Friday, January 29, 2010

Circumcision Deserves Circumspection

By Elizabeth Reis, Ph.D.
Read more by Reis

Banner image courtesy of Sweet Little Bundles Birth Services

Twenty-one years ago I agreed to have my son circumcised. Today I signed a petition urging the American Academy of Pediatrics NOT to recommend circumcision to parents of newborn baby boys.

Why the change of heart? Nothing traumatic happened to my own son; in fact, he’s sick and tired of my apologies regarding his circumcision and wishes I would never mention it again. I began to change my mind when I actually saw the procedure done, and as I’ve researched the reasons for genital surgery and the ethics of informed consent over the years, I’ve become more and more convinced that neonatal infant surgery is ethically wrong.

I signed the petition because I do not want the supreme authority on children’s health, the American Academy of Pediatrics, to issue a statement that will affect thousands of pediatricians’ judgments around the country and potentially sway the decisions of the parents of baby boys.

Circumcision has a long and disturbing history in this country. In the nineteenth century doctors touted it as a cure for masturbation primarily, but also paralysis, syphilis, eczema, gangrene, tuberculosis, impotence, general nervousness, and convulsions, among other ills. By the 1920s, some 50 percent of the urban male population was circumcised; by World War II, it was pretty clear that circumcision didn’t prevent masturbation, but the threat of sexually transmitted diseases loomed large. Doctors convinced the public that circumcision prevented STDs, and so by the 1970s, 85 percent of men were circumcised. As it happens, these assertions were misguided; today the United States has the highest rate of STDs of any developed nation, the highest rate of heterosexually transmitted HIV infection, and also the highest rate of circumcision. Go figure.


Circumcision rates rise and fall, based on prevailing social, rather than strictly medical, trends. In 1999 the American Academy of Pediatrics ruled that, in fact, there was no compelling reason to circumcise boys, other than religious and/or cultural ones. Absent any clear medical reason for the surgery, parents could make their own informed decisions, the AAP advised. Now, with recent discussion about circumcision preventing HIV infection in Africa, we’re back to the disease justification again, and the AAP might determine next week that baby boys should be circumcised for this public health reason.

I would hope parents would actually heed the “informed” part of their consent, but if they’re like me, they will likely make the decision based on other factors: some want the baby to look like the dad (who probably will be circumcised based on the rates in recent history); some choose the surgery because “it looks right.” But think about it: why should surgical alteration of a baby’s penis make it “look right?” There’s something wrong with this rationalization.

Others, like me, do it for religious reasons, without evaluating the necessity of the procedure. I’m not even religious. I don’t observe any of the other Jewish laws; why this one? If anyone had told me that my son could still be Jewish (just because his mother is Jewish), even if he wasn’t circumcised, I would not have gone through with it. But no one mentioned that possibility to me because circumcision is an enduring and undebated ritual in Judaism. And in American culture more broadly, it is sadly a choice that gets made without a whole lot of thought.

Even in the world of medical ethics, circumcision is a subject that is largely ignored. Several of the major medical ethics textbooks don’t even include it in their indexes. And this is what I object to. I think that circumcision needs to be recognized as most parents’ first ethical decision that they make about and for their child. Parents should be informed of what the procedure actually entails. Remember that video of the birth process that many of us had to watch in prenatal classes? Why not see a video of a circumcision? I am convinced that most people do not know what they are consenting to, and if they did, they would avoid the procedure like the plague.


Not to get too personal, but I had never even seen an intact penis until my son was born. So when people assured me that it was not a big deal -- “just a snip of skin” -- I naively believed them. I didn’t know how sensitive the foreskin is, what its purpose is, how protective it is, how many nerves it contains and are cut off. A 2007 study of circumcised and uncircumcised men suggests that penile sensitivity of circumcised men is lessened, and why not? The most responsive part of the penis has been excised. [Women are also impacted as a result of male circumcision.]

Even if all the studies on the spread of HIV in Africa were valid and we all agreed that circumcision prevents HIV, I think there are solutions other than surgery that would work to decrease the spread of the disease. Condoms prevent HIV, and in fact, they’re still necessary to avoid the virus even if men are circumcised. Fewer sexual partners would also help. Babies circumcised now won’t be having sex for several years, when we hope to have new and more effective strategies for preventing HIV. Avoiding HIV in adults simply isn’t a good enough reason to recommend cutting off a perfectly healthy, useful, and pleasurable part of infants’ bodies.

If men want to make this decision for themselves, for public health or personal reasons, then let them. The American Academy of Pediatrics should elevate the principle of autonomy and encourage parents to let their male children make the choice about circumcision when they’re all grown up.


Elizabeth Reis is Associate Professor of Women’s and Gender studies at the University of Oregon and the author of Bodies in Doubt: An American History of Intersex. (Johns Hopkins University Press, 2009).

22 comments:

  1. Great post! Very factual and to the point without being combative. :) I like it.

    ReplyDelete
  2. I have always second-guessed the medical establishment, and fought for no-episiotomy deliveries (2 out of 3), and did not have my 2 boys circumcised. Unnecessary surgery is unnecessary surgery, regardless of birthdate. My boys are now 28 and 12, and both are happy and healthy (and I had quite the argument 28 years ago to take my baby boy HOME without waiting to have him circumicized!)

    ReplyDelete
  3. Agreed. Have you seen 'the Cut'? Very informative and a good movie for the wavering parent!

    ReplyDelete
  4. I was just researching the Kosher laws and read that Leviticus forbids picking fruit from trees which are less than three years old because to do so would be "circumcising the foreskin" (Orlah)of a tree. They specifically use the words for foreskin and circumcision. Why is it okay to do this to a human boy but not okay for a tree?
    I'm not religious (my husband was raised Jewish) so I am only asking as an outsider trying to understand.

    ReplyDelete
  5. I totally agree, we choose to keep our son "intact" for these same reasons, it's his body, and if he wants to someday he can make that choice!!:)

    ReplyDelete
  6. Great post, thanks for sharing!

    ReplyDelete
  7. Don't need surgery to protect against HIV - just a condom.

    ReplyDelete
  8. or just being choosy!

    ReplyDelete
  9. should i cut off my breasts to prevent breast cancer? it's a argument that doesn't make any sense.

    ReplyDelete
  10. that is a very nice article, as a mom of three intact sons :)

    ReplyDelete
  11. Even IF it prevents any and all STIs its no excuse for circumcising an infant. It is still a decision that can be left until the child can participate in the consent (even if it can not wait until the child is 18)

    ReplyDelete
  12. The video this article shows should be MANDATORY to watch for EVERY parent who wishes to have their child circumcised! Every video I've ever watch gets me so SICK to my stomach I can't finish them...I don't know how any body in the world could recommend it or even perform the procedure! Those poor babies! :'(

    ReplyDelete
  13. I am glad that a major Gender Studies academic has seen fit to let down her hair in this fashion.

    Many Jewish families in Latin American and in Europe no longer circumcise. Intactivism has a foothold even in Israel, a country where many people are more committed to liberal views on sex than on any religious tradition. More and more educated people find obvious the sexual value of what circ destroys.

    An intact man who can prove Jewish ancestry via his maternal line always has the option of having himself circumcised as a gesture of faith or of loyalty to the Jewish people and their tradition. Or simply out of deference to a frum fiance. To freely choose to undergo bris after one's 21st birthday is a very very meaningful religious ritual. To cut off the foreskin of a helpless 8 day old cannot have religious meaning.

    The film "Cut" shows a bris graphically, and revolted me with its barbarity. The boy was left naked on the table, sobbing his heart out. When I saw that something snapped inside of me. I felt the male warrior on me struggling to get out. The part of me that wants to protect minors from sexual violence.

    The sexual violence of hospital circumcision raises grave doubts in my mind about the ethical sensitivity of American medicine.

    Ladies, I have the bits we are all fighting to protect. As such, I can assure you that those bits are the epicenter of my sexual feelings. They also make foreplay easier and richer. No need for oral.

    ReplyDelete
  14. If American circumcised psychology would bother to look, my guess is they would find a lot of bachelors and loners who deeply regret this unjust violation. They might even discover that crushing the feelings off a boy could result in hostility and later violence against women.
    I was brought home to grow up in a family that had never done this, and never did it again, after me. The trust I should have with others is not there anymore.

    ReplyDelete
  15. Neither condoms nor circumcision prevents HIV. Only monogamy does. We should quit giving people false hopes that a loose lifestyle has no consequences. ~ I had 4 of my boys circumcised and I'm glad I did. Many of us will continue to request circumcisions. I would like to see you discuss the best ways to do it. I had one done with a plastic cap, one with a ring and string, one with microscopic surgery. I'll have to remember about the fourth one. I also hate the severe crying; some doctors just have no mercy. I nursed my baby as soon as I was able to comfort him. How do the orthodox Jews do it? I heard they use liquor instead of the shot for anesthesia, and that they have assigned doctors who are good and quick. I once asked a Jewish circumcision doctor to do my son's surgery, and he refused. He only helped Jews. I would be interested to hear of methods of 1.) quickness. 2.) least intrusive anesthesia. 3.) best end result. I believe in the 8th day as the best day. If more people had access to studies, vocabulary, best procedures, and asked for them, then the market would maybe supply those requests. So, you who are good at studying all about babies please give us the vocabulary and the choices. Since we are going to do it, anyway, which is against your opinion, maybe you could lead us to the better choices.

    ReplyDelete
    Replies
    1. Barbara, the "best end result" is leaving it alone. It is always going to be painful. It is never going to be quick. Anesthesia is always intrusive and does not eliminate pain. I don't need to study circumcision to know that cutting off a normal, healthy body part is not a "better choice" than leaving it alone. However, the many studies that are available do show exactly what I've stated. I kindly request that you consider the multitude of studies out there showing the harms caused by circumcision. I know it is hard to consider that circumcision may be wrong when you've done it to your own children, but when you don't know the risks and don't understand exactly what it is that you're taking away, it may seem like just a "minor surgery." It's not. Please educate yourself on the functions of the foreskin and realize exactly what circumcision takes away from your children and their future partners. Many mothers, once they have educated themselves and looked at the studies available, have regretted. "When you know better, you do better." - Maya Angelou

      Delete
    2. Why in the world would you do it anyway? You don't see that it's a huge human rights violation? That there is no medical need for it to be done? That it is harmful and traumatic? Why would we talk about a "better" way to do something that is not ok to do at all?

      Delete
  16. It seems that Barbara missed the part about Human Rights.

    ReplyDelete
  17. As if pain and crying were the issue. Female circumcision would not be justified if there were "better, faster, less traumatic" ways to do it. Change the sex of the baby and see how you feel about this woman. Imagine a Malaysian woman saying "Since we are going to do it, anyway, which is against your opinion, maybe you could lead us to the better choices." A mother of a male child sounds no less idiotic.

    Oh, female circumcision is "different?" Female circumcision is "worse?" Well maybe that's just your...

    "Opinion," right? Duh, huh, huh...

    "...you who are good at studying all about babies please give us the vocabulary and the choices."

    Steinbeck said it best: "No one wants advice - only corroboration."

    How about we tell you about better ways to protect your child from disease? How about we give you advice on how to NOT HURT YOUR CHILD? How about actually listen to advice and not just go around searching for people to corroborate with you?

    Isn't it the point of medical science to make horrible procedures and modes of treatment obsolete? To replace the old with the new and better? Not set our knowledge back 6,000 years?

    Normally we allow facts to be the test of our principles. When we see what the facts are, we can retain or modify our principles. To start out with principles from the first (a priori) and to use them as the basis for accepting or rejecting facts is to do it the wrong way round. It is to commit the fallacy of apriorism.

    "I believe in the 8th day as the best day."

    Usually, the best day to do it, actually the only day to do it is when and if your child has a medical or clinical indication.

    Normally doctors don't assign surgery to the healthy.

    Oh and normally, it's doctors that make the call as to whether or not there is medical necessity for surgery, regardless of what you "believe."

    Circumcision is the only exception.

    The foreskin is not a birth defect. Neither is it a congenital deformity or genetic anomaly akin to a 6th finger or a cleft. Neither is it a medical condition like a ruptured appendix or diseased gall bladder. Neither is it a dead part of the body, like the umbilical cord, hair, or fingernails.

    The foreskin is not "extra skin." The foreskin is normal, natural, healthy, functioning tissue, with which all boys are born; it is as intrinsic to male genitalia as labia are to female genitalia.

    Unless there is a medical or clinical indication, the circumcision of a healthy, non-consenting individual is a deliberate wound; it is the destruction of normal, healthy tissue, the permanent disfigurement of normal, healthy organs, and by very definition, infant genital mutilation, and a violation of the most basic of human rights.

    Without medical or clinical indication, doctors have absolutely no business performing surgery in healthy, non-consenting individual, much less be eliciting any kind of "decision" from parents.

    Genital mutilation, whether it be wrapped in culture, religion or “research” is still genital mutilation.

    It is mistaken, the belief that the right amount of “science” can be used to legitimize the deliberate violation of basic human rights.

    Sorry, this is not a place to find comfort for your beliefs; this is a place to learn how to care for your child in a peaceful, non-violent manner.

    If this is not the "advice" you want to hear, if you're looking for a parenting group to masturbate your ego, if you're looking for a place that tells you parents can do no wrong, you might fare better going to like CafeMom or something.

    ReplyDelete
  18. Dear Barbara, would you ask a vegan how to butcher a cow? Would we tell an alcoholic the best way to get drunk? This is not the place to ask advice about fastest and least painful ways to cut baby penises so they look pleasing to their pro-circumcision mother.

    ReplyDelete

LinkWithin

Related Posts with Thumbnails