Circumcision Deserves Circumspection
Human Bodies

Elizabeth Reis

, 01/28/2010

Circumcision Deserves Circumspection

(Human Bodies) Permanent link

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

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

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

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

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

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

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

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

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

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

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

 

Elizabeth Reis is an associate professor of women’s and gender studies at the University of Oregon and the author of Bodies in Doubt: An American History of Intersex. (Johns Hopkins University Press, 2009).

 

Posted by Susan Gilbert at 01/28/2010 02:48:39 PM | 


I was circumcised shortly after being born. I really wish my parents had let me make my choice regarding non-therapeutic surgery that altered my genitalia. My hope is that enough academics will speak out about infant circumcision violating the bodily integrity of the infant.
Posted by: restoringtally@yahoo.com ( Email | Visit ) at 1/28/2010 8:38 PM


It must be recognized that circumcision is trauma. Even if a victim doesn't feel like he was traumatized, the cut is there, the scar, the lack of nerves, veins, etc. So "nothing traumatic happened" is pontificating. Maybe he *was* fortunate, though, not like so many that have so much skin removed that it inhibits their sexuality.

The reason to sign the petition should not because of what some "supreme authority" might say, but because circumcision is ethically wrong. Do it for the right reason. We should not even have a non-supreme authority, like the local physician, advocating for genital cutting.

Not only do parents need to be better informed, but we MUST start teaching our children the functions of their sex organs, such as the foreskin, or they will grow to be adults that would allow this to be done to their children.
Posted by: gburlin@eskimo.com ( Email ) at 1/29/2010 6:03 PM


While the American Academy of Pediatrics (AAP) generally is knowledgeable regarding child health, I would disagree that the AAP has any special expertise on the matter of child circumcision, which is neither therapeutic nor a medical procedure.

The AAP has a habit of convening a "task force' about once a decade to do a quick study on the medical literature regarding child circumcision and issue a statement. In the intervening decade or so between statements, the AAP does not maintain a special office on circumcision to keep up to date, so they start from scratch every decade.

There are several factors which tend to create a bias in favor of circumcision such as:

1. being born in a circumcising society.
2. being circumcised.
3. performing circumcisions in clinical practice.
4. granting consent for the circumcision of a child.

Most of he appointees to the AAP taskforce, therefore, usually are biased in favor of circumcision because they come under one or more of the above classifications. Doctors biosed in favor of circumcision tend to read the medical literature differently and find reasons to justify circumcision, whereas a non-biased doctor would not interpret the literature in that way.

Also, the AAP is an association of medical doctors, many of whom profit from doing circumcisions. There is a huge conflict of interest between the best interests of the physician members and the best interests of the child patient.

For all of these reasons, the AAP is a poor authority to give advice to the American people on non-therapeutic child circumcision.
Posted by: iconbuster@bellsouth.net ( Email ) at 1/29/2010 6:45 PM


It's illegal to cut off a girl's prepuce, or to make any incision on a girl's genitals, even if no tissue is removed. Why don't boys get the same protection? Everyone should be able to decide for themselves whether they want parts of their genitals cut off.

Circumcision is a dangerous distraction in the fight against AIDS. There are six African countries where men are *more* likely to be HIV+ if they've been circumcised: Cameroon, Ghana, Lesotho, Malawi, Rwanda, and Swaziland. Eg in Malawi, the HIV rate is 13.2% among circumcised men, but only 9.5% among intact men. In Rwanda, the HIV rate is 3.5% among circumcised men, but only 2.1% among intact men. If circumcision really worked against AIDS, this just wouldn't happen. We now have people calling circumcision a "vaccine" or "invisible condom", and viewing circumcision as an alternative to condoms.

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw.

ABC (Abstinence, Being faithful, Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.
Posted by: ml66uk2@yahoo.com ( Email | Visit ) at 1/30/2010 11:50 AM


Excellent article! I have one suggestion about a term used in the article. The word "uncircumcised" connotes an incomplete or unfinished condition. A much better and more accurate word is "intact" or "genitally intact." We wouldn't describe an Egyptian girl who managed to escape mutilation as "unclitoridectomized."
Posted by: hartleygreg@verizon.net ( Email | Visit ) at 1/30/2010 12:19 PM


It is my understanding from bioethics that parents are entitled to give proxy consent for surgery on their children only when it is for therapeutic purposes and if more conservative treatments have been tried and failed. Circumcision, as a non-therapeutic, purely cosmetic surgery does not meet these conditions. Therefore, it is not the right of the parents to make this decision at all, even if they are "fully informed." It is about time male children have the same rights to bodily integrity as female children.
It is unethical for parents to request amputative surgery of healthy tissue from an infant, and it is completely unethical of doctors to perform it.
Posted by: jen.petrus@earthlink.net ( Email ) at 1/30/2010 1:50 PM


If American circumcised psychology would bother to look, my guess is they would find a lot of bachelors and loners who deeply regret this unjust violation. They might even discover that crushing the feelings off a boy could result in hostility and later violence against women.
I was brought home to grow up in a family that had never done this, and never did it again, after me. The trust I should have with others is not there anymore.
Posted by: trexp@ruraltel.net ( Email ) at 2/1/2010 4:38 PM


Ms. Reis,

More than anything I just want to say THANK-YOU for having the courage to speak out on this topic.

I could not agree more with your conclusions.

Regarding this new HIV 'justification'... if individuals are expected to wear condoms, then the foreskin or lack thereof would be completely covered. The entire argument is thus null and void! Luckily medical organizations in Australia and Canada have already disregarded these studies.

Please keep speaking out on this topic, your voice is so important.

Thank you, Thank you, Thank you!!
Posted by: gnomesaneman@gmail.com ( Email ) at 2/2/2010 4:18 AM


I speak as someone who chose not to have her sons (aged 30 and nearly 20)circumcised. I decided against it because while I am Jewish, I am not religious and I am not in favor of any unnecessary surgery. Also, their father was uncircumcised, so there was no pressure on that score. However, it is not very realistic to suggest that parents should be encouraged to let their sons decide for themselves when they're grown up. A circumcision on a newborn may cause pain briefly; a circumcision on a grown man is a more complicated and infinitely more painful procedure. I know, because I had a boyfriend who went through it (after repeated monilia infections) in his 20s. So if there's a health reason to circumcise (and there's debate about this in the medical profession), it should be done as soon after birth as possible.
Posted by: steinbock@albany.edu ( Email ) at 2/5/2010 7:29 PM


The idea that most circumcised men can never allow into consciousness is that they were robbed for life of most of their capacity for erotic pleasure. The hurt and rage and sense of betrayal is so overwhelming that most of us need to banish the truth told by the scar we live with from our minds forever.  But the rage and hurt never go away. They lurk deep within, waiting to be unleashed on the next generation in the sad and endless cycle of abuse. 

As Ms Reis noted, today the American Academy of Pediatrics is threatening to endorse this abuse and robbery. That would be the gravest of failures of professional ethics. The current and latest justification offered is questionable, some say fraudulent, claims of HIV prevention. All of the previous justifications proved in the end to be vacuous. But not before one generation of abused males could take out their hidden rage on a new, defenseless generation.

The time has come to stop this cycle of abuse.

Please take a moment to do the ethical thing that Ms Reis has done. Click on the first link in her article above and sign the petition. Ask the AAP to get out of the mutilation and robbery racket and not to recommend circumcision for any reason.
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I have always second-guessed the medical establishment, and fought for no-episiotomy deliveries (2 out of 3), and did not have my 2 boys circumcised. Unnecessary surgery is unnecessary surgery, regardless of birthdate. My boys are now 28 and 12, and both are happy and healthy (and I had quite the argument 28 years ago to take my baby boy HOME without waiting to have him circumicized!)
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