Ask Dr. H: Week 4
April 28, 2016
Dear Dr. H,
I am a male, and I am very angry that, like most U.S. males, I was circumcised as a baby. I believe this is a very painful process and has taken away pleasure in sex. Why is male circumcision justified (“It’s cleaner”; “It looks nicer”, etc.) but female circumcision is illegal? How is this ethical?
Dear anonymous,
Wow, great question—so many layers! You are right: Male circumcision is common in the U.S., and this is a decision left mostly to the parents of babies (nearly 60 percent of newborns are circumcised). In that sense, I can sympathize that you feel violated that a decision was made about your body without your knowing. That being said, I do want to discuss the health impact of male circumcision and make important distinctions between male circumcision and female genital mutilation.
Male circumcision is the removal of some or all of the foreskin from the penis. Although there are some associated risks, these are greatly reduced when circumcision occurs on infants (vs. children) in a medical setting (versus outside of a medical setting) by a medical practitioner (vs. a traditional practitioner). In the U.S., circumcisions are done in this way, and a general numbing agent is used to substantially control pain. There are some reports of men experiencing a decrease in sensitivity during sex post-circumcision as adults; however, the Centers for Disease Control (CDC) finds the majority of research shows men report either improvement or no change.
Research shows that circumcision can greatly reduce the spread of sexually transmitted infections, including HIV, as well as the incidence of related cancers. The evidence is so clear that contemporary public health interventions for HIV reduction in high-risk areas now include widespread circumcision on newborn and adult males. For more, fascinating reading on this, please visit the CDC and search “male circumcision”.
So, why is “female circumcision” illegal? Recognizing the true nature of these practices, the term female genital mutilation (FGM) is now used to underscore the vast difference between the surgical procedure that is done on males and the violent procedure that is done on females.
Although it is illegal in the U.S., there are other communities in parts of the world that practice FGM as part of their culture.
We can argue male circumcision is done for health; we cannot state the same for FGM. Removing the clitoris of young girls robs them of their ability to experience sexual pleasure. Removing the clitoris and either all or part of their labia, as well as narrowing the vaginal opening by sewing it together, increases risk for infection, as well as the risk of death for both the mother and child during pregnancy.
FGM is not done for health reasons; it is done to disempower women. For more, devastating reading on this topic please visit the World Health Organization website and search “Female Genital Mutilation.”
On the topic of ethics, we trust parents to make many decisions for their children. If we have a safe and effective procedure to reduce the spread of STIs, including HIV, shouldn’t we implement it on a mass scale? This is similar to childhood vaccinations. Johns Hopkins Medical Center reports that male circumcision is actually on the decline – so there are parents out there that may feel more like you than you know.
However, a word from an expert: “Our economic evidence is backing up what our medical evidence has already shown to be perfectly clear,” says Aaron Tobian, M.D., PhD., of Johns Hopkins University School of Medicine. “There are health benefits to infant male circumcision in guarding against illness and disease, and declining male circumcision rates come at a severe price, not just in human surfacing, but in billions of health care dollars as well.”
If you’re ever in the position to make this decision for your child, perhaps you will make a different one than your parents. And that’s your right. Just equip your child with radically accurate and comprehensive sex education, so he has the skills, confidence, and resources to use condoms every time he has sex, to get regular STI screening and to discuss testing history with his partners.
Paul Mason • May 5, 2016 at 6:28 am
3 points:
1. FGM includes Types !, II, II and IV (WHO/UNICEF). The “full monty” is about 10%. Some of these – ordained by Allah or intended to reduce a girl’s promiscutiy in adolescence. Rabbi Maimonides argued the same benefit fr male circumcision, as did US Dr Kellogg (of the corn flakes family) in the C19th.
Some FGM does less physiological harm than MGM (Male Genital Mutilation).
It is illegal because it stereotypes the bodies of girls. MGM stereotypes the bodies of boys.
Babies Are People.
2. The “medical” issue is nonsense. You cannot compare risk and benefits if you cannot quantify the risks – and the data just is not there,
3. How do you compare the (small) benefit of partial lifetime relief from various diseases with the (small) risks of death by exsanguination or deformation by excessive tissue removal (i.e. missing member)?
Kyan Mulligan • Apr 30, 2016 at 10:18 pm
I already made a comment, but I am compelled to write again after learning that the author works specifically in the area of sexual assault.
It is the most tragic of ironies that a sexual assault educator cannot recognize sexual assault.
It is cynically disingenuous to say that the majority of male genital cutting in the US occurs due to belief in health benefits.
It is cultural, just as female genital cutting is. The author is Westernizing “the other” who performs female genital cutting, saying it is across the board to disempower women. The majority of female genital cutting occurs due to the exact same same-sex social pressures that cause male genital cutting in the West. Those who do not engage in genital cutting in genital-cutting societies are shamed. This is true across the board. The idea that health benefits are the primary driving force for genital cutting in the US is false. It’s a whitewashing of a cultural practice. Male genital cutting reached its peak in the US when the AAP found no evidence to promote the practice and it has reached its nadir as the the AAP and CDC attempt to find medical rationalization, with the AAP recently having to retract some of its claims due to the international embarrassment it faced over a stance that is at odds with the rest of the modern world and its pediatric societies. It admitted its stances were culturally biased and that its recommendations were only for parents who intended to genitally cut their sons for non-medical reasons. It has admitted that it formed its most current policy statement preemptively against bans of genital cutting.
Perhaps seeing male genital cutting outside of a Western context would help to see what sexual assault of children looks like:
http://www.dailymail.co.uk/news/article-3545835/300-boys-undergo-mass-circumcision-Philippines.html
It is harder to see practices and motivations within one’s own culture.
Kyan Mulligan • Apr 30, 2016 at 9:12 pm
This response ignores the origins of genital cutting of both males and females, and it ignores why male genital cutting is performed in the US. New health claims have been added to the practice after its widespread existence, and after previous health claims fell out of favor. Health claims have been made for female genital cutting by Western doctors, and female genital cutting had a larger existence in the US than is commonly recognized.
This response also ignores the fact that there are huge variations in both all types of genital cutting. As recently as 2010, the American Association of Pediatrics was advocating pinprick “circumcisions” of female infants in the United States. Under the World Health Organization classification, this is a form of female genital mutilation and to the author’s point concerning violence is far less violent than the current forms of male genital cutting currently practiced in the US.
There are no legitimate medical reasons for genital cutting of any infant. The claims that the practice becomes more dangerous as time goes on is based on the fact that general anesthesia is used outside of infants. General anesthesia is dangerous—so dangerous that it would almost never be used on an infant. The reason it isn’t used on infants is not that they don’t need the same pain relief as children and adults but because of the great harm it would cause. It is a specious argument to make that infants somehow don’t “need” pain relief like children and adults. The truth is that they are simply less likely to survive it. So a surgery is done without it, making the operation seem somehow simpler and less dangerous. It is a logically flawed assertion. We know based on Danish studies that the pain of infant genital cutting remaps the brain’s perception of pain, and that those genitally cut at birth show higher pain response to subsequent vaccinations at six months of age.
Brian • Apr 29, 2016 at 4:46 pm
Sorry for the auto correct above : Foreskin not forsaking
Brian • Apr 29, 2016 at 4:45 pm
She finds male circumcision ” fascinating ” and female circumcision ” devastating ” . Ugh…they let anyone be a doctor these days. Google forsaking function and learn. She’s way off.
Juan • Apr 29, 2016 at 7:49 am
Science shows female circumcision is cleaner and reduces the folds where bacteria and viruses can hide. Since Jill didn’t have it done at birth, we will have to create a cirumcstraint where she will be held down by her arms and legs so she can’t move while we remove–for health–what skin we feel will make her–and all of America–healthier.
Because all the men in Europe, and South America, and Central America, and China are intact. Oh, Russia too. And where is the health crisis in these places?
Ronald Goldman, Ph.D. • Apr 28, 2016 at 4:38 pm
Studies show that circumcision causes significant pain and trauma, behavioral and neurological changes in infants, potential parental stress from persistent crying (colic) of infants, disrupted bonding between parent and child, and risk of surgical complications. Other consequences of circumcision include loss of a natural, healthy, functioning body part, reduced sexual pleasure, potential psychological problems, and unknown negative effects that have not been studied.
Some circumcised men resent that they are circumcised. Sexual anxieties, reduced emotional expression, low self-esteem, avoidance of intimacy, and depression are also reported. Some doctors refuse to perform circumcisions because of ethical reasons. Relying on presumed authorities (e.g., American Academy of Pediatrics or doctors who echo AAP views) is not sufficient because of their personal, religious, financial, and political conflicts of interest. Instead, watch a circumcision video and trust your instincts. Would you allow someone to do that to YOU?
Many professionals have criticized the studies claiming that circumcision reduces HIV transmission. The investigators did not seek to determine the source of the HIV infections during their studies. They assumed all infections were heterosexually transmitted.
Many HIV infections in Africa are transmitted by contaminated injections and surgical procedures. The absolute rate of HIV transmission reduction is only 1.3%, not the claimed 60%. Even if the claim were true, based on the studies, about 60 men had to be circumcised to prevent one HIV infection.
Authorities that cite the studies have other agendas including political and financial. Research shows that circumcision causes physical, sexual, and psychological harm, reducing the sexual pleasure of both partners. This harm is ignored by circumcision advocates. Other methods to prevent HIV transmission (e.g., condoms and sterilizing medical instruments) are much more effective, much cheaper, and much less invasive. Even HIV/circumcision studies advise using condoms. With condoms circumcision adds no benefit to HIV prevention.
Think Think Think • Apr 28, 2016 at 12:14 pm
There is a world of difference between Female Circumcision (partial or complete removal of the clitoralhood), and Female Castration (removal of external female genitalia)
The poster clearly stated Female Circumcision, and the response failed to respect that distinction. This displays a cultural bias and you should be aware that many view MGM and FGM as equally horrific.
Think Think Think • Apr 28, 2016 at 12:10 pm
Doubt that the moderators are going to be honest enough to approve anything critical of Male Genital Mutilation (MGM)….
Think Think Think • Apr 28, 2016 at 12:08 pm
Male Circumcision is ->directly<- comparable to Female Circumcisions. The removal of an infants foreskin is as horrific as the removal of an infants clitoral hood.
Anyone that claims otherwise is being intellectually dishonest and is displaying a deep cultural bias that has served to normalize and perpetuate a painful, and sometimes deadly human rights violation for millions of innocent infants.
MGM and FGM are equally horrific, and are both done to reduce sensation in the victims.
For Dr. H to quote the questionable HIV claim shows he/she did very poorly in statistics. Further infants do not have sex so the minuscule (1.4%) reduction is not going mater until after puberty.