Saturday, February 9, 2013

So why do we still circumcise baby boys?

In circumcision debates, intactivists often compare the rationale of male circumcision (MC) to that of female genital mutilation (FGM), which usually catches the casual reader by surprise. Quite often the reaction is one of disbelief, as was the case of a recent blog entry that stated: "To even suggest [MC] as [mutilation] and dare compare it to the actual devastating mutilation of women genitalia that does still occur in some parts of the world is disgraceful." (1)

This is often followed by a succinct description of what FGM is: "a destructive operation, during which the female genitals are partly or entirely removed or injured with the goals of inhibiting a woman’s sexual feelings. Most often the mutilation is performed before puberty, often on girls between the age of four and eight, but recently it is increasingly performed on nurslings who are only a couple of days, weeks or months old. Female Genital Mutilation happens primarily in Africa, in particular in North-Eastern, Eastern and Western Africa. However, it also takes place in the Middle East, in South-East Asia – and also among immigrants in Europe. " (2) And everybody will reiterate that it is done with broken glasses or rusty blades, without anesthesia, causing bleeding, deaths and excruciating pain during sex and labor. See (3). See also the WHO's factsheet on FGM (28)

By contrast, MC has health benefits, it's done in sanitary conditions by health professionals on babies who don't remember the procedure and are not affected sexually, and the risks are minor, with the most common being bleeding and infections which are easily controlled. That's what everybody says. See (4)

People often argue that comparing MC to FGM trivializes the suffering of women as FGM is far more damaging.

But every now and then it is a good exercise to reevaluate our comfortable beliefs and look deeper into the meaning of those things we do ordinarily.

One of the first points that we need to address is that "female circumcision" existed and still exists in the English speaking countries for medical reasons. But to address this we need to look back in history.

Medical circumcision had its beginning in the 1870s, when Western medicine followed the theory of irritation and reflex neurosis, (5)(6) which postulated that the sexual organs and the erotic sensations they produced were the cause of all human disease. Of course this lead to the major culprits of diseases, sex, orgasm, and even more specific, masturbation. Masturbation was considered the cause of epilepsy, paralysis, blindness, insanity and other maladies.

Masturbation was so damaging that it was often dealt with severe measures, including penile amputation and castration. (7)

In 1871, M.J. Moses declared that the Jews were immune to masturbation because they were circumcised. (8) In 1888 J.H. Kellogg advocated MC to cure masturbation.

Female sexuality was equally or even more scary. In 1866 Isaac Baker Brown in the UK described the use of clitoridectomy as a cure for several conditions including epilepsy, catalepsy and mania, which he attributed to masturbation (9). Baker Brown's career fell in disgrace shortly after, accused of performing clitoridectomies without his patients' consent.

However, clitoridectomies were better received in the United States, where Kellogg and other doctors advocated them.

In 1915 Benjamin E. Dawson said that since the clitoral hood is the source of many neuroses, female circumcision is necessary (8).

As the germ theory replaced the reflex neurosis as an explanation to the cause of diseases, masturbation as the culprit became an obsolete concept, but the doctors were not ready to let go of the procedures. Penile cancer, cervical cancer and syphilis were the new bogey men, and Jews also appeared to be immune to them, most likely because of their circumcision. So in 1926 it was claimed that circumcision prevented penile cancer; in 1942 circumcision was found to prevent prostate cancer, in 1949 it prevented venereal diseases and in 1951 it was found to prevent cervical cancer. (8)

Well into the 1950s, clitoridectomies were still practiced, with C.F. McDonald stating in 1959 that "the same reasons that apply for the circumcision of males are generally valid when considered for the female. (8)

In 1959, the rationale for female circumcision started to change, when Rathmann invented his clamp and presented new indications for the procedure. Rathmann stated that "Redundancy or phimosis of the female prepuce can prevent proper enjoyment of sexual relations; yet some modern physicians overlook indications for circumcision.[...] Properly carried out, circumcision should bring improvement to 85 to 90 per cent of cases - with resulting cure of psychosomatic illness and prevention of divorces." (10)

Rathmann's circumcision was different from previously practiced clitoridectomies in its goal, its subjects and its purpose. Now it was not about blunting the incipient sexuality of female minors, but about allowing better expression of the sexuality of female adults. Instead of removing the clitoris, this procedure removed the clitoral prepuce and exposed the clitoris glans -being the best equivalent to MC, which removes the prepuce to expose the glans penis.

It was previously believed that MC prevented premature ejaculation (11) because removal of the prepuce caused a toughening (cornification or keratinization) of the glans, thus reducing sensibility and allowing the male to last longer. So how was it possible that the same procedure would cause opposite results in males (delaying orgasm by desensitizing) and females (facilitating orgasm by exposing the sensible organ)? This question was apparently ignored in the furor of the era.

In the 60s, doctors in Sudan, Somalia, and Nigeria began to speak out about the health consequences of FGM as practiced in Africa (12) . In 1967 Joseph Lewis published his book "in the name of humanity: speaking out against circumcision".

In 1966 Masters and Johnson claimed that circumcision had no sexual effects (8) and in 1969 Morris Fishbein was still calling for circumcision to cure masturbation (8). How could the same procedure cure masturbation and have no sexual effects seems to be another question that eluded the critical thinking of the era.

In 1971 Abraham Ravich claimed that circumcision prevents cancer of the bladder and the rectum, yet the same year the AAP concluded that "there are no valid medical indications for circumcision in the neonatal period", position that they reiterated in 1975 (8), followed one year later by Dr. Benjamin Spock, who had previously endorsed the practice for decades. Yet circumcision continued to be practiced in the United States.

The 1970s saw the birth of intactivism as is known today. Van Lewis in Florida, Kenneth Hopkins in California, Marilyn Milos and others started speaking against MC. Jewish Nobel prize George Wald was questioned by Van Lewis and soon wrote an essay about circumcision, which editors refused to publish. (13)

In 1973, Playmate published an article promoting female circumcision, again as a sexual enhancement for adult women.

In 1979, the World Health Organization (WHO) sponsored a seminar about FGM which led to a poll with the purpose of eliminating the practice.

In 1980 Edward Wallerstein, Jew Engineer, published "Circumcision: an American health fallacy", a book that addressed all the existing arguments for circumcision and proved how those benefits were the result of fabricated, manipulated and misinterpreted data, and even more, social, cultural and racial prejudices.

Yet the 80s saw more reasons to continue circumcising: In 1985 Thomas E. Wiswell claims that circumcision prevents urinary tract infections, and in 1986 Valiere Alcena hypothesized that circumcision could prevent AIDS, followed shortly by Aaron Fink. In 1989, the AAP's Task Force led by Edgar Schoen declared that circumcision was necessary (8).

The 90s brought two important setbacks for circumcision advocates:  in 1997 it was discovered that babies felt significant pain during circumcision without anesthesia (14) (what took them so long?) and in 1996-1999 John Taylor described the anatomy of the prepuce, finding that the mucocutaneal transition area or ridged band was richly innervated and highly sensitive, contradicting the generally accepted belief that the prepuce was a useless flap of skin, or at best a protection to the glans (15). In 1999 the AAP went back to a neutral statement that "potential medical benefits of newborn male circumcision... are not sufficient to recommend routine neonatal circumcision" (8).

1996 also saw the federal ban of FGM in the United States with no exceptions for religious or cultural beliefs.(48)

Through the first decade of 2000 three trials took place in Africa to test circumcision as a preventive measure against HIV. The trials were said to prove that circumcision reduced the risk of a male contracting HIV from an infected female by up to a 60% (16), causing the WHO, UNAIDS, PEFPAR, UNICEF, the Bill & Melinda Gates Foundation and other organizations to promote MC as part of a comprehensive package in the prevention of HIV.

In 2007, Catherine Hankins working with the WHO, wrote that "it is therefore critical that messaging about male circumcision for HIV prevention not only clearly distinguishes it from FGM but also contributes to efforts to eradicate FGM" (17).

This is very clear. At this point, a double standard is created. FGM is to be eradicated. MC is to be promoted for HIV prevention. Catherine Hankins repeated in her article the same old rhetoric: circumcision prevents penile cancer, cervical cancer, syphilis, infections, HPV... Circumcised men are cleaner... Women prefer circumcised men... (17) All the arguments that had already been debunked by Wallerstein in 1980.

Now, why is FGM considered bad?

Is it because it's done in non-sterile environments? Is it because it's damaging to sexuality? Is it because it has no health benefits? Is it because it's painful? Is it because it's unethical to operate the genitals of a non-consenting individual?

If FGM is bad because it's performed in non-sterile environments, then it is ironic that the WHO has condemned any attempt at medicalizing FGM. In fact, several countries, including Australia (18), United States (19), Egypt (20) and some other African countries (21) have debated or called for some medical version of FGM in an attempt to "minimize the harm", and Indonesia and Malaysia's (22) practice of medical FGM is perceived as a threat to the advocacy against FGM.

If FGM is bad because it is damaging to sexuality, studies have proven that FGM does not prevent women from experiencing orgasm, angering those who believe that these studies will only encourage the practice of FGM (23).

If FGM is bad because it has no health benefits, then it is worth of mention that at least two studies show less prevalence of HIV among circumcised women (24) (25). Regarding hygiene, it is known that female genitals are harder to clean than male genitals and also produce smegma, which has been (erroneously) considered as a carcinogen at some times and the word still seems to elucidate a negative response.

If FGM is bad because it's painful and causes infections, then medicalization could be a response. But the WHO opposes it.

So, is it bad because on an ethical level it constitutes an unnecessary operation on the genitals of a non-consenting individual? Could we postulate a principal of a feminine right to genital integrity?

Or is it bad because it is "their" custom and not "ours"?

Mohamed Kandil in 2012 wrote an article called "Female circumcision: limiting the harm" (formerly titled "Where's the evidence"). In it Kandil declares that "there is insufficient evidence to support the claims that genital cutting is a harmful procedure if performed by experienced personnel in a suitable theatre with facilities for pain control and anesthesia" and concludes that "Law makers around the globe are invited to review the legal situation in relation to female genital cutting. Proper counseling of parents about possible risks is a must in order to make informed decision about circumcising their daughters. The procedure should be offered to parents who insist on it; otherwise, they will do it illegally, exposing their daughters to possible complications", yet in a disclaimer the author rushes to indicate that he does not condone female genital cutting. (26)

Yet in December of 2012 the United Nations approved a resolution calling for a global ban of FGM regardless of cultural or religious beliefs.

Is it a human rights problem? The WHO states that "FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death." (28).

It is interesting that while female genital cutting of minors became banned, some operations that fall under the umbrella of female "circumcision" are still practiced in the United States and Europe: vaginal rejuvenation, clitoral hood reduction (exactly what Rathmann called female circumcision in 1959) and Labiaplasty (similar to a partial excision). The legality of these procedures stems from the adult patient's consent, as adults are recognized being entitled to their own health decisions. However the WHO's definition in the previous paragraph does not rule out FGM being a human right violation when practiced on adults.

Now that we've analyzed FGM, perhaps we can reverse the same analysis to MC.

MC, considered as part of the prevention of HIV places the burden of prevention on the male, but it also seems to consider that no matter what, those men will have sex with multiple females (one of which could be infected) and transmit the virus to their regular partners or other casual partners. This alone seems to indicate that the general perception is that males cannot control their impulses or be trusted to practice safe sex, so a surgical solution is needed. Basically, it's a sexist paradigm.

Even Catherine Hankins argues that "Male circumcision is an irreversible procedure which provides a child with no benefits in relation to HIV before sexual debut, except for reduced likelihood of urinary tract infections in infancy" (17) leading her to the conclusion that "Parents may prefer to leave the decision to the child, waiting until be has the capacity to decide on his own. Or they may view the lower risk of surgical complications associated with the procedure when it is performed in infancy as being in the child's best interests."

Anti-circumcision activists consider infant MC a human rights violation. But is it?

FGM is said to "reflect deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women". In that same sense, it could be asserted that MC reflects inequality toward males (as it puts the burden of prevention on males and it assumes that males will submit to uncontrolled sexuality), thus constituting a a form of discrimination against males.

Infant MC could also be said to be "always carried out on minors and is a violation of the rights of children." After all, if a girl has the right to grow with her genitals intact, why wouldn't the same principle apply to boys?

The WHO's definition continues saying that "the practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death."

Does MC violate the right to health? How do we define violating the right to health? MC has surgical risks and potential complications. But even more, MC causes known damages to the male's genitalia. For example:

As mentioned before, John Taylor described the anatomy of the prepuce, finding that it has a high concentration of nerve endings (Meissners corpuscles) (15). In 2007, a study showed that the tip of the foreskin is the most sensitive part of the penis - and it is always ablated by circumcision (29). In 2011 a study in Denmark showed that "Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfillment  Thorough examination of these matters in areas where male circumcision is more common is warranted" (30). In 2013 a study in Belgium showed 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" (31). Additionally preliminary studies have suggested an association between circumcision and ED (32) and alexithymia (33).

The fact that MC has sexual effects was even known to Jewish philosophers of antiquity (34) (35) and to the Victorian doctors of the XIX century (such as J.H. Kellogg) who advocated it to control masturbation. It was only in 1966 that Masters and Johnson said that MC had no sexual effects. The real answer to this doesn't come from statistics but from a simple biological analysis of the functionality and mechanics of the penis.

So, does changing the mechanics of male genitalia, possibly creating sexual difficulties, accelerating onset of ED, perhaps even causing psychological trauma, "qualifies as violating the right to health"?

The Royal Australasian College of Physicians evaluates the risks of the procedure by stating that "Some of the risks of circumcision are low in frequency but high in impact (death, loss of penis); others are higher in frequency but much lower in impact (infection, which can be treated quickly and effectively, with no lasting ill-effects). Low impact risks, when they are readily correctable, do not carry great ethical significance. Evaluation of the significance of high-impact low-frequency risks is ethically contentious and variable between individuals" (36). Do these high-impact low-frequency risks "violate the right to health"?

The WHO also speaks about "the right to be free from torture and cruel, inhuman or degrading treatment". Is being strapped on a circumstraint, restrained and crying, often with limited or no anesthesia, having the balanopreputial membrane forcefully broken (what the physicians euphemistically call "separating adhesions") and the most sensitive part of your private areas cut off, "cruel, inhuman or degrading treatment"?

To answer that question let me remind you that in 2005 an Ethiopian student was sent by the CIA and MI6 to Morocco to a shadow prison to be tortured; he claimed that "he underwent the strappado torture of being hung for hours from his wrists, and scalpel cuts to his chest and penis" (37). In his words "They took a scalpel to my right chest. It was only a small cut. Then they cut my left chest. One of them took my penis in his hand and began to make cuts. He did it once, and they stood still for maybe a minute watching. I was in agony, crying, trying desperately to suppress myself, but I was screaming... They must have done this 20 to 30 times in maybe two hours. There was blood all over."

George Wald described witnessing a circumcision: "After the first bout of crying on being fastened down, it seemed to me more as though the infant were trying to withdraw into himself. To my astonishment, at one point right in the middle of the operation he seemed to be falling asleep! Someone later showed me an interview with the psychiatrist Wilhelm Reich, in which he said: 'Circumcision is one of the worst treatments of children. And what happens to them? They can’t talk to you. They just cry. What they do is shrink. They contract, get away into the inside, away from that ugly world.'"(13)

Ronald Goldman also explained: "If I forcefully cut off one of your healthy fingers, my reason would make no difference to you, even if I sincerely believed that amputating your finger was for your own good. Your experience of the event would be the same—pain, shock, horror. In the case of circumcision, what we are doing to the infant is cutting off a part of his penis. No explanations can change that fact. Our reasons, whether they involve religious belief, cultural conformity, or pleasing a relative, may make us feel better, but they make no difference to the infant" (38).

Van Lewis himself described witnessing a procedure: "With the crushing of the center line of the top of the foreskin with the hemostat the baby’s screaming and thrashing ratchet WAY up (he was restrained by tie-downs, put in place in preparation for this human hurricane they already knew from long experience was coming) and when the clamp comes off and the dorsal cut is made the baby begins to vomit—projectile vomiting—the most violent vomiting I have ever witnessed from any human being. Blood from the baby’s penis spurts everywhere. The vomiting interrupts the screaming and the screaming interrupts the vomiting. The mutilator takes out his sewing kit and starts sewing. With every puncture of the needle a new blood-curdling scream comes rushing out, with every pulling of the thread through the foreskin the baby turns bluer and screams louder and harder and finally, when I think the police are going to arrive, or the baby is going to die, or God is going to strike us all dead on the spot—the baby goes totally silent and completely limp. He passes out, knocked cold by the trauma of the mutilating" (47)

It would be clear that babies cannot understand why they are being subjected to this treatment and can only cry or withdraw, and this would qualify as "torture and cruel, inhuman or degrading treatment".

Furthermore, there is growing awareness that many adult men wish they had not been circumcised. T. Hammond (1999) argues that "Recognizing the loss of body parts can produce grief for loss of body image, function, or both. Anxiety, depression, and sexual problems correlate to the magnitude and type of loss, as well as personal vulnerability. Both avoidance and obsessive preoccupation with loss can be problematic" and alludes the procedure of foreskin restoration by saying that "circumcision produces patients who later invest time, money and effort to ‘undo’ the effects". Hammond concludes that "serving children’s best interests involves recognizing genital cutting customs as a human rights issue and that, 'Individuals who wield the least power need increased social and legal protection'". The final conclusion indicates that "it can no longer confidently assume that circumcising a healthy boy will be viewed by him later as beneficial. Increasingly, circumcised males are learning the functions of intact genitals, documenting the harm from circumcision and pursuing genital wholeness. They will undoubtedly increase their pressure on circumcising societies to affirm male genital integrity and to prevent involuntary nontherapeutic circumcision. " (39)

Finally, the WHO's paragraph says that FGM violates "the right to life when the procedure results in death". Deaths from MC are not unheard of. The AAFP estimates one death in 500,000 procedures (40) while anti-circumcision activists estimate a high number due to deaths with a different primary cause which was consequence of the circumcision procedure (41). Regardless of, with an estimate of 1.2 million circumcisions per year in the United States, circumcision would account for at least 2 or 3 deaths (using a conservative estimate) to 117 (using Dan Bollinger's estimate) per year.

Even more, with traditional circumcisions in African initiation schools, tens of deaths are recorded every year and hundred of hospitalizations, including full penile amputations (42). Yet the WHO, UNAIDS and those institutions are not doing anything to prevent these deaths.

"Voluntary" male circumcision programs in Africa have also empowered tribal violence, such forced circumcision of adults in Uganda, where men were chased in the street by mobs and circumcised on the spot (50) in June of 2012, or the killing a male teenager in South Africa in January of 2013, who was found with his throat slit and his foreskin stolen (51).

The same voluntary MC programs which started targeted to adults are now specifically targeting neonates: "Build the capacity of partner governments to begin planning for and financing an integrated, long-term early infant male circumcision (EIMC) program" (52). Obviously infants do not voluntarily submit to the procedure. Another interesting little fact is that these circumcision programs often use mobilizers or recruiters tasked with finding "clients", who receive monetary compensation. In Kenya "If a mobilizer recruited a male aged 15-18 years (or 15-21 years for certain implementing partners), then they received 50 Kenyan Shillings. If a mobilizer recruited a male aged 18 or 21 years and above, they received 100 Kenyan Shillings." (53)

A 2012 Johns Hopkins university "study" (I use quotes as the study is basically a simulation, which means that it's an estimate and not real evidence) conducted by Aaron Tobian (56) indicated that if the circumcision rates in the United States were to decline to the levels of Europe, healthcare costs would increase by millions due to "new cases and higher rates of sexually transmitted infections and related cancers among uncircumcised men and their female partner". The "analysis showed that, on average, each male circumcision passed over and not performed leads to $313 more in illness-related expenses, costs which Tobian says would not have been incurred if these men had undergone the procedure." (54) What is not clear is if Tobian considered the cost incurred from the complications of circumcisions, corrective surgeries, malpractice lawsuits due to wrongful deaths and injuries, lifelong counseling and therapy to injured men. It's also not clear why American penises are so much more defective that its healthcare cost would raise, while Europeans are not affected by similar healthcare issues. In my opinion, this "study" denies human dignity by putting a price tag on a healthy body part and commits methodological flaws by extrapolating African data (coincidentally reported by Tobian's college Dr. Ronald Gray (55)) as hypothesis and applying it to a different American population.

We could then paraphrase the WHO's factsheet on FGM and state that "Infant MC is a violation of the human rights of boys and men. It reflects deep-rooted inequality between the sexes, and constitutes a form of discrimination against men. It is always carried out on minors and is a violation of the rights of children. The practice also violates a person's rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death."

So why is it acceptable to circumcise boys?

Is it acceptable because circumcision constitutes a religious custom for Jewish and Muslims? FGM is also a religious custom for many Muslims, and yet the Western society makes no exception for religious reasons.

Is it acceptable because there are "potential health benefits"? As mentioned previously, most of the "potential healthy benefits" were debunked since 1980 in Wallerstein's book (11). The only new "benefit" afterwards is the role of circumcision as prevention of HIV (16), result from the African Randomized Controlled Trials (RCTs), which have been challenged in methodology (43) (44) (45) and even Catherine Hankins, researcher and advocate, indicated that MC "provides a child with no benefits in relation to HIV before sexual debut"(17).

Is it acceptable because it's done in sterile environments? If that's the case, why don't we speak against the African initiation schools? Why do we condemn medicalized FGM?

Is it acceptable because people think that it doesn't affect male sexuality? As shown earlier in this article, there is plenty of evidence that there is a detrimental sexual effect.

Or is it acceptable because it is "our" custom and the custom of the Jews, and not "theirs", the custom of primitive black Africans?

Perhaps it is accepted because we still hold to a racial superiority or cultural superiority that blinds us from accepting that we may have been performing a damaging procedure all along, while priding ourselves in condemning a damaging procedure in another culture?

Perhaps it is accepted because parents feel empowered by the AAP's statement that "in the pluralistic society of the United States, where parents are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare, it is legitimate for the parents to take into account their own cultural, religious, and ethnic traditions, in addition to medical factors" (4), not realizing that this statement should also apply to FGM but it doesn't and not realizing that what this means is that even though the medical factors are not enough to recommend circumcision, the AAP still wants to present the option to parents and collect the appropriate fees.

Or do we have no option but to accept that infant MC, just like FGM, is an unnecessary and irreversible operation on the genitals of a non-consenting individual?

Is it perhaps time that we postulate a principle of a right to genital integrity which respects gender equality?

The purpose of comparing FGM and MC is not to trivialize FGM, but to recognize that MC has objective victims, who are often hushed by shame, if not mocked when they dare to speak up. And while most FGM practices (but not all) are far more damaging than medical MC, MC can have high impact (even if low frequency) consequences such as the loss of the penis and death. In some cases the injuries suffered by a baby have led to the suicide of the adult many years later. (49)

Perhaps we can re-read Catherine Hankins statement again: "it is therefore critical that messaging about male circumcision for HIV prevention not only clearly distinguishes it from FGM but also contributes to efforts to eradicate FGM" (17) and read it for what it is: a manifesto of propaganda and a declaration of principles to create an artificial separation between MC and FGM with the double standard of eradicating FGM while promoting MC. A very smart strategy that seems to have worked in large segments of our population who are convinced that they understand what FGM is and how it's different from MC.

Even if we could demonstrate that there are potential health benefits of MC, we would still have positive sexual harm for the adult that the baby will become, which makes a decision less clear.

Even if we could demonstrate health benefits; even if we could minimize the risks; it still holds true that we are amputating healthy normal and functional tissue from a healthy baby without regard for his consent -or his future preference, and this is ethically troublesome whether we are speaking of males or females.

Does it need to be a parental decision at all? Or could we follow the example of other countries where circumcision is not a parental decision? Where infant circumcision is not another entry in the menu of options for the future parents?

Even more troublesome is the documented use of neonate foreskins, euphemistically "donated" to manufacture (such as SkinMedica) and research facilities (Histogen), in contradiction with ethical policies (46) and behind the back of parents (who do not know that the tissue will be "donated" for commercial profit) and the babies (who definitively did not consent to "donate" any tissue at all).

Are we circumcising babies as a public health measure, in the quest for "potential health benefits", as a social custom, as a religious custom, or as an aesthetic preference (and why are parents entitled to force their genital aesthetic preference on their male children at all)?

Or are we circumcising them because we can get away with it and we can convince insurance companies to pay for the procedure, and we can obtain compensation in exchange for the "donation" of tissues?

Or are we circumcising babies because circumcised parents don't want to face what was done to them, instead retreating into their own illusion of benefits, cleanliness and aesthetic, thus perpetuating a cycle of abuse and denial?

Or are we circumcising babies because we cannot come clean and recognize that we were wrong, that those benefits were really not that great and that positive damage that we denied for so long actually exists?

Or why do we still circumcise baby boys?


REFERENCES (Under construction)

(1) http://blog.dermstore.com/index.php/oprah-and-the-can-fap/
(2) http://www.desertflowerfoundation.org/en/what-is-fgm/

(3) https://www.mtholyoke.edu/acad/intrel/jc.htm and http://www.guardian.co.uk/theobserver/2012/jul/29/the-big-issue-male-circumcision

(4) http://pediatrics.aappublications.org/content/130/3/585
(5) http://www.historyofcircumcision.net/index.php?option=content&task=view&id=90
(6) http://www.cirp.org/library/history/gollaher/
(7) Sexual Mutilations: A Human Tragedy
 edited by George C. Denniston, Marilyn Fayre Milos

http://books.google.com/books?id=qof6J4n1860C&pg=PA20&lpg=PA20&dq=curing+masturbation+with+penile+amputation+and+castration&source=bl&ots=-8sHROgf7z&sig=UNCg6oG4vmqy3tpnWKFUcdPLvgU&hl=en&sa=X&ei=fdYVUcL3J4eu9AS7t4GwCg&ved=0CDEQ6AEwAA#v=onepage&q=curing%20masturbation%20with%20penile%20amputation%20and%20castration&f=false



(8) https://sites.google.com/site/completebaby/medicalization
(9) http://en.wikipedia.org/wiki/Isaac_Baker_Brown
(10) http://www.noharmm.org/femcirctech.htm
(11) http://www.cirp.org/library/general/wallerstein/
(12) http://en.wikipedia.org/wiki/Female_genital_mutilation#Since_the_1960s
(13) http://www.mendocomplain.com/references/1153-2/
(14) http://www.cirp.org/library/pain/lander/
(15) http://www.cirp.org/library/anatomy/taylor/
(16) http://www.jhsph.edu/research/centers-and-institutes/rakai-health-sciences-program/
(17) http://www.biomedsearch.com/article/Male-circumcision-implications-women-as/166186234.html
(18) http://sheikyermami.com/2010/05/30/retreat-from-the-nick-not-so-fast/
(19) http://pediatrics.aappublications.org/content/125/5/1088.abstract
(20) http://www.desertflowerfoundation.org/en/egyptian-gynaecologists-speak-out-against-abolition-of-fgm-law/
(21) http://csde.washington.edu/fogarty/casestudies/shellduncanmaterials/day%203/Shell-Duncan%20Medicalization.pdf
(22) http://womennewsnetwork.net/2013/01/18/medicalize-female-mutliation-destroy-fgm-advocacy/
(23) http://www.rnw.nl/africa/article/female-circumcision-orgasm-still-possible
(24) http://www.tzonline.org/pdf/femalecircumcisionandhivinfectionintanzania.pdf
(25) http://www.ncbi.nlm.nih.gov/pubmed/1442755
(26) http://f1000research.com/articles/1-23/v2
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