed by com-
binations of Chinese characters (kanji) that are unlikely to appear in
daily conversations. The use of words such as genitals (inbu), penis
(inkei), vagina (inkaku), vulva (inmon), pubic hair (inm), scrotum
(inn) and testicles (fuguri) [gives to] sex related conversations a
sense of science and seriousness, different from slang and/or por-
nography (Castro-Vzquez 2007, 4). Some of the men in the group
implied that the Japanese scientific approach to sexuality is difficult to
understand because the language is complex. They highlighted that
although there is a large sex and pornography industry in Japan, it
does not necessarily mean that Japanese people are unrestrained and
can talk about the genitals and sex without problems. Onodera-san
(aged 35, single, white-collar worker, circumcision status undisclosed,
homosexual) referred to it in the following manner:
This is just strange . . . Sex and the genitals are not something you want
to talk about . . . It is a private thing . . . In Japan, it is taboo . . . It also
sounds kind of vulgar (gehin), a bit indecent (yarashii). We do have a
proper way to talk about sex, but it is not common, . . . but maybe few
people know it. The language is like scientific . . . and not used in daily
conversations.
Mens Views 73
What do you mean?

Well, it is formal language . . . that we usually learn at school . . . or the
language doctors use . . . In general, we do not talk about sex and stuff.
It seems to me that porn and sex shops are almost everywhere,

then I dont understand why you dont talk about sex, can you
explain?
Hmmm, maybe, the sex industry is big and porno is almost everywhere,
but we dont talk about that . . . It is really taboo.
Really?
Yes, I think so . . . It is very difficult to talk about this . . . People
feel uncomfortable if they have to . . . This is maybe a very Japanese
thing . . . I dont know.
On the other hand, a typical sex talk is done through innuendos, euphe-
misms, and jokes that need to be kept for the private space of homosocial
relationships. Conversations with women did not seem to occur, even in
the case of the married men in the group. As Ota-san (aged 27, married,
student, circumcision status undisclosed, heterosexual) elaborated:
Maybe this is odd, . . . but in Japan, we dont talk about that . . .
What do you mean?

I mean, we know that a male body is different from the female body . . .
and that the main difference is there (asoko) [giggling] but . . . serious
conversations? . . . I do not think I have had one even with my wife . . .
Really?
Yes, I think so . . . hmm . . . maybe with a doctor when you are sick . . .
or with your friends while drinking and joking . . .
Joking?
Yes, joking, but this joking is usually about womens bodies . . . I dont
know . . .
What about your education at school?

Hmm . . . you know that in Japan, any conversation related to sex is
kind of taboo . . .
Why?
I dont know, but it could be maybe . . . because it is a private thing . . .
I think that teachers struggle when they have to teach it . . . If they talk
about that, which is rare . . . I think . . . it is usually from a scientific

point of view (kagakuteki) . . .
What is that point of view?

I dont know how to put it, . . . but it is a very formal way of speak-
ing . . . as if you were talking to a doctor . . . maybe . . .
Although the relevance of the genitals seemed conspicuous, doubts

about the form and appearance of their own sexual organs were most
likely solved by accessing the mass media, pornographic materials,
and/or their peer group. Some of the interviewees implied that the
information in the media and pornography might not be accurate,
but at least men do not feel embarrassed and their privacy is some-
how protected. This could help explain why beauty clinics insist on
offering counseling and advice through their sites. Some of the men
suggested that information displayed on the Internet, for instance,
could be valid and reliable because it was presented within the
frame of medicine and scientific knowledge. Murase-san (aged 32,
single, white-collar worker, circumcision status undisclosed, homo-
sexual) put it:
To be honest with you, we dont talk about that . . .
Really?
Yes, I think so . . . I dont think anyone does . . . It would be very odd
to start a conversation about that . . . a lot of guys could know about
phimosis (hkei), but they dont ask . . . Somehow (nantonaku), you
get the information . . .
How do you get information?

Nowadays things are simpler because of the Internet, . . . and the ads
that beauty clinics produce are the easiest way to learn about it . . .
How accurate is that information?

I really dont know, but it seems that it is written by doctors . . . I am
not sure though.
Have you looked for information on the Internet?

Hmmm . . . I dont remember . . . maybe yes, when I was younger . . .
What was the thing that worried you?

I dont know . . . I guess . . . like other guys, you always want to know
if there is OK . . .
Mens Views 75
In retrospect, pornography might be a rather explicit and graphic

way to learn about the male body and the genitals. Nonetheless, local
productions were of little help due to official censorship and regula-
tions banning any explicit display of genitalia, in particular the male
penis. As for international pornography, in line with the theorizing of
Epstein and Johnson (1998), this group of men has developed a form
of literacy, which is a kind of common sense that let them read ico-
nographies and realize that pornography is not a teaching device.
The bodies included in pornography are most likely to provoke sexual
arousal and fantasies in the audience than to teach anything. Kano-
san (aged 29, single, student, circumcision status undisclosed, hetero-
sexual) commented:
Maybe Japanese guys learn about sex by watching porn . . . I am not

sure, . . . but I dont think you can learn about your body or your willie
by watching Japanese porn . . . In Japanese porn, you cant really see
there [the penis] . . . especially mens genitals are covered, they have
a mosaic blur (mozaiku) . . . In porn coming from other countries,
. . . on the Internet for example, . . . you can see the organs, . . . but we
all know that they are all fake . . . somehow . . . They look very big . . .
They know how to play with the camera and stuff . . . The main point
is to provoke excitement (kfun saseru).
Are you saying that the penises in porn are not real?
Hmm . . . it is difficult to say, . . . but I dont think that in real life men
have such a big thing . . . black guys maybe . . . [giggling] . . . dunno.
So why do you think guys watch pornography?

Well, I dont really know, but . . . I dont think guys watch porn to learn
anything. They just want to relax and have fun.
On the other hand, information provided by the group of peers

is always questionable. The majority of the men in the group said
that they could not really trust their peers. Men tend to share the
same assumptions and ignore the same information. Furthermore, as
Shibuya (2009) highlights, a conversation about male genitalia within
the group of peers is usually framed within the idea that they are com-
peting against each other. The group of men elicited that the penis
can easily turn into a symbol to establish power relationships between
men. This implies that [t]he role of the symbolic phallus . . . [which]
has nothing to do with the physical difference between the sexes as
such, but the cultural significance which the phallus is given as a mark
of the difference which governs entry into language and our construc-
tion of the sexed objects, that is, the difference between the sexes is
fundamental to our becoming language-using social beings (Jackson
1999, 82, original emphasis). In this light, talking about genitalia is
most likely a part of a funny story, to intimidate someone and/or to
brag about it. Tsuda-san (aged 18, single, student, circumcision status
undisclosed, sexual preference undisclosed) noted:
Hmmm . . . in my experience, talking about the sexual organs with

friends has never been a serious conversation . . .
What do you mean?

How can I put this, . . . it is more like a victory-or-defeat kind of game
(kachimake asobi).
Why is it so?
I dont know, but it is like that . . . when you are young, I think that
you get a bit nervous about your thing [penis] . . .
Why do you get nervous?

I am not sure . . . is it maybe because you want to know but you can-
not ask . . . With friends, you always make jokes . . . some guys use it
to bully.
To bully?
Yes, because the thing is too small . . . because the thing is too big . . .
because it looks awkward . . .
In exploring the interpersonal dimension underpinning circumcision,

my interviews with this group of men reveal that it is largely through
their homosocial daily interactions that the narrative becomes real
and the penis appears as a central element in understanding what the
male body entails. As Jackson and Scott (2010b, 142) put it, The
genitals are not meaningful in themselves but are culturally produced
in the everyday doing of gender attribution, which entails a variety of
cultural competences and complex interpretational processes.
The sexuality-related education of these men is chiefly grounded
in the mass media and their peer group. Talking about the sexual has
been mostly a process full of innuendos and silences. Together with
their homosocial interactions it conflates to produce a sexual culture
that the cosmetic and beauty industries could effectively use to make
of circumcision a commodity.
Mens Views 77
Em b odiment and the P repuce

My interview analysis suggested the prevalence of a phallocentric cul-
ture through the daily interactions of this group of men. Such interac-
tions tended to center the reading of the male body in line with the
size and form of the genitals, reducing the gendered and sexual self
of Japanese men to a penilized male self. Nevertheless, in moving
deeper into the intrapsychic dimension, my transcripts of the inter-
views indicated that these men were able to position themselves dif-
ferently within the phallocentric tendencies and that their positions
could be multiple and not always static and sometimes contradictory.
As Jackson (1999, 24) elaborates, While the social and cultural order
in which and through which we live our gendered, sexual lives pre-
dates us and is thus, in a sense, external to us, this does not mean
that there is no room for active agency. The complexity of social life
permits considerable everyday choice and negotiation. The recogni-
tion of agency is crucially important if we are to admit of the possibil-
ity of resistance to hegemonic forms of gender and heterosexuality,
as well as the ways in which we might be actively complicit in their
perpetuation. Social and cultural constructions certainly influenced
the readings of the male body and helped produce a sort of com-
mon sense about what might be empirically knowable (Jackson and
Scott 2010b, 1). However, Bourdieus distinction between repre-
sentation and practice became apparent to understanding the view
of most of the men in the sample (Bourdieu 1977). My transcripts of
the interviews elicited that the actual experience of feeling their bodies
encompassed an effective guide to discard or incorporate informa-
tion gained through their peer group, mass media, and pornography.
Exploring their bodies was particularly relevant to knowing what the
prepuce entails and how it relates to their gender identity. There was
a general consensus that men who believe in the penilized male self
and the information on circumcision circulating on the Internet and
in fashion magazines were either inexperienced young men and/or
completely isolated men who were unable to talk about penile con-
cerns. Exploring the genitals indeed entails a form of embodiment;
it is key to knowing what the prepuce means: Adult masculinities
are produced through a complex process of growth and development
involving active negotiation in multiple social relationships, [because]
[t]he result of adulthood is generally a complex personality structure,
not a homogeneous one, in which contradictory emotions and com-
mitments co-exist (Connell 2000, 31). Nevertheless, this group of
men tended to agree that the sexual entails a critical element in the
process of becoming an adult man. As Hori-san (aged 30, married,

student, circumcision status undisclosed, homosexual) observed:
When you are a young man, . . . somehow your life seems to move
around there . . .
What do you mean?

When you are a young man, it seems that your willie is the most impor-
tant thing to worry about.
Really?
Yes, I think that everyone has passed through that as your body changes,
and it is growing up (seichshiteiru kara) . . . There is always a concern
about your willie . . . and because it is difficult to talk about it . . .
Why is that so?

I really dont know, but most of the time, you have to find it out your-
self . . . alone . . . and you worry a lot.
When do you stop worrying?

Hmm . . . I guess that once you learn that you can have an erection
and that it is not covered . . . you can see that there is nothing to worry
about . . . then, you stop worrying . . .
Experiencing and touching ones own genitals, however, needed to be

framed within the civilizing process (Elias 1994) that chiefly revolves
around transiting from the primitive or raw-desires (nature) . . . [to]
the habitus (nurture) where they emerged as socially sanctioned tastes
or preferences (Turner 2008, 13). The majority of the men sup-
ported the idea that young men, in particular, were unmistakably
concerned about their own bodies and certainly that masturbation
(hitori ecchi), for instance, was a pleasurable act that helped also
confirm that the sexual organ worked properly. Self-exploration of
the body could be identified as an integral component of a process of
becoming an adult (otona ni naru, ichinin mae ni naru). However,
it does not occur in the vacuum, becoming an adult is an individual
act that has social implications and thus exploring the body becomes
an unspeakable matter that most likely occurs in private, which is in
contrast to concepts of late modernity that envisage the self as cast
adrift from traditional cultural expectations, from habitual taken-for-
granted ways of being (Jackson and Scott 2010b, xi). In being asked
about the importance of masturbation, Ishikawa-san (aged 24, single,
Mens Views 79
blue-collar worker, circumcision status undisclosed, sexual preference

undisclosed) said:
To get rid of your thing . . . you do it . . . you masturbate (hitori

ecchi) . . . I think that everyone does it . . . somehow doing it is impor-
tant to become an adult . . . to become a man . . .
A man?
Hmm . . . yes, I believe so . . . somehow sex is the difference between
a man and child . . . but sooner or later, you learn that you dont talk
about it . . . you dont say what you did.
Why is it so?
I dont know . . . well, maybe with your friends you joke about it,
. . . but you dont really want to talk about it . . .
Why not?
I am not sure, but I think it is maybe because it is a private thing . . .
A private thing?
Yes, something that you do, but you dont talk about it . . . but it is
important that you do it . . . it somehow makes the difference between
a boy and a man . . . that is what I think . . . and a man does not talk
about it . . . I guess.
The information displayed by aesthetic clinics suggesting that the geni-

tals are key to casting light on issues related to mens self-esteem and
confidence was elicited from my transcripts of interviews as well. The
majority of the interviewees agreed that male self-assurance and self-
esteem was largely related to the genital area when you are a young man.
Nonetheless, in the process of becoming an adult, real men needed to
locate their source of pride on something less mundane and primi-
tive as the pure flesh. The explanation suggested that adult men tended
to find self-pride through achievement and success at school, the arts,
the workplace, and sports, for instance. Consequently, men who believe
in the advertisements for circumcision and who saw in the surgical pro-
cedure a means to attain confidence and respect could be seen as infan-
tilized men, unmanly (memeshii), men who did not grow up (seijin
janai otoko) or who are not an adult (ichinin mae ni natteinai).
How does it happen?

Hmmm . . . how can I explain it? Hmm . . . I dont know . . . as a young
man, you are definitively worried about your willie . . .
Worry?
Yes, I think so . . . it is maybe because you truly think that your thing
is small . . .
The size is so important?

Hmmm . . . I am not sure . . . but I think it is . . . and if you think that
it is small . . . you might have a kind of complex . . . but then you accept
it . . . you cant help it . . . maybe . . . you start thinking that your wil-
lie is not that important . . . you tend to place your confidence in your
work . . . in your achievements . . . at school . . . in the sports . . .
What do you mean?

You stop worrying about your body . . . I guess . . . if you are a bit too
concerned about your body, it is because inside yourself you are still a
child . . . you are a kind of unmanly (memeshii) . . . a kind of . . . you
are not an adult (ichinin mae ni natteinai) . . . you did not grow up . . .
maybe . . . that is what I think . . . (Ota-san, aged 27, married, blue-
collar worker, circumcision status undisclosed, heterosexual)
Such assertions reflect Dasguptas findings concerning the relation-

ship between work and masculinity: [I]t would be hard not to see the
underlying extension of his sense of [job related] achievement[s] to
his own masculine self-esteem (2013, 84, original emphasis), which
largely revolves around the master narrative underpinning the sala-
ryman ideology. Real men, and thus true masculinity, most likely
entail a degree of disembodiment because real men tend to construct
their gender identity through the world of rational thinking and
achievement, which could be related to the idea that [m]iddle-class
male bodies, separated by an old class division form physical force,
now find their powers spectacularly amplified in the man/machine
systems (the gendered language is entirely appropriate) of modern
cybernetics (Connell 1995, 56). Matsukate-san (aged 43, married,
white-collar worker, circumcision status undisclosed, heterosexual)
explained:
I truly think that guys who are a bit too concerned about their willie
and stuff are a bit immature . . .
Really?
Yes, I think so . . . I think that it is the case of men who did not grow
up (seijin janai otoko) . . . I know that as a man, you need to find
something in yourself to be proud of . . .
Mens Views 81
Proud of?
Yes, something like graduating from a good university . . . working for
a big company . . . those men who are a bit too concerned about their
bodies are a bit unmanly (memeshii) . . . or immature (mijuku) . . . you
need to accept your body as it is and keep going.
What does accepting mean in this context?

Your body is somehow something that you cannot change . . .
What do you mean?

I mean . . . for instance . . . if your willie is big or small, you have to
accept it . . . You place your pride in something more mental . . .
Mental?
Yes, for example . . . your work performance . . . something that you
can achieve at work . . .
Most of the men, especially the older ones in the group, insisted
that true men stop worrying about their bodies and become largely
unconcerned about the size and shape of the genitals. This empha-
sized the idea that penile concerns, and thus issues of circumcision,
were most likely for young and nave men. However, the idea became
unsupportable when looking at prices for the surgery at beauty clinics.
It is practically impossible that a young man without a regular income
could afford the medical procedure.
Yes, I think that the surgery is mostly for young men . . . those young
men who are growing up and are a bit too concerned about their wil-
lie . . . like teenagers . . . kind of . . .
If you say that circumcision is basically for young men, I dont

understand why the surgery is so expensive?
Hmm . . . I dont understand either . . . I have not thought of that
either, . . . but it is really expensive . . .
What do you think makes the surgery expensive?

Hmmm . . . I dont know . . . is it maybe because it is cosmetic surgery,
. . . and thus you cannot use your health care insurance . . . I dont
know . . .
Do you think that teenagers can pay for it?

Hmm . . . I dont think so . . . maybe their parents pay for it . . . I dont
know . . . anyway . . . one thing is true . . . the surgery is expensive . . .
and I dont know why . . . (Takamura-san, aged 29, single, student,

circumcision status undisclosed, sexual preference undisclosed)
There was another aspect in my analysis of the interviews that equally

challenged the idea that penile concerns and circumcision are for ado-
lescents and young men. The data revealed a general agreement that
concerns about penis length are always present in the intrapsychic
dimension of men, which made all Japanese men potential clients for
the cosmetic surgeon. Evidence of such concerns could be indicated
by the fact that conversations about genitalia only occurred within a
homosocial context and mainly through jokes. This could be because
humor is a means to gain pleasure despite the painful affects which
disturb it; it acts as a substitute for this affective development, and
takes its place (Freud and Brill 1938).
Do you really think that only young men worry about their penis?
Hmm . . . now that you are asking this to me . . . I dont know . . . I am
not sure . . . let me think . . . I can tell you something interesting . . .
What is that?
I dont know but . . . it is a bit odd that talks on male genitalia are
mainly through jokes . . .
Jokes?
Yes, and I dont know why . . . is it because talking about the penis
(dansei seki) is always a sensitive thing (binkan na tokoro).
Why is it a sensitive thing?

I dont know, but that is why we always joke about it . . . maybe
[giggling] . . . I think that we laugh and play because it is a sensitive
thing . . . maybe . . .
Can you have serious conversations about this?

Hmm . . . I dont think so . . . maybe if you are sick or something . . .
and you go to the hospital or something . . . otherwise . . . it is always
joking . . . maybe . . . (Ishikawa-san, aged 24, single, blue-collar worker,
circumcision status undisclosed, sexual preference undisclosed)
Some of the younger men in the group elicited that the penis, and
thus circumcision, could be not only a matter for pubescent or young
men. The so-called miemuki habit (kuse) that refers to men pulling
back the prepuce before entering a bath could illustrate that adult
men are equally concerned about their penis and the condition of the
Mens Views 83
prepuce, as Takane-san (aged 18, single, blue-collar worker, circumci-

sion status undisclosed, sexual preference undisclosed) explained:
What you say is not strange . . .
Why is that so?

I have heard that before . . . teenagers worrying about their willie look
for circumcision . . . hmm . . . but I think adults could look for it too.

Hmm . . . do you know the word miemuki?
No, not really. What does that mean?

It refers to a man who has false phimosis (kasei hkei) and uncovers it
[the penis glans] before entering a public bath, in case someone looks
at it . . . we call that miemuki . . .
Do you think that everyone does it?

Hmm . . . I dont know . . . maybe . . .
But I think that you cover up your penis with a towel . . .

Yes, we do but still guys do miemuki.
I see, and adults do that too?

Of course, everyone does it . . . maybe . . . most Japanese men have a
long prepuce (hkei) but dont want guys to know that it is . . .
Why is that so?

I dont know . . . but it could be maybe because having the thing cov-
ered is like awkward (kakko warui), maybe . . . I am not sure.
Wearing a small towel as a symbol of good manners in public baths

to cover the genitals together with the so-called miemuki habit could
indeed indicate that Japanese men, regardless of age, are concerned
about the penis in general and the condition of the prepuce in particu-
lar. This could be a reason for the existence of the number of beauty
clinics that specialize in circumcision and for men willing to have the
prepuce removed even if it means paying for a pricey minor surgery.
Although the majority of the men tend to oppose the idea of the
penilized male self promoted by the aesthetic industry, covering the
genitals and the so-called miemuki habit show the contradictions and
inconsistencies concerning some aspects of the intrapsychic dimension

underneath circumcision from the viewpoints of this group of men.
S ex ual S el f and Circ um ci s i on

The experiences of the circumcised men in the group allowed for a
reading of the intersection between the interpersonal and intrapsychic
dimensions in relation to having the prepuce removed. Their experi-
ences made it clear, as well, that social life is not as simple as the
iconographies of circumcision could suggest and that although this
group of Japanese men can exercise agency, they sometimes might be
actively complicit in the reproduction and perpetuation of the master
narrative that reduces the gendered and sexual male self to the size
and shape of the penis.
Opposing viewpoints of cosmetic surgeons and urologists concerning
circumcision exist. Nevertheless, the reflections of a circumcised man
pointed out that the script that the sexual originates in the genitals and
that intercourse most likely involves vaginal penetration might be the
same for both cosmetic surgeons and urologists. One of the circumcised
men in the group pointed out that the National Health Insurance (NHI)
at a local hospital covered his circumcision and thus it was inexpensive,
because having a large prepuce was allegedly a hindrance for a married
heterosexual man to get his wife pregnant, as Mitsubishi-san (aged
40, married, white-collar worker, circumcised, bisexual) elaborated:
Yeah . . . I know what you mean . . . It is crazy that some guys have
to pay such an amount of money at a beauty clinic for the surgery;
. . . in my case, it was cheap and simple because I could use my health
insurance . . .
Why could you use your insurance?

Well, I think actually . . . that everything depends on the reason you
have . . .
What do you mean?

Well, in my case having the thing cut off was simple because she could
not get pregnant . . . then it was . . . because . . . we were married and
we apparently wanted to have children . . .
And you did not want to have children?

Well . . . we wanted maybe . . . but part of the truth is that I did not feel
comfortable having fun.
Mens Views 85
Having fun? What do you mean?

Hmm . . . when I have fun with guys . . . I mean . . . I am bisexual,
maybe.
I see. Why did not you feel comfortable?

I dont know, it was just a feeling.
Do you think that if you had said to the doctor that you are
bisexual, you might not have been able to use your health care
insurance?
Maybe . . . I am not sure . . . but I think that everything was smooth
because my wife could not get pregnant . . . so I could use my insurance
and it was not expensive . . .
In spite of identifying himself as bisexual, Mitsubishi-sans sexual

preference was never questioned and his official access to circumci-
sion was largely guaranteed because of being a married man willing to
impregnate his wife. This relationship of sexual preference and circum-
cision in the Japanese settings became clearer through my interviews
with the homosexual men in the sample, who found it intriguing that
circumcision in Japan appeared as a surgery for heterosexual men. The
surgery is apparently not publicized in gay magazines at all. This actu-
ally implied an interesting medical conundrum. Just as homosexual
men seem bombarded with propaganda and messages concerning
HIV/AIDS that indirectly conveyed the idea that the pandemic is
a matter for homosexual men, heterosexual men are inundated with
information about circumcision, which seems a medical issue for het-
erosexual men. Onodera-san (aged 35, single, white-collar worker,
circumcision status undisclosed, homosexual) explained:
Yeah . . . it is interesting what youre asking . . . I have never seen ads

for circumcision in gay magazines . . .
Why?
Hmm . . . I dont know . . . is it maybe because HIV/AIDS among gay
people is higher? . . . I dont know . . . well . . . it does not mean that
gay men are not interested in it [circumcision] does it?
What do you mean?

I think that there are gay men interested in the surgery too . . . they
want to get the thing cut off . . . but ads are certainly for heterosexual
men . . . Is it maybe because of the idea that gay men are all effemi-
nate . . . then . . . they do not need a bigger thing [penis]?
I thought that circumcision was to prevent disease . . .

Yes, it seems to be . . . hmm . . . I am not sure . . . well . . . in general,
Japanese people use condoms . . .
What do you mean?

I am not sure, but I heard that in some places, the surgery is to prevent
HIV or something, . . . but in Japan, most guys wear condoms . . . even
if AIDS is increasing . . . hmm . . . I have no idea, honestly . . . but
certainly, circumcision seems to be for straight guys . . .
Reflections about gay dating sites on the Internet concerning circum-

cision were also insightful. Although the Japanese beauty and cosmetic
industries convey the idea that circumcision entails a major concern
for heterosexuals, the surgery could in reality be an issue for homo-
sexual men in the world. Japanese gay sites (deai kei saito) include in
the profiles of their users, for instance, categories such as top (tachi)
or bottom (uke), which refer to the person who penetrates and the
one who receives penetration, respectively. However, no reference is
made to circumcision status. Non-Japanese sites such as Gaydar or
GayRomeo, however, contain in the profiles of their users categories
such as cut or uncut, which refer to being circumcised and uncir-
cumcised. This also creates some linguistic confusion in the Japanese
language because the expression cut is referred to as muke and
uncut as hkei, which are inaccurate translations.
Are you saying that gay men are rather worried about being cut?
I am not sure, but it could be.

I dont know, . . . it is true that most of the ads and stuff in Japan are
for straight guys (nonke) . . . anyway . . . something makes me think
that gay men are rather worried about having there [the prepuce] cut
or not.
Why do you think they are rather worried?

Well, if you check the Japanese gay sites, you can see that guys here
say that they are bottom or top in their profiles . . . but if you look at
international sites, you can see that guys there say also if they are cut
or uncut . . .
Why is that so?

It could be maybe because most Japanese guys are uncut? So asking
that does not make sense . . . it could be also because hkei is not a good
Mens Views 87
word . . . I dont know . . . anyway if you think carefully . . . you could

say that it is a bit confusing.
What is confusing?
On the sites they translate cut as muke . . . but muke does not mean
that you are cut . . . I mean, cut is that the thing [the prepuce] has been
cut off, isnt it? If you say muke in Japanese, it means that you can pull
down the thing . . . maybe.
I see, how do you say cut in Japanese then?

I dont know . . . katsurei [circumcision] maybe . . . but I am not sure.
(Tsuda-san, aged 18, single, student, circumcision status undisclosed,
homosexual)
The lack of advertising explicitly targeting the homosexual commu-

nity does not mean that they do not access the surgery. In spite of
being expensive, some of the homosexual men in the group wanted
to have the prepuce removed. This is contrary to Harrison (2002),
who makes a strong case for opposing circumcision by arguing its
negative impact and ramifications on sexual behavior. In particular,
Harrison emphasizes that removing the foreskin makes the sexual less
pleasurable. A relevant example is that circumcised homosexual men
are unable to perform docking [which] involves one man extending
his foreskin in such a manner that it forms an orifice that is then pen-
etrated by another (presumably erect) object (Harrison 2002, 310).
As the advertising of aesthetic clinics suggests, after the surgery, the
penile glans becomes less sensitive because it is always exposed. My
analysis of the interviews suggested that some Japanese homosexual
men would like to be circumcised because it was beneficial to sexual
relationships among men, and this degree of insensitivity permitted
them to have longer lasting erections, which meant a more rewarding
sexual play or real play (hont no asobi). In this context, sexual
play chiefly meant long-lasting sessions where a couple or a group of
people could enjoy and explore each others bodies, in opposition to
the traditional heterosexual intercourse that was usually concerned
with a couple willing to reproduce. Nomura-san (aged 38, single,
white-collar worker, circumcised, homosexual) elaborated:
Well, in my case, having the thing [the prepuce] cut off was a good
thing . . . you know we can have fun for a longer time . . . I dont
know . . . I think that for gay people, its different than for straight men
(nonke), this idea of longer sessions is important, and as the thing [the
prepuce] gets a bit insensitive (chotto kankaku nakunateiru), you can
control it better and come [ejaculate] when you want . . . as we dont

do it to have children . . .
Are you saying that the meaning of intercourse is different if you

are homosexual?
I am not sure . . . I have ever had sex with a woman, but something
makes me think that they are a bit too worried about having babies and
stuff . . . I dont think they really enjoy . . . maybe . . . if you do it with
a guy, it is maybe more relaxed . . . to enjoy . . .
What does enjoy mean?

I do not know, try different things . . . that is why it is important that
you dont come too fast . . . that is why I got the thing [the prepuce]
cut . . . if you come too fast it is over.
Are you saying that intercourse finishes when you come?

Hmm . . . I think so.
It was rather difficult to explore these ideas about pleasurable sexual

intercourse and the relevance of being circumcised to control ejacu-
lation. Most of the men did not want to expand and/or offer details
about their sexual experiences, and a common reason to evade the
topic was that they were unable to talk about it because they were
uncircumcised. However, some of the men in the group implied
that heterosexuals were not only concerned about having babies
but also equally looking for pleasure. It was difficult to verbalize
what pleasure means, but they highlighted that being circumcised
might not be relevant because controlling an ejaculation most likely
involves a mental process and a level of embodiment. Men learn how
to ejaculate at will, which means that they have the mental faculty to
decide when to do it, but it requires knowledge of their own body.
Intriguing, however, was that regardless of sexual preference and
circumcision status, most of the men underscored the significance
of ejaculating and tended to agree that it marked the end of the act.
Tomita-san (aged 44, married, white-collar worker, uncircumcised,
heterosexual) explained:
In the first place, I dont think that we are only worried about having
babies . . .
What do you mean?

Sex is to enjoy too . . .
Mens Views 89
What is enjoying in this context?

Hmm . . . I dont know how to say it . . . it is like feeling good (kimochi
ga ii) maybe . . . I dont know.
Do you think that feeling good has something to do with being

cut or not?
I dont think so . . . I am not . . . and I enjoy sex.
Some people think that it is connected to ejaculation?

What? . . . ah, I know what you mean . . . some clinics say in their ads
that it is good to be cut because the thing becomes less sensitive . . . I
dont think so . . .
Why?
Hmm . . . I think you can come [ejaculate] when you want . . . it is a
matter of will and knowing your body . . .
What do you mean?

If you are a bit too young, you dont know how to do it, but you learn
how to do it . . . at least that is my case.
Anyway, why is ejaculating so important?

I am not sure, but somehow we learn that if you come, everything
finishes and nobody enjoys . . . you need to learn when to come . . .
maybe.
My transcripts of the interviews did not indicate consensus that

the relationship between the male sexual self and the prepuce was
especially significant. For some of the men, circumcision meant
indeed improved sexual performance, which was closely related to
the viewpoint presented in the ads to promote the cosmetic pro-
cedure. However, the implications of being circumcised seemed
to contradict the idea that the surgical procedure is a sanitary
measure with the potential to prevent disease. Some of the men
stated that after having the prepuce removed, their hygiene habits
changed and they stopped paying close attention to cleaning their
genitals.
What about cleaning and hygiene, any change?

No, not really . . . I dont think so . . . hmm . . . let me think . . . I
think that after I got cut . . . I dont pay too much attention to clean-
ing there . . .
What do you mean?

Before getting the thing cut . . . it was more like . . . oh, I have to
uncover it, kind of . . . and it was more like consciously doing it . . .
So, you dont clean it anymore . . .

Hmm . . . it is not that I dont clean it . . . well, as it is uncover you just
clean it . . . I dont know how to say this . . . but I feel that something
has changed . . . like the idea that you have to check if there is clean or
not . . . I am not sure . . .
Do you think that men in general would stop paying close atten-
tion like you?
I cannot say anything, because I dont know many cut Japanese men . . .
and you dont really talk about that, . . . but . . . it would be interesting
to know how they change . . . (Nomura-san, aged 38, single, white-
collar worker, circumcised, homosexual)
Some of the uncircumcised men actually implied that circumcision

could be detrimental to hygiene because men might stop cleaning
the genitals in a proper way. They also emphasized that the surgery
was rather unnecessary because having a long prepuce does not affect
sexual performance in any visible way. In Japan, circumcision has basi-
cally turned into a product that the cosmetic-surgery industry is inter-
ested in promoting to improve their profits. Takamatsu-san (aged 45,
married, white-collar worker, uncircumcised, heterosexual) reflected:
Why should I get the thing cut off?
In many places in the world, they do it because of hygiene, for

example.
See, I am already 45 years old, and I have never had any problem . . .
you just keep your penis cleaned and thats it . . . on the contrary, if
you cut the thing . . . it looks odd, and you might stop cleaning it . . .
maybe . . .
Why do you think you might stop cleaning?

Because if you dont have to roll back the skin, you might think that it
is already clean . . . I dont know . . . you need to ask someone cut . . .
Do you think that there are many cut guys in Japan?

I dont know . . . hmm . . . I dont think so because it is not really a
custom . . . I dont know . . . maybe be there are some guys . . . But
Mens Views 91
you dont ask . . . and I dont think they want to tell you . . . this kind
of conversation could be a bit awkward . . .
Some ads in the Internet say that cut guys have better sex?
Better sex? . . . hmm . . . What is that? I cannot say much . . . because I
am uncut . . . but I have already two kids and still enjoy having sex . . .
In what way sex could be better . . . I dont understand . . . In Japan
at least, it is pretty much something that cosmetic surgeons created to
make money . . . maybe . . . it is like cosmetic surgeries that are becom-
ing more and more popular . . . behind that is money . . . maybe . . .
As a result, intercourse was highly valued to understanding the rela-

tionship between the sexual self and the prepuce. My data suggested
that sexual practice most likely encompasses a learning process, which
elicits the level of embodiment attained by the man involved and
allows for an understanding of how agency materializes in the lives
of this group of men. Their level of critical awareness concerning the
foreskin and the male body appears directly proportional to the per-
sonal sexual experience. Critical awareness sets the grounding for an
alternative reading of the relationship between circumcision and pro-
phylaxis as well. Overall, my interviews with these men indicated that
sexual practice entails a form of body-reflexive practice that is not nec-
essarily internal to the individual because it includes social relations,
symbolism, and large-scale institutions, such as the cosmetic-surgery
industry. As such, through body-reflexive practices, more than indi-
vidual lives are formed: a social world is formed (Connell 1995, 64).
Co nc lusio n
Exploring the interpersonal and intrapsychic dimensions underpin-
ning circumcision in Japan through the daily experiences of this group
of men provided an insightful reading of the surgical procedure. Their
experiences shed some critical light on the social process underpin-
ning the biomedical practice as well as ideas about what the male body
entails. My interview transcripts indicated the salience of the penis
in the everyday homosocial interactions of these men. This is key to
theorizing circumcision and understanding how it can be commercial-
ized as a surgery that could reshape the gendered and sexual self of
Japanese men.
Ideas about the penilized male self that are pervasive in the adver-
tising produced by the cosmetic and beauty industries to promote
circumcision appear to be largely anchored in a sexual culture of
silence, pretense, and misinformation. School- and home-based edu-

cation appeared largely ineffective to contest common sense that the
sexual and gendered self largely depends on the genitals. The tradi-
tion of having communal baths, however, has become educational
for these men. Through social interactions in the bath, men are
introduced into a culture of phallocentrism that confirms the cen-
trality of the penis in understanding what the male body entails and
uncovers homosocial power relationships as well as gender dynamics
underpinned by the shape and size of the genitals. Social interactions
in baths are also relevant to approaching issues concerning penile
hygiene.
Despite my interview transcripts revealing a staggering overlap
between interpersonal relations and the phallocentric culture, explor-
ing the intrapsychic dimension through the interviews with this group
of men suggested a level of critical awareness that largely depends on
body-reflexive practices. Intellectually, the group of men challenged
ideas of the penilized male self by inserting male self-confidence and
pride into a process that could be called becoming an adult man.
Within the process, pubescent and young men tend to place great
importance on the genitals, in contrast to adult mens pride and
confidence, which tends to lie in work-related achievements. Thus
circumcision is most likely a teenagers concern. However, the sur-
gery is so expensive that only a man with a regular salary could afford
it. Furthermore, the habits and behavior of Japanese men at public
baths suggest that all Japanese could equally want to get circumcised
regardless of age.
Masturbation and sexual intercourse appear as a form of embodi-
ment that helped some of the men contest ideas concerning the
advantages of being circumcised. Sexual pleasure and the ability to
control an ejaculation do not necessarily depend on the condition
of the prepuce; thus circumcision could be redundant. Furthermore,
some of the men, contrary to medical expectations, contended that
being circumcised could deter men from observing proper penile
hygiene.
Some of the men indicated that circumcision has been culturally
produced as a medical intervention for heterosexual men, just as HIV/
AIDS is most likely an issue for homosexuals. This of course does not
stop homosexual men from looking to have the prepuce removed,
as they see in the practice a strategy to enhance sexual performance,
which is largely in line with the biomedicalization of circumcision.
Furthermore, references to gay dating sites on the Internet implied
that homosexual men could be rather concerned about having a long
Mens Views 93
prepuce or not. Since circumcision has been socially constructed as

a biomedical intervention for heterosexual men in Japan, the next
chapter explores the views of Japanese women to examine how the
symbolism attached to the prepuce impacts on their sexual and gen-
dered selves.
4
Chapter 4
Womens Views
Hmm . . . I dont think Japanese women know anything about

males and the genitals.
(Maeda-san, aged 25)
Circumcision is not really a matter of health for women, is it?

. . . It is a cosmetic surgery for men, I guess.
(Onodera-san, aged 21)
I t is clear from current campaigns to promote adult circumcision

that women have an important role to play. From an international
perspective, it is through sexual intercourse with infected women that
uncircumcised men are at a higher risk of acquiring the HIV, and thus
heterosexual circumcised men might request unprotected sex because
they have a natural protection. From the social reality of Japan, cos-
metic surgeons tend to insist that women supposedly prefer circum-
cised men because they are largely a guarantee of sexual satisfaction
and hygiene. Nonetheless, [f]ew researchers have reported solely on
the acceptability of circumcision for HIV prevention among women
(Kelly et al. 2013), and very little is known about the relationship
between womens sexual pleasure and circumcision.
Within the Japanese context, current tendencies imply that the
younger generation of Japanese women has become rather sexually
active and sex knowledgeable. Yet Maeda-san, as can be seen in the
earlier quote, utterly expressed ignorance in the first place. Is it really
that she does not know? Could it be that she does not find herself
comfortable talking about the sexual with a male researcher? Could
it be that she does not have the proper vocabulary to talk about
or that she just does not want to engage in conversation that is not
suitable for women? In which case, she is just putting on a false
front. The truth is that circumcision could be considered as being far
removed from a womens issue because, as Onodera-san in the earlier
quote highlights, the procedure is largely offered as cosmetic surgery
for Japanese men without any apparent benefit for women.
In disentangling the intrapsychic and interpersonal dimensions
underpinning circumcision from a female viewpoint, this chapter
draws on my transcripts of conversations with a group of Japanese
women who voluntarily agreed to be interviewed. Finding women
willing to participate was indeed a major issue because it elicited the
idea that circumcision was effectively a topic of conversation not suit-
able for women.
Exploring the intrapsychic dimension underneath circumcision
suggests that open conversations about the sexual in general, and the
medical procedure in particular, are daunting because they tend to
place the sexual reputation of the woman involved at risk. This of
course does not necessarily mean that these young women are abso-
lutely uninformed. Indirect communication and pretend ignorance
become key to understanding the social process underpinning how
young women can effectively keep themselves informed and express
their concerns. The interpersonal dimension underpinning circumci-
sion from the insights of these young women unveils the relevance
of homosociality. Not only does home-based sex education appear
to be chiefly conducted by and for women, but the group of peers
also entails a critical avenue of learning about the sexual and cir-
cumcision too. This chapter emphasizes the relevance of girls talk
that represents an opportunity for women to know about the surgi-
cal procedure. However, the prevalence of innuendos and jokes in
those talks seems to enlarge the idea that knowing about circumcision
is effectively opposite to femininity. Although some of the women
appropriate the language of circumcision for expressing sexual needs,
none of them stated that they preferred the circumcised penis.
Th e Mal e Bo dy and E du cati on

In exploring the interpersonal and intrapsychic dimensions under-
pinning circumcision from the viewpoint of this group of Japanese
women, my interviews included their knowledge about the male body,
in general, and the prepuce, in particular. However, introducing this
topic of conversation was not easy. The tone of their voice and facial
expressions mirrored some uneasiness. Similar to my interviews with
Womens Views 97
men, the young women tended to draw on their sex-related education

to point out that they did not have any formal education concerning
male genitalia. In the recollection, some of them referred to their pri-
mary and secondary science courses. When Shirashi-san (aged 19) was
asked about circumcision, she said:
Hmm . . . I dont think I know anything about that . . . nobody really

talks about these things . . . circumcision is not really something that
we learn about . . .
What about the male sexual organ?

About the male sexual organ?
Yes.
Hmm . . . I am not sure . . . maybe . . . when we were in primary school
or secondary school . . .
What course was that?

Hmm . . . I am not sure . . . I think it was science . . . yes, I think it was
the course of science . . .
What did they teach you?

It was human anatomy or something like that . . . maybe we saw some
diagrams of the human body . . . we learned about that . . . but I am
not sure.
My analysis of the interviews suggested that offering vague refer-

ences to school-based education was largely a strategy that helped
them reduce the level of anxiety, as this largely meant that the young
women were not really talking about personal experiences. Talking
about school-based education helped create a form of impersonal
communication; an informal and superficial conversation without
involving the feelings of the person involved. However, as the inter-
view progressed, they felt more at ease. Not only did their tone of
voice change, but they also appeared a bit more eager to offer details
concerning their school-based sex education. My transcripts of the
interviews suggested that teachings were largely grounded in a form
of scientific morality (Castro-Vzquez 2007), which was not par-
ticularly significant in their learning process about sexuality. They
mostly learned about menarche-related issues as well as responsible
sexual behavior. By emphasizing the consequences of unwanted
pregnancies, teenage abortion, and sexually transmitted infections
(STIs), teachers most likely wanted the young women to delay sexual
initiation. Similar to Jacksons findings, through their school-based
education, the young women learned about reproduction and where
babies come from but nothing of substance related to real feelings
and experiences [that would] help managing their sexuality (Jackson
1999, 68); Maeda-san (aged 25) stated:
Hmm . . . I dont think Japanese women know anything about circum-

cision and the genitals . . . sex education, in my experience, did not
include information on the male body or circumcision at all . . .
What about your science class, for example?

Hmm . . . Yes, in the science class, we learned about human anatomy
but nothing concrete about sexual behavior . . . Ah! We had some talks
about menstruation . . . nothing else . . . but I think that it was in the
home economics class, or . . . physical education? . . . I am not sure . . .
What I remember is a video on abortion . . . it was quite scary . . .
blood . . . suffering . . .
Why do you think they screened that video?

I am not sure, but . . . I think it was basically to stop us from having
sex . . . to show that having sex when you are too young can be danger-
ous; you might get pregnant . . . or catch a bug . . . I dont know.
Did they actually say to you that it was dangerous?

I dont think so, . . . but you could get easily the idea . . . they did not
say anything positive about having sex.
I see, anyway, circumcision and sex are not related, are they?
Well, it is somehow related as it involves the genitals . . . maybe.
Different from the experiences of the men, the majority of the young
women in this group had a form of home-based education. Although
less scientific because of the language and vocabulary used, the
experience was not that different from their school-based instruction
because the contents tended to revolve around menstruation, the use
of sanitary napkins, and hygiene. The male body and/or circumcision
were never included. Conversations occurred usually because men-
struation started, within a homosocial context and always in a form
of indirect communication (Hendry and Watson 2001). Similar to
Holland et al. (1998, 61), who found that girls sex education pro-
vided in the home is most likely to come from mothers, with some
older sisters and aunts also providing information on sexual matters,
Womens Views 99
the young women reported that their instructor was typically their
mother or an elder woman in the family who usually conveyed mean-
ings by using innuendo, metaphors, and gestures and that the main
objective could have been to deter illicit sexual practice (Hockey,
Meah, and Robinson 2007, 150). Through this form of education,
most of them learned very early in their lives that the sexual was either
unspeakable or communicated by using the appropriate code . . .
whilst adhering to the norms of respectability by avoiding explicit sex
talk (Hockey, Meah, and Robinson 2007, 150). In reflecting about
her learning experience at home, Ito-san (aged 25) elaborated:
I would say that it is very common that young girls get some informa-
tion at home because of their periods . . . When it starts, our mums
usually talked about how to use tampons and stuff . . . hmm, in my case,
it was actually my aunt because my mother had passed away . . . but still
I dont think it was not really a conversation . . .
What do you mean?

How can I say it? I dont know . . . she somehow let me know that I
became a woman . . . but should not start having sex . . . because of the
risk of having a baby . . .
Did she actually talk about the risk of having a baby?

I dont think so . . . as Ive told you . . . it was not really a conversation,
but you somehow understand that . . . I dont know . . . somehow . . .
it is just my feeling, . . . but to me, . . . it was more like a warning . . .
A warning?
Yes, . . . like to be careful because you might end up pregnant . . .
maybe . . . that is what I feel . . .
I see, anything about circumcision or the male sexual organ?

What? [a bit surprised] No, of course not . . . I mean, we talked about
this because of my period . . . how could we talk about that?
As the interviews progressed, it became apparent that, in line with the

results of surveys from the Japan Association of Sex Education (Nihon
seikyiku kykai 2013), some of the young women in the group have
largely relied on the mass media and pornography to learn about sex,
which was also their main source of information about circumcision.
Some of them had actually seen some of the advertisements discussed
in Chapter 2, which suggested that talking about circumcision could
be mainly done through indirect communication. The guy wearing
the turtleneck sweater who was used by one of the clinics to advertise
the surgery has become a sort of icon. Some of the young women
said that they had seen guys teasing each other by playing with their
clothes and covering half of their face just like the advertisement. As
Shirashi-san (aged 19) put it:
Hmm . . . I am not sure, but I think that I have seen guys in the univer-
sity covering their faces like the guy in the ads [giggling] . . .
What guy is that?

Oh . . . you might have seen it in mens magazines . . . it is a guy wear-
ing a turtleneck sweater covering half of his face . . .
Covering his face?

I think that everybody knows that cosmetic clinics have made it to
advertise the surgery . . . maybe.
Why his face?

Hmm . . . that I dont know but it is like this . . .
What do you think the connection between the face of the guy and
circumcision is?
I really dont know . . . Ive thought about it . . . it is a bit strange
maybe . . . I am not sure . . .
Due to the media publicity, most of the young women referred to the
surgery in terms of fashion. Rather than a procedure to prevent or cure
disease, circumcision was seen as a cosmetic surgery for men who want
to change their appearance. The young women tended to locate the
procedure within the current Japanese body aesthetics (Miller 2006),
which is most likely a contentious effort of young Japanese men to
look good by getting closer to their ideal body image (Luciano
2001). Nonetheless, the penis is not a part of the body that can be
seen in public. It was thus unclear how circumcision would change the
physical appearance, as Kitamura-san (aged 26) concluded:
Well, I think that everyone knows that the surgery is a kind of cosmetic
surgery.
Really? I thought it was to prevent a disease.

Disease? How? Where? . . . Hmm I dont know . . . I dont think so . . .
I mean I have seen the ads and I thought that it is just like any other
cosmetic surgery . . . What kind of disease can it prevent? . . . I am not
Womens Views 101
sure about other countries, but in Japan, it is just a surgery for men who
want to change . . .
Change? What do they change?

Their physical appearance . . . they do that because it is fashion . . . it is
like piercing the ears . . . maybe.
Well, that could be a reason, but how does the physical appearance
change if the sexual organ cannot be shown in public?
Hmm . . . I dont know . . . I have not thought about that, but . . . it is
a cosmetic surgery in Japan.
In talking about the contents of the publicity, some of the young

women found it strange that a minor surgery on a part of the body
that cannot be seen is so expensive. They suggested that cosmetic
surgeons could make good profits out of selling circumcision because
the surgery involves the genitals. Japanese men might think that the
surgery changes their appearance because they are unable to get accu-
rate information about the genitals. My transcripts of the interviews
revealed that the commercialization of the surgical procedure largely
relies on mens ignorance and the incapacity to discuss their concerns.
Similar to the research reported by Holland and her colleagues, in
the English language, conversations related to the sexual organs are
either very formal or extremely informal or vulgar and are consid-
ered a normal talk (Holland et al. 1998), as Maeda-san (aged 25)
explained:
In talking about circumcision, the main problem is language . . . there

is this bunch of technical termsfalse and true phimosis (kasei
hkei, shinsei hkei)that nobody really understands or the colloquial
stuff . . .
False and true phimosis? Can you explain, please?

I am not sure . . . I think I have seen the words in the ads . . . and some
drawings to explain what that is . . . but in reality, I dont know . . .
could be maybe because I am not a guy . . . Whats more, the word
hkei sounds really rude (gehin) to me . . .
Rude?
Yes, I dont know why, but it is one of those words that you dont say in
public . . . Anyway, why do you want to discuss circumcision? I cannot
even imagine a daily conversation about the topic . . . the topic is weird
(hen na hanashi).
Do you think that guys know better?

Well, they might but . . . maybe not . . . I have not spoken to a guy
about that, but I dont think that they can talk about it so easily . . .
Why?
I dont know, but it is something like private . . . why do they want to
talk about that . . .
Some of the young women suggested the term pretend ignorance

(shiranai furi) to explaining why circumcision was expensive. Pretend
ignorance largely revolved around the construct of civilized morality
reported in the literature. In elaborating about the meaning of pre-
tend ignorance, Kawazaki-san (aged 26) stated:
How can I explain this? Hmm . . . Can I give you an example?
Yes, please.
See, for instance . . . honestly . . . I think that most of us have learned
about intercourse through the media . . . At school, nobody talks about
it, and home conversations on sex are unthinkable . . . It is very interest-
ing though . . . everybody knows that information about sex is every-
where, but we do our best to pretend that we dont know anything
(shiranai furi) . . .
Why do you have to pretend?

I am not sure, but . . . it could be because in Japan . . . it is taboo.
What is taboo?
Talking about sex is taboo . . . I think.
I see, what about circumcision? Is it the same?

I dont know . . . It is really taboo . . . and I dont think anyone takes
it seriously . . . I mean . . . it is advertised in magazines and the net
[Internet], . . . but it is basically a plastic surgery . . . I guess it is just like
coloring the hair . . . piercing, or wearing cosmetic contact lenses . . .
Guys go for circumcision because they think it is fashionable . . . It is
expensive though . . .
Why do you think it is expensive?

Hmm . . . I really dont know, but . . . it could be because guys cannot
talk about that . . . so they end up believing that having the thing done
is cool . . . I dont know . . .
Womens Views 103
Similar to my interviews with the men, the analysis of the interviews

with these young women indicated how language issues could facilitate
the commercialization of circumcision. The lack of specific vocabulary
might create linguistic inaccuracies and confusion in understanding
what exactly the surgical procedure entails. Furthermore, school- and
home-based sex education conflate to enlarge the power of a sexual
culture of silence and pretense that makes any discussion about the
male body problematic.
G e nder and the P ro c e dure

Two of the young women suggested some gender insights on circum-
cision by reflecting on their research on female genital mutilation in
Africa. The investigation of Kumada-san (aged 25) revolved around
the social processes underpinning the decision to be mutilated. In
the interview, she pointed out that through popular knowledge and
religious faith, elder women, in particular, decided when and how
female genital mutilation ought to be done. However, when talking
to some women who have endured mutilation, they were rather con-
vinced that mutilation was not imposed on them because it was a
personal decision and done in their best interest because mutilation
was a form of rite of passage that helped them become women.
She did not know much about circumcision in Japan but thought of
it as mutilation of the human body too. She was rather intrigued and
wanted to know how circumcised men justified it because the practice
could not be linked to any Japanese tradition or religion. Being rather
familiar with sociological jargon, she implied that gender could be a
crucial factor to understanding circumcision among Japanese men, as
she elaborated:
I really do not know much about circumcision in Japan, but having

done research with African women, I can tell you that talking about
genital mutilation (seiki setsujo) is not easy . . . Not many people want to
talk about it, . . . but when I managed to talk to some women there . . .
I was really surprised when they told me that they actually wanted to
have the thing done because it was like becoming a woman.
And you think that they did not want it in reality?

That is very difficult to know, . . . but if you ask a bit more . . . you can
see that it was pretty much older women . . . who decided when and
how the thing was done . . . Also, the women were a bit too young
to fully understand what was done on their bodies . . . I dont think
they really knew what that meant . . . their experiences were a bit dra-
matic . . . things are not simple of course . . . and religion and traditions
play a very important role . . . maybe you can tell me how Japanese men
can justify circumcision.
What do you mean?

Well, I think that circumcision is also a mutilation of the human body,
but . . . in Japan, . . . it is hard to justify it . . . Here we do not really
have a ritual or religious explanation . . . I would like to know how cir-
cumcised Japanese men explain it . . . I would not be surprised if it was
linked to gender, though.
Gender? What do you mean?

Hmm . . . I am not sure, but . . . maybe some Japanese guys might look
for it because they think that their identity depends on the sexual organ
just like the African women . . .

I dont know, but . . . have you seen the prices? It is very expensive if
you want to have it done in a cosmetic clinic . . .
Some people might think that they do it because of fashion, what

do you think?
Hmm . . . I am not sure, but . . . see . . . for example, you color your hair
or do your nails . . . because of fashion . . . people can see that, but . . .
if you got the thing [circumcision] done, nobody knows . . . If you have
the thing done or not, nobody knows, because it cannot be seen . . . I
do not know . . . I am just guessing . . .
Meguro-san (aged 26) was the other young woman in the group who
has done research on female genital mutilation and emphasized the
strong opposition that the practice has encountered globally. Con-
tenders considered it even a violation of human rights, but circumci-
sion has never faced the same disapproval. This indeed mirrored a
form of gender imbalance: although critiques of female circumcision
have been widely taken up, general public opinion toward male cir-
cumcision remains indifferent (Bell 2005, 125). She was the only
participant who was aware of campaigns in Africa to promote adult
circumcision to prevent the transmission of HIV but was unclear
about the rationale underpinning such campaigns. In her opinion, the
lack of a logical explanation of circumcision in Japan was staggering.
In Africa, circumcision could be at least justified by using religion and
traditions and recently medical knowledge. Circumcision in Japan is
Womens Views 105
most likely a strategy of the cosmetic industry to gain economic prof-

its. Thus there is seemingly an intriguing contradiction between the
condemnation of female genital mutilation and the apparent social
acceptance and open commercialization of circumcision at Japanese
beauty clinics. In being asked about campaigns to combat HIV/AIDS
in Africa, she said:
Well, I have been doing research on female genital mutilation for a

while . . . and was interested in any form of mutilation of the human
body . . . You know that most genital mutilations there [in Africa] are
part of their cultural traditions and religions . . . and I think that this
is the first time that circumcision is used for medical purposes . . . I am
not sure how HIV and circumcision are connected though . . . anyway,
now that you are asking this . . . it is very interesting . . .
What is very interesting?

The attitudes of Japanese people toward circumcision . . .
What do you mean?

Most people here would say that female genital mutilation is a horrible
thing, . . . but they do not say anything about those clinics that sell
circumcision.
Sell circumcision?
Yes, I am sure that you have seen the ads in magazines and the Inter-
net . . . I would not be surprised if a lot of guys get the thing done
because of the influence of the clinics . . . and I dont think they need
that . . .
Why do you think so?

I am not sure, . . . but if they really needed it, . . . they should have it
done at a hospital where surgeries usually take place . . . if it were really
a matter of health . . . dont you think?
Yes, maybe, so why do you think they do that?

I am not sure . . . I have not done research on that, but something
makes me think that it is not really health what is behind this . . .
Some of the young women vaguely related womens cervical cancer to

circumcision, but they could not offer details and/or mention penile
hygiene at all. The prophylactic benefits of circumcision depicted in
advertisements were indeed largely unknown by this group of women,
as Ikegami-san (aged 24) explained:
I think I have heard something about womens cancer and the surgery
[circumcision].
What was that?

I am not sure . . . something like cancer of the womb . . . maybe . . . I
am not sure.
Where did you learn that?

Learned? . . . I think I have read about it somewhere . . . I dont
remember . . . It could be a newspaper . . . I dont think so . . . It could
be because of the pink ribbon thing? . . . Hmm, I think that that is
about breast cancer . . . maybe . . .
Anyway, what is the relationship between cancer of the womb and

circumcision?
I really dont know . . . but I have the impression that it is connected.
Could it be related to hygiene?

Hmm . . . hygiene? I am not sure . . . in what way? I really have no idea.
However, in delving further into the intrapsychic dimension underpin-

ning circumcision, my interviews suggested that knowing about the
procedure is gendered and that pretend ignorance and a proper femi-
nine identity appeared strongly entwined. The attitudes of some of the
young women could be outlined by the so-called ladylike cultivation,
which largely refers to forms of sitting, walking, dressing, and making
polite talk (McVeigh 1997). It entails a form of etiquette that obviously
does not include any reference to the sexual. In this light, knowing or
willing to know about circumcision is not feminine. It is danger-
ous because it connotes the loss of innocence and fears about the
corruption of the young (Epstein and Sears 1999, 1), and justifying an
interest in the surgical procedure is challenging because women do
not have any formal instruction concerning male genitalia and the pre-
puce; also, advertisements concerning the surgery are clearly directed to
men. In being asked about the difficulties of Japanese women in talking
about circumcision, Ogihaba-san (aged 25) said:
Why do we need to know about that [circumcision]? Women do not

have a penis . . . As I have told you . . . at home or school, nobody talks
about that . . . If you look at the ads, it is a thing for men . . . If you
are a bit too interested in knowing . . . is not really like something a
woman should know . . . it is not something a woman wants to know,
maybe . . .
Womens Views 107
Are you saying that women do not know anything about the
procedure?
Hmm . . . I dont know, but even if they know . . . they do not say it . . .
it is just odd . . . I have never seen a woman talking about that . . . It
could be only me . . . I am not sure.
Why do not they say it?

I dont know . . . It sounds just strange . . . Nobody says it . . . It would
be very awkward to try to talk about that . . . a conversation about that
is, like, a bit rude . . . I dont know how to say this . . . It would be very
uncommon . . . If I heard a woman talking about that, I would be kind
of surprised . . . maybe.
My analysis of the interviews implied that a woman interested in or

willing to know about circumcision is most likely the Other, which is
closely related to the image of so-called bad girls (Miller and Bardsley
2005)that is, women who want to know about sex. Although the
procedure might imply some health benefits to men and women, it is
not difficult to assume that a woman willing to know about the surgi-
cal procedure is a woman interested in sex. She is most likely a girl
who is having fun (asondeiru) or perhaps an easy lay (karui), as
Maekawa-san (aged 19) clarified:
I dont know . . . What you are asking is a bit strange . . . See, I dont
think that in Japan, baby boys are circumcised like in other places, like
for example . . . because they are Jewish or something like that . . . In
Japan, there is not that tradition . . . hmm . . . also, if you take a look at
the ads, . . . they are all for adult men . . .
When have you looked at the ads?

I dont remember exactly, . . . but it is not unusual as they are in fashion
magazines for guys . . . I think . . . I am not sure . . .
Well, if that information is for guys, how do women get

information?
Well, I cannot even imagine women openly discussing circumcision.
Why do we want to know that? . . . Where can we do that? It does
not involve our body at all . . . This is maybe a prejudice, . . . but a
woman willing to know about circumcision is because she is having fun
(asondeiru), that is why she wants to know . . . Otherwise, why does
she want to know about the penis? . . . Things are changing of course,
. . . but a woman openly talking about that is still seen as easy (karui
kanji) maybe . . . I dont know.
What is like being easy?

Hmm . . . how can I say this? That she is playing around . . . maybe . . .
I am not sure.
In talking about advertisements for circumcision, an intriguing con-

tradiction became apparent: although the majority of the women
tended to affirm that they did not know what circumcision entailed,
most of them were able to describe the contents of publicity in maga-
zines and the Internet. The lack of a convincing medical or religious
discourse to support a practice that is largely performed at beauty
clinics and chiefly involves the sexual organ of adult men makes it
difficult indeed to think of it as disease preventive measure. The sur-
gery becomes largely sexualized and most likely the topic of a kinky
conversation (eroi hanashi). Participating in such a conversation is
particularly daunting for women because it puts at risk their sexual
reputation (Holland et al. 1998), hence the need to pretend igno-
rance. As Ogihaba-san (aged 25) put it:
Well . . . yes, I have seen the ads but it does not mean that I know about
that . . .
What do you mean?

It is difficult to explain . . . I dont know . . . it is somehow difficult to
explain . . .
Why is it difficult?
Well, it is basically a surgery for men on their willie . . . This kind of
conversation is difficult for a woman, . . . even if she knows what this is
about . . . I dont think she wants to talk about it . . . I might be wrong,
but . . . here, talking about that is like a kind of kinky conversation
(eroi hanashi) . . .
What is a kinky conversation?

Hmm . . . it is a conversation when you talk about sex and stuff . . .
It is usually a conversation among men . . . maybe . . . something like
lewd (sukebe).
And women dont talk about that?

Maybe yes, but I dont think that they want to be seen as kinky or
lewd . . . I am not sure, . . . but in Japan, . . . that is a kind of conversa-
tion for an old man . . . talking about that is like a kinky old man (eroi
oyaji) conversation . . .
Womens Views 109
In disentangling the intricacies of talking about circumcision, a dif-

ferent angle of the intrapsychic dimension underneath the surgical
practice became visible: talking about the procedure is gendered.
Femininity appeared as a major obstacle that largely constrains
Japanese women from engaging in open conversations about the sur-
gery. My interviews clearly showed that pretend ignorance is the most
common strategy among these young women to keep up their sexual
reputation. This means that they are not completely ignorant and that
they are possibly able to talk about circumcision within the right
context.
Ho mo so c ial ity, the S e xual

S el f, and the P repuce
The intersection between the intrapsychic and interpersonal dimen-
sions underpinning the minor surgery showed that the lack of access
to public discourses and/or home- or school-based education did not
necessarily mean that the young women were absolutely uninformed.
Similar to my conversations with the group of men, these young
women cited friends as the main source of information concerning
the sexual and circumcision in general. The interpersonal dimension
underpinning the procedure could be easily explored through girls
talk (gyaru tku), where women might be able to gain information
about it because, in line with the research findings of Holland et al.
(1998), this group of young women valued the group of peers as
a source of information about the sexual. In the context of a girls
talk, circumcision could be sometimes included as long as the topic
is introduced as a comic story or a joke (jdan, jku). In being
asked about the meanings of girls talk, Shirashi-san (aged 19) stated:
Hmm . . . girls talk is like . . . when we get together and talk about
our things . . .
Your things? What are those things?

Dating . . . boyfriends, occurrences . . . incidents . . . and stuff . . .
What about circumcision?

Yes, we sometimes talk about that . . .
Really? I understood that you didnt talk about it at all?

Well, it is not really talking . . . It is more like joking [giggling] . . .
Girls talk is full of jokes . . .
I see, why is that so?

Hmm . . . I dont know, . . . but we laugh a lot . . . I dont know . . . We
also gossip and stuff . . . We talk about other peoples stuff . . .
Can you have also serious conversations?

Yes, we can . . . When something happened to someone in the group . . .
like when someone is looking for advice . . . or something . . .
What about circumcision, can you talk about that?

Yes, we sometimes joke about that . . .
But it is a medical procedure, isnt it? How can you joke about
that?
Hmm . . . I am not sure, . . . but yes, you can joke . . . I dont think that
anyone wants to talk about that . . . like in a serious conversation . . . It
is more like a joke . . .
Similar to my conversations with the group of men, joking was key to

understanding the dynamics of homosocial interaction. My analysis
of the interviews with these young women elicited that joking was
largely a verbal strategy to create a distance between the content of
the conversation and the speaker. Through comic stories, speakers let
the group of friends know that they are not actually talking about any
personal experience. However, joking could be like dropping subtle
hints about a personal concern. It could help mask a real concern with
laughs because girls talk is largely a form of daily interaction that
helps control and patrol the gender identity of young women in the
group. In line with the research of Holland et al. (1998, 68), [m]
uch of what young women learn from their friends is not about sex
or sexuality, but about the boundaries of feminine identity and the
operations of the social mechanism of sexual reputation. In describ-
ing the intricacies of girls talk, Ito-san (aged 25) said:
Well . . . when you are with your friends, you can talk about almost
anything . . . I guess women, . . . just like guys, are curious and want to
know about sex, . . . for example.
So, girls talk is to talk about sex?

Hmm . . . not only . . . but it could be a common topic . . . Girls talk
is like when women can talk about their things . . . boyfriends . . . rela-
tionships . . . gossip . . . who is dating who . . . speak ill of someone . . .
and so on . . .
Womens Views 111
Could you also get some advice?

Yes, you could . . . when, for example, something happened to you . . .
if you had a quarrel with your parents and stuff . . . if there is a guy that
you like . . . I dont know many things . . .
Does that include circumcision?

Yes, . . . it could be sometimes . . . If you want to know about mens
things . . . about what is written in the ads . . . of course, you cannot ask
about that just like that . . .
What do you mean?

In girls talk . . . we usually joke . . . especially if it is something related
to sex . . . You dont want the girls to know that you are in doubt . . . It
could be a bit like getting yourself into hot water [yabai] . . .
Why is that so?

I dont know . . . Somehow you need to be careful about what you
say about yourself . . . People like to talk about other peoples private
stuff . . . gossip . . .
Gossip? But they are your friends, arent they?

Yes, we are friends, but . . . but we gossip . . . you never know . . . You
dont want people to know about your stuff . . . How can I explain this?
. . . Hmm . . . I dont know, . . . but it is like this . . . you somehow need
to be careful . . . maybe.
I see, but how does that relate to circumcision?

It is not directly related . . . maybe, . . . but at the end of the day, . . . it is
about the male thing [penis] . . . If you want to know about that, . . . it
is a bit strange . . . maybe . . .
Intriguingly, circumcision was never regarded as a mere surgical

procedure but was linked to the sexual life of the person willing to
talk about it. Conversations on circumcision with peers are problem-
atic not only because they could place at risk the sexual reputation of
the woman involved but also because the quality of the information
granted is always questionable. According to Holland et al. (1998,
68), [L]earning from female peers . . . is often a case of Chinese
whispers. Messages become progressively distorted as they circulate
from person to person, picking up sexual meanings for information
that was not explicit to begin with. Young women describe learning
by picking things up and just catching on. Often this takes the form
of hearing sexual innuendo in the form of jokes which, like sexual
reputation, can also serve the function of social censure. In girls talk,
nobody can know whether it is really a joke or otherwise, as Onodera-
san (aged 21) explained:
It is really odd what you are asking [giggling] . . . My immediate reac-

tion is that women do not talk about that at all, . . . but thinking care-
fully, . . . I could say, yes, women can talk about that when it is like a
kind of girls talk.
What do you mean?

When women get together, . . . they can talk about sex and stuff but
always joking, otherwise the girls could know that it is something like
a personal thing . . . Of course, you can get hints about the thing,
but nothing is ever clearly stated . . . Somehow you know what they
mean . . . It is never directly said . . . maybe.
Why not directly said?

Hmm . . . you never know . . . It is just like this . . . I guess . . .
Anyway, how does your personal experience relate to circumcision?

Well . . . if you want to talk about guys stuff, . . . it is not difficult to
imagine that it is because something happened to you . . . like because
you started having sex . . . or because you want to have it . . . Some-
how you understand that . . . It is like a kinky conversation . . . I dont
know . . . It is because you are thinking of sex . . . or something . . .
otherwise why do you want to know about that? . . . You know what I
mean? . . . That is why we joke, I guess . . .
I see . . . but if you are joking, can you really solve your doubts?
Hmm . . . you get the hints . . . if you are really in doubt, you can always
look at the Internet . . . maybe . . .
Could girls talk include womens health and circumcision?

I dont know . . . I dont think so . . . and circumcision is not really a
matter of health for women, is it? . . . It is a cosmetic surgery for men,
I guess.
Some of the young women highlighted the relevance of developing a

form of common sensethat is, reading the air (kki wo yomu) that
facilitates daily interactions with the girls. The bases of such forms of
knowledge include an adequate and broad understating of homosocial-
ity, as well as the scripts concerning the body, which largely means that
the body as a topic of conversation is almost always problematic, and
Womens Views 113
the genitals are almost an unspeakable part of the body. My interview

analysis elicited that joking has indeed become a valuable recourse, a
form of indirect communication in a society that has produced laws to
constrain the use of language to refer to the body as it could be con-
sidered a kind of sexual harassment. In line with the conversations with
the group of men, talking about male genitalia is a rather sensitive issue.
Some of the young women suggested that introducing circumcision
as a topic of conversation is rather similar to engaging in a talk about
womens breast sizes, as Kawazaki-san (aged 26) elaborated:
I think you somehow understand as you grow up . . . talking to friends

is very important . . . But you somehow learn what you can and cannot
say . . . it is like reading the air (kki wo yomu) . . . Through friends,
you can get a lot of information about things . . . about sex . . . about
the body . . . and stuff . . . When you are with your girl friends, . . . you
can say a lot of things that you cannot say to your parents or teachers . . .
What kind of things for instance?

Well, when you are growing up . . . your body changes and . . . I
guess everybody has something to ask . . . When you start dating some-
one . . . if you want to start having sex and stuff, . . . you need to be
careful though . . .
Why do you need to be careful?

When talking about the body or the genitals, you need to be careful . . .
you need to read the air . . . Hmm . . . I dont know . . . You might
hurt your friends . . .
Hurt your friends?

Yes, hurt their feelings . . . Not everyone is happy with the body they
got . . . You know what I mean?
Yes, but how does that relate to circumcision?

Hmm . . . it is a surgery in a private part of the body . . . You dont talk
about that . . . maybe when you are with your friends, you joke about
that but not more than that . . .
I see, but why do you joke?

I dont know . . . It is very sensitive, I guess . . . It is something that
you learn . . . It is maybe because you are not saying it directly . . . I
dont know . . . Somehow you understand that . . . Whats more, it has
become a serious thing in Japan . . . like for example, a boss cannot make
comments or say something about the body of their employees . . . I
think that that is sexual harassment (sekuhara), maybe . . . It is a very a

sensitive thing . . . It is like talking about womens breasts . . .
What do you mean?

Hmm . . . like you dont talk or ask about womens breasts because it is
sensitive . . . I dont know, . . . but I think that that is always a womens
concern . . . if it is too small or too big . . . kind of thing . . .
And how does that relate to circumcision?

Hmm . . . I am not sure, but it is bit like asking if the thing [penis] is
big or small . . .
Why is that so?

I am not sure . . . I am just guessing . . .
In exploring why circumcision is such a delicate topic of conver-

sation, my data analysis suggested that the sensitivity of the subject
matter largely revolves around ideas presented in advertising that bio-
medicalize the surgery and tend to present it as a strategy for penile
improvement. Circumcision is most likely included within a package
of surgeries that improve the image of the penis, which includes
length and thickness. In this light, all the young women tended to
agree that a conversation about circumcision is awkward because
rather than a medical procedure to prevent disease, the talking point
is penis size. Some of the young women found it bizarre (hen) the
ways circumcision is commercialized, however it was somehow natu-
ral (tzen) that the procedure is linked to penis size because it is
offered as cosmetic surgery on the male sex organ, which could be
almost identical to womens breast implants that make the bust look
bigger, as Ogihaba-san (aged 25) argues:
Of course, talking about this [circumcision] is naturally (tzen ni)

linked to the organs size because it supposedly makes the sex organ
bigger . . . It is a bit bizarre, but . . . that is the way it is sold in Japan . . .
That is why it is a bit bizarre to talk about it . . .
Bizarre?
Yes . . . hmm . . . how can I put it? Hmm . . . it is like womens breasts.
Like womens breasts?

Something makes me think that . . . just like women go for cosmetic
surgery to make the breast look bigger, . . . some guys might look for
circumcision . . . to make it [the penis] appear bigger too.
Womens Views 115
But in the case of women, they actually get implants, right?

Hmm . . . yes, they do.
So what is the connection between circumcision and breast

implants?
Hmm . . . I dont think there is a direct connection . . . maybe, . . . but
I thought that if you see circumcision as something similar to the ways
women think about their breasts, . . . you would understand a bit more
about circumcision in Japan . . .
But I thought that circumcision was to prevent disease.

I really dont know . . . but nobody would think of circumcision as
something related to health . . . Its a matter of choice (konomi no
mondai) . . . It is like getting your nose done . . . or your breasts oper-
ated on.
As some of the conversations progressed, discomfort was reflected

in the faces of some of the young women because they found them-
selves suddenly discussing sexual experiences. Although reassurance of
privacy and confidentiality was expressed all the time, some of them
refused to provide details and changed the direction of the conversa-
tion. Some of them, however, acknowledged that an interview on cir-
cumcision was a bit odd because the majority of Japanese men were
uncircumcised and circumcising newborns or children was almost
unthinkable. None of them had actually seen a circumcised man in
real life. Nonetheless, they also found it strange that there were clin-
ics offering the procedure as a specialty. As Maekawa-san (aged 19)
puts it:
[giggling] I dont think . . . I have ever seen a guy or boy like that [cir-
cumcised] . . . I dont think that getting the thing done is a common
thing . . . that is why somehow this interview is a bit odd . . .
What do you mean?

Hmm . . . see, for example, I think nobody would do the thing on a
young boy . . . I have never heard that parents want to have their boy
operated on . . . Maybe if they are sick or something . . . otherwise, why
do they want to do that . . . And men . . . hmm, I dont think there are
too many guys who have gotten the thing done . . .
How do you know that?

I am not sure . . . as I have told you, I have never seen a guy like that . . .
It could be maybe only me . . . I dont know.
I dont know numbers either, but there are a number of clinics

offering the surgery, that is why I thought that there could be
many more circumcised men than we know of.
Hmm . . . I dont know, . . . but yes, there are clinics offering the
surgery, . . . which is also a bit odd, . . . but I dont know . . . Anyway,
it could be very difficult to know . . . you dont ask about that . . .
maybe . . .
In discussing the apparent lack of social visibility of circumcised men,

some of the young women suggested that linguistic nuances make
it difficult to obtain accurate information. The expression He is
not phimotic (hkei janai) does not necessarily mean that the man
involved has been circumcised; it most likely means that his penis is
large enough to have the glans exposed when having an erection.
Likewise, saying that a man is phimotic (hkei) does not necessar-
ily imply that he has a medical condition either. It could mean that
his penis is small. Although interpretations could be multiple, calling
someone hkei is most likely an offense because it implies that the
person involved is not a real man because his penis is small, like the
penis of a child, as Tanaka-san (aged 19) clarifies:
My boyfriend is not hkei.
Does that mean that he is circumcised?

Hmm . . . I dont think so . . . [her face turned red], when it gets
erected, it is OK . . .
Are you talking about false phimosis (kasei hkei)?

I dont really know what that means, but hkei is not a nice word.
What do you mean?

Hmm . . . calling a guy hkei is really rude . . . I dont know if people
still use it, but I dont think that it is polite . . . I think that guys say that,
say hkei, when they were having an argument kind of . . .
Why is that so?

Hmm . . . I am not sure, but I think that calling someone hkei . . .
could mean that his thing [penis] is small . . . just like the size of a
childs thing, . . . then it could mean that he is not a real man . . . I
could be wrong . . . You better ask other people, . . . but that is my
impression . . .
Womens Views 117
The issue of sex with someone whose penis is large enough to have
the glans exposed when erected was largely related to the sexual script
that assigns the origin of the sexual to the genitals and that a bigger
penis represents sexual satisfaction. These two scripts are effectively
used in the advertising of circumcision. Some of the young women
referred to sexual intercourse as requiring vaginal penetration but that
the act did not necessarily terminate with his ejaculation. In playing
with linguistic nuances, some of the young women implied that hav-
ing had sex with a phimotic guy (hkei datta) was usually a deroga-
tory expression that was almost completely disconnected from the
condition of his foreskin. In the context of girls talk, women could
complain about an unsatisfactory sexual performance by calling the
male partner involved hkei. This certainly did not involve a preference
for circumcised men, as beauty clinics suggest. Some of the women
hinted that sexual satisfaction was linked to penis size and female
orgasm, but they were unable to explain, as Oikawa-san (aged 25)
suggested:
In conversations with girls, yes, you could say something about it . . .

Let me think, . . . you could say that he was phimotic (hkei datta).
What does that mean?

I am not sure, . . . but I think that it could mean that . . . to say that
sex was bad . . .
Is that related to circumcision?

No, . . . it could be maybe that his willie was small.
Are you saying that having sex with someone with a small penis is
not good?
Hmm . . . I really do not know, but some women might say so. I think
it is related to womens feelings.
What do you mean?

It is maybe that he cares about her, that he makes her feel good, not
that he just does his thing and stops when having sex . . . I am not sure,
though.
What does do his thing mean in this context?

Hmm . . . I am not sure . . . I think it is something like just inserting
the thing and ejaculating . . . Hmm . . . It could be maybe that he is
concerned about her getting satisfied [her face showing that she was
getting a bit anxious], but . . . I am not sure . . .
I see, one last thing, do you think that getting satisfaction is related
to having sex with a man who is circumcised?
What? . . . I dont know . . . I have not had such experiences . . .
I am asking this because ads say that Japanese women prefer hav-
ing sex with circumcised men.
Hmm . . . I think that is not necessarily true . . . I dont know . . .
I dont think that many Japanese guys are circumcised, in the first
place . . . so, not many women could compare . . . I dont know . . . It
could be that they say that to sell the surgery, to convince guys . . . I
dont really know.
Delving into the intrapsychic dimension underpinning circumcision

placed some of the young women in a difficult conundrumnamely,
talking about sex with a stranger (Holland et al. 1998, 220).
Although all the young women acknowledged having initiated their
sexual life and some of them said that they were dating someone; that
did not necessarily mean that they were willing to talk about their
experiences. Discomfort expressed in their faces or ways of speaking
could mean that they were largely reluctant to discuss such matters
with [an older male] researcher (Hidaka 2010, 72). Such reluctance
could be linked to two major factors: the sexual is usually talked about
within a homosocial context, as part of girls talk, and the lack of
appropriate language to refer to the sexual without sounding vul-
gar, which might compromise their sexual reputation.
Co nc lusio n
Exploring circumcision from the vantage point of this group of young
Japanese women was insightful and valuable in light of campaigns
to promote adult circumcision to prevent the transmission of HIV.
[C]ircumcision would result in sexual risk compensation (Kelly et al.
2013), as is demonstrated at a Kenyan setting in which more women
than men feel that HIV is less threatening because their partners are
circumcised (PlusNews 2012). Conversely, data I have discussed in
this chapter could challenge the validity of circumcision to HIV pre-
vention not only because most Japanese men are uncircumcised and
HIV/AIDS infection rates remain comparatively low but also because
the medical procedure is seen as cosmetic intervention rather than a
prophylactic measure.
The cultural dimension underneath circumcision locates the surgical
procedure within a sexual culture largely constructed by the Japanese
Womens Views 119
cosmetic industry, which relies on the script that grounds masculin-

ity in the penis and sexuality in the genitals in order to sell a plastic
surgery to adult men. Therefore, rather than medical knowledge, sex-
related instructions become key to understanding what circumcision
entails in Japan. Despite academic and media references implying the
existence of the sex-knowledgeable woman, my interviews with
these young women suggested that school- and/or home-based sex
education was unhelpful and that their views on sexuality, the male
body, and circumcision largely came from the media, pornography,
and their group of peers.
As the medical intervention is part of a surgical package to pro-
mote penile improvements, the sociality of circumcision suggested
that conversations on the surgery were problematic. This is because
the topic of conversation was not prophylaxis but penis size, which
made both the language to refer to circumcision and the knowledge
about it, gendered and the intent to know unfeminine. Conversations
with peers presented an option for women to discuss circumcision;
however, while individuals can sometimes create their own personal
solutions [ . . . ] they cannot always manage safety, nor claim legiti-
macy for these solutions in a wider social context (Holland et al.
1998, 193)that is, the prevalence of innuendos and jokes in girls
talks seemed to enlarge the idea that knowing about circumcision
was effectively opposite to femininity.
Exploring the intrapsychic and interpersonal dimensions underpin-
ning circumcision from the viewpoints of this group of young women
corroborated the dominance of a narrative of polarized gender or a
view that emphasizes the power of a dualistic gender over that of
abolished gender (Plummer 1995, 158). On one hand, some of the
women appropriated the language of circumcision for expressing sex-
ual needs. At risk of losing sexual reputation and although still within
the script that placed the sexual largely centered on the genitals, some
of the women suggest that a binary of sexually dominator-dominated
did not fully explain current relationships and that female sexual satis-
faction ought to be considered. On the other hand, the cosmetic and
beauty industries can profit from circumcision by deploying a narra-
tive that places masculinity and femininity as opposites in collision
and that valorizes the sexual submission of women under circumcised
men. To offer a comprehensive view of such a dualistic gender view,
the next chapter draws on the viewpoints of a group of Japanese urol-
ogists and cosmetic surgeons.
4
Chapter 5
Urologists and Cosmetic

Surgeons
In my opinion, circumcision is a form of mutilation of the male

body and should be prevented.
(Dr. Ishi, urologist, aged 50)
Having the foreskin removed means, somehow, for some men,

happiness, confidence and willingness to live.
(Dr. Takenaka, cosmetic surgeon, aged 30)
T he intricacies of circumcision are intriguing. It is technically a sur-

gical procedure that entails minimum risk to the life of the patient. It
is indeed a minor operation to remove a tiny piece of skin, which
as a religious ritual, can be performed without anesthesia. Nonethe-
less, despite being a time-immemorial practice, it is still the subject of
protracted and bitter disputes. Japanese urologists such as Dr. Ishi, as
shown in the first quote, voice discontent and disapprove of a practice
that, in their opinion, ought to be stopped because it chiefly implies
a mutilation of the male body. Dr. Ishis viewpoint largely represents
a radical perspective in opposition to those who might openly advo-
cate the operation, especially pediatric circumcision, and who con-
sider it an efficacious method to treat and/or prevent disorders of the
penis. Up to the present time, circumcision has been at the center of
a debate of irreconcilable positions.
Matters are complicated further when including the opinions of
cosmetic surgeons whose main concern is not physical function but
physical appearance. Adult circumcision, in particular, appears to be a
minor surgery that makes the penis look pretty. More important, as
Dr. Takenaka in the second quote suggests, not only does removing
the foreskin transform the physical appearance of the sexual organ,
but it also results in an increase of mens happiness, confidence, and
willingness to live. Thus the implications of circumcision are com-
plex and cannot be explained by using a single medical paradigm of
disease-treatment-cure. The reasons for men to opt for circumci-
sion are as diverse as the consequences the procedure might have on
them.
This chapter illustrates how the Japanese cosmetic industry has
effectively biomedicalized the surgery, which as a procedure, repre-
sents penile improvements that work on the bodies and the souls of
men. Drawing on the outcomes of my interviews with a group of 14
Japanese male health-care professionalsfour urologists and ten cos-
metic surgeonsthe chapter explores how medical knowledge can be
instrumentally employed to oppose or support circumcision in Japan.
The views on circumcision of this group urologists and cosmetic
surgeons reflect a debate of irreconcilable positions. The group of
urologists clearly objected to the promotion of circumcision and intro-
duced the notion of the informed parent to challenge discourses on
circumcision. From their viewpoint, the interpersonal dimension of
the minor surgery elicits the relationship between health-care provid-
ers and parents.
Conversely, the group of cosmetic surgeons tended to draw on the
cultural dimension underpinning the medical practice to emphasize
the power of social imagery and sexual taboos that promote circum-
cision. From the vantage point of this group of cosmetic surgeons,
the intrapsychic dimension underpinning circumcision suggests that
circumcision has become a medical technology that offers psychologi-
cal and physiological benefits to sexually failing Japanese men.
Despite urologists and cosmetic surgeons having contradictory views,
their standpoints tend to converge on the idea that the penis is crucial
to the construction of the male gendered self and that the origin of
the sexual is the genitals.
Medic al K nowl edge

My interviews with these medical professionals allowed for a nuanced
reading of the cultural and structural dimensions underpinning cir-
cumcision. The debate of polar extremes was vividly reflected in the
interviews because urologists completely opposed the surgical proce-
dure, while cosmetic surgeons supported it. The group of urologists
Urologists and Cosmetic Surgeons 123
suggested that the procedure is rather unnecessary because it is mostly

induced in the patient [ . . . ] based on the physicians examination,
manner, or discussion (Illich 1976, 14). Circumcision is not really
a response to any form of genital physiological/anatomical malfunc-
tioning or disease. As Dr. Inaba (aged 45) put it:
In Japan, like everywhere, opinions toward the surgery are divided . . .

Some urologists say, yes, baby boys should be circumcised to prevent
phimosis . . .
But I understand that pediatric circumcision is rare in Japan.

Yes, it is, . . . but still there are doctors who want baby boys circum-
cised . . . some of them also support adult circumcision.
What do you think about that?

To me, the procedure is not really needed . . . I have seen serious cases
of phimosis, but we have always found a way to deal with it . . . without
removing the prepuce.
I see. If you have those experiences, why do you think there are
doctors still suggesting the procedure?
Hmmm . . . some doctors would say that it is the most effective method
to prevent any disease, . . . but as I have told you, opinions are diverse
and it is very difficult to reach an agreement . . . especially if it is for
cosmetic reasons . . . Circumcision depends totally on the opinion of
the doctor . . . Do you know what I mean?
Yes, but why for cosmetic reasons?

Well, you know that most of the circumcisions in Japan are done at
beauty clinics.
Why there?
Because the prepuce is removed, not really because there is disease
involved, but because of cosmetic reasons . . . I think.
Do you think that this is particular to Japan?

Hmm . . . I dont know, but these days, genital cosmetic surgeries are
becoming more common . . . I believe.
Circumcision in Japan nicely illustrates the meaning of the construct

of iatrogenic effects of the medical practice (Illich 1976), which
refers to the undesired consequences of a medical treatment. Draw-
ing on his experiences treating infant and adult cases of paraphimosis
where the penile glans was strangled by a tight foreskin that could not
return to its original position, Dr. Toda (aged 54) highlighted that
nonsurgical methods can be always used to loosen the prepuce and
release the glans:
Based on my experience, I can unmistakably tell you . . . circumcision

is not required at all . . . even when the penile glans has gotten horribly
strangled . . . I have used oils, for instance, to make the foreskin less
tight . . . and solved the problem without any surgery.
Why did you start using oils?

Well, I was looking for alternatives . . . I dont see why a healthy piece
of skin has to be removed.
But paraphimosis is a medical condition, isnt it?

Hmm . . . that is also debatable . . . especially when I have found that
using oils can help . . . Yes, when the glans gets strangled, you need
to do something, but that something does not necessarily have to be
a surgery . . . especially when you think that every surgery could have
unwanted consequences . . .
Consequences?
Yes . . . every surgery, even if it is a minor surgery, could have unwanted
consequences, especially if you realized that it is not really required . . .
and that nonsurgical methods can be used . . .
The group of urologists openly advocated penile hygiene as an

effective method against genital infections. Similar to the so-called
informed patient discourse, which refers to a sort of ideal model
of how heath care consumers should engage with health services.
Informed patients (IPs) are understood as taking increasing respon-
sibility of their own health and those of their families and commu-
nities by actively seeking health information and making informed
choices through engagement in shared decision making with health
professionals (Henwood and Wyatt 2009, 18). IPs are meant to help
democratize medical decision-making processes. In the specific
case of circumcision in Japan, the group of urologists appealed to the
notion of the IP to refer to the role of parents. In their opinion, it
is parents who should be fully accountable for any medical action on
the bodies of their children and help prevent pediatric circumcision.
From this viewpoint, the interpersonal dimension concerning pediat-
ric circumcision is underpinned by the social interactions of parents
and health care professionals. Ideally, parents should actively look for
accurate information to engage in discussions with health-care profes-

sionals and together choose the best course of action to maintain the
bodily integrity of baby boys. In reflecting about the obligations of
parents to prevent circumcision, Dr. Ishi (aged 50) said:
In my opinion, circumcision is a form of mutilation of the male body

and should be prevented.
How do you prevent it?

I think that the root cause of the problem lies in the hands of parents.
What do you mean?

Well, I think that parents should look for information to stop circumci-
sion . . . It is, at the end of the day, the body of their young boys that
is going to be mutilated. They should get the right information and
decide together with the doctor if they want to have their son operated
on.
Do you think that parents can really discuss circumcision with

doctors?
They should be able to if they get the right information.
Where can they get that information?

Books, magazines . . . these days the net [Internet] is very useful . . .
They just need to be actively seeking information if they are really
concerned.
But how accurate is that information?

Hmm . . . that is why they need to talk to a doctor after looking for the
information to see how accurate that is . . .
Are there many Japanese parents willing to have their sons

circumcised?
Well . . . there are no official numbers, but health-care insurance can
cover the surgery . . . If parents are not properly informed, they might
look for it . . . There are some urologists who might suggest it, in case
of paraphimosis or penile infections, for instance . . .
Some of the urologists highlighted the impact of the role of informed

parents to stop child as well as adult circumcision. Well-informed par-
ents should understand that penile hygiene is the main strategy to
prevent disease and makes circumcision redundant. In the explana-
tion, penile hygiene should be incorporated as soon as possible into
the early training (shitsuke) of young boys. Afterwards, parents should

engage in conversations about the genitals with their sons, which will
help them understand that the shape and size of the penis is irrelevant
as long as it functions properly. This actually could help reduce the
temptation to remove the foreskin later in life. As Dr. Murakami (aged
56) points out:
Penile hygiene is the solution and this is not really a secret . . . It applies
to any part of the body . . . Poor hygiene can lead to or aggravate any
condition, including HIV infection. Penile hygiene rather than circum-
cision has to be promoted.
How do you promote penile hygiene?

It is certainly parents responsibility . . .
Responsibility?
Yes, and the keystone is the correct knowledge (tadashii chisiki). Par-
ents need to be well informed about the consequences of having their
children circumcised . . .
How do parents become well informed?

We live in an information society . . . Everything seems to be on the
net, though . . . of course the information alone does not make much
sense . . . Parents need to enforce hygiene too . . .
What do you mean?

Children need to learn how to clean the penis.
How do you teach that?

Cleaning the penis needs to become, little by little, part of a boys early
training (shitsuke) . . . also, parents have to make their sons understand
that the shape and length of the sexual organ is not important.
Not important?
Yes, they need to know that as long as the penis is healthy and works
without problem, there is no need to have any surgery . . . Young men
have to understand that too . . .
Unsurprisingly, the Internet has become a major source of informa-

tion about the procedure. The Internet has turned into an integral
element in supporting medical decisions by offering access to infor-
mation that can assist the processes of increased self-reliance and
self-care (Henwood and Wyatt 2009, 18). The Internet has largely
substituted the function of telephone advice and helpline services,

which had been important anonymous and confidential resources
(Banks 2001). Through the interviews, the formidable influence of
the Internet as a means to gain information was conspicuous. Parents
might not need to discuss anything with urologists and/or medical
professionals because the Internet could help them solve any doubts.
In reflecting on the interactions between parents and medical profes-
sionals, Dr. Murakami (aged 56) elaborated:
I know that talking about male genitals is not easy, . . . but I think that
parents have to talk to doctors at some point . . .
Why is it not easy?

Hmm . . . it could be that doctors are not used to explaining medical
concepts to parents in a simple way, . . . but it could be also that parents
are not used to asking too . . .
Not used to?

Yes, in general, parents tend to follow instructions rather than asking
about treatments . . . Of course, things are changing and there are
more parents asking, . . . but still, talking about the genitals is not a
common thing yet . . . It could be that some of them think that it is a
bit taboo . . .
But they are talking to a doctor, why is it taboo?

I think it is a matter of getting used to . . . and, in general, parents have
some resistance . . . They might feel uncomfortable . . . they might
think that it is a bit unusual . . . It is also that Japanese people are used
to finding information by themselves . . . through the mass media and
friends . . . There are still helplines . . . like the family planning associa-
tion helpline . . . where they might find advice, . . . but something makes
me think that more and more people use the net nowadays . . . so they
dont have to talk about the genitals . . . and feel a bit uncomfortable.
What do you think are the consequences of having the Internet?

Well . . . I really dont know, but it could be that because of the Internet,
fewer parents might feel that they have to talk to doctors. . . . maybe . . .
In disentangling why parents could feel uncomfortable talking about

the sexual and the male body in front of a medic, the group of urol-
ogists introduced the notions of ones true feelings (honne) and
what one professes or says in public (tatemae). As Sugimoto (2002,
28) explains, Honne designates . . . desires which cannot be openly
expressed because of the strength of tatemae. If tatemae corresponds

to politically correctness, honne points to hidden, camouflaged, and
authentic sentiment. In this light, parents might not feel at ease talk-
ing to a medical professional because they have learned that the sexual,
and certainly anything related to the genital area, has been scripted as
belonging to the area of the individual authentic sentiments, while a
conversation with a medical professional is usually framed in politi-
cally correct terms. As Dr. Toda (aged 54) puts it:
I am not sure if you are familiar with the terms honne and tatemae . . .
I think I know the terms, but please explain them to me.

Well, honne is what the person really feels . . . and it is usually said to
friends, family members . . . but tatemae is like talking in a formal way,
what can be said in public . . . Hmm . . . like not saying what you really
think . . . Honne is more like a private thing, what you say to people you
know, you dont say it to strangers . . .

Well, some parents might feel uncomfortable talking about that because
Japanese people somehow have learned that sex and the body-related
matters are private . . . You dont talk about that easily . . . Do you know
what I mean?
Yes, but we are talking about a medical consultation, arent we?

Yes, but still people are not used to . . . It is something that you have
learned and you are not used to . . . of course, things are changing and
people should be able to discuss circumcision with a doctor, . . . but I
think that the difference between honne and tatemae can still be used to
explain the relationship between parents and doctors.
Could it be also that doctors are not expecting parents talking

about their real feelings with them?
Hmm . . . I have not really thought of that, but it could be a reason . . .
I am not sure though . . .
Because of this, would you say that parents prefer to look for
information on the Internet rather than talking to a doctor?
Yes, that could be a reason . . . maybe . . .
These ideas about hiding an authentic sentiment appeared largely

related to the notion of pretend ignorance expressed in my inter-
views with young women and could equally be explained by using
Gagnon and Simons (2005) theorizing on sexual scripts. The sexual

has been primarily scripted and identified as a private matter that can-
not be discussed in public, thus the Internet appears a suitable way to
solve doubts without having to expose the individuals real feelings
in public. This of course does not mean that the urologists did not
offer a critical view concerning the use of the Internet and the mass
media at large. Following Dasgupta (2003, 119), an evaluation of
the Internet, in particular, is significant given the hype that often
surrounds questions about the Internets potential for socio-cultural
transformationboth the utopian visions of the liberating poten-
tial . . . , as well as the dystopian views which highlight the policing
and surveillance potential of the Internet. This issue is particularly rel-
evant when talking about Japan, given the rapid expansion of Internet
use in recent years, due to the development of new technologies like
the i-mode mobile phone Internet service. The group of urologists
tended to convey a dystopian view of the mass media and Internet,
specifically, to criticize the Japanese cosmetic industry that oversees
prophylaxis and openly commercializes circumcision, which entails a
mutilation of the male body and a human rights violation (Boyle et al.
2002; Goldman 1997). In being asked about the difference between
pediatric and adult circumcision, Dr. Murakami (aged 56) stated:
I think that a major difference could be related to numbers.
What do you mean?

I think that there is a bigger number of circumcised adults because of
the bad influence of the Internet.
What is that bad influence?

You might not know, but in Japan, the surgery is basically a cosmetic
surgery and it is advertised like that on the Internet . . . It is basically a
surgery for adult men . . . We do not know the exact number of men
who have been circumcised, but I would not be surprised that a lot a
guys look for it . . .
Look for it? Could it be like the campaigns to prevent HIV/AIDS?

Not at all . . . because here . . . it is a cosmetic surgery, . . . which if you
think of it seriously, it is like a violation of human rights.
A violation of human rights?

Yes, I think that it is a form of genital mutilation that should be con-
demned. It is just as bad as female genital mutilation.
What do you think can be done to stop this?

It is not easy of course, but I think that promoting penile hygiene could
prevent the transmission of any disease and the right information could
stop guys from being circumcised at beauty clinics.
Nevertheless, the urologists approach tended to overlook the

social relations underpinning health carerelated decision making
(Irvine 1995). Similar to the Ministry of Health, Labour and Wel-
fares (MHLW) viewpoint, social and cultural influences are largely
sidelined and Japanese men and doctors appear as if they lived in a
cultural and social vacuum (Parker 2010, 6). The so-called Health
Belief Model (HBM; Rosenstock, Strecher, and Becker 1988) chiefly
underscores urologists approach because they tend to rely on the idea
that accessing the right information about adult circumcision is key
to preventing the practice. In line with the principles of the HBM,
men would not want to have the prepuce removed if they felt that the
negative impact of the procedure could be avoided, that avoiding the
surgery would have a positive impact on them, and that the procedure
could be successfully avoided, as Dr. Numata (aged 59) conveys:
More and more young men are willing to have the prepuce removed,
and I think that this is the bad influence of the Internet. Plastic sur-
geons take advantage of ignorance to sell a surgery that could even
be a violation of human rights . . . there is no medical justification for
circumcision.
How can this influence be stopped?

Through education, . . . but I dont think it is school-based education,
sex education at home has a big role to play . . . Parents should discuss
genitalia with their sons to make them understand the consequences of
having the foreskin removed.
Does this mean fear of the minor surgery?

Yes, somehow . . . but not exactly . . .
Can you explain please?

Hmm . . . they need to understand that having the prepuce removed could
have serious consequences and that most of them are irreversible because
once the piece of skin has been removed, it cannot be reconstructed . . .
What are those serious consequences, for instance?

Well, I have seen cases of young men who want the foreskin back to its
original form . . . because the penis looks ugly . . . it does not have the
physical appearance they expected, . . . and they paid a lot of money

because they did not use their health care insurance . . . and all this is
unneeded . . . it can be avoided . . .
How?
As I have told you . . . information and education is very important.
Do you think that people can talk about this without a problem?
Hmm . . . maybe not, but they should.
Cosmetic surgeons, conversely, proposed a rather realistic gaze to

circumcision. Their viewpoints placed the surgery within a sexual cul-
ture of silence, denial, and taboos. In line with Coleman (1983), the
cosmetic surgeons highlighted the difficulties of Japanese men willing
to discuss male genitalia and sexual performance at public medical
facilities. Actual discussions on genitalia and hygiene are unrealis-
tic. Instead, they proposed an educational approach grounded in
the Internet and the notion of the so-called technosexuality, which
broadly refers to [t]he connection between technology and sexuality
[that] has been with us for some time, particularly with regard to the
Internet . . . It seems that almost as soon as the Internet came into
use, its sexual potential was put to work. It appears that the sexual uses
of the Internet and related technologies are now understood by some
to comprise technosexuality and to have many implications for inti-
mate life and civil society (Davis 2009, 23). Beauty salons websites,
in particular, display scientific information that works in tandem
with interactive cybermedical consultation. A utopian view of the
Internet underpins cosmetic surgeons strategies, which take advan-
tage of the Internets triple A features: accessibility, anonymity,
and affordability. This means that [t]he Internet is available, conve-
nient, and easily accessed by increasing numbers of people world-
wide . . . Affordability is based on the economic principle of supply
and demand . . . [which] leads to lower prices for consumers . . . The
belief, whether true or not, that ones identity is concealed online can
have a powerful effect . . . [T]he Internet increases the sense of free-
dom, willingness to experiment, and pace of self-disclosure, as well as
enhancing a persons ability to talk about . . . concerns and fantasies
(Cooper and Griffin-Shelley 2002, 23). Such features can be clearly
appreciated in Japanese chat rooms, mailing lists, and sites dealing
with cosmetic/plastic surgery for men (Dasgupta 2003, 114). The
so-called cybermedical consultation also shows the advantages of the
Internet, as Dr. Imoto (aged 35) said:
We need to be realistic . . . In Japan, conversations about circumci-

sion, genitalia, and sex are unlikely to happen . . . Beauty salons have
a realistic (genjitsu teki) view and offer scientific information on their
websites . . . Clients and surgeons can freely interact because nowadays,
the Internet can be accessed even from mobile phones, which is rather
cheap and anonymous.
Do you think that the success of your services relies on this form
of service?
Yes, partly, yes, we are using the net to offer free advice and consulta-
tion . . . Guys do not feel the pressure of having to talk about their
private concerns in front of a stranger . . . We are just somehow moving
together with the new tendencies . . .
What are those tendencies?

People interact more and more through the net . . . They look for
casual sex, relationships, pornography, information . . . and we offer
medical advice . . . You would be surprised at the ways men can express
themselves when they know that nobody is looking at them, . . . and
they can do it almost everywhere now that they can access the web from
their phones . . . It is just like having a medical consultation almost
everywhere . . .
Cosmetic surgeons thus suggested that the interpersonal dimension

underpinning circumcision has mainly become a social interaction of
medical professionals and Japanese men through the Internet. They
also tended to disregard medical malpractice and negligence that
could lead to unsatisfactory and/or unexpected results concern-
ing circumcision. Fully aware of the niche market circumcision rep-
resents, this group of surgeons introduced the notion of informed
client to justify the role of aesthetic clinics as a form of producers of
medical knowledge (Henwood, Greenand, and Balka 2009, 2), and
thus men looking for circumcision are regarded as clients, who are
always free to compare and/or discard the information provided. Fur-
thermore, beauty salons somehow helped empower Japanese male
clients by providing accurate information through the Internet that
is neutral and value free (Henwood, Greenand, and Balka 2009,
34), as Dr. Tanaka (aged 39) expressed:
You need to remember that the information displayed on the Internet

can be always compared with other sources . . . These days, the same
information can be found in so many different sites and expressed in
so many ways . . . that men can gather a lot of information about the
surgery before deciding if they want to have it done.
Do you not think that too much information might confuse them
instead?
Well, that is always the risk, . . . but it is better that they get enough
information before deciding whether they want to be circumcised or
not . . . to us they are our most valuable clients . . .
What does that mean?

We need to treat them well because our business depends on them . . .
We offer free counseling so they can be fully informed about what cir-
cumcision is . . .
Some doctors would say that the information displayed on the

Internet could be incomplete and misleading, what do you think?
I dont think so . . . As I have told you, men are valuable clients for us.
Our business depends on them . . . Counseling is really an integral part
of the services provided by beauty clinics . . . clients are to be objectively
and fully informed before any surgery . . . Clients are in a position to
decide by themselves.
Do you also mention the advantages of keeping the prepuce intact?

Yes, some sites include that information too, please take a look at the
information . . . you will see.
What about penile hygiene?

There are some sites that mention that too.
Although the surgical procedure is also advertised in print media,

through my interviews, the relevance of the Internet to understand-
ing circumcision in Japan became apparent. The existence of the
surgery largely depends on cybermarketing strategies, which include
cybermedical consultation too. Men looking for the cosmetic sur-
gery are fully informed clients who can freely opt to be circum-
cised. Nonetheless, cosmetic surgery is about physical appearance
rather than physical function (Parker 2010, 3), health-related aspects
become largely irrelevant and issues concerning gender and sexuality
have a major role to play when deciding to have the prepuce removed.
The G endered S el f
Conversations with the plastic surgeons nicely recreated the social
imagery presented in most of the advertising of circumcision. My
interviews confirmed that the intrapsychic dimension beneath circum-
cision revolves to a great extent around the idea that true masculinity
is almost always thought to proceed from mens bodies (Connell
1995, 45). In particular, the script that the penis is central in the
construction of the gendered self of Japanese men became apparent
because, ultimately, as one of the slogans says, [T]he pride of a man
is in the lower half of his body (kahanshin ha otoko no puraido da!;
Hills Tower Clinic). In disentangling the relationship between mascu-
linity and the genitals, Dr. Onodera (aged 42) argued:
Some people might say that this is an old way of thinking, but when
you look at the net or the so-called magazines for men, the kind of
jokes they make and so on, . . . you can say that the sexual organ is still
very important for Japanese men.
In what way is it important?

Hmm . . . for instance, men tend to worry about the size and shape . . .
they might think that they are not manly enough . . . that they cannot
attract women . . .
I see, but who are these men you are talking about?
Well, obviously, it is basically guys who come to look for our services . . .
Some people think they want to get circumcised because they are
a bit too young?
Hmm, I do not think so . . . Yes, we see in the clinic very young men,
. . . but they are not able to pay for our services . . .
Why is that so?

Because the costs of a cosmetic surgery are not covered by the national
health-care insurance in general. Also, if they are minors, they need
to look for the consent of their parents, which makes things a bit too
complicated.
Some of the interviews thus showed that the claim that circumcision is
rather a matter for pubescent and/or young men, as stated by some of
the men I introduced in Chapter 3, became implausible. In addition,
some of these surgeons suggested that circumcision is a medical inter-
vention that enhances the quality of life of Japanese men who, similar to
British men opting for penis enlargement procedures, dont feel com-
fortable . . . [and look for] a better life (Usborne 2012). The surgical
procedure is most likely a tool working on the soul (Foucault 1988)
because men who have the prepuce removed feel safe, respected, [and]
in control (Bordo 1999, 57), as Dr. Takenaka (aged 30) stated:
It is maybe difficult for you to understand, but decisions on circumci-

sion are beyond rational thinking . . .
Beyond rational thinking, what do you mean?

Well, things seem to be changing, but in reality . . . I think that for many
Japanese men the genitals still have a great sense of importance . . . it is
an important element in their identity, maybe.

Well, I have seen so many guys . . . Having the prepuce removed means,
somehow, for some men, happiness, confidence, and willingness to
live . . . It is just amazing how removing the prepuce can change the
physical appearance . . .
The physical appearance? Could you please explain?

Yes, you might say that different from other surgeries, nobody knows
whether you are circumcised or not, . . . but the man involved knows it
and he likes it . . . If he likes his body, he is like a different person . . .
He somehow gets a different physical appearance.
In line with Parker (2010, 3), thinking of men who look for circumci-
sion as cultural dopes does not allow for [men]s self-determination
or individual agency. It is a view that tends to oversimplify the expe-
riences of Japanese men willing to have the prepuce removed as well
as to ignore the role of the surgeon in transforming the body and
the soul of the man concerned. My analysis of the interview tran-
scripts highlighted that circumcision certainly helps remold the physi-
cal appearance of the penis, which definitely impacts on the sense of
self. This view of the intrapsychic dimension underpinning the surgi-
cal procedure elicited that education and information might not be
major factors influencing the decision to get circumcised as suggested
by some of the urologists. In talking about the profile of men willing
to be circumcised, Dr. Izumi (aged 47) explained:
Men who look for the surgery are those men who want a change . . .
I am pretty sure that you, like everyone has a part of your body that
bothers you . . . that you dont like . . . that if you had the opportunity
to change, you would . . . this is actually our role . . . we can make you
feel closer to the body that you always wanted . . . I know that many
doctors do not like circumcision and think that men who want to have
the surgery done do so because they are ignorant, because they do not
have accurate information, . . . so they do not know what they really
want . . . Well, I dont think so . . . they do know what they want.
What is the thing that they want?

To change their physical appearance.
I see, but how does circumcision change your physical appearance?

Well, the physical appearance changes but also the mind-set changes . . .
They think of their body in a different way . . . They like their body, so
they like themselves . . .
Are you talking about the psychological impact of cosmetic

surgeries?
Yes, somehow . . . actually, in my experience, I would say that men who
look for the surgery are a bit brave because they are able to summon up
the courage to decide and get the body they liked.
In clarifying their viewpoints, the cosmetic surgeons provided a range of

anecdotes that illustrated the relevance of having the prepuce removed.
Most of their anecdotes elicited the so-called biofantasies (Hersey
1996) to stress the radical change in the life of Japanese men after cir-
cumcision. Such biofantasies largely implied the centrality of the penis
in understanding the place of men in society. Similar to the narrative
expressed in the iconographies of circumcision, my interview analysis
implied that male prowess, potency, and performance depended on the
size of the penis, and the condition of the prepuce was used to indicate
the size of the sexual organ. Therefore, getting the penile glans always
exposed is essential to making the penis look larger, which suppos-
edly has an impact on self-confidence (jishin) of circumcised men. This
makes the intrapsychic dimension of the medical procedure grounded
in a model of the male body that hinges on the foreskin, which sidelines
penile hygiene, as Dr. Onodera (aged 42) suggests:
Removing the foreskin is the easiest way to make the penis look
nicer . . . longer.
What is a nicer looking penis?

Well, that is difficult to answer because it depends on the man involved,
. . . but generally speaking . . . in my experience, . . . guys always want
to have a penis that looks longer . . . a penis that does not have a long
prepuce covering the glans . . . that could be a nicer looking penis . . .
maybe . . . and circumcision helps a great deal . . .
Why do you need to do that?

You know that men are always concerned about size . . . I can tell you,
when men are young they compete against each other to show who has
the biggest thing . . . and when they become older, they always prefer
to have big organs . . . when the prepuce is a bit too long, men can be
bullied . . . it is not unusual that men tease each other about having a
long prepuce . . .
Who are these men you are talking about?

Mainly, men who have come to my clinic looking for surgeries . . .
removing the prepuce is an easy way to get that . . . circumcision makes
the thing look bigger.
I see, but I understand that the majority of Japanese men are

uncircumcised?
Well, nobody really knows the real number of circumcised men, but . . .
mockery still exists and that could be linked to having a long prepuce.
What about penile hygiene and HIV prevention?

Yes, circumcision can prevent disease, but . . . this is maybe particular
to Japanese men, . . . they do not look for circumcision because of pro-
phylaxis, they dont think of venereal diseases (sei by) either, . . . they
yearn for a penis that looks bigger . . . As for HIV? There is evidence
that circumcision can prevent HIV transmission, but I still dont think
that Japanese men think of AIDS when looking for circumcision.
In this light, medicalization does not fully explain the cultural and
structural dimensions supporting circumcision. Instead, the construct
of biomedicalization appears relevant to understanding why Japanese
men would opt to have the prepuce removed. My interviews with
these cosmetic surgeons indicated that circumcision has essentially
been integrated into a package of surgical procedures that produce
penile improvements and help men attain a perfect penis. In bio-
medicalizing circumcision, what is seriously problematic is of course
the understanding of penile improvement as well as the definition of
a perfect penis. The situation closely resembles the marketization of
drugs to treat erectile dysfunction (ED) because no clinical defi-
nition exists for what comprises a normal erection . . . , any erection
that is not fully erect can be viewed as a problem by the patient, even
if he has no problems functioning sexually (Carpiano 2001, 445),

which largely translates into a formidable business for the pharmaceu-
tical industry. In the same vein, circumcision represents a profitable
niche market for the cosmetic industry because any penis that does
not please the man involved can always be resculpted even if it
does not pose a health problem. In being asked about the importance
of circumcision, Dr. Kikuna (aged 38) said:
Well, it is really important to have these surgeries that help men change
their body as they want . . . At the end of the day, every single man has
some concerns about their sexual organ, . . . and I dont think that this
applies only to Japanese men.

If you check statistics on men looking for cosmetic surgeries in the
world, you will see that many of them involve the genitals . . . It is
somehow like breasts in the case of women . . .
What are those surgeries that involve the genitals?

Like, for instance, penile implants or enlargements . . .

Well, if you get the foreskin removed, . . . you somehow get the penis
that you like . . . that makes you feel comfortable . . . that gives you
confidence . . .
Are you saying that circumcision is just like any other cosmetic
surgery on the genitals?
Yes, it is. It improves the shape and the form of the penis . . .
What about disease prevention?

Well, that is a plus . . . circumcision can also help prevent disease . . .
Different from other interventions, circumcision can have prophylactic
benefits, . . . but for us here, it is mainly just like another cosmetic
surgery.
Following Loe (2004, 77) and her discussion on the implications of

Viagra, the Blue Pill and circumcision have something in common.
They both can restore and relieve distressed and deficient people
and bodies. Overall, the conversations with these male surgeons sug-
gested that men looking for consultation at beauty clinics are men
who suffer alone because they cannot rely on friends to talk about
their penile concerns. The majority of men feel embarrassed and many
of them have faced mockery and bulling. The condition of the pre-
puce easily becomes a joke. Men who want to be circumcised tend to
feel that they are abnormal, and to some extent, they feel emas-
culated. Thus getting circumcised cannot be divorced from the
achievement of normal masculinity because circumcision is con-
structed as a surgical intervention that restores masculinity (Loe
2004, 77). Dr. Onodera (aged 47) highlighted the suffering of
some of his clients and explained:
Yes, some of our clients who want to get circumcised really bring
with them heartbreak stories . . . Many of them have a sense of
hopelessness . . .
Is it really that dramatic?

It sounds a bit dramatic and difficult to imagine, but most of them do
not have friends to talk about their concerns . . . They feel lonely . . .
many of them have been bullied . . . and had very bad experiences when
they took baths together with their friends . . . You need to remember
that in Japan, the culture of taking baths together with other men is
very important . . .
Yes, I know about that culture but why bullied?

Well, when other men realized that they have a long prepuce . . .
A long prepuce? But I understand that the majority of Japanese

men have a long prepuce because they are uncircumcised.
Well, that is a bit confusing . . . These men I am talking about have
got something that we call true phimosis . . . and the head of the penis
cannot be seen . . . it is always covered by the foreskin . . . the foreskin
cannot be pulled down . . .
I see, but how do other men can know about that? I understand
that men generally cover the genitals with a towel when they enter
the bath.
That is true, but still, everyone seems to be checking on each other . . .
Some of these men do not want to take baths together with other
men . . . and many of them do not want to have sex with women
because they fear rejection . . . Somehow they feel that they are not a
complete man . . . that something is missing in their lives . . .
As I discussed in Chapter 3, it is particularly relevant to take into con-

sideration the tradition of bathing in Japan in order to grasp the soci-
ality of circumcision. In addition, the cosmetic surgeons completely
agreed that having the prepuce removed is a surgical procedure that

changes the vision men have of themselves. Not only does the minor
surgery change the physical features of the genitals, but it also helps
normalize the gendered self of Japanese men. Such a process of
normalizing masculinity, however, might be at odds with social real-
ity, because a normal Japanese man is most likely to be uncircum-
cised. Nonetheless, the surgeons insisted on the power of the medical
intervention to restore masculinity. This was particularly conspicuous
when thinking of the sexual self of circumcised men.
The S ex ual S el f
The interpersonal dimension underpinning circumcision through the
eyes of the medical doctors takes us to an analysis of the ways circum-
cised and noncircumcised male bodies relate to each other, as well as
the implications of such a relationship for the female body. My discus-
sions with the cosmetic surgeons presented the outcomes of these
relationships in terms of hierarchy, gender, and sexual behavior. Wajc-
man (2007, 293) contends that gender relations can be thought of
as materialized in technology, and gendered identities and discourses
as produced simultaneously with technologies. As such, circumci-
sion appears as a medical technology that produces and reproduces a
range of gender relationships grounded in the symbolism attached to
the phallus, which is master signifier, and femininity is symbolically
defined by lack (Connell 1995, 65).
In understanding how the surgical procedure produces hierarchical
relations of gender, differences between the circumcised and uncir-
cumcised male bodies become apparent. Circumcision is a medical
technology directly impacting current gender relations because cir-
cumcised men appear to be in a position of domination and ascendency
in relation to uncircumcised menthat is, their larger-looking
sexual organ makes them manlier and Japanese women tend to
prefer sexual intercourse with circumcised men. As Dr. Tachibana
(aged 32) argued:
You have no idea about how important the prepuce is for some guys . . .
it can be a kind of obsession to have the penile glans exposed . . . It is
not unusual to see guys doing their best to rolling back the foreskin
before entering a hot spring, for instance. I believe that having the
thing [penis glans] exposed makes the sexual organ look bigger and
men feel confident.
But dont you use a towel to cover up the genitals?

Yes, we do that, but guys roll the thing back anyway . . . They know
that they are being seen anyway, and it is like loosing face to have the
penile glans unexposed . . . They are like competing against each other.
Competing against each other, what does that mean?

Somehow, if your penis is covered by the glans, it means that you are
still a child . . . that you have not grown up . . . that you are not a man
yet . . . I might be wrong, . . . but that is what I think, . . . and of course,
women prefer circumcised men.

Well, we have conducted some surveys.
And the results of your surveys show that Japanese women prefer
circumcised men?
Yes, there is a tendency . . . especially among women who have some
sexual experience.
Who are these women?

Well, we have conducted anonymous surveys, . . . but you might know
that women are changing.
In what way are they changing?

They tend to be better informed about sex-related matters, . . . and
of course, many of them have started their sexual life earlier than
before . . . Some of them understand better what sexual satisfaction
is . . . they are more in a position to choose . . .
To choose?
Yes, to choose between circumcised and uncircumcised men.
Can they really choose? I thought that most Japanese men are
uncircumcised.
Hmm . . . we do not know the actual number of men who are circum-
cised, but in our surveys, we saw that if women could choose between
circumcised and uncircumcised they would definitively like to have sex
with a circumcised man.
The conversations with the cosmetic surgeons largely elicited social

imagery concerning the younger generation of Japanese women who
have supposedly become rather sexually active and assertive. Now-
adays, women are most likely carnivorous and prefer intercourse
with circumcised men. Unfortunately, the quality of the data provided

did not appear reliable enough to support the idea that these women
existed in real life. Similar to Kinsella (2013, 20) and her argument
that the story of prostitute schoolgirls [in Japan] was incubated [and
produced out of] statistics on deviant sexual behavior and the genera-
tion of what might be considered a form of pseudo-ethnography,
cosmetic clinics have most likely assembled a number of surveys and
statistical data to imply that circumcised men are preferred. Nonethe-
less, the surgeons were largely unable and/or unwilling to discuss the
quality of their surveys. In being asked whether Japanese women pre-
ferred sexual intercourse with circumcised men, Dr. Tachibana (aged
32) responded:
Yes, Japanese women are more likely to want sex with circumcised men.

Because Japanese women these days know what they want . . . different
from older women . . . I think that younger women have a more active
sexual life . . . They have more information about sex . . . so they are
also concerned about health . . . that is why we know that in general
they would like to have sex with circumcised men.
Who are these younger women you are talking about, anyway?
Could you please be more specific?
I think that the clinic has conducted some surveys with Japanese women
and the results show that . . . if you were interested in knowing details
the results are displayed in the net.
How did you contact these women?

I am not sure . . . I think they just answer some surveys.
How did you conduct the surveys?

Hmm . . . I think that women were asked to answer a number of ques-
tions online . . . because the topic is a bit sensitive . . . it is an anony-
mous questionnaire . . .
How can you know that the person who answered the question-
naire is really a Japanese woman?
Because the questionnaire is in Japanese.
I see, but anyone who can read Japanese could answer it, right?
Hmm . . . you are right, maybe.
A major selling point concerning circumcision refers to the sexual

benefits that can be attained. In line with the advertisements, the
group of cosmetic surgeons has found through cybermedical con-
sultation that Japanese men are sexually failing due to two main
sex-related afflictionsnamely, ED and PE. Psychological stress
and depression could be thought of as the origin of both afflictions.
Nonetheless, the surgeons experiences suggested that circumcision
could be a rather effective and inexpensive method to grapple with
both afflictions because psychological therapy is rather expensive and
still unusual in Japanese society, as Dr. Kikuna (aged 38) explains:
This needs to be fully studied, but in my experience, most men looking

for circumcision have experienced erectile dysfunction and/or prema-
ture ejaculation.
Why is that so?

Well, they think that their sexual organ is small, which makes them lose
confidence . . . Some of them are depressed . . .
Dont you think that a psychologist could help instead?

No, psychological therapy is rare and still a stigmatized practice in
Japan . . . Not many people want to be seen going for mental health
services, which on the other hand, are still expensive.
Anyway, what is the relationship between being circumcised and

erectile dysfunction and premature ejaculation?
Well, the explanation is simple . . . circumcised men gain confidence
because they think that their penis is not tiny . . . also the surgery makes
the penile glans less sensitive, which helps them control ejaculation . . .
And why do they want to control ejaculation?

Because they want to have longer sessions that make women enjoy sex
better.
How do you know that women enjoy sex better?

We have conducted some surveys online.
As I have discussed earlier, the historical roots of the surgical proce-

dure are largely entwined around the reproduction of a patriarchal
gender regime. Conversations with the cosmetic surgeons confirmed
that circumcision has largely become a medical technology that helps
institutionalize heterogender or the understanding that heterosexual-
ity is the normal and preferred sexual orientation. Circumcision is a
medical procedure primarily offered to heterosexual men. Although

homosexual men could have access to the procedure, the surgeons
were unable to offer an opinion on the sexual preferences of their cli-
ents. In being asked whether circumcision was for heterosexual men,
Dr. Onodera (aged 29) answered:
No, not really, but most of our clients are heterosexual . . .

Well, we dont really ask anything about sexual preferences, but homo-
sexual men can be circumcised too.
Oh, I see. Why do you think homosexual men want to be

circumcised?
I have no idea.
Could it be for health purposes?

I really dont know, . . . but something makes me think that health is
not really a reason . . . I do not think that many people in Japan think of
circumcision as something related to health . . . like any other cosmetic
surgery . . . I dont think that there is one single reason . . . men might
have different reasons to get circumcised.
What is the main reason for heterosexual men to get circumcised,

in your opinion?
As I have told you, women prefer sex with circumcised men because
sex lasts longer.
Why do women prefer sex that lasts longer?

Because if he ejaculates too fast, she is unlikely to enjoy sex . . . that is
why it is called premature ejaculation.
So how long is a sex act that lasts longer?

That is very difficult to say because it depends on when the couple gets
satisfied.
Clearly, these surgeons implied the idea that sexual intercourse is an

act that habitually entails vaginal penetration and that it finishes with
his ejaculation, which is why PE becomes problematic. However,
similar to the notion of a normal erection, disentangling what PE
encompasses is difficult because there is no technical definition of it.
Nobody has ever produced a scale to indicate the average time sexual
intercourse should last because it largely depends on the opinion of
the couple involved. Such ambiguity enhances the power of the cos-
metic industry to commercialize circumcision because any couple who
thinks that intercourse is not long enough might consider the sur-
gery as a procedure that makes it last longer, as Dr. Izumi (aged 47)
elaborates:
You cannot imagine the radical change in the lives of some couples after
circumcision.
What do you mean?

After the guy in the couple got circumcised, they could enjoy sex better.

Because we follow up our clients after the surgery, remember that we
meet with them after the surgery to check that everything is OK.
I see, but why could they enjoy sex better?

Apparently the problem was that the guy was ejaculating a bit too fast.
Why is ejaculation so important?

Well, that is pretty much common sense. Everybody knows that if he
ejaculates, the act is somehow over.
And how does that relate to circumcision?

After being circumcised, the guy was able to control ejaculation and
have longer sessions.
Do you have an idea about how long a session should last?

That, I dont know . . . and I dont think anybody can answer that . . .
It depends on so many factors, . . . but one thing is true, if circumcision
can help couples enjoy sex, we should offer it as a practical solution . . .
I think . . .
In discussing these supposed benefits of circumcision with the group

of urologists, they were emphatic: the procedure was a cosmetic sur-
gery that did not cure anything but could have the effect of a pla-
cebo. They highlighted that scientific evidence ought to be provided
before endorsing and/or offering circumcision as a treatment for ED
and/or PE. The biomedicalization of the procedure commodifies the
male body and represents good financial revenues for the cosmetic
industry. However, opposing circumcision did not necessarily mean
resistance to the script that centers sexual behavior in the genitals
and/or opposition to the heterogender regime of practice that it also
implies. The group of urologists tended to agree that disseminating

truly scientific information is the only authentic way to discredit cam-
paigns to promote circumcision. As Dr. Ishi (aged 50) puts it:
There is nothing else to say . . . they say that circumcision is good

for preventing erectile dysfunction and premature ejaculation, but I
doubt it.
Why do you doubt it?

Because I have not seen any scientific evidence that shows that circum-
cision can cure anything . . . in the first place, it is very difficult to know
what premature ejaculation is, also we do not know what exactly causes
erectile dysfunction . . .
Why is it so?
Because nobody can state clearly what is the actual range of time that
sexual intercourse should last . . . How can you decide that? Who is
going to decide that? I dont think that there is an answer to those
questions . . . Also, erectile dysfunction . . . we do not really know what
causes it . . . Cosmetic surgeons somehow take advantage of this.
What do you mean?

Since people do not really know what causes these sexual problems,
they believe that circumcision can cure them . . . They do not think
scientifically . . . As I have told you before, I do not think that cir-
cumcision is needed at all . . . I could say that it does not have any real
effects . . . it could work like a placebo, though.
A placebo?
Yes, people are not cured, they think they are cured and somehow it
works . . . This becomes a matter of faith not of science . . . See, for
instance, if they have low self-esteem and lack confidence because they
think their penis is small, . . . if they are concerned about sizes, I can
tell you that from a scientific perspective, a five-centimeter-long erected
penis is long enough to have sexual intercourse.
What do you mean?

A man can penetrate a woman without a problem if his penis is five cen-
timeters long when it gets erected . . . She could even get pregnant . . .
if that were the problem.
My interviews with the cosmetic surgeons clearly showed how the sex-
ual self becomes materialized through circumcision, but this does not
mean that urologists, despite opposing circumcision, hold a different
view about the gendered and sexual self of Japanese couples. Both
urologists and cosmetic surgeons seemed to share the same script that
the sexual is primarily located in the genital area and involves hetero-
sexuality and vaginal penetration with an ejaculation.
Co nc lusio n
The cultural and structural dimensions underpinning circumcision
from the vantage point of this group of urologists and cosmetic sur-
geons confirm that medical knowledge concerning the procedure
remains an uneven terrain full of uncertainties, which create much
controversy and irreconcilable postures. While urologists openly
object to the practice, cosmetic surgeons vindicate the surgery.
Contextualized within current international debates on circumci-
sion as a method to prevent HIV/AIDS for heterosexual couples, the
relationship between HIV/AIDS and circumcision does not apply to
Japanese settings because the surgery is largely offered as cosmetic
surgery, which sidelines any form of prevention or prophylaxis embed-
ded in the medical procedure.
The group of urologists clearly objected to the promotion of cir-
cumcision on the grounds that the demand for the procedure is an
iatrogenic effect, and they uphold penile hygiene as an effective method
to prevent genital disease and infections, including HIV/AIDS. They
blamed the Japanese cosmetic industry for taking advantage of the
mass media and laymens poor medical knowledge to commercialize
circumcision. The notion of the informed parent, which includes par-
ents looking for medical information, enforcing penile hygiene, and
engaging in discussions on genitalia with their sons, was suggested
to challenge discourses on circumcision. The viewpoint, however,
tended to dismiss the sociality of medical and sexual knowledge to
imply that decision making in relation to male genitalia was a largely
rational process undertaken by individuals in isolation and out of
fear of disease.
The group of plastic surgeons, conversely, tended to underscore the
power of social imagery and sexual taboos to promote circumcision.
Aesthetic and beauty salons tended to rely on a master narrative of
gender and sexual scripts as well as cybermedical consultation to attain
the biomedicalization of the surgical procedure. Within the intrapsy-
chic dimension underpinning circumcision, the procedure appeared
as a medical technology that offered psychological and physiological
benefits to sexually failing Japanese men. The surgery suppos-
edly works, similar to penis enlargement procedures in the United
Kingdom (Usborne 2012), on the psyche of Japanese men to boost

self-confidence and improve their quality of life. While removing the
foreskin was meant to be a medical treatment for ED and PE, the
prophylactic benefits and HIV/AIDS prevention matters concerning
circumcision remain unclear.
Despite divergence in the views of urologists and plastic surgeons
concerning circumcision, their standpoints tended to converge in the
idea that the penis was crucial to the construction of a male gen-
der identity and to the sexual script that places sexuality as having
its source in the genitals. Androcentric and heterosexist assumptions
permeated the viewpoints of urologists and plastic surgeons in rela-
tion to sexual intercourse because male sexual needs appear to be the
bench-mark [of] what sexuality should be like (Jackson 1999, 10).
The needs of Japanese women were largely read in line with the
myth of the vaginal orgasm (Koedt 1972), thus sexual intercourse
was meant to be an act where men dominate women.
Given the salience of the role of parents to prevent circumcision
at large, the next chapter revolves around the views of a group of
Japanese women on the medical procedure.
4
Chapter 6
Mothers Views
It was very sad and embarrassing because my son got an infection

there [the penis]. It was very red and I did not know what
to do.
(Abe-san, aged 37, mother of one son aged ten)
No, I dont think it a good idea to have them circumcised [ . . . ]

My son is already ten years old and he has not had any problem
there. I know that some mothers have struggled with infections
and things like that, but not my son.
(Nakanishi-san, aged 30, mother of one son aged ten)
T he most logical and rational way to deal with a baby boy who
has gotten an infection in the penis is to take him to the hospital and
have it checked. He most probably would get a round of antibiotics
that would get him well in approximately a weeks time. That would be
the end of the story. Nonetheless, Abe-san in the first quote suggests
that the situation is a bit more complicated. She seems a desperate and
rather embarrassed mother because the penis of her son is infected.
Her desperation could certainly be related to the physical vulnerability
of the baby, but that does not fully explain her embarrassment. Her
feelings might be related to where the infection is located. It is most
likely the symbolism attached to the penis, which places Abe-san in a
social conundrum and makes her feel ashamed.
Opinions are diverse, but those supporting routine circumcision
would say that the easiest way to prevent penile infections is to
have all newborn babies circumcised. Yet Nakanishi-san, in the second
quote, elicits that that is a rather drastic solution because not every
baby boy gets genital infections. Removing the foreskin eventually

means cutting off a healthy part of the body. This might be the ori-
gin of the stigma and discrimination in Japan, a country where the
majority of men are uncircumcised. Enforcing penile hygiene would
be, instead, a rather conducive and feasible strategy to help prevent
infections and to preserve the male body intact. Nonetheless, such a
strategy might create a different social conundrumnamely, having
to deal with the genital health of newborn and young boys.
In exploring the interpersonal and intrapsychic dimensions under-
pinning pediatric circumcision and penile hygiene, this chapter draws
on the outcomes of my interviews with a group of twenty Japanese
mothers who have at least one male offspring. Despite seven of the
mothers having struggled with the penile infections of their sons,
none of them said that their son was circumcised. Given that the sur-
gical procedure is largely a cosmetic surgery for adult Japanese men
and the legacy of a poorly developed school- and/or home-based sex
education, the mothers reflected on the quality of the information on
pediatric circumcision and penile hygiene. Their sources of informa-
tion were largely restricted to the group of peers. Penile infections
were a major event in the lives of some of the mothers, who have
to grapple with an unfriendly environment at medical facilities and
a sexual culture of silence and pretense that makes conversations on
genitalia unfeminine.
The mothers prioritized penile hygiene over circumcision. Never-
theless, the reasoning behind their decision appears far removed from
the realm of medicine. While the medical procedure appears effec-
tive to prevent penile infections and allows Japanese mothers to
avoid the difficulties of training and supervising the genital cleaning
of young boys, it is ineffective because circumcised boys could be
discriminated against in a society where circumcision is not the norm.
Ta l king abo ut Circ umci s i on

and P enil e H ygiene
As my interviews with the group of urologists showed, parents seem
key to promoting or deterring circumcision, as well as instilling penile
hygienerelated habits in young boys. Well-informed parents are
appreciated and, in theory, they should help propagate scientific
and accurate information about the prepuce and the sexual at large.
Nonetheless, the outcomes of my interviews with the Japanese men
and women indicated that though home-based education concerning
the male body and the sexual has been largely absent, it is mothers
Mothers Views 151
rather than fathers who are chiefly concerned with any instructional
duties at home. Exploring circumcision and genital hygiene from the
vantage point of a group of mothers is thus relevant.
In approaching this group of Japanese mothers, the salience of sex-
ual scripts became immediately apparent because both circumcision
and penile hygiene involve the genitals. This placed the conversations
within a Japanese sexual culture, rather than a salutogenic and medical
frame of reference. The mothers asserted that in discussing circumci-
sion and/or genital hygiene, the main issue was an almost complete
lack of vocabulary that did not sound rude or vulgar. Euphemisms
and silence pervade conversations on the male body and sex-related
matters, which the mothers tended to link to a poorly developed
school-based sex education and an almost complete lack of sex-related
instruction at home. In being asked why talking about circumcision
was rather unusual, Kumada-san (aged 44, mother of two sons aged
7 and 8) answered:
Yes, talking about this is a bit too odd . . . It is a bit embarrassing

(hazukashii) . . .
Why is it embarrassing?
Because we are not used to talking about it . . . Being asked things like
this in a direct way is somehow not normal . . . I am pretty sure that
you know that anything concerning the genitals and things like that is
never said directly . . .
But we are talking about a medical procedure.

Yes, but still, it is something that involves the genitals . . . We always feel
like, a bit reticent. We dont really want to talk about this.
Is it the same everywhere?

Hmm . . . if you are at a consultation room with a doctor, it could be
a bit different, I guess.
Why is that so?

I guess that it is because you are sick or something, . . . but still, it is
not really a conversation that would go smoothly . . . I believe that a
conversation with a doctor is more or less like receiving instructions.
What do you mean?

If you are sick, the doctor tells you what to do and thats it . . . I dont
think you really want to engage in a conversation about sex-related
things . . . It is really difficult. . . .
Why is it that difficult?

I really do not know how to explain this, but somehow . . . I think it
is because we are not used to . . . It could be because of the education
we have . . . It could be just only me, but I feel that talking about this
is a bit odd.
Some of the mothers reflections vividly mirrored the meaning of homo-

sociality, elicited in my conversations with the young women noted in
Chapter 4. As Gagnon and Simon (2005, 40) underscored, Women live
in a homosocial world as do men, but it is a homosocial world composed
of both adult women and peers who primarily value the girl for her ulti-
mate status as wife and mother. In retrospect, it was clear that for these
mothers, the main source of information about anything related to the
genital area was the group of peers. Some of them assumed that things
are changing because younger mothers could have conversations on sex
even with their male children, but none of the mothers reported open
talks about the genitals or the male body even with their own husbands,
because as Kawanishi (2009, 86) reports, Japanese mens communica-
tion skills are hopelessly poor . . . poor communicator husbands are
divided into two types: one is cold and unemotional, the other childish,
dependent, and seeking a motherly figure in his wife. In this regard,
Mori-san (aged 39, mother of two sons aged 7 and 10) elaborated:
To you this is maybe a bit strange, but in Japan, nobody thinks of cir-
cumcision as something related to health . . . It is practically a cosmetic
surgery on the genitals . . . which makes it a difficult topic . . .
What makes it difficult?

Language, I guess . . . talking about sex and the genitals in Japanese.
There is nothing in between . . . either all that scientific jargon or vul-
garities and dirty talk (shimoneta).
Why is it so?
It could be related to a poor education that makes the topic unusual in
daily life conversations . . . I am not sure . . . Things are changing of
course . . . These days, things seem to be changing and on TV, there is
lot of information about sex, for example, . . . but it is never said clearly
in those terms, there is a lot of innuendo . . . it sounds something like a
double entendre kind of . . . I dont really know how to say this . . . It
is something that always makes people laugh . . .
Why do you think it makes people laugh?

I dont know, but it is always like this . . .
Mothers Views 153
What about conversations with your husband?

It is the same . . . I dont think that men are better informed than
women . . . and men in general, at least in my case, do not talk
about that. I think that in general, men are not talkative. I dont
know about other women, but in general, sex is something that
you do, not something that you talk about (hanasu mono dewa-
naku yarumon desu) . . . I have never had a conversation on this . . .
I dont think that men want to talk about it . . . It is very difficult
to start a conversation on this . . . I think that in general, men are
not talkative.
Who are these men you are talking about?

My husband for instance . . . and the husbands of my friends in
general . . . I think.
Although embarrassment together with linguistic inaccuracies made

it difficult to talk about circumcision, the mothers revealed that their
husbands were not true phimotic (kasei hkei) because their penis
glans became exposed when having an erection. This discussion cre-
ated a level of anxiety, visibly reflected in their faces, once the mothers
realized that they were discussing penis sizes and not a medical proce-
dure, as Fuji-san (aged 42, mother of two sons aged 7 and 8) stated:
See, this is the point . . . I think that many women would feel uncom-
fortable and a bit embarrassed talking about this because, at the end of
the day, it seems as if we were talking about the size of the sexual organ.
Why is that so?

Hmm . . . I am not sure, but at least in my experience when I have
talked about it with friends, for instance . . . you get that impression . . .
It could be because of the influence of the clinics where men get cir-
cumcised . . . I dont know . . . or jokes about it . . .
What kind of jokes?

I am not sure, . . . but I think that in general, people would refer to
someone as hkei because his penis is small . . . maybe . . . of course you
dont say that directly . . . It could be very rude . . . I dont know . . .
I think I am just guessing, but one thing is true, . . . circumcision is a
very unusual topic of conversation.
So would you say for instance that your husband is hkei?

My husband? [the tone of her voice showing that she got a bit anx-
ious] . . . I dont think so.
Does that mean that he is circumcised?

No, I dont think so . . . when he gets an erection, his penis is nor-
mal . . . I guess . . . I am not sure.
I see, I thought that someone uncircumcised was called hkei?

Hmm . . . I dont know . . . I have not been taught about that . . . any-
way, I dont think that many Japanese men are circumcised, but I dont
think that everyone is hkei . . . and as I have told you, I dont think
people really want to talk about this.
No form of dialogue with men on male genitalia and/or circumcision,

aside from medical personnel, was reported and nothing was mentioned
about circumcision to prevent the transmission of HIV. Any possible pro-
phylactic benefit of the surgical procedure was chiefly ignored. However,
some of the mothers highlighted that circumcision has largely become
taboo because the advertisements produced by the cosmetic industry
transmit the idea that the minor surgery is for adult men who want their
penis to look bigger. In trying to elucidate the perception of circumci-
sion in Japan, Hayashi-san (aged 30, mother of one son aged 4) said:
This is maybe unique to Japan, but here, circumcision is barely seen as

something related to health . . .
What do you mean?

Most people would say that it is a plastic surgery for men who want
there [the penis] to look bigger . . .
Look bigger? How come?

Most conversations on the topic . . . imply that the surgery is to change
the size of the thing (asoko no ookisa) . . .
Does the surgery really make it bigger?

Hmm . . . I dont know, I have never seen a circumcised man, . . . but
if you look at the ads . . . hmm . . . it is easy to infer that the surgery is
offered as something that makes it look bigger . . . thats why talking
about this is embarrassing and obviously taboo . . .
When did you see the ads?

I dont remember exactly, but they are almost everywhere in fashion
magazines for men . . . I think that some weekly magazines have some
too . . . I dont know . . . It is not something that interests me, but I
guess that everyone has seen the ads . . . they just dont say it because
it is really kind of taboo . . .
Mothers Views 155
Taboo?
Hmm . . . yes, this kind of conversation is odd . . . somehow, it sounds
to me as if you were asking a guy if his penis is big or small . . .
Why is that so?

Hmm . . . I am not sure, but I think that there is this idea that if the
skin [the prepuce] is covering it is because the thing is small . . . [visibly
flushed], . . . which is embarrassing and obviously taboo.
I thought that circumcision was to prevent disease?

Really? I dont know . . . it could be, . . . but I dont think so . . .
Within the moral implications of sexual scripts, having the prepuce

removed becomes an act endowed with moral importance that will
indirectly shape its sexual meaning (Gagnon and Simon 2005, 27).
Conversations on circumcision and penile hygiene tend to be distress-
ing and gendered because they undermine the reputation of the
person involved. Coleman (1983, 16768) suggests that a sexual-
related talk typically consists of jokes and anecdotes. The joking
spirit suggests anxiety; the typical setting, a men-only drinking ses-
sion, suggests a spirit of taboo. Indeed, such discussions have a pejo-
rative label (waidan, filthy of smutty talk), and there are sanctions
against displaying undue interest or preoccupation in sexual matters;
the man who initiates discussion of sexual topics runs the risk of being
stigmatized as no-account or shiftless (roku de mo nai). Hongo-
san (aged 45, mother of one son aged 9) explained:
Talking about this is a bit strange . . . especially if you ask a woman.
Why is that so?

Talking about sex, male genitals, and things like that are usually mens
conversations . . . This is maybe an old way of thinking, but . . . I dont
think that women want to talk about this . . .
But circumcision is a medical procedure, isnt it?

Yes it is, but it involves the genitals . . . talking about this is usually like
mens conversation.
Usually mens conversations? What do you mean?

Hmm . . . I dont know. I got the impression that when men get
together, they usually talk about sex and things like that; it is just a
common thing. At least that used to happen when I was younger.
Do you think that things are different now?

It could be, but I am not sure . . .
So do you think that because things are changing, younger women

can talk about circumcision?
I am not sure.
Some of the mothers explained that conversations on circumcision

and male genitalia are most likely done by the Otherthat is, guys
popularly identified as akiba kei (a term referring to otaku, who are
men with obsessive interests), implying that men showing and/
or voicing an open concern about sex and genitalia are most likely
framed within socially pathological discourses of youth [that con-
vey] the image of . . . a sexually promiscuous and potentially criminal
group (Toivonen and Imoto 2012, 15). Women openly discussing
sex and circumcision is almost unthinkable, as Iijima-san (aged 47,
mother of two sons aged 13 and 15) expressed:
Let me think . . . I would only think of guys obsessed about sex . . .
Who are these obsessed guys?

I dont think there is one particular group right now, but it could be
guys similar to the so-called akiba kei who are obsessed about games
and stuff . . .
Games? Could you please explain?

Yes, guys who talk about this [circumcision] makes me think of that
kind of guys who are a bit weird (kawatta hito) and are obsessed
about their genitals.
But circumcision is a medical procedure, could it be that they are

concerned about health?
Health? Hmm . . . I dont think so, hmm . . . maybe if they get sick,
but you know . . . if you get sick you go and see a doctor, . . . you dont
talk about it . . . I am not sure . . . hmm . . . it could be also because the
image we have in Japan about the surgery comes mainly from the ads
produced by the cosmetic industry . . . I dont know.
What are those ads?

Ads mainly produced by cosmetic clinics, you might not have seen
them, and you might not know, but in Japan, this kind of surgery is
mainly done at cosmetic clinics . . . It is actually a cosmetic surgery . . .
that is why. I dont know, it is for guys who are a bit too obsessed about
Mothers Views 157
their penis and want to have it changed . . . that is why they want to
talk about this, maybe.
What about women? Do you think women talk about this?

Hmm . . . I dont think that women can engage in this kind of conver-
sation at all . . . I am not sure though . . . these days, things are chang-
ing very fast, and younger women might talk about this . . . I am not
sure though . . . but that is my impression.
My conversations with this group of mothers largely confirmed that

the cultural dimension underpinning circumcision makes it difficult to
have an open discussion about the surgery. Nonetheless, some of the
mothers were forced to know and speak about pediatric circumcision
in order to deal with penile infections of their sons.
P enil e I nf ec tio ns
Different from the interactions with men and women introduced in
Chapters 3 and 4, for some of the mothers in this group, learning
about pediatric circumcision was linked to penile hygiene and was a
dramatic experience when their sons grappled with genital infections. In
retrospect, the experiences meant a combination of sorrow, irritation,
despair, and shame because the mothers tended to blame themselves.
Similar to the results of the research presented by Borovoy (2005, 169
70), the majority of the mothers in this group felt always ultimately
held accountable for their childrens behavior, an there is little agree-
ment on where (if at all) women should draw the line in what they are
willing to do for their children . . . The child-centric model of the fam-
ily continues to predominate, even as women give birth to fewer and
fewer children on average. Some of the mothers in the group angrily
lamented their poor formal and informal education because they did
not receive accurate information on sexuality and nothing about penile
hygiene. For most of them, however, the biggest barrier was their own
gender assumptions that make conversations on genitalia unfeminine.
Abe-san (aged 37, mother of one son aged 10) stated:
It was very sad and embarrassing because my son got an infection

there [the penis]. It was very red and I did not know what to do . . .
Embarrassing? Why? Your son was sick.

I dont know, but I felt somehow that it was because of me . . . because
I was not taking care of him in the right way . . . At the end of the day,
he is my son . . . It was somehow my fault that he got sick because I did

not know how to prevent the problem . . . I did not know and did not
get the right information.
What do you mean, what information is that?

I mean, as a woman, you never get information about that, and you
do not know that you might need it . . . When you are young, you talk
about that with your girl friends, . . . but it is never serious, it is more
like gossiping . . . rather than learning about the male sexual organ . . .
You dont want really to talk about that . . . I mean not in a serious way.
Why not?
I am not sure, but somehow asking about that is unwomanly
(onnarashikunai) . . .
What do you mean?

I mean talking about sex and genitals and things like that is not really a
topic of conversation for women.
Really?
Hmm . . . things could be changing . . . and younger women might talk
about sex and things like that, but it is not unusual that people still look
coldly on you (shiroi me de mirareru) if you show an open interest
about sex and want to talk about that . . . Women might talk about sex
but not in a serious way, not in the way that you would like to . . .
What is that way?

Truly informative . . . only when you become a mother, because at the
end of the day, your son is your own responsibility, you see how impor-
tant it is to know about that . . . I was a bit angry too . . . even if you
get some sex education it is always very superficial.
The cultural dimension underpinning penile-related concerns makes

it difficult for mothers to know about them. Not only do gender
assumptions seriously constrain access to information, but available
sources also seem largely inadequate. The media appears mostly unre-
liable because the cosmetic industry takes up almost all the means
of information to promote circumcision as a cosmetic procedure for
adult males, which largely neglects issues of penile hygiene and barely
includes anything related to children. Although the mothers acknowl-
edged that medical personnel were the best source of information,
pediatricians and nurses were reported as largely unfriendly because
their attitude was rather accusativethat is, mothers felt blamed
Mothers Views 159
because they did not look for information on genital hygiene. Murata-
san (aged 41, mother of one son aged 11) explained:
I am not sure if I should be talking about this because it was one of the
worst experiences in my life. I felt so hopeless and helpless.
Why did you feel like that?

Because my son got an infection and I got desperate . . . his penis was
badly infected.
What did you do?

First, I did not know what to do and thought that it was really a minor
thing, but . . . after a week or so, things went bad and worse . . . He
got some fever and then took him to the hospital . . . It was like an
emergency, but things there got a bit uncomfortable.
What do you mean?

I felt like the nurse was putting the blame on me . . . as if she was accus-
ing me because I didnt know, because I did not act promptly and let
things go that bad, . . . but honestly, I did not know what to do . . . I
looked it up and could not find much information . . .
Where did you look at?

I dont quite remember . . . it was maybe the Internet . . .
What kind of sites did you find?

Let me see . . . I think that I was looking for something related to how
to clean the penis . . . and for some reason, I found all those sites on
circumcision, but they are not really for mothers like me. Most of the
information is for adults. I did not find anything useful.
Did you tell the nurse what you did?

I dont remember.
Do you think that she was really putting the blame on you?
That is what I felt . . . it could be maybe that I was a bit too stressed,
but still it is a very bad memory.
Some of the narratives appear similar to cases reported in the literature:

Women use pronouns and evasive expressions when discussing sexual
topics . . . When combined with the Japanese languages potential for
ambiguity, this tendency makes it very difficult for women to describe
their problems . . . one doctor candidly reported that when he has to
ask his patients to be more specific they sometimes become flustered

or even indignant (Coleman 1983, 157). Discomfit appears cultur-
ally rooted and related to parental concerns about the male body.
Osman and Batley (2006, 281) report that a core issue concerning the
diagnosis of pediatric cases of buried penis is the attitudes of parents
unwilling and/or feeling uncomfortable discussing their worries with
medics because of stigma associated with penis size. Nonetheless,
some of the mothers insisted that physicians appeared rather inter-
rogative (shiritagaru) when talking about genitalia, as Makidai-san
(aged 45, mother of one son aged 14) elaborated:
In my experience, it was a complete lack of information . . .
What kind of information were you looking for?

Something accurate and clear that explicitly showed how to take care
of my sons willie.
Where did you look for it?

Well . . . I am not sure, but I think it was basically the Internet, but the
information there is mostly for adults.
What did you do then?

Well, at the end of the day, you know that if your son has an infection,
a doctor needs to see him. I went to the hospital, but it was really
odd . . . the environment at the hospital was odd . . .
What do you mean?

They do not really want to talk about the genitals . . . and tend to put
the blame on you because you dont ask . . . it was my first son, and [I]
did not even think of asking . . .
How did you learn about penile hygiene then?

I had to summon up the courage to ask, but then the doctor wanted to
know about my husband . . .
About your husband? Why?

I dont remember exactly what that was, but I felt that the doctor was
a bit interrogative (shiritagaru) . . .
What do you mean?

I felt like he wanted to know about my private life and my husbands
willie . . . He kind of implied that married women know about the
thing . . .
Mothers Views 161
What was that thing?

I dont know . . . I think he implied that because you have had sex you
know about how to clean a willie . . . I am not sure . . . anyway, I felt
very uncomfortable.

I dont remember how the consultation finished, but in the end, a
nurse instructed me on how to clean my sons willie.
In dealing with issues of penile hygiene, my interview transcripts largely

suggested that Yamamoto, Holloway, and Suzuki (2009) were rather
accurate when they said that the fact that many women do not receive
sufficient support from their husbands . . . they tend to depend on other
social networks, and friends support becomes particularly influential. It
has been found that Japanese mothers tend to seek information and
support from within their circle of female friends, and that friends are
the most frequently identified consultant. Similar to my conversations
with the young women, this group of mothers implied the salience of
homosociality in understanding the interpersonal dimension underpin-
ning issues concerning childrens penile hygiene. Conversations with
peers most likely created an environment where mothers could clear
their doubts, and most of the mothers learned how to bath a baby,
change diapers, and clean the babys genitals through other mothers, as
Kariya-san (aged 46, mother of one son aged 7) explained:
Hmm . . . now that you are asking this, I can tell you, my friends have
been a great support . . . I think that I could take care of my baby
because of their support.
Who are these friends?

Mainly mothers like me who had a baby and did not know what to do.
What kind of support did they offer?

Well, it was almost everything, from how to deal with rashes, mild
fevers, and change diapers.
What about penile hygiene?

Hmm . . . yes, actually one of them was of great help when my son got
a small infection there.
What about your husband?

My husband was posted away from us in Osaka . . . but even if he had
been around, I dont think I could have talked about this to him.
Why not?
I dont know, there is this kind of thing . . . It is like getting used to . . .
It is easier to talk about this kind of things with my friends. Also, I felt
somehow that children are mainly my responsibility . . . like I dont
want to bother him with this stuff . . . I dont know . . . also, men are
too busy working to pay attention to this kind of thing. Anyway, it was
not a serious thing and everything was solved . . . Talking about this
kind of thing with your friends is easier because some of them have
experienced similar things . . . and because they are mothers and under-
stand you better, I feel . . .
Very few of the interviewees had their own mothers providing instruc-
tions on penile hygiene because extended families have become rare, and
none of them reported their own husband as a source of information as
well. Common among the mothers whose children suffered penile infec-
tions was the lack of friends to support them; nevertheless, none of them
had their sons circumcised because female nurses trained them in genital
hygiene. Furthermore, my interview analysis suggested a contradictory
feminization surrounding male genitaliathat is, women are expected to
be ignorant about sex and male genitals, while being experts at dealing
with penile cleanliness. In reflecting about her experience dealing with
penile infections, Urawa-san (aged 31, mother of one son aged 6) said:
This is a kind of odd common sense.
What is that common sense?

Nobody really teaches but . . . you are supposed to know how to deal
with the willie of your son.
Why do you think nobody teaches you?

I dont know . . . it is maybe this big taboo that talking about the
genitals in Japan is. It seems to me that there is no place to clear your
doubts . . . especially if you are a woman.
Why is that so?

I do not know . . . it is still difficult for women to speak openly about sex
and things like that. It is somehow easier if you talk about it with friends,
or maybe to your mother. When this thing happened, my mother did not
live nearby, and I did not have other mothers around to look for advice.
What about your husband?

I dont know . . . it is maybe me, but I did not feel like talking to
him . . . It is just like something that you are not used to. Something
Mothers Views 163
like he is working to bring in money, so I have to take care of

my son.
But he also got a penis, he could have helped you, dont you think?
Hmm . . . maybe, I dont know . . . Anyway, I was so desperate . . .
the infection got really serious . . . you know that it is a very sensitive
part . . . really dont want to touch it.

I took him to the hospital, and only after a round of antibiotics and the
help of a female nurse the problem was solved.
What did she do?

She taught me how to roll back the skin to clean the penis . . . some-
how . . . everything seems to be in the hands of women.
My conversations with this group of mothers clearly illustrated the social

and cultural conundrum that penile hygiene represents. The difficulties
this group of mothers faced could be linked to the pervasive influence
of the script that has placed womens sexuality . . . as a social prob-
lem . . . young women should remain innocentin other words igno-
rant (Jackson 1999, 147). One possible consequence of such ignorance
becomes apparent when as mothers, women have to deal with the genital
health of their sons. In the event, some of them might think it feasible
that removing the foreskin of the newborn baby is a potential solution.
Bet ter Cut?

The Japanese word for early training and childrearing is shitsuke,
whichalthough usually written in phonetic scriptcan be expressed
by a Chinese character that has an earlier meaning of the beauty of the
body (Hendry 1986, 11). Holloway (2010, 12223) documents the
social changes during the postwar period and acknowledges that since
that time, children spent increasing long hours at school and fathers
spent increasingly long hours in distant office buildings, there were
fewer opportunities for interaction between father and child. Mothers,
conversely, were excluded from activities other than those connected
to the home. The result of these changes was that mothers became
the only consistent source of shitsuke in the lives of young children.
Goldstein-Gidoni (2012, 88), in her research with housewives of Japan,
implies that the early training of young boys is still mainly womens
responsibility because [a]lthough there has recently been some kind of
mainly media attention to the possibility of househusbands in reality

it is still very rare for Japanese men to become stay-at-home-dads. In
this light, mothers are supposed to help beautify the bodies of their
children. Nonetheless, the notion does not seem to include the genital
area. Most of the mothers expressed reservation in manipulating the
penis of their children to clean it, and to avoid infections, their main
strategy was to change their diapers regularly. As Morita-san (aged 39,
mother of one son aged 9) put it:
That was a very difficult thing.
What was that?

Avoiding infections in the willie of my son.
Why was that difficult?

You really dont know what to do, you dont really want to touch it,
you dont know how to clean it, but still you need to be aware that if
pee remains there, it might cause infections.
What did you do to avoid infections?

The best way to do that is to check that the baby is dry.
What do you mean?

I mean, you have to change his diaper regularly so he is always dry.
Where did you learn that?

I am not sure, but I think that we talked about that once with my friends.
I see, but when you bathed him you clean his penis, didnt you?
Yes, somehow you clean it, but you never know if it is really clean,
because the skin is tightly attached to the penis, and honestly, you dont
want to touch it.
What do you mean?

Hmm . . . I dont know . . . It is kind of weird . . . You dont really
want to touch it.
Why not?
I dont know . . . It is just like this.
Did he have any infection, anyway?

No, not really. I was lucky. I have heard that it is not uncommon that
baby boys get infections there, though.
Mothers Views 165
However, when their children started to bathe by themselves, super-

vising penile hygiene became an issue. Teaching genital hygiene is
gendered and because fathers are incompetent to instruct their
daughters on menarche and the use of sanitary napkins, mothers are
practically unable to deal with the embarrassment of teaching or
supervising their sons penile hygiene. Such embarrassment underpin-
ning the act of cleaning the penis, as Gagnon and Simon (2005, 27)
elaborate, does not derive from anything that resembles sexual plea-
sure, but from the mysterious and unnamed qualities that are ascribed
to the behavior by the adult world. Murata-san (aged 41, mother of
one son aged 11) reported:
Now that I am saying this . . . I really dont know why anything related
to the genitals is so difficult to handle.
Difficult to handle?
Yes, it is something that nobody wants to talk about . . . and of course,
it is more difficult in the case of boys, as you have to teach them how
to clean there.
Why is that so?

I dont know, but when cleaning the willie, you are always in doubt
about touching . . . I guess you do not really touch it . . . You
are just careful about changing diapers regularly . . . [The] prob-
lem is when your son grows up and you have to teach him how to
bathe . . .
A problem? What do you mean?

Teaching them how to clean there [the genitals] is also part of early
training, but it is not easy.
Why is it not easy?

You never really know if it is really clean . . . They do not let you touch
it, and you dont feel it is correct to touch it either . . .
Why is it so?
I think it is a matter of privacy.
Who should teach them how to clean then?

I guess that is a fathers obligation . . . it is just like instructing girls
about their periods and the use of tampons . . . mothers have to do
that . . . maybe.
Did your mother teach you how to use tampons?

Hmm . . . I dont clearly remember, but something makes me think that
we had a kind of conversation about that because my period started . . .
I am not sure.
So who taught your son about how to clean his penis?

I dont know . . . I think my husband did . . . I am not sure, we never
talked about that.
Learning about genital hygiene appeared completely gendered and

extremely difficult to monitor. Mothers are meant to perform a deci-
sive role to inform their daughters of the dangers of sexuality and the
possibility of menstruation (Gagnon and Simon 2005, 29). How-
ever, mothers duties do not end there, as they might need to engage
in the early training of their young sons as well. None of the mothers
were clear about the medical reasons underpinning circumcision and
the idea that the surgery is a cosmetic procedure was recurrently men-
tioned to imply that it is not required because even penile infections
can be tackled without circumcision. However, some of the mothers
suggested that circumcision could help deal with the mortification of
having to instruct and/or supervise genital hygiene of young boys, as
Takao-san (aged 41, mother of one son aged 9) elaborated:
It is clear in my mind that circumcision is not needed. My son is already

nine years old, and he has never had any problem there. My problem
was to teach him how to clean there.
Why was that a problem?

Because once he started taking baths alone, I had to ask him if he had
cleaned there . . . I felt like a bit embarrassed and he was too.
Why did you feel embarrassed?

I dont know it is difficult to explain . . . It is just like this, I guess. That
is why sometimes I thought that if they did not have the skin covering
it, you could clearly see if the thing is clean . . . I dont know . . . It is
just an idea.
Is your son circumcised?

No, of course not . . . but now . . . that I am talking to you, I think that
it could be a good idea.
Are you saying that it is better to circumcise boys?

No, not really, but if they dont have the skin they can have the thing clean.
Mothers Views 167
So your son does not have it cleaned?

I dont think so.
In teaching penile hygiene, none of the mothers suggested that

school-based education could be helpful and despite acknowledging
that fathers should be the instructors, the mothers were unable to
confirm that it happened. Official campaigns calling for the involve-
ment of fathers in childrearing exist (Roberts 2002), but it is uncom-
mon for children to go to their fathers for life advice (Kawanishi
2009, 81). As the men introduced in Chapter 3 suggested that taking
baths together with a father could be instrumental in learning about
penile hygiene, I explored the sociality of taking baths with this group
of mothers too. Indeed, the mothers in this study highlighted that
fathers bathing with their children has become rather unusual, which
leaves issues of penile hygiene largely a maternal responsibility. As
Kishi-san (aged 38, mother of two sons aged 4 and 7) uttered:
It was really harsh.
What was harsh?

I dont know, after the bad experiences dealing with the infections of
my elder son and after talking to you, I guess that having them circum-
cised could be the easiest way to get rid of infections.
But did your second son get any infection?

No, he didnt because I was extremely careful.
What did you do?

Well, cleaning his penis very carefully and changing his diapers almost
immediately after he got wet. The problem starts when they grew up
and start taking baths by themselves.
Why was that a problem?

Checking if the thing is clean or not is a problem . . . If they are circum-
cised, you dont have to worry about explaining how to clean there . . .
It is really embarrassing, especially when they grow up.
What about asking your husband?

He is always busy working. I dont know . . . also, this was really embar-
rassing, and I did not feel like talking about this.
Why not?
I dont know, things are just like this. I guess it is pretty much that
mothers have to deal with all this alone.
But did you have them circumcised?

No, I did not.
Why not?
Because it was not really needed, . . . it is just a bit uncomfortable deal-
ing with this, but in the end, circumcision was not really needed.
Did you think of having your sons circumcised?

No, not really.
As Tokuhiro (2010, 73) suggests, Not only men but also women
strongly adhere to, or are pressured into, the idea that mothers should
be the ones to raise their children and this limits their behavior. In
exploring the rationale underlying pediatric circumcision, my interview
transcripts showed that rather than medical reasoning, the social aspects
of circumcision were critical in deterring the mothers from having their
children circumcised. The participants highlighted the relevance of com-
munal baths and hot springs being still deeply ingrained in the socializa-
tion of Japanese children. This means that circumcised boys could endure
exclusion and stigmatization if their peers realized that their genitals look
differenteven though most children are uncircumcised anyway. Con-
trary to publicity suggesting that circumcision helps boost masculinity and
improves male sexual performance, the mothers indicated that ostracizing
children because their genitals look different could lead to psychological
trauma, feelings of emasculation, and poor sexual performance later in
life, as Nakanishi-san (aged 30, mother of one son aged 10) expressed:
No, I dont think it a good idea to have them circumcised.
Why?
I dont see any medical benefit.
What do you mean?

Hmm . . . it is pretty simple. My son is already ten years old, and he has
not had any problem there. I know that some mothers have struggled
with infections in their sons willies and things like that but not me. So
I dont think it is really needed, whats more, if you have your son oper-
ated on, that might create more problems.
What do you mean?

You know that in Japan, communal baths are very common, and most
children are uncut. Circumcision is very unusual in Japan, and being
cut will lead to bullying (ijime).
Mothers Views 169
Why bullying?
Because his willie looks different.
I have seen some newspaper articles saying that Japanese mothers

want to have their sons circumcised, what do you think?
I have not seen anything like that. Whats more, I have not met any
mother willing to have her son circumcised.
Also, the ads say that being circumcised brings men confidence,
what do you think?
Hmm . . . I dont know, but something makes thing that that kind of
stuff is said only to sell the surgery . . . to convince men that they need
to be circumcised . . .
What do you mean?

Well, circumcision is basically a cosmetic surgery, so doctors need to
find a reason to sell it, I think. I do not think that men need that. It is
because of the ads that men end up thinking that they need that, whats
more, if boys were bullied because their willie looks different, because
they are different from other children, that might cause a trauma.
Why a trauma?
Yes, if they feel excluded, that might cause sexual problems when they
grow up. I dont know, but you know that bullying is very common in
Japan and children are sometimes looking for an excuse to bully each
other. I think that having a willie that looks different is the perfect
excuse to bully and exclude someone.
Would you say that exclusion is a major reason?

Yes, I think so.
This reflects Hidakas (2010) discussion of the case of a young boy

who felt embarrassed when taking baths on a school trip because of
being different from others. Moreover, the reasoning this group of
women offered to avoid circumcision does not seem particular to
Japan. Empirical evidence from the United Statesa country with a
long history of enforcing routine circumcisionshows that parents
decision-making processes to have their sons circumcised are largely
underpinned by emotional and social factors: [F]ear that their son
will not be socially accepted, a social concern; or fear that he will
get a disease or infection, a medical concern (Goldman 1997, 43).
Deciding to have a baby boy circumcised appears also largely in the
hands of pediatricians because most parents in the United States tend
to defer to medical authority (Goldman 1997, 46). Nonetheless, a

stronger motive to enforce neonatal circumcision appears absolutely
social and deep-rooted in tradition because parents most likely want
the baby [to] look like his father, brothers, and friends (Goldman
1997, 64). In this light, Japanese and American parents might reject
or accept pediatric circumcision, respectively, because of social con-
formity and fear their sons will become the Other. Any salutogenic
reasoning appears sidelined. The circumstances of parents in Japan
and South Korea could not be that different either. Although the
current circumcision rate for South Korean high-school boys is more
than 90 percent, this does not necessarily mean that parents are well
informed and opt to have them circumcised because of medical rea-
sons (Pang and Kim 2002): [C]ommon beliefs held by parents about
the prepuce or circumcision differ significantly from current medical
knowledge, and these beliefs have a major influence on the practice of
circumcision in Korea (Oh et al. 2002, 426).
Co nc lusio n
Current debates on pediatric circumcision reveal polarized views
that is, supporters who see in the surgery a longer-term prevention
strategy, including HIV contagion, versus opponents who promote
penile hygiene as a rather effective prophylactic method. My interview
transcripts with this group of mothers, however, implied that both
viewpoints could be neglecting the sociality (Jackson and Scott
2010b) beneath male genitalia and produce unrealizable expectations.
My interviews with these mothers shed a critical light on the cultural,
interpersonal, and intrapsychic dimensions underpinning pediatric cir-
cumcision and penile hygiene.
My interview transcripts highlighted that sources of informa-
tion concerning young boys genitalia, hygiene, and circumcision
are largely restricted to Japanese mothers peers because of a cos-
metic industry engaged in the commercialization of circumcision, an
unfriendly environment at medical facilities, and the legacy of a poorly
developed school- and/or home-based sex education that tends to
enforce the script suggesting that sexual knowledge is unfeminine.
The trials and tribulations of some of the mothers in dealing with
their sons penile infections indicate the power of the ideology
enforced by social structuresthat largely prevents mothers from
developing any form of critical conscious awareness (Ramazano-
glu 1989, 140) that allows them to question the commonsensical
norm that assigns women full responsibility for childrearing and early
Mothers Views 171
training. My interview analysis suggested that the feminization of

young boys penile hygiene contradicts social imagery concerning
femininity because women are meant to be ignorant about mens
genitalia but fully responsible for penile hygiene as mothers.
Concerning the intrapsychic dimension underpinning circumcision
and penile hygiene, the mothers prioritized penile hygiene over cir-
cumcision. Nevertheless, the reasoning behind their decision appears
far removed from the realm of medicine, which makes circumcision
like a double-edged sword: while the medical procedure appears
effective to prevent penile infections and skips the difficulties of
training and supervising genital cleaning of young boys, it is inef-
fective because circumcised boys could be discriminated against in a
society where circumcision is not the norm. Similar to Korean parents,
peer pressure seems to be the most influential factor in deciding upon
circumcision (Oh et al. 2002, 426) rather than health concerns.
Lastly, since none of the mothers have had their sons circumcised
even in the case of penile infectionsthe outcomes of the interviews
suggested that pediatric circumcision could be redundant and, in line
with Kayaba et al. (1996, 1814), poor genital hygiene is rather the
cause of infections than the unretractability of the prepuce.
4
Conclusion
T he social history of circumcision indicates that unresolved con-

troversies surrounding the surgery have always served as fodder for
skepticism. The controversies are largely the result of a practice that
can be justified in cultural, religious, and/or medical terms but have
serious social and political implications. Removing the prepuce is thus
a procedure that has always had an impact on the male body and the
social body at large.
Its origin can be traced back as early as 2400 BC in Egypt. Histori-
cal records indicate that the procedure could have been established
as a prophylactic measure to eliminate the risk of disease caused by
the accumulation of the sebaceous secretion in the fold of the mans
foreskin known as smegma. Removing the foreskin was most likely a
practical response to the lack of functional bathrooms, regular bath-
ing, soap and water [. . . to] ensure good hygiene (Renshaw 2006,
283). Given that anesthesia was not invented yet, the practice could
have also been part of a rite of passage for young boys and maybe a
marker of social ascendency among adult men.
The procedure, however, has largely remained alive until the
present day as part of the religious bodies of Islam and Judaism. Cir-
cumcising young boys is indeed a matter of faith with political and
social repercussions. Not only is the surgery an integral element in the
construction of the male subject for Jewish and Muslim communities,
but it is also a relevant factor in the foundation of a state, as it could
be the case of Israel, and an element that facilitates social cohesion
namely, a brotherhood of Muslim nations or a mechanism that helps
justify social exclusion/inclusion, as could be the case for adult men
who are circumcised as a sign of religious conversion.
While the cohesive power of the surgical procedure as an act of

faith is apparent, it does not necessarily mean that views among Jew-
ish and Muslim communities are uniform. Conservative tendencies
largely contend that the practice is vitally important for consolidating
religious community ties as well as a measure that prevents disease.
Liberals tend to emphasize that the procedure ought to be prohibited
because it most likely entails a conspicuously old-fashioned ritual
similar to barbaric tribal fertility ceremonies. In any case, circumci-
sion is so ingrained in the religious frame of reference that any form
of criticism appears futile. Furthermore, preserving the tradition has
largely helped set the grounding of a patriarchal regime of practice
grounded in religion.
The medicalization of the prepuce has also played a critical role
in the continuation of the practice and its current social visibility.
Although evidence to sustain the salutogenic benefits of circumcision
has never existed, the malignant effects of smegma have been repeat-
edly used to support the validity of routine pediatric circumcision.
Historical data suggests, however, that routinization could have been
socially rather than medically motivated. Routine circumcision could
have resulted from a civilizing process (Elias 1994) and the pro-
motion of bourgeois respectability, resulting in the enforcement of
manners and habits to hide body fluids. All fluids were considered
unhygienic except tears, and smegma became one of these unde-
sired secretions that could be eradicated by cutting off the foreskin.
Moral uneasiness has also been seen as major reason to enforce a prac-
tice that could prevent the vice of male masturbation.
The medicalization of childbirth has also been thought of as a
reason to substantiate routine pediatric circumcision. In the United
States, for instance, where the procedure has been thoroughly
endorsed, issues of hygiene together with parental social class aspira-
tions could have weighed in favor of opting to have a newborn baby
circumcised. An uncircumcised boy might have indicated that his par-
ents were most likely uneducated and at the margins of respectable
society (Gollaher 2000, 108). Being uncircumcised could be a sign
of backwardness, and thus the idea that removing the foreskin is a
symbol of civilization could be underpinning newborn and children
circumcision despite efforts to enforce the practice as a prophylactic
measure.
Nowadays, the procedure still appears mired in irreconcilable
debates. Supporters insist that circumcision helps fight against the
pernicious effect of smegma, which could be linked to the propaga-
tion of genital cancers. The surgery could also help prevent sexually
Conclusion 175
transmitted infections (STIs) and protect men against HIV infection

in the context of heterosexual intercourse. As such, circumcising chil-
dren as well as adult men should be thoroughly enforced and should
be a medical priority because it works like a surgical vaccine (Mor-
ris 2007, 1147). Contenders, on the other hand, refute any form of
circumcision, challenge any form of knowledge used to justify the
practice, and call for an evaluation of the [e]thics of circumcision as
an intervention (Bonner 2001, 151), which is deemed a mutilation
of the male body and a violation of human rights. Stronger criticism
is particularly directed to advocacy in relation to HIV/AIDS because
being circumcised might create a false sense of safeness that could
cause men to neglect other means of protection as well as increase
womens vulnerability to acquiring STIs, including HIV, because cir-
cumcision does not appear to have any impact on transmission rates
from HIV positive men to their partners (Bonner 2001, 152). Con-
tenders also highlight tinges of neocolonialism because campaigns
to promote adult circumcision are largely concerned with African
populations. Furthermore, the fact that circumcision appears chiefly a
strategy to prevent men from acquiring HIV in the context of vaginal
penetration has ignited further controversy.
Japanese C irc umc ision

Returning to my original question, the social reality of Japan largely
stands against the medical paradigm underpinning circumcision and
offers a different angle on the debate. Religious circumcision does
not exist, and prophylaxis can hardly become a tenet to support the
practice. Circumcising newborn babies has never been medically rou-
tine, and despite most Japanese men being uncircumcised, HIV infec-
tion ratesthough increasingare comparatively lower in relation to
other industrialized nations. In addition, adult circumcision is largely
commercialized as cosmetic surgery, which renders the construct of
medicalization largely insufficient in explaining the Japanese case. The
concept of biomedicalization instead sheds some critical light on the
social process underneath a surgical procedure that is included in a
package of surgeries that promise penile improvements. Following
Foucault (1988), removing the foreskin in Japanese settings becomes
a technology of the self that operates in the body and the soul of
men. Not only does circumcision make the penis appear longer and
maybe prettier, but it can also equally help repair the gendered
self of Japanese men as well as enhance their sexual performance.
Against this background, I have proposed a theorizing of circum-

cision in Japan that requires a reading of the surgery from a gender,
sexual, cultural, and medical viewpoint. In the attempt, the construct
of script (Gagnon and Simon 2005) unraveled the interpersonal, intra-
psychic, structural, and cultural dimensions underpinning the sociality
and symbolism of a surgery that is meant to be a minor operation on a
major organ. Investigating the social processes supporting the surgical
procedure also cast some critical light on the everyday life interactions
and learning process supporting the social construction of the sexual
and gendered body in current Japan.
The symbolism of Japanese circumcision largely revolves around
scripts implying that the genitals are almost the most significant part
of the body and that the sexual largely originates in the genital area.
These scripts become real when looking, for instance, at the earliest
forms of parental sex education that largely entails a set of warnings
chiefly directed to kill childrens curiosity and interest in the geni-
tals. Children learn very early in their lives that the genital area is an
untouchable and unspeakable part of the body. Within an atmosphere
of remorse and guilt, they learn to keep secret any information, as
well as using innuendo and euphemisms to refer to the genitals. This
scripting could be clearly seen in the daily lives and social interactions
of Japanese people. In spite of religious and popular festivals, as well
as the huge pornography and prostitution industries conveying the
idea that Japan is a sexually unrestrained and liberal society, the
so-called civilized morality (Allison 1996, Pflugfelder 1999) pervades
common sense and Japanese people are unwilling and/or unable to
engage in conversations concerning the sexual and the genitals. Allu-
sive and oblique remarks as well as polite terms are common to refer
to the sexual, and censorship and guilt make talking about circumci-
sion very problematic.
I have centered the review of the ways the sexual and gendered
self has been constructed in Japan on the well-known theories of the
Japanese, which encompasses a master narrative that presents men
and women within a patriarchal regime of practice. While the gen-
dered selves of men and women are largely concerned with the roles
of breadwinner and housewife, respectively, their sexual selves most
likely revolve around reproduction and the preservation of the house-
hold name through patrilineality. However, such a narrative appears
insufficient in explaining the current social reality. Patriarchy seems to
be cracking. While men appear unwilling to become a breadwinner
and maybe asexual, homemaking and reproduction are unappealing
to women. The new master narrative, which is key to understanding
Conclusion 177
the sociality of circumcision, entails the image of the so-called fail-

ing men in opposition to the sexually active women. As the media
suggests, Women [are] showing greater openness about sensuality
(The Asahi Shimbun 2013).
My iconographic and textual analysis of the images and informa-
tion produced to commercialize adult circumcision suggested that
the surgical procedure is most likely for failing men or for men
who lack confidence and have low self-esteem. The narrative implies
that these psychological matters stem from dissatisfaction with their
penis, the most important part of their body. Such dissatisfaction is
largely expressed as sexual failure and cosmetic surgeons suggest that
erectile dysfunction (ED) and premature ejaculation (PE) are con-
crete examples of this. The beauty and aesthetic industry thus offers
circumcision as a procedure that could help palliate ED and PE, two
major diseases affecting Japanese men at the present time.
Therefore, the cultural and structural dimensions underpinning the
circumcision of adult men encompass a new form of sociobiology
that locates the male gendered and sexual self on the shape and size of
the prepuce. The narrative mirrors a penilized male self that permits
a reading of the relationship between power and gender because a
circumcised man largely represents a form of hegemonic masculinity
that allows domination and subordination of uncircumcised men and
women. Cosmetic surgeons largely promote circumcision as a remedy
for ED and PE as well as a biomedical strategy to improve the well-
being of heterosexual couples. A circumcised penis entails a promise
of longer-lasting intercourse, which is allegedly a guarantee of
female sexual satisfaction. Circumcision, therefore, meets the needs of
sexually active women. In this sense, the minor surgery could be seen
as an index of sexual and cultural change in contemporary Japan.
Th e S o c ial ity o f Circ um ci si on

The intrapsychic and interpersonal dimensions underneath circum-
cision from the vantage point of my interviews with Japanese men
showed that the commodification of the prepuce largely relies on lin-
guistic nuances and ambiguity. This makes it difficult to understand
what exactly the surgery entails and places the practice within the lim-
its of civilized morality and a sexual culture of silence and pretense.
Their reflections on the tradition of taking communal baths allowed
me a reading of the relevance of genitalia in relation to the male body,
as well as the sociality underpinning the foreskin and penile hygiene.
The group of male interviewees opposed, in principle, the idea of

the penilized male self and suggested that only ignorant or sexually
inexperienced pubescent and young men would believe in the bio-
medicalization of the procedurein other words, the transformative
power of circumcision. Nonetheless, circumcision is a pricey surgery
inaccessible to young men without a regular income. Furthermore,
the habit known as miemuki, which refers to men pulling back the
prepuce to make the penile glans visible before entering a bath, could
indicate a general concern about the foreskin among men regardless
of age. This might mean that almost every man could be tempted to
get circumcised. My conversations with the homosexual men in the
group, on the other hand, showed how heterogender underpins the
commercialization of the procedure as well as the sexual significance
of having the prepuce removed in the context of nonheterosexual
intercourse. The interviews did not show any reference to the health
benefits of the surgery, however.
My encounters with the group of young women offered a fresh
insight into the intrapsychic and interpersonal dimensions supporting
a surgical procedure that is largely to enhance their sexual well-being.
Talking about an operation that is predominantly a cosmetic surgery
for adult men, however, meant a formidable challenge because the
topic of conversation appeared to be not health-related matters but
penis size, which seemed rather unfeminine. Nonetheless, it did not
mean that the young women were completely uninformed. Joking
was a recurrent form of indirect communication, which through
homosocial relationships, allowed the group of young women to gain
knowledge while protecting their sexual reputation. Their problem
was, however, to produce a form of common sense to filter informa-
tion and identify reliable sources.
Despite all the young women having initiated their sexual lives,
they said they had never seen a circumcised man. Hence my interview
transcripts did not provide any evidence to sustain the link between
circumcision and female sexual satisfaction. In addition, the relation-
ship between prophylaxis and circumcision remained unproven. At
least for this group of young women, the idea that [m]ost women
prefer the circumcised penis for appearance, hygiene and sex (Morris
2007, 1147) did not apply. The ways some of the women appropriated
the language of circumcision to express sexual needs and complaints
was intriguing, however. Since few studies have explicitly reported a
female gaze on circumcision (Kelly et al. 2013), it is totally relevant
to further investigate how the circumcised penis influences womens
sexual pleasure as well as their views on STIs, including HIV.
Conclusion 179
My analysis of interviews with the group of urologists and cos-

metic surgeons vividly mirrored the polarized views on the surgery.
The urologists condemned a practice that commodifies the male
body and sidelines genital hygiene. They emphasized that the prepuce
should never be removed and largely relied on the role of the so-called
informed parent, which would lead to [a]wareness and practice of
cleanliness, [because] [t]he fresh surgical wound of circumcision is
a deliberately imposed risk where education is absent and hygiene
neglected (Renshaw 2006, 283). For these urologists, the interper-
sonal dimension underpinning circumcision was chiefly expressed in
terms of the relationship between physicians and parents, who were
most likely placed in a vacuum and decided rationally on the health
and well-being of their children.
The group of cosmetic surgeons, on the other hand, insisted on
the power of a surgical procedure that transforms the gendered and
sexual self of Japanese men. They drew on cybermedical consultation
to suggest that the interpersonal dimension underlying circumcision
implied a relationship between cosmetic surgeons and afflicted men
through the Internet. Their anecdotes suggested that genital hygiene
and STIs were not the main concern of men looking for circumcision.
Despite sustaining radically opposed perspectives, both urologists and
cosmetic surgeons seemed to agree with the scripts that make the
origin of the sexual in the genitals and the meaning of sex an act that
most likely involves foreplay, following by intercourse, followed by
his orgasm [. . . which results in . . .] ideals of sexuality [that] are
masculine ones and sexual relationships . . . male dominated (Jackson
1999, 172, 42).
My conversations with the group of mothers brought a human
face to the idea of the informed parent who can prevent circumcision.
Due to the prevalent feminization of childrearing, the interpersonal
dimension beneath pediatric circumcision and penile hygiene chiefly
involves the role of mothers. Their experiences implied that health-
care professionals tend to reinforce the idea that the genital hygiene
of young boys is the responsibility of mothers, which made evident a
seemingly gendered contradiction. Women are socially expected to
be ignorant about male genitalia and the sexual in general but fully
responsible for the early training of young boys, which includes issues
of penile hygiene.
Homosocial interactions were key to understanding how this group
of mothers was able to learn and effectively perform their expected
roles and avoid circumcision. The dramatic experiences of some of the
mothers dealing with penile infections, as well as the mortification of
having to supervise penile hygiene of young boys, demonstrated the

relevance of thoroughly implementing routine newborn circumcision
as a prophylactic measure. Nonetheless, the mothers reported that
circumcision was not actually needed because their sons were uncir-
cumcised and had grown up without any genital health problems.
From their insights, the social implications of being circumcised in a
country where the majority of men are uncircumcised became clear.
Contrary to the information displayed by cosmetic clinics to com-
mercialize the procedure, being circumcised could become a serious
psychological trauma. Circumcised young boys could be bullied when
taking baths with their peers because of having a penis that looks
different. Furthermore, young boys who feel differentthe Other
could face sexual issues in adulthood.
In understanding pediatric circumcision, social compliance rather
than medical concerns ought to be considered. Having a circumcised
son in Japan is problematic because children are generally uncircum-
cised. Conversely, empirical evidence suggests that in South Korea
(Pang and Kim 2002, Oh et al. 2002) or the United States (Goldman
1997, Boyle et al. 2002), where neonatal circumcision is prevalent,
having a boy whose prepuce is uncircumcised could be socially unac-
ceptable. Despite tendencies insisting on the salutogenic value of
removing the foreskin, pediatric circumcision could be a social rather
than a medical issue.
Patr iarc hy and the Male Body

Overall, the investigation of circumcision in Japan implies that Kim-
mel (2001) is correct when he asserts that the surgery is always con-
cerned with the reproduction of patriarchy. Although the use of the
procedure for cosmetic purposes appears particular to Japanese soci-
ety, it does not imply that scripts underpinning the practice are essen-
tially different. In line with the gender panic in twentieth-century
Japan (Kinsella 2012, 72), removing the foreskin appears as a medi-
cal technology that could help heal the bodies of emasculated
and asexual men, as well as repair the Japanese social body by fixing
the cracking patriarchal order.
Not only does the narrative underpinning the surgical practice con-
firm the notion that [t]rue masculinity is almost always thought to
proceed from mens bodies (Connell 1995, 45), but it also implies
that real men are circumcised. As such, circumcision in Japan would
not exist without the power of biological determinism (Con-
nell 1995, 47) that makes the prepuce an essential element in the
Conclusion 181
construction of the gendered and sexual self of men. Such determin-

ism largely revives the script that the sexual is centered in the genitals
and that sex largely involves vaginal penetration. This encompasses a
male definition of sexuality that tends to prioritize male orgasm and
relegates acts that produce female orgasm to the rank of foreplay
(Jackson 1999, 11).
The prevalence of such determinism could be effectively explained
by the notion of antinomy, which as Jackson and Scott (2004)
elaborate, helps challenge postmodern stances suggesting a conspic-
uous and gradual sense of progress in contemporary gendered and
sexual relations. The existence of antinomies contradict, for instance,
notions of plastic sexuality and pure relationships (Giddens 1992)
or theorizing that implies the borderline between the heterosexual
and homosexual has become rather blurred due to the queering
of sexual mores (Roseneil 2000). Circumcision in Japan shows that
progress in real life is not a linear process and that social continu-
ities and changes exist together creating tensions and contradictions
around gender and sexuality, which largely enlarges the power of patri-
archal heterosexuality and the asymmetrical stratification of the sexes.
Circumcision in Japan helps one understand the prevalence of het-
erogender and it is, indeed, a great example of antinomy. Japanese
circumcision is similar to surgical procedures that promise penile
improvements, such as penoplasty or penile enlargement surgeries
that are becoming popular in the United Kingdom (Usborne 2012)
and the United States (Dillon, Chama, and Honig 2008). Circumci-
sion in Japan is mostly a cosmetic surgery for adult men, thus the
health benefits of removing the prepuce require further investigation.
Notes
I ntro duc tio n

1. Circumcision is used to refer to the removal of the males foreskin
throughout the book.
2. The terms prepuce and foreskin are used interchangeably throughout
the book. However, the former is technically and the latter is colloqui-
ally used to refer to the retractable roll of skin covering the end of the
penis.
3. This is defined as the way in which the scientific knowledge of medi-
cal science is applied to behaviors or conditions that are not necessarily
biological (Turner 2006, 379).
4. An imaginary disease that designated almost any loss of semen other
than in intercourse with ones wife as pathological, and of which mas-
turbation or a long foreskin was held to be an important cause (Darby
2005, 8).
5. Biomedicalization is underpinned by five interrelated process: (1) A
new biopolitical economy that entails a complex field integrated by
biomedical knowledge, technologies, services, and capital; (2) a new
emphasis on health (in tandem with current attention to illness, disease,
and capital), optimization, and enhancement, as well as the elabora-
tion of risk and surveillance at individual, group, and population levels;
(3) a growing biomedical dependency on science and technologies or
technoscientization; (4) renovation of biomedical knowledge produc-
tion, information management, distribution, and consumption; and
(5) reshaping of bodies and the production of new individual, collective,
and population identities that have a technoscientific nature (Clarke et
al. 2003).
C hapter 2
1. Given the ambiguity of the term, hkei is translated as long foreskin.
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Index
abusive pricing, 8, 49 binary, 10, 11, 18, 24, 28, 30, 31,
adult (otona ni naru, ichinin mae), 41, 63, 119
78, 79, 80 biofantasies, 136
adulthood, 35, 77, 180 biological determinism, 19, 31, 180
advertisements, 8, 9, 14, 43, 50, 52, biomedical, 7, 8, 9, 15, 66, 91, 93,
79, 99, 100, 105, 106, 108, 177, 183
143, 154. See also mass media, biomedicalization, 12, 14, 15, 16,
pornography 30, 53, 60, 63, 92, 137, 145,
Africa, 17, 1035, 175. See also 147, 175, 178, 183
black women/men bisexual, 36, 84, 85
agency, 13, 21, 40, 60, 77, 84, 91. black women/men, 17, 55, 75. See
See also sexual: agency also Africa
AIDS, 6, 7, 17, 48, 85, 86, 92, 105, bloody rites of passage, 2, 3
118, 129, 137, 147, 148, 175. body
See also HIV aesthetics, 100
America, 3, 4, 170. See also United reflexive practice, 13, 91, 92
States sexualized, 30
anatomic confirmation, 18, 22, 40, bourgeois respectability, 4, 5, 174
52 boys, 3, 5, 10, 11, 16, 2224, 28,
anatomy, 1, 22, 98 47, 61, 62, 69, 107, 123, 125,
antinomy, 181 126, 150, 16366, 16871,
Atsune Hirata, 45 173, 179, 180. See also children
breast, 34, 106, 11315, 138
bad girls, 26, 35, 107. See brothels (fzoku), 54
also carnivorous women Buddhism, 44. See also religion
(nikushokukei joshi), unfeminine bullying (ijime), 168, 169
bathhouse, 45. See also communal
baths, public: baths (sent) cancer, 5, 6, 49, 53, 105, 106, 174.
beauty See also carcinogenic
clinics, 14, 31, 46, 53, 54, 56, carcinogenic, 6. See also cancer
63, 74, 81, 83, 105, 108, carnivorous women (nikushokukei
117, 123, 130, 133, 138 joshi), 30, 141. See also bad girls
industries, 29, 63, 76, 91 cathexis, 60. See also sexual: desires
200 Index
children, 5, 11, 14, 16, 22, 23, 26, disembodiment, 29, 80

3335, 40, 41, 47, 49, 61, 62, domination, 40, 57, 58, 140, 177
84, 88, 115, 124, 126, 152, dorsal slit, 47
157, 158, 16165, 16769, dystopian, 129
17476, 179, 180. See also boys
Christianity, 44. See also religion early training (shitsuke), 16, 61, 126,
civilized morality, 33, 34, 41, 72, 163, 165, 166, 179
102, 176, 177 easy lay (karui), 107. See also
civilizing process, 4, 33, 34, 78, sexually: unrestrained
174. See also good manners Edo Era, 45, 62
colonizing the body, 33 Egypt, 2, 173
commercialization, 11, 14, 16, 29, ejaculation, 59, 88, 89, 92, 117,
34, 48, 63, 101, 103, 105, 14347
170, 178. See also niche market premature (PE; sr), 44, 59,
commodity, 76 143, 144, 146, 177
communal baths, 15, 68, 92, 168, emasculation, 8, 168. See also
177. See also bathhouse unmanly (memeshii)
condoms, 86 embarrassing (hazukashii), 54, 149,
cosmetic 151, 154, 155, 157, 167
industry, 12, 46, 49, 52, 57, 63, embodiment, 13, 36, 66, 77, 88,
105, 119, 122, 129, 138, 91, 92
145, 147, 154, 156, 158, empirical evidence, 2, 14, 15, 47,
170 169, 180
intervention, 31, 118 (see also empower, 132
surgery: cosmetic) erectile dysfunction (ED; bokki
counseling, 54, 55, 74, 133 shgai), 44, 137, 143, 146, 177
cybermedical consultation, 131, ethics, 37, 40
133, 143, 147, 179. See also euphemism, 23, 33, 41, 73, 151,
Internet, websites 176
desexualized, 30 failing men, 11, 14, 18, 30, 41,

dimension 177. See also herbivorous boys
cultural, 1316, 18, 24, 31, 40, (sshokukei danshi)
42, 62, 65, 118, 122, 157, father, 3, 22, 70, 71, 151, 163, 165,
158, 176 167, 170
interpersonal, 1215, 21, 42, 58, female
62, 64, 76, 96, 109, 119, body, 12, 19, 30, 38, 60, 73, 140
122, 124, 132, 140, 161, genital mutilation (seiki setsujo),
17779 1035, 129
intrapsychic, 12, 20, 21, 55, 65, feminist, 39
66, 77, 82, 84, 91, 92, 96, feminization, 30, 162, 171, 179
106, 109, 118, 122, 13436, contradictory, 162
147, 150, 170, 171 foreplay, 179, 181
structural, 43, 63, 122, 137, 147, free consultation (mury
177 kaunseringu), 54, 55
Index 201
freeters (furt), 27, 28 homosexual, 30, 66, 67, 71, 72, 74,
full-time housewife, 24, 25, 41 78, 8588, 90, 92, 144, 178,
181
Gagnon and Simon, 7, 12, 13, homosocial, 15, 66, 73, 76, 82,
1823, 35, 41, 71, 129, 152, 91, 92, 96, 98, 109, 110, 112,
155, 165, 166, 176 118, 152, 161, 178, 179
gender honne (true feelings), 58, 61, 127,
dissonance, 22, 27 128
identity, 29, 63, 77, 80, 110, 148 hot springs (onsen), 53, 68, 168. See
panic, 11, 25, 59, 180 also communal baths
regime, 14, 25, 27, 41, 143, 145 household central pillar (daikoku
relations, 13, 2426, 39, 63, 140 bashira), 10, 24
genital infections, 124, 150, 157. humanized penis, 55, 60
See also penile: infections human papillomavirus (HPV), 6
girls (gyaru), 2224, 26, 30, 33, human rights, 104, 129, 130, 175
35, 41, 98, 99, 107, 109, 111,
112, 117, 142, 165 iatrogenic, 123, 147
gonorrhea, 6, 54. See also sexually: impersonal communication, 97
transmitted infections (STIs), indecent (yarashii), 72
syphilis, venereal disease (sei indirect communication, 96, 98, 99,
by) 113, 178. See also euphemism,
good manners, 68, 69, 72, 83. See innuendos
also civilizing process informed
good wife and wise mother (rysai client, 132, 133
kenbo), 10, 26, 30 parent, 122, 125, 147, 150,
179
Health Belief Model (HBM), 130 patient, 124
health benefits, 2, 15, 107, 178, innocence, 35, 106
181 innuendos, 15, 41, 71, 73, 76,
herbivorous boys (sshokukei 96, 119. See also euphemism,
danshi), 11, 28. See also failing indirect communication
men interactionism, 12, 13, 18, 19
heterogender, 10, 143, 145, 178, Internet, 8, 9, 14, 35, 36, 42, 49,
181 5254, 58, 61, 62, 74, 75,
heterosexual intercourse, 6, 12, 77, 86, 91, 92, 102, 105,
16, 61, 87, 175, 178. See also 108, 112, 12533, 159, 160,
sexual: intercourse, vaginal 179. See also cybermedical
penetration consultation, Japanese gay sites
heterosexuality, 10, 39, 40, 77, 143, (deai kei saito), websites
147, 181 Islam, 3, 44, 173, 174. See also
hierarchy, 56, 140 Judaism, religion
HIV, 5, 6, 7, 17, 43, 47, 48, 85, 86,
92, 95, 104, 105, 118, 126, Japan Association of Sex Education
129, 137, 147, 148, 154, 170, (Nihon seikyiku kykai), 30,
175, 178. See also AIDS 35, 51, 52, 99
202 Index
Japanese gay sites (deai kei saito), medicalized, 35, 7, 29, 44, 137,
86. See also Internet, websites 174, 175
Judaism, 2, 3, 4, 5, 6, 107, 44, 173, subordinated, 56, 63
174. See also Islam, religion mass media, 9, 14, 21, 27, 35,
justice, 13, 39, 40 42, 48, 49, 52, 74, 76, 77,
99, 127, 129, 147. See also
keratinization, 6 advertisements
kinky conversation (eroi hanashi), master narrative, 10, 11, 1315, 18,
108, 112. See also talk: dirty 19, 2227, 30, 35, 40, 41, 43,
(shimoneta), talk: filthy 52, 61, 63, 67, 80, 84, 147,
(waidan) 176
knowledge masturbation, 1, 4, 22, 23, 78, 92,
biomedical, 7, 183 174, 183
correct (tadashii chisiki), 126 medical
guilty, 23, 35, 41 malpractice, 8, 9, 49, 52, 57, 132
medical, 1, 4, 12, 14, 15, 36, technology, 14, 15, 60, 122, 140,
50, 52, 104, 119, 122, 132, 143, 147, 180
147, 170 menarche, 97, 165
popular, 103 mens studies, 11, 27
scientific, 74, 183 middle class, 5, 11
sexual, 95, 119, 147, 170 miemuki habit, 82, 83, 178
Ministry of Health, Labour and
ladylike cultivation, 26, 35, 106 Welfare (MHLW), 8, 9, 10, 25,
language 29, 46, 49, 130
ambiguity, 145, 159, 177, 183 mosaic blur (mozaiku), 75
English, 50, 101
gendered, 80 national health insurance (NHI;
inaccuracies, 103, 153 kokumin kenk hoken), 7, 10,
Japanese, 28, 31, 50, 72, 86, 44, 46, 51, 84
159 neonatal, 170, 180
nuances, 44, 50, 63, 116, 117, newborn, 5, 9, 10, 14, 16, 18,
177 4547, 61, 62, 115, 149, 150,
scientific, 72, 98, 131, 132, 146, 163, 174, 175, 180
152 niche market, 9, 12, 15, 29, 44,
long foreskin, 45, 46, 54, 65, 183. 48, 67, 132, 138. See also
See also phimosis, prepuce: commercialization
long normalize, 19, 140
Lost Decade, 25
operation on a phimotic penis (hkei
marketing, 44, 52, 58, 133 no shujutsu), 46, 50
masculinity ordinary lives, 12, 21, 24
complicit, 56, 57 the Other, 107, 156, 170, 180
hegemonic, 24, 5658, 63, 77,
177 (see also salaryman) paraphimosis (kanton hkei), 9, 46,
marginalized, 56, 57, 63 47, 50, 51, 53, 12325
Index 203
pathologization, 53 139 (see also long foreskin,

patriarchal phimosis)
dividend, 57 retractability, 47, 55, 56, 171
division of labor, 24 presocial, 20, 21
order, 25, 180 pretend ignorance (shiranai furi),
patriarchy, 3, 13, 19, 56, 57, 60, 64, 96, 102, 106, 108, 109, 128
176, 180 primitive, 3, 34, 78, 79
peer group, 23, 35, 52, 74, 76, 77 privacy, 33, 37, 51, 72, 74, 115, 165
penile procreation, 3, 25
hygiene, 7, 16, 47, 53, 92, 105, professional mother (kyiku mama),
12426, 130, 133, 136, 137, 61
147, 150, 151, 155, 157, prophylactic measure, 3, 14, 43,
158, 16063, 165, 167, 170, 118, 173, 174, 180. See also
171, 177, 179, 180 (see also penile: hygiene
prophylactic measure) psychological
infections, 16, 37, 125, 149, therapy, 143
150, 157, 162, 166, 170, trauma, 44, 54, 56, 63, 168, 180
171, 179 (see also genital (see also self: -esteem)
infections) puberty, 23, 69
penis public
enlargement, 135, 147 baths (sent), 68, 70, 83, 92 (see
normal (seij na penisu), 56 also bathhouse, communal
size, 69, 114, 117, 119, 153, baths)
160, 178 morals, 34
phallocentric, 65, 77, 92
phallus, 56, 75, 140 quality of life, 29, 134, 148
phimosis
false (kasei hkei), 50, 51, 53, racism, 17
5558, 83, 101, 116, 153 rapid economic growth (kdo keizai
hkei, 45, 46, 48, 49, 50, 53, seich), 24
58, 61, 65, 74, 83, 86, reading the air (kki wo yomu), 112,
101, 116, 117, 153, 154, 113
183 religion, 2, 3, 32, 41, 44, 103,
true (shinsei hkei), 50, 53, 57, 104, 105, 174. See also Islam,
62, 101, 139 Judaism
physical maturation, 69 reproduction, 26, 41, 98, 176. See
placebo, 145, 146 also role: reproductive
pornography, 41, 72, 74, 75, 77, risk compensation, 118
99, 119, 132, 176. See also ritual circumcision (katsurei), 2, 3,
advertisements 45, 50, 62, 87, 104, 121, 174
power relations, 12, 13, 39, 55, 75, role
92 productive, 11, 24
prepuce reproductive, 10, 11, 41 (see also
long, 46, 50, 53, 54, 56, 58, 59, reproduction)
61, 62, 83, 90, 93, 137, routinization, 5, 174
204 Index
salaryman, 24, 26, 27, 28, 29, performance, 8, 60, 63, 66, 89,
41, 80. See also masculinity: 90, 92, 117, 131, 168, 175
hegemonic play, 87
sanitary napkins, 98, 165 pleasure, 59, 61, 92, 95, 165,
secrecy, 23, 43 178
self reputation, 96, 10811, 118,
-confidence (jishin), 8, 54, 55, 119, 178
63, 66, 79, 80, 92, 121, satisfaction, 59, 60, 63, 66, 95,
122, 135, 136, 138, 143, 117, 119, 141, 177, 178
146, 148, 169, 177 (see also scripts, 7, 10, 14, 18, 20, 22, 34,
self: -esteem) 52, 129, 147, 151, 155
-esteem, 55, 63, 66, 79, 80, 146, taboos, 122, 147
177 (see also psychological: sexually
trauma, self: -confidence) active women, 11, 14, 18,
gendered, 1015, 40, 52, 63, 92, 41, 177 (see also bad
122, 134, 140, 175, 176 girls, carnivorous women
penilized male, 65, 66, 77, 83, [nikushokukei joshi])
91, 92, 177, 178 liberated women, 26
sexual, 1012, 1416, 18, 2123, transmitted infections (STIs), 6,
41, 63, 6567, 77, 84, 89, 53, 97, 98, 175, 178, 179
91, 109, 140, 146, 147, (see also gonorrhea, syphilis,
177, 179, 181 venereal disease [sei by])
technology of the, 12, 13, 65, unrestrained, 26, 41 (see also easy
175 lay [karui])
semen, 2, 183 Shintoism, 44. See also religion
sex silence, 23, 33, 66, 71, 76, 92, 103,
education, 23, 35, 41, 49, 70, 71, 131, 150, 151, 177
96, 97, 98, 103, 119, 130, culture of, 66, 103, 131, 150,
150, 151, 158, 170 177
talk, 73, 99 smegma, 2, 4, 5, 6, 49, 53, 173,
sexual 174
agency, 60 (see also agency) social
conduct, 1921 attribution, 22
culture, 76, 91, 103, 118, 131, class, 174
150, 151, 177 compliance, 180
desires, 13, 21, 60 (see also construction, 14, 18, 32, 67, 176
cathexis) history, 173
drives, 20 interaction, 14, 18, 19, 20, 21,
intercourse, 6, 10, 12, 13, 15, 32, 36, 41, 92, 124, 132,
5860, 63, 66, 88, 92, 95, 176
117, 140, 142, 144, 146, semiotics, 31
148 (see also heterosexual sociobiology, 57, 177
intercourse, vaginal South Korea, 170, 171, 180
penetration) spermatorrhea, 4, 5
Index 205
sphincter control, 41. See also unexplained voluntarism, 13, 31

voiding and bowel control unfeminine, 15, 119, 150, 157,
stigma, 56, 143, 155, 160, 168 170, 178. See also bad girls,
surgery unwomanly (onnarashikunai)
cosmetic, 43, 46, 81, 90, 91, United Kingdom, 181
95, 96, 100, 101, 112, 114, United States, 1, 169, 174, 180,
129, 133, 134, 138, 144,
181. See also America
145, 147, 150, 152, 156,
unmanly (memeshii), 79, 80, 81. See
169, 175, 178, 181 (see also
also emasculation
cosmetic: intervention)
minor, 710, 14, 17, 40, 44, 50, unwomanly (onnarashikunai), 158.
63, 83, 101, 109, 122, 124, See also bad girls, unfeminine
130, 140, 154, 177 utopian, 129, 131
plastic, 102, 119, 131, 154
syphilis, 1, 4, 5. See also gonorrhea, vaginal penetration, 16, 84, 117,
sexually: transmitted infections 144, 147, 175, 181. See also
(STIs), venereal disease (sei by) heterosexual intercourse,
sexual: intercourse
taboo, 36, 66, 71, 72, 73, 102, 122, venereal disease (sei by), 1, 54, 137.
127, 131, 147, 154, 155, 165 See also gonorrhea, syphilis,
talk sexually: transmitted infections
dirty (shimoneta), 15, 33, 152 (see (STIs)
also kinky conversation) voiding and bowel control, 23. See
filthy (waidan), 155
also sphincter control
girls (gyaru tku), 15, 96,
vulgar (gehin), 72, 101, 118, 151,
10912, 117, 118
152. See also indecent
tatemae (what one professes or says
in public), 127, 128 (yarashii)
technosexuality, 131. See also
cybermedical consultation websites, 31, 46, 53, 58, 131, 132.
theories of the Japanese See also Internet
(nihonjinron), 10, 176 the willie (ochinchin), 49, 6872,
theorizing, 12, 1820, 23, 31, 35, 75, 7881, 83, 108, 117,
39, 60, 75, 91, 129, 176, 181 16062, 164, 165, 168, 169

(Genaro Castro-Vázquez (Auth.) ) Male Circumcision

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(Genaro Castro-Vázquez (Auth.) ) Male Circumcision

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Male Circumcision in Japan

Male Circumcision in Japan

First published in 2015 by PALGRAVE MACMILLAN in the

Palgrave Macmillan is the global academic imprint of the above

Palgrave and Macmillan are registered trademarks in the United

Castro-Vzquez, Genaro, 1966

A catalogue record of the book is available from the British Library.

Design by Scribe Inc.

First edition: October 2015

I owe debts of gratitude to a number of people who provided help

Sayre recommended circumcision, maintaining that even if it

S ayre was a prominent physician and a leading figure in the intro-

indicates that advocating circumcision has always caused controversy

Anc ient Ritual s

passage in primitive societies. Judaic circumcision as well as bloody

illness, revolutionized the medical world. The so-called germ theory

that included phimosis, onanism, and spermatorrhea. Likewise,

C a nc er, H I V, and the P repuce

gonorrhea and cervical cancer on Jewish men and women, respec-

uncircumcised men as well. Circumcision has thus been presented as

A P ro f itabl e Bio medic al Proj ect

circumcised adult implies the identity of a man that is grounded in

implications of circumcision have realized that some clinics advertise

2003, 9, emphasis added). Mens studies (Taga 2005) has opened up

Daily I nter ac tio n s

be a medical intervention that implies a form of embodiment for het-

Th e Struc ture o f This Book

circumcision within Japanese gender and sexuality frames of reference.

chapter establishes that urologists and cosmetic surgeons share the

Circumcision is a minor surgery on a major organ.

W e are at the eighteenth International AIDS Conference and ready

This reference to the symbolic meaning of the practice made me

and structural power to differentiate the circumcised penis from the

constructivist understanding to sexuality because they were truly the

behavioral instructions around which individuals improvise to pro-

S c r ipts and the Bo dy

body and adult experience are applied to childrens early attempts to

Th e G e ndered and S ex ual S elf i n Japan

C u r re nt G ender and S ex ual Dynami cs

Increasing rates of singleness, divorce, postponed or refused mar-

in Japanese mass media and academic reports in which he identifies

the household, as well as the social, political, and financial system. As

The desire to marry was, however, a critical part of freeters decisions

Furthermore, younger Japanese men have become bodies that mat-

Th e Bo dy and the New Bi nary

society and whose quality of life, in general, depends on his academic

medicalize the male body, the recent emphasis on externalization

The panic in Japan over the emergence of grass-eating or herbivorous

This new binary is important to understanding how circumcision has

M e a nings and Representati ons

cultural environments. Nevertheless, signs that represent circumcision

Ta l king abo ut Circ umci s i on

and disease. The truth is that, outside a hospital environment, daily

festivals such as Hnen Matsuri (one of the fertility festivals where

the Japanese state outlawed bodily exposures (i.e., nursing in pub-

Censorship is still enforced and mirrored in contemporary laws on

[P]art of the allure of femininity is sexual unattainability, which depends

It is not difficult to identify such mystery of femininity in the Japanese

Contrary to any form of biological essentialism, Japanese men

of mine, who is circumcised, introduced the first cosmetic surgeon.

or university classroom to prevent incomplete or biased informa-

together with the patriarchal regime it sustains, revolves around its

the earliest forms of sex education encompass an assortment of moral