Category: FCD

Flawed Circumcision Defense: Wesley J. Smith (Yet Again)

Wesley Smith is back again in National Review to demonstrate he does not understand genital mutilation. Last week he urged President Trump to sign HR 6100, The STOP FGM Act of 2020, which seeks to resolve the concerns of the federal court that dismissed prosecution in Michigan under the Anti-FGM Act of 1996. Within the bill:

“(a) Except as provided in subsection (b), whoever, in any circumstance described in subsection (d), knowingly—

“(1) performs, attempts to perform, or conspires to perform female genital mutilation on another person who has not attained the age of 18 years;

“(2) being the parent, guardian, or caretaker of a person who has not attained the age of 18 years facilitates or consents to the female genital mutilation of such person; or

“(3) transports a person who has not attained the age of 18 years for the purpose of the performance of female genital mutilation on such person,

shall be fined under this title, imprisoned not more than 10 years, or both.”

A principled individual would read that in its most direct application: non-therapeutic genital cutting on an individual who can’t consent is prohibited, full stop, without exceptions. Alas, like far too many people, Smith believes this applies to only some children, and cites this language from the bill as a foundational defense of discrimination:

It shall not be a defense to a prosecution under this section that female genital mutilation is required as a matter of religion, custom, tradition, ritual, or standard practice.

It shall not be a defense to a prosecution under this section that female genital mutilation is required as a matter of religion, custom, tradition, ritual, or standard practice to impose on a child who neither needs nor consents to surgical intervention. This is so blindingly obvious as a principle that it requires severe mental gymnastics to escape the implication to male (and intersex) children. Smith engages in those gymnastics.

I am a strong defender of religious freedom and the free exercise thereof. But the right is not absolute. The Smith case (which I oppose and hope the SCOTUS will overturn) stripped protection for religious freedom when laws are of general application — as is this bill. In other words, the bill does not single out a particular faith or group in the prohibition.

If the law protects all children, as it should, not a single word of that paragraph needs to change, excluding the parenthetical, which I’ll get to in a moment. Basically, Wesley Smith acknowledges that, under current law and precedent, restricting a religious freedom is permissible when the law is generally applicable and furthers a legitimate state interest. There is nothing more generally applicable than “you can’t mutilate the genitals of a healthy child”. And if that isn’t a compelling state interest, the state literally shouldn’t exist because it will have ceased to defend the rights of its citizens least capable of defending themselves.

Smith’s parenthetical demonstrates that he acknowledges a law prohibiting non-therapeutic genital cutting on boys without exemption for religion is the correct interpretation under current law, or he wouldn’t worry about the case in this context to protect religious “rights” at the expense of human rights he doesn’t value. In America, it’s impossible to argue that circumcision is a strictly religious practice, or that any prohibition would only stop religious parents from circumcising. Every male child can be mutilated at the request of his parents, so a law protecting his right is generally applicable. Thus, everything Smith tacks on after this is special pleading for lawless human rights violations.

That designation certainly applies to a law that prohibits the mutilation of minor girls, which, I should note, is not required by the Koran or any holy book of which I am aware and is done for the express purpose of suppressing the victim’s normal sexual functions. FGM is a direct attack on the equal intrinsic dignity of females and hence, an assault on the human exceptionalism philosophy of our societies.

He just praised the text of the bill that dismisses any claim of a religious requirement, so the fact that he’s not aware of any requirement is irrelevant. Of course, if Smith bothered to look, he’d find interpretations that conclude a requirement exists. I have no doubt Smith would – correctly – dismiss these claims as undermining this prohibition. So, his concern here is, again, special pleading to pretend that a religious requirement matters when he praised the text making it clear it doesn’t.

His belief that parents who cut their daughters always do so with the express purpose of suppressing the victim’s normal sexual functions is also unsupported with even a minimal amount of searching. That is usually the outcome, and it’s always a violation of their body and rights, but Smith assumes his opinion is fact because it’s the narrative, not because he has evidence or has studied the topic beyond a cursory review.

It’s also odd to believe that we need to defend against a direct attack on the equal intrinsic dignity of females by protecting them from what he expressly demands we continue permitting on their brothers. Where is the equality? Where is the dignity? Where is the principle he claims to defend, other than “what we do is good, what they do is bad”? If it’s wrong to cut, it’s wrong to cut.

I anticipate that the “intactivists,” that is, zealots who want to outlaw male infant circumcision, will say that their cause is the same as prohibiting FGM. It is not. First, circumcision is a specific religious requirement of Judaism that brings the infant into the faith, and is also strongly promoted for religious reasons in Islam. Second, it does not destroy sexual function, nor is that the purpose of the procedure. Third, it is not undertaken as a means of oppression. Finally, medical associations believe that the decision to circumcise — regardless of religious issues — should be up to the parents as there is a modest hygienic benefit attained by the procedure.

Of course non-therapeutic genital cutting is one cause, regardless of sex. Non-therapeutic cutting of the prepuce of a non-consenting male violates his bodily autonomy the way such a surgery on a girl’s prepuce would. They both have the same property right in their own body. The only ethical position is that we won’t cut children. This shouldn’t require a law, but it does because people violate their children in this manner. And again, the state has an interest in protecting the rights of every citizen, not just those with the correct cultural favor.

And Smith already demonstrated why his concern that circumcision is a specific religious requirement is irrelevant to whether or not we should protect male minors. Laws of general applicability are generally applicable, not narrowly applicable in blatantly discriminatory ways.

Contra Smith’s opinion, circumcision destroys sexual function. Refusing to acknowledge that the normal anatomical structure of the penis, foreskin included, follows the same biological concepts as every other part of the body, including female genitalia (with foreskin), does not render the removal of the foreskin a non-destructive act inflicting no permanent harm. All surgery is battery. It is harm. The STOP FGM Act of 2020 does not make distinction for degrees of harm or intent to cause harm. The act itself is harmful to the child, and would be prohibited. Some forms of FGM are considerably more severe than a normal male circumcision. Some forms are considerably less severe. All forms will be illegal if Trump signs the bill. There is no “as long as it’s not too harmful” threshold to save male circumcision from ethical rejection.

If Smith actually cared about the complexities in this issue, he’d know that FGM is often undertaken to “improve” the girl, not to oppress her, and at the request of her female relatives over the objection of her male relatives. It still oppresses her, despite any “good” intentions, but we’re talking about the outcome, not the intent, which is what the law explicitly criminalizes.

Smith is correct that parents (generally) do not intend to oppress their sons when they circumcise. It still oppresses them. It is a form of permanent sexual control. “Your genitals will be what I approve of” is control. “You will have this potential benefit through surgical intervention, even if you’d rather just wear a condom” is control.

Having gotten this far in Smith’s shallow analysis leaves no doubt that he hasn’t assessed what “medical associations” say, such as in the APP’s policy statement. It’s an appeal to authority, except the most-often-cited authority’s policy is deeply flawed, misleading, and unethical. The very statement¹ he thinks supports a conclusion that the benefits outweigh the risks ignores the costs (i.e. harms) entirely to reach a conclusion satisfactory to people who will ponder circumcision as superficially as Smith. From the section on ethics, for example, “[r]easonable people may disagree, … how the potential medical benefits and potential medical harms of circumcision should be weighed against each other.” Reasonable people includes the human being who will live with the consequences of others choosing the most radical intervention for him as a prophylactic against mostly minor future risks that can be generally resolved with non-invasive treatments, which is the approach we take with their sisters.

So, yes. Male genital cutting is the same as female genital cutting in causing permanent harm, its ultimate violation, and the irrelevance of its religious nature on the prohibition of its imposition on children.

¹ The AAP doesn’t have a policy statement on male circumcision, because the technical report from 2012 explicitly states “[a]ll technical reports from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.” It’s now eight years since this statement, and it has not been reaffirmed, revised, or retired.

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: Wesley J. Smith (Again)

I expect garbage opinions on male circumcision. Too many people don’t think about it, letting the inertia of ignorance fill in the gaps in their knowledge as parents (and humans pondering anatomy). But I don’t expect such trash from a magazine like National Review that prides itself on being smart, honest, and principled. (More on that in a moment.) Here, Wesley J. Smith shows an embarrassing lack of curiosity and imagination. (Again, since Smith has shown he doesn’t understand the subject before.)

“Intactivists”–the nutty name anti-circumcision activists have given themselves–who aim to outlaw infant circumcision, claim that the procedure has no benefits and constitutes child abuse.

Baloney. There are at least mild health benefits for men, to the point that the American College of Pediatricians recommends that the choice of whether to circumcise be left to parental discretion.

He should talk to more people against non-therapeutic male child circumcision, since he doesn’t appear to have met those like me. The procedure has potential benefits. Removing a body part inherently means something that can happen to it can no longer happen. Phimosis, for example, is no longer possible. Or name any potential benefit, real or made up. It doesn’t matter. Smith cites a new rehashing of studies by Brian Morris¹ showing potential benefits to the health of female sexual partners. Fine. I’ll concede it, even though much of the context is often dropped. Male circumcision offers that benefit, whether it does or not.

Here’s the problem: so what? That something is possible does not prove it’s acceptable to do it. Acceptance of science (with disagreement on the veracity of claims) is compatible with rejecting the application of that science to the healthy, normal body of another human being without that person’s consent. Non-therapeutic male child circumcision does not meet the ethical threshold for proxy decision-making. It can be delayed until the male can consent, given that it’s non-therapeutic. There are less invasive prevention methods and treatments available for every potential issue non-therapeutic circumcision seeks to address. The child owns his body, including his foreskin. This is the same human right everyone has over their body and genitals.

That’s all before we even get to preference. What does the individual want for his body? All tastes and preferences are unique. The individual has to live with the decision. If left intact with his choice, he has to live with it for 18 years, at which time he can change it. Or not. If circumcised, he has to live with it for the rest of his life, including the decades he’ll spend as an independent adult. He can’t reject what didn’t need to be forced. The ethical difference in those two scenarios is stark.

Notice, too, that Smith can’t even cite the right organization, calling the American Academy of Pediatrics the American College of Pediatricians. The latter exists, but is not the source² of his link. If he can’t cite them correctly, what is the likelihood he read the AAP’s technical report that fails to support their position?.

Smith concludes:

The utter obsession some have about outlawing circumcision–whether undertaken for religious or health reasons–has always puzzled me.

But now we know that other than emotion and a bizarre belief expressed by some intactivists that sex isn’t as good for the circumcised, there appears no substantial reason to oppose the practice, much less outlaw it.

If he addressed his puzzlement with research rather than cognitive dissonance and confirmation bias, he might understand there’s more than BUT MUH BENEFITS. That Wesley J. Smith can’t think of a reason against non-therapeutic child circumcision is not proof there is no reason against it. The reasons are real and substantial.

For example, he would know the “belief” expressed that sex isn’t as good for circumcised men is an argument that sex isn’t the same, which is a fact, and that it likely isn’t as good, an educated guess based on data and anecdotal evidence. Removal of the foreskin means sex with a circumcised penis is sex without a foreskin. If you change form, you change function. The skin and nerves and functionality there at birth are no longer there. Again, that is a fact. Whether that’s good or not is a different matter. And again, all tastes and preferences are unique.

Anecdotal opinions are easy to find, but you have to be willing to search for and understand the implication of “…[n]ever felt I was too sensitive before circumcision but in retrospect I was.” Will every man think he was “too” sensitive? Does that suggest circumcision changes sex, at least?

Or do you need someone with a few more credentials, such as Dr. Laura Berman, who states “[r]emoving the foreskin also removes thousands of nerve openings that make sex more pleasurable.”

Or do you want a scientist and ethicist who studies circumcision, like Brian Earp, who reads studies rather than headlines to understand what research means. This includes when he read and analyzed³ a study by Jennifer Bossio, writing⁴, “you will be surprised to learn—I am quoting directly from the paper now—that ‘Tactile thresholds at the foreskin (intact men) were significantly lower (more sensitive) than all [other] genital testing sites’ including the sites in circumcised men (emphasis added).”

Or do you want another researcher who studies circumcision and sensitivity, like Dr. Kimberly Payne, who wrote in her study, “[i]t 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, Brian Morris used Payne’s study, which he rated as the highest quality, in another rehash he used to conclude, “the highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.”

The people who seem to care the least about the details of circumcision generalize toward the view they already held going in. Morris is a propagandist, and presumably Smith relies on him because he wants to believe. He’s not unique in that approach, but it’s not something he should put on display as he did.

Which leads me back to National Review’s Credenda. Among their convictions:

A. It is the job of centralized government (in peacetime) to protect its citizens’ lives, liberty and property. All other activities of government tend to diminish freedom and hamper progress. …

Non-therapeutic child genital cutting, including circumcision, violates the rights of the child, who is an individual and a citizen. Removing his foreskin deprives him of his property and liberty.

It is appropriate for the government to prohibit the non-therapeutic circumcision of male minors, as it already does for female minors. Whether or not that’s the fastest path to ending the cultural abomination is worth discussing. I think it isn’t, unfortunately. But it’s an appropriate legitimate action of government, since it would protect the rights of citizens, the substantial reason government exists. The government ignoring this diminishes freedom.

Whatever your opinion of National Review, Smith’s defense of circumcision should embarrass everyone at National Review.

¹ If you want to read the Morris study, follow the link to Smith’s post. If you want to know how to analyze one of the papers Morris cites in this new rehash, which is one of his previous rehashes of prior papers, read here and here. But notice the pattern of Morris rehashing papers over and over for the casual reader like Smith to think, “ahhh, a new study, and look at the volume of past studies showing the same thing!”. Stop being a dupe for his propaganda.

² The American College of Pediatricians has an official statement on Female Genital Mutilation. Its only reference to male circumcision is when it states:

The terminology itself has generated controversy. The World Health Organization emphasizes the fact that there are no medical benefits associated with even the least invasive procedure. Therefore, the WHO uses the term ‘mutilation’ to “establish a clear linguistic distinction from male circumcision, and emphasize(s) the gravity and harm of the act. Use of the word ‘mutilation’ reinforces the fact that the practice is a violation of girls’ and women’s rights, and thereby helps to promote national and international advocacy for its abandonment.“ (source)…

That linguistic distinction is propaganda, in the definitional, non-pejorative context, which the end of the quote acknowledges. There is harm in genital cutting, regardless of the victim. The practice is a violation of the victim’s rights, regardless of the specific genitals of the victim.

Yes, FGM is usually worse than male circumcision. Not always, and the law against FGM in the United States do not permit those harms equal to or less harmful than male circumcision. We treat the issue differently depending on who the victim is, which is logically and ethically flawed. The presence or absence of potential benefits is irrelevant to both. The absence of both need and consent is all that’s relevant.

³ Predictably, Brian Morris mischaracterized this finding in another of his rants.

⁴ Earp also clarifies with an 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.”

Lazy thinking seems to be a prerequisite for those who advocate non-therapeutic male child circumcision.

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.

Discomfort Them So They Won’t Be Discomforted?

In the comments to the article in yesterday’s post, Bryan Swilley wrote the following:

This article is another example of the media using sex to generate readers when no real controversy exists. Sure, a few detracters exist to circumcision but they are a small minority. In my medical career I have counseled virtually no one concerning any mishaps during the procedure or any mental anguish from having it done and can remember only 1 american parent in 30 years who was steadfast against it, but I do remember the discomfort some men faced following an elective circumcision performed when they were adults. The procedure tends to help when it comes to cleanliness and I remember senior physicians during my training discussing cancers that were hidden under a foreskin later in life when no circumcision was performed.

We could easily play a game of “Whack the Fallacy”, but there are only so many hours in each day. I want to make rhetorical points instead.

Why is it difficult for people to recognize the absurdity in citing the “discomfort” of elective adult circumcision as a justification for infant male circumcision? It’s elective, so do they value the circumcision or not being in discomfort more? Do people believe an infant doesn’t experience “discomfort” during his elective elected circumcision? Why is the issue of consent not shining in their minds?

Flawed Circumcision Defense: Barbara Kay

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

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

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

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

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

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

She continues:

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

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

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

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

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

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

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

Kay goes on to write:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

¹ Consider Fuambai Sia Aahmadu, and from 2008.

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”).

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.

Flawed Circumcision Defense: Karin Klein

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

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

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

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

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

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

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

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

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

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

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

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

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

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

And:

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

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

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

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

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

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

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