In the September issue of their journal Pediatrics, the American Academy of Pediatricians published a newly revised policy statement on circumcision. This was the first new statement on circumcision since 1999, and it took a much more strongly procircumcision stance, arguing that the benefits of circumcision outweighed the risk, and that the procedure should be covered by medical insurance so that parents were free to choose it regardless of their finances. The outcry from the intactivist community was loud indeed. Critiques were written of the policy, it was criticized as unethical and unscientific and the AAP was accused of being biased. See here, and here. In addition an initiative was begun which collected pictures of individuals with the phrase “AAP No Ethics” written on their palms.
I hope to devote future blog posts to a more thorough critique of each of the arguments against the AAP’s statement. There are so many allegations that I can’t address them all in one blog post, and I hardly know where to begin. Suffice to say that I don’t find the arguments against the science convincing; the evidence has been growing for real but moderate benefits to circumcision. Many of the criticisms show an ignorance about common scientific language or technique that invalidates their arguments. Some don’t seem familiar with the AAP’s accompanying technical report which explained their reasoning and fleshed out the recommendations in the official policy statement. I plan to go through some of these objections to the statement in later posts, and point out where the objections are flawed and why. However, I want to start by touching on where I agree with the intactivist criticisms. This doesn’t mean that I think the AAP statement is invalidated, but I do think there are some legitimate complaints about it.
So, some criticisms which I believe have some merit:
The AAP has a cultural bias.
Now, some of these criticisms claim that the AAP committee has a bias due to a reliance on scientific thinking, which I do think is absurd. In contradiction to the Circumcision Resource Center’s post, I think that the possible benefits and harms of circumcision are absolutely discernible through scientific inquiry, and controlled, replicable and falsifiable studies are a much better gauge of the truth than either feelings or common sense, which are far more subject to cultural bias. However, the researchers DO have a cultural bias: circumcision and the circumcised state are viewed as normal and acceptable, unless there are proven harms. I think that intactivists are somewhat correct in saying that scientists wouldn’t even be investigating circumcision and possible benefits if it weren’t already acceptable to a degree in Western society. However, just because this preexisting bias makes American doctors more willing to consider circumcision doesn’t mean that it doesn’t have real benefits, it just means that the researchers are more open to those benefits. And while there might be concern that this normalcy encouraged the researchers to be more procircumcision in their review of the scientific data, it is also possible that the cultural distaste for circumcision leads other groups to overlook or minimize possible benefits of circumcision. Bias goes both ways. It is definitely possible, however, that this bias influenced how much benefit the committee believes that one needs to see before circumcision is justifiable, and that leads to my next point.
The AAP placed no value on bodily integrity.
I think that this statement is true. I have seen this stated in a few sites or a few different ways, some more inflammatory than others. I agree that the AAP seemed to place no value on keeping the child’s body whole, rather they looked only for objective evidence of harms and benefits. Since the committee members view circumcision as normal and the circumcised state as normal as the intact state, they didn’t seem to require a large benefit to justify the procedure, evidence of greater lifetime benefits than lifetime harms seems to be sufficient for them. However, in this document they also stress parental choice, and acknowledge that different parents will bring different values to their decision making. I also do not believe that this means that the AAP does not care about ethics or about the well being of boys, it just means that in their decision making system the presence or removal of the foreskin had no value, no decision making weight, in and of itself. The value was determined solely on the effects, positive and negative, on the child’s health and well being. This is certainly different to the philosophy of ethics of intactivists, but it is not an absence of ethics. It is perhaps a more utilitarian ethics.
The AAP does not make clear the magnitude of the benefits of circumcision.
Although the AAP does try to quantify the magnitude of any benefits and likewise the magnitude of any risks, I don’t believe that it provides sufficient evidence for parental decision making. The most useful number is the “number needed to treat,” which indicates how many circumcisions are necessary to prevent one negative outcome in comparison to the intact state. This could be more easily compared with the numbers available on complication rates. The AAP technical report provided numbers needed to treat for the issues of urinary tract infection and penile cancer. For most other benefits, it provided information on relative risk ratios only. For instance, the report cites a CDC study which estimated a 15.7% reduction in the individual’s lifetime risk of HIV with neonatal circumcision but doesn’t provide information on the absolute risk of infection. A 16% reduction in a 1.87% absolute risk of contracting HIV may seem much less than persuasive to many. The CDC study did provide estimated numbers, which vary based on race. “The number of circumcisions needed to prevent one HIV infection was 298 for all males, and ranged from 65 for black males to 1,231 for white males.” This is the kind of information that is truly needed for a decision on the benefits of this procedure, and they suggest that the benefits for each individual are far from equal.
These listed criticisms are not minor. They are not, however, criticisms of the science itself, which I believe the AAP Technical Report shares in a fair manner. They are instead related to the application of those scientific findings to the decision of whether or not to circumcise. If one is going to argue against routine circumcision, then I feel that these are the points to focus on. I think it is important, however, to keep in mind that the question of “how much benefit is necessary to justify circumcision” is a question based on the parents’ own philosophy, and that different parents can make different decisions based on the same evidence, all while desiring the best for their son’s well being.
November 27th, 2012 at 4:59 pm
Look at the picture in this page: http://damagefromcircumcision.blogspot.com/p/keratinization.html see the difference in texture between the glans of those two organs. One is obviously shiny and smooth, the other one isn’t and the texture is very marked. This is not an age based difference – this is a circumcision caused difference. My own glans used to look like the one at the bottom, and since I’m doing foreskin restoration it looks more like the one at the top. Perhaps you won’t call that “keratinization”, but then what would you call that difference?
I can tell that when mine was like the one on the bottom, it felt hard and dry. Since I started restoring it feels softer and slightly moist.
From my experience, those two in the picture are typical samples, not extreme cases of circumcised or uncircumcised men. Don’t you agree?
November 27th, 2012 at 6:26 pm
I’ve seen that page. The DAMAGEFROMCIRCUMCISIONDOTCOM part led me to believe it might not be unbiased! I’m not sure, but I think we might have the ability to digitally manipulate photos these days, so any differences could be seriously enhanced while at the same time being seriously irrelevant. It honestly doesn’t MATTER if they LOOK different. They already LOOK different. If there’s some sort of functional difference, then that is relevant…but otherwise this just comes across as your attempt to advertise the status of your penis on my blog. I have no interest in discussing that, for your information.
No, I don’t agree with you that those are ‘typical’ examples of penis differences. They’re all vastly different.
November 28th, 2012 at 5:57 pm
Okay, end of discussion then.
Wow. You really don’t get it. I guess you would need to have one in order to really understand it.
November 28th, 2012 at 7:36 pm
If you choose. I don’t feel it was a particularly fruitful conversation, nor do I find you particularly convincing. I know you do though. Just because I disagree with you, though, doesn’t mean I don’t get it. That’s the thing about you intactivists. You really are caught up in your own woo. You really can’t conceive that people could have done adequate research into this topic and come to a different conclusion than you have. As far as ‘having one’ to understand, isn’t that one of the arguments you guys commonly wail about? That they “let the dad make the decision, because he has the penis”? It can’t really go both ways. Either the women who make that comment are wiser than they’re getting credit for, or you’re throwing a hissy fit because I don’t agree with you that the circumcised penis is somehow irrecoverably damaged by the circumcision. I have yet to run across a circumcised penis that was ‘hard, dry and cracked’. If I did, I’d probably run far far away, on the assumption the man had an STI.
November 14th, 2012 at 7:46 am
I tried to post a comment. Not sure if it didn’t go through due to filters, or if it requires approval. This is just a test.
November 15th, 2012 at 11:14 am
Comments are moderated. Yours is up now.
November 14th, 2012 at 7:37 am
There is another criticism that I think its noteworthy. Or two:
a) The Policy Statement as you mentioned placed no value on the foreskin, but it doesn’t make that obvious. When we are discussing an amputation as preventive medicine, I think it would certainly be valuable to discuss what is it that is being amputated and what are its functions. Of course this might be difficult for the 8 members of the AAP to assert, as it is very likely that none of them has a foreskin themselves. Of course they could have referenced Taylor, JR; Lockwood AP; Taylor AJ (February 1996). “The prepuce: Specialized mucosa of the penis and its loss to circumcision”. British Journal of Urology 77 (2): 291–295. doi:10.1046/j.1464-410X.1996.85023.x. PMID 8800902. for example, for a detailed anatomical study, but this reference is curiously absent from their scientific literature review.
b) They minimized the risks with the following statements: “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)”, “Financial costs of care, emotional tolls, or the need for future corrective surgery (with the attendant anesthetic risks, family stress, and expense) are unknown.”. However the risks are far from trivial, and what they are calling “case reports” are cases where a person died or was severely injured for life. For example, Brian Mathew Brandt, from California, committed suicide last year at 28 years of age; his suicide was the result of a life of depression and self loathing due to a botched circumcision that left him mutilated and unable to experience a normal sexual life. The AAP for an institution that is purposed to be “Dedicated to the health and well-being of infants, children, adolescents and young adults” certainly fails when they so easily dismiss those “case studies”. Isn’t each person a case study?
Surgical mishaps, complications of surgery or post-surgery, allergic reactions, systemic infections and other issues causing deaths (even if it’s a suicide 28 years later due to an injury that was never healed) from an elective non-therapeutic surgery are too much.
You do take exception to the often quoted estimation of 117 deaths per year. I do too, because most people don’t realize that it’s just an estimation, not a documented list. However the AAFP in 2007 estimated 1 death in 500,000 circumcisions (“Circumcision: Position Paper on Neonatal Circumcision”. American Academy of Family Physicians. 2007. Retrieved 2007-01-30.), which would still amount to 2 or 3 deaths per year given the estimated number of 1.2 million infant circumcisions per year. The AAP made no attempt to present its own figure, and yet they state that “benefits outweigh risks”. How is that so?
In fact, the AAP prepared some speaking points for its members. These points were leaked. One of those points was an answer to the question of recent circumcision deaths. Their answer was:
“Isolated cases of morbidity and mortality after ritual circumcision have been reported in the U.S., and have been related to circumcisions that were not performed under sterile conditions. These cases and the practices that led to them have been limited to a specific group. ” (http://www.foreskin-restoration.net/forum/showthread.php?t=12186)
The assumed question was “What about the recent deaths of infants after ritual circumcision? ” But both the question and the response is misleading, because it assumes that deaths have occurred only in the context of ritual circumcisions (i.e., the babies that contracted Herpes from an orthodox mohel performing metzitzah b’peh in NY). But that’s far from being the case. There are documented deaths from medical circumcision for almost every year, for example 2 year old Jaamal Coleson, Jr and infant James Connor (both died 2011), baby Joshua Haskins (a baby with a severe heart defect that should not have been a candidate for circumcision and doctors should have known better) in 2010, Bradley Dorcius in 2009, Eric Keefe (2008), an unnamed infant who died by bleeding following circumcision in Creswell, Oregon,February 2007, Sacred Heart Hospital, Eugene, Oregon, etc.
When you risk killing or damaging a person’s life, how acceptable are the health benefits?
Are those benefits so great that we can ignore (or exclude) those case reports? Are those cases really so rare? What is the tolerance level? How many yearly deaths are acceptable? How many yearly severe mutilations are acceptable?
I’ve read the AAP’s technical report many times and I don’t find the answer to these questions. And I think those are questions hard to ignore and hard to justify even from the point of view of utilitarian ethics. What do you think?
November 15th, 2012 at 12:06 pm
a) I think that including some information on the function of the foreskin would have been good, but as the statement and technical report were solely reviewing the evidence on the risks and benefits, I don’t agree that it is wrong for the AAP to omit it. The document is aimed at medical professionals who should have received such information as a standard part of anatomy and physiology.
b) “When you risk killing or damaging a person’s life, how acceptable are the health benefits?”
If those health benefits include reducing damage and death, as circumcision does through reducing HIV and HPV infection as well as infant UTIs which are quite dangerous, then the benefits might actually outweigh the risks. There is some published evidence suggesting that this is the case even when looking solely at UTIs in infancy. Other analyses disagree. In any case, the simple fact that circ can cause damage and death doesn’t mean that it doesn’t prevent more of this than it causes. This is what at issue in the report, and it is difficult to make such a determination when the reported rate of complication varies widely.
You’re right that every death or disability, whatever the cause, is a tragedy.
November 18th, 2012 at 8:00 pm
a) I disagree on several accounts:
1) I disagree that they should have been limited on solely reviewing the evidence on the risks and benefits. If the statement is about circumcision, it should have been about every possible aspect of circumcision. Otherwise how can it serve the purpose of provide accurate and unbiased information?
2) I disagree that the document was aimed only at medical professionals, given the media spectacle made out of the release of the statement – specially making sure that all the media used the catch phrase (“benefits outweigh risks”) as part of the headline. This on its own sounds more of a recommendation in pro of circumcision than the actual words of the statement. Imagine what the impact would have been if the headline read “there are potential health benefits but not enough to recommend circumcision” – which is more consistent with what the report actually says. They knew that their statement was going to grab attention of the media and parents.
3) I disagree that professionals have really received real information on the anatomy and functions of the foreskin as part of their standard training.
4) I propose that giving accurate information about the functions of the foreskin is important and yet it’s avoided by every institution that performs circumcisions; if you look at the page of the mayo clinic or the cleveland clinic on circumcision, you never find any information on functions of the foreskin. This is a very convenient omission: if we are discussing the optional amputation of a part of the body, it makes all the sense in the world to discuss what that part of the body does and how its removal may affect the adults that the children will grow to be. From this omission one can conclude that aa) The foreskin has no functions but they did not bother to even state that, bb) The foreskin has functions and explaining those may reduce the chances of parents circumcising their children, or cc) The foreskin has functions but they don’t know enough about them or don’t consider those functions valuable.
b) You said “In any case, the simple fact that circ can cause damage and death doesn’t mean that it doesn’t prevent more of this than it causes. “. This kind of utilitarian ethic and logic would make sense in a population where most of the members are at an immediate risk of dying. For example, if you have patients with one disease where they had 90% chances of dying within 6 months, and a treatment that has a 50/50% chance of curing or killing the persons, then this kind of ethics and logic would make sense.
However this is not the case with circumcision. The patients receiving the treatment are in no immediate risk of dying from any condition, so the problem is that any baby that dies and any adult that grows with damaged genitalia are individuals that were otherwise healthy and in no risk of suffering any condition, which makes the damage non-proportional.
The problem is that any potential preventive benefit is not directly traceable to the procedure, meaning that the fact that a person grows to old age being healthy and happy cannot be traced to be a result of RIC, but a baby who dies from exsanguination or sepsis from a circumcision wound or an adult who grows up with damaged genitalia and incapable of having a normal sexual life (David Raimer being a worst case scenario for this) can be directly traced to be a result of circumcision.
In conclusion, the damaged or killed individuals as result of the treatments are not necessarily the ones that would have experienced some benefit from the procedure.
This reminds me of a joke I heard in my country (in Spanish) of a hen who had two chicks, one of the chicks got the flu, so the hen killed the other chick to make some chicken soup.
November 19th, 2012 at 2:42 pm
“In conclusion, the damaged or killed individuals as result of the treatments are not necessarily the ones that would have experienced some benefit from the procedure.”
This is true for every preventative health measure, and it is true for many indicated instead of routine health measures as well. For instance, even indicated antibiotics. There is a risk of serious allergic reaction or other side effects, and the individual who has a negative reaction may not have been the one who would have ended up with a more severe invasive infection, or rheumatic fever, or the other negative health consequences that are the reason for the use of the antibiotics.
If we had a crystal ball then we could perform procedures only when we know that they absolutely will be of benefit for a particular individual, but we simply don’t have that information. We have to make decisions based on the evidence that we do have, and that tends to be based on population level information. We can know that if we do this procedure, X people will have this beneft and Y people will have this side effect, but we don’t know with certainty who will be affected in what way. With regard to circumcision, one of the more dramatic benefits does occur in infancy — it reduces UTIs, which are a very serious and dangerous matter in infants. I’m planning a post to share more about that.
As for your other points, I don’t think that you can hold the AAP responsible for the media’s response. And again, I’d prefer to see a discussion of the function of the foreskin in the paper, but I don’t think it is essential. For a lot of the purported functions, the evidence is actually minimal.
November 19th, 2012 at 6:19 pm
The funny thing is, how can the evidence be minimal in a world with a majority of men who have their whole body?
For example, the fact that the foreskin is a moving part of the penis, and that by being able to move it prevents excessive rubbing against the wall of the vagina. That’s simply visible, as long as there is an intact man around to look at. One intact friend told me about watching American porn, that when he saw an actress giving a guy a hand-job, it just looked like “an impossible movement” due to the tightness of the skin. It’s simple: an uncircumcised man masturbating holds and moves the skin up and down the shaft. A circumcised man, being unable to move any skin, rubs his hand up and down the skin of the shaft – which is why lubs and hand lotions are so important.
Another quite simple one: visual comparison between the glans of a circumcised and an intact man shows immediately the difference. A hardened, dry, cracked glans, vs a shiny, moist and soft one.
It’s not that there’s no evidence. It’s not that it’s esoteric. It’s simply that we just don’t care enough to see it.
November 27th, 2012 at 2:24 pm
There’s actually no difference in the keratinization of the glans of a circumcised man versus uncircumcised, per a small study done in Egypt. I also have never had sex with a man with any part of his penis being hardened, dry or cracked. You’re basically saying ‘My anecdata trumps anything anyone else can say’. Circumcised men have no problems experiencing sexual pleasure, and there’s nothing supported by science that says there’s any difference in sexual sensitivity or pleasure. Further, so what if they have to masturbate differently? ALL men have to masturbate differently.
Here’s my anecdotal experience – two of my uncircumcised male friends have told me explicitly that their foreskin is not sensitive at all, and they don’t particularly get any pleasure out of having it touched. That goes against everything intactivists share in their echo chambers, I believe.
December 4th, 2012 at 11:10 pm
Hi, I still have 2 comments pending for approval, but today I realized you might not have understood what I meant with the explanation of either “keratinization”, or “dry, hard and cracked”. The issue I’m referring to is acknowledged in “Parents’ Guide to Bris Milah
Covenant of Circumcision
by
David A. Bolnick, Ph.D.
Certified Mohel” http://brismilah.com/bris.pdf
On page 16 he explains: “Image 1 shows an uncircumcised penis. Image 2 shows the same penis immediately
following circumcision. You will also notice that the glans is red and glossy. This is because
the skin covering the glans of an uncircumcised penis is mucous membrane – like the skin
on the inside of your cheek. Once exposed, the mucous membrane will transform and in time
take on a normal appearance – like the skin on the outside of your cheek.”
So the surface of the uncircumcised glans is a mucosa, but once exposed it transforms developing the texture and feel of the skin.
Parenting in America: An Encyclopedia, Volume 1 also explains:
“When the foreskin is removed, the surface of the glans becomes thickened (keratinized). This adaptation of the glans to environmental exposure provides some protection akin to that of a condom. Debate continues whether keratinization of the glans works to protect the penis against infection more effectively than does the intact foreskin. Even less clear is the effect of the absence of foreskin on sensation. Some reports by men circumcised later in life indicate a significant decrease in perceived sensation to touch over the glans after the procedure, compared with the level of sensation to touch perceived before the procedure.”
I hope this explains what I was referring to, better than I did.
December 7th, 2012 at 5:43 pm
I understand what you’re referring to. First of all, the glans is not characterized as mucousal tissue, but it is similar. Second of all, it may affect a different appearance, but that doesn’t necessarily reflect the truth of the cells at autopsy. There is no difference in the level of keratinization of circumcised and uncircumcised men.
So I understand what you are saying, but I disagree with your conclusion. They may look different (in some cases not drastically so) but appearance doesn’t necessarily reflect any change in anything OTHER than appearance. If you prefer that look, that’s fine, but it’s an aesthetic issue.
I left your other post in moderation since it was directed at truthful mother. However, I find it interesting that you essentially agree that it may not cause any long term negative effect and so decide to latch onto the choice argument. At least it shows you’re willing to listen to other people’s arguments, anyway.
I’m also not sure why you insist on essentially copy/pasting the conversations from the comments section of your blog. Your comments had an odd tone that made me feel like you were trying to use my blog to blog for yourself, and that felt like verification. I have no problem with you writing your opinion of my blog posts or the comments in your blog, but to just copy and paste them with no commentary makes me uncomfortable. If you continue to do that, your comments will not be allowed through, even after we quit moderating comments (coming soon, guys).
December 7th, 2012 at 8:17 pm
To paperoairplane, it was actually the moderation queue which made me copy/paste the conversation to my blog, as I wanted to keep track of the dialog. Moderation queues make me feel frustrated. Have a good weekend.
November 28th, 2012 at 10:51 pm
Dreamer – “A circumcised man, being unable to move any skin, rubs his hand up and down the skin of the shaft – which is why lubs and hand lotions are so important.”
Disagree with the circumcised man being unable to move any skin. We are all different and not everyone is wound up tight. Just because there is a lack of foreskin, doesn’t mean nothing moves. That’s a generalization based on your example of your intact friend’s take on circ porn…
November 29th, 2012 at 10:16 am
You are right, it’s a generalization.
I think that when the remaining skin can’t comfortably glide up the glans, there’s something missing in the mechanics of the procedure; being able to move the skin up the glans makes a nice difference, not necessarily because the foreskin itself is sensitive, but because it produces circular pressure around the glans like a custom size set of lips – especially if there’s some lubrication in the subpreputial space (sorry if the description is a bit graphic, I prefer realism to abstraction) and because the moving layer of skin massages the internal areas of the shaft.
Some circumcised men can do it, some can’t. Others have to rub the raffe and the frenular delta or do something else to get stimulation. Again, this is just my belief and based on observation, not the result of a randomized control trial.
November 29th, 2012 at 3:14 pm
I think this gets into the question of what the function of the penis is. Many would argue that even though the mechanics of sex or masturbation might be different in a circumcised man, that doesn’t mean that the penis overall does not function just as well for its intended purpose. I could see more than one perspective here, but to me the focus on overall sexual satisfaction, which seems to be no different between intact and circed men, makes more sense.
November 30th, 2012 at 5:58 am
You are getting into an interesting point dear Master of Truth.
Consider this: what is the role of the nipples (male or female) on sexuality? Are they necessary for sexual activity? Are they a component of sexual intercourse?
Could we do without them?
Of course the answer is highly individual. Each person may or may not enjoy them, may find them way too sensitive (too much to be comfortable) or not sensitive at all, or essential to their sexual satisfaction.
If we removed them from a baby, they would never be able to make that determination. They just wouldn’t have them. And of course they would adapt and find a way to express their sexuality without those nipples.
But for anyone who knew different, it would be clear that the option to find out was taken away from that baby. He or she won’t be able to make a decision because he or she had the nipples removed and there’s no sewing them back.
I think that’s very similar to what happens with the removal of the foreskin. If left untouched, it may develop conditions or not; it may be part of the sexual experience for some men, or it may not for some others. Some may not even be aware that it is a part of their sexual experience, because the totality of the penis acts as an organic system, so they may not understand the individual contribution of each part.
So when we remove the foreskin from a baby, the body still looks for ways to adapt in order to express the function of the penis. (For any part of the body that is lost or removed, the body will look for ways to compensate and replace the function, whether it’s holding things with 3 fingers in absence of the thumb, intensifying the hearing to compensate for loss of vision, or exaggerating walking movements to compensate for lack of arms for balance).
So a man without a foreskin, in absence of major complications, is very likely to be able to have a happy, satisfying sexual experience and never even think about it.
But it remains true that their chance to decide if that foreskin was a component of their own sexuality or not was removed from them before their sexuality even developed.
So you say, “what is the function of the penis?”, and it’s a good question. Is it to reach orgasm? Is it to reproduce? Is it a sensory organ? In fact, what is sexual satisfaction? I think the comparison to the erogenous role of the nipples is a starting point.
Yes we can argue that the main functions of the penis remain there. Reaching orgasm, reproducing…
In fact, that’s what Moses Maimonides said back in the XII century:
“None of the activities necessary for the preservation of the individual is harmed thereby, nor is procreation rendered impossible, but violent concupiscence and lust that goes beyond what is needed are diminished. The fact that circumcision weakens the faculty of sexual excitement and sometimes perhaps diminishes the pleasure is indubitable. For if at birth this member has been made to bleed and has had its covering taken away from it, it must indubitably be weakened. The Sages, may their memory be blessed, have explicitly stated: It is hard for a woman with whom an uncircumcised man has had sexual intercourse to separate from him. In my opinion this is the strongest of the reasons for circumcision.” Part III, Chapter 49, Maimonides, Moses. The Guide of the Perplexed. Translated by Shlomo Pines. Chicago: The University of Chicago Press, 1963.
So, we can satisfy ourselves with the thought that the overall main functions of the penis remain. Or we may wonder about the ethical value of removing from a baby the ability to find out for himself if this part was a component of their sexuality or not. Perhaps utilitarian ethics will acquit us from removing that choice. That’s a question that every person has to answer on his/her own.
December 7th, 2012 at 6:34 pm
That is “veritasmater.” Truthful mother? Mother of truth? Mother of Verity? Take your pick.
In your hypothetical example, would removing the nipples also have health benefits? Would performing the removal of the nipples later, in adulthood, have the same health benefits? What social consequences would there be to being nippleless? I thought about bringing up the function of nipples in infant feeding but figured that this would just muddy the waters.
There are indeed a range of factors influencing the risk/benefit analysis of circumcision, and taking the future choice away from the child is indeed one of the strongest non-medical values to consider. There are a couple of points that could be brought up against it. First, it is only neonatal circumcision that offers a protection against urinary tract infections. For boys with conditions predisposing them to such infections, circumcision has clear immediate medical benefits. On a routine basis, this may not be sufficient to recommend the procedure but might be sufficient to argue for the timing when the later benefits are also considered. Secondly, circumcision is more easily performed on a neonate. Hemostasis is easier to achieve and stitches are rarely necessary. Later on the procedure is more involved, it is more likely to result in complications, especially bleeding, and stitches are routine. Outside of the neonatal period, general anesthesia is commonly used which has significant risks of its own. Finally, the later benefits of circumcision in terms of protection from STDs are dependent on the the circumcision being performed before the boy becomes sexually active, which is often before the age of majority. Postponing the issue until adulthood means that you may lose some protections.
These points don’t fully undercut the strength of your argument, but they are factors that many parents will want to consider when making this decision.
December 7th, 2012 at 8:12 pm
My apologies on mis-reading your username.
December 8th, 2012 at 11:01 pm
No problem! I’ve done the same with others’ names before.