Circumcision debate

UCLU ASHS 28/02/13

Antony Lempert (GP & Chair of the Secular Medical Forum)

vs.

Jonathan Arkush (Vice President, Board of Deputies of British Jews)

Here’s the full audio of the debate; it’s about 1hr 10mins but I’ve put highlights in my Pod Delusion report! I’ve also put timings on my notes below so that you can skip to the relevant bits if you like.

Antony had met Jonathan in July 2012 for Sunday Morning live, they had some email exchanges but they stopped because:

“he didn’t seem to like my Human Rights arguments and kept saying things like live and let live

- which I thought was funny, because that is pretty much the crux of the anti-circ position. And that boring old “human rights” argument people keep digging up, ugh!

Antony has tried in previous years to get routine infant circumcision debated at the BMA annual meeting; apparently, though, changing the wording of a proposal to remove “female” so that you’re discussing infant genital surgery generally is a no-no. Better luck this year, hopefully.

Debatable

It’s worth noting that some of the oft-discussed issues around MGM were irrelevant in this case. Arkush (I’ll refer to him as JA and to Antony as AL throughout) argues only from the perspective of a Jewish man upholding his faith; his interest is in the “religious rights” of individuals and families, so ignores arguments to do with necessity/benefit, health, female genital cutting and so forth. (For more on these, please see previous posts.)

I think an important take-home from this debate was something AL also pointed out: that there does seem to be a confusion in these of arguments. People cite “parental rights”, requesting tolerance, respect and permission to keep doing what they want to do. All well and good, until you harm other people.

The problem here seems to be that some parents do not believe their children are people in their own right. Interesting, as I wonder how many anti-abortion campaigners (especially in the USA) are pro-circumcision?? That’s a tangent though.

Without recognising that a child’s right to bodily integrity exists and you should really respect it, people end up thinking they can treat their child-property however they wish – sometimes culminating in something as disturbing as removing their most sensitive erogenous body part.

Obviously I am completely biased as a fully-fledged intactivist; there was no way JA would have convinced me of his position. He was at all times calm and polite, to his credit. However he also clearly holds some disturbing views about mental health (accusing all men who are unhappy about their circumcised status, who claim emotional trauma, to in fact have some other underlying condition) and the non-religious (with another worrying suggestion that lack of faith may lead to psychological issues, and people being devoid of values).

AL has kindly allowed me to use his slides to add information here, so you can find some interspersed with my notes below (part 2. AL 15 minutes).

Summary

JA considers it his right as a Jewish person to remove his sons’ foreskins in accordance with the traditions of his culture. He does not believe it is at all harmful. He argues against banning things we find distasteful, carrying this argument to an interesting and shocking conclusion when he disagrees with banning one of the most disturbing forms of male circumcision: the metzitzah b’peh, in which the Mohel sucks the blood off the child’s wound, thus exposing him to disease and an increased risk of death. Live and let live? The baby being worth little consideration here, apparently.

AL draws on strong arguments based in medical ethics to highlight that non-medically justified (it very rarely is) routine infant circumcision (RIC, or more accurately NTEF: non-therapeutic excision of the foreskin) is a permanently damaging procedure with complications that are often serious, and parents should not have the “right” to choose cosmetic surgery for minors, just because they are their parents. The child is not their property, and their responsibility is one of protection.

1. JA 15 minutes

00:00:00

Started with an appeal to tradition “Judaism is one of the world’s oldest faiths” (00:02:00)

The bible is clear that is matters “how we treat other people…” Indeed!

Rules, customs, values and ethical considerations

He follows Jewish traditions because he wants to

He would like family to inherit his tradition and values in turn

Judaism & Islam practise circumcision (asks us to note only boys at 8 days in Judaism) (00:02:45)

God commanded the practice from Abraham, with no reason given (00:02:55) “I wanted to keep that precept”

He “some Jews” pick and choose which parts of the tradition to keep, seemed to disapprove (00:03:30)

‘Brit’ (as in Brit milah, the circumcision ceremony) means covenant or promise (00:03:45)

It’s “more logical to keep all the rules I possibly can” (00:04:20)

Says circumcision is “safe and simple” (00:04:30)

Must be performed by specially trained and regulated individuals, “many are doctors” (00:04:45)

Initiation Society” set up in 1752 (00:05:05)

Cited example of royal family being circumcised and the same doctor cutting him as did Prince Charles ?! (00:05:45)

“In the Jewish community, complications are virtually unknown” – cited high standards (00:06:00)

Appreciates the arguments against and respects them (00:06:50). Guesses they consist of:

1) Wrong to impose on babies? “There are many things we decide for our children” (00:08:00) Waiting would be worse, it’s “safest and kindest … when the child is 8 days old” (00:08:50) and “more painful at 18″ (00:11:15)

2) Psychological issues? He dismisses these, calls it an “odd” claim, saying “some people believe they are… not in my experience” thinks any problems are down to something else and people blame circ only as displacement. (00:09:45)

Children have a right to be brought up in a faith we choose for them…” (00:10:20)

People are glad and relieved and grateful this was chosen (00:10:45)

I would not like to look different from them” ! (00:11:00)

To “we disapprove of this ritual/custom/value so we ought to ban it” he says the fact you disapprove is not a reason to ban; unless socially harmful (00:11:45)

We regulate rather than ban e.g. smoking (00:12:20)

Taking away “rights to believe” (00:12:45) – “It is not a fair way to run society… unless you can prove it is harmful to society as a whole” – 4000 years Jewish/muslim tradition… 60% American men cut (00:13:30)

Somehow tries to justify by quoting BHA (00:14:25) “Recognises the dignity of individuals… treats them with fairness and respect… respects and promotes freedom, democracy, human rights and the rule of law, and equal treatment of everyone regardless of religious belief” – “so please give me that equal treatment, let me circumcise my son” – from the perspective of a parent who wishes to cut children.

2. AL 15 minutes

00:15:50

Main points:

Function & sensitivity; autonomy; irreversibility; indoctrination; confusion in discussing parental rights

It is often argued by those in favour of ritual circumcision that parents have the right to procure circumcision in much the same way as they decide which school to send them to, whether to baptise them and the favourite comparator, whether or not to vaccinate their child. (00:17:45)

Childhood immunisation is an intervention that cannot wait until adulthood and one with overwhelming evidence of protection from serious childhood diseases such as measles and tetanus. It does not remove body parts.

(00:18:15) Responsibilities of doctors

GMC guidance first words: “make the care of the patient your first concern”

Primum non nocere

(00:18:50) In September 2012 GMC issued a child safeguarding statement acknowledging possible damaging influence of religious and cultural beliefs:

In some cases, it may be difficult to identify where parents’ freedom to bring up their children in line with their religious and cultural practices or beliefs becomes a cause for concern about a child’s or young person’s physical or emotional well-being.

(00:19:20) Key principles of Medical Ethics:

1) Autonomy 2) Beneficence 3) Non-maleficance 4) Justice

People think “their rights are under threat when they can’t cut someone else’s body?!” (00:20:10)

constraints on personal autonomy should never be used by people claiming ‘cultural autonomy’ to justify the forced removal of healthy body parts from non-consenting people. (00:21:05)

It has been illegal to tattoo children from 1969 (00:21:50)

For those without the capacity to choose, questions must be asked about procedures: is it permanent or temporary? Is there clinical benefit? Any restriction of future decisions? (00:22:20)

Not only do medical associations not recommend it, many condemn (00:23:10):

The Royal Dutch Medical Association “…a violation of a boy’s rights to autonomy and physical integrity.”
The President of the British Association of Paediatric Surgeons, (BAPS) “…an irreversible mutilating procedure… rarely, if ever, an indication for male circumcision of boys aged less than 5 years old”
Chairman of the Swedish Paediatric Society “…an assault”
Australasian Association of Paediatric Surgeons “…does not support… routine circumcision”

Was promoted to limit masturbation (00:24:30)

1993 study in the Journal of Surgery, looked into complications (00:24:50):

- Meatal Stenosis (narrowed urethra opening)
Scarring and sinuses
- Erectile dysfunction
- Denuding of penile skin
– Psychosexual problems
Infection and bleeding
– Urinary difficulties
Amputation of the Penis
Death

Nigerian midwife manslaughter conviction 2013, baby Goodluck

Birmingham hospitals provide circumcisions on the NHS. FOI requests have revealed data showing that complications often cited as “tragic and unforeseen” “isolated incidents” are actually quite common (00:26:20)

Birmingham data

For an operation the British Association of Paediatric Surgeons say is rarely if ever needed.

Sorrells 2007 and Hoebeke 2013 on sensitivity and function; circumcision removes the most sensitive area of the penis. (00:27:10)

Frisch 2011 reported on circumcision harms to women: “Frequent Orgasm Difficulties in Danish men… and a range of frequent sexual difficulties in women” (00:28:15)

Men who speak out about circumcision damage are often isolated by circumcising communities, threatened and ignored. They are not well-supported to argue their case and are conveniently seen as non-existent, with advocates always saying they “haven’t heard” anyone complaining. It’s a sensitive issue anyway and being shunned for disagreeing makes it even less simple to do. (00:28:45)

November 2009 lawsuit between 20 y/o man and his GP over his meatal stenosis, dysuria, abrasive pain, tight circumcision, a sinus and asymmetric scarring leading to bent penis; was told he had “no case for medical negligence, because this level of damage is fairly routine” (00:29:20)

The UN convention on rights of the child 1989 – signed by all countries except Somalia and the USA
Article 14 (1) Respect the right of the child to freedom of thought, conscience and religion
Article 19 (1) Protect the child from all forms of… violence, injury or abuse… including sexual abuse whilst in the care of parent(s)…or any other person who has the care of the child
Article 24 (3) Take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children. (00:30:10)

Blinded by religious privilege, we can lose sight of the child, and the adult the child will become

3. JA 5 minute retort

00:31:45

Emotive language!! Anti-semitic? (!)

40 million Jews, who collect data (really? Where is it?)

we don’t argue that it’s needed so that’s a moot point

WHO, AAP ‘pro’ stances

I don’t follow the practice because of health benefits “although HIV is drastically lower”

BMA and GMC have circ guidance! Ethical and religious values are important

These [negative comments] are minority views and not reflective of the whole practice

I want to make decisions for my children

in society we tolerate costly things e.g. drugs and smoking

4. AL 5 minute retort

00:36:35

We should aim for progress, not tradition

Actually the USA is the minority view.

legalizeforeskin.tumblr.com-image-44340298361

Obviously it’d be better to have some actual data on here!

In Jewish law: if 3 of your babies die, you don’t have to cut the 4th

Mohel reports are… where? Also easily dismissed

Milah UK Autumn 2012 set up to challenge German ruling

BMA is clear on circ, illegal under Human Rights act? BMA conference debates

5. Questions and discussion

00:41:00

1) Edward Presswood

You said your son was circumcised and didn’t even cry. Can you describe how it was done without making him cry?

JA: “I’m a bit squeamish but I wasn’t there. Local anaesthetic, quick, guard in place, wine in mouth to encourage child to sleep, feeding after, Mohel visits for following 2 days” (00:41:10)

Defends Jewish practices in comparison to ‘less well regulated’ procedures (00:42:05) such as baby Goodluck and another boy who died after a Rabbi cut him (00:42:40). Blamed the mother for ignoring instructions to call doctor/hospital/mohel if there was any bleeding. AL interjects with further information (00:43:25). “The issue is that taking a knife to a normal child’s body exposes them to risk that they don’t need to have”

JA: “complications in the Jewish community are extremely rare”

2) Jewish audience member: possible harm to welfare [when not cut]? Would boys have preferred “most likely” to have had it when they were younger? (00:45:20)

3) Difficulty with making things illegal; wouldn’t it still happen (00:46:25) – see FGM. No prosecutions. Doesn’t mean we shouldn’t make things illegal.

4) USA ‘looking normal’ concerns (00:47:55)

JA: Jewish community isn’t responsible for USA high circumcision rate; social reasons

AL: AAP is a trade organisation; it’s a cultural phenomenon and doctors profit from it (00:49:25).

5) EP: Orthodox Judaism Mohels – what about tolerating/banning the sucking [metzitzah b'peh] practice? (00:50:15) – JA wouldn’t ban it!! “I’m just very chairy about going for bans” (00:52:25 – sorry about my phone buzzing there!)

00:52:50: AL on deaths from circumcision being excluded from studies’ data analysis (approx. 200/year)

6) 00:54:30 – asks AL for opinion on HIV/circumcision research. NB/ 57:30:00 a member of WHO circ “expert” board invented circumcision devices?

7) My question (00:58:15): would you really consider opposition to genital mutilation (as it is generally universal where it occurs; regarding male or female, hospital or elsewhere, religious or cultural etc.) to be anti-semitic?

I won the debate with this, because JA fell for Godwin’s law, and compared us all to Nazis and communists (00:58:45-01:00:40):

“the chancellor Angela Merkel was acutely concerned about a country where circumcision was last banned – incidentally 2 world rulers in modern times who sought to ban circumcision were Hitler and Stalin – so that’s the company you’re in”

At that point I did a \o/

8) How can you agree with criminalisation of theft and not with thieving a part of someone’s body? (01:02:10)

JA: parental decision because child is too young, a parent is entitled to that – compares to ear piercing or tattoos. Defends his right to remove healthy body parts from an incapacitated child. Cites “everyone I know in the Jewish community feels the same way”

AL: reiterates that those who speak out are ostracised by “the community” (01:04:30) and JA confirms that one woman on the Board of Deputies was removed because of her synagogue was ‘upset’ by her dissenting opinions (01:05:15). Insists someone would not be ignored if they said they were “born with” a circumcision that harmed them, but is picked up on this because he already dismissed them in his speech.

9) How would you feel if your son had to be castrated (?), how would you explain that to him? (01:07:00)

JA doesn’t seem to accept that risk of serious injury or death is a good reason to avoid this unnecessary surgery, saying hewould feel “desperately guilty and sorrowful” – he would say “I consciously exposed you to such risk as there was … but I probably would make the same choice again”

EP: asks if he does recognise there is a risk (yes) (01:08:45)

He also let slip that he believes those who lack faith also lack any values (01:09:15). Nice.

Cuts, labels and preferences

Last night I stumbled upon (via a friend) what is probably one of the best posts I’ve read in a long time about male circumcision – it’s got just about everything there. The religious angle, of course, since the article is written by Jewish Nobel prize winner, George Wald.

But more than that, it highlights what a complex issue genital cutting is and expands upon the probable motivations that drive people to it. Where angry victims tend to place the blame (squarely upon mothers, except in Judaism); FGM; issues of gender and misogyny; the less reported forms of MGM outside of the USA and Europe; basic embryology; health myths (for the skeptical readers!); and personal perspectives from those involved.

My one problem with article is minor but it started me thinking, so here it is. His use of the term “bisexual“. I think in the article’s context he means something more along the lines of intersex/hermaphroditic. He’s talking about the first people in creation myths being of both genders, parallel with the contested view of a god who is “both male and female”. That’s not what bisexual means, at least now – what it actually means is being attracted both to people who identify as the same gender as you do, and to those whose gender identity is different from yours.

To improve understanding, a common point is that you wouldn’t be surprised by someone who likes people whatever their hair/skin colour, height, or weight. For many bisexual people, gender is also no bar to attraction or, indeed, love. Through ignorance and misunderstanding, there are so many misconceptions and insults thrown at those who self-identify as bi, and in recent years I have become more aware of it and more annoyed by it. Bisexuality does not imply greed or promiscuity, it is not a product of indecisiveness, immature experimentation or a phase. Assumptions along these lines are offensive.

http://en.wikipedia.org/wiki/Bisexual_pride_flag

Bisexual pride colours

Biphobia, including the assumptions listed above, may not be a concept everyone is familiar with. Sometimes people argue bisexuality doesn’t even exist, but I disagree very strongly for many reasons. Bi-invisibility is part of biphobia; people often (consciously or otherwise) try to erase bisexual identity when they find it. Settling down with a partner of the opposite or same sex does not then magically make you straight or gay! Just as a prolonged involuntary dry spell does not make anyone who would rather be sexually active in fact asexual. Bisexual individuals who have only had sexual experiences with the opposite sex do not have to identify as “curious” – would you question someone’s professed heterosexuality at age 21 just because they happen to have remained a virgin?

Not everyone chooses a label for themselves. Some do not find it necessary, some find it restricting – people who have absolutely no boundaries with respect to gender (or anything else) and their relationships may, for example, prefer pansexual. However, there are good arguments against using semantics and etymology as reasons to shun labels – but especially, against criticising other people’s self-identification with them.

Many labels are reductive, they kind of have to be by their very nature. But people often like to be part of a group, it helps us to feel we belong and are accepted. Most of us crave that; we seek out communities that value similar ideas and this helps us value ourselves. It can be integral to our happiness, though may not be essential for everyone. Uniting under a banner – literally or figuratively – can also help push forward the drive for equality and fair treatment. It is important to bear in mind that identification with labels is (or should be) a choice that people make and when minority groups attack each other for it (bisexuals are somewhat famously persecuted by both gay and straight communities) it is so self-defeating.

Coming to grips with these ideas in theory is one thing. Living them in practice is another. For example, having seen otherwise sensible and lovely people come out with some nasty transphobia (something I have shamefully done in the past myself), I still consider direct experience – meeting people and getting to know them – to be one of the best ways of overcoming irrational prejudices. Once you meet people and see that your assumptions were total crap, it’s much easier to move on and make positive changes to opinions and behaviours. This, for me, is also one of the strongest arguments against segregated education, particularly on religious grounds.

I did go to a single-sex school, but that didn’t preclude my having male friends. It did mean I encountered a lot of homophobia (obviously going to school with pupils of one gender automatically makes you gay!) and, indeed, biphobia (well if you fancy any of the girls, you must fancy all of them! Another stupid biphobic idea that’s so obviously ridiculous if you apply it to straight or gay people) – but ultimately I feel positive about my education at least in academic terms. That’s a whole other post, though. Feel free to leave your views, teachers and single-sex/co-education fans!

The “gender binary” is a problematic idea for lots of people and even male/female labels can be oppressive. This fantastic article sparked a little debate recently. I have had abuse shouted at me when I’ve not been looking obviously female – which probably isn’t too often but still – and people are often shocked by this. I hate that women and men are expected to look certain ways, and if you look out for it I’m sure you’ll see that insults based on this are common.

For some reason, not being able to work out the contents of someone’s pants (or indeed their sex chromosomes) is a legitimate source of comedy or, worse, justification for derision or violence. “Justin Bieber looks like a girl in that photo! Hahaha!” “Is that person over there a boy or a girl? I don’t know! Let’s beat the shit out of them to teach them a lesson.” – what? Why are people required to be open books? Misogyny, homophobia, transphobia – people don’t realise it, and they continue it.

Yet this kind of restriction is something that the majority don’t think about – they probably don’t have to, if they’re lucky to fit within the “normal” boxes that the culture has predefined. That extends to many lifestyles, decisions and qualities – we are not all the same and society’s (as opposed to the individual’s) need to label is often so restrictive that it oppresses huge numbers of people. But something else that annoys me is hypocrisy around protecting people’s right to choose and the nature of preferences.

I believe people can do whatever they like, especially when it comes to sex, if all necessary consent is obtained and no one is being harmed. So, I get pretty angry when people start throwing around accusations of -isms and -phobias based on other people’s sexual preferences. Thankfully we do have the right to decide who we sleep with! We have no obligations to anyone in that regard, from asexuals to enthusiastic sex workers, our choices are (or should be) our own. Don’t talk about choice and how important it is and then dictate to people what they should and shouldn’t do with their sex lives.

Attraction (or lack thereof) is innate, not chosen, as pro-equality campaigners will tend to argue. If you’re not attracted to someone of the same sex, not sleeping with them does not make you a homophobe, obviously – similarly, not being attracted to people from a particular “race” – or to none except similar to yours – does not make you racist. As long as your only discrimination is not sleeping with them, I don’t see how you could possibly come to any other conclusion. You’re looking for things to be angry about, perhaps. I witnessed a bit of a Twitter argument about this recently, and it’s one I’ve had myself, so now is a good time to make the point.

There are also different kinds of attraction: including (but perhaps not restricted to) physical, emotional, intellectual – different people place different levels of importance on those things and choose their partners accordingly. I’m a fan of all three at once, which is reflected in my history (that’s my own business unless I choose to talk to people about it!) and preferences – some decide to call that “picky”. Those with broader tastes might say they don’t have “a type”, or disconnect their physical experiences from other aspects of their lives.

These are all choices we can make, yet often we find ourselves judged for them. The “less discerning” among us might be labelled sluts or studs (again, depending on your gender and the ridiculous expectations people hold based on it) and those who are very selective about who they sleep with or simply place little importance on the physical might be frigid or gay – that most pathetic of insults that I still struggle to banish from my vocabulary because of the university environment.

This destructive judgmental behaviour is a bit like feminists sneering at women who have chosen to be stay-at-home-mums when that’s what makes them and their family happy and works in their relationships. Or when polyamorous folk start calling their monoamorous friends “weird”. When people with a particular fetish put down those who happen not to share it. Acceptance has to be given as well as received, and if you are going around being very negative about groups you don’t identify with then I’m not sure you’re helping, however active you are in other progressive causes. Live and let live.

Choice is what it’s all about. You should be free to choose things for yourself, in your own life, especially when you are harming no one. However, the imagined “parental choice” to cut the genitals of their children needs to go. That dangerous decision takes away choice from the victim, who can never regain what is taken from them, who can never choose for themselves what was done to their body. Irreversible damage. Adults choosing body modification/cosmetic surgery/assignment surgery for themselves is clearly different and irrelevant to the GM debate.

I might write a post that’s actually about GM soon..!

My no. 1 overlooked issue in skepticism

This week I submitted a guest report for the Strange Quarks podcast (you can also listen on the Guardian website, ooh!); you can follow them on Twitter.

Here’s what I said in text format with some links and a bit of stuff that had to be left on the cutting room floor; also see my earlier posts here and here for expansion. I hope to find time to do a proper post on the HIV/circ issue some time but my free time is practically non-existent right now!

I’m going to talk about my number 1 overlooked issue in skepticism, which is: circumcision. I think people should be talking about it more.

We’re quite rightly disgusted by and vehemently opposed to female genital mutilation or FGM.

All its various forms are reviled and usually illegal, from those as minimal as a pinprick to the most severe and life-threatening.

However, the developed world, including the UK, used to widely practice FGM alongside male circumcision or MGM both for similar reasons, including beliefs of hygiene benefits, curing disease or unwanted behaviour and aiming to reduce or remove sexual desire.

But girls now have their healthy, functional tissue – their bodily and genital integrity – protected by law; makes sense.

I’d argue all children should be protected from unnecessary, damaging, permanent genital surgery; routine infant circumcision is cosmetic surgery, encouraged by parents, religious traditions, or physicians who sometimes make a profit from it, in the case of the US.

No baby can consent to having a healthy part of his body removed or altered and this is surely a violation of his basic right to protection from abuse and, indeed, of a doctor’s oath to Do No Harm. Edit: it pays to think before it starts to matter more, because then it can be too late. Watch this medical student, and read his comment underneath his video.

There are a lot of lame excuses around.

People wrongly believe that “It’s harmless!” The deaths of over a hundred babies per year in the US alone suggests otherwise, not to mention non-fatal complications such as scarring, meatal stenosis, skin bridges, fistulas, cysts, impotence and the one-in-a-million chance of the loss of the penis altogether.

Edward Wallerstein said, “Circumcision is a solution in search of a problem.”

It’s been cited as a cure for all sorts of ridiculous things down the decades, from epilepsy and masturbation to bed-wetting and blindness. It offers no more hygiene benefit than 10 seconds in the shower with a bar of soap. I file it with alternative medicine-style quackery and the reasons for its persistence are strangely complex.

One problem now being recognised with the latest in a long line of dubious justifications is that suggesting “circumcision could prevent the spread of HIV!” to already poorly-educated populations causes a sort of invincibility complex to form, where people believe they are resistant and therefore end up spreading the virus even more.

Improving sanitation, education, barrier contraception availability, and reproductive autonomy for women are things we should be striving for anyway, not trying to shoe-horn in outdated surgical procedures.

Then there’s the “He won’t remember if we do it when he’s a baby!” line. People don’t really remember anything from their infant days but that doesn’t mean you can abuse them in any way you like.

“Oh, the foreskin is useless!” people proclaim light-heartedly. A false perception likely the product of depressingly insufficient sex education, including within medicine. It’s actually the most nerve-dense, sensitive part of the penis. Any volunteer test subjects for this assertion? I thought not.

Studies assessing whether circumcision affects sexual function and pleasure often make two critical mistakes in the groups they compare to intact men; 1. those circumcised at a young age (who therefore have no ‘natural’ sexual experiences to relate to) or 2. recently-cut adult men reporting increased pleasure, when it takes a few years for permanent glans exposure to have its desensitising effects. Men attempting foreskin restoration in later life should surely also be consulted – yes, there is such a thing, do check it out.

Some will make exceptions for “it’s a religious/family tradition” – or even “we want him to look like his dad!” The children of amputees surely feel relieved. These also reasons given for FGM that we reject.

It’s quite sickening to read women’s comments about their sexual preferences used as reasons to force it upon their children– “it looks better!” and “intact is ugly” are too frequently heard. If a man confessed to saving up for his daughter’s breast enlargement or labioplasty we’d be appalled, right? We don’t do this with any other body part.

There is also increasing evidence that permanent psychological damage can result from such a huge physical trauma in early life, including Post-Traumatic Stress Disorder. These effects are not only limited to recipients of the surgery; read experiences of women who deeply regret allowing it here (NB/ is quite upsetting). One man seeking compensation writes:

I was circumcised as an infant and my mother was not informed of the great injustice being performed on her only son. Not only has it caused great physical trauma but psychological and emotional as well. Damages are immeasurable. I want justice for what was done to me, and I never want another child to be sexually assaulted and butchered in their first moments of life. It has long lasting horrid affects. How can you ever trust when the first thing you know is pain and the most pleasurable part of your body is taken away?

There are other quote-unquote ‘reasons’ for the practice, which I’ve gone into more detail on in my blog and maybe could expand upon at a later date. No medical organisation recommends routine infant circumcision, yet thousands of boys are subjected to it every day.

Why?

Have you thought about it?

FGM and MGM; still a long way to go

For some time there has been an apparent hypocrisy, particularly in the United States, with regard to non-medically-necessary genital operations performed on infants and children, a subject I posted about previously.

This article is a reasonable summary for starters, apart from the perhaps over-emotive first paragraph, but to be honest I’m inclined to find it appropriate.

Girls have long been (at least officially) protected from damaging genital surgery, although along with MGM it used to be common in the developed world – for similar reasons (myths regarding hygiene benefits and the wish to reduce or destroy sexuality). Sadly, while there are laws against FGM (it is illegal in Egypt but the problem has certainly not disappeared), it is still practised not only in the developing world  but also in the UK and the US.

Boys have not been afforded the same protection, despite the fact that more than 100 boys die because of circumcision complications every year in the USA. That may not seem like a lot in terms of the population size but that’s 100 families whose lives have been shattered, 100 lives lost needlessly. One is too many.

There is an interesting Wiki article on circumcision-related law, past and present. ‘Cosmetic circumcision’ is banned in Australian public hospitals, it seems in Britain we cannot make a firm decision on the matter despite some encouraging analyses:

Fox and Thomson (2005) argue that consent cannot be given for non-therapeutic circumcision. They say there is “no compelling legal authority for the common view that circumcision is lawful.”

Finland seems to be moving towards criminalisation (see the case of a mother being fined after her son developed complications, for example) and Denmark seems to be flirting with the idea.

The American Academy of Paediatrics (AAP) has recently revised its statement on female genital mutilation (FGM). To address the hypocrisy and sexism in the USA regarding genital mutilation of children (where it’s OK to remove healthy, sexual tissue  from the penis but not the vulva), instead of doing what would seem like the sensible thing – officially stating that neither FGM nor MGM is recommended – it has actually relaxed its position on FGM. Truly astonishing.

“Ritual cutting and alteration of the genitalia of female infants, children and adolescents, referred to as female genital cutting (FGC)*, has been a tradition in some countries since ancient times and continues today in parts of Africa, the Middle East and Asia.

According to a new policy statement from the American Academy of Pediatrics (AAP), “Ritual Genital Cutting of Female Minors,” in the May issue of Pediatrics (published online April 26), the AAP opposes all forms of female genital cutting that pose a risk of physical or psychological harm, and encourages its members not to perform such procedures.

In addition, the AAP urges pediatricians and pediatric surgical specialists to actively dissuade parents from carrying out ritual FGC and provide families with education about the lifelong physical harms and psychological suffering associated with the procedure.

Many parents who request FGC do so out of tradition**, and also out of concern for daughters’ marriage ability within their culture, so physicians need to remain sensitive while informing them of the harmful and potentially life-threatening consequences.”

Intact America has released this statement in response to the AAP and Forward rightly calls it “A step backwards for women’s rights”.

* The ridiculous decision to switch to a more PC-term, ‘genital cutting’, avoiding ‘mutilation’ is analysed well by Jezebel. Mutilation is an apt term for this practice, if one looks up its dictionary definition.

** The tradition argument should NOT be acceptable for this. It’s the 21st century and we’re still accepting the most basic, childish argument as justification for such an act. ‘Well, they did it, why can’t I?’

You’re only free to do whatever you want as long as you’re not harming anyone else. Your freedom to do what you like ends when you start infringing on the freedom of others. I cannot imagine many greater infringements of personal freedom than lopping off bits of a child’s genitals, because you want to or you have some half-baked reasoning behind it (see earlier post for a few of those).

For example, I was recently quite shocked by a girl stating (after someone brought up their reasons for not particularly wanting to convert to Judaism):

Well it can be good for women, so why not! … Makes them last longer

I cannot find this sentiment anything other than disgusting. Increased male pleasure is one of the many ‘reasons’ given for severe FGM. In fact, if you talk to enough women you are likely to find that this is not the consensus opinion (anyone who’s found themselves bored, staring at the ceiling after half a repetitive hour can partly appreciate why), if it even matters; advocating unnecessary and dangerous genital surgery on minors for your own sexual gratification… well, I don’t really have the words for it. Selfish wouldn’t suffice.

For anyone who is interested, http://www.norm.org/comes highly recommended by friends who are restoring; trying to recover something of what was taken from them without their consent. Let me know if you want me to put you in touch with them.

Here are a couple of good videos I saw today:

Dr John Geisheker speaking about American physicians escaping justice after babies die as a result of cirumcision.

Steven Svoboda on the currently popular myth that circumcision is a miracle strategy to prevent HIV spread.

This page has some very good educational videos on the functions of the foreskin and consequences of circumcision (not safe for work, obviously)

Finally, the following is from Guggie Daly; a fairly comprehensive run-down of foreskin functions (for all the ‘It’s just a useless bit of skin!’ people).

All of the following comprise the foreskin and are removed in the typical American circumcision:

(1) The Foreskin
comprises up to 50% (sometimes more) of the mobile skin system of the penis . If unfolded and spread out flat the average adult foreskin would measure about 15 square inches( the size of a 3×5 inch index card). This highly specialised tissue normally covers the glans and protects it from abrasion, drying, callousing (keratinisation), and contaminants of all kinds.The effect of glans keratinisation has never been studied.

(2) The Frenar Ridged Band
The primary erogenous zone of the male body. Loss of this delicate belt of densely innervated, sexually responsive tissue reduces the fullness and intensity of sexual response.

(3) The Foreskin’s ‘Gliding Action’
– the hallmark mechanical feature of the normal natural, intact penis. This non-abrasive gliding of the penis in and out of itself within the vagina facilitates smooth , comfortable, pleasurable intercourse for both partners. Without this gliding action, the corona of the circumcised penis can function as a one-way valve, scraping vaginal lubricants out into the drying air and making artificial lubricants essential for pleasurable intercourse.

(4) Nerve Endings
Nerve Endings transmit sensations to the brain – fewer Nerve Endings means fewer sensations; circumcision removes the most important sensory component of the foreskin – thousands of coiled fine-touch receptors called Meissner’s corpuscles. Also lost are branches of the dorsal nerve, and between 10,000 and 20,000 specialized erotogenic nerve endings of several types. Together these detect subtle changes in motion and temperature, as well as fine gradations in texture.

(5) The Frenulum
The highly erogenous V-shaped web-like tethering structure on the underside of the glans; frequently amputated along with the foreskin, or severed, either of which destroys its function and potential for pleasure.

(6) Muscle Sheath

Circumcision removes approximately half of the temperature-sensitive smooth muscle sheath which lies between the outer layer of skin and the corpus cavernosa. This is called the dartos fascia.

(7) The Immunological Defense System of the soft mucosa.

This produces both plasma cells that secrete immunoglobulin antibodies and antibacterial and antiviral proteins such as the pathogen-killing enzyme lysozyme.

(click ‘more’ below the links for references)

This page with illustrations demonstrates the functions of the male prepuce:
http://www.circumcision.org/foreskin.htm

Dr. Peter Ball on the function of the foreskin:
http://www.norm-uk.org/function.html

Video showing a computer generated model of the function of the foreskin during sexual activity.
http://www.youtube.com/watch?v=wj6UjduMTiU

Contrast and compare pictures of cut and intact penises:
http://www.circumstitions.com/Restric/comparison.html

What is lost due to circumcision?
http://www.norm.org/lost.html

The three zones of penile skin:
http://www.foreskin.org/3zones-c.htm

The functions of the foreskin:
http://research.cirp.org/func1.html

Read the rest of this entry »

Why should I care? A GM that I DO oppose.

Please sign this petition to the CDC! Thank you.

NB/ this post contains sexually graphic content and may not be for the feint-hearted. It’s medical, not pornographic, but if you’re easily offended I’d advise against reading on. In fact, you better close the site altogether…

“Circumcision is a solution in search of a problem.”

- Edward Wallerstein

Many people ask me, upon learning of my staunch opposition to all forms of GM (genital mutilation; male or female [MGM/FGM], baby or child, US or Africa, hospital or village…), “what’s your problem with circumcision?”

It is simply another example of quackery that has somehow survived into the (relatively) enlightened age – I will bundle it in with homeopathy, chiropractic and any other ‘alternative medicines’. It’s a throwback, supported only by myths and ignorance, continued for profit and more sinister reasons.

Firstly, if you can stomach it, watch the procedure being performed on a baby. I’d put a youtube link but if you want one, you can find it. I’m not going to rely entirely on Appeal to Emotion here though so read on if you wish. No one should choose it without knowing exactly what it entails. For the more sinister stuff mentioned, look up circumfetish for starters.

What is MGM?

It’s something pretty much everyone has heard of. Yet few people understand it, especially in Europe where, thankfully, the practice is relatively rare. My issues with it began when we were shown a video of a Jewish circumcision (‘bris’) in an RE class at school. The baby’s strapped down while a mohel, not a qualified physician, removes a substantial amount of the child’s penile skin; just days after he’s born. He cries his eyes out, quite naturally. Apparently this is a necessary initiation into Judaism (though not according to my favourite kinda Jews); something a baby can never understand, let alone consent to. Similar is found in Islam where ‘initiates’ range from babies to teenagers and indeed adult converts. The point regarding medical training is somewhat moot, however – there is no right way to do a wrong thing.

I didn’t think much of it for some time, until I begin to learn about FGM. What horror is this? Girls having their genitals butchered out of tradition, fear of the unknown (it is thought that the clitoris is a dangerous organ capable of growing and killing women or babies should they touch it at birth, or simply that the female sex organs are a source of uncontrollable sexual desire and no woman should be walking around with that) and misogyny.

Isn’t FGM so much worse?

At first glance, it seems so much worse than something 15-30% of the world’s men are living with (depending on whose figures you believe); it carries risks for the girl (she may bleed to death or die of septicaemia) and any future children she may have. There is also the most severe (but thankfully rarest) form called infibulation, in which the external part of the clitoris and labia majora are removed then the vulva sewn shut with only a small hole for urination and menstruation. When a man wishes to have sex with her he will open the wound with a knife and sew it shut again afterwards to make sure she isn’t unfaithful while he’s away.

No doubt FGM has some forms which are truly horrific, but the majority are prepucectomy/female circumcision (directly analogous to MGM). MGM also has some very scary manifestations around the world which often result in death (indeed there are reports to be found of children dying because of their circumcisions weekly but they are not well-publicised e.g. this and this), problems with urination and sex and so on.

The main problem is that people tend to focus on infibulation-type FGM and the commonest/least shocking forms of MGM – which is an uneven comparison. Comparison isn’t even the point; and that is what I wish to highlight with this whole argument.

The ‘maleness’ of a foetus comes into being when certain genes on the Y chromosome are activated during development. This is why men have nipples; they don’t do anything, they just developed before the man-genes kicked in. Male and female sex organs develop from the same tissue in the foetus; for a large portion of development, XX and XY are visually indistinguishable.

Indeed, in some individuals the difference is not clear-cut. Sex and gender are complicated issues beyond the scope of this post, however.

What’s the problem?

The point I wish to make is that the outward appearance of a child should not matter – they should be protected from unnecessary, damaging, permanent genital surgery; cosmetic surgery, chosen by parents (or physicians making a profit from it in the case of the US) for ridiculous ‘reasons’.

These tend to include:

THE MYTHS

Intact is disgusting! Well, that’s subjective and however many men may have the opinion that the female genitalia are ugly, surgery will never be forced on baby girls in accordance with that. Nor should it.

Intact smells bad! Not if you shower for a few seconds. It’s very simple; lots of men can tell you that. The only people who smell are people who don’t wash themselves at all and in that case, what their penis smells like is one of many problems.

It prevents penile cancer! No it doesn’t. It’s an incredibly rare cancer to begin with (<1% cancer cases in the US, but around 10% in Africa, where circumcision is commonest), and not absent in the circumcised population. Cutting off the foreskin does not protect against it (for an in-depth summary of literature up to 2000). Wallerstein (UCNA, 1985) found the same rate of the cancer in non-circumcising countries as in the US where it is still common. With few quality studies bringing together epidemiological data, it is unjustified to pin down ‘not-being-circumcised’ as a significant risk for penile cancer; an incredibly rare condition best prevented by not smoking and keeping clean; many thousands of children must undergo circumcision to prevent a single case, statistically. That is not acceptable medical practice.

So 1) Sanitation and education alone drastically reduce risk of this cancer anyway 2) there is now an HPV vaccine so for the cases caused by that, vaccination of girls AND boys would be preventative, at no physical cost to individuals.

A clinical trial proposal/analysis written by R.T.D. Oliver (BJUI, 2009. Incidentally, at the same university, medical school and indeed institute as myself) even states at the start:

“…penile cancer has reduced substantially without implementing circumcision. In Denmark, penile and cervical cancer decreased by 28% and 24%, respectively, between 1940 and 1990, coincident with an increase from 35% to 90% in the proportion of dwellings having a bath [8]. In India, high caste and better educated uncircumcised men have less penile cancer than less-educated circumcised Muslims, and the prevalence of cervical cancer in equivalent females mirrors this trend [9]. In Brazil, where there has been considerable investment in sanitation facilities [10], there is a gradient of increasing penile and cervical cancer in the areas of the country that have least provision of sanitation. In China, where before 1951 penile cancer was the most frequent urological malignancy, accounting for 39.5% of cases, it had declined to the least frequent, and only accounted for 1.6% of urological malignancies by 2000 [11], due at least in part to the better domestic sanitation facilities for a larger proportion of the population.”

Another major problem is with suggesting to already poorly-educated individuals that “circumcision could prevent the spread of HIV!” (another widely-cited benefit) is that a kind of invincibility complex begins to form, where people believe they are resistant and therefore end up spreading the virus even more. Also one of the studies was ended early due to the finding of increased male-female transmission, so women are put at even greater risk of becoming HIV positive with circumcision in some cases. Really nice articles in Lay Scientist and on BBC.

It really is a solution in search of a problem. STD spread is best tackled with education, barrier contraception availability and use and reproductive autonomy for women. Things we should be striving for anyway, not trying to shoe-horn in an outdated surgical procedure that some people want to justify any way they can.

No medical organisation recommends it as a prophylactic treatment. Just as we wouldn’t remove girls’ breasts at the first opportunity – and breast cancer is incredibly common by comparison.

It stops UTIs! Again, it doesn’t*. Plus, UTIs are not life-threatening and are easily treatable with antibiotics and good hygiene. Women get far more UTIs than men anyway.

*Edit: This analysis states “Given a risk in normal boys of about 1%, the number-needed-to-treat to prevent one UTI is 111″ – meaning you have to circumcise 111 boys to prevent just one UTI, which are as I said generally not that serious anyway. That’s 110 put at risk of serious complications, left without an extremely sensitive part of their anatomy that was perfectly healthy – to theoretically prevent one transient infection.

I don’t want my son teased at school! Kids will lay into anyone for any reason. They’re cruel, it’s what they do. Better be teased for it than be without that part of your body forever. Again, if some classmate is studying your privates that intently, their making fun may not be your only worry.

It’s a family tradition/we want him to look like his dad! That’s a big reason FGM is still performed, too. An invalid one, in my view. How messed up is it to want your son’s genitalia to match your partner’s?! It’s pretty sick to read women’s comments about their sexual preferences and using it as a reason to force something like this on their children. If a man confesses to saving up to get his daughter a boob job we’d be disgusted, right? We don’t do this with any other body part. Also I don’t think dads and sons spend much time comparing their members. Again, if they do, there are more problems afoot.

It’s easier to deal with this way! Guess what, kids get messy. Raising children is difficult. There are lots of nasty things we have to learn to cope with and lots of reasons they get ill. We don’t insist on shaving their hair off all the time (hooray, head lice), removing all nails, laser-treating the armpits, taking out teeth, cutting off ears and so forth. We all have to learn to wash ourselves; taking care of the penis is no different. Doctors telling mothers to force their son’s foreskin back when it doesn’t naturally detach until puberty does not help. Women can talk to each other (and thanks to the age of communication, now are) and physicians can stop giving people bad advice. Medical training and indeed lower education can stop shying away from sexual health. The functions of this part of the body (VERY graphically explained & demonstrated here, don’t click at work!) should not be taken lightly.

He won’t remember if we do it when he’s a baby! Well, some people don’t remember being raped if they’re drugged up enough. Also, your baby won’t remember much at all, doesn’t mean you can abuse them in any way you see fit. This is not an argument at all.

Below are examples of ‘clinical’ and tribal instruments of circumcision.

To summarise

I do not care whether we’re talking about a baby in a hospital in the US who may not remember much of it or a 15 year-old stood in front of his tribe not permitted to show pain in order to be considered a man. I do not care if we’re talking about a girl held down by her female relatives while they ‘operate’ on her then tie her legs together to make sure the wounds heal together or a baby undergoing a ritual, ceremonial pin-prick. I do not care if it’s scalpels and clamps or razor blades and glass. All are unacceptable – gender, age, location, manner, extent of damage, ‘reasoning’. Unacceptable because it removes an individual’s choice. Cosmetic surgery should only ever be elective and no child can choose this, much less understand it. Medical necessity is a different issue, but this procedure is currently ‘over-prescribed’ mainly due to ignorance, in the US it’s profitable and yet again religion is an acceptable trump card to overcome questionable (to say the least) ethics.

Genital mutilation is a human rights issue; it’s a throwback to even more ignorant times than we currently know. People need to be outraged by it and stop legitimising some forms by being tolerant of others. This is not the extent of it, but I hope it’s somewhat educational and helps people to understand my personal views.

It is not my intent to make anyone feel negatively about themselves (though the resistance to feeling like a victim is a big part of what keeps such traditions going), but to condemn this ‘tradition’ and break the vicious cycle. We cannot change the past but we can spread knowledge and make future lives better.

This facebook group has a great list of links for FGM-oriented charities and organisations etc.

http://www.intactamerica.org/ is probably the biggest anti-MGM movement currently and well worth keeping up-to-date with. Some major changes may be happening in the US soon, thankfully.

Thank you for reading. Edit 2014: Brian Earp has this excellent post that calmly addresses the “but they’re not the same!” knee-jerk reaction. Do read it.

Timeline of ridiculous ‘justifications’ for circumcision through medical history is also shown (click to read on below), for those who are interested. Why the WHO recommends male circ but not female circ, despite similar ‘benefits’ being reported for both. Also how the anti-ageing industry comes into play.

Read the rest of this entry »

%d bloggers like this: