Wednesday, April 23, 2008

Circumcision. I think not.

I was talking to a guy and a gal yesterday and the topic of circumcision came up. After doing some research and seeing video footage of babies in hospitals tied to boards with Velcro straps and watching them go into shock after being circumcised, I am not in favor of the procedure.

My compatriots argued that babies don’t remember being circumcised, so it doesn’t matter. This troubled me as a reason to go ahead with it. I believe that the pain is still a part of a baby's experience and remains with them forever, as a part of them, even if now subconscious. I came up with an analogy this morning—what if I drugged someone, and altered their body, either by giving them a tattoo or maybe removing a finger or raping them, and then woke them up again once they've healed. They wouldn't remember it, but would it still matter? I believe it would be hard to argue that it doesn't matter. I'm disturbed that we treat our babies' bodies as something we can modify only because we have the power to do so, not because of their consent. (Thanks, Mom, for letting me decide when I could get my ears pierced.)

I'm not likely to change someone's mind if they've been too strongly enculturated to accept circumcision without question, but I'd ask that everyone do research and actually take a peek at what happens during circumcision before agreeing to it from an emotional response of fear that one's child will be made fun of in the locker room.


Mark Lyndon said...

Just because babies don't remember, it doesn't mean it hasn't affected them. They have more problems breastfeeding, and also show more reaction to injections years later.

Drops in male circumcision:
USA: from 90% to 56%
Canada: from 47% to 14%
UK: from 35% to about 3% (less than 1% among Christians)
Australia: 90% to 12.6%
New Zealand: 95% to below 3% (mostly Samoans and Tongans, less than 1% among whites)
South America and Europe: never above 3% (includes many of the world's most Christian countries eg Poland, Spain, Italy, Brazil)

Major Generalist said...

Hi Mark,
Thanks so much for your post. I've seen the figure before stating that more than 40% of babies in the U.S. are not circumcised. This is great progress.

Could you cite your sources?


Mark Lyndon said...

The figure of 56% comes from here:
CDC National Hospital Discharge Survey 2003
(table 44, page 59).

Apparently the comparable rates for 2004 and 2005 were 57.4% and 56% respectively, but I don't have links for those.

The 2003 rates varied from 77.8% in the Midwest to 31.4% in the West.

There will be some circumcisions after leaving hospital, including most Jewish circumcisions, but these are likely to be more than offset by the number of states where Medicare has stopped paying for elective neo-natal circumcision since 2005.

(in Australia, where almost everyone used to be circed, elective circumcision is now *banned* in public hospitals in all states except one)

Hugh7 said...

Hi Major, you may like The Intactivist Pages, which - unlike most medical advice - start from the position that intact genitals are normal (and healthy and fun) and explore how so much of the world (notably the US, of course) found its way anywhere else. Most issues are covered there. Have a look around.

Major Generalist said...

Hi Mark,
Thanks so much for your your citations. Much appreciated! It's always good to know where things come from.

I had no idea that elective circs in public hospitals were now banned in Australia. That's really interesting.

Hello, Hugh7,
Thank you, too, for your post. I look forward to doing a lot of reading on the Intactivist pages.

Another question for anyone out there: Where do intersex babies fit into this equation? Are you aware of any organizations that seek to protect children born with ambiguous genitalia from having genital surgery until they are old enough to decide for themselves who they are?

Many thanks again,

Mark Lyndon said...

Some anti-circ organisations don't have a position on intersex children, but that's probably because there simply aren't as many of them, and not many people are aware of the issues.

At least two anti-circ organisations also include intersex children. That's why the Intactivism Pages are "against the involuntary genital modification of children of any sex". There's also the International Coalition for Genital Integrity which defines genital integrity as "the principle that all human beings—whether male, female or intersexed—have a right to the genitalia they were born with."

I don't know much about intersex people, but they seem to be against operations to "make" intersex children either male or female.

Hugh7 said...

To find out more about Intersex, visit The Intersex Society of North America website.

Their Mission:

"The Intersex Society of North America (ISNA) is devoted to systemic change to end shame, secrecy, and unwanted genital surgeries for people born with an anatomy that someone decided is not standard for male or female.

We have learned from listening to individuals and families dealing with intersex that:

* Intersexuality is primarily a problem of stigma and trauma, not gender.
* Parents’ distress must not be treated by surgery on the child.
* Professional mental health care is essential.
* Honest, complete disclosure is good medicine.
* All children should be assigned as boy or girl, without early surgery."

I wasn't expecting the last one, but I guess that makes things simpler all round, and if they guess wrong, the child will tell them.

The Intactivism Pages also look at other once-customary interventions that have parallels with circumcision, notably castration and foot-binding .

Major Generalist said...

Thank you both for the intersex info.

I, too, was surprised to see that the official position of the Intersex Society of North America says that children should be assigned a gender, but I suppose that makes some sense considering the way our society is set up. And presumably they can change later, as you mentioned.


Anonymous said...

Dear Major,

I just wanted to make a few comments about your post in which you unequivocally denounce neonatal circumcision. You refer to a video in which infants are shown going into “shock” after circumcision. The term shock is used to describe lack of blood flow to the body with resulting end-organ damage which would be exceedingly rare after elective circumcision. In fact, the rate of complication after neonatal circumcision is about .2% . I assume you referring to emotional shock?

I think your analogy comparing a parent’s decision to circumcise her baby to drugging and raping a stranger is at best not analogous to the situation at hand and at worst very offensive. As a parent, one has the responsibility to make decisions for another human being who has not yet developed the ability to do so. As part of that responsibility, a parent should be educated about the risks and benefits of any medical procedure or treatment performed on their child. There are several documented medical benefits of circumcision (and none that I know of for rape, tattoos, or cutting off someone’s finger), and I think it is unfair to imply that that mothers who circumcise their babies do so just because they “have the power to do so.”

Clearly, obtaining consent from a newborn is not possible and parents will never be able to predict how a child with ultimately feel about decisions made on his behalf as a child. The adult man may ultimately be angry that his body was disfigured as a baby and wish he had been allowed to make his own decision. However, the adult man with penile cancer (which occurs exclusively in the un-circumcised) may be upset that he now has to have his entire penis amputated because of totally preventable cancer.

Currently the American Academy of Pediatrics (AAP) does not endorse routine circumcision. Proven benefits of circumcision include reduced risk of urinary tract infection, prevention of penile cancer, and likely a reduced risk of HIV. Preliminary data from a recent study from South Africa showed that circumcision reduced the risk of HIV infection by 70%.

With regard to the pain question, the AAP also recommends the use of local anesthesia which is adequate pain control even in adults undergoing circumcision.

Ultimately, parents should be allowed to make an educated decision based on a discussion with their health care provider about the potential risks and benefits. Clearly, it is an emotionally charged issue, and it is not easy for new parents without a medical background to distinguish biased propaganda from medical and scientific fact.

Major Generalist said...

Hi there,
Thanks for your post. I was wondering when someone with an opposite view would turn up.

First off, please cite your sources!

Regarding a baby going into shock, I was not present at the time the babies were circumcised in the videos that I have seen, so I couldn't have medically analyzed their physical responses. However, the children were clearly transported out of the moment, stopped moving around, and an expression of extreme pain was evident. That qualifies as enough "shock," from my perspective, to clearly realize that a baby is being harmed.

As for equating circumcision to raping, etc., it's an extreme comparison, for sure, but I'm fine with being potentially offensive because this issue is about the violation of a person's body.

As for the reduction in HIV infections, it seems that:

"Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded."

As for penile cancer, the American Cancer Society says:

"In weighing the risks and benefits of circumcision, doctors consider the fact that penile cancer is one of the leas't common forms of cancer in the United States. Neither the American Academy of Pediatrics nor the Canadian Academy of Pediatrics recommends routine circumcision of newborns."

It's the least common form of male cancer!

Also, you're trying to make the point that doctors know best and that those of us who are not in the medical professions cannot make informed decisions; however, this quote above states that the major medical academies of the US and Canada (doctors!) are against circumcision. Are you saying the majority of doctors are uninformed, biased and chock full of propaganda?

Ultimately, my perspective is coming from a place of freedom and personal choice. Yours is coming from fear, and from trumped-up implications that diminish significantly when placed up against the sexual expression and physical wholeness that *not* circumcising a child provides. If you teach them how to wash themselves, being uncircumcised is not that big of a problem.

At the end of the day, my belief system fully extends to "my body, my choice" whether that includes a womans' right to choose, or the avoidance of genital mutilation in all its forms. I can't imagine being dissuaded from that point of view.

If I were to have a son, I would allow him to make this decision on his own. When he turned 18, I'd be more than happy to allow him to get circumcised if he felt that was what he wanted.

But until then, our children deserve to have the chance to make a decision whether to have optional medical procedures like circumcision.

Mark Lyndon said...

1) It's simply not true that "penile cancer occurs exclusively in the un-circumcised". The rate does seem to be lower in circumcised men, but it's very rare anyway, and it appears that hygiene and smoking play a far greater role.

2) Some countries which don't circumcise have lower rates of penile cancer than the USA.

3) More men die of breast cancer than penile cancer.

4) Almost one in eight women get breast cancer. This could be eliminated by surgery on newborn girls, but we would never consider it.

5) Your "rate of complication after neonatal circumcision" obviously doesn't include the 100% of men that have the most sensitive part of their penis cut off, or the 7% risk of meatal stenosis. You can't just look at the extreme complications such as the rare cases of death or penile amputation.

6) Promoting circumcision to fight AIDS is bizarre. Circumcision can only possibly help men who have unsafe sex with HIV+ partners, so why focus on genital surgery when we know that ABC works better than circumcision ever could? (ABC=Abstinence, Being Faithful, Condoms). The two continents with the highest rates of AIDS are the same two continents with the highest rates of male circumcision. Rwanda has almost double the rate of HIV in circed men than in intact men, yet they've just started a nationwide circumcision campaign. Other countries where circumcised men are *more* likely to be HIV+ are Cameroon, Ghana, Lesotho, Malawi, and Tanzania. Something is very wrong here. These people aren't interested in fighting HIV, but in promoting circumcision (or sometimes anything-but-condoms), and their actions will cost lives.
Latest news is that HIV+ men are more likely to transmit the virus to women if they are circumcised.
Female circumcision seems to protect against HIV too btw, but we wouldn't investigate cutting off women's labia, and then start promoting that.

7) You mentioned the AAP's position. This is what the Royal Australasian College of Physicians has to say:
"After extensive review of the literature the RACP reaffirms that there is no medical indication for routine neonatal circumcision." (those last 9 words in bold on their website).
RACP Policy Statement on Circumcision

Most of the people responsible for this statement will be circumcised themselves or married to circumcised men, since the circ rate in Australia was 90% in 1950 (down to 12.6% now). Now why would a bunch of circumcised doctors say that routine circumcision was unnecessary? There is no group of intact doctors promoting circumcision. In fact, there is no national organisation of doctors that recommends circumcision anywhere, not even in Israel.

Routine male circumcision is now *banned* in public hospitals in all Australian states except one. The children's commissioner in Tasmania wants to ban it there altogether.