News about circumcision from Australia and around the world : 2013

The Australasian Institute for Genital Autonomy supports NSW Minister for Family & Community Services Pru Goward’s concerns about female genital mutilation (FGM) in Australia. Ms Goward has stated that although tough laws are in place, social and cultural conditions need to be addressed to eradicate the “hideous” crime against children. AIGA welcomes Ms Goward’s suggestion that changing social norms and cultural education are important to protect children’s rights to bodily autonomy and self determination. However, her comments that “immigration authorities have to get much more vigilant about advising communities” about children’s rights casts the issue as exclusively a problem for immigrating communities and fails to acknowledge the broader context within current Australian culture and fails to consider how to protect girls from being removed (for example) to South East Asia for religious and cultural “sunnat” or genital cutting, including UNICEF/WHO Types I, II (some tissue removed) and Type IV (no tissue removed).

Elwyn Moir, Secretary of the AIGA said “it’s easy to imagine genital cutting crimes against children are a problem only in foreign cultures; however Ms Goward’s argument that we need social change in Australia highlights the importance of a consistent approach to children’s rights and genital autonomy”. AIGA accepts that parents submit their children to genital surgeries with the best intentions, but point out that they overlook the fact that they are irreversibly removing their children’s right to their own later freedom of choice. Mr Moir said “unnecessary genital surgery on boys and intersex children are still confusingly mistaken as parental choices in Australia, which remain a minority practice. To reduce the incidence of FGM in this country, we need to re-examine our own cultural assumptions and promote the right to mature self-determination and an open future for all children, not just girls.”

Law reform reviews in Queensland and Tasmania have suggested clarifying legislation criminalising unnecessary circumcision of boys. In 2013 a Senate Inquiry recommended court supervision of unnecessary surgery on intersex children as their rights to genital autonomy are not protected by supposed parental rights. Inconsistent legislation and out-dated Medicare rebates continue to send mixed signals that perpetuate these human rights abuses. AIGA takes the UN Charter of Human Rights and Rights of the Child as its starting point and contributes to advancing an ethical approach in our culture to issues of unnecessary surgery on children’s genitals.

There’s gold in them there scars:

Business admits circumcision reduces penis sensitivity

The debate over whether circumcision reduces the sensitivity of the penis has finally been decided. Researchers from each camp can argue as much as they like in the learned journals, but the acid test is in the business world: is there demand for a product that could improve sensitivity and reduce the impact of circumcision? If there is, it shows that large numbers of men feel and believe that circumcision has inhibited their sexual response and reduced the sensitivity of their penis. The American company Innovus Pharma has just announced the release of an ointment intended to restore sensitivity in circumcised men, and that it has been approved for sale in Morocco - an Islamic country in which most of the men are circumcised as infants or young boys. Big business is not altruistic: the company would not bother to market such a product unless their research had showed them that it would be likely to sell and make a profit. And if it sells, it must mean that there is a demand; if there is a demand it means that men believe they have been harmed by circumcision and are willing to pay in the hope of reversing some of the damage. Whether the serum works or not, the fact that it has been developed and is about to be marketed to circumcised men is further evidence that circumcision really does reduce the sensitivity of the penis.

As the press release states: “Reduced Penile Sensitivity ("RPS") results from a gradual loss of penile sensitivity over time. As a person [i.e. circumcised male] ages, the dulling effect can increase. RPS can happen at any age and its prevalence is consistent across all ages. According to the CIA world fact book, over 98 percent of Moroccan men are circumcised, representing a group of approximately 15 million individuals. Recent medical studies identify a correlation between circumcision and reduced sensation. The British Journal of Urology International reports that circumcised men can experience up to a 75 percent reduction in sensitivity compared to men who are not circumcised. In a user survey conducted by Centric Research Institute, 75 percent of circumcised participants reported an increase in sensation and greater sexual satisfaction after regular use of the product and 80 percent reported feeling results after just 14 days of using CIRCUMserum(TM).”

Whether the serum works or not, the fact that it has been developed and is about to be marketed to circumcised men is further evidence that circumcision really does reduce the sensitivity of the penis. That, after all, was the main reason why anti-sex doctors in the Victorian period introduced the practice.

Source: Innovus Pharma Announces Start of Its CIRCUMserum(TM) Commercial Phase in Morocco With Initial Order of 10,000 Units by Its Partner Ovation Pharma - Press Release, 27 December 2013. See also annotated report at Circumstitions.com.

Nigeria: Circumcision spreading hepatitis

Up to 40 million Nigerians are infected with Hepatitis B or C, most of which is transmitted by non-sterile instruments during surgical procedures, especially circumcision. A survey by the Nigeria Centre for Disease Control and Roche found that about 11 per cent of the population carried the Hepatitis B virus, and 2.2 per cent of the population the Hepatitis C virus. Circumcision was found to be the most common means by which the virus was transmitted; according to the report in All Africa News, 43% of Hepatitis B cases were caused by circumcision, and 52% of Hepatitis C cases:

“The survey found people who had undergone local circumcision were 43% more likely to contract hepatitis B, mostly from using unsafe implements. It also found people were 17% more likely to contract the virus while getting tribal markings, 15% during blood transfusion, 13% during non-sterile surgical procedures and 11% during body piercing. For hepatitis C, the commonest risk factor was 52% in local circumcision, 21% in body piercing and 19% in unsterile blood transfusion. … “Unfortunately not much attention has been given to hepatitis control globally and especially in Nigeria even when the burden of hepatitis is rapidly increasing,” said minister of health Onyebuchi Chukwu. Global figures indicate hepatitis is a more serious disease than HIV: some 400 million infection of hepatitis occur every year compared with 34 million for HIV, but while nearly $2,774 is spent on each person living with HIV, only $20 is spent per viral hepatitis patient."

Source: Judd-Leonard Okafor. Nigeria: Survey - 40 Million Nigerians Have Hepatitis Virus. All Africa News, 24 December 2013.

The fact that circumcision has been found to be the primary means by which hepatitis infections are spread in Nigeria gives support to the argument of David Gisselquist that the World Health Organisation and other medical agencies have consistently under-estimated the importance of non-sterile medical procedures in spreading HIV. See his paper Points to Consider and blog, Don’t Get Stuck With HIV. If these findings are valid, it may be, as Robert van Howe and Brian Earp have argued, that the WHO-Gates-USA-sponsored circumcision programs in poor African countries could actually increase HIV infections, not reduce them:

When bad science kills, or how to spread AIDS

The “Sand Myth” revisited:

Was sand really such a menace to the foreskin? Did lack of circumcision really cripple armies?

The Summer 2007 edition of The Skeptic magazine included an article by Brian Morris on the medical benefits of routine circumcision. In the course of this rather aggressive excursus he defended old claims that the origins of ritual circumcision among certain ancient Middle Eastern tribes lay in health problems caused by the accumulation of sand and dust under the foreskin. Attacking an earlier article by David Vernon he derided a paper by Robert Darby in the New Zealand Medical Journal in which Darby showed, contrary to a medical urban myth, that sand under the foreskin was not a serious problem among Australian and allied soldiers in North Africa and the Middle East during the Second World War. Professor Morris sought to refute this argument with information gleaned from a volume of the official history of the United States Army. In a reply to this attack, Robert Darby examines Professor Morris’s claims and assesses whether they can withstand sceptical scrutiny.

See The Sand Myth Revisited on this site

Pro-circumcision professor denies links with sexual fetish group

Brian Morris, recently retired as a professor of molecular biology at Sydney University, has denied that he has links with the Gilgal Society, an English-based group with a sexual interest in circumcision. The head of the society, Vernon Quaintance, was convicted of possessing child pornography in 2012, and has recently been charged with a series of offences against under-age boys going back to 1966. Responding to allegations aired in the webzine International Business Times-Australia, Professor Morris stated that the claims were “highly offensive and completely at odds with my behavior as a respected academic who has recently been elevated to the position of Professor Emeritus”. Although IBTimes subsequently published an apology, observers note that a series of leaflets on the benefits of circumcision written by Professor Morris in 2006-7 were published jointly by him and the Gilgal Society and bore the logo of the latter. These were rebadged when news of Quaintance’s conviction arrived in April 2012, though the text remains the same. It is also a fact that Professor Morris acknowledges the assistance of “the Gilgal Society, in particular Tony Ainley” in the acknowledgements to his pro-circumcision manifesto, “Why circumcision is a biomedical imperative for the 21st century” (Bioessays 29 (11), 2007: 1155-6).

Source: Vittorio Hernandez, Author of Aussie study on circumcision linked to Gilgal Society. International Business Times Australia, 16 December 2013. See also the letter at Circkleaks Blog.

Doctor who botched 30 circumcisions “studied best methods”

A Quebec doctor is under investigation by the Quebec Collège des Médecins following complaints that he had performed more than 30 circumcision procedures resulting in complications that required further surgery to correct. Dr. Raymond Rezaie will have a hearing before the college disciplinary council, after its investigative unit documented 30 cases in which boys whom he circumcised required corrective surgery under general anesthetic at Montreal's Sainte-Justine Hospital or the Montreal Children's Hospital. It is alleged that the doctor performed in an “inadequate and inappropriate way, a surgical circumcision under local anesthesia on a child". Rezaie is a family doctor who began practising in Quebec in 2006. On his website, Rezaie says he travelled across Canada researching the best infant-circumcision techniques by experienced doctors. He says he "developed his own circumcision technique, combining the most effective elements of what he learned,” the site reads.

Comment: This sad case just goes to emphasise the take-home lesson from a recent paper by Canadian urologists, that there is really no completely safe method of circumcision. As Hugh Young points out in the comments on the report on CBC News, “There is no dotted line, and no "right" amount of foreskin to cut off, so how can there be a "best technique"? A baby's penis is tiny, and any mistake is magnified when he grows up, like writing on a balloon. (That's one reason tattooing children is illegal, as well as the violation of the bodily integrity.)” The only sure way to avoid circumcision complications and botched circumcisions is not to perform unnecessary circumcision operations in the first place.

Source: Quebec doctor accused of botching circumcisions, CBC News Montreal, 11 December 2013

UPDATE, 18 December: CBC News reports further claims of circumcision damage against Dr Rezaie: Nadia told CBC’s Daybreak that Rezaie circumcised her three-month-old son this fall. She said she trusted the doctor because members of her mosque had recommended him. But after the procedure, Nadia said her son was in pain for weeks. An infection developed under some of the skin left behind after the procedure, and it started to bleed, she said. Nadia said she returned to the doctor’s office several times for advice, but her son’s condition continued to worsen. That’s when she took her son to the Sainte-Justine hospital, where she was told her son would need to see a surgeon. “Three days later, I saw surgeon and he was like, ‘Wow what's that?’”

So circumcision is a simple, safe, pain-free procedure, best done in infancy?

Health benefits of masturbation greater than those claimed for circumcision

Forget what the Victorians claimed and what your old scoutmaster told you: masturbation, in both males and females, has definite health benefits. According to an article in The Conversation by Spring Cooper and Anthony Santella, masturbation can reduce the risk of infections in the cervix and urinary tract, and may even lower the risk of diabetes. In men, increased frequency of masturbation can lower the risk of prostate cancer and boost the immune system. It is well known that masturbation (whether solitary or with partners) is safe sex, and thus a way to lower the risk of contracting sexually transmitted infections. These observations are consistent with the fact that the main reason for the introduction of widespread circumcision of boys in the late nineteenth century was the desire to discourage masturbation. A study by Kim and Pang found that circumcision led to reduced pleasure and a less satisfactory sex life, while one by McCredie et al found that circumcision was positively related to an increased incidence of prostate problems - probably because circumcised men had less sex.

Spring Cooper and Anthony Santella, Happy News: Masturbation actually has health benefits. The Conversation, 5 December 2013.

DaiSik Kim and Myung-Geol Pang, The effect of male circumcision on sexuality. BJU Int 99(3):619-22

McCredie M et al. Prevalence of urinary symptoms in urban Australian men aged 40-69. J Epidemiol Biostat 2001;6(2):211-8.

Jewish scholar compares male and female circumcision, defends rights of child

In an article published recently at The Conversation, English political scientist Rebecca Steinfeld argues that male and female genital cutting have many similarities and may validly be compared. In a further article published in the Israeli newspaper Haaretz, she argues that efforts to regulate and restrict non-therapeutic circumcision of boys is not an expression of anti-Semitism, but a necessary next step in child protection.

Like FGM, cut foreskins should be a feminist issue. The Conversation, 18 November 2013

It cuts both ways: A Jew argues for child rights - Censuring circumcision in Europe is about child protection, not anti-Semitism. Haaretz, 26 November 2013 (free and simple registration required to view full article) Also available at Rebecca's website.

See also Jewish voices against circumcision getting stronger on this site.

Richard Dawkins comes out against circumcision - agrees it is a human rights violation

In the course of a Twitter exchange, noted scientist and science communicator Richard Dawkins denied that there was any such thing as “a human right to cut your child” and agreed with a questioner that he was referring to circumcision.

Babies quick to recognise “body ownership”

A study involving 40 cute, pudgy babies found that they were aware of their bodies — and even displayed a sense of ownership of them — less than two days after being born. Both of those qualities are key ingredients in realizing your own existence, says the study’s lead author, Maria Laura Filippetti, a doctoral candidate specializing in cognitive development at Birkbeck College, University of London. “Body awareness refers to the feeling of being alive,” she told Shots. “Body ownership refers to the feeling of having a body, the sense that this body belongs to me.” Past studies revealed how important these two aspects of human life were for infants, but this study was the first to discover it in newborns at birth. In other words, although they lack the power to communicate, newborn babies are full moral agents with a sense of their own personhood, and should be treated as such. As John Locke famously remarked in his Second Treatise of Government, a person’s ownership of his own body is the foundation of all personal liberty and civil rights: “every Man has a Property in his own Person. This no Body but himself has any Right to but himself.” But if an infant recognises that he owns his own body, removing parts of it must violate those rights and may amount to theft.

Source: Thomas Gustafson, Babies seem to know themselves soon after birth. Shots: Health News from NPR, 21 November 2013, citing Maria Filippetti et al, Body Perception in Newborns, Current Biology 23, December 2013.

New study: Circumcision does not prevent sexually-transmitted infections

A new study by urologists shows no link between circumcision and reduced risk of sexually-transmitted infections. Researchers performing a clinical study on over 800 African American men found that circumcision does not prevent STIs (sexually transmitted infections). The most important factor was the number of sexual partners. The researchers say their results throw doubt on commonly held beliefs about the connection between circumcision and STIs, which they say are largely based on extrapolations from studies performed on men in Africa. These African studies and their policy implications, which includes the recent American Academy of Pediatrics' circumcision policy statement, were widely criticized by child health experts and human rights organizations. The latest American study was performed by urologists from the University of Michigan, Ann Arbor, the University of Illinois, Chicago, and Mount Sinai Hospital in New York. The study was presented at the Annual Meeting of the American Society for Reproductive Medicine, held conjointly with the International Federation of Fertility Societies in Boston in October.

Source: J.R. Gonzalez et al. A population-based study of circumcision and non-HIV sexually transmitted infections in a contemporary group of African American men: The flint men's health study. Fertility and Sterility 100 (3) Supplement, September 2013

Acknowledgements to IntactNews

Canada: Student nurse wins nursing ethics essay prize

Student nurse Kira Antinuk has won the Paul Wainwright Nursing Ethics Student Essay Prize 2013 with an essay entitled “Forced genital cutting in North America: Feminist theory and nursing considerations”. Published in the September 2013 issue of the journal Nursing Ethics, the article argues that non-therapeutic genital cutting of children is contrary to accepted principles of bioethics and human rights, and that there is no logical or medically relevant reason to treat genital cutting of boys (circumcision) differently from genital cutting of girls (female genital mutilation). Kira is a director of the Canadian human rights organisation, Children’s Health and Human Rights Partnership.

Source: Kira Antinuk. Forced genital cutting in North America: Feminist theory and nursing considerations. Nursing Ethics 20 (6), September 2013. (Log-in required; copy available from circinfo.org on request.)

Nurses for the Rights of the Child

Charleston bioethics debate highlights harm of circumcision

The Twentieth Pitts Lectureship in Medical Ethics at the Medical University of South Carolina was the scene of a remarkable confrontation between members of the American Academy of Pediatrics Task Force on Circumcision and Attorneys for the Rights of the Child. The debate, held on 18-19 October 2013 in Charleston, was a clear defeat for the defenders of circumcision, led by task force members Douglas Diekema and Michael Brady, who failed to provide a convincing defence of the AAP’s circumcision policy as issued last year. Other members of the panel and the audience generally were more impressed with the arguments against circumcision put forward by the ARC team led by director J. Steven Svoboda and legal adviser Peter Adler, who were able to demonstrate not only a better understanding of the legal, ethical and human rights issues, but a sounder grasp of the science as well. As Mr Svoboda remarked afterwards, the debate marks a turning point in the United States debate about the permissibility of non-therapeutic circumcision of children. Papers arising from the conference will be published in a special issue of the Journal of Law, Medicine, and Ethics in early 2014.

Full report by Steven Svoboda

Political scientist questions “cutting traditions”

Do the rights of parents to manifest their cultural traditions outweigh rights of their children to bodily integrity, freedom of religion and the protection of the laws of the countries in which they live? In a talk given at the BBC’s Festival of Ideas in October 2013, political scientist Dr Rebecca Steinfeld considered recent controversies over non-therapeutic circumcision of boys and asked why such practices should be given a free run when any genital cutting of girls is both condemned and usually prohibited by law. Dr Steinfeld is Visiting Scholar, Department of Politics and International Studies, School of Oriental and African Studies, University of London. She aroused controversy and attracted a certain hostility from Jewish organisations in 2011 when she wrote in support of the California initiative to make circumcision of male minors illegal. The fact that she is herself Jewish goes to emphasise the point that the strongest critics of Jewish circumcision practices have always been Jewish people themselves.

A transcript of the full talk is available at her website.

In her talk Dr Steinfeld referred to the efforts of certain Roman emperors to suppress Judaism and ban the practice of circumcision. This is not quite accurate, as the aim of Roman imperial policy was not to ban Jews from circumcising their own sons, but to stop them from circumcising their slaves - who were not normally Jewish themselves. This is a important point, as Genesis 17 requires Jews to circumcise their slaves as well as their sons, and this was the practice until the Greek (Hellenic) and later Roman rulers of the Middle East tried to stop it. The point is relevant to current debates: nobody today would regard it as remotely reasonable for a Jewish employer to require his employees to be circumcised; yet the text of Genesis 17 requires that with no less force than its directive to fathers to circumcise their sons. This shows that customs can change and that people tend to be selective about which of the rules of their traditional culture they choose to observe, and which to ignore. For details, see Ra'anan Abusch, Circumcision and castration under Roman law in the early empire. In Elizabeth Wyner Mark (ed), The Covenant of Circumcision: New Perspectives on an Ancient Jewish Rite (Brandeis University Press, 2003).

Genital warts infections plummet as HPV vaccination program rolls out

Following the introduction of safe and effective vaccines against Human Papilloma Virus in 2007, the incidence of HPV infection among women and heterosexual men has fallen dramatically. HPV is a group of viruses responsible for genital warts and a variety of genital cancers, usually spread by sexual contact. According to the most recent figures from the Kirby Institute (University of New South Wales), following the introduction of the vaccination program the incidence of HPV infection in young (under 21 years) women fell from 12% in 2007 to less than 2% in 2012; and in young heterosexual men from 14% (2006) to less than 2% in 2012. The fall for bisexual and homosexual men was less dramatic (from 9 to 6%), but this is because the program to vaccinate young men and boys was introduced only in 2010-11 and has not yet had time to take effect. As the Kirby Institute Surveillance Report states:I

Information available through the Genital Warts Surveillance Network indicates that the genital warts diagnosis rate among Australian born women, aged 21 years or younger in July 2007 and thus eligible for free HPV vaccine, was above 10% in 2007 and then declined to less than 2% in 2012 (Figure 39). Among Australian born heterosexual men in the same age group, the genital warts diagnosis rate was above 12% in 2007 and declined to less than 2% in 2012 (Figure 40). The genital warts diagnosis rate among homosexual and bisexual men has not followed a declining trend to the extent observed in the heterosexual population (Figure 41).

Kirby Institute, Sydney. HIV, viral hepatitis and sexually transmissible infections in Australia Annual Surveillance Report 2013, p. 27.

These figures pull the rug out from under the feet of people such as Brian Morris, who claim that circumcision of baby boys is necessary as a means of preventing HPV infection in sexually active adults. In fact, there is no reliable evidence that circumcision does reduce the risk of HPV infection, and even if it did we now have a far more effective, safer, cheaper and non-injurious alternative that does not deprive people of normal body parts. Morris is fond of accusing circumcision critics of being anti-vaccination, but the odd thing is that he himself has been rather cool on the idea of vaccination as a preventive of HPV; in a recent polemic in the UK Skeptic Magazine he complained that since vaccination provided only 35% protection (whatever that means), circumcision was to be preferred. In fact, as the Kirby figures show, the new vaccines are highly effective against HPV infection and are far preferable to disfiguring surgery.

A right royal myth: British royal family “circumcision tradition” an invention

Claims that there was some sort of tradition of circumcision within the British royal family have been exposed as an urban myth. In an article published in the on-line journal Sage Open, Robert Darby and John Cozijn demonstrate that the various stories about Queen Victoria and George I that circulated in response to the birth of Prince William’s son last August have no factual basis; the proposition that circumcision was introduced by either of those monarchs is shown to be a contemporary legend or urban myth, originating within the Anglo-American Jewish community, and spread to the wider society by United States-based circumcision promoters such as Dr Edgar Schoen. The abstract of the article follows:

The birth of Prince William’s son in July 2013 was the occasion for an outpouring of media speculation about the fate of the royal baby’s foreskin. The possibility that he might be circumcised was connected to a purported tradition of circumcision within the British royal family, said to be have been initiated either by Queen Victoria or by George I. In this article, we trace the origins and evolution of these stories and assess their validity. Our conclusion is that belief in a royal circumcision tradition derives from the reported circumcision of Prince Charles by the mohel Jacob Snowman in 1948, and the efforts of the British Israelite movement to concoct a “lost tribes of Israel” origin for the British race. These elements merged into a fully developed narrative that was widely disseminated from the late 1990s. The initially separate claim that the tradition was imported from Hanover by George I can be sourced precisely to 2012. We further show that these stories are inventions, and that the royal family circumcision tradition should be regarded as a classic instance of a contemporary legend or urban myth.

Source: Robert Darby and John Cozijn, The British Royal Family’s Circumcision Tradition: Genesis and Evolution of a Contemporary Legend. Sage Open, 16 October 2013.

Update, December 2013: Darby and Cozijn report further sightings of the myth.

Resentment of circumcision: Media acknowledge the pain

Recent articles on foreskin restoration suggest that the mainstream media are finally beginning to recognise that thousands of men are unhappy and resentful at having been circumcised as babies, and want their foreskins back. An article published by News Limited reveals that many men experience emotional and physical difficulties because of their parents’ decision to have them circumcised, and are trying to restore what was taken away. One man is quoted as saying: “I have been looking into what was stolen from me for a couple months now. It’s always on my mind, I just revolve between being crushed emotionally and being soooo f---ing mad I start twitching. I just want to curl up into a ball and disappear. This is the most shameful/angry/sad/hateful/depressing feeling I've ever had.” The article includes comments from Australia’s Paul Mason, former Children’s Commissioner in Tasmania, who has formed an organisation called the Australasian Institute for Genital Autonomy, and Elywn Moir, whose article on why he wanted his foreskin back was published by The Punch last year. The existence of a large and growing foreskin restoration movement refutes the claims of anti-foreskin activists that most men do not mind or even prefer being circumcised.

Meet the circumcised men who want to restore their foreskins, News Lifestyle, 9 October 2013

The men who want their foreskins back, The Kernel, 7 October 2013

Non-therapeutic circumcision harmful and unethical

Non-therapeutic circumcision of male minors deprives boys of an integral part of their genitals and violates their right to physical integrity and personal autonomy. In a statement issued on 10 October, the Nordic Association for Clinical Sexology expressed concern that to circumcise a boy with normal genitalia “deprives him of his right to grow up and make his own informed decision. Unless there are compelling medical reasons to operate before a boy reaches an age and a level of maturity at which he is capable of providing informed consent, the decision to alter the appearance, sensitivity and functionality of the penis should be left to its owner”. The full statement from the association follows.

Non-therapeutic circumcision of boys

The penile foreskin is a natural and integral part of the normal male genitalia. The foreskin has a number of important protective and sexual functions. It protects the penile glans against trauma and contributes to the natural functioning of the penis during sexual activity. Ancient historic accounts and recent scientific evidence leave little doubt that during sexual activity the foreskin is a functional and highly sensitive, erogenous structure, capable of providing pleasure to its owner and his potential partners.

As clinical sexologists, we are concerned about the human rights aspects associated with the practice of non-therapeutic circumcision of young boys. To cut off the penile foreskin in a boy with normal, healthy genitalia deprives him of his right to grow up and make his own informed decision. Unless there are compelling medical reasons to operate before a boy reaches an age and a level of maturity at which he is capable of providing informed consent, the decision to alter the appearance, sensitivity and functionality of the penis should be left to its owner, thus upholding his fundamental rights to protection and bodily integrity.

Every person’s right to bodily integrity goes hand in hand with his or her sexual autonomy. By signing this statement we support the resolution of September 30, 2013, issued by the Nordic ombudsmen for children, and the resolution of October 1, 2013, issued by the Parliamentary Assembly of the Council of Europe, in which governments are urged to take the necessary measures to protect children’s bodily integrity with regard to non-therapeutic genital surgery.

Source: STATEMENT ON NON-THERAPEUTIC CIRCUMCISION OF BOYS, Nordic Association for Clinical Sexology, 10 October 2013

Swedish doctors condemn circumcision

A meeting of Swedish medical authorities and human rights officials have issued a statement condemning non-therapeutic circumcision as medically unnecessary and a violation of the rights of the child. The Swedish (English language) newspaper The Local reports:

There is no medical reason to circumcise little boys; the procedure is painful, irreversible and can cause complications, according to Sweden’s children's ombudsman and representatives for several healthcare organizations. “To circumcise a child without medical reasons and without the child's consent, runs contrary ... to the child's human rights and the fundamental principles of medical ethics,” they write in a debate article in the Dagens Nyheter daily on Saturday. The ombudsman Fredrik Malmberg, together with representatives from the Swedish Society of Medicine (SLS), the Swedish Society of Health Professionals (Vårdförbundet), the Swedish Paediatric Society (BLF) and the Swedish Association of Pediatric Surgeons (SLF), argues that Swedish law requires that the child’s own preferences be taken into account wherever possible. Circumcision is a procedure which is typically carried out at a very young age and it is this issue of consent which is paramount, they argue. “We consider circumcision of boys without the child’s consent to be in contravention of article 12 of UN Convention on the Rights of the Child (CRC) which gives children the right to have an opinion in matters which concern them.”

Source: Circumcision breaches human rights of the child, The Local, 28 September 2013

In related developments, Gerald Dworkin, professor of legal philosophy at University of California, Davis, has doubts about the ethics and legality of non-therapeutic circumcision. And a German court refuses Kenyan mother’s application to have her 6-year old boy circumcised. This case is notable for the frivolity of the mother’s reason for wanting him circumcised - that she was planning a visit to Kenya and was worried what the relatives might say if they saw his foreskin - and the inaccuracy of the news report - which states that her reasons were “religious” in character. In fact, as the report also reveals, the family is Christian, and thus have not the slightest religious reason to circumcise.

Source: Court: Circumcision too risky for six-year-old, The Local, 26 September 2013. Details of the court decision (in German)

Too many circumcision complications in Canada hospitals

Canadian urologists report a disturbingly high incidence of complications and other adverse outcomes from circumcisions performed on infants by surgeons in Ontario hospitals. In a study published in the August 2013 issue of the Canadian Urological Association Journal, the authors conclude that “most physicians performing neonatal circumcisions in our community have received informal and unstructured training. This lack of formal instruction may explain the complications and unsatisfactory results witnessed in our pediatric urology practice. Many practitioners are not aware of the contraindications to neonatal circumcision and most non-surgeons perform the procedure without being able to handle common post-surgical complications.” In other words, even under the most favourable conditions - qualified medical personnel, modern hospitals and the latest equipment, an advanced Western society - circumcision of infants still cannot be safely performed. Although they are not aware of it, the authors confirm the conclusion of Hugh Young, in a study of circumcision techniques, that no fully satisfactory and entirely safe method has ever been devised and - given the complex and variable anatomy of the foreskin - none is ever likely to be.** Perversely and illogically, the authors of the Canadian study suggest that the the solution to the problem is better training. We suggest that it would make more sense not to perform circumcision in the first place, but rather to instruct medical personnel and parents in the value of the foreskin, the simple rules for taking care of it, and drive home the message that routine circumcision is likely to do more harm than good.

Source: Jorge DeMaria, Alym Abdulla, Julia Pemberton, Ayman Raees, Luis H. Braga. Are physicians performing neonatal circumcisions well-trained? Canadian Urological Association Journal, Vol 7, August 2013.

** Hugh Young. Evolution of Circumcision Methods: Not “Just a Snip”, in G.C. Denniston et al (eds), Genital Cutting: Protecting Children from Medical, Cultural, and Religious Infringements. Dordrecht: Springer 2013. Full text available on Injury and Harm Page.

How Slate broke the internet and abuse their power:

Intemperate attacks on circumcision critics will backfire

When James II fled as the forces of William and Mary neared London in December 1688 he threw the Great Seal into the Thames. The gesture had no practical effect, but was merely an act of spite by a pathetic loser who had failed to turn the clock back. A similar example of spiteful desperation is the vitriolic attack on child protection advocates that appeared recently in Slate. In the aggressive style perfected by Stalin’s bully boys, Joseph Stern denounces “intactivists” (critics of non-therapeutic child circumcision) as a pack of lying sophists who have somehow taken over the Internet and turned Americans against circumcision. If so, it is a remarkable achievement for a loose coalition of community activists whom Slate derides as a lunatic fringe – an achievement that die-hard believers in the magical benefits of circumcision evidently cannot accept. For a magazine with Slate’s reach to host such an intemperate assault on a group of people who devote countless hours of unpaid labour in the cause of children’s welfare, and to offer them no opportunity to reply, is an abuse of its power, a denial of natural justice, and an attack on the spirit of American democracy itself. But we must ask whether it really matters, for it seems likely that Stern’s hissy-fit will have no greater long-term impact than James Stuart’s own act of spite. James was not able to defeat the Glorious Revolution that laid the foundations for liberal democracy and personal autonomy; Slate will not be able to turn back the tide of opinion that regards circumcision as a personal choice, not a mark of ownership imposed by adults on children.

For a restrained reply to Stern, showing all the dignity and respect that he fails to extend to his target, see Brian Earp’s An Open Letter to the Author of “How Circumcision Broke the Internet”

National Post publishes reply to Slate polemic

Unlike Slate, Canada’s National Post had the decency to publish a reply from one of the crazy intactivist wackos attacked by Mark Stern in his article, "How circumcision broke the internet". What is interesting about the response of readers is the difference in tone between the pro- and anti-circumcision comments: the pro-circumcision comments tend to be sarcastic, coarse and angry; the anti-circumcision comments, by contrast, tend to be well-informed, calm and courteous: says it all, really.

Source: J. Steven Svoboda, The Perils of Circumcision. National Post, 4 October 2013.

Young American scholars turn critical eye on circumcision

An ominous sign of the growing American disenchantment with circumcision is an increasing number of papers and theses by young undergraduates and graduate scholars who are taking a very critical look at this hitherto taken-for-granted practice. A few years ago, it was only members of the dedicated anti-circumcision movement who were carrying out research into the history, medical rationalisations and bioethical aspects of circumcision; today we find papers being given at mainstream academic conferences, and theses written by under- and post-graduate students at prestigious universities. A well-researched thesis by an American undergraduate, Shemuel Garber, particularly considers the practice of circumcision among the Jewish people, and as justified and practised by American medical authorities today. In “The facade of inevitability”, an MA thesis from Iowa State University, Chris Jones takes a cool and highly critical look at the policy statement on circumcision issued by the American Academy of Pediatrics in August 2012. He presents a provocative argument that, contrary to the AAP’s claims, the policy is not an objective scientific assessment, but an exercise in rhetoric and persuasion. While the AAP claims it is merely providing information to assist parents to make a decision, in reality the policy is nudging them, not so subtly, in making a decision in favour of circumcision. The significance of Jones’ thesis is wider than the specifics of his argument, for he is really declaring that the emperor has no clothes. The AAP likes to regard itself as the pre-eminent world authority on all matters relating to the health of children; according to this unimpressed graduate student, it is nothing more than a professional interest group with an ideological axe to grind.

Read more about these studies here

US circumcision rate falling

At the same time, recent figures show that the incidence of circumcision in the United States is falling rapidly, especially in the western states, where the operation is now performed on only 30 to 40 per cent of baby boys. In those regions, circumcision is now a minority practice. Further details on the United States page.

Circumcision: Sexual violence against males

A paper just published in the Journal of Medical Ethics shows that forced circumcision (i.e. circumcision without the informed consent of the subject) is both far more common than generally believed, and argues that it is a serious human rights violation that should be of concern to human rights agencies. The author, Michael Glass (an independent Sydney researcher), gives many examples of situations in which adult men have been forcibly circumcised against their will, and observes that both the media and human rights bodies have paid surprisingly little attention such violence; in situations where both males and females have been victims, the media have consistently highlighted the suffering of the women while ignoring or downplaying what was done to the men. Mr Glass concludes: “No man should be circumcised against his will. Reports of forced circumcisions must not be dismissed as sporadic incidents, but recognised as widespread, recurring sexual assaults. Assailants should be punished accordingly. When forced circumcisions happen during war or civil strife, they must be seen, as with rapes, as sexual terrorism and war crimes.”

This is a very telling paper, for if it is true that forced circumcision of an adult male is a violation of his human rights, it must follow that forced circumcision of a male minor – a boy or an infant – is a violation of his human rights and equally wrong. The age at which it is done does not matter – as you can see from this thought experiment.

ABSTRACT The forced circumcision of men is a widespread human rights abuse that often accompanies other human rights violations. It occurs in clashes between circumcising and non-circumcising cultures, or when individuals in circumcising cultures reject circumcision. This article documents the forced circumcision of men against their will, shows how evidence of forced circumcision has been downplayed and discounted, and outlines and discusses some measures that could help to reduce its prevalence.

Source: Michal Glass. Forced circumcision of men. Journal of Medical Ethics, on-line first, 6 September 2013

United States falls behind on child health outcomes

A report by the United Nations Children’s Fund has found that children in the United States are worse off than children in western Europe and most other developed countries. The report compared children in 29 Western countries in five areas: material well-being, health and safety, behaviours and risks, housing and environment, and education. The United States falls in the bottom third on all five measures of well-being, and particularly low on education and poverty. The United States is joined at the bottom by “emerging” European economies, while the Scandinavian countries and the Netherlands come out on top. What is particularly significant about the report is how poorly the United States scores on child health, coming 26th out of 29 countries, below Estonia, Greece and Slovakia, and only just beating Lithuania, Latvia and Romania. The countries that score best are Iceland, Sweden, Finland followed by the other countries if northern and western Europe. Unlike the United States, none of these countries practices circumcision. This is bad news for the American Academy of Pediatrics, which is still touting circumcision of infants as a valid and important means of improving child health - to say nothing of some of their defenders, who insist that the foreskin is so dangerous that no male should be allowed a choice as to whether he wants to keep it.

The obvious question is: if circumcision is so good for children, how come children are so much healthier in places where they are not circumcised, and so much worse off in places where more than half of them are? Like the OECD report published in 2009, and reports on Australia’s children and men's health by the Australian Institute of Health and Welfare, it just goes to show that circumcision does not improve child health outcomes. The figures show that there is a correlation between good (or at least better) child health outcomes in places that do not circumcise boys, and poor (or poorer) outcomes in places that do circumcise (see Canada's ranking). This does not mean that circumcision leads to (causes) poor health outcomes or that not circumcising leads to good child health outcomes. But it is consistent with the propositions that lack of circumcision does not worsen child health outcomes, and circumcision does not necessarily improve child health outcomes. The figures certainly do nothing to support the claims of aap or fanatics who claim that circumcision is an essential measures of child and public health, and a biomedical imperative for the 21st century.

See comparative table here

Source: Caitlin Dewey and Max Fisher, UNICEF: U.S. kids worse off than many of their Western counterparts. Washington Post, 18 April 2013

Circumcision and sexual satisfaction: Flat earth society won’t give up

An article “by Sydney researchers” published in an obscure journal, claiming that circumcision does not damage or might even enhance sexual response, has been receiving undeserved media attention. That Sydney researchers would seem to have nothing better to do but to worry about boys’ penises seems strange, until you find the same old name: none other than the ubiquitous Professor Brian Morris, author of circinfo.net, the most rabidly fanatical pro-circumcision site on the web, founder of the Circumcision Foundation of Australia, and author of the book "In Favour of Circumcision" - a book criticised by sexual health experts as so misleading that the publishers ought to withdraw it. Given the professor’s obvious bias, it is not surprising that the paper reaches such improbable conclusions, but what sort of study is it? Readers of the media reports might get the impression that Morris and Co have done their own research, but in fact the article is nothing more than a literature review. As the article explains, “A systematic review of published articles retrieved using keyword searches of the PubMed, EMBASE, and Cochrane databases was performed.” From this, 2,675 publications were identified and “rated” on their quality level, with the result that “The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.” Oh what a surprise! In other words, the authors have gone through the literature, picked out the papers that support their pre-existing prejudice, declared them to be “high quality”, and discarded everything else. The trouble is that the discarded “low quality” papers are actually the ones by real researchers who have conducted original research on live human subjects, and who have reached the opposite conclusions.

What does it matter, anyway? There are now quite a few studies showing that female circumcision does not eliminate sexual sensation, and also that female circumcision can confer health benefits, such as resistance to HIV infection. Does this mean that circumcision of women should be promoted? Women have never been asked to prove that their external genitalia have some sort of function before being allowed to keep them. Why should men be required to justify the retention of their foreskin to people like Professor Morris?

For more reliable information on the functions of the foreskin and the harm of circumcision, follow these links.

Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction?- No Morris, it doesn't work that way

Circumcision and sexual satisfaction (on this site)

Does circumcision affect sexual satisfaction (on this site)?

Does male circumcision harm women? (on this site)

Quotes on circumcision and sexual function (on this site)

Circumcision and sexual satisfaction (Circumstitions)

Circumcision and sexual function (CIRP)

Neurology of the male genitals: Lecture by Ken McGrath

Circumcision deaths and injury on the rise

Recent reports from Western Australia and South Africa show a rising incidence of death and injury from circumcision. In Perth an increasing number of men are seeking legal redress over circumcision operations gone wrong. Medical law specialist Karina Hafford from Slater and Gordon said so far this year about six men, almost one a month, had come to her for legal advice. She said it was worrying to see the men looking for help, as she had never had an inquiry over male circumcision before. I had never seen these types of issues until this year when I've had a handful of inquiries in as many months.” Commenting on the report, Gary Geelhoed, chief medical officer at the Western Australian Department of Health, said he was not aware of a rise in the number of cosmetic circumcision procedures being done, and the operation was not performed in the WA public health system unless medically necessary.“Male circumcision is not generally recommended,” he said. “Although it is a minor operation, like any surgery it has risks, including infection.” Ms Hafford said men should carefully check their surgeon’s credentials and history of investigations or complaints before going ahead with a circumcision. A surgeon's credentials can be found at ahpra.gov.au.

Source: Kaitlyn Offer, Botched circumcisions on the rise, Perth Now, 22 August 2013.

What is interesting about this report is that the complainants appear to be adult men who elected to be circumcised but who are seriously unhappy with the result. There is no indication as to why they wanted to be circumcised - whether, for example, they had been influenced by propaganda from Brian Morris’s Circumcision Foundation of Australia, or whether they had some sort of penis problem that required medical attention. Either way, the spate of legal claims drives home the point that the foreskin is a delicate piece of biological engineering, best not interfered with unless it is absolutely necessary.

In South Africa, a 4-year-old boy died following circumcision at Medicross Hospital, Germiston. An hour after the operation it was found that the boy’s heart had stopped and that he was not breathing. Despite attempts to revive him, he was pronounced dead a week later. The distraught father commented: “We are always advised to circumcise our children young, and we did this so that he’d be okay in future. Unfortunately, we took him to a slaughterhouse.”

Source: Vuyo Mkize, Child dies after circumcision at hospital, IoL news (South Africa), 16 August 2013

Meanwhile, the traditional tribal circumcision performed on teenage boys of the Xhosa group continues to claim lives. So far this year nearly 80 boys have died as a result of injuries and complications sustained during the operation. Further details here

We expect circumcision carried out in tribal situations to carry a higher rate of death and injury than those performed in a modern medical setting; but as the other South African report shows, boys can also die when circumcised in a fully equipped hospital. The least-risk course of action is to avoid unnecessary surgery.

Protecting boys from circumcisions: The role of the civil law

The civil law should play a greater role in protecting boys from circumcision by making it easier for men to sue those responsible and recover damages. This is the argument of two recent papers, one by the Canadian legal scholar, Aniaka Oluchi, the other by Australian Dr Robert Darby in his submission to the Tasmania Law Reform Institute inquiry into the legal status of male circumcision. Oluchi argues that religious and culturally motivated circumcision should not be exempt from legal restriction, but that outright criminalisation may be ineffective or even counter-productive; more fruitful ways ahead involve respectful dialogue with religious leaders and increasing the scope for aggrieved men to launch civil actions for damages. Dr Darby agues that non-therapeutic circumcision of minors is already illegal under the normal laws of assault, but that since the practice is tolerated nobody is prosecuted. Accordingly, the most feasible ways to give boys a fraction of the protection already enjoyed by girls is by tighter regulation of the practice; public education; and legal reforms to make it simpler for men who have been harmed to sue those responsible.

Further details on the circumcision and human rights page

Boys HPV vaccination program a success

A program to vaccinate adolescent boys against human papilloma virus (HPV) has been hailed as a great success, with very few adverse side effects. Referring to an article in the 3 June issue of the Medical Journal of Australia, the director of the National HPV Vaccination Program Register, Dr Julia Brotherton, told MJA Insight that “The second round of the first year of human papillomavirus vaccinations for adolescent boys has been completed with no reports of serious adverse outcomes”. HPV is a large group of viruses, some of which can cause various types of cancer in both males and females (especially cervical cancer), as well as anal and genital warts. Some years ago Australian researchers developed an effective vaccine, and health authorities launched a program to vaccinate girls. As a result of this effort, the incidence of genital warts among young women has fallen by about 80%. The vaccine also provides protection for males, as well as ensuring that they will not be carriers of the virus and at risk of infecting female sexual partners; Australia is the first county in the world to endorse a program to vaccinate adolescent boys.

Cate Swannell, Boys’ HPV vax going well. MJA Insight, 3 June 2013

Hazel J Clothier et al, Human papillomavirus vaccine in boys: background rates of potential adverse events. Medical Journal of Australia 198 (10), 3 June 2013, 554-558.

The HPV vaccine protects against the two main types of cancer-causing HPV (HPV16 and 18), as well as two types that cause genital warts. Clinicians have already seen a dramatic decrease in genital warts in young women since the vaccination program was introduced in mid-2007; the prevalence of genital warts plummeted from 9.6% in 2004, to less than 2% in 2010-11. It is likely that a similar decline in throat cancers will result from vaccination, especially as boys are included in the immunisation program in Australia.

Dyani Lewis, Michael Douglas, oral sex and cancer – the facts about HPV. The Conversation, 3 June 2013.

This is an effective reply to circumcision advocates (such as those in the so-called Circumcision Foundation of Australia) who try to use fear of cervical and other cancers caused by HPV to promote forcible circumcision of baby boys. Unlike circumcision, vaccination is an effective, modern, scientific way to reduce the risk of infection with cancers and other serious diseases without harm or damage to the body. Vaccination is modern medicine; circumcision is nineteenth century quackery.

Further information on cervical cancer

Circumcision and vaccination

Circumcision is not a surgical vaccine

“Botched circumcision”: $1.3 million awarded for circumcision damage

CHICAGO (CBS) -- A North Shore family has won a lawsuit against a physician at Northwestern they say botched their baby son’s circumcision. A jury has awarded more than $1.3 million to a 5-year-old boy and his north suburban family. The family’s lawyer Dan Kotin says in 2007, when the boy was 12 hours old, a doctor at Northwestern inadvertently amputated the tip of the boy’s penis. Kotin says the doctor missed at least three safety procedures that should’ve been followed. And Kotin says the boy “suffered the amputation of the top 40 percent of the head of his penis.” The attorney for the doctor says the procedure was performed correctly and what happened was one of the unfortunate complications of a circumcision. But Kotin says “If that were a known complication to a circumcision procedure, I suggest to you that nobody would dare have a circumcision done because it would be too risky.”

Source: North Shore Family Awarded $1.3 Million for Botched Circumcision of Newborn. CBS Local News, Chicago, 29 May 2013. Also reported by Sun Times Media, 29 May 2013

Comment: Well, it is now a known “complication of circumcision”. Strictly speaking, the distal tip of the penis is not the glans, but the foreskin, which extends beyond it and which is always amputated by circumcision. That’s what circumcision is: amputation of the distal portion of the penis, as well as a variable proportion of the loose tissue covering the shaft. For explanation, see Robert Darby and J. Steven Svoboda, “A rose by any other name: Symmetry and asymmetry in male and female genital cutting”, in Chantal Zabus (ed.), Fearful Symmetries: Essays and Testimonies around Excision and Circumcision (Amsterdam and New York: Rodopi, 2009).

South Africa: 33 circumcision deaths (so far)

As many as 33 young men are now thought to have died over two weeks in one province of South Africa as they took part in traditional initiation ceremonies that included circumcision and extreme survival tests. Police have confirmed that they have opened murder investigations into all but one of the deaths in northern Mpumalanga province, which President Jacob Zuma described as a "massive and unnecessary loss of young life".

Tens of thousands of young South Africans take part in traditional initiation ceremonies each year where circumcision is normally performed by traditional healers. Although fatalities during the winter ceremony season are not uncommon, the high toll has prompted calls for a public inquiry into the policing of the traditional schools and their care of initiates. Just over half of South African men undergo circumcision, which has been promoted by the government as key in the fight against HIV/Aids.

What exactly goes on during the ceremonies is shrouded in mystery, but initiates are often painted with red clay and spend long periods of living in the bush, often with little or no clothes. Some are given herbal concoctions to drink. In the past, deaths during initiation have been caused by botched circumcisions, infection and loss of blood, or by dehydration and hypothermia. The highest previous death toll from initiations in Mpumalanga province was reported to be eight.

Dr Wilson Makgalancheche, head of the country's National House of Traditional Leaders, said some schools failed to conduct health checks on initiates when they arrived, and some brought along younger siblings who were not ready to take part. He said there was no question of initiations being banned. "It's a cultural practice embedded in people's lives and they feel that without these practices, they might cease to exist," he said. "The important thing is for them to be better policed and updated to fit with modern life." Mr Zuma, a Zulu traditionalist who has spoken openly about his own circumcision for health reasons, called for "swift justice" for those responsible for the deaths. "It cannot be acceptable that every time young men reach this crucial time in their development, their lives are culled in the most painful of ways, in the care of circumcision schools," he said.

Source: Aislinn Laing, 33 men die in South African circumcision ceremonies, Daily Telegraph (UK), 22 May 2013.

“Culturally inappropriate”: New Guinea women object to circumcision as HIV control tactic

A study of women’s attitudes to adult male circumcision in New Guinea has found that a significant majority are opposed to circumcision, mainly because they regard it as inconsistent with their traditions and “culturally inappropriate”. The abstract of the study, published in the journal Qualitative Health Research, states: “Adult male circumcision has been shown to reduce the transmission of HIV. Women’s acceptability of male circumcision is important in Papua New Guinea’s preparedness to introduce male circumcision, and in ethical considerations of its use as a biomedical technology for HIV prevention. We conducted 21 focus group discussions and 18 in-depth interviews with women in all four regions of Papua New Guinea. The majority of women objected to the introduction of male circumcision for three main reasons: circumcision would result in sexual risk compensation [i.e. thinking that it is no longer necessary to wear a condom]; circumcision goes against Christian faith; and circumcision is a new practice that is culturally inappropriate. A minority of women accepted male circumcision for the prevention of HIV and other sexually transmitted infections, and for the benefit of penile hygiene and health. Women’s objections to circumcision as a biomedical method of preventing HIV reemphasize the importance of sociocultural and behavioral interventions in Papua New Guinea.”

Comment: We constantly hear advocates of circumcision talking about “cultural sensitivity”, by which they mean that circumcision should always be performed on children from cultures that traditionally practise it. But cultural sensitivity is a two-way street: if respect for traditional values and culture is as important as circumcision advocates insist, it is equally important to respect the traditions of cultures that do not practise circumcision. This means that circumcision should not be forced on, or even advocated in, societies that do not traditionally observe this custom

Source: Angela Kelly, Martha Kupul, Herick Aeno, Patti Shih et al. Why Women Object to Male Circumcision to Prevent HIV in a Moderate-Prevalence Setting. Qualitative Health Research 23 (2), February 2013: 180-193

Circumcision and sexually transmitted infections: Circumcision does not reduce risk

A large scale study of the relationship between circumcision and the risk of contracting a wide range of sexually transmitted diseases has found that circumcision makes very little difference, but that circumcised men are at greater risk of urethral infections such as gonorrhoea. Uncircumcised men are at greater risk for genital ulcers, but because urethral infections are far more common than ulcers, circumcised men are at greater risk of contracting an STD overall. For other infections, such as syphilis, herpes and human papilloma virus circumcision made no significant difference. The study by Robert Van Howe is what is called a meta-analysis: that is, it examines the methods and conclusions of previous published studies and surveys, and then systematically collates the results. In this case, Van howe identified nearly 100 studies and presented their findings in a series of tables, accompanied by commentary. It is one of the largest studies of the relationship between circumcision status and sexually transmitted disease ever published, with highly embarrassing conclusions for circumcision advocates, and particularly the American Academy of Pediatrics, which claimed in their recent policy statement that prevention of sexually transmitted diseases was a valid reason for circumcision of male infants. Compared with this analysis, the survey of the medical literature performed by the AAP’s “circumcision task force” is selective, unbalanced and skewed towards their bias in favour of circumcision. But as Van Howe comments, “the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision, and any policy of circumcision for the general population to prevent sexually transmitted infections is not supported by the evidence in the medical literature.”

ABSTRACT: The claim that circumcision reduces the risk of sexually transmitted infections has been repeated so frequently that many believe it is true. A systematic review and meta-analyses were performed on studies of genital discharge syndrome versus genital ulcerative disease, genital discharge syndrome, nonspecific urethritis, gonorrhoea, chlamydia, genital ulcerative disease, chancroid, syphilis, herpes simplex virus, human papillomavirus, and contracting a sexually transmitted infection of any type. Chlamydia, gonorrhea, genital herpes, and human papillomavirus are not significantly impacted by circumcision. Syphilis showed mixed results with studies of prevalence suggesting intact men were at great risk and studies of incidence suggesting the opposite. Intact men appear to be of greater risk for genital ulcerative disease while at lower risk for genital discharge syndrome, nonspecific urethritis, genital warts, and the overall risk of any sexually transmitted infection. In studies of general populations, there is no clear or consistent positive impact of circumcision on the risk of individual sexually transmitted infections. Consequently, the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision, and any policy of circumcision for the general population to prevent sexually transmitted infections is not supported by the evidence in the medical literature.

Source: Robert S. Van Howe, Sexually Transmitted Infections and Male Circumcision: A Systematic Review and Meta-Analysis. ISRN Urology, April 2013 (Article ID 109846); http://dx.doi.org/10.1155/2013/109846. The full article may be read at ISRN Urology on-line.

Timely advice on foreskin care from French doctor

Good advice on care and management of the infant foreskin is provided by Dr Martin Winckler, in an interview published at Peaceful Parenting. Dr Winckler, an experienced French general practitioner, counters the utterly erroneous view (promoted by ignorant American doctors) that the foreskins of baby boys should be pulled back so that the interior can be cleaned, and reminds us that the No 1 rule with foreskin care is Leave it alone! Dr Winckler writes: “Many young mothers today are very worried because their mother, or their mother-in-law, or their doctor, told them they must “clean” the glans (head) of the penis of their baby boy, and that to do so, you must retract (i.e. roll back) the foreskin like a turtleneck. In reality, however, this should not be done. The practice of retraction only causes problems and has no benefits. What follows is an article interview printed in the L’Arbre à bébé Association’s November 2005 issue. For this interview I answered some questions on the delicate topic of proper penile care and retraction that I am now sharing here with you.”

The full interview is reposted on this site

More than $80 million awarded in US circumcision damage lawsuits

More than 80 million dollars have been paid out in court settlements for circumcision damage or unauthorised procedures in the United States since 1985.The United States human rights group, Attorneys for the Rights of the Child, has compiled a full list of known cases and published it on their website. The damages awards range from $22.8 million to a boy in Atlanta, Georgia, who was severely burnt, down to $30,000 to a Palm Beach, California, boy who lost more than his foreskin to a mohel. Two of the cases, totalling $18.3 million, were won against Mogen Circumcision Instruments Ltd, makers of the Mogen clamp. The company has gone out of business, but the Mogen clamp is still being used, especially in the African circumcision campaign. The number of incompetently performed circumcision cases that were settled out of court or which were successfully blamed on something else, such as an undiagnosed pre-condition or poor aftercare, are unknown. As ARC comments, these court victories, although they do not give boys their penis back, at least prove the harm of circumcision.

These facts seem not to have come to the attention of the circumcision task force of the American Academy of Pediatrics. In its report and policy statement it stated confidently: "The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this literature review).” This gap in their research no doubt made it easier for them to assert that the "benefits of circumcision" outweighed the risks. Unaware that the Mogen company had been driven out of business by successful lawsuits, the task force nonetheless discusses the Mogen clamp as an acceptable method of circumcision in its section on “technique”. How out of touch can you get?

Circumcision a surgical vaccine?

An article in the (British) Journal of Public Health Ethics argues that it is “inaccurate and misleading” to refer to circumcision as a surgical vaccine. The paper, by Barry Lyons, criticises the suggestions of circumcision advocates such as Brian Morris and Alex Wodak that widespread circumcision of male infants should be introduced as a tactic for controlling HIV infections in developed countries. He argue that to remove the foreskins from infants merely in order to reduce the danger of their contracting a disease to which they will not be at risk until they are sexually active adults, and not likely to be exposed to in any event, is morally objectionable and a poor allocation of health resources .The article supports and confirms criticism of the Morris-Wodak claims published in the A&NZ Journal of Public Health in 2011 and reported on this site.

Source: Barry Lyons, Male Infant Circumcision as a ‘HIV Vaccine’. Public Health Ethics 6 (1), April 2013, 90-103.

Child health experts criticize American circumcision policy

The policy statement on circumcision (that is, non-therapeutic circumcision of normal male infants and boys) released last year by the American (i.e. United States) Academy of Pediatrics is meeting a growing chorus of disapproval, rejection and ridicule. In an article published in the AAP house journal Pediatrics, child health experts from Austria, Britain, Denmark, Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Sweden, the Netherlands, Canada, the Czech Republic, France and Poland have condemned the statement as unbalanced, tunnel-visioned, ignorant, wrong on many medical issues, and grossly inadequate in the all-important areas of medical ethics and human rights. In the United States itself, a clinical professor in pediatrics and a human rights lawyer have condemned the policy as culturally biased and invalidated by its neglect of such crucial issues as the anatomy, physiology and functions of the foreskin, the harm and complications of circumcision, and whether the removal of body parts from healthy children can be justified within accepted principles of medical ethics and human rights. And from Australia, medical historian Dr Robert Darby considers the flaws of the new AAP policy in a updated version of The Sorcerer’s Apprentice –– his analysis of the United States continuing obsession with circumcision, published as an e-book on Amazon.

Read full story on this site

Circumcised men less likely to use condoms

An American study has confirmed previous reports that circumcised men are less likely to use condoms in penetrative sex. In a paper published in the International Journal of STDs and AIDS, the authors report as follows: This investigation compared circumcised and intact (uncircumcised) men attending sexually transmitted infection (STI) clinics on condom perceptions and frequencies of use. Men (N = 316) were recruited from public clinics in two US states. Circumcision status was self-reported through the aid of diagrams. Intact men were less likely to report unprotected vaginal sex (P < 0.001), infrequent condom use (P = 0.02) or lack of confidence to use condoms (P = 0.049). The bivariate association between circumcision status and unprotected sex was moderated by age (P < 0.001), recent STD acquisition (P < 0.001) and by confidence level for condom use (P < 0.001). The bivariate association between circumcision status and infrequent condom use was also moderated by age (P = 0.002), recent STI acquisition (P = 0.02) and confidence level (P = 0.01). Multivariate findings supported the conclusion that intact men may use condoms more frequently and that confidence predicts use, suggesting that intervention programmes should focus on building men's confidence to use condoms, especially for circumcised men.

The authors do not offer reasons as to why circumcised men are less likely to use condoms than men with foreskins, but the obvious explanation is that the reduced sensitivity of their penis resulting from circumcision is reduced still further by the latex, making sex less pleasurable or impossible.

Source: Crosby R, Charnigo RJ. A comparison of condom use perceptions and behaviours between circumcised and intact men attending sexually transmitted disease clinics in the United States. Int J STD AIDS. 2013 Mar 20. Abstract in PubMed.

Canberra doctor disciplined for circumcision errors

A Canberra doctor has been disciplined and subjected to practice conditions by the Australian Health Practitioner Regulation Agency – the Commonwealth authority that replaced the State medical boards a few years ago. The following conditions have been imposed on Dr Timothy Dermott O’Neill, a general practitioner in Dickson:

1. Will not undertake circumcision without the use of adequate analgesia in accordance with the Royal Australian College of Physicians (RACP) guidelines.

2. When performing a circumcision he will only use the appropriate equipment required in each specific case.

3. That he provides the Board every 12 months with a statement of the number of circumcisions he has performed and details of the anaesthetic procedure used in each of the circumcision procedures. This monthly notification is to continue until December 2013.

In addition, O’Neill is required:

1. To see a Board appointed psychiatrist, at the Board’s expense, within three months of the publication of this decision.

2. To attend a mentor of his choice, for supervision, once a month for six months. For the mentor to prepare a written report at the end of this period, as to his progress, to the Board.

APHRA has not provided the reasons for these conditions, but we may infer from the requirements that when O’Neill performed circumcisions he did not provide an appropriate, adequate or recommended anaesthetic; and that he used inappropriate instruments. The implication is that he was causing an unacceptable level of pain, injury and surgical complications in the unfortunate boys brought to his surgery. The requirement that he see a psychiatrist has disturbing implications, and one would like to know what factors led AHPRA to impose such a condition.

When the AHPRA decision was reported in the Canberra Times (17 Feb 2013), the name of the offending doctor was suppressed, and the journalist declined to give it to an inquiry from Circumcision Information Australia. Likewise, a request to AHPRA for his name was met with a refusal, and the useless advice that the presence of conditions or other disciplinary action on doctors could be checked on the AHPRA website – but to do this you need the name of the doctor. These obstructive attitudes suggest a greater interest in protecting the business interests of medical practitioners than the health and welfare of the public.

Further questions leap to mind. Why is O’Neill performing circumcision operations at all, when Australian medical policy since 1971 has consistently stated that routine circumcision is certainly not necessary and probably undesirable? Is somebody who graduated as long ago as 1973, and who is now required to see a psychiatrist, really the sort of person who ought to be performing delicate surgical operations on small and highly sensitive body parts? We calculate that if O’Neill was 25 when he graduated he must now be 65, an age at which he (like most people) might be expected to be thinking of retirement.

Finally, we note the presence of the usual sexist double standard. Why is somebody who damages the genitals of boys treated so much more leniently than somebody who damages the genitals of women, such as Graeme Reeves, widely denounced as a mutilator and recently gaoled in Sydney. (See report of Reeves’ trial on this site.) No doubt the harm inflicted by O’Neill was less than that inflicted by Reeves, but the principle is not so different, and the judge in Reeves’ appeal case – increasing his gaol sentence – laid great stress on the lack of informed consent on the part of the patient. How many baby boys consent to have part of their penis cut off?

Details of the registration of medical practitioners may be searched at the AHPRA website here. You will need the name of the doctor and the state in which he/she practices.

Children’s rights organisation calls circumcision a human rights violation

A report by the International NGO Council on Violence against Children on harmful traditional practices has turned the spotlight on male circumcision and argues that non-therapeutic (medically unnecessary) circumcision of male minors constitutes a serious human rights violation. The organisation has not previously discussed circumcision of boys, but in its latest report (October 2012) it states that “a children’s rights analysis suggests that non-consensual, non-therapeutic circumcision of boys, whatever the circumstances, constitutes a gross violation of their rights, including the right to physical integrity, to freedom of thought and religion and to protection from physical and mental violence.”

The relevant paragraphs are reproduced in full on the children’s rights page.

Mother murders son after circumcision shrinks his penis

An Indonesian woman has drowned her nine-year-old son in the bath, claiming she was worried that his "small penis" would affect his prospects for the future, police say. The 38-year-old woman from Jakarta told police her son had had a small penis prior to being circumcised, but that it appeared to shrink further after the operation,** police spokesman Rikwanto told AFP. "She told police investigators that she killed him as he would have a bleak future with his small penis," Rikwanto said. "She drowned her son in a bathtub filled with water. She then dressed him and laid him on a bed. After that, she went to a nearby police office to report her crime." Rikwanto said the woman was fully conscious of what she had done, but police ordered a psychological test to assess her mental condition.

Source: Brisbane Times, 28 February 2013

** This is a recognised “complication” of circumcision, known as buried penis.

Double standard on genital mutilation criticised

Why does our society make such a distinction between male and female genital cutting, the latter legally prohibited as female genital mutilation, the former tolerated (or even encouraged) as a harmless snip? This question is asked by Robert Darby in an article at Online Opinion, in which he comments on a survey in the British Medical Journal reporting that cosmetic surgeons are using the Internet to entice women to seek female genital cosmetic surgery (FGCS) by picturing the normal female genitals (and especially a “large” labia) as ugly, smelly, difficult to keep clean, prone to irritation and likely to repel men. The article warns that the information on websites is misleading, often erroneous and potentially dangerous. Essentially, it is a case of profit-minded medical business operators creating a demand for unnecessary surgeries by implying that normal genitals are somehow defective and can be improved (and made more attractive to sexual partners) by a little judicious trimming. It is cynically preying on women’s anxieties about their body and fears of rejection.

Following the comments of bioethicist Brian Earp, Dr Darby points out that nearly all the objections to FGCS can also be levelled at non-therapeutic circumcision of male minors. pro-circumcision websites warn that the normal penis (and especially one with a “large” foreskin) is ugly, smelly, difficult to keep clean, prone to irritation and likely to repel female sexual partners. Like the surgeons touting FGCS, the medical entrepreneurs who make money from excising (and sometimes then selling) infant foreskins paint lurid scenarios of the disease-risk posed by the unmodified penis, and imply that normal genitals are somehow defective, but can be improved (and made more attractive to sexual partners) by a little judicious trimming. It is cynically preying on men’s anxieties about their body and fears of rejection. Despite this, there seems be more concern shown at the risks faced by adult women who choose genital surgery for themselves than at the losses experienced by male infants and boys who are circumcised at the request of others without agreement, understanding or consent. To highlight the double standard, Dr Darby goes on to contrast the highly protective policy of the Royal Australasian College of Physicians on FGM with its rather fence-sitting policy on circumcision of boys.

Source: Loose lips mean profits, On Line Opinion, 22 February 2013

Gaol sentence increased for genital mutilation doctor

The New South Wales doctor who excised a woman’s genitalia “for her health” has had his gaol sentence increased by a further 18 months. In March 2011 former south coast gynecologist Graeme Reeves was convicted of inflicting grievous bodily harm on a patient, Carolyn DeWaegeneire, and sentenced to two and a half years gaol. Both he and the prosecution then appealed, Reeves because he claimed the jury had been wrongly directed, the prosecution because the sentence was “manifestly inadequate” to the gravity of the offence. On 21 February 2013 the Court of Criminal Appeal rejected Reeves’ appeal and increased his sentence by a further 18 months.

Read full story on this site

Circumcision cuts sensitivity and damages sexual response

A new study has found what thousands of circumcised men already know: that circumcision significantly reduces the sensitivity of the penis and has an adverse impact on male sexual functioning. The study, by researchers at the Department of Urology, Ghent University Hospital, Belgium, confirms earlier findings by Kim and Pang, Sorrells, Frisch and others that the foreskin is the principal source of sensation in the penis, that it facilitates all kinds of sexual activity and enhances sexual pleasure. The authors conclude: “This study confirms the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning. Furthermore, this study shows that a higher percentage of circumcised men experience discomfort or pain and unusual sensations as compared with the uncircumcised population. Before circumcision without medical indication, adult men, and parents considering circumcision of their sons, should be informed of the importance of the foreskin in male sexuality.”

The study was published in BJU International, 4 February 2013. Further details on the sexuality page.

Circumcision harm survey results published: The organiser of the Global Survey of Circumcision Harm, Tim Hammond, has sent the results of his survey to the Canadian Pediatric Society. In this Youtube video he outlines the purpose and results of the survey and explains why he sent the letter.

Circumcision violates child’s right to an open future

A paper in the Journal of Medical Ethics (on-line first, 30 January 2013) argues that non-therapeutic circumcision is ethically objectionable and legally borderline because it violates the child’s right to an open future. This principle is widely accepted in ethical and legal circles and has often been applied to limit the power of parents to indoctrinate children into particular political beliefs or cultural identities. It has less often been applied to bodies rather than minds, and never previously to so dramatic and permanent an alteration as circumcision. In this paper, the author (Dr Robert Darby) elucidates the open future principle and considers whether it is applicable to non-therapeutic circumcision of boys, whether performed for cultural/religious or for prophylactic/health reasons. He argues that the principle is highly applicable to non-therapeutic circumcision (NTC), and concludes that NTC would be a violation of the child’s right to an open future, and thus objectionable from both an ethical and a human rights perspective. Dr Darby suggests that NTC is similar to designer deafness (i.e. deliberately causing a child to suffer hearing loss) because it also results in sensory deprivation, and further that circumcision is comparable to smoking, in that it is really a bad habit that causes long term harm to the body. Preventing a child from smoking and protecting his foreskin have the same rationale: to preserve the body for future use and ensure that the future adult is able to make autonomous decisions about such intimate personal matters.

Full details on the ethics and law page

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