Sunday, January 02, 2011

Medical Congress on Children's Pain: A Report from the Field

By Nicolas Maubert 
Read in French here; Translated to English for DrMomma.org
[Note: Although circumcision is uncommon in France, there are still those who cut children for religious justification.]




We recently held a conference in Paris, France, The Pain of Circumcision: What to Do?, which was a part of the Medical Congress on Children's Pain and organized by Pediatol.

Dr. Daniel Annequin led the conference and indicated that while the topic is a controversial one, we were gathered to discuss the subject of circumcision pain, not the ethical issues that the actual surgery draws up. A program was given to all participants that read, “This literature review deals only with the management of circumcision pain and does not enter into the controversial and pressing subject of neonatal circumcision in particular."

When the question was raised that circumcision is often performed for religious reasons, Annequin quickly dismissed the question with, "We have nothing to say." In this case, why do we “have something to say” something about female circumcision, which is also commonly performed for religious justifications?

I will not detail the course of the entire conference here (several slides below), which focused solely on the pain aspect of genital cutting and ways to respond. But, it is of significance that Dr. Annequin showed images of infants screaming in pain while they were being circumcised, as well as a lot of horrible “tools” of the circumcision trade (including a seat used in U.S. hospitals in which a baby is literally tied up so he cannot move, while his legs are forced apart and the foreskin is amputated). It is possible that merely through the display of these images, those in the Medical Congress were made aware of the horrors of this practice (regularly conducted on U.S. soil).


 


 

Another significant aspect of the Congress report which caught be my surprise is when Annequin compared human babies to lab animals. "Our children are less well protected than even laboratory animals," he said. And then continued, "It is a paradoxical situation: we've never performed circumcision on other mammals or practiced the surgery on an unanesthetized animal. We've never even considered such research in the lab."


This gives us reason to pause and think about the truth of such things...

After his comparison, questions were taken from physicians in the audience. Dr. Michel Cymes, the medical host of a show on France 5, was there to lead questions and respond.


Like Dr. Annequin, Dr. Cymes reminded the Medical Congress that this is a sensitive issue, but we were gathered to discuss the subject of circumcision pain - not to speak upon the ethical issues of male genital cutting.

At this point, I decided to change my question to the Congress, because I was prepared to ask:
I would like to know what the position of the French medical profession is on the serious ethical problem of circumcision? One which is a violation of the basic human right to bodily integrity and the right of the child. Dutch medicine unanimously came down against circumcision on May 27, 2010. What is the position statement of France?
But with the insistence that we did not bring up ethical concerns, I chose instead to focus on the importance of the prepuce (foreskin).
Do you believe that the minimum we should do as medical professionals is to inform parents of the many functions of the foreskin? An organ which plays an essential role in the sexuality of men?
I could have added research citations to clarify that the foreskin is an organ richly endowed with both outer and inner sub-sections, but at the moment this is all I could pose.

The question was genuine - no information highlights the foreskin and its many purposes. It is clear (as we've witnessed when parents become informed) that the rate of infant circumcision would fall if parents were accurately and adequately educated on the prepuce.

Dr. Cymes answered me in two stages. My audio recording of his response is not the most clear, but essentially he replied:

- First by minimizing and joking about my question. He said that while the foreskin does play an important role in male sexuality, those who are circumcised are probably not "insensitive." It is impossible to adequately translate into English the meaning of his laughable response, but it was understood clearly in French and garnered a chuckle and applause from some in the audience.

So yes, we recognize that men who were circumcised as infants have not lost 100% of their sensation, but is this justification to continue taking the same from future men? If we follow this reasoning, we may as well begin tomorrow to re-instate female circumcision. After all, we do not amputate the entire clitoris (most of which is an internal organ) - circumcised women still have sexual pleasure and sensation as well! The majority of women who were circumcised as infants or children continue to have sexual function, and experience orgasm, to the same degree as their intact peers.

This is likely the way I should have responded, but I was in shock at his reply and unable to react properly and professionally - feeling helpless, really.

- In a second response, Dr. Cymes cited the African HIV/circumcision trials and proposed that male circumcision may reduce HIV transmission. Of course, we know that more recent studies demonstrate that those same areas in Africa where men were circumcised are those that have seen an increase in HIV infection. Circumcised men (believing they are 'protected') start having sex without condoms. Cymes did note that circumcised men "should not believe themselves to be protected from HIV" only moments after he mentioned the trials and their asserted outcomes. It is not difficult to understand: condoms alone protect against AIDS - not circumcision!

Interestingly, if medical societies around the world bought into the claims made by those African trials, the the rest of the globe would advocate for adult male circumcision. Yet the Dutch and the French and all other national health organizations do not favor the practice. Why is it only in Africa that we deem circumcision to be a "good thing?" It seems to be an easy way out: instead of providing condoms to African peoples, we prefer to tell them to cut off a part of their genitals! What a deep contempt for Africa we must have...

And this is what I wished to answer with. But I could not find the words to do so... I just mumbled, "These studies are contradictory." Cymes interrupted and said no, the trials were accurate, and I could not add any more.  My question was bypassed, and obviously there was no willingness to inform parents on the prepuce and its functions. (I wonder, how would women react if we laughed at their sexuality, their whole genitals, at a medical conference, and claimed they were not important - and could be removed without significant implication?)

Cymes at this point demanded again that questions be posed only "about the pain" of circumcision - making it clear that questions like mine had no place at the conference.

As we concluded, I stood at the podium to speak with them both, but Cymes quickly left the room. Annequin and I discussed the recent study finding a reduced sensitivity for men who were circumcised. He seemed to agree, stating, "Yes, when parents are informed [on the functions of the foreskin] just as we have witnessed among some groups of parents in the U.S. - rates decline."

Annequin still appeared a bit embarrassed and I do not know if he could express precisely what he thought among peers in this room, but truly he seemed to be a professional against circumcision. I intend to re-contact him by mail.

I spoke with another attendee - a nurse - who agreed that there is a fundamental human rights/ethical issue posed by circumcision and that it is key for us to inform both parents and practitioners on the foreskin and its functions.

In the end, I am disappointed with my "contribution" to this conference, and the way in which the subject was dealt with. It was a Medical Congress devoted to children's pain, yet clearly we were not allowed to engage in the ethical dilemma of the cause of this pain!

At future conferences, I hope to be better prepared to respond appropriately to physicians who are still too cowardly to condemn the male genital mutilation that occurs annually to millions, most of whom are born on U.S. soil, and cut before they ever have the opportunity to realize what was taken from them.


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2 comments:

  1. One of the PowerPoint slides shown above states that in 2007, French socialised medicine paid for 56,000 circumcisions under general anesthesia. Only 1700 of these were performed before the first birthday. So routine infant circ is rare, but circ later in childhood is not rare at all. Circ between 3 and 9 years of age is standard Islamic practice, and about 10% of French people are of Islamic ancestry. It looks like French health care cheerfully circumcises Moslem boys when the parents request it.

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  2. Would there EVER be a similar meeting to discuss "only the pain" of female genital mutilation? Any of the "benefits?" No. Absolute sexism.

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