Saturday, June 06, 2009

Circumcision - To Cut or Not to Cut?

The following is a discussion regarding male circumcision, its validity, and if/how it should be compared with female genital mutilation (with acknowledgment that my term indicates part of my stance).
Below is a cut and paste of a status update by Justin Trottier and then various comments that followed.:

Justin Trottier Circumcision is a barbaric human right violation. Global TV: "16X9 exposes a new side to circumcision this Sunday--www.global16X9.com"

Darren McKee
Darren McKee
Perhaps, but it does reduce the transmission of HIV. See the links and/or the second segment -
http://www.ottawaskeptics.org/the-reality-check/62-episodes/200-the-reality-check-29-the-nocebo-effect-circumcisionaids-chicken-eggs-myth
Justin Trottier
Justin Trottier
and should female genital mutilation be shown to impede the spread of HIV (I wonder if we would ever even consider doing such research), would society then be advocating for it, or is a person entitled to bodily autonomy rather than having their penis used as a means to society - or some other individuals' - end?
Summer Blossom
Summer Blossom
Male circumcision is necessary when done for medical reasons. When its done for religious reasons, than it is barbaric & ignorant. I have never heard of female circumcision done for medical reasons, only for religious/cultural reasons. Therefore, I am against female circumcision until the day science proves that its necessary for medical reasons.
Darren McKee
Darren McKee
Necessity is a tricky one. I'll just say I don't equate the two procedures for various reasons and I think most comparisons are false (due to severity, purpose, result, etc)
Bob Margolese
Bob Margolese
I think that what Summer is saying (and I agree) is that you can equate the two if you're talking about a religious or cultural reason for doing it. When the concept of male circumcision was first introduced, the health benefits were not known therefore it IS a barbaric ritual.

When you take away the ritual part of it, there are still questions as to the morality of doing it to babies however, the reasons for doing so are far more understandable therefore the barbarism simply isn't there.

I equate the two in the first scenario and think they are completely different in the second.
There's my .02 but in these tough times, I'll charge you a quarter!
Justin Trottier
Justin Trottier
Many parents are performing this act for reasons of aesthetics, religion, cultural norms, etc, and not considering the medical points, so I submit that in a large percentage of cases it is barbaric.

I'm not convinced by the medical arguments (especially their relevance in north america). We don't prescribe vaccines until they've gone through rigorous testing and been shown to be more effective than alternatives that do not have side effects (in this case harming a man's ability to fully enjoy his sexuality AND the drama to the infant). Until such has been shown to be the case here there should be a moratorium on the practice.

Perhaps in an effort to justify male genital mutilation we've funded the sort of research we'd never think to fund in the case of female genital mutilation. The latter we somehow realize is fundamentally immoral and can in no way be legitimized....

As to Darren's point, I'm not convinced the percentage of the genital brutally removed defeats the comparison.
Darren McKee
Darren McKee
I still think there are two separate, but related, issues: (1) The reasons for the action itself; and (2) the act itself.
The reasons for male circumcisions and FGM are nearly always completely different. This does not in itself justify either, but there are differences that should be part of the discussion; (2) The act itself- The severity and resulting of effects of FGM are so different from male circumcision that while they may both be along a continuum, I would not put them near each other.
Contrasting different cultural practices is useful to understand issues and the supposed reasons supplied for continuing such practices, but each of FGM and MC should be evaluated for what they are.

Somewhat relatedly, while replying to this I ended up thinking about other 'harmful acts' that parents inflict upon their children such as ear piercings, bad haircuts and forced involvement in numerous activities. I'm not saying any of the above are related to the main topic(I've run out of room!
Justin Trottier
Justin Trottier
Darren, there is major difference between the permanent and irrevocable damage of MGM and ear piercings, bad haircuts and other activities, all of which can - in principle - be undone by a child's decision down the line. Also, can you be more precise about why you wouldn't put MGM and FGM near each other by specifying in what quantifiable or qualifiable sense they are different? And what are the different reasons for MGM and FGM?

You watch a video of a helpless infant being mutilated (and I'll give you a link if you want) or attend the actual event and then tell me the practice isn't abominable. Let's not just philosophize in the dark. We're talking about something committed against like half of all boys on this continent. The numbers alone - far, far higher than FGM - suggest we should give this matter far more consideration.
Bob Margolese
Bob Margolese
But as someone born and raised a religious jew, I have been to many brit milah's (brisses) and it is a barbaric ritual where the baby is given wine and then mutilated. It's much different from having a true medical procedure.

The claims have changed many times as to the health ramifications of removing the foreskin however, to my knowledge, the evidence that it has been proven healthy has been unchanged in many years.

Again, I would appreciate evidence to the contrary if it's there. I hate to be under a wrong or misinformed impression.
Thanks again for an interesting topic and healthy debate!
Justin Trottier
Justin Trottier
Well I think we're all agreed that the jewish and likely other religious practices are an abomination. Period. The government should remove all funding to any jewish/muslim/etc communities (eg. their heavily publicly funded community centres) where such rituals are being practiced. I might recommend you boycott these brisses. I was raised a jew too and i would never set foot at one.

When you refer to the evidence that is has been proven healthy, what health benefits are you referring to?

We don't condone medical practices except when they've been shown in repeated tests to be better than a placebo and better than alternatives with less or no side effects with respect to a well defined medical problem we wish to solve, and after years of study. Is that the case here? Or did we go looking for problems we could use circumcision to solve in an effort to justify an unjustifiable cultural practice? The process whereby MGM has been raised up as a health panacea is troubling.
Bob Margolese
Bob Margolese
I haven't been to a bris since my youngest nephew's and I would love to boycott them however that would lead to a divorce and loss of contact with my entire family so it's not a good idea in my case. I simply go when I have to and step into an outer room when the ritual takes place. I was asked to stand by the baby last time and I refused.

As far as the health benefits, I am not talking about the prevention of AIDS because I still can't see how that is proven.

I have read quite a few reports (and unfortunately, I can't cite them right now nor do I have time because I'm heading out shortly) on how circumcision prevents infections due to cleanliness and although I've never experienced an infection there nor do I know anyone who has, the thought of it is unpleasant to say the least.
Xander Miller
Xander Miller
(Tongue in Cheek) There is a continuum of types of female circumcision too. The proceedures range from a mere estetic trimming away of the outer libia - a practice comparable to the removal of the foreskin, to removal of the clitoris - comparable to removing the penis, and the intentional scoring and stitching of the flesh so almost the entire vaginal opening is sealed over by scar tissue.
As for the health benefits as a medical proceedure, they are undeniable and the same as completely severing a penis: by making clandestine sex impossible it offers 100% protection against STDs.
(Tongue between teeth) The medical benefits to
sub-saharan african males who routinely use prostitutes is besides the point. We don't let parents arbitrarily make permanent physical modifications to there children except for this one case that has been culturally grandfathered in. MGM should stop.
Xander Miller
Xander Miller
To elaborate on what I mean on permanent physical modifications, I mean having their teeth altered to look like shark teeth or the teeth of a vampire, which would be cool but also grounds for calling children's aid. Or body tattoos or havign silicon inserted under the skin to creat the appearance of bone ridges or horns. If MGM is either so painless and harmless or has such great health benefits (the arguments seem to go both ways) then why not wait for children to reach an age where they are able to make the rational decision for themselves.
If there is doubt you could rationally convince a young man to cut off the tip of his penis at age 18 then it is immoral for you to inflict that on him as a helpless infant, end of story.
Jonathan Abrams
Jonathan Abrams
I have a few points to make:
1) The health benefits and risks of male circumcision are analyzed and weighed on a regular basis by major medical bodies. Health Canada's most recent judgement is that the benefits equal the risks and therefore they instruct doctors to not recommend the procedure, nor recommend against it (I looked this up a while ago).
For more on the health/risks see Harriet Hall's article on it:
http://www.sciencebasedmedicine.org/?p=269
2) I don't think you should refer to male circumcision as genital mutilation. Mutilation is too strong a word to describe an act that apparently does not cause harm. Reports of reduced sexual pleasure is purely anecdotal. My personal anecdote is that I couldn't imagine enjoying sex more than I already do. (I'm circumcised)

3) Comparing male circumcision to female circumcision is not only inaccurate but it's damaging to the perception of the true horror that is female circumcision.
Jonathan Abrams
Jonathan Abrams
I find it odd that you would find the science around the benefits of circumcision to be 'unconvincing'. Do you know more than doctors with this issue? Without good evidence to back up a 'going against the scientific consensus' stance, you'll end up looking like a crank with an axe to grind.

Here's reporting (by a doctor) on another recent study showing the STD reducing benefits of male circumcision.
I'm sure you'll pick up on this:
"they found that men reported decreased erectile function, decreased penile sensitivity"...

But don't forget to read:
"but increased satisfaction"

http://www.sciencebasedmedicine.org/?p=431
Justin Trottier
Justin Trottier
Jonathan, your personal experience and anecdotes don't constitute proof. "Mutilation is too strong a word to describe an act that apparently does not cause harm." How can you justify such a statement. Male genital mutilation does cause harm. Watch the video: http://www.intact.ca/. The fact that you couldn't imagine enjoying sex more is also baseless because you'll never have the experience of having sex with a foreskin. Nor will I. Talk to the men who have trouble getting an erection cause they were mutilated.

Since when does benefits= risks mean we allow a procedure? If benefits=risks in any other medical area we advise against the procedure, don't we? Again, we are ignoring the usual medical process in order to justify the unjustifiable.

I'm comparing MGM&FGM on the legitimate grounds that they both cause needless pain and should be abolished. I'm not arguing that one is more harmful than the other. Why do some advocates against FGM feel they need to defend MGM?
Jonathan Abrams
Jonathan Abrams
I never said my anecdotes constitute proof. you seemed to have conveniently ignored the actual evidence I provided to back up my claims. I suppose it was a mistake to counter anecdotes with an anecdote.

Here's the study showing that most men were satisfied with being circumcised:
http://bit.ly/IuDZG
I find it highly unlikely you could find a similar study about FGM. You are not just equating male circumcision and FGM because "they both cause needless pain". In that case, you should be talking about ear piercing, it's far more common in this culture. You bring up FGM as a way to make MGM appear more horrific than it actually is, and I don't think that helps this debate.

Now I don't mean to argue that babies should be circumcised (you may have read it that way). I just wanted to make clear that it isn't the obvious horror you make it out to be. I personally am still undecided whether my "future son" should be circumcised. I have equally heated debates with the other side.
Darren McKee
Darren McKee
Hello all, first off I just wanted to say that it is great that we have having an interesting discussion about important issues and we haven't descended into name calling or other absurdities (but I do have it on good authority that Xander is a witch; try to drown him, you'll see!)
In addition to my previous comments, I align with much of what Jon has stated. So, let me reiterate and be more specific.
1) MC without anesthetic and proper medical procedures should definitely be ceased.
2) The negative effects of MC, in my opinion, do not indicate it is clear MC should be prohibited because of the positive effects. In addition to the link Jon posted (http://www.sciencebasedmedicine.org/?p=269), there is also this from Mayo - http://www.mayoclinic.com/health/circumcision/PR00040/NSECTIONGROUP=2
3) MC and FGM are so different that, again, I don't think they should be seen as similar and also that the phrase MGM should not be used. Compare the pros and cons of MC with FGM (CONTINUED)
Darren McKee
Darren McKee
CONTINUED from above:
3) Compare MC with FGM - http://www.idebate.org/debatabase/topic_details.php?topicID=610
4) Note that I am not prescribing MC for everyone. I just do not think it is overtly clear that it should be banned (given the aforementioned/linked pros and cons)
5) As we all know the plural of anecdote isn't data, this is a tricky one because if we leave out anecdotal info, then all testimonials, from the people who love their circumcision to the people who are trying to reconstruct their foreskin are thrown out. Consequently, we have to go with current studies, which again do not clearly indicate a ban on MC, as well that one could tenable argue that MC and FGM are different.
6) Justin, I do agree that some of this research was likely done with sketchy motivations, but the data stand on their own. (and the samples in the HIV study were mostly older boys/men).
Jonathan Abrams
Jonathan Abrams
I would also like to add to Darren's comments about anecdotes that anecdotes don't help settle scientific questions (i.e. is MC harmful/helpful?). But anecdotes can help to inform one's opinion. For example, my personal anecdote is that I don't 'feel' mutilated, therefore it will be very hard to convince me that MC is 'mutilation'. But I am open to the argument that it should not be done, because of other reasons (pain to the child, risk of infection etc.)

By labeling it mutilation, MC opponents are trying to bring out an emotional response of disgust, one that I just don't share.

I'm personally more annoyed with being raised to believe in the lies of religion than with being circumcised.
Justin Trottier
Justin Trottier
Jon, by that logic we should insist that opponents of FGM not use the term mutilation since it risks invoking emotional arguments of disgust, but I see no one having trouble with that terminology (perhaps because disgust is a valid response!). In fact, it is often those opposing FGM who go out of their way to distinguish it in terminology from male genital mutilation by insisting the latter be termed circumcision, who have created this situation where one is seen as entirely different than the other. As I mentioned, there is this belief that any redirection on our concern onto the wellbeing of boys/men risks trivializing the plight of girls/women, but that is obviously part of a larger debate.

And the fact that you don't "feel" mutilated is hardly proof that you're not and by your own admission that feeling will prejudice you against admitting the truth should that be the case.
Justin Trottier
Justin Trottier
FYI, please continue this debate on my personal blog where more than just my facebook friends can participate. In fact, I'll be deleting any comments that are placed here in an effort to encourage a larger debate at the blog. www.equalismactivism.com

8 Comments:

Blogger Xander said...

I think we get sidetracked from what's at stake here. The critical moral issue is what should be permissible for parents to do to their children. I was trying to draw a juxtaposition between more benign forms of female circumcision, other forms of body modification and male circumcision to make my point. But judging by the way my arguments have been ignored I think I have failed so I will attempt to be more direct and succinct.
The issue is not whether men should be circumcised, the issue is whether parents have a moral right to make that decision for their children. Given the premise that an informed rational adult may reasonably choose not to undergo the procedure the answer to that question is clearly no: it is not morally permissible for parents to inflict this procedure on their child.
Since the health benefits are related to sexual activity, I see no substantial arguments for why circumcision has to be performed on children other than that they are less likely to be willing to go for the procedure later on in life. Acknowledgement of this reluctance becomes further evidence that parents are likely doing something against the child's future considered consent.
Young adults whether male or female can always op to get circumcised at a reasonable age of consent, just has they can the op to get other forms of body alteration. The ethical issue is purely one of individual autonomy and parental authority. Not so long ago parents had the right to beat their children with a leather strap or force them to work in a factory rather than go to school. They don't have that right anymore. By the same token I don't think parents should have the right to trim the extremities off the genital of their children.
To respond to Jon, Most women who have been circumcised don't consider themselves mutilated either, they see uncut womanhood as an unclean abomination. In fact some of the most ardent supporters of female circumcision are women who have been circumcised. Ayaan Hirsi Ali was circumcised while in the care of her traditionalist grandmother against her parent's consent. So your personal feelings about your own MGM don't distinguish it from the typical case of FGM.

7:15 PM  
Blogger TLC Tugger said...

Hi,
The main difference between male and female genital cutting is this: cut a female - or even use a pin to draw a ceremonial drop of blood - and you WILL go to jail in the US, with no religious exception. FGM is illegal (if not always enforced) for 94% of the world's population.

Cut a off over half a male's pleasure-receptive nerve endings and 15 square inches (in the adult) of exquisute sexual interface, eliminating protection for the glans and adjacent mucosa, and preventing the awesome frictionless rolling/gliding mode of stimulation for a man and his partner - and you can send out party invitations and let people watch, as an incompetent hack takes as much of the skin as your whim dictates, possibly to the point of painfully tight or curved erections, hair all the way up the shaft, bulgy painful truncation of veins, pitted/gouged glans, skin bridges, etc.

The position of North American medical associations has been mis-stated here. They say "potential benefits do not outweigh known risks and drawbacks." The US is the last country still cutting a majority of infants for non-religious reasons.

Foreskin feels REALLY good. All debate can be set aside for this simple reason. It's HIS body, absent a medical emergency it's HIS decision.

11:00 PM  
Anonymous Anonymous said...

The following is what Maimonises, the famous Jewish physician had to say about 'Male Circumcision.'


Maimonides, Moses
The Guide of the Perplexed
Translated by Shlomo Pines
The University of Chicago Press, 1963
(Many scholars consider this to be
the most authoritative translation to date.)

Similarly with regard to circumcision, one of the reasons for it is, in my opinion, the wish to bring about a decrease in sexual intercourse and a weakening of the organ in question, so that this activity be diminished and the organ be in as quiet a state as possible. It has been thought that circumcision perfects what is defective congenitally. This gave the possibility to everyone to raise an objection and to say: How can natural things be defective so that they need to be perfected from outside, all the more because we know how useful the foreskin is for that member? In fact this commandment has not been prescribed with a view to perfecting what is defective congenitally, but to perfecting what is defective morally. The bodily pain caused to that member is the real purpose of circumcision. None of the activities necessary for the preservation of the individual is harmed thereby, nor is procreation rendered impossible, but violent concupiscence and lust that goes beyond what is needed are diminished. The fact that circumcision weakens the faculty of sexual excitement and sometimes perhaps diminishes the pleasure is indubitable. For if at birth this member has been made to bleed and has had its covering taken away from it, it must indubitably be weakened. The Sages, may their memory be blessed, have explicitly stated: It is hard for a woman with whom an uncircumcised man has had sexual intercourse to separate from him. In my opinion this is the strongest of the reasons for circumcision.

Some circumcised men want this same result, but the majority of men would prefer to make any decision that would decrease their sexual pleasure. The decision to have a natural penis(intact foreskin) or a circumcised one can only be made by the owner.

12:29 PM  
Anonymous Anonymous said...

June 2, 2009
Once routine, now often thought unkind, the cut may also be illegal. Parental consent might not be enough to protect the circumcisers of baby boys from later legal action.

In a rare legal analysis of the medical procedure, the Tasmanian Law Reform Institute found that criminal and civil law lacked certainty, and may abuse the rights of a child.

No specific laws regulate the removal of the foreskin in Australia, and there are few clear answers in general law, according to an institute researcher, Warwick Marshall. "What is clear is that the current laws were not framed with male circumcision in mind," he said in an issues paper released yesterday.

About 12 per cent of newborn boys are believed to be circumcised in Australia, down from 90 per cent in the 1950s.

Routine circumcision is no longer performed in most Australian public hospitals, and Australian medical colleges combined to conclude in 2004 that "there is no medical indication for routine neonatal circumcision" .

However, according to the law reform institute, most practising Jews still consider it a requirement of their faith, to be conducted by a specially-trained circumciser eight days after birth, while Muslims are the largest identifiable group who do it today.

Concerns about the circumcisers' legal position were first raised by the Tasmanian Children's Commissioner, Paul Mason, who referred the issue to the institute.

"The whole subject of non-therapeutic circumcision on boys is so fraught with emotion and unreasonable assumption that it is hard to find answers to the most basic legal questions," Mr Mason concluded.

He found that the risks included pain, surgical mishap or complications, and decreased sexual pleasure. Among the claimed benefits were reduced chance of infections, and cultural or religious conformity.

The institute's paper, "Non-Therapeutic Male Circumcision" , found that the consequences of an ill-advised procedure could be particularly grave.

"Even if a court considers the physical loss following circumcision negligible, the social and psychological effects of a wrong decision can be devastating. "

The institute said in law the operation might be considered an assault or a wounding, though there was little legal guidance on whether a routine circumcision was injurious.

"There is uncertainty as to whether the consent of a parent for the circumcision of their child is sufficient to allow a circumciser to legally perform the procedure," it said.

source: http://www.watoday. com.au/national/ circumcision- may-be-a- crime-20090603- buo6.html

1:30 PM  
Anonymous Anonymous said...

Subj: Adverse sexual and psychological effects of male infant circumcision.


: Psychol Rep. 2001 Jun;88(3 Pt 2):1105-6.
Related Articles, Links

Adverse sexual and psychological effects of male infant circumcision.

Boyle GJ, Bensley GA.

Department of Psychology, Bond University, Gold Coast, Queensland, Australia.

A survey of the 35 female and 42 gay sexual partners of circumcised and genitally intact men, and a separate survey of 53 circumcised and 30 genitally intact men themselves, indicated that circumcised men experienced significantly reduced sexual sensation along with associated long-lasting negative emotional consequences.

PMID: 11597060 [PubMed - indexed for MEDLINE]

12:46 AM  
Blogger Jonny_eh said...

I highly recommend people read this scientific paper on the pros vs cons of male circumcision.

It's hugely informative, and easy to read.

1:53 PM  
Anonymous Anonymous said...

Jonny_eh said...
I highly recommend people read this scientific paper on the pros vs cons of male circumcision.

It's hugely informative, and easy to read.
---------------------------------

I took a look at it and it's no more than a 'Pro-Circumcsion' website. It's no more scientific than some of what has been already been posted here.

3:19 PM  
Anonymous Anonymous said...

Is Neonatal Circumcision Clinically Beneficial? Argument Against
Robert S. Van Howe


Nat Clin Pract Urol. 2009;6(2):74-75. ©2009 Nature Publishing Group
Posted 03/26/2009

Clinical benefit is only one facet of clinical decision making; medical risks and financial costs also need to be considered. For example, many of the benefits espoused by advocates of circumcision would be more effectively achieved by penectomy, which has the additional benefit of preventing unwanted pregnancies. Of course, penectomy is too invasive, and is not a practical solution. Many of the "clinical benefits" lauded by advocates of circumcision include reduced risk of phimosis, balanitis, urinary tract infections (UTIs), genital cancer and sexually transmitted infections (STIs); however, evidence for these benefits are weak or nonexistent, and several alternatives to circumcision are available that are more effective, less invasive, and less expensive.

Circumcision removes a complex, pentilaminar, specialized, junctional structure that contains nearly all the penis' fine-touch neuroreceptors. Not surprisingly, the foreskin is the most sensitive portion of the penis. Circumcision can reduce the sensitivity of the glans to fine-touch and vibration.[11,12] No wonder adults who undergo circumcision report less-satisfying sex, reduced sensitivity and erectile function, difficulty with intromission, and increased premature ejaculation.[13] Other commonly reported complications of circumcision include infection (1–3%), excessive bleeding (1–9%), meatitis (20%), meatal stenosis (5–8%), subcutaneous granuloma (5%), balanitis (16%), coronal adhesions (30%), skin bridges (2%), and phimosis (1–2%). Parents also request a repeat circumcision for cosmetic reasons in 2% of cases. Furthermore, circumcised newborn boys are 12 times more likely to acquire community-associated methicillin-resistant Staphylococcus aureus infections than uncircumcised newborns.[14] Other less-common complications of circumcision include septicemia, meningitis, Fournier gangrene, staphylococcal scalded skin syndrome, osteomyelitis, septic arthritis, tetanus, herpes simplex infection, empyema, pubic hair strangulation, denudation of the penis, glans amputation, urethral fistula, penile edema, pyogenic granulomas, acute urinary retention with acute renal failure, ruptured bladder, UTI or urine advancing in subcutaneous fascial plains, penile ischemia, pneumothorax, pseudoparaphimosis, pulmonary embolism, unilateral leg cyanosis, gastric rupture, myocardial injury and erythema multiforme.

Circumcision has no medical indication during the newborn period, and it is not the first-line preventive for any illness. Very few adult men choose to be circumcised, full disclosure is a rarity, and parental proxy consent for newborn circumcision is not valid.[15] No reason exists that can justify why circumcision cannot wait until the infant is old enough to choose for himself. As a public health measure, newborn circumcision in the US has failed to show a benefit in protecting against cervical cancer, penile cancer, STIs, and HIV.

Reprint Address

Department of Pediatrics and Human Development Michigan State University College of Human Medicine, 1414 West Fair Avenue Suite 226, Marquette, MI 49855, USA; E-mail: rsvanhowe@mgh.org

Robert S. Van Howe, Clinical Professor in the Department of Pediatrics and Human Development, Michigan State University College of Human Medicine, Marquette, MI, USA.

3:33 PM  

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