Circumcision without consent reveals

I have two caveats applicable to my analysis of this story. I am not an attorney. The charge against the individual is an allegation.

Ocala Police said they arrested a man who allegedly attempted to circumcise his 1-year-old nephew while babysitting Saturday.

Police said Larry Leroy Floyd was watching the boy while his father was at the store. They do not know why Floyd attempted to circumcise him.

The boy was taken to the hospital. Ocala police arrested Floyd and charged him with domestic aggravated battery.

For the sake of analysis, I’ll assume that Floyd attempted to circumcise his nephew and did so without permission of either of the boy’s parents. There are many implications from that. I want to analyze this more than I should. I’ll choose prudence instead, based on my first caveat.

Circumcision is surgery. Surgery inflicts some level of harm, regardless of the benefit(s) pursued. Harm is battery. Circumcision, as surgery, is battery. That much is simple and should be non-controversial.

Not all surgery is legally actionable. Informed consent is a defense against surgery. Consent is why we don’t prosecute doctors for performing surgery. Again, this is simple and should be non-controversial.

This (alleged) surgery is legally actionable, obviously. If circumcision didn’t categorically (and objectively) constitute harm, the criminal charge would need to be something else, if anything at all. But circumcision involves harm, as all surgery involves harm. That presents the proper issue in the debate about non-therapeutic child circumcision. Whose consent to this harm should be required?

Too often the assumption in favor of parental choice via proxy consent ignores harm. (e.g. AAP) Society defends parental choice for non-therapeutic circumcision by favoring irrelevant, flawed distractions focused only on an overblown applicability of potential benefits and a minimized view of risks. The inevitable harm from circumcision matters. Harm must inform who should – and should not – be permitted to consent. For non-therapeutic male child circumcision, society needs a rethink.

Not every male would have foreskin anxiety

It’s rare that I read something providing both confirmation and frustration. Such is the case with this interview with Aaron Calloway, a man who chose circumcision for himself as an adult. Some of Mr. Calloway’s thinking precedes the Q&A in the interview:

“I have been in a couple of social circles where people would be talking and say, ‘Ugh, yeah. He was uncut,’ and I, like, didn’t want that,’” Calloway told me, when we spoke a second time about his circumcision. “And I’m sitting there with an uncut penis. People don’t really assume you may not be [cut]. They just assume that you’re cut and if you’re not, it’s kind of like this abomination.”

I’ll assume everyone is familiar with this because it certainly matches my experience. Americans generally assume every male is – and should be – circumcised. It’s what we do. It’s “good”. I take a different view on what to do with society’s perception. Of course I don’t have the same experience Mr. Calloway does. Mine is people assuming I’m happy with being circumcised, because why wouldn’t I be? It’s strange, and annoying because I don’t care what other people think about my preference. I’d rather have my normal body, which I had until my parents made my choice.

Early in the interview, Jenny Kutner, asks a question that expands on this:

How would you say it’s perceived to be uncircumcised [sic]?

It’s strange because it really depends on being asked. If you are someone who prefers a cut penis, or to be circumcised, it’s weird because the preference — they automatically associate it with cleanliness. It’s considered a more proper penis and uncircumcised is like, weird. But it makes me think, it’s weird to actually be born and have your penis hacked at. I am glad that I made the decision on my own to do it. There’s something empowering about that.

I’m glad Mr. Calloway had his choice, even though I don’t (emotionally) understand – and wouldn’t make – the choice he made. He’s correct that it’s weird to be born and have your (healthy) penis hacked at. That weirdness is why I dreaded this excellent, necessary question:

Since you found it empowering to decide yourself, what do you think you would do for your son if you had one?

I would probably get him circumcised, only because I wouldn’t want him to deal with the social embarrassment of [not being circumcised], because it can come off that way. I’ve been in situations where if I let myself, I could’ve felt embarrassed, but I chose to own it. I think I had enough resilience where it didn’t get to me, but I think that some people in that situation, it does get to them.

I wanted to turn off my monitor, unplug it, and throw it in the garbage when I read this, just so I’d never be able to read that answer again. Because the obvious question is obvious: What if that hypothetical son wouldn’t be embarrassed by social pressure to be circumcised? Or, what if the social pressure is no longer the same 15+ years after that hypothetical son is born in the future? And, I still remember, “I am glad that I made the decision on my own to do it” from the previous question. Is there a reason to assume a hypothetical son wouldn’t want his choice, too?

My frustration with Mr. Calloway’s answer grew later in the interview when the question turned to Mr. Calloway’s results:

Aside from not being able to ejaculate for a while, were there any other negative side effects?

Besides the desensitization –

So you do have less sensation now?

Yes, and that is something that I’m a little bit sour about. I used to have very intense orgasms–my legs would curl and my head would go back. It was cool. I was very into it. Now, I’ll cum or whatever, and it’s just more calm. It’ll feel good, but it’s not as dramatic as before, which was nice, because it felt sexual and passionate, and now it’s just like, get out.

Is it worth it?

Is it worth it? I would say, in my situation, and my experiences, yes, it is to me, because I just personally feel better about it. I was with some friends who were talking about the word “smegma” and making jokes about it, and now I don’t have to feel uncomfortable in that situation, and that’s really nice. I think for me and my personal psyche, it is worth it. I’m not saying that when I cum I don’t feel anything. No. That’s not the situation either. I still get horny. I want to have sex. It still feels great and I still have an orgasm. Is it to a lesser degree? Yes. Is it an orgasm nonetheless? Definitely.

It’s consistent to say “I’m a little bit sour about” it and “in my situation, and my experiences, yes, it is [worth it] to me.” All preferences are unique to the individual. Mr. Calloway values the aesthetic and social benefits more than the healing process and diminished sensitivity. Given that I only advocate for each person to make his own choice, not that no one be circumcised, I’d be a hypocrite to criticize his conclusion. I criticize his current thinking that he would circumcise a future son. There’s also time for him to see the error in his thinking there.

To the possible objection with this interview, of course Mr. Calloway’s claim is subjective and anecdotal. This does not prove that adult or infant circumcision leads to desensitization. I think the inference is logical, given how circumcision changes the normal penis. Still. No, this isn’t proof.

It does support my focus on individuals rather than groups. We must remember how critical this is when reading generalized garbage such as what the CDC offers on page 26 of a detailed supporting document for its proposed recommendations to teens, adults, and parents of newborns.

… However, in one survey of 123 men following medical circumcision in the United States, men reported no change in sexual activity and improved sexual satisfaction, despite decreased erectile function and penile sensation. [Abstract and study]…

From the results section of the study’s abstract:

A total of 123 men were circumcised as adults. Indications for circumcision included phimosis in 64% of cases, balanitis in 17%, condyloma in 10%, redundant foreskin in 9% and elective in 7%. The response rate was 44% among potential responders. Mean age of responders was 42 years at circumcision and 46 years at survey. Adult circumcision appears to result in worsened erectile function (p = 0.01), decreased penile sensitivity (p = 0.08), no change in sexual activity (p = 0.22) and improved satisfaction (p = 0.04). Of the men 50% reported benefits and 38% reported harm. Overall, 62% of men were satisfied with having been circumcised.

As the study concluded, and the CDC’s use failed to understand, “adult circumcision appears to result in worsened erectile function, decreased penile sensitivity and improved satisfaction.” Again, those don’t have to be inconsistent for an individual. But it’s indefensible to assume infant circumcision results in a different outcome, or that results one and two ethically coexist with result three for healthy children.

Even in this study supposedly supporting the CDC’s recommendation, only 62% of men were satisfied. The other 38% matter, too. In the absence of need, the only relevant issue is always individual choice. And looking at the math, the results show that far fewer than 100% of men circumcised for (probable) need were satisfied. Remember this every time someone implies every male should¹ be satisfied with non-therapeutic circumcision because some males are satisfied with therapeutic circumcision.

I appreciate what Mr. Calloway has done with his interview. His honesty is informative in both its insights and its flaw. We need more honest, focused discussion like that. I don’t assume all men circumcised as adults would report reduced sensitivity. I know there are enough that it might help break through the societal barriers we maintain against ethical protections for the normal bodies of male children.

¹ Consider Mr. Calloway’s results in the context of a recent silly lifestyle trend piece. It concludes with a man from Staten Island named Boris who had himself circumcised at 33. Okay, fine, good for him. Even though he said that “[t]he next six months weren’t normal,” everything is apparently okay with circumcision because now “[w]e’re expecting a baby next month — everything works just fine!” Clap, clap, except no one is making the argument that circumcision prevents ejaculation or climax (Except in those rare cases of death where it prevents that). “Sex still feels good” is the most persistent and most pernicious straw man in the circumcision debate.

Read this response instead.

Swedish, Danish medical groups call for respecting rights of children

1/31/15 Edit: This news is from last January. I first saw it in this story posted this week. I looked for other news articles and used the one in this post because the quote from Mr. Ullenhag was more complete. I noticed the date of January 26th, but missed that it was from last year, unlike the link above. My analysis is the same, obviously, but the mistake is mine.

Interesting news:

Large medical associations in Sweden and Denmark recommended banning non-medical circumcision of boys.

In Sweden, the recommendation came in a resolution that was unanimously adopted last week by the ethics council of the Sweden Medical Association — a union whose members constitute 85 percent of the country’s physicians, the Svenska Dagbladet daily reported on Saturday.

It recommended setting 12 as the minimum age for the procedure and the boy’s consent. Jewish ritual circumcision, or brit milah, is performed eight days after birth. Muslims typically circumcise boys before they turn 10.

In Denmark, the Danish College of General Practitioners — a group with 3,000 members — said in statement that non-medical circumcision of boys amounted to abuse and mutilation, the Danish BT tabloid reported Sunday.

I don’t know that 12 is the right minimum age, but I’ve long been willing to accept an age below that of majority as long as the boy can offer his informed consent. I have concerns about how informed it could be at earlier ages, but I’m willing to leave the option for consideration.

The resolution is non-binding, which is still fine for this process. Less change is needed in Scandinavia than in the United States, but change is still needed. This is a step in demonstrating that even well-intentioned non-therapeutic circumcision constitutes harm, and the boy himself has the sole right to request or reject non-therapeutic circumcision for himself.

Any effort at respecting ethics in this area always brings some variation of this quote, with little variation:

“I have never met any adult man who experienced circumcision as an assault,” [Sweden’s minister for integration, Erik] Ullenhag said. “The procedure is not very intensive and parents have the right to raise their children according to their faith and tradition. If we prohibit it, we must also address the issue of the Christian ritual of baptism.”

Mr. Ullenhag has apparently done little research on the issues of circumcision and ethics. He is ignorant of what many adult men think of their parents making this choice. He does not understand the principle against direct physical harm involved that distinguishes circumcision from baptism or virtually any other ritual of any religion in which parents may want their children to participate. His approach implies no limits on parental authority. Surely he does not believe that is valid.

These recommendations are progress. These medical authorities, unlike American medical authorities, grasp the issues involved for the child. They are taking a principled stand. It is a positive and, more importantly, necessary step in the process to achieving proper protection for the rights and bodies of all children.

“Voluntary” Never Means “Voluntary”, Part Who Can Keep Count?

Zimbabwe has a plan, because public health officials just know.

THE ministry of health has launched an ambitious US$100 million male circumcision programme that is expected to see at least 80 percent of the male population being voluntarily circumcised.

Some 400 235 males have been circumcised since 2009 with ministry managing to introduce the non-surgical method of circumcision at some sites and launch preliminary studies on infant male circumcision.

If the infants aren’t volunteered, they might not volunteer. So, as always, when public health officials propose voluntary, adult male circumcision, they never mean voluntary or adult. (e.g. EIMC) Bonus points to Zimbabwe’s health minister, I guess, because he didn’t pretend the plan was only aimed at adults. But, as I wrote in the PEPFAR-EIMC post, I suspect that means officials know they no longer need to pretend to care about ethics. That isn’t progress.

Rhetoric and Purpose

I’ve written about how dreadful Lindy West’s thinking has been on male circumcision. But it’s possible she’ll understand the ethics involved and how it requires a slight-but-critical shift in her approach to the issue. There is a much better chance that will happen by challenging her mistaken idea rather than attacking her. In an interesting episode of This American Life where Ms. West tells of interacting with “her meanest troll”, she explains why this approach makes sense.

If what he said is true, that he just needed to find some meaning in his life, then what a heartbreaking diagnosis for all of the people who are still at it. I can’t give purpose and fulfillment to millions of anonymous strangers, but I can remember not to lose sight of their humanity the way that they lost sight of mine.

Humans can be reached. I have proof. Empathy, boldness, kindness, those are things I learned from my dad, though he never knew how much I’d need them. Or maybe he did.

I’d rather reach people, including Ms. West.

The same sentiment is in this post by economist David Henderson at EconLog. He discussed how his mother stood up for a student suspended for growing his hair long. She did so anonymously, and to the principle. When she had a chance to attack a man whose life contradicted his own defense of the suspension, this:

“Come on, Mum” (we used the British rather than the American version), I said, “Make it more direct. Say something like ‘others with our choices of scarves.'”

“No,” she said.

“How come?” I said, disappointed that she wouldn’t stick in the knife.

“Two reasons,” she said. “First, that’s mean. And that’s enough of a reason. Second, I want to convince not just the other readers but the person who will read this most closely: Harry. If I embarrass him, he’s less likely to reconsider his views.”

That is the activism in which I strive to engage.

NPR link via The Stag Blog, where Lucy Steigerwald writes, “Obviously I have major problems with Jezebel, and sometimes with Lindy West in particular, but I enjoyed her This American Life segment on talking to her meanest troll. Humans are humans! Just imagine!”

President’s Endless Plan for Avoiding Rights

PEPFAR held an event today, described as:

Join global health experts in PEPFAR’s sixth VMMC Webinar to consider the pros and cons of offering early infant male circumcision (EIMC) as part of routine Maternal, Newborn and Child Health (MNCH) care.

The title of the event was, “Scaling Up Routine Early Infant Male Circumcision within Maternal, Newborn and Child Health”. I wonder what the outcome of considering the pros and cons will be.

It’s also worth noting how circumcising infants has been separated as EIMC from “voluntary” male “medical” circumcision (VMMC). Is it progress if they’ve stopped pretending that infant circumcision is voluntary? Not really, I think, since no one involved cared anyway and dropping it means they’re comfortable with making it clear they don’t care.

Framing with Reason or Emotion

Dr. Adam Aronson, for Kids First Pediatric Partners, has an explainer, “Circumcision: A Parent’s Choice”. It’s predictable rather than what it should be. But given that there are countless versions of this same refusal to take the ethical stand, I highlight this one because it’s poorly framed in an instructive way.

Reasons Parents May Choose Circumcision
There are a variety of reasons why parents choose circumcision.

Medical benefits, including:

  • A markedly lower risk of acquiring HIV, the virus that causes AIDS.
  • A significantly lower risk of acquiring a number of other sexually transmitted infections (STIs), including genital herpes (HSV), human papilloma virus (HPV), and syphilis.
  • A slightly lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised (sic) infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.
  • A lower risk of getting cancer of the penis. However, this type of cancer is very rare in all males.
  • Prevention of foreskin infections.
  • Prevention of phimosis, a condition in uncircumcised (sic) that makes foreskin retraction impossible.
  • Easier genital hygiene.

These are stated as facts. I concede¹ them as facts for my purpose here, even though I think it’s critical to mention, for example, that the relative risk reduction for female-to-male HIV transmission applies to populations with high incidence of HIV and low circumcision rates, which doesn’t map to the HIV problem in the United States. Also, the absolute risk is tiny. Whatever. Yay, facts, I guess, because none of that justifies applying them to the normal, healthy foreskin of a child (i.e. parental choice).

But that isn’t the issue. This is:

Reasons Parents May Choose Not to Circumcise
The following are reasons why parents may choose NOT to have their son circumcised:

  • Fear of the risks. Complications are rare and usually minor but may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.
  • Belief that the foreskin is needed. Some people feel the foreskin is needed to protect the tip of the penis. Without it, the tip of the penis may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be surgically corrected.
  • Belief it can affect sex. Some feel that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life.
  • Belief that proper hygiene can lower health risks. Boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and STIs.

Parents “fear” the rare and usually minor risks, yet the potential benefits were presented as parents’ reasoned approach to risks rather than parents circumcising because they fear statistically-unlikely problems. This is especially odd since most of the potential problems used to justify non-therapeutic infant circumcision are even less likely to occur during the years parents are responsible for their child’s health.

Parents hold a “belief” that the foreskin is needed. They “feel” the foreskin protects the tip, as if circumcision removes only the foreskin around the tip of the boy’s penis. And the transition to the facts of irritation and possible meatal stenosis holds the stigma of “belief” rather than “reasons not to remove an individual’s normal, healthy foreskin without his consent”.

Parents may have a “belief” that circumcision can affect sex, even though this is a fact once the foreskin is gone. Changing form changes function. It doesn’t have to get to a change in sensitivity.

Parents trust in “belief” that proper hygiene² can lower health risks, which we know is a fact. It’s also our default expectation that parents properly care for every normal part of a child, except a boy’s foreskin, because that has a hygiene exception where surgery is somehow justifiable as a parental choice.

This frame appears over and over again. “Reasonable” people understand that circumcision provides important benefits that are “good”, as the Los Angeles Times Shareline demanded yesterday. It appears in almost every interview Dr. Douglas Diekema gave on behalf of the AAP or CDC in the last few years, such as when he said “If you talk to reasonable people about what the data shows… it’s real. …” Circumcision is designated as the rational approach. Parents who impose it are presented as more rational because they looked at facts, at science. Parents who respect their son’s normal, healthy body as they respect their daughter’s normal, healthy body are presented as emotional, anti-science, or “foreskin fetishists”. Their argument allegedly amounts to nothing more than “don’t hurt the babies”. They “believe” in spite of facts.

Here’s the first list again, processed through the second list’s filter:

Reasons Parents May Choose Circumcision

  • Fear of HIV, even though the absolute risk of female-to-male vaginal transmission in the United States is markedly low.
  • Belief that he will be at risk of other sexually transmitted infections (STIs), including genital herpes (HSV), human papilloma virus (HPV), and syphilis. Condoms protect significantly better against STIs, and a vaccine exists for HPV that is approved for males, as well.
  • Belief that the adhered, non-retractable foreskin could trap dirt, leading to a UTI. Some research suggests that infant circumcision causes at least as many UTIs as it prevents.
  • A belief that foreskins lead to cancer of the penis. However, this type of cancer is very rare in all males.
  • A belief that the foreskin can’t be cleaned sufficiently, leading to infections.
  • Belief that phimosis is more common than it is and can only be treated with circumcision. Steroid creams and manual stretching can often resolve non-retractable foreskin issues.
  • Fear of smegma. Males and females produce smegma. Regular bathing minimizes risk.

How does it look now?

Proponents of parental choice need to reconsider their support, for they are wrong. They must prioritize the facts of the boy’s (i.e. the patient’s) present, and how there is no problem in need of the most invasive solution. Science without ethics is a monstrosity posing as a reasoned set of facts. There is no defense for prioritizing fear of a statistically-unlikely future to imagine validity for parental choice for non-therapeutic genital cutting of children (male-only, “obviously”) now.

¹ I do not concede them as valid justifications. I’ve omitted the social and religious reasons sections from discussion. Potential medical benefits are insufficient to justify non-therapeutic child genital cutting. Social and/or religious reasons should obviously be recognized as particularly insufficient to justify proxy consent for (non-therapeutic) surgery.

² I do not concede this item as a fact, even for rhetorical purposes. “Easier” caters to the ignorant and lazy. This should be clear from Dr. Aronson’s last paragraph, “What If I Choose Not to Have My Son Circumcised?”.

… Keep in mind that the foreskin will not fully retract for several years and should never be forced. When your son is old enough, he can learn how to keep his penis clean just as he will learn to keep other parts of his body clean.

So, for the bulk – or all – of the time that parents will be primarily responsible for keeping their son’s genitals clean, it requires no extra work to clean an intact penis. This excuse deserves no credibility.

Flawed Circumcision Defense: Karin Klein

Encouraging half-baked opinions, like this one by Los Angeles Times reporter Karin Klein, is the inevitable result of the CDC’s proposed recommendation. The opinion piece is titled, “It’s time to end inaccurate criticisms of male circumcision”, which suggests its author should not offer an incomplete analysis in defense of male circumcision. That is what Ms. Klein offers.

The recent report by the U.S. Centers for Disease Control and Prevention should quell the unfounded arguments that male circumcision is no better than or different from female circumcision, also known as female genital mutilation. According to the draft guidelines released by the CDC, the benefits of male circumcision clearly outweigh the risks, in the form of reduced risks of urinary tract infection as infants and penile cancer later in life, and lower risk of contracting HIV and other sexually transmitted diseases.

The short version of her essay is “Shut up.” It’s her introduction and conclusion. Alas¹, no.

“According to the draft guidelines released by the CDC” involves undue weight for the recommendation. The CDC’s conclusion is subjective. The equation is not merely benefits versus risks. There is a direct cost (i.e. harm) in the loss of the foreskin. That matters, yet it isn’t factored into the CDC’s analysis (or the AAP’s before it or Ms. Klein’s here). And the CDC ignores the individual foreskin owner’s preferences. Someone might value his foreskin more than reduced risks of future maladies. As I do. It isn’t defensible to declare that the potential benefits “clearly” outweigh the risks, for everyone, or that this demonstrates anything conclusive.

The comparison of male circumcision to female genital mutilation rests on the principle involved, not indifference to the disparity in recognized potential benefits. Non-therapeutic genital cutting on a non-consenting individual is unethical. Minimal or maximal cutting is relevant for punishment, but not for whether the individual’s human rights are violated. A female owns her body from birth, including her genitals. A male owns his body from birth, including his genitals.

It’s understandable that circumcision has become controversial. It’s a permanent change made to the body, usually in infancy. (It should be noted that parents make all kinds of decisions that affect their children’s lives permanently; circumcision happens to be a particularly visible one.) …

It’s a permanent change made to the healthy body. Defending this removes any limitation on what parents may do. It isn’t that it’s a particularly visible effect. It’s that circumcision alters the child’s body without need. Proxy consent requires the patient’s need, not the proxy’s preference. Non-therapeutic circumcision is still cosmetic surgery, contra the silliness Ms. Klein will shortly suggest.

Nor is non-therapeutic circumcision acceptable because parents make all kinds of decisions. This common argument rests on the flawed premise that a) Parents make decisions for their children, b) Non-therapeutic genital cutting is a decision, therefore c) Parents may cut the healthy genitals of their children sons. It’s ridiculous. Treating all decisions equally to defend an extreme, gendered decision makes no sense. It imagines a strange scope of parenting we don’t accept, as evidenced by the required strikethrough in c) to narrow the conclusion to what parents may legally decide on non-therapeutic genital cutting. It’s about parental rights only to the convenient extent that it maps to what we want to do. It’s arbitrary.

The CDC report won’t end the debate, nor should it necessarily do so. Perhaps its most important short-term good will be to increase the likelihood that the procedure will be covered by health insurance, because circumcision could not be viewed as solely a cosmetic procedure, but rather one that carried health benefits backed by the most current scientific research. That gives parents the option — either way.

It is still cosmetic surgery, even with potential health benefits backed by the most current scientific research. It is backed by an incomplete analysis of all factors involved. Arguing only from potential benefits and risks without factoring in the costs (i.e. harms), as well as preferences for how an individual weighs those three aspects for himself, is biased, inaccurate nonsense. The CDC shouldn’t peddle it. Ms. Klein shouldn’t defend it.

But it should end the scurrilous argument that male circumcision, with its very low complication rate, is mutilation on par with female circumcision. There are no known health benefits to female genital circumcision and a long list of not-uncommon consequences, including fistulas, abscesses and childbirth complications.

If Ms. Klein is going to use a word like scurrilous to criticize critics, she should first understand mutilation. Should we assume that a case of non-therapeutic female genital cutting without the girl’s consent that doesn’t result in a complication, or at least only a “very low complication rate”, isn’t actually mutilation? I assume Ms. Klein’s answer is the correct answer, which is “obviously not”. We can also search for the unifying principle that shows how weird it is to argue that parents should have the choice to surgically alter the bodies of their children, except this choice is for sons only because we’ve researched that. For example, in the WHO factsheet on Female Genital Mutilation, this:

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.

Partial removal or other injury to the genital organs for non-medical reasons? As long as you don’t foolishly suggest “reduced risk of X” is somehow a medical reason² for non-therapeutic circumcision, removing the foreskin is clearly such an injury.


FGM has no health benefits, and it harms girls and women in many ways. It involves removing and damaging healthy and normal female genital tissue, and interferes with the natural functions of girls’ and women’s bodies.

Removing and damaging healthy and normal genital tissue, and interferes with the natural function of bodies? Male circumcision fits that, too. Without need or consent, male circumcision is indefensible genital mutilation. Awareness of potential benefits does not change the equation. It is mere question-begging.

Of course, even religious traditions shouldn’t outweigh health concerns. Just as female genital mutilation is outlawed in this country no matter what the religious beliefs of the parents, if the CDC report had found similar complications with male circumcision, then there should be serious conversations about whether the procedure should be allowed. But that’s not what the science shows; until there is solid evidence to contradict the CDC report, conversations about restricting parents’ ability to make this decision for their sons should end.

It makes sense to ask if the boys who suffer the complications, including the most serious outcomes, could be considered mutilated, or is it merely based on the intent we assume for the parents? (The simplistic, “Male genital cutting is well-intentioned. Female genital cutting is ill-intentioned.”) But complications and consequences are unique. Consequences includes the costs (e.g. loss of the foreskin). That ignored aspect is what makes non-therapeutic male circumcision an unacceptable parental choice. Again, using the subjective conclusion that the benefits outweigh the risks while excluding the factual harms and the child’s preference is an incomplete analysis. Demanding, as Ms. Klein does, that we guide policy on this subjective opinion is ludicrous.

The CDC’s recommendation and Ms. Klein’s demand aren’t made better by using SCIENCE! as an incantation. Å normal, healthy foreskin is science. The numerous methods short of circumcision to prevent and/or treat maladies are science. A condom is no less SCIENCE! than circumcision. Antibiotics are no less SCIENCE! than circumcision. Soap and water are no less SCIENCE! than circumcision. It might be interesting that parents prefer SCIENCE! to SCIENCE!, but the issue involves ethics. The ethics are the same, whether it’s daughters or sons. Non-therapeutic genital cutting on a non-consenting individual is unethical. We all have the same basic rights. Non-therapeutic genital cutting without the individual’s consent violates her – or his – basic human rights.

¹ The piece includes a “Shareline” suggestion to tweet out a link to it with propaganda, “There are reasonable debates about male circumcision — but not about its benefits vs. risks”. That’s also nothing more than “Shut up”. It poisons the conversation by setting boundaries on what’s “reasonable” to debate. It’s also incorrect.

² The factsheet makes it clear that this would not be accepted for any non-therapeutic female genital cutting, as the law against FGM in the United States also makes clear. There is a principle, and it doesn’t negate the principle of equal rights simply because we’ve agreed to study the possible benefits of cosmetic surgery.

Start a pilot project on the ethics of consent

It’s banging a well-beaten drum, but as always, when public health officials discuss voluntary adult male circumcision, they never mean voluntary or adult. Again:

Kenya could expand circumcision of newborn babies if a pilot project in Nyanza is successful.

The organisation carrying out the pilot exercise reports that more parents are warming up to the idea of their babies being cut a few days after birth. The exercise follows earlier studies that proved circumcision of infants would be safe and acceptable.

Nyanza Reproductive Health Society says they have cut 600 male infants since January in the pilot programme.

If the 18-month project is successful, infant circumcisions will be rolled out countrywide. “The circumcision of an infant is safer, less technically challenging, faster, easier to care for postoperatively,” says Marisa Young, the PhD student at University of Illinois who is heading the project.

Was it acceptable to the 600 males circumcised in this program since January? Science without ethics is disgusting.

In 2012, Marisa published a study in the journal Pediatrics [ed. note: link], which revealed a high acceptance of circumcision for infants in Nyanza where circumcision is not a rite of passage.

“As adult MC becomes more prevalent, demand for Infant Male Circumcision (IMC) is likely to increase,” Marisa says in the study, which found mothers more willing to have their babies circumcised, compared to men.

From the beginning, WHO/UN/UNAIDS aimed for social acceptance, which would lead to high acceptance of circumcision for infants. We don’t want to admit we’ve made a mistake or been harmed in any way. To admit this, we must admit the obvious flaw in believing that “high acceptance of circumcision for infants” matters. The issue is always whether there would be high acceptance of circumcision by these infants. We do not know. Post hoc defenses are interesting, at best. They are irrelevant. But as we see again here in Ms. Young’s unethical study and program, the key is always to circumcise males before they can choose not to volunteer. It would be too obvious a violation to force circumcision on non-consenting adults, so children become the target.

Cutting matters more than the “why”

Mona Eltahawy writes in The New York Times:

I am a 47-year-old Egyptian woman. And I am among the fortunate few of my countrywomen whose genitals have not been cut in the name of “purity” and the control of our sexuality.

This is an important topic. She explains it well as it pertains to Egypt. But this paragraph bothers me:

The practice is sometimes erroneously referred to as circumcision. According to the World Health Organization, it “comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for nonmedical reasons.” The procedure has no health benefits. We hack away at perfectly healthy parts of our girls’ genitals because we’re obsessed with female virginity and because women’s sexuality is a taboo. This cutting is believed to reduce a girl’s sex drive. And families believe their daughters are unmarriageable unless they are cut.

“Sometimes erroneously referred to as circumcision” is meant to distinguish FGM from male genital cutting. “No health benefits” demonstrates this point for the few readers who didn’t catch the “male circumcision is okay” implication¹. That’s nonsense. It’s reasonable to state that the two inflict different degrees of harm in common practice, and that difference can be significant. It is not reasonable to distinguish the two as “acceptable” and “unacceptable”. The World Health Organization quote she used describes male genital cutting, too.

The end of the paragraph demonstrates this point. Were I to write the second half of that paragraph, I’d write it from this perspective:

We hack away at perfectly healthy parts of our girls’ genitals.

That sentence doesn’t need the because. She was correct to include it. It’s relevant for explanation. But the sentence as I wrote it does not need a “because”. It doesn’t matter why we do it, hacking away at a child’s perfectly healthy genitals is always wrong. Get the principle right and the comparison takes care of itself.

For example, does anyone believe Ms. Eltahawy would change her mind if someone discovers health benefits for any form of FGC? Would she be okay with research studies to determine if there are benefits? I wouldn’t. I don’t believe she would. What about cases where her “because” is wrong and parents are honest-but-mistaken in their intent? Nothing changes. The truth that we shouldn’t hack away at a girl’s healthy genitals is clear. There is no excuse for making or endorsing an implication that hacking away at a boy’s healthy genitals is somehow acceptable. People who make the argument Ms. Eltahawy makes in that paragraph advocate for special rights, not human rights.

¹ See also.