Wednesday, September 30, 2009

The First Cut is the Deepest

A proposal to remove the foreskin of every infant boy in America on health grounds is pointless, illiberal and harmful.


by Ethan Epstein

Opposition to female circumcision has become something of an article of faith for international development organizations. While there are still great and unresolved debates among policymakers and intellectuals about the importance of promoting democracy, bestowing foreign aid and mandating international standards of criminal law, everyone seems to agree that female circumcision is abhorrent and needs to be stopped.

The consensus, for once, is right: female circumcision reduces – if not eliminates – sexual pleasure, provides no apparent health benefits, and violates individual autonomy. At its core, female circumcision is a degrading and brutally unfair practice.

All of this is true of male circumcision – the removal of penis foreskin – as well. Yet, as the New York Times recently reported, the Centers for Disease Control (CDC), an arm of the United States federal government, is now considering a plan to ‘promote [the] routine circumcision’ of infant boys in the US with the aim of reducing the spread of HIV (1). This proposal is as degrading as it is illiberal.

The scientific evidence that the CDC is relying on in considering the new recommendation is laughably weak. Consider, first, the people who were the object of the study: the population group surveyed was from sub-Saharan Africa, where sexual mores and cultural conditions are utterly different from those of the US.

The study found that adult circumcision led to a modest reduction in the transmission of HIV. However, the cited research found a reduction only in the incidence of HIV transmission as a result of sex between men and women. This is an extremely rare form of transmission in the US. Most damningly, even advocates of circumcision as a means of HIV reduction concede that circumcised men still need to use condoms to protect themselves. But this simply raises the question: why remove the foreskin in the first place, then? At best, therefore, the health benefits of circumcision are marginal.

Moreover, another recent study determined that circumcision does absolutely nothing to reduce the spread of HIV amongst men who have sex with other men – the group most likely to come into contact with the virus, at least in the US (2). Self-evidently, circumcision will do nothing to combat the spread of the disease among intravenous drug users, another group beset with HIV problems. And despite the claims of medical fearmongers regarding the supposed AIDS ‘epidemic’ in the US, fewer than 500,000 Americans are living with the disease in a country of over 300million people (3). To recommend universal circumcision is a wild overreaction to this problem.

While science gives us little reason to pursue this policy, it does tell us something important about circumcision: it greatly reduces sexual pleasure. To take just one academically determined example of what is quite self-evidently true, Gregory Boyle of the University of Australia has observed that the ‘inner layer of the foreskin comprises thousands of erogenous nerve endings’. He further determined that circumcised men enjoy ‘significantly less penile sensation as compared with genitally intact men’ (4). This makes plain sense: after all, the foreskin is an erogenous zone, and removal of said zone is bound have a deleterious result on sensation. To deny men a life of sexual pleasure because of highly dubious claims of ‘health benefits’ is ethically unjustifiable. To add insult to (ahem) injury, other studies have concluded that not only does circumcision deny males pleasure, it actually causes them pain as well (5).

More troubling, the plan to mandate circumcision betrays an insidious disregard for individual autonomy. Indeed, even if circumcision could be shown significantly to reduce the spread of HIV, the practice of circumcising infants would remain an affront to human dignity. It denies men autonomy over their own bodies. No right-thinking person would ever endorse the involuntary circumcision of adult males – indeed, even the most vehement supporters of the practice shy away from this. Why should the case of an infant male be any different? The detriments to his life he is likely to receive as a result of the procedure will only affect him when he is an adult.

Is there really any ethical difference between circumcising a baby against his will and circumcising an adult against his will? What kind of ethical framework is it that allows parents the right to deny their children future sexual pleasure?

Lamentably, many American elites have ridiculed and maligned opponents of compulsory cutting. Substituting mockery for argumentation, Hanna Rosin, writing in the influential Atlantic Monthly, referred dismissively to the circumcision ‘controversy’ (note the use of scare quotes) and accused opponents of being ‘hysterical’ (6). Emily Bazelon, a senior editor at the highly respected web magazine, Slate, characterized critics as ‘crazy’ and ‘on the rabid side’ (7). It is difficult to imagine two liberal women being quite so glib about opponents of female circumcision.

Of course, the impulse to regulate personal behavior in the name of health and safety has been ascendant in Western society for some time now. But that impulse, as we have seen time and again, can go too far. If we were really to pursue such an outlook to its logical conclusion, we would demand a ban on homosexual sex, since this would result in a far larger reduction in HIV transmission than circumcision. This, most people would agree, would be ridiculous, but if any regulation is permissible in the name of health and safety, then why not simply mandate this?

The safety impulse is the same one that has brought us public smoking bans, seatbelt laws, and fees on shoppers’ use of plastic bags. And now, left unchecked, that safety impulse is set to hit American men where it really hurts.

For more on this topic see:

**HIV/Circumcision Public Health Policy Site

**The Nuts & Bolts of HIV in the USA and Why Circumcision Won't Protect Men

** The Truth About Circumcision and HIV

** Female & Male Circumcision in the U.S. - The Similarities

**Here We Go Again: HIV & Circumcision

**Bloggerheads: Rosin, Bazelon & The NY Times

** Functions of the Foreskin: Why You WANT to Keep It!

** For a "lighter" look:
Penn & Teller Discuss the Latest


Ethan Epstein is a business writer living in Portland, Oregon.

(1) Officials Weigh Circumcision to Fight H.I.V. Risk, New York Times, 23 August 2009

(2) Large US study finds circumcision doesn’t protect gay men from AIDS virus, Los Angeles Times, 25 August 2009

(3) HIV and AIDS statistics by state, AVERT

(4) Boyle, Gregory J; Svoboda, J Steven; Goldman, Ronald; Fernandez, Ephrem (2002). Male circumcision: pain, trauma, and psychosexual sequelae. Bond University Faculty of Humanities and Social Sciences

(5) American Academy of Pediatrics Task Force on Circumcision (March 1, 1999) Circumcision Policy Statement, Pediatrics 103 (3): 686–693. doi:10.1542/peds.103.3.686. ISSN 0031-4005 PMID 10049981

(6) Lose the foreskin, The Atlantic, 25 August 2009

(7) Should the CDC push circumcision?, Double-X, 27 August 2009


11 comments:

  1. Great article! The more info you put out the more crazy I feel about this!! What are your thoughts on health reform and the chances that if we get a public option that circumcision will be part of what's covered?! I had thoughts of writing to Obama about this!!

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  2. Until it is made illegal (as FGM is illegal) MGM could be covered in the U.S. Although, it is NOT covered in other countries that have universal health care (such as Germany, Australia, New Zealand and our neighbor, Canada). But other countries either have genital mutilation laws in place protecting both boys and girls, or they simply have never cut up 50% of their non-consenting baby boys like we do in the first place...

    Right now circumcision is being paid for by YOUR tax dollars via Medicaid in 34 states. This pamphlet has a map: http://www.coloradonocirc.org/files/handouts/Medicaid_and_Circumcision.pdf

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  3. What could Obama do about it?

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  4. What COULDNT Obama do? He is the President afterall:) but seriously I see what you're saying as he hopefully gets this passed but wouldn't be actually running it (public health care). I am just feeling really motivated to be vocal to someone who can do something!!

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  5. You can - the CDC and AAP (and their recommendations and statements for or against things) directly impact what Medicare pays for and how laws are written. Want to come out to D.C.?! We are meeting with and demonstrating in front of the AAP Oct 17-20 http://drmomma.blogspot.com/2009/09/important-aap-demonstration-oct-17-20.html

    You can also talk and share accurate information with people around you. The more people know about the prepuce and its amputation, the less it happens.

    You can come to D.C. for International Genital Integrity Week in March and help with events (and the march) around the White House and Capitol. In addition, see the MGM Bill site for more immediate ways you can get involved in support of this bill. http://www.mgmbill.org/takeaction.htm

    Sign the Petition and get involved with Intact America: http://www.intactamerica.org/

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  6. Another good article, thank you Danelle. CDC and AAP, that's more like it. Laura, you're right, I understand your enthusiasm, but telling the President, to me, doesn't seem like it would work, the same as wanting better maternity leave benefits and being allowed to pump or nurse at work. It seems that we always have to go through the big agencies or get the whole Congress and Senate on board for things to happen. We have to be our own lobbyists.

    Writing in support of the MGM bill and to the AAP sounds great! (I already sent a letter to the CDC and signed a petition.) And I teach breastfeeding classes but always find a place to add the nocirc info in the beginning when telling about the birth of our perfect babies who don't expect to be assaulted when they enter our world.

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  7. Circumcision impacts breastfeeding as well - this could be a great tie-in to your class. My mother (a pediatrician who used to work L&D) said it is clear that the majority of breastfeeding problems that come up within days after birth are boys who are cut - especially if they latched well to begin with and then started having 'problems' after their amputation. We don't see this with girls who are left intact and homebirthed babies (where both the birth process AND babies' genital integrity are respected). I will try to find some articles on the topic if you like.

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  8. Yes, thank you. I know there is a link. Would love to see some of what you have, (which I notice above that you have some things that I need to read.) The new mothers that I go to see to help with breastfeeding problems, when asked about if he was circumcised usually say that their little boy "didn't even cry, or just slept, he was fine and was showing no signs of problems" It's so frustrating because they fool themselves into thinking that their son is 'OK' when clearly he shut down, went into shock, or is not nursing well because of the circ.

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  9. Yes, most parents who opt for their son's genital cutting do not even go in with him (or are not allowed in). So they do not witness the entire event. Many babies also QUICKLY shut down and go into a comatose state in order to survive the painful trauma. We have studies where probes have been connected to monitor brain activity during circumcision and know this to be true. It DOES impact neuro activity, whether a parent wishes to acknowledgment this fact or not.

    All this aside, however, WHY would anyone wish to do this to their son in the first place?! For what purpose? If parents were simply FULLY INFORMED ahead of time, I genuinely believe most would opt to keep their sons intact. Very few people would abuse their newborn for no medical reason, and so much physiological, mental, social, and emotional loss.

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  10. Why don't they inform parents about this procedure in childbirth classes or pregnancy classes? I think they should show a circumcision being performed just like they show women giving birth. What is wrong with this picture? I am sure that if parents could witness this procedure they would not be able to agree to have it done to their perfect little baby boy.

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