Purely a figment of your imagination

What amuses, annoys, concerns or otherwise interests me – Noodlemaz


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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.

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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.

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Invisible Lives

It’s a skeptics in the pub write-up!

In case you missed it, I luckily made it to Westminster Skeptics to see Juliet Jacques give her talk,

Thinking critically about transgender issues

and you can listen to it on the Pod Delusion but I shall write up my notes for those who prefer to read!

Firstly Belinda Brooks-Gordon introduced the talk by saying that trans rights have not really moved forward along with women’s rights. To try to highlight this and educate people, Juliet has a Guardian blog where she posts regularly about trans issues.

Now we can hear what Juliet has to say – it’s a lot of stuff, hugely informative, and it was a great talk!

I’ve put in a few thoughts of my own with [Comment: …] along the way.

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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?


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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

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