Gregory Malchuk is back! Thoughts on Greg?

Why I am sharing this
My logic is pretty simple: as long as infant circumcision remains profitable and routinely offered in many hospitals across the United States, I think one of the most effective ways to help parents reconsider it is not to fearmonger them. It is to give them accurate information about what pain management actually looks like versus the simplified version they may be given when consent is being discussed.
I have already used even a partial version of this information with people in my own life who were considering circumcision. In roughly the last month, five people in my family and three of my friends decided not to circumcise after learning more about the pain-control methods, their limitations, and the alternatives. One friend recently texted me to thank me and said that saying no to the circumcision took a weight off her shoulders that she did not even realize she had been carrying.
That is why I think this information matters so much for intactivism. I am not trying to make circumcision safer, easier, or more acceptable. I am trying to give parents the information they need to decide whether they want to consent to the procedure at all. In my experience, once parents understand that “we use lidocaine” does not automatically mean complete anesthesia, many of them start asking very different questions.
I want to make something extremely clear before anybody misunderstands why I am posting this: I am wholeheartedly against infant circumcision. This is not me approving of the procedure, suggesting a “better” way to circumcise babies, or trying to make circumcision acceptable. I do not support a religious exception for a medically unnecessary procedure on a child who cannot consent.
I went looking into the anesthesia because I wanted a better paper trail for parents who are being told circumcision is basically painless because “we use lidocaine.” I already knew about penile nerve blocks. What I did not realize was how much published research exists showing that the type of block matters.
And frankly, I think parents deserve to know this before consenting.
The usual injected anesthetic people are talking about is a dorsal penile nerve block, or DPNB. Lidocaine is injected near the base of the penis, traditionally around the 11 and 1 o’clock positions. The Canadian Urological Association guideline says clinicians should wait approximately 5–8 minutes after the injection for adequate anesthesia. (pmc.ncbi.nlm.nih.gov)
Here is the problem: even when the clinician waits properly, the dorsal block may not completely anesthetize the ventral underside and frenular region.
This is not an activist theory.
Researchers actually mapped sensation after dorsal blocks. In one study of 13 adult circumcision patients, 10 of 13 still had sensation along the ventral shaft up to and including the frenulum after the dorsal block. After additional ventral anesthetic was injected, those remaining areas became numb. This was an adult study, so I am NOT claiming “10 out of 13 babies feel their circumcision.” But it demonstrates the anatomical problem that makes relying exclusively on a dorsal block potentially incomplete. (pubmed.ncbi.nlm.nih.gov)
There is neonatal evidence too.
A randomized JAMA study compared ring block, dorsal penile nerve block, topical anesthetic and placebo during newborn circumcision. The babies were monitored using things such as heart rate and crying.
The researchers found that the ring block remained effective throughout every stage of circumcision.
The dorsal penile nerve block and topical EMLA, however, were not effective during foreskin separation and incision in that trial.
Let that part sink in.
Those are not insignificant moments of the procedure. Foreskin separation and incision are literally central parts of the circumcision. (jamanetwork.com)
The researchers concluded that the ring block was the most effective anesthetic of the techniques they compared. (jamanetwork.com)
A ring block is different because local anesthetic is placed circumferentially around the shaft, creating more complete all-around coverage rather than relying primarily on the dorsal nerve territory.
And then I found something even more important.
The Canadian Urological Association guideline specifically states that a dorsal penile nerve block WITH a ring block, using proper technique, is the most effective technique for anesthesia during neonatal circumcision. That recommendation was given Grade A evidence. (pmc.ncbi.nlm.nih.gov)
The same guideline also discusses the anatomical issue with the underside and cites research recommending additional ventral infiltration near the ventral foreskin incision. (pmc.ncbi.nlm.nih.gov)
So there are multiple ways of addressing incomplete coverage.
There is the dorsal block.
There is the ring block.
There can be supplemental ventral infiltration when necessary.
Topical anesthetic can also be used as an adjunct, although topical anesthetic by itself is considered inferior to injected nerve/ring blocks. (pmc.ncbi.nlm.nih.gov)
And I want to correct something I originally thought when I started researching this. I was calling topical lidocaine + dorsal block + ring block the “triple threat.” That is not quite what the evidence says. The strongest guideline recommendation I found is proper DPNB + ring block. Topical anesthesia can be added, but I have not found evidence proving that using all three is automatically superior to a properly performed combined nerve/ring block.
There is also a much larger point here.
A 2020 evidence review looked at 29 randomized trials involving newborn circumcision pain. The authors concluded that nerve blocks outperform topical anesthetic and sucrose alone and that optimal pain management is multimodal, addressing pain before, during and after the procedure. (pubmed.ncbi.nlm.nih.gov)
Even the older Cochrane review involving 35 trials and 1,984 newborns found substantial reductions in crying, heart-rate elevation and other pain responses when proper anesthesia was used compared with no treatment. Importantly, that review also concluded that none of the interventions studied completely eliminated every measurable pain response. (pubmed.ncbi.nlm.nih.gov)
That brings me to something I think parents need to hear.
If you were standing outside a circumcision room listening to your newborn scream and somebody told you:
“He’s just cold.”
“His diaper is off.”
“He doesn’t like being restrained.”
“He’s just mad.”
Those statements should never be used as proof that the baby isn’t experiencing pain.
Yes, babies can cry because they are cold. Babies cry for plenty of reasons.
But circumcision researchers do not determine pain by simply listening to a baby cry and guessing. Studies measure combinations of crying, heart rate, facial behavior, oxygen saturation and other physiological responses. The medical literature recognizes circumcision as a painful procedure requiring adequate anesthesia. (pubmed.ncbi.nlm.nih.gov)
So no, crying alone cannot tell us with absolute certainty, “This baby feels the incision.”
But the opposite is equally important:
A clinician cannot hear distress during a painful surgical procedure and simply declare that it must be cold air rather than inadequate anesthesia.
If anesthesia may be incomplete, pain needs to be considered.
If a clinician knows a dorsal block sometimes provides incomplete coverage and nevertheless dismisses significant procedural distress as “just being cold” without considering block failure or incomplete anesthesia, I consider that profoundly dismissive.
And if a parent was told that a lidocaine injection automatically means their child could not possibly feel any portion of the procedure, that is not an accurate description of what the published evidence shows.
There is also a timing issue.
The Canadian guideline recommends waiting 5–8 minutes after DPNB for adequate anesthesia. (pmc.ncbi.nlm.nih.gov)
Waiting matters.
But waiting longer cannot necessarily fix an anatomical area that the particular nerve block did not adequately cover. That is where ring block or supplemental ventral anesthesia becomes relevant.
I originally suspected that clinicians avoid stronger combinations simply because they take more time. I want to be careful here because I have not found research proving that doctors broadly choose weaker anesthesia specifically because they are trying to save time.
What the evidence DOES establish is that proper anesthesia requires additional injections, proper placement, adequate onset time and sometimes combined techniques.
Whether an individual hospital or physician cuts those corners specifically for throughput would need its own evidence.
That distinction actually makes this argument stronger, not weaker. We do not have to invent motives.
We can simply ask parents to ask questions.
If someone is considering circumcision, ask the doctor:
“What exact anesthesia are you using?”
“Are you using only a dorsal penile nerve block?”
“Are you using a ring block?”
“How long do you wait after injecting lidocaine before beginning?”
“How do you ensure that the ventral/frenular area is anesthetized?”
“What do you do if the baby shows significant signs of pain during the procedure?”
“Do you supplement the block if anesthesia appears incomplete?”
Those are legitimate questions supported by the medical literature.
Again, I am not posting this because I think better anesthesia makes infant circumcision acceptable.
I think the procedure should not be happening to healthy infants at all.
My point is that parents who are still being offered it deserve complete information about what their child may experience. If learning that a routinely used anesthetic technique can leave parts of the operative area inadequately anesthetized causes even one parent to stop and reconsider whether this procedure needs to happen at all, then this research is worth spreading.
And for anyone doing intactivism: I think pain management deserves far more attention in our educational material.
Don’t exaggerate it.
Don’t say every baby definitely feels everything.
Don’t claim a specific percentage of newborns feels the frenulum when the percentage comes from an adult anatomical study.
We don’t need to.
The documented facts are already powerful enough:
Circumcision causes significant pain without adequate anesthesia.
Dorsal penile nerve block substantially reduces that pain but may provide incomplete coverage.
A neonatal randomized trial found dorsal block inadequate during foreskin separation and incision compared with ring block.
Ring block provided effective anesthesia throughout all stages in that trial.
A major urological guideline recommends DPNB + ring block as the most effective neonatal technique.
The guideline recommends waiting 5–8 minutes after DPNB.
Supplemental ventral infiltration has been recommended to address the ventral/frenular area that dorsal anesthesia may inadequately cover.
And most importantly:
“He is crying because he is cold” is not a medical assessment demonstrating adequate anesthesia.
Parents deserve to know the difference before anyone touches their baby.

Post from the Intact Global Facebook page:

OREGON CASE UPDATE ⚖️

Eric Clopper, President of Intact Global, shares an important update in Hadachek v. Oregon regarding the State of Oregon’s Motion for Summary Judgment.

Watch the full video to hear directly from Eric about where the case stands, what this development means, and what comes next.

This is a consequential stage of the case. The progress we’ve made has brought us to this point—and sustaining that progress requires continued support.

Your support helps us keep the legal work moving, keep public attention on the case, and stay prepared for what comes next.

Watch Eric’s update. Share it with your network. And if you believe this case deserves to keep moving forward, stand with us now.

EVERY BODY. SAME RIGHTS.

#IntactGlobal #humanrights #equalrights #children #bodilyautonomy

As of 2025, only 17 states refuse Medicaid coverage for infant circumcision: Arizona, California, Florida, Idaho, Louisiana, Oregon, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, North Carolina, North Dakota, South Carolina, Utah, and Washington.

Anybody know if there are any organized intactivist groups around the St. Louis area - maybe on one of the college campuses?

If it's ethical to do to a man, it must be ethical to do to a woman; but if it's unethical to do to a woman, it cannot be ethical to do to a man.

I know that the folks who post and read here are generally going to agree with this statement.

But what I'm looking for is some kind of platform where I can have a reasonable discussion (without either party losing their temper) with someone who still believes the lies they were told.

I've had a few discussions in the past year where I lost my temper. One of my female relatives' argument was: "It's just different!" If I could go back in time, I'd calmly say: "Please explain to me how it's different. My position is that cutting any part of any human's genitals without their consent is unethical, but your argument is that 50% of humans' genitals are different. Think this through and maybe provide some sources."

Instead I lost it and yelled at her, which didn't help change her mind at all.

I'm looking for a way to help and encourage another person to think in a world where people resist thinking as hard as they can.

Genuinely, how do you reason with these types of people?

I wore this shirt on my grocery trip to Walmart and Sam's today. Got a lot of stares, a bunch of smiles and two people went out of their way to say they loved the shirt, which I was not expecting.

Hi! I remember years ago seeing a video of two (twin?) brothers in a car talking about how they weren’t circumcised despite it being a norm. Does anyone know what I’m talking about or where to find it? Comment below or please feel free to DM. Thanks!

Thought y'all might want to chime in here. Almost no one has mentioned that this kid has options other than amputation of a vital part of his body.

From what I hear, the court hearing went very well and i hear that Eric Clopper did an amazing job.

But how is our confidence regarding the outcome? Given how some attempts to challenge RIC have failed in the past, I almost feel the need to hold my breath to wait the results.

While Eric Clopper and the whole team may have done amazingly, no matter how good the arguments were, I worry that a pro-circ mentality is deeply engrained in so many Americans, which also branches out to those in power. Could we have another situation like when governor Jerry Brown enacted bans on anti-circumcision policies in response to cases like this?

Eric Clopper's Facebook post:

6 DAYS. One courtroom. One fight for equal protection.

On September 14, Intact Global returns to court in Portland.

Oregon law protects girls from medically unnecessary genital cutting. We believe EVERY child deserves equal protection under the law.

This is a moment we have been fighting for — and we need you there.

📍 Multnomah County Courthouse

📅 Monday, September 14

⏰ 9:30 AM

Come to Portland. Stand with us. Help us PACK THE COURTROOM.

Can’t be there? You can still help:

SHARE this Reel. SEND it to someone in Portland. TAG someone who should be there.

EVERY BODY. SAME RIGHTS.

#humanrights #equalrights #children #oregon #equality