Joint Government Effort to Eradicate Consent

Posted: June 19th, 2015 | Author: | Filed under: "Voluntary", Control, Ethics, HIV, Public Health | 2 Comments »

As always:

The Ministry Of Information and Communication Technology in partnership with the Ministry of Health and the centre for Disease Control in America are collaborating on a National Strategic framework known as the Voluntary Medical Male programme which is a joint government effort to eradicate the long struggle of HIV/AIDS infections.

HIV/AIDS has always been the countries top priority with the health ministry being pressured to reach their ambitious 2030 vision to bring HIV/AIDS infections to zero in the country.”The Centre for Disease Control and the Ministry of health have had three randomised controlled trial runs of the voluntary medical male circumcision programme prior to it’s launch in 2009. With the success of the programme around 20,000 sexual active males have been circumcised to date thus raising 80% awareness to men to encourage more males in considering medical circumcision,”said programme specialist Mr Dan Rutz of CDC.

Somehow success is measure in “males circumcised” without giving any statistics on HIV rates¹. So it’s easy to predict what “encouraging more males to consider ‘medical’² circumcision” means:

“Medical male circumcision has been found to be cost effective, as well as all procedures are free at clinics it has been known that healthy employers increases work productivity within any work environment which leads to a steady healthy work environment that enables the economy to grow,” added Rutz.All males that have not been circumcised are encouraged to do so as procedures can be performed at all local regional clinics in the country as government want to achieve it’s target to circumcise 330,000 men between 15 to 49 years by the end of 2016.The Ministry would also like to implement a national policy programme known as an Early Infant Circumcision strategy in the near future that will enable newly born babies to be circumcised.

“Enable”. Newborn males won’t get to consider or volunteer. They will be considered and volunteered, their needs, preferences, and preventative options deemed irrelevant. They are only pieces by which public health officials measure their own professional success.

As always, when public health officials discuss voluntary or adult circumcision, they never mean voluntary or adult.

¹ A drop in HIV infections would be welcome. It cannot justify violating ethical obligations to protect the rights of non-consenting individuals.

² Circumcision in this context is medicalized, not medical. Merely performing non-therapeutic genital cutting in a sterile operating environment does not make it necessary. This is also not a defensible term to justify performing non-therapeutic genital cutting on a person who does not offer explicit consent.


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

Posted: January 30th, 2015 | Author: | Filed under: "Voluntary", Control, Ethics | No Comments »

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

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

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

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


President’s Endless Plan for Avoiding Rights

Posted: January 28th, 2015 | Author: | Filed under: "Voluntary", Ethics, HIV, Politics, Public Health | 1 Comment »

PEPFAR held an event today, described as:

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

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

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


Start a pilot project on the ethics of consent

Posted: December 1st, 2014 | Author: | Filed under: "Voluntary", Ethics | No Comments »

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

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

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

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

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

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

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

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

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


“well, perhaps to you, but this is MY body!”

Posted: November 16th, 2014 | Author: | Filed under: "Voluntary", Logic, Regret | 1 Comment »

Musician and YouTuber Emma Blackery posted an excellent response to a question on Tumblr, Why are you getting rid of your tattoos? :(. Her reasoning is perfect and word-for-word applicable to circumcision, except for the obvious point that she chose her tattoos, whereas most circumcised males didn’t choose it.

Gonna answer this publicly – not for any malicious reason (as I’m not mad at anyone!) but simply because I’ve had SO many people phrase this question in a way to make me feel guilty.

I got many of my tattoos when I was quite young. The one on my leg is (in my opinion) very obnoxious, as well as being a mess as it was a coverup. The ones I can see in the mirror just don’t make me happy anymore. I’m a different person to the one that got all of these tattoos and they just don’t reflect me anymore.

My problem isn’t the people asking – it’s the way people are putting it, with unhappy emoticons and saying ‘why? they’re great!’ well, perhaps to you, but this is MY body! i’m the one that has to look at them every day, and i no longer want them. that’s honestly it.

“‘Why don’t you want circumcision? Circumcision is great!’ Well, perhaps to you, but this is MY body! I’m the one who has to live with it every day, and I don’t want it.”


If the press release says it’s “voluntary”…

Posted: August 1st, 2014 | Author: | Filed under: "Voluntary", Media Marketing, Politics, Public Health | No Comments »

There are few things more predictable in an article titled A Lesson in Health: Scaling Up Voluntary Medical [sic] Male Circumcision than the false use of voluntary. (all emphasis added)

[Seventh-grade teacher at Kopong Primary School in Botswana, Mothusi Joseph] Kgomo and five of his students who were circumcised that day (with their parents’ consent) are a few of the more than 1 million men and youth in sub-Saharan Africa who have chosen to protect themselves and reduce their lifetime risk of contracting HIV by participating in Jhpiego-supported VMMC programs. …

While the unprecedented scale-up of this lifesaving intervention in countries with high HIV-infection rates is impressive, what’s more remarkable are the people who helped make it happen: fathers who brought their sons to clinics, best friends who encouraged their peers, military lieutenants who set an example for their platoons, tribal chiefs and concerned wives, as well as nurses who took on added responsibilities and roles at health centers, and healthcare providers from neighboring countries who traveled long distances to help their fellow Africans during busy VMMC campaigns. …

This article – by Leslie Mancuso, President and CEO of Jhpiego – is adapted directly from a press release (pdf). That press release¹ declares that “More than 1 million men and youth in sub-Saharan Africa have chosen to protect themselves and reduce their risk of contracting HIV by participating in Jhpiego-supported voluntary medical male circumcision (VMMC) programs.” It’s always the same. When public health officials say “Voluntary Medical [sic] Male Circumcision,” they never mean voluntary. Never. I’d suspect the word will eventually be dropped altogether, just as adult disappeared, except it’s useful for the propaganda needed to circumcise healthy children.

¹ How soon before we get another “news” story about Selemani Nyika, Triza Liyasi’s husband, or Lt. Suwilanji Musamba?


The Majority of This Post’s Authors Oppose Unethical Practices

Posted: June 19th, 2014 | Author: | Filed under: "Voluntary", Control, Ethics, Media Marketing | No Comments »

It’s no longer surprising to see the hyperbole concocted to make circumcision appear legitimate. The latest example comes from the Southern Africa HIV and AIDS Regional Exchange, which summarized a survey with the following:

New study in Kenya reveals the majority of women prefer circumcised partners

To summarize the study – Women’s Beliefs about Male Circumcision, HIV Prevention, and Sexual Behaviors in Kisumu, Kenya, by Thomas H. Riess, Maryline M. Achieng, and Robert C. Bailey – the way SHARE does is presposterous. The study involved 30 women, with 23 of them saying they preferred circumcised men. The proper way to summarize it is the second line from the abstract:

Women’s beliefs about MC and sexual behaviour will likely influence the scale-up and uptake of medical MC.

Counter to SHARE’s summary, the authors note (emphasis added):

There are limitations to this study. Since we relied on self-reports it is possible that some respondents could have fabricated answers or not fully disclosed information based on what is socially acceptable, particularly on sensitive topics such as sex and HIV. We did attempt to select respondents who were representative of sexually active women ages 18-35 but given the small sample size and geographic location of our research, our data might not be generalizable to other populations, particularly those where MC is not being promoted as HIV prevention. Our intention has been to gain insights into female perceptions and sexual behaviors related to MC in western Kenya in order to inform and improve programs scaling up MMC for HIV prevention in the region.

It’s misleading to report the study as revealing what the majority of women prefer.

Of course, it’s irrelevant what the majority of women prefer. The ethics center on what the male prefers for himself. In what ways could we rewrite this paragraph to allegedly demonstrate something about what women should do – or have done to them – to conform to the preferences of men?

Respondent: Actually, me personally, I hate uncircumcised men.
Interviewer: Why?
R: I just feel they are dirty and, … this last time, some other guy seduced me, … I didn’t know he was uncircumcised. So when we went out a bit for around four months, so it’s this day was he was telling me like we go to bed, after finding out that the guy is uncircumcised I just told him it can’t work. He should go get circumcised first and come back.
I: So how did he react?
R: Well actually he felt bad, but later he came to understand. That is when he went and got circumcised and we are together now. (25 year-old Luo woman)

Body shaming is body shaming, whoever its target may be. Repeatedly the excerpts emphasize a belief that circumcised men are “clean” and intact men are “dirty”. While the authors note this, and are perhaps genuine, in saying:

… While some women support MC based on their personal experience and beliefs, there may also be the potential for discrimination against uncircumcised men as circumcision programs scale up in sub-Saharan Africa. …

I find no reason to believe public health officials cared or will care. Discrimination is a strategy of these campaigns, as in this awful propaganda ad from Uganda. And the tactic is already paying the expected dividends. The interview excerpts in this study are evidence of that:

I: Do you desire circumcised men?
R: Of course a circumcised one (laughs).
I: Why not the uncircumcised one?
R: I don’t want diseases. (22 year-old Luo woman)

And:

I: And say you get some man who is not circumcised, what will you do?
R: You tell him that circumcision is good, a circumcised person has less chances of getting infected with these diseases, these minor diseases.
I: And if he still refuses?
R: If he refuses you just leave him. (27 year-old Luo woman)

The excerpts also reveal the well-tested “heads, circumcision wins / tails, foreskin loses” approach to sexual satisfaction.

… no matter how the lubrication is, that foreskin will, I don’t know, it moves … and then let me say they don’t stay long. … Yeah they didn’t stay long when you guys are the uncircumcised. Out of curiosity I did ask how come you don’t take long. They say like if that skin is moving it makes them crazy and they release so fast, and I said, okay. And then unlike the circumcised people maybe it’s to our advantage, the ladies, maybe it could be not to them but I think to our advantage they’ll take long. Like they might make you reach a peak faster than the uncircumcised. (23 year-old Luo woman)

The authors state that circumcision campaigns “should ensure that MMC promotion campaigns and counselling are clear that studies have shown that MC does not affect male time to ejaculation.” But campaigns like this count on individuals to sell the message, however well they grasp or fail to grasp that message. Intentionally engaging people to market on behalf of public officials involves spreading anecdotal evidence. There is no comfort or absolution in “the studies show” once they’ve started the game of telephone.

There also remains the possibility that the sources for the claim that circumcision does not affect male time to ejaculation are inaccurate. Note, too, that whether or not the male considers this change good is nowhere to be found. The ethical issue remains absent in this push for networked propaganda.


Another Reminder

Posted: April 15th, 2014 | Author: | Filed under: "Voluntary", Public Health | No Comments »

When public health officials advocate for voluntary adult male circumcision, they never mean voluntary or adult. From Zimbabwe:

The ministry was working together with the Population Services International (PSI) on the programme.

PSI director for voluntary medical male circumcision Ngonidzashe Madidi said for the purposes of sustainability, they were studying the early infant male circumcision (EIMC) to ensure protective effect of male circumcision is sustained.

Madidi said they wanted EIMC to run parallel with the adult Voluntary Medical Male Circumcision (VMMC) programme.

“Currently, EIMC is in a study phase and we are happy to say we managed to circumcise at least 560 babies successfully,” Madidi said.

Are the infants happy? Do they think it was successful?


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.


Flawed Circumcision Defense: Yair Rosenberg, Part 3

Posted: December 30th, 2013 | Author: | Filed under: "Voluntary", Ethics, FCD, Logic, Media Marketing | 1 Comment »

It won’t come as a surprise to read that I don’t think much of Yair Rosenberg’s lazy approach to analyzing non-therapeutic infant male circumcision. Add another example. This time he’s misreporting the findings of another meta-analysis by Brian Morris. Mr. Rosenberg quotes from a Daily Mail article that amounts to little more than a press release.

But first his introduction:

Across Europe, pushes to ban circumcision have rested on its supposedly deleterious effects on a child’s body, and lack of demonstrable benefits. Anne Lindboe, Sweden’s child welfare adviser, has gone so far as to label the practice “violence against children,” claiming that parents who perform it do so out of “ignorance.” She and her counterparts in Denmark and Finland have classified child circumcision as a “human rights violation” and called for it to be criminalized. A German court similarly banned the procedure on the grounds that it caused “bodily harm.” The only problem with these stances? They completely contradict everything science has found about circumcision’s impact on children’s health.

Findings of potential benefits from voluntary, adult male circumcision do not contradict the ethical, rights-based position against non-therapeutic infant male circumcision. Proxy consent is not the same as the consent given by adult volunteers to this permanent, irreversible surgery. Circumcising healthy minors violates their rights to bodily autonomy and integrity, just as any other permanent, non-therapeutic intervention is a violation. It’s the same principle that applies to even the tiniest, less-invasive-than-male-circumcision cut on a female minor’s genitals, which we’ve rightly criminalized. Potential benefits and human rights violation are not mutually exclusive. The presence of potential benefits does not eliminate the fatal ethical flaw. Nor does deciding that circumcision diminishing sexual function, sensitivity, or satisfaction is a “myth”, as Mr. Rosenberg claims of the new meta-analysis by Prof. Morris and Dr. John Krieger.

With that misguided frame, Mr. Rosenberg presents the study:

“The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction,” Professor Brian Morris told The Daily Mail. Morris and his co-author looked at 36 studies covering 40,473 men, half circumcised and half not. They ranked each in terms of scientific rigor and quality, according to accepted official guidelines. And they found that circumcision “had no overall adverse effect on penile sensitivity, sexual arousal, sexual sensation, erectile function, premature ejaculation, duration of intercourse, orgasm difficulties, sexual satisfaction, pleasure, or pain during penetration.” Indeed, after 24 months, 99.9 percent of men were satisfied with their circumcisions–and 72 percent said sensitivity had increased.

There’s a lot to unpack there. The largest point is that Mr. Rosenberg clearly didn’t read the 12 page paper because he regurgitates the results in the digestible (i.e. misleading) package given in the news article. Reading it might reduce his confirmation bias. There are enough obvious limitations, as well:

While the review considered a large body of evidence, there are some factors that may be influencing the findings.

For example, many studies were surveys, and the recruitment process for them is not described. It could be the case that men who have a satisfying sex life may be more willing to participate and answer questions on sexual performance and satisfaction that those who aren’t.

Also, most of the responses in the study are subjective, and what one person considers to be a sexual problem or sexual satisfaction, another might not. There may also be differences in the culture and ethnicity of the participants of certain studies, meaning that their findings cannot be so easily transferred elsewhere.

Beyond that, focus on the conclusion from the study. They state that their analysis suggests this conclusion. Suggests is not a synonym for proves. Yet, even though the Daily Mail article doesn’t use the word in quoting Morris, Mr. Rosenberg states:

Morris told The Daily Mail that he saw his study disproving circumcision’s adverse effects as complementary to those showing its benefits. …

He repeatedly misses the critical issue of consent versus force. In a previous article Mr. Rosenberg summarized a finding that “[i]t would have been unethical to continue without offering circumcision” to the remaining intact volunteers in a study with a simple statement that it would be “[u]nethical not to circumcise the men.” It appears that Mr. Rosenberg is not a reliable filter for news pertaining to circumcision.

There are obvious problems in the current meta-analysis. I will accept their methodology and reasoning as presented, which lead to their “suggests” conclusion. Assuming it is accurate, so what? The findings were not 100%. Of course, 99.9% is presented as essentially the same thing, which is even better than the result we’d expect from a dictator’s latest popular election. From the Krieger et al. Adult Male Circumcision study in Kenya [15]¹, 8.9% of circumcised men identified their penile sexual sensation as something other than “increased” or “the same” 24 months after circumcision. It’s ridiculous to pretend that these men don’t matter and that their experience should be ignored to allow a perceived universal defense for circumcising male minors.

Mr. Rosenberg concludes:

Yet the findings of science have done little thus far to deter Europeans politicians and health officials from seeking to criminalize circumcision, and labeling those who practice it “ignorant” and “barbaric.” It remains to be seen if this study will alter their course.

A utilitarian defense for violating human rights is ineffectual because the defense relies on using only a preferred subset of factors to reach a conclusion. “It’s mine” is a sufficient reason for a male to want his foreskin. He owns his foreskin as much as he owns any other part of his anatomy. Potential benefits valued by his parents are irrelevant while his body is healthy. Proxy consent for this non-therapeutic intervention is invalid because the net benefit or harm is subjective to the individual himself.

This is obvious if considering the question Morris and Krieger asked. Does male circumcision affect sexual function, sensitivity or satisfaction? In order, yes, maybe, and maybe. The findings suggest as much if we look at the participants in the included studies as individuals with their own unique tastes and preferences rather than as statistics. The paper’s focus is sex as a measurable number, which is an idiotic way to reach a conclusion about a subjective topic like human sexuality.

For sexual function, the foreskin is removed. That changes function. Maybe that’s “good”, maybe it’s “bad”. Each person must decide before circumcision what he thinks he wants. What his parents prefer is meaningless.

As for sensitivity, the results are equivocal. I’m willing to accept the negative findings as lower-quality studies for this purpose. But in a study Morris and Krieger rate as 2++, Payne et al [12], this:

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

Yet, for Morris and Krieger, this is support for their “suggests” conclusion because:

… More circumcised participants reported an increase in their level of sexual arousal, while more uncircumcised men reported being unaffected by the erotic stimulus. …

They want to believe, so they believe. That’s the only way I can reconcile the source study with their analysis.

In certain aspects sensitivity is quantifiable, but there is a an element of experience to human sexuality that a generalized “yes” or “no” here dismisses. That same element of experience, but without the ability to quantify in a utilitarian summary, exists in personal evaluations of satisfaction. This is why I don’t state that someone is wrong for preferring circumcision or believing it improves their experience of sex or life, in general. But that is also why it’s wrong for Morris, Krieger, Rosenberg, or anyone else to support parental choice (i.e. proxy consent) for non-therapeutic circumcision. Declaring one’s own preference as a truth applicable to someone else – without concern for the individual’s preference for himself – is the critical mistake inseparable from their argument.

One final point: It’s important to read the abstract and the study rather than just the abstract, even as a layman. Doing so reveals a lot of nuance, as the AAP’s revised position statement in 2012 so embarrassingly showed. It avoids the “It’s official!” conclusion too many (like Mr. Rosenberg here) want to staple to the evolving science involved in circumcision. The Payne [12] study is another example of the importance of this maxim, as are the remaining studies reviewed by Morris and Krieger, probably.

¹ Bracketed numbers correspond to the same-numbered footnote in the Morris/Krieger review.