Category: Pain

Flawed Circumcision Defense: Barbara Kay

[10/19 Update: Edited for clarity and to reduce speculation since late night posting is imperfect and probably unwise.]

National Post columnist Barbara Kay used Brian Morris’ latest rehash on circumcision to repeat her ignorant thoughts on the subject. She begins by regurgitating claimed benefits, which can all be conceded here for the sake of time because they’re irrelevant to the only issue, ethics. Then:

… Dr. Morris and his American co-authors state, “We found that up to 65% of uncircumcised males might experience at least one of these [medical conditions] over their lifetime.” …

Until May 2015 Morris claimed the number as 33%. Since June 2015 he claims it’s 50% in a brochure on his website. And it’s apparently 65% in this new review. When will he settle on 100%? But more to the point, it’s obvious he likes whichever way he can claim this number because it’s flashy. “Ooooooh, 33/50/65 percent is high. Such danger!” But it’s a meaningless number in the context of non-therapeutic circumcision of boys. I assume Morris knows this. I assume Kay doesn’t, so a review of Morris’ history could help. Instead of those numbers, this is what is worth discussing here, from Morris:

Up to 10% of males reaching adulthood uncircumcised [sic] will later require circumcision for medical reasons.

Not only is the number only 10%, it’s only up to 10%. Medically necessary circumcision is rare, at any age. There is no ethical case for imposing the most radical solution without consent when at least 90% of males will never need it.

She continues:

… Their risk-benefit analysis of the procedure led them to conclude the benefits exceed the risks by about 100 to one. (In another study, published in the Journal of Sexual Medicine, Dr. Morris and colleagues found circumcision produced no adverse affect on sexual function or pleasure, a charge often leveled by anti-circumcision activist groups.)

Much like when Yair Rosenberg accepted Morris’ claim unexamined, Kay doesn’t appear to know the primary source.

But in a study Morris and Krieger rate as [highest quality], Payne et al [12], this:

… It is possible that the uncircumcised penis is more sensitive due to the presence of additional sensory receptors on the prepuce and frenulum, but this cannot be compared with the absence of such structures in the circumcised penis. …

Payne’s study published in 2007. In 2011 Kay wrote:

Set aside the rights-based rhetoric. It’s about sex: Circumcised men have greater pre-orgasmic endurance; non-circumcision permits more frequent ejaculations. …

So, circumcision either delays orgasm, assumed to be positive for all men, or has no effect on sexual pleasure. Like Morris, she appears to play “heads I win, tails you lose”.

Kay goes on to write:

… The AAP states: “The new findings show that infant circumcision should be regarded as equivalent to childhood vaccination and that as such it would be unethical not to routinely offer parents circumcision for their baby boy. Delay puts the child’s health at risk and will usually mean it will never happen.”

That quote is not from the AAP. It’s from Prof. Morris. He wrote it in a press release more than 18 months after the AAP published its revised position statement. Kay doesn’t bother to fact check the most basic statement. [ed. note: Kay asked the online editor to correct her error.] Nor does she pursue how Morris’ quote undermines their case for non-therapeutic neonatal circumcision since he acknowledges that circumcision is rarely necessary.

Thus, while it’s inexcusable, it’s hardly shocking when she continues:

The CPS could not condemn the practice on grounds of increased morbidity. After thousands of years of what is essentially a controlled study with virtually all Jewish men, with a large percentage of Muslim men on one side, and uncircumcised men on the other, it has been unequivocally concluded that circumcision presents no health risks; quite the contrary, as we shall see.

Even Morris doesn’t pretend that circumcision “presents no health risks”. He understates them, and ignores the guaranteed harm from the removal of the foreskin (and possibly frenulum) in 100% of circumcisions. But he’s not so biased that he’ll posit such an obvious untruth. Yet, there’s Kay’s indifference masquerading as hyperbole for all to see.

… Morris’s team estimates the combined frequency of adverse events at 0.4% overall, arguing that “the cumulative frequency of medical conditions attributable to [having an intact foreskin] was approximately 100-fold higher” than the cumulative risk of circumcision.

Even if we accept the numbers, he’s arguing frequency of medical conditions attributable to the foreskin, not the frequency of medically necessary circumcision. It’s fascinating, perhaps, but a transparent obfuscation. The anti-science charge is often leveled at activists here, but soap, water, antibiotics, steroids, condoms, and so on are also science. To start with the most extreme solution at the tiny prospect of a problem sometime in the future is ridiculous.

When she gets to the comparison of male and female genital cutting, she ignores the principle.

The single most irrational argument one often sees is the charge of moral equivalency between circumcision and female genital mutilation. FGM is a phenomenon that is, apart from both affecting the genitals, …

Apart from both affecting the genitals, indeed. Affecting the genitals of a healthy child who does not need or consent to the permanent alteration of said healthy genitals. Non-therapeutic genital cutting on a non-consenting individual is unethical. The individual has inherent rights to bodily integrity and autonomy from birth. Non-therapeutic circumcision violates those rights.

… quite separate from circumcision. Unlike circumcision, which removes an unnecessary piece of skin, …

Unnecessary circumcision removes a piece of skin. It’s the same words, but made objective rather than subjective. It’s the fact-based opposite of “heads I win, tails you lose”.

… in no way prevents natural and satisfying sexual function, …

In addition to calling back to the Payne study and Kay’s earlier comments about delayed orgasm, circumcision removes the foreskin, a natural part of the body. That is “natural”. Its mechanism is gone, so circumcision certainly prevents that function. And “satisfying” is subjective. Would all men prefer delayed orgasm and the loss of the foreskin? (I don’t.)

… FGM is a misogynistic practice created as a means for men to control women, …

Circumcision controls men. Its imposition is another’s assessment that the male’s body should be the way someone else prefers. It is then made that way (hopefully, except when complications occur, including possible death). The male is never asked. He is to say “thank you”, praise the imposition, and impose it on his sons as soon as they’re born.

Kay’s argument rests on control as intent rather than action. I doubt she would accept that parents cutting their daughter’s genitals for the reasons we allow them to cut their son’s genitals. She assumes their intent is always evil, but is it the intent or the act that matters here? If she believes intent with FGC is only what she writes, as she appears to believe, she should read more¹ on the topic. And then extrapolate back to the disparity in the intent and the violence of male circumcision.

… meant to prevent sexual desire and gratification in women to ensure their fidelity, and which removes a portion of the genitals absolutely vital to gratification. It is the very epitome of patriarchy, whereas circumcision is a rite of passage conceived by males for other males, and for thousands of years rooted solely in spiritually contractual language and meaning. Women who have been subjected to FGM invariably come from countries in which extreme misogyny is the norm. Circumcision carries no moral or gender-injustice baggage of this kind whatsoever.

I agree that FGM is awful. But it’s silly to repeatedly claim a definitive knowledge that male circumcision does not remove of portion of the genitals absolutely vital to gratification. She ignorantly cites bad summaries of studies and only uses groups of males circumcised at birth or as young children as reference points for this opinion. She doesn’t appear interested in males as individuals with rights and preferences of their own for their foreskins. (“Conceived by males for other males”.) Preference for the foreskin or circumcision is an individual decision. What other males prefer is only valid for themselves.

She closes by misunderstanding the ethics involved one last time, in a disgusting manner:

Parents deserve to be informed of all the evidence, pro and con, when the issue of circumcision arises. It is not necessary for the CPS to actively recommend circumcision to keep to the path of ethics and professional responsibility, but given the accumulation of evidence demonstrating the positive effects of circumcision, it would be unethical of the CPS – or any pediatricians individually – not to present the science available, or worse, to recommend against the procedure.

She’s dancing close to the silly proposition that boys have a right to grow up circumcised. The only ethical position is absolute opposition to (and prohibition of) all non-therapeutic genital cutting without the patient’s consent. It’s the right she recognizes for females. Her source (inadvertently?) recognizes that circumcision is rarely needed ever and can be (but likely won’t be) chosen later. She cites evidence of males who are dissatisfied with circumcision and being circumcised. But she ignores these in favor of her own biases. Cognitive dissonance (and a non-sequitur) is the best she can offer. She is ignorant. She should aim to be less ignorant.

¹ Consider Fuambai Sia Aahmadu, and from 2008.

Some of us wouldn’t dream of having any procedure

There is an inherent flaw always present in “parents should decide on genital cutting (but only for boys)” essays. An asinine dismissal of the ethical principle will exist. Although the case against must be made each time, the ethics obviously do not support that stance. Non-therapeutic genital cutting on a non-consenting individual is unethical. It violates bodily autonomy. Any facts supposedly in favor of at least allowing parents to decide can’t overcome this basic principle. So when an essay is titled “Why the decision to circumcise should be left in the hands of the family”, the flaw is guaranteed to be there. It’s the only way to seemingly make the premise hold. Yet, I’ve never seen the flaw so ridiculously written as in Dr. Jeremy Friedman’s essay.

Deep into the essay (emphasis added):

I understand that there are many vocal groups who feel that circumcision has a negative effect on sexual function and pleasure. I also realize that some feel it is unethical to remove something from an infant’s body without a clear medical need and without the infant having some input into the decision.

As a pediatrician, I’m not really professionally qualified to discuss the merits of these viewpoints but I respect the right of those individuals to express them. I am, however, qualified to tell you that babies are capable of experiencing pain and I don’t think it is acceptable to perform a circumcision in a newborn without some form of analgesia. There are a number of different options to prevent pain, and this should be discussed with the practitioner chosen to do the procedure, well ahead of the circumcision.

Dr. Friedman stated that he’s not professionally qualified to discuss the merits of these viewpoints, yet this is the next paragraph, his conclusion:

So what is my take-home message? The decision should be left in the hands of the family. Current medical evidence points to some specific advantages to being circumcised, especially in certain higher risk groups. In Canada I’m not convinced that there is sufficient medical evidence to advocate for circumcision in a family that would not choose it for religious/cultural/family reasons. Nevertheless in those who do choose it, I think they should be allowed the right to proceed, but I will put in a plea for encouraging adequate pain relief. Let’s face it: None of us would dream of having any procedure on this rather sensitive part of our anatomy without it.

He can’t evaluate the validity of individual autonomy for a human being, but he’s qualified to draw a conclusion without concern for the effect on his conclusion from the ethical claim he did not test. That’s pathetic. It isn’t acceptable to punt an aspect of the debate and then claim victory. It’s more ridiculous because he felt competent to draw an ethical conclusion on pain relief. It’s a minor distance from a plea to use pain relief to a plea to refrain from medically-unnecessary circumcision.

**********

In a paragraph aimed at defending parental choice because a study claims the complication rate is lower for newborns, he wrote:

… My interpretation of this data is that when circumcision is performed by adequately trained individuals, complications are infrequent and usually fairly minor. Most common would be infection and bleeding which can be treated quite easily. Nevertheless severe complications such as penile injury can occur, albeit very rarely. If one wants one’s son circumcised then it appears to be much safer if done in the newborn period.

Penile injury occurs in every single circumcision. Less severe penile injury isn’t irrelevant simply because it was intended.

Renee Lute’s Circumcision Decision Deserves No Respect

At The Good Men Project Renee Lute makes a request: Please Respect Our Circum-Decision. It only requires a short response: No. Still, her essay is worth analyzing to explain why the only answer is “no”.

Circumcision on a healthy child is a permanent body alteration without the child’s consent. I’m under no obligation to respect that. I do not believe anyone should respect that. If Lute understood circumcision as well as she claims, she’d understand how absurd it is to request respect for her decision from someone who recognizes this surgical intervention as the human rights violation it is.

She is, of course, due a respectful rejection of her request. I will not engage in ad hominem, nor will I call her names as a result of what she intends to do. Anyway, facts and logic are enough to demonstrate her errors.

She begins:

… I’m apologizing to [my unborn son] for writing this piece, because now the world will know just a little bit about the future state of his penis, and most little boys don’t have to deal with that. …

This common theme is strange. Intact genitals are the human default. Unnecessary intervention is the only reason the status of a child’s genitals is considered an issue if people know, as if knowing is a Big Deal. Or, rather, unnecessary intervention is the only reason the status of a boy’s genitals is considered an issue if people know. This bizarre reality is the result of intervening, not some inherent shame in having others know we have human genitals.

That gets to the reason why I won’t respect her and her husband’s decision for their unborn son. A daughter’s normal, healthy genitals are off-limits for surgical intervention, and rightly so. Those who recognize the ethics involved as gender-neutral must stand against the opinion that a son’s normal, healthy genitals can be subjected to surgical intervention. (There will be more on the valid comparison below.)

She discusses Mark Joseph Stern’s terrible Slate piece (my post) and Brian Earp’s reply at The Good Men Project. She writes:

Neither of these articles really threw me. I know the arguments against circumcision, and I know the arguments for circumcision. What did surprise me, however, was what I found in the comments section under The Good Men Project article. …

Never read the comments. We know that doesn’t mean “never read the comments”. But it’s a reminder that the Internet is a place for bad manners and emotional responses. That’s particularly true in comment sections. Discussion of circumcision is no different. I’m not excusing the behavior. The rude, hateful, and misogynistic garbage is wrong and needs to stop. But reasoned proponents of bodily integrity, as I aim to be, have our argument harmed only in the sense that someone is willing to generalize about those who disagree based on the miscreants that any group has.

… I am not a circumcision enthusiast. In fact, I could not care less whether other people circumcise their sons or not. Do it if you want! Don’t if you don’t want! But I am begging you—begging you—to not make families who choose to circumcise their sons feel like they are abusers of children, or human rights violators.

“Do it if you want! Don’t if you don’t want!” is the false argument. What does the child who will live with the circumcision want? That is the core. Without knowing what he will want, imposing it as a non-therapeutic intervention is a human rights violation. I suppose it’s unfortunate if that makes someone feel bad about circumcising their healthy son(s). But I recognize that my parents violated my rights when they circumcised me. I won’t pretend¹ that someone else circumcising their son isn’t violating his rights because stating a truth makes them feel bad about the choice they make. (I do not take a position on how individual males should feel about being circumcised.)

Why am I going to have my son circumcised? Because his father and I have done our reading. We’ve talked about it, and we’ve made our decision. There are legitimate reasons. Circumcision eliminates the risk of phimosis (in which a foreskin is tight and cannot be fully pulled back, which makes cleaning and passing urine difficult, and increases the risk of penile cancer). This affects 1 in 10 older boys and men. Circumcision reduces the risk of inflammation and infection of the head of the penis and the foreskin, and greatly reduces the risk of urinary tract infections in infants. Uncircumcised men have a 15-60% increased risk of prostate cancer (which affects 1 in 6 men). [1] We are not uneducated about circumcision. …

That last line is not necessarily true, given what comes before it in that paragraph. The sole source cited for this knowledge is a pamphlet by Brian Morris, which contains no sourcing of its own. (Some of the material in this excerpt is verbatim from Morris, without quotes to indicate as much.) It contains information that is biased and exaggerated.

To the claim that circumcision eliminates the risk of phimosis, this is incorrect. Contrary to the risk of phimosis being a “legitimate reason” to circumcise a healthy child, the ethical standard is that the risk of complications is a legitimate reason to refrain from intervening on a healthy child. Remember, too, that Brian Morris is the cited source for the 1 in 10 claim. He’s stated that all boys are born with phimosis, which is false. Even if the statistic is true, it is that phimosis will affect 1 in 10, not that it will require circumcision in 1 in 10. This mirrors his claim in the pamphlet that “the foreskin leads to 1 in 3 uncircumcised boys developing a condition requiring medical attention.” A condition requiring medical attention is not a synonym for circumcision. This is a rhetorical sleight of hand. The true incidence of medical need for circumcision within an intact male’s life is approximately 1%, which includes for phimosis.

As for the “15-60% increased risk of prostate cancer” statistic, that is a correlation, not a proven fact. “Circumcision before first sexual intercourse is associated with a reduction in the relative risk of PCa in this study population.” To quote the author, “‘These data suggest a biologically plausible mechanism through which circumcision may decrease the risk of prostate cancer,’ said study researcher Dr. Jonathan Wright, an assistant professor of urology at the University of Washington School of Medicine. He noted that the study was observational; it did not show a cause-and-effect link.”

She continues:

… One of the aforementioned commenters wrote that anyone who would have their child circumcised should have to experience it themselves, first. Well, my husband has experienced it (and remarkably, he gave me his permission to tell the world just now), …

I don’t like that pointless suggestion because it invites that pointless rebuttal.

…and while I have not gone through the completely incomparable horror of female circumcision (I am not going to detail why it’s incomparable here, but I do encourage you to research the differences if you don’t know what they are. You’ll find some information here), …

I know what the differences are. I know what the similarities are. The difference is in degree, not in kind. That difference in degree can be great, of course, but non-therapeutic genital-cutting on an individual without the individual’s consent is not a gendered principle. The WHO defines female genital mutilation as “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.” The perceived difference², including in the link Lute provides, rests on what constitutes a medical versus non-medical reason. If we assume the “no known health benefits” argument against FGM turned into “known health benefits”, would people change their mind and decide it’s no longer mutilation? Some might say “yes”. They’d be wrong. I suspect most people would not change their conclusion. As the WHO states, FGM “also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.” That would still hold true if their were potential benefits. It holds true for male circumcision, as well.

… My husband and I aren’t unfamiliar with pain, and we are willing to put our child through a moment of discomfort for the benefits this procedure provides. Kind of like we’re willing to put our child through a moment of discomfort for the benefits that vaccinations provide.

But is their child son willing to have the moment (i.e. 1+ week) of discomfort and a lifetime without his foreskin for the potential benefits this procedure provides? (Remember from above that the Lutes do not appear to understand the benefits.)

Circumcision is not like a vaccination. Vaccinations work with the body’s immune system to trigger disease resistance. Circumcision merely removes a part of the body because it might cause a problem later. The comparison needs critical thinking beyond “prevents disease”, lest we further open parental decision-making to other ridiculous interventions.

This piece is both explanatory and pleading. I am pleading with you. Don’t make these perfectly well intentioned families—like us—feel like monsters because you’ve decided to go a different way with your own sons. We’re doing something different, and that’s okay. We each have our reasons. I don’t care whether you breastfeed or formula feed. I don’t care whether you co-sleep or have your babies in their own cribs, and I don’t care whether you’ve named your child something completely traditional (like Kate) or whether she’ll be answering to Zenith for the rest of her life. I’m asking for the same courtesy.

It’s okay to do something different. It is not okay to do this something different. You can’t respect one right of your son less than the same right of his sister and brush it aside as “parenting”. If someone asks me to respectfully tell them they’re wrong, I agree with that request for decency. But I will not respect what is obviously indefensible and deeply offensive to basic human rights.

¹ I don’t call circumcision “abuse”. (c.f. Truth and Loaded Words)

² The other mistake is in thinking that FGM is designed to control sexuality, but that male circumcision isn’t and doesn’t. It controls male sexuality because it forces a specific form on the child for his genitals. (e.g. It’s more aesthetically appealing to women.)

There is also a history, up to the present, in circumcision reducing sexuality. Read Moses Maimonides or this.

Dumbest Sentence I’ve Read Today

From the Anne Arundel Medical Center’s information page on (infant) circumcision, in the “How is circumcision performed?” section:

Circumcision is performed only on healthy babies.

I will never understand how medical service providers can recognize that and still think nothing is wrong with their participation in their imposition of this non-therapeutic surgery on their patient.

The AAP Worsens Its Flawed Circumcision Position

A lot has already been said about the AAP’s revised policy statement on non-therapeutic circumcision on non-consenting male children.

More will be said today and beyond. Much of it will be uncritical regurgitations of the AAP’s revision by news organizations. There will also be analysis from those who recognize and highlight the glaring deficincies and oversights in the policy. I expect to contribute my own thoughts. For now, I’ll highlight one key aspect from my initial read-through before going into what I think is a more important consideration to this apparent-but-not-really temporary setback.

The short version of the statement ends with this (emphasis added):

Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families.

That’s so close to the ethical stance. Remove families and focus on the individual and it would be ethical¹.

The way the promoted portion of the new “finding” within the revised statement differs from this conclusion is the key takeaway to challenge the supposed change from the AAP, which is really more-or-less just an exercise in urging politicians to permit circumcision on Medicaid. Here, the AAP demonstrates that its evaluation of the net benefit, that possible benefits outweigh the risks, is subjective and determined only by individuals. This directly contradicts the supposed proof based on their review of research that the potential benefits outweigh the risks (and the costs – the direct harm in every case – that they ignore). We should repeatedly emphasize that as often as necessary.

My concern is that we’ll get stuck in this low-level, short-term portion of the larger debate. It’s clear from European medical associations and courts that the eventual destination is public policy against non-therapeutic circumcision. The AAP and American society, in general, are (inexcusably) behind. But both will get there. Activists for the rights of children can make that happen sooner than it otherwise might happen.

The key is that we must give people the opportunity to save face, to avoid digging in to protect their egos. The problem is their stance, not necessarily their character. It should be obvious to them that their stance is incorrect. It isn’t. To address that, do we want to express an irrelevant, limited sense of superiority or convince others that we’re correct because facts and ethics demonstrate the case we’re making? If we impugn their motives and/or character by choosing the former, we may extend the period during which this policy statement stands or encourage people who can be influenced either way to choose the inferior stance of the AAP.

Edit note: I changed “it’s” to “their stance” to avoid possible confusion.

¹ The existing societal view treats certain basic human rights – for boys only – as a buffet from which parents may pick and choose for their own reasons. This is the problem merely expressed within the AAP’s policy statement.

“Moral Case for Circumcision” Ignores Morality

In this essay Rabbi Shmuly Yanklowitz attempts to make the moral case for infant circumcision. Rabbi Yanklowitz fails in every all seven attempts, and in the familiar ways. This is not surprising since non-therapeutic genital cutting on a non-consenting individual is immoral.

He starts with health. He makes the mistake of focusing on relative risk without concern for absolute risk or the implications of his approach. He concludes the paragraph with this:

… Is it fair to avoid giving a boy protection when it is available? It’s not only Jewish law to maintain one’s health but also Jews should serve as a model for this important health practice.

“To avoid giving a boy protection” is a weird way to frame this point. It shows the flaw because it suggests that the conclusion informs the defense rather than the reverse. It assumes parents are unreasonable if they don’t circumcise healthy boys. Is it fair to avoid giving any child any protection that might reduce the risk of something, regardless of how small that risk?

This approach to healthy children is only applied to the male foreskin. Every other possible intervention is rejected. We are not immoral when we “avoid giving” other potential protections. The moral case against infant circumcision demands its rejection as we already refuse to consider any other intervention that might reduce something at some point. Rejecting infant circumcision is the only consistent moral approach.

Next, explaining circumcision’s role in “sexual morality”, he quotes Maimonides and responds:

… Circumcised men may not have less sexual desire or more self control but teaching a value of sexual moderation may be one pedagogical goal of this ancient ritual. We have many sexual wrongs in society to be reminded of such as rape, adultery, impropriety, and molestation. Perhaps circumcision can serve as a sacred reminder for men, in our over-sexualized world, to cultivate self control.

What is this, if not a means to control male sexuality? I’ve written before about the mistaken belief that non-therapeutic male child circumcision does not involve control. It does, even if this is not consciously understood when expressing intent. So it is again with Rabbi Yanklowitz’s reasoning.

Worse, this is borderline insulting because he seems to imply that men are less likely to control themselves without some external intervention against their genitalia. If my foreskin hadn’t been removed shortly after birth, would I now be inclined to commit rape, adultery, impropriety, and molestation?

Next, Rabbi Yanklowitz offers a utilitarian approach:

If an uncircumcised man chooses to have the procedure done later in life, it will be much more painful (even with anesthesia) and dangerous than it would be for a newborn. It is the responsibility of parents to shield their children from unnecessary pain.

There is no guarantee a male left with his foreskin and choice will need or want circumcision later in life. Statistics show neither is likely. Yet, pain is guaranteed when a child is circumcised. The choice that shields the most children from unnecessary pain is to leave everyone intact until need arises or they can make the choice themselves. Instead of every child – male only – experiencing pain, only those who have the misfortune to have a malady or who decide that the potential benefits outweigh the costs (e.g. pain) for them will experience pain. From a utilitarian standpoint, the prudent (i.e. moral) position is to leave children intact with their normal genitals because this non-action causes the least amount of unnecessary pain.

It’s also questionable whether or not circumcision later in life is more painful and dangerous. If it’s more dangerous¹, the individual facing the danger can consent or reject the surgery if he doesn’t want the risk. (My assumption there is for elective, non-therapeutic circumcision, which is the issue involving infants.) And infant circumcision has its own dangers, since the foreskin is fused to the glans and it’s difficult to judge how much to take off since the child still has all of his growing remaining. Severe consequences like amputation and death can – and do – occur, as well.

The utilitarian approach is subjective and has a tendency to favor whatever argument someone is making because it assumes all people favor the same choices. Yet, each person must provide his own weighting to the relevant issues. (The typical flaw of utilitarianism is to completely ignore the value of the foreskin in the equation. Its loss somehow isn’t a cost of the surgery.) The utilitarian push for circumcision ignores that individuals are must live with the negative outcomes and/or the intended outcomes he may not want. All children together won’t share the lost glans, lost penis, or lost life in the instances of severe complications. It makes no sense to consider all children lumped together.

His fourth point is parental values and social acceptance. The topic itself demonstrates the necessary proof that this is about control. That control makes it immoral. The circumcision is unnecessary, yet the values of the parents override the child’s lack of need and possible preferences throughout his life. Making sure that others accept him via surgery elevates the opinion of others above his own about his body. It denies personal autonomy. The paragraph endorses that view, but these sentences warrant focus:

… Not circumcising a Jewish boy may hinder his social acceptance and his chances of finding a Jewish spouse. The overwhelming majority of Jewish women look for a mate who is circumcised. It would be cruel to prevent a man from potentially finding a suitable mate. …

This is a claim commonly made in defense of female genital cutting. If we reverse the genders in his position, it’s easily understandable that this is about controlling the child. There is no compelling reason why this defense is acceptable for male genital cutting while being (rightly) rejected for female genital cutting. It is immoral when imposed on either gender.

Next, he extols the virtues of modesty. I don’t have much to say on this. Parents surgically altering their son to remind him to live up to their idea of modesty is self-evidently about control, and thus, immoral.

Next, “unconscious memory”:

…We give our baby boys one token formative experience, and then we do all we can to protect and shelter the child. This experience helps to ensure that the boy can be a moral agent. However, this reasoning, of course, should not be extended beyond this minor example.

Whether this experience is “token” or not must be decided by the individual receiving it, not the individual giving it. It is a subjective judgment.

Beyond that, empathy is a wonderful trait. There are better ways to instill this in children involving parenting rather than surgery. Are males not empathetic enough, or capable of learning through logic and example, that they require such an experience before they can practice it in their lives? This is preposterous and impossible to prove. Using it as a defense isn’t acceptable, as evidenced by the qualifications offered at the end of the paragraph. Again, they suggest that the conclusion informed the defense rather than the reverse. (Every defense of circumcision suggests this in some way.) Inflicting pain and the removal of healthy body parts to teach lessons is immoral.

The last item is that circumcision is a symbolic reminder. It focuses on religion, which I’m going to leave alone. My response is that symbolism isn’t valid if the individual doesn’t value the symbols. There seems to be a considerable chance that a child will value many of the same things his parents value. I accept that without reservations. But the focus must be on the individual. This is not guaranteed for any individual. Permanently altering a child to remind him of something he may one day reject is problematic, at best.

Rabbi Yanklowitz proved nothing he set out to prove. The moral case for infant circumcision he attempted is little more than the most common responses given. The emphasis is on the parents, not the child. The moral case for surgery with children starts and ends with their physical need. For circumcision, there is no need. There is no moral case for non-therapeutic infant circumcision.

¹ This is where I’ll invoke the articles on the PrePex as an example. My objection to the recent pieces about it centers on the poor journalism rather than the device. I expect the device will eventually be tweaked to allow for infant circumcision at some point. That would be wrong. For now it’s a device for voluntary, adult circumcision. I have no objection to that. The claimed risks involved with the device are low. The claim that adult circumcision is more dangerous than infant circumcision doesn’t appear to hold up, generally, regardless of the method. This claim is a framing device of dubious quality rather than a fact to be negate ethics.

Flawed Circumcision Defense: Dr. Paul Rein

As activists we’ve all encountered poorly thought out, often incomprehensible arguments advocating for non-therapeutic child circumcision. In their mildest forms, these merely conclude that parents should do what “works for their family”, as if all penises in the family belong to the parents. In their worst form, they’re clueless, uninterested in learning, and offer any number of bizarre justifications that defend the decision while remaining ignorant of basic facts. This essay by Dr. Paul Rein is built on the latter foundation, with the surprise of an irrational excuse for surgically altering healthy boys that I’ve never heard before.

After an introduction and a brief, incomplete history of circumcision, Dr. Rein quotes Genesis 17, including the bit about circumcising one’s slaves. In response, he writes:

… WOW, pretty powerful stuff when taken literally. So why do you think this “law” came about? For me, like Jewish dietary laws (sic) it was all about health. In days past, before modern times, food such as a pig was not considered ok to eat by the Jews because pigs were dirty, ate garbage and carried worms. Bottom feeders in the waters fall in the same category. Circumcision was a matter of numbers of complications for not doing it. Circumcision is done on day 8 of life for what reason? Is there something magical about day 8? It turns out that on day 8 of a boy’s life his blood clotting factors are normal, such that his risk for bleeding is less. In most countries of the world where babies are delivered in the hospital a circumcision if performed is done in the first couple of days and the babies are given a shot of Vitamin K which helps the blood clot, in other words it is a convenience to be done then. Surely the Jews figured out by trial and error that day 8 was the earliest, best and safest time to perform the circumcision. Most likely their dietary laws also discovered that eating pigs caused more illness than not eating them. So lets get back to circumcision.

This is conjecture. It shows the logic-optional framework upon which Dr. Rein is willing to build his conclusion on non-therapeutic child circumcision. I’d like to see citations for the number of complications throughout history “for not doing it”. But I can accept that without citations because it’s irrelevant to the more immediate question: what is justified today?

For example, whether or not there’s something magical about day 8 or the availability of Vitamin K may be interesting, but neither is a valid defense for circumcising healthy infants. Being convenient doesn’t make it acceptable. Any biological magic of a healthy human’s Day 8 ability to properly clot his blood still applies to his Day 6,574¹ ability to properly clot his blood. But, ethically, only one of those is valid.

When Dr. Rein begins to discuss risks of circumcision, he fails to include a complete list of objective outcomes. Some are possible and some are guaranteed.

… The risks include, pain on performing the procedure, bleeding and infection, irritation of the glans, increased risk of meatitis- which is an inflammation to the opening of the penis, injury to the penis during the procedure, and a belief by some that removing the foreskin decreases sexual pleasure. There are also some people who believe it is a violation of the child’s human rights because they did not consent to the procedure.

He should’ve mentioned that circumcision includes the risks of amputation and death. Those are rare, but if he’s not including the absolute risk of the maladies against which non-therapeutic circumcision is a prophylaxis, a full set of known risks should be included.

He should also state that circumcision leaves a scar. That could lead into an actual discussion of whether the male himself wants that, as well as the intended cost of the surgery, the loss of his foreskin. The foreskin is not, biologically, an inert afterthought. I’m not surprised he would omit this because I don’t think he understands this. But the burden is on him to be educated, not on others to defend why healthy, normal body parts exist.

His advice focuses into one key paragraph:

What is a FAMILY to do when they have a newborn boy? …

Celebrate and not cut his healthy genitals. This is what a family does when they have a newborn girl.

… As I have mentioned in the past it is up to you to make informed choices. You as the responsible adult who has had a child should make an informed decision. Educate yourself as to the benefits and risks remembering that most of the risks are small, but when they do happen to you they are 100% in your experience. Nothing is without risk and you weigh the risk versus the benefit. …

Being the “responsible adult” does not mean that option is valid. Tradition does not justify its imposition. The possibility of benefits, the “responsible adult’s” subjective minimization of the risks involved, or the doctor’s omission of the full costs also fail as justifications. The surgical alteration is not medically indicated or necessary. That is the sole relevant information. Where circumcision is being imposed on another who can’t consent, only medical need can justify it.

… Regarding circumcision if you choose not to have your child circumcised and as an older boy or adult he needs to be circumcised the risks increase. The risk of surgery such as pain, bleeding and infection are higher for older boys and men. …

This logic could be applied to any non-therapeutic surgery one might choose to force on a healthy child, primarily with respect to pain. The claimed inability to remember the pain as an infant does not mean the infant does not experience the pain. As an adult, the individual has the choice to use sufficient pain management. It’s also worth noting that actual need for circumcision is rare. Where an adult male’s circumcision is optional, his preference for the possible benefits demonstrate that he values them more than the costs, including the pain. Infants don’t get that choice.

… If you believe that the pain of a circumcision is traumatic to the child and affects him for the rest of his life then don’t do it. To that I say, c’mon. A newborns brain is immature and the few seconds to minutes of crying is no more traumatic that a night of crying from colic. Does that baby who has colic from a formula become so traumatized that he never wants to drink from a bottle? …

Dr. Rein’s lack of concern for the child and what he may experience from unnecessary surgery is scary. Is “c’mon” the scientific term for a newborn’s pain coping mechanism?

… Arguments such as decreased sexual pleasure from a man’s point of view are pretty tough to make. Do you really know any guys who say, geez I wish ….?

Here I am: Geez, I wish I had my foreskin. I am not alone. Dr. Rein should research the topic before he mocks opinions he does not understand. Research would allow him to reject his own incorrect ideas that are easily refuted.

It gets worse:

… Another thing to think about in making your decision is are you a single mother having this child? Little boys, 5 and up are probably not inclined to have their mom making sure that they are practicing proper hygienic techniques and in light of the fact that the USA has the highest rate of single parent homes in the western world that might be something you want to consider. …

Yeah. I thought I’d heard all the dumb arguments. I’m not pleased to know that more creative stupid excuses develop. Raising children involves teaching them proper hygiene and setting expectations for maintaining that throughout childhood. Dr. Rein’s suggestion is nothing more than telling parents (i.e. the “responsible adults”) it’s okay to abdicate their parental responsibilities because that responsibility is too uncomfortable.

To put it in a different perspective, as someone stated in the comments section of the essay, would it be legitimate to suggest that single fathers have their daughters’ genitals cut because it would be too uncomfortable to monitor their hygiene? Even if I accept the incorrect suggestion that forced, non-therapeutic female and male genital cutting don’t involve the same rights (and ethical) violation, the underlying implication of Dr. Rein’s statement is that parents should act against their child if it’s more convenient for them to do so. All other considerations be damned. It’s about the parents, not the patient. That’s unethical, anti-science nonsense.

Dr. Rein addresses the human rights point, badly:

… Finally the human rights issue is in my opinion a weak argument. As parents we are making many decisions for our children. Children don’t get to make too many medical decisions including vaccinations and antibiotics that are often forced on them when they don’t need them.

This decision is not like other decisions. It’s the unnecessary surgical alteration/reduction of a child’s body in pursuit of subjective outcomes based on someone else’s preferences. Parents vaccinate to protect their children, so, yes, in that limited non-useful manner, vaccinations and non-therapeutic circumcision can be viewed the same way. But the same thing could be said about comparing vaccinations to removing the healthy breast buds of a girl whose family has a history of breast cancer. There has to be more for it to be intelligent and useful. So, vaccinations work to build the body by using its natural mechanisms. Circumcision simply removes a body part that may develop a future problem. Dr. Rein’s comparison is invalid.

If Dr. Rein thinks that the irresponsible use of antibiotics by parents is a defense of the irresponsible use of circumcision, he’s more interested in establishing defenses for his pre-determined conclusion than reaching a conclusion based on facts and logic. I’m going with that because I read his essay. He didn’t provide any evidence for me to conclude otherwise.

¹ Or Day 6,575…

Fear Still Exists in the Modern World

When discussing circumcision, it’s vital that activists speak openly and honestly about all relevant facets of sexuality. That includes snicker-inducing topics like masturbation, which is why it’s wonderful that Cracked included a critical, almost scathing examination of male circumcision in its article, “5 Insane Ways Fear of Masturbation Shaped the Modern World”. The entire circumcision section is worth reading, but I want to quibble on one point.

Second, many doctors thought that removing the foreskin made masturbation much more difficult (which, as about half of our readers know, it totally doesn’t). By the way, that 1895 medical journal suggests that another way to prevent boys from masturbating is to sever the fucking nerves to the penis, so there just wouldn’t be any feeling there at all.

Removing the foreskin makes masturbation more difficult, even though evidence suggests that circumcised males masturbate at least as much as intact males. (Much is too subjective with regard to difficulty, and unnecessary to prove my point here.) With a normal, intact penis, a male is generally able to masturbate without additional lubrication or concern. He may use additional lubrication, but it isn’t necessary, as his foreskin provides all the mobility he needs.

Circumcision changes the form of the penis, thereby changing its function. The male no longer has his foreskin to provide lubrication and mobility. His sexual experience changes from one based on pressure to one based on friction. He generally must use some form of lubrication to make masturbation comfortable. Without it he can easily chafe his penis. He may also experience pain from masturbation (and other sexual activities) if too much of his foreskin was removed, for example.

Some have speculated, reasonably, that circumcised males engage in a wider variety of sexual activities because it takes more to achieve satisfaction. Even if the opposite were true, it’s clear that circumcision alters the penis and makes sex different, if not obviously more difficult.

Pain Is Only One Human Rights Issue

There are complicated issues of religion involved in this essay. As I intend to make clear in the future, they’re not so complicated that we shouldn’t discuss them for fear of offense or pretend that religion is in some way a special exception to the basic human rights issue involved in non-therapeutic child circumcision. However, I don’t want to delve too deeply into them this early in Choose Intact’s history.

Instead, I want to focus on the last sentence of the essay’s first paragraph to discuss framing. The religious aspect of the first paragraph is superfluous for this point. (emphasis mine)

Human rights start at home. We must defend them for children in the Jewish community as much as adults in others. Day eight in the life of Jewish boys should be no exception, even as we engage in the ritual excision of foreskin from their penises. Both the pain and unnecessary foreskin can be cut together.

As I wrote on Twitter this morning, [a]lways be aware of how #circumcision advocates mix subjective adjectives and objective facts for equal consideration. The author(s) frame the remainder of the essay with the stated assumption that the foreskin is ‘unnecessary’. This is true in the simplest form of argument, in that a boy does not need his foreskin to survive. Neither does a girl need her labia to survive. The latter is usually more horrific than the former in practice, but both are horrific because they remove healthy, functioning tissue from a non-consenting child.

The author(s) inevitably do not intend this meaning. ‘Unnecessary’ is short-hand for ‘unwanted’ or ‘superfluous’, for the belief that the child will be indifferent, at worst, to the removal of his foreskin. It frames the discussion away from the considering potential objections from the child. We are to accept that he wants circumcision because his parents want him circumcised. There is no way to confirm this for any individual child. The child may want his foreskin.

From the basics of circumcision, whether ritual or cultural, we can only draw the conclusion that the pain is unnecessary, not that the foreskin is unnecessary. That is the objective fact involved, as long as the child is healthy. No pain is necessary. In order to respect the child’s human rights, we must therefore refrain from inflicting any form of it if human rights are to mean anything. (Related: The author(s) talk of proper anesthesia during the procedure, but ignore the question of post-operative pain from the surgery. This matters, too, since children can’t receive the same pain management as adults.)

The human right involved is summarized in a simple principle: non-therapeutic genital-cutting on a non-consenting individual is wrong. Contrary to the essay, the only way to honor that is to not circumcise the healthy child. If he wants to be circumcised, he may choose it for himself. Imposing circumcision on a him violates his human rights. It’s more humane to use proper pain management when circumcising, but it isn’t a meaningful victory for human rights.