Flawed Circumcision Defense: Children’s Urology, Austin

Posted: February 3rd, 2015 | Author: | Filed under: Ethics, FCD, Media Marketing, Parenting, Surgery | 1 Comment »

Hey, a press release (Links omitted):

New Austin parents wishing to heed the American Academy of Pediatrics and the Centers for Disease Control recent guidance on circumcision, which endorse the procedure because of resulting health benefits, have access to a new in-office resource dedicated to circumcision — the Newborn Circumcision Clinic at Children’s Urology.

The CDC’s draft proposal aimed at medical providers has not been formalized as a recommendation. It says so in the public notice (emphasis added):

“… The draft recommendations include information about the health benefits and risks of elective male circumcision performed by health care providers.”

Even though the press release acknowledges the draft status of the proposed recommendations, Children’s Urology uses the draft proposal to sell non-therapeutic circumcision. That’s odd.

It’s odder still because the CDC’s draft proposal ignores the direct physical costs of circumcision to the patient. The CDC’s draft proposal stumbles on the ethical analysis of applying the potential benefits to healthy children. The CDC’s draft proposal fails to mention or evaluate many options for prevention and treatment of maladies that are less invasive and more effective than circumcision, such as the HPV vaccine. The CDC’s draft proposal is half-baked. Half-baked is a poor basis for eliciting any level of informed consent.

There’s a reason this next paragraph closes the Notice document:

In addition to obtaining public comment on the draft Recommendations, CDC considers this document to be important information as defined by the Office of Management and Budget’s (OMB) 2004 Information Quality Bulletin for Peer Review and, therefore, subject to peer review. CDC will share the summary of public comments with external experts who conduct a peer review of the evidence on this topic. Their review will include an evaluation of completeness, accuracy, interpretation, and generalizability of the evidence to the United States and whether the evidence is sufficient to support the draft counseling recommendations.

No worries, though. The Newborn Circumcision Clinic at Children’s Urology is ready to sell new Austin parents surgery for their healthy sons. It says so in their press release. Jillian Moser, PA-C, or someone on the circumcision provider team, will circumcise the healthy baby if he’s six weeks old or younger, weighs 10 pounds or less, and has normal appearing anatomy. The circumcision provider team does not require a boy to need any form of intervention before they’ll perform surgery. One might be inclined to think that a strange requirement to dismiss. However, lest healthy newborn boys worry they might not be in good hands, Children’s Urology knows what healthy newborn boys care about most for their genitalia: the comfort of their parents.

“Our Newborn Circumcision Clinic offers a comfortable, in-office experience for families interested in following the recommendations and pursuing circumcision for their son,” said Leslie McQuiston, MD, pediatric urologist at Children’s Urology.

Of course, it’s curious that Leslie McQuiston, MD, believes the CDC’s draft proposal a) targeted parents and b) recommends circumcision of newborns. Either of those beliefs suggests that Dr. McQuiston hasn’t read the CDC’s draft proposal (or the longer document that supports the draft proposal). The claimed link to the CDC’s draft proposal in her clinic’s press release loads a PDF announcing the draft proposal for public comment. Since Children’s Urology doesn’t seem to know where the actual draft proposal is located, it’s possible they haven’t read the draft proposal, which would be understandable. Who has time for reading dense material when so much science needs urgent applying to healthy children? Healthy children can’t possibly wait for the draft proposal to be finalized, much less wait until they might have a need for the most radical intervention. The science of newborn male genital anatomy isn’t scientific without a scalpel, after all. Duh. Everybody knows that.

Maybe the confidence of new Austin parents wouldn’t be so high after considering the totality of evidence from Children’s Urology’s press release. Trust them, though. Right in the press release, it says their clinic is “the premier pediatric urology practice in Central Texas,” and that it “specializes in the medical and surgical treatment of genitourinary conditions from birth through adolescence.” That’s great, and probably true, but we’re all now thinking the same thing. Okay, maybe the folks at Children’s Urology aren’t thinking this, but most of us not selling surgery on healthy children to parents using a flawed draft proposal are thinking it. Circumcision isn’t a genitourinary condition. I know, right? It seems obvious. But, on the contrary, we’re all wrong. It says so right on Children’s Urology’s site, under Conditions We Treat.


  • Ambiguous Genitalia¹ (DSD)
  • Chordee
  • Circumcision
  • Concealed / Hidden Penis
  • Epispadias
  • Hypospadias
  • Labial Adhesions
  • Meatal Stenosis²
  • Micropenis
  • Phimosis

I know, I know. It’s weird that circumcision is offered to treat the genital condition, “circumcision”. It’s weirder, I guess, because Children’s Urology convinced me we agree. Parents, doctors, activists, the AAP, the CDC, and Children’s Urology all need to work together to eradicate this awful scourge, circumcision, that somehow persists for healthy boys in modern society.

¹ I’ll refrain from speculating on this item because I do not know what Children’s Urology recommends for these children.

² It’s worth remembering that meatal stenosis and adhesions are possible complication from circumcision (i.e. the treatment for the condition, “circumcision”).

Circumcision without consent reveals

Posted: February 1st, 2015 | Author: | Filed under: Law, Parenting, Politics | No Comments »

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

Posted: January 31st, 2015 | Author: | Filed under: Ethics, FCD, Hygiene, Locker Room, Logic, Parenting, Regret | No Comments »

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.

Circumcision Is

Posted: September 8th, 2014 | Author: | Filed under: Ethics, Logic, Parenting | 4 Comments »

In a comment on a post last month, paper0airplane wrote:

Sorry this comment had a typo, and now apparently my blog is being screen capped and line by line minutia is being debated so I want to make sure there’s no confusion or conspiracy theory because I delete or edit the comment lol.

Act shocked when I note that paper0airplane has used screen caps five times in posts in the last month. Some of that appeared to be in direct response to my criticism of unsupported claims. And I’m not actually criticizing the use of screen caps. I think they can be useful, as some of those links show, even if their point is incorrectly generalized. If it helps make the point, and they’re presented as fairly as possible, why not? For example, they can demonstrate when someone deleted a post, as this screenshot shows that paper0airplane deleted a post without comment.

That’s merely an intro for my “line by line minutia” response to this post.

Medical Circumcision and Brit Milah is not…

Circumcision is not rape

On the obvious intent of that statement, I agree. This has been the biggest frustration for me recently. It’s offensive. It isn’t effective. There’s more nuance involved, which I addressed in Truth and Loaded Words, but that isn’t how “circumcision is rape” is used. So, here, the core point remains. I agree with paper0airplane.

Circumcision is not violence

To the extent that paper0airplane probably means “intent” to injure or harm, sure. But that’s a pedantic way to address it. Circumcision is violence. There is a foreskin. Then there isn’t a foreskin. The foreskin doesn’t just fall off without specific action. That action is violence.

Circumcision is not dangerous

Again, I suspect paper0airplane means “intent”. Again, that’s a pedantic way to address it. Or the claim is that complications are usually minor. Either way, it’s wrong. Circumcision is objectively dangerous. There is always risk involved. How dangerous it is and whether that danger is worth the trade-offs are subjective. The problem here is that in paper0airplane’s view, the subjective preference of a (male only) child’s parents is enough to ignore the objective danger involved without concern for the child’s preference (or – obviously – need, as the circumcision we’re discussing is non-therapeutic). If circumcision weren’t dangerous, the death rate would be zero. The complication rate would be zero. Neither rate is zero. And there is objective harm in every instance. Circumcision is dangerous. When circumcision isn’t therapeutic, proxy consent is unethical.

Circumcision does not ruin your sex life

Probably, although I hope we can agree that a boy who loses his penis or his life probably has a ruined sex life. Policy from the margins is usually bad. Ignoring the margins for policy is usually bad. This does the latter, which is unacceptable here because there are individual human rights involved. It’s foolish and cruel to treat individuals as mere statistics within the group. We can’t know which boys will actually have their sex life ruined. We can know that some will. For a non-therapeutic intervention, that is indefensible.

Circumcision does not mean your parents didn’t love you

Circumcision is almost never the reason you’re not enjoying sex

Almost certainly, although the same caveat about the margins applies.

Circumcision does not increase sales of Viagra or increase ED

I wouldn’t make the opposite claim because I can’t prove it. A citation for the negative claim would be appropriate for such a definitive stance.

Circumcision does not make someone a pervert

I read this as “circumcising”, not “being circumcised”. Both are obvious. To the former, support for bodily integrity rights for all people (i.e. opposition to non-therapeutic male child circumcision) does not make someone a pervert, either, despite the ease with which some propagandists casually lob that smear. To the latter, being circumcised does not guarantee a preference for being circumcised, regardless of how many times someone like Brian Morris¹ trots out the irrelevant “regarded by most men and women as being more attractive”.

Circumcision does not make someone a cripple

In the generalized context, this is true. How much can we debate the crippling effect of rare-but-serious complications from (non-therapeutic) circumcision? This is about individual rights, so individual outcomes matter.

Circumcision is not replaceable with a made up ceremony for Jewish boys

It seems like there are Jewish individuals who disagree with that point. Even if that false claim were true, individual rights in a civil society must trump the religious rights of another individual over that person when the rite inflicts objective harm. Circumcision inflicts objective harm, regardless of the obvious-but-irrelevant implication above that parents do not intend harm. Of course they don’t, usually. But circumcision always inflicts harm. So, even if I grant paper0airplane’s point here, it’s irrelevant. Religions must adapt, not human rights.

Circumcision is not to blame for everything wrong in the world


Circumcision is not on the decline

Please provide a citation. Even Brian Morris recognizes that circumcision among newborns has declined. That paper claims an increase to 81%, but I hope we can agree that an increase from 79% to 81% among 14 to 59 year old males is hardly the demographic in this debate. Where those 14 to 18 who don’t consent matter here, the remaining males in that group are irrelevant to this part of the debate. (Note, too, that he states, “Delay puts the child’s health at risk and will usually mean it will never happen.” A delay that means circumcision will usually never happen means that circumcision will never be necessary or needed. That’s damning.)

Circumcision is not used to routinely acquire foreskins for cosmetic or medical uses and never without parent’s informed consent

This asks used and routinely to do too much work, to the point of question begging. Are neonatal foreskins routinely used for cosmetic or medical purposes? No, I don’t think so. Does it happen? Yes. Whatever happens to the foreskin matters, whether it’s used for another purpose or is tossed in an incinerator. It matters because the foreskin belongs/belonged to the individual, not his parents. Their informed (or uninformed, which is also permitted) consent to this non-therapeutic surgery isn’t sufficient to negate his right to self-ownership. A male’s foreskin is part of his self. He owns it.

And until things change with presentation…

Intactivism will not succeed at changing minds.

That’s a weirdly broad statement. But I agree with the implication that making unsupported claims, tossing around hyperbole, and generally being an ass are unhelpful, at best. In the sense that people who nominally share a goal with me believe those are acceptable, there is work to do. And I’ll state it as many times as it takes for the point to be internalized into others’ activism, circumcision is not rape. This claim is offensive and unhelpful.

May I trust that the same expectation to improve one’s activism applies to those who (mistakenly) believe that parents have a right to choose genital cutting (for their sons only – of course, somehow)?

¹ I never provide hyperlinks to Brian Morris’ site. Throw a dart at any paper he’s authored and you’ll probably find this claim. Regardless, the specific quote is from the summary page of his site.

Facts about circumcision

Posted: August 30th, 2014 | Author: | Filed under: Ethics, Logic, Mission, Pain, Parenting | No Comments »

Here is another good video about circumcision from Dr. Lindsey Doe, a clinical sexologist.My only caveat: I’m not a fan of the book Dr. Doe recommends at the end. I’ll post a review here eventually to explain why.

Flawed Circumcision Defense: The indecipherability of “ga ga goo goo ooga bahfah fum”

Posted: August 3rd, 2014 | Author: | Filed under: Control, FCD, Parenting | 3 Comments »

Daulton Gatto asked to interview me. I agreed on the condition that he first answer a question from my last post. In response to Daulton’s alleged critiques of my “stupid arguments which claim to show that Mike Gatto likes to cut up baby boys’ wieners with surgical instruments,” I asked: “Why do you state my claim as something unconnected to what I’ve written?” I got something resembling an answer.

“Tony” seems to have taken issue with a statement I made in a previous post, which spoke to his implied belief that Mike Gatto likes to cut up baby boys’ wieners with surgical instruments. While I will acknowledge that Tony never actually stated such a belief in so many words, it is my position that his distorted interpretation of California AB 768 provides ample justification to draw such a conclusion.

The link you provide to California AB 768 doesn’t contradict my interpretation of the bill, which you excerpted in your answer. The rest of your answer appears to recognize that I interpreted the bill correctly. Instead, you’re agitated about this:

… I stated that [Mike Gatto] believes male minors do not have the same rights to their bodies as every other citizen of California. … But he incorrectly believes he and every other parent has the valid authority to choose, and, in his capacity as a legislator, to protect that authority in law.

That is the gist. The authority to impose non-therapeutic genital surgery on a child is illegitimate.

To which I respond:

Of course parents have the authority to have their infant children circumcised. Do you really expect a newborn baby to make this decision for himself? Or do you think that every single male in the world should be forced to wait until they gain legal control over their own medical care to have their stinky, ugly foreskin snipped off? As the proud owner of a smooth, polished penis … I can unequivocally state that my own experience with circumcision has been overwhelmingly positive …

Your thinking on this is too narrow. It’s absurd to imagine¹ that parental authority is specific within genital cutting so that it only applies to the healthy prepuce of a son but not the healthy prepuce of a daughter. As I wrote before, if parents have the authority you say they possess, that applies to control over their daughters’ genitals, too. It would be about the parents, not the child. Yet California law already prohibits this for exactly the reasons I state that non-therapeutic male circumcision is not a legitimate parental choice. Non-therapeutic genital cutting is an individual rights issue for the child (i.e. the surgical patient), which trumps this supposed parental right to proxy consent for sons only. The right to bodily integrity is the core of self-ownership and includes the genitals, even for male minors.

I don’t expect a newborn baby to make this decision, or any decision. But the standard for proxy consent (i.e. parental authority) is not “babies can’t make decisions for themselves”. And you have a curious understanding of what “force” entails. I think that every single male should be able to choose, absent medical need before he is able to decide for himself. No male should be forced to live with a circumcision he does not need, probably won’t need, and may not want. I don’t think this requires that he wait until he’s an adult to choose, but it should never be forced on him without need or his consent.

I’m happy for you that your experience with your circumcision has been positive. You don’t have to share my preference for my body. I don’t have to share your preference for your body. That’s the uncomplicated thing about individual preferences. They’re all subjective to the individual. A presumption of shared circumcision preference between a child and his parents is too convenient for public policy. It assumes away the value of self-ownership to the individual himself.

Parents have the legal right to make decisions about the medical care of their children until their children come of age. Otherwise, emergency rooms around the country would be filled with blubbering infants going “ga ga goo goo ooga bahfah fum” when doctors ask them whether or not they want their booster shots. …

I haven’t said anything suggesting otherwise about a general approach to parenting and its interaction with the State. I didn’t write that parents do not have the authority to make medical decisions, period. You’re not claiming I did, but this isn’t a good buildup for where you’re going with it.

… This legal right necessarily extends to circumcision, …

Necessarily? We agree that parents may choose circumcision where there is medical need, although I’ll add that there is an ethical duty to exhaust less invasive solutions first. This legal right does not “necessarily” extend to non-therapeutic circumcision. All you’ve done here is argue “Parents make decisions, Circumcision is a decision, Parents may decide on circumcision.”

… and the only objections are coming from a small minority of extremist demagogues who erroneously believe that Mike Gatto’s protection of parental rights is tantamount to supporting genital mutilation. …

I recommend that you look up the definition of demagogue again, and perhaps reread our series of posts after doing so, before tossing it around like that.

Mike Gatto protected genital mutilation. I do not know if he supports genital mutilation. Again, if AB768 bill protects a valid parental right, then the California penal code violates parental rights. Mike Gatto is duty-bound to try to correct that if he and you are correct about a parental right to have a child’s healthy genitals cut to satisfy their own preferences.

… I see no reason to offer a more thorough explanation, as it is my firm belief that your argument critiques itself by its circular and misguided nature. It’s Sunday, I’m hung over, and I can’t be bothered to make an exhaustive list of the endless number of logical fallacies you’ve and your supporters have committed.

Don’t worry, you were thorough enough to show the gaps in your argument.

¹ I take it as a given that you oppose female genital cutting, as prohibited in California law. Please correct me if I’ve assumed too much on that point.

“Enough. No. I will protect my son.”

Posted: August 1st, 2014 | Author: | Filed under: Ethics, Logic, Parenting | No Comments »

There is so much to praise in this post from a mother who researched and rejected circumcision for her son. I like this the most:

So if you’re still reading, you are probably thinking, “Damn, okay you didn’t circumcise your little boy. He didn’t feel the pain, and his penis is just fine. So why are you still talking about it?”

I’d answer you with this: If everyone just stopped talking about it, where would mothers like me who were wavering in their decision find the information and the courage to say, “Enough. No. I will protect my son.” I was so lucky to know a woman who was passionate and outspoken, and at times even aggressive, about educating parents and protecting baby boys. She was such an invaluable resource for my entire pregnancy and labor/delivery and continues to be a good friend. She truly gave me strength. There were times when I may have given in to my husband and others pressuring me, but this woman gave me strength. She made me realize that it IS a BIG DEAL. No baby deserves to suffer through a needless surgery like circumcision. Thank God for her. She sparked something in me, and now here I am trying to pass it on to you.

The full post has a lot to offer. I recommend it.

Some of us wouldn’t dream of having any procedure

Posted: June 5th, 2014 | Author: | Filed under: Ethics, Media Marketing, Pain, Parenting, Science | No Comments »

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.

As if.

Posted: May 6th, 2014 | Author: | Filed under: Ethics, Parenting, Science | No Comments »

Of all the mentions about actress Alicia Silverstone revealing that she and her husband, Christopher Jarecki, did not circumcise their son, I’m fascinated by this one. Anthony Weiss writes:

In her new parenting book, “The Kind Mama,” Silverstone announces that she did not circumcise her son, Bear Blu, according to the anti-circumcision website Beyond the Bris. Her decision apparently raised some family hackles.

“I was raised Jewish, so the second my parents found out that they had a male grandchild, they wanted to know when we’d be having a bris (the Jewish circumcision ceremony traditionally performed 8 days after a baby is born),” she wrote, according to Beyond the Bris. “When I said we weren’t having one, my dad got a bit worked up. But my thinking was: If little boys were supposed to have their penises ‘fixed,’ did that mean we were saying that God made the body imperfect?”

Obviously I’m inclined to agree with that. I probably need to finally write my long-promised post on religion, but for now, I think her statement works consistently within the framework I and many others posit. Non-therapeutic circumcision isn’t something that parents should impose on their sons. Good for her.

That’s not really the interesting part, though.

Her stance sets her in opposition to recent scientific evidence, which indicates that neonatal male circumcision can have substantial health benefits that significantly outweigh the risks.

Her stance does not put her in opposition to scientific evidence, recent or otherwise, about the potential benefits of circumcision. Her stance puts her in agreement with the ethical principle involved. The subset of scientific evidence¹ presented by Prof. Morris’ paper does not prove anything about the application of that subset of scientific evidence to a healthy (hey, science!) child who can’t consent. I don’t have to deny the science to reject its unethical application. Science and the application of science to human beings are not the same concept.

Think of this in terms of Angelina Jolie’s voluntary double mastectomy. Because she carries the BRCA1 gene, the scientific evidence suggests she has a higher risk of developing breast cancer, significantly higher than the absolute risks of a foreskin-related malady requiring circumcision. She judged this evidence and applied it to herself. There is no ethical problem there. But should she apply that scientific evidence to the bodies of her daughters? Mr. Weiss’ approach would require us to conclude that Ms. Jolie not having her daughters’ breasts removed is in opposition to scientific evidence. That’s indefensible even if we restrict it to her daughers who carry the BRCA1 gene. There’s no reason to understand the flaw in Ms. Jolie’s case but pretend the claim is reasonable for non-therapeutic infant circumcision. Proxy consent for the application of science is not the same as consent for the application of science to one’s self.

Also, if you follow the link to Mr. Weiss’ reporting on the recent Brian Morris rehash, you won’t find a coherent argument. Instead you’ll see another example of what I criticized about the journalistic treatment of circumcision. The paper’s focus is the declining circumcision rate. The unsupported “benefits outweigh the risks” is tacked on to criticize that decline. Of course, the paper does not prove that contention about benefits and risks, as Robert Darby and Hugh Young deftly demonstrate. But Mr. Weiss floats around the narrative in a way that makes me think he didn’t read Prof. Morris’ paper.

Darby and Young’s paper also hit on the truth that the “benefits outweigh the risks” narrative persists through assigning no value to the foreskin itself, and by claiming a mathematical finding (i.e. 100 to 1) where no quantification is possible.

¹ Condoms, soap, antibiotics, and other less-invasive methods of prevention and treatment involve scientific evidence, as well. Nor should anything here be taken as an endorsement of the accuracy of anything Prof. Morris has written, anywhere, except for this:

“… Delay puts the child’s health at risk and will usually mean [circumcision] will never happen.”

That statement is true, which discredits everything else he’s ever said in favor of non-therapeutic child circumcision.


The rest of Mr. Weiss’ article discusses Ms. Silverstone’s stances on vaccinations and diet in an attempt to make her appear wrong on circumcision. I’ll only comment that I support vaccination.

The Equation Is Unnecessary Genital Cutting Minus Consent

Posted: March 23rd, 2014 | Author: | Filed under: "Voluntary", Control, Ethics, FCD, FGM, Logic, Media Marketing, Parenting, Politics | 1 Comment »

Many have heaped scorn on Mary Elizabeth Williams’ Salon piece that criticized Alan Cumming for calling male circumcision genital mutilation and comparing it to female genital mutilation. This scorn is deserved.

Alan Cumming wants to tell you about his penis. He wants it to be a shining example to the world. In a candid interview with Drew Grant this week in the New York Observer, the 49-year-old Scottish actor reveals his strong opinions on “Girls,” naughty cellphone pictures, and, most controversially, circumcision. Or as he puts it, “genital mutilation.”

“There’s a double-standard, which is that we condemn the people who cut off girls’ clitorises, but when it happens to boys,” Cumming says. “I mean, it is the most sensitive part of their bodies, it has loads of nerve endings, and it can go horribly wrong. I’m speaking out against it … I’m just so suspicious of the medical industry, which just flings pills at people to ensure everyone is reliant on things. ‘Here are some pills, Mommy. Take them, and we’ll take your baby away and hack its thing off, and then we’ll bill you for that too.’”

I don’t share Mr. Cumming’s view of the medical industry. Its complicity strikes me as cultural inertia and cowardice. My experience suggests that profit-driven focus on circumcision is limited, although it motivates some. But that’s a distraction. The key is that he is correct about the comparison.

Circumcision of a healthy male minor is mutilation of that male’s genitals. To be valid, it must involve his consent prior to the surgery, not assumed to be later granted retroactively. This is the standard inherent in 18 USCS § 116, which criminalizes all non-therapeutic genital cutting on female minors without regard for parental justifications or potential benefits. The difference we imagine is an accident in the history of Western child genital cutting.

Later in the essay:

… And earlier this week, protesters threatened to disrupt Bill and Melinda Gates’ TED Vancouver talk because of their organization’s efforts to increase the practice in Africa as a means of “limiting the spread of HIV in the parts of Sub-Saharan Africa.”

There is good reason to find the work of the Gates Foundation repugnant, as it pertains to male circumcision. It speaks in the euphemism of voluntary medical male circumcision, when it also means infant circumcision. This is unethical because it violates the principles of bodily integrity and consent. And this study, commissioned and funded by the Gates Foundation, hardly provides reassurance when examining the context of WHO and UNAIDS, who think violating this human right of male children can be legitimized through question begging. Mental gymnastics like that are not admirable.

Cumming’s equation of circumcision with female genital mutilation is an insultingly inaccurate one — boys are not circumcised as a ritualized means of suppressing their future sexual enjoyment,

Although it’s easy to find similar defenses of male circumcision, ritual or not, this implies that the critical issue is intent rather than outcome. Female genital mutilation, in all its forms, is wrong because the female is mutilated, not because she is mutilated for “bad” reasons. Some reasons given are the same as those for male circumcision. And not all females who were mutilated reject or condemn it. Yet all reasons for surgically altering the healthy genitals of a female minor are still bad. This focuses on the principles and facts involved, not our feelings.

Notice, too, how often erroneous claims like “[t]here is no evidence whatsoever to support the notion that it affects function, sensation or satisfaction” are made about male circumcision, as it’s made with that quote from Williams’ link to reader comments on an article. The statement is wrong on its face because circumcision changes the function. If you change the form, you change the function. The function of the penis, including its structure, should not be lazily defined as “to have sex” or something similarly ridiculous. The foreskin is normal anatomy with functions for the penis and belongs to its owner.

The quote is disputable on sensation, considering the (anecdotal) arguments in favor of male circumcision stating that males can “last longer“. Consider the heads I win/tails you lose efforts of Brian Morris here, as all outcomes are assumed to be favorable to overall satisfaction, even when the studies cited do not involve anything near 100% on the subjective evaluation of satisfaction.

nor does a clean male circumcision compare with the often crude, blunt and unsanitary practice of female genital mutilation.

Those qualifiers obfuscate. What about clean female genital cutting compared with crude, blunt, and unsanitary male circumcision? A sterile surgical environment does not grant legitimacy to a rights violation. Again, the act is what matters. There are degrees of harm possible, but the inevitability of harm requires first priority, whatever the degree.

The World Health Organization calls FGM “a violation of the human rights of girls and women” with consequences that include “severe pain, shock, hemorrhage (bleeding), tetanus or sepsis (bacterial infection), urine retention, open sores in the genital region and injury to nearby genital tissue,” while it in contrast notes, “There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.”

WHO also explains that female genital mutilation “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.” There is no unethical caveat for “but if we find some benefits to female health, or even male health, we’d have to weigh mutilating injury against potential benefits.” That unethical caveat is always applied to male genital mutilation, as Williams does here. An adult male volunteering is not the same as an infant male being volunteered. Consent is the issue, not how horrible female genital mutilation usually is or how innocuous and/or beneficial male circumcision appears to be. Non-therapeutic genital cutting on a healthy individual who does not consent is unethical. It involves harm. Gender is irrelevant to the principle.

One can argue, quite persuasively, about whether the practice of circumcision still has validity here in the West, especially among those who don’t have a religious directive. What’s needed, however, is education and enlightenment, so families can make the healthiest choices for their children. …

I reject the premise. This is a not a decision parents should be allowed to make for their children. The argument that parents may decide this for their healthy children requires this decision to be a parental right. If it’s a parental right, then the prohibition of non-therapeutic genital cutting on daughters is indefensible. The basis for thinking about genital cutting can’t be girls and the parents of boys. That’s absurd.

… It’s not helpful to make far-fetched comparisons, and it certainly isn’t constructive to imply that men and boys who are circumcised are somehow damaged, “mutilated” goods. That’s a shaming technique that serves no one, one that turns having a foreskin into a bragging point. …

Why are we only worried about shaming men and boys by using the term “mutilation”? Isn’t there the possibility or likelihood that women and girls will feel shamed if we describe their genitals as mutilated? Are the psyches of females more able to handle facts?

There is a difference in stating a fact and demanding a value judgment from that fact. The bodies of males who were circumcised as children were mutilated. Their rights were violated. Circumcised males are not obligated to think this is bad or shameful. The obligation (for everyone) rests in understanding that it is unacceptable to perpetuate this violation on their children or to permit its continued practice in society.

Or to put it in terms of individual autonomy, circumcision mutilated me through the deprivation of an essential¹ part of my body. Where I had a normal human foreskin, I now have only scars. My penis is mutilated. No one gets to reject that fact for me. But I do not feel shame. This sense that males might feel shame is what encourages parents to circumcise their sons for conformity. We have to stop being afraid of shame. We’ll achieve that only when we are no longer afraid to state that shame belongs with those who circumcise, not those who are circumcised.

… And it’s an unfair judgment coming from a man who admits, “I myself don’t have kids. I just have managers, assistants, agents and publicists.”

I feel second-hand embarrassment, so that at least someone feels what her statement deserves.

¹ Quibble with essential as something other than an obvious stand-in for normal, and I’ll roll my eyes and ask if normal parts of female genitalia are essential.