Category: Parenting

Valid Dinner Table Topics: Ethics

When I listen to podcasts discussing circumcision, I’m prepared to sigh and grumble in frustration. Listening to The Dinner Table podcast: Circumcision involved a different experience. I talked pointedly at my radio as I listened, pausing every 30-45 seconds to digest my irritation. It was generally an unpleasant experience because the discussion needed much more reflection and thought in place of the talking-point regurgitation. However, I’m glad I stuck with the episode. It contains numerous succinct examples of both exactly why we shouldn’t circumcise children and how people encounter truth but manage to pick themselves up and scurry off before having to confront reality.

Note: I’ve kept the conversational tics in the transcript from the hosts, Tessa Osborne and Griffin Wiles. (I will do this for their interview with Dr. Joel Greenberg, which I’ll review in my next post). I left them in because they demonstrate the speaker working through the thought in real time, which I think is fairer than editing it. I do not interpret or intend these tics within the transcript to suggest anything else.

Here are some observations:

Wiles: Mmm hmm. And there’s, of course, there’s hygiene. People who are not circumcised as a child, and later on in life, get circumcised, it’s a hygienic reason. If they do it themselves, or if parents circumcise their kids… … or if parents circumcise their kids, it’s for hygienic reasons. Adolescents and young adults are more likely to be circumcised. Social and sexual desirability are also really big social determinants in being circumcised.

Boys should and can be taught to wash themselves. Surgery is neither a replacement for nor an ethical change to this basic life skill.

The next section in the podcast covers some of the perceived medical benefits. I’m not interested in refuting them in detail again here, so I’ll both point to my archives and reiterate that every possible benefit argued for can be achieved and/or treated with less invasive methods and with the consent of the individual himself. That’s the core of the topic, not whether or not imposing it on someone can achieve something.

Anyway, in my experience, the perceived medical benefits are the cloak of respectability placed over the real reason, which is some variation of “I like it, aesthetically”, which Wiles states directly. It’s also, “women prefer it”. Or, more crudely, “women won’t have sex with him if he’s not.” It’s the cultural lie society repeats without questioning whether or not it’s true. If it were true, as people pretend, we don’t stop to consider that maybe the individual male would rather have his foreskin than sexual attention from someone for whom he is not good enough without surgical modification.

After a bit more about the perceived benefits making risks “significantly” lower, a statement that isn’t true in the context of absolute risks (or when compared to less invasive alternatives):

Wiles: … Along with the medical aspect, a lot of people think that circumcision diminishes sexual pleasure, or that it diminishes sexual desire, and there is little evidence that supports the theory that sexual function and sexual desire is diminished. So, really,…
Osborne: Good to know.
W: … the studies are inconsistent in the results that they yield…
O: Mmm hmm.
W: … so there’s really little evidence to suggest that circumcision has an impact on sexual desire and sexual function, period.

There is ample evidence that circumcision diminishes sexual function. Even studies cited favorably by circumcision advocates demonstrate the undeniable truth that the foreskin has nerves (e.g. ridged band and frenulum) and functions (e.g. gliding mechanism). Circumcision removes both. It’s objectively incorrect to conclude anything else with regard to function¹.

Moving to the ethical question reveals a missed opportunity for contemplation on the primary question involved:

Osborne: I want to know, what do you think ethically about circumcision?
Wiles: Alright, well. Personally, I grew up circumcised, was circumcised very early on.
O: Can I go as far as to ask you, are you still circumcised to this day?
W: I am still circumcised, it did not grow back.
O: Ok.
W:
O: Just the way you had made it sound, you were like, “I *was* circumcised. I *was*.”
W: I was at a time circumcised, yeah. So I… … I thought that all penises looked like circumcised. I thought penises were, they just came circumcised, like I didn’t know it was a whole procedure until later on in life. I’m glad I was circumcised, I have to be honest, I am glad, because I think aesthetically, for one circumcision makes the penis look more attractive.
O: Mmkay. Have you ever met a guy that said that he didn’t want to be circumcised?
W: I’ve met guys who are uncircumcised but I have never asked if they want to be.

Ponder that last question more, please. It’s what matters here, as the intact guys can still choose. (If it isn’t obvious, I’m a guy who doesn’t want to be circumcised, but I had no choice in the decision.)

Osborne: Ok. How do you feel about, like, if, you know, if you gave a child that choice, like you decided not to circumcise them, and you said, like, if when they’re an adult, and they want to do it, they can do it. Do you think that’s, like, right, or do you think…
Wiles: I think that’s…
O: …….. or do you think, just do it when they can’t feel it?
W: I think that’s right, umm. I do feel like there are advantages to doing it when they are younger, especially with the disease prevention and the convenience. If you’re already in a hospital, you might as well.
O: Ok, I… I, personally, under the topic of genital… … mutilation, if we could call it that. I wouldn’t… like, if I had a son, I wouldn’t want to make that decision for him. I don’t think that’s fair for me. Umm… I think that might be violating some of his rights. And I think that he can do it when he’s older. I mean, we’ve got good medicine, he can be knocked out, get it done.

“You might as well” is not an ethical argument. It is a pithy shorthand for the abdication of parental responsibility for which so many people justify circumcision.

Last, while Osborne’s overall approach is strong, I don’t understand the assumption within “when they can’t feel it”. Babies can feel pain, including after the procedure during healing. I doubt she believes babies don’t feel it, and this was a thinking-out-loud shorthand for “can’t remember it”. If so, that has its own problems, as any thought experiment would show we can do all kinds of awful things to babies that they won’t remember. Not remembering them wouldn’t make any of them ethical to impose.

There’s still an interview to analyze, but that will get its own post.

________________________________________________
¹ In the linked study, Bossio found that the foreskin is the most sensitive part of the penis to light touch, which seems clearly relavant to the typical sexual experience. It’s absurd to find this objective fact and then explore subjective explanations valuing only other aspects. Some men will value other aspects more, yes, but some won’t.

Or, as the linked article by Brian Earp explains:

So let me try another analogy. Saying that removing the foreskin “doesn’t reduce penis sensitivity” is a bit like saying that removing the pinky finger doesn’t reduce hand sensitivity. What you really mean is that removing the pinky finger (which is part of the hand) doesn’t reduce sensitivity in the remaining fingers—although, as we’ll see, it’s not even clear that this part of the analogy holds up in the actual study.

In other words, it’s an odd way to frame the hypothesis. To continue the analogy, my guess is that most people—if faced with the claim that removing the pinky finger doesn’t reduce sensitivity of the hand—would say, “But what about the pinky finger itself?!”

Flawed Circumcision Defense: Dr. Laura Berman

tl;dr version:

Dr. Berman writes:

… Thankfully, [male circumcision] is a choice that we do have here in America, unlike the millions of young girls across the globe who must endure genital mutilation with no option to decline.

Her analysis shifts depending on whether a male or female is cut without need or consent. Male circumcision is “a choice that we do have here in America”. “Thankfully”¹. Her male circumcision argument is about parents, without consideration for the child. She then compares the victims of FGM “who must endure genital mutilation with no option to decline.” When did I have the option to decline my mutilation? When did any boy circumcised without need have the option to decline? Her argument is sophistry. It’s garbage and shows why any defense of male circumcision as ethically different from female genital mutilation is mistaken. Dr. Berman should feel shame for even thinking that sentence.

**********

Dr. Laura Berman posted a question on Facebook, asking:

Men, how do you feel about your circumcision (if you were circumcised)? Do you wish you weren’t, or do you think your parents made the right choice? And women – do you have a preference when it comes to partners who are circumcised vs. uncircumcised?

The replies are roughly in line with what anyone should expect from a circumcision thread. In response to some comments asking her opinion, she followed with a blog post about it, “When You Miss Your Foreskin: The Real Deal on Male Circumcision”. Early on, she writes:

First, as a Jewish woman, I want to acknowledge that there is a cultural legacy behind circumcision which informs many people in my community and their decision to circumcise. While I appreciate and love my Jewish heritage, I realize this is not enough of a reason to perform surgery on an infant without medical cause.

That statement takes courage and is worth commending. Unfortunately, she does not let that inform enough of the rest of her post. She continues:

The pediatric community is still largely in favor of circumcision, as they say that the benefits of circumcision outweigh the risks. What are these benefits?

She links the AAP’s 2012 statement there, which I’m omitting because you can get there here or here, instead. Apart from quoting the AAP’s flawed statement, quoting the AAP as “the pediatric community” is silly. The *American* pediatric community is still largely in favor of (non-therapeutic infant) circumcision. Most of the rest of the world is not in favor, for the reason Dr. Berman touches and then skips. There is not enough of a reason to perform surgery on an infant without medical cause. (There is no reason. There is no medical cause.) That’s the ethical principle applicable here, as in non-therapeutic genital surgeries on female minors. There’s no reason to exclude male circumcision from ethics.

After reviewing some potential benefits of circumcision, including the casual sexism of “for little boys who hate to bathe”, which should be rewritten as “for parents who abdicate their responsibilities”, Dr. Berman gets to some negatives. She writes:

Loss of nerve endings. Removing the foreskin also removes thousands of nerve openings that make sex more pleasurable.

It’s beyond comprehension how someone can write that fact and not end the post there with, “Yeah, this is wrong. We must stop immediately. And we should apologize for every non-therapeutic, non-consensual circumcision performed before now, because we were wrong to perform every one of them.” But she doesn’t, because of the usual consequentialism and moral relativism involved in this debate that predictably appears in her post. She continues:

… Along with physical pain, many men later report that they feel they feel violated as their circumcision was done without their consent.

Although I feel violated, that is a direct result of being violated. My non-therapeutic circumcision occurred without my consent. My circumcision violated me. I know why we avoid acknowledging this as a society, but it’s too blatant to be defensible.

Dr. Berman shifts to something worth repeating:

Last, before I end, I want to address the issue of consent around circumcision. One man on my Facebook post compared circumcision to rape, and while I appreciate his right to anger about his circumcision, we must be very, very careful when we use the word ‘rape’ to describe anything other than rape. Words matter. They are powerful. They shape our beliefs and they inform the way we live in this world. So when we use the word ‘rape’ to talk about a medical procedure performed in good faith, this does a grave injustice to rape victims who have been abused, traumatized, penetrated and dehumanized by a sexual predator(s).

I agree with this, and stand by what I’ve written on it.

However, what is consent, if not the ability to reject something you neither need nor want? It shouldn’t be discussed in the context of calling circumcision “rape”. We must discuss consent, though,
because it’s the crux of the violation. You don’t believe in consent if you believe consent in non-therapeutic genital cutting is sometimes relevant and sometimes not.

She moves on to the comparison of female genital mutilation/cutting and male circumcision. It’s flawed:

Nor do I think it is appropriate to take over a conversation about female genital mutilation by bringing up male circumcision in the Western World. There is a giant difference between FGM which occurs across the globe in places like Africa, Indonesia, and more. There are currently 200 million women living today in 30 countries who have been victimized by female genital mutilation in which these young girls near puberty are held down while some or all of their external genitalia are cut off with a sharp blade or piece of glass or similar cutting instrument.

It’s usually not appropriate to take over a conversation about FGM. The problem arises when the writer changes the analysis used for non-therapeutic female and male genital cutting, as most writers on the comparison do, and as Dr. Berman does here. Is it wrong to alter the healthy, normal genitals of a girl in a sterile operating theatre with appropriate pain management and the best parental intentions, the context assumed for male circumcision? It is still wrong in that context because it harms the girl without her consent. “One is almost always worse” is true and irrelevant to the principled analysis of non-therapeutic genital cutting without the recipient’s consent.

The usual caveats appear to continue the false distinction:

Unlike male circumcision, there are absolutely no benefits to FGM,…

If there were potential benefits to FGM, very few would change their opinion on FGM. Rightly so, because they would look at the costs – the guaranteed harm – and judge it unethical. There is no excuse for distinguishing this violation of males from this violation of females.

… and unlike circumcision, it is not performed to protect male sexual health …

Harming an individual to protect him from harm that can be prevented with lesser interventions is an absurd justification. He may not prefer this “protection” at the expense of his foreskin.

… but in order to erase female sexual pleasure and to lay ownership to a woman’s genitals. …

What did Dr. Berman ask? “And women – do you have a preference when it comes to partners who are circumcised vs. uncircumcised?” Why is that question relevant to the discussion? Dr. Berman doesn’t use the “women prefer” argument, but enough proponents use it to make the comparison. At best, we do not discourage “you prefer circumcision, so circumcise your son”. So, is the argument that it isn’t intended to lay ownership to a man’s genitals or that it doesn’t lay ownership? Even when the former is correct, it’s irrelevant because the latter is always incorrect in non-therapeutic child circumcision. “Son, you should prefer our preference(s), so we’ll make this choice that forces you to live with our preference(s) forever” is the antithesis of self-ownership.

When Dr. Berman later talks about whether “circumcision is the right choice for you and your family”, she implies that the penis belongs to the family rather than the boy. The best intentions don’t change the action. It is permanent control over part of the child’s sexuality.

After more awful facts of FGM, and embedding an Instagram post from WHO (correctly) declaring FGM a violation of human rights, Dr. Berman continues:

FGM is a violation of the human rights of girls and women. There are many who feel that male circumcision is a violation of the human rights of baby boys, and for these people, deciding to keep their baby intact is the correct choice. Thankfully, it is a choice that we do have here in America, unlike the millions of young girls across the globe who must endure genital mutilation with no option to decline.

Circumcision is a violation of the human rights of boys and men. This is true for the same reason non-therapeutic, non-consensual genital cutting violates the human rights of girls and women. There is neither need nor consent. Any cutting in that context violates the individual. Any analysis beyond that is sophistry for one’s preferences and biases.

Re-read the tl;dr above if it isn’t burned into your mind.

And then:

Why am I making this distinction between FGM and circumcision? Because, again, I think it does a disservice to woman who can feel no sexual pleasure, women who endure a lifetime of pain and loss, and young girls who are held down and tortured because their bodies are viewed as dirty and sinful to a medical practice which is performed safely, hygienically and with a baby’s health in mind.

Again, what is done to the genitals of girls and women is horrific, barbaric, and indefensible. Also again, this uses a different standard for assessing what is done to girls and what is done to boys. Would she approve of FGM if it is “performed safely, hygienically and with a baby’s health in mind”? Nope, and to reiterate, correctly. Consequentialism and moral relativism have no place in the analysis of genital cutting, including male circumcision. Genital cutting is wrong for boys for the same reasons it’s wrong for girls. (Especially when we consider “their bodies are viewed as dirty” in the context of “for little boys who hate to bathe” and “I chose to circumcise because I thought it was cleaner.”)

In summary, using the last link in the previous paragraph, Dr. Berman writes:

While nothing can ever undo that man’s circumcision,…

“While nothing can ever undo that man’s *non-therapeutic, non-consensual* circumcision… That’s the whole story. Stop ignoring it.

¹ I’m not thankful male circumcision is a choice “we” have in America, because “we” decided my penis without me.

√erifying what you want to believe

WZZM, the ABC affiliate in Grand Rapids, Michigan, has a “verify” article purporting to address the following:

The story of a female genital mutilation case in Detroit has prompted lots of questions from our viewers on what this procedure actually is and how it compares to circumcision in males. So, we set out to Verify this issue by reaching out to the experts.

WZZM “verifies” this in a surprising and predictable manner. There’s a video associated with the article. It’s what I will use as a summary for two reasons. I assume that’s what most people who arrive at the link will use. But I’ll focus on the video because it addresses what WZZM researched, not the comparison the article said they aimed to verify. (Most of the sections of the article are rote talking points. Also, I’m unconvinced the article had an editor for content because it did not have one for grammar.)

First, the on-air reporter, Val Lego, provides a summary of the two procedures.


(Larger size here)

This is the surprising part. It’s accurate. As those of us who recognize the valid comparison have said, both inflict permanent harm for non-therapeutic reasons and without consent. This is where the discussion should end. If this were investigating the correct question, the comparison as posited in the article, Ms. Lego would say, “As you can see, they are comparable. They are both a violation of the child.”

But this wasn’t investigating the correct question. Contrary to the accompanying article, WZZM sought to “verify” the difference between female genital mutilation and male circumcision. WZZM begged the question that they’re different. So, even with the ethical comparison established, the analysis works to provide the flawed, predictable psychological comfort for the viewer. Anyone with even a basic understanding of American culture can predict the outcome:


(Larger size here)

Here’s the completed list. It’s “√erified”. You got it right, didn’t you?


(Larger size here)

While accurate in the merely factual sense, none of it is relevant to the question of whether child genital cutting is acceptable. The comparison established before this list demands equal protection for everyone based in the ethical principle¹, whether female or male, adult or child. Everyone has the same human rights. There are no exceptions in the right to bodily integrity for “rooted in parents’ religion”, “potential health benefits”, or “only lifelong consequences we care about”. Religious rights belong to the individual, including the choice to reject genital cutting. The potential health benefits are of subjective value² because the child is healthy. Only he may decide if he values them more than his foreskin. And permanent removal of normal body parts is harm, always. That harm occurs in varying degrees, but harm is guaranteed with every cut.

Going back to the article, it ends with this:

Dr. Megan Stubbs, sex and relationship expert, says that there is a distinct intent to curb a woman’s sexual desire when she undergoes FGM/C – women and girls may face serious, lifelong medical and sexual dysfunction.

“Men who have been circumcised typically lead happy, health lives. Circumcised men still enjoy sex, with or without a foreskin,” Dr. Stubbs states.

Again, FGM is evil in all its forms. “May face” is true here because some less-common forms of FGM do not inflict serious, lifelong harm (or inflict harm similar to circumcision). Those forms are still illegal, as they should be. Good so far.

Dr. Stubbs then counters objective harm to a female victim with “still enjoy sex” for male circumcision. It’s a ubiquitous attempt at a distinguisher, the psychological comfort to parents of boys. But Dr. Stubbs changed the criterion, going from factual statements about FGM to a subjective statement about male genital cutting. Changing form (i.e. cutting away genital parts) changes function (e.g. loss of foreskin’s gliding mechanism). Whether that’s good or not depends on the individual recipient’s opinion. Outcomes vary for every individual. Preferences for or against those outcomes differ for every individual.

The issue is proxy consent for non-therapeutic genital cutting. The first picture above makes it clear how this should be answered. It is not a separate analysis for female versus male patients. (There is perhaps a separate analysis of punishment for what is inflicted on the victim.) Without need, inflicting permanent harm on an individual via proxy consent – with unknown severity and long-term consequences – is indefensible.

No individual’s experiences (or rights) are less valid than another’s because his or her outcome isn’t typical or as severe as another’s, or because his or her parents had the perceived right intention. “Still enjoy sex” is not a Get Out of Violating Human Rights Free card. Nothing in that video or article makes me think those who oppose FGM and defend circumcision would accept FGM if potential health benefits were discovered. (It wouldn’t be ethical to research the question on children, anyway.) That’s correct because FGM/C violates the girl’s body and rights. Thinking the items in the “√erified” column excuse or differentiate male circumcision in a meaningful manner is wrong and hypocritical.

¹ Non-therapeutic genital cutting without consent of the recipient is unethical.

² Science isn’t stagnant, either. It’s realistic to imagine a future with even better ways than our existing less-invasive-than-genital-cutting options to respond to the problems prophylactic male circumcision might address.

The “Hacking Away at Perfectly Healthy Genitals is Bad” Principle

How many times have we seen a quote like this?

In Jacksonville, Dominic Morris, a 30-year-old father of two, said he did not understand what all the fuss was about. He said he was not mutilated during his circumcision, didn’t bleed at all and felt nearly no pain during or after the procedure. “Mutilation is horrible, but it’s not true that it happens here” in America, Mr. Morris said. “They cannot stop us. It’s our tradition.”

That’s said every time an activist discusses circumcision for what it is rather than what people think it is. It’s accepted thought. We’re told we owe complete deference to it. Who are we to tell people their dismissal of inconvenient facts is wrong? We’ll assume they’re informed, whatever they’ve been told or choose to believe. Parents have this absolute right to have their healthy children cut for whatever reason they desire. Sons only. Obviously.

Except, wait. I just noticed an error. I transcribed that quote wrong. Here’s the real quote from that story:

In Jakarta, Fitri Yanti, a pregnant 30-year-old mother of two, said she did not understand what all the fuss was about. She said she was not mutilated during her circumcision, didn’t bleed at all and felt nearly no pain during or after the procedure. “Mutilation is horrible, but it’s not true that it happens here” in Indonesia, Ms. Fitri said. “They cannot stop us. It’s our tradition.”

We will never accept that defense in the context of female genital cutting. Rightly so, of course. But I choose not to be a hypocrite, so I don’t accept it for male genital cutting, either. The basic fact is the same. It’s non-therapeutic genital cutting on a non-consenting individual. Therefore, the principle is the same. They are both unethical. Opposition to one necessitates¹ opposition to the other².

We should also be clear on what Ms. Fitri may be arguing.

Experts in Indonesia said the practice there had largely involved a less drastic version of cutting, usually a surface scratch or nick, as compared with more severe disfiguring. The Indonesian government’s survey asked parents if their young daughters had undergone circumcision. Ms. Cappa said it was possible that there were some more severe cases in Indonesia, but she said the official Indonesian government definition of female circumcision was “an act of scratching the skin that covers the front of clitoris without injuring the clitoris.”

That is objectively less harmful than male circumcision. Still, the official government definition could be irrelevant to the reasons parents are answering “yes”. The parents could be openly admitting something much more severe. This possible difference matters for prevention and response. In principle, it’s irrelevant. We recognize even “a surface scratch or nick” on a female minor’s genitals, which will likely heal without permanent injury or scarring, as unethical and worthy of prohibition. The WHO’s definition of FGM is effectively “any genital injury for non-medical reasons”. The universal principle is obvious and applies without regard to sex. We must all reject the silly, biased distinction the WHO and others demand. Possible health benefits are not a “medical” reason for non-therapeutic male genital cutting. (“Medicalized” is not the same as “medical”.)

What happened to Ms. Fitri is unethical. What will/did happen to Ms. Fitri’s children is unethical. For every male who was/is the hypothetical Dominic Morris as a child, what happened to them as a child is unethical.

(Title reference here.)

¹ Opposition to both does not necessitate equal activist efforts from everyone. Care more about FGC/M? Agitate for change. Care more about MGC/M? Activate for change. The cumulative effort will work itself out. Just don’t dump on those agitating more for one than the other, or for making the logical comparison of the two.

² Or it necessitates support for both, but I assume no one reading this wishes to be horribly wrong and unethical.

The One Concept You Need to Know about Routine Infant Circumcision

Here’s a frustrating analysis of circumcision, 5 Ways Circumcision Affects the Rest of Your Life. It’s throwaway click-bait at its core. I clicked, they won. There’s still something interesting within the list:

Most guys have no choice in whether they have a foreskin or not. Nearly 60 percent of male newborns in the U.S. get circumcised at birth, according to the Centers for Disease Control and Prevention. But your parents’ decision about that tiny bit of skin has far- and wide-ranging implications. …

The list deserves credit for not being entirely ridiculous in its approach. It provides the ethical map from its first words. The first item is circumcised men “last longer”. That isn’t presented as an unquestioned benefit. And the second item is the possibility of sexual difficulties for female partners from male circumcision. So, yay. But then the third item:

Before you get bitter[¹] about the female orgasm thing, thank Mom and Dad for this: Circumcised men are less likely to get penile and prostate cancer[²], research finds. …

It’s reasonable to get bitter about the “female orgasm thing.” It’s even more reasonable to get bitter about the “last longer” thing. The first five words of the author’s essay, “most guys have no choice,” demonstrate that mom and dad deserve no thanks or applause for taking that choice away. I accept that some men “thank mom and dad” for “last longer”. That post hoc rationalization can’t change the ethics. Bad things happen in every circumcision. Other bad things can also happen from circumcision. Until the child expresses his affirmative consent to non-therapeutic circumcision, mom and dad need to keep their preferences to their own body. His body isn’t their choice.

¹ Whether bitterness (i.e. anger) is productive as a driving motivation is a separate concern.

² Again with this.

Flawed Circumcision Defense: Children’s Urology, Austin

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.

Genitalia

  • 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

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

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

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

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

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

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

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

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

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

Not every male would have foreskin anxiety

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

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

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

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

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

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

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

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

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

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

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

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

Besides the desensitization –

So you do have less sensation now?

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

Is it worth it?

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

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

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

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

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

From the results section of the study’s abstract:

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

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

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

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

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

Read this response instead.

Circumcision Is

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

Agreed.

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.