Category: “Voluntary”

The New Marketing in Action

Last month I showed that the marketing for circumcision had changed again to eliminate any remaining concern for either voluntary or adult. Voluntary, adult male circumcision had been rebranded down to “safe male circumcision”. Here is the inevitable goal being realized in Botswana. Babies to be circumcised:

As a long term plan to fight the HIV/AIDS spread the Ministry of Health will now introduce a Safe Male Circumcision (SMC) programme targeted at male babies and infants. In the past few years the government has been preaching SMC to males who are in sexually active ages.
…

“Towards the end of this year we want to enrol babies in the SMC programme and parents will be sensitised on the programme and its procedures. We have realised that targeting sexually active aged men and youth is not enough; we should have a long term vision for our strategies; targeting babies will result in the country having less people at risk of being infected with the virus in the next 15 to 20 years,” [Conrad Ntsuape, the National SMC Coordinator in the Ministry of Health] said.

When public health officials say voluntary or adult, they never mean voluntary or adult. They are “targeting” and “enrolling” infant males. It’s propaganda.

Also notice the fallacy that circumcising infants will result in fewer people at risk of being infected with HIV in the next 15 to 20 years. That is inaccurate, and a warning sign that they do not understand what they are doing. Circumcising infants will (allegedly) result in more males with a reduced risk of becoming HIV infected during vaginal intercourse with an HIV-positive female. Each male still retains a risk of infection, and without other (more effective) changes, including consistent condom use, men – and their partners – will still become infected. Spreading this incorrect understanding is an effective way to continue the spread of HIV.

Relevant to this problem with marketing:

Media were singled out as not playing a visible role in relaying the message on SMC. Beauty Gakale, the SMC Regional Coordinator said SMC should be given wide coverage to avoid confusion and misconceptions about it in the public. “Media, especially private media have been less active in relaying the SMC message and it is high time they played a role in this. We are also urging political leaders to play their role by encouraging men to undergo the SMC. ”

Public officials should worry about their own mistakes before demanding that media assist them in pushing propaganda. For example:

Asked why the advantages of the SMC are communicated to the public while the disadvantages are hardly discussed, Dr. [Adrienne] Musiige said SMC is like any other surgery and can be susceptible to infection if not well managed.

That didn’t answer the question.

Flawed Circumcision Defense: Rabbi Shmuley Boteach

Rabbi Shmuley Boteach has an opinion piece in The Wall Street Journal titled, “Germany’s Circumcision Police”. It starts off well.

There was a head-spinning moment in Germany last week: News emerged that a rabbi had been criminally charged for performing his religious duties. Rabbi David Goldberg of northern Bavaria, who shepherds a 400-member community, is the first person to run afoul of a ruling by a Cologne judge earlier this year that criminalized circumcision, a basic religious rite.

There is some precedent outside of Germany for such a ruling. …

Even though we disagree on policy, agreeing on basic facts is always good. But his essay slowly falls off the path.

… In the United States, a San Francisco ballot initiative tried last year to make circumcision an offense punishable by a $1,000 fine and up to a year in prison; it failed to get enough votes. …

That’s not an accurate summary of what happened last year. A court ruled that the local ballot initiative conflicted with an existing state law and struck it from the ballot. It had nothing to do with getting enough votes.

… But the circumcision ban deserves universal scorn.
…

Does the German government really want to get into a public battle over whether they are better guardians of the health and welfare of Jewish (and Muslim) children than their parents?

As long as parents continue to circumcise their healthy sons, I hope so. Obvious physical harm for subjective non-therapeutic benefits is unacceptable without the individual’s consent. Protecting the rights of all citizens is a legitimate role of the state.

The Los Angeles Times recently cited a study predicting that as the number of circumcisions goes down in the U.S., the cost of health care will steadily climb. Eryn Brown reported that “If circumcision rates were to fall to 10% . . . lifetime health costs for all the babies born in a year would go up by $505 million. That works out to $313 in added costs for every circumcision that doesn’t happen.”

I’m not impressed by Rabbit Boteach endorsing the idea that a child’s normal body – and by extension, his rights – has a price beyond which we’ll justify non-therapeutic intervention to remove parts of it. But, more importantly, the key in that is not $313. It’s predicting. Aaron Tobian and his co-authors used a data model to make a guess. There are many factors involved. They are not constant. Cost, availability, and need could be quite different in two decades. For the potential benefits against sexually transmitted infections, circumcision can be chosen later. That would match the ethics of the studies that used adult volunteers. This study seeks to “prove” that a specific, non-urgent solution should be applied now, regardless of ethics.

Why? Because circumcision has been proven to be the second most effective means—after a condom—for stopping the transmission of HIV-AIDS, with the British Medical Journal reporting that circumcised men are eight times less likely to contract the infection.

He gets credit for mentioning condoms, which puts him ahead of the AAP. Still, condoms provide greater protection than circumcision, and remain necessary after circumcision. So, cost-wise, it’s condoms or condoms and circumcision. The former is cheaper and ethical. Infant circumcision is not ethical, including when potential benefits against STDs are cited.

While the Germans decry the barbarity of circumcision for men, they also overlook the benefit to women who are the men’s partners. Male circumcision reduces the risk of cervical cancer—caused by the human papillomavirus, which thrives under and on the foreskin—by at least 20%, according to an April 2002 article in the British Medical Journal.

They overlook the potential benefit to women? Do they? They can agree that (voluntary, adult) circumcision may confer reduced risk to female partners while also finding it unacceptable to impose circumcision on infant males (i.e. not “men”). Rabbi Boteach ignores the ethical foundation for the court’s ruling.

While some attempt to equate male circumcision with female clitoridectomy, the comparison is absurd. Female circumcision involves removing a woman’s ability to have pleasure during sexual relations. …

Not necessarily. Yet, in spite of that, it remains unethical. At some point, the human rights principle(s) involved must factor. Equal protection is a human rights principle.

… It is a barbarous act of mutilation that has no corollary to its male counterpart. …

This is also not true. Within what he wrote, it is, because he limited himself to clitoridectomy. The scope of illegal female genital cutting/mutilation is much broader than that, including any cutting that is anatomically analogous to (or less harmful than) male circumcision. That’s relevant.

… Judaism has always celebrated the sexual bond between husband and wife. Attempts to malign circumcision as a method of denying a man’s sexual pleasure are ignorant. …

Male circumcision controls male sexuality, with a long history as an attempt to limit sexual pleasure. It is still used to reduce pleasure for males.

… Judaism insists that sex be accompanied by exhilaration and enjoyment as a bonding experience that leads to sustained emotional connection.

If we ignore explicit statements in favor of circumcision as a way to diminish male sexual pleasure, Rabbi Boteach’s claim here is not mutually exclusive from reduced sexual pleasure. Intent does not guarantee outcome.

We Jews must be doing something right in the bedroom given the fact that, alone among the ancient peoples of the world, we are still here, despite countless attempts to make us a historical footnote.

This is evidence that male circumcision does not eliminate male reproductive ability. No one has claimed it does. His statement is a non-sequitor. The ability to reproduce is not proof that circumcision is acceptable or that it does not affect sexual pleasure or inflict harm.

Related: From the Cut Podcast, a debate between Rabbi Shmuley Boteach and Cut director Eliyahu Ungar-Sargon.

AAP Task Force Member Douglas Diekama Maligns Circumcision Opponents

The Washington Post’s parenting blog has a new post, ‘Intactivists’ furious at new AAP circumcision policy, that contains a misdirection from Dr. Douglas Diekema. After quoting Ronald Goldman and a few commenters to an earlier post, this:

AAP officials expected such a reaction.

“For individuals who have decided that circumcision is wrong, no amount or quality of data will put these questions to rest,” Douglas Diekema, who served on the AAP task force that wrote the report, told me last week when I asked him about potential pushback.

Diekema implies that people who are against circumcision simply haven’t correctly considered the data, which means “reached his personal conclusion”. He implies that opponents have made a demonstrable error in judgment. This is nonsense. It’s consistent to accept every single piece of data the AAP considered, and to ignore the relevant information the AAP explicitly ignored in its consideration, yet reach the conclusion that non-therapeutic infant circumcision is unjustified medically (and ethically), contra the AAP’s biased and flawed statement. To quote Douglas Diekema himself:

… But it does have medical benefit. Not everyone would trade that foreskin for that medical benefit. …

No kidding. That’s the ethical issue, but it also shows that the benefits do not outweigh the risks for every individual. Diekema is engaging in propaganda, facilitated by The Washington Post. Both aspects of that are inexcusable.

I’ve sent an e-mail to the Washington Post blogger, Janice D’Arcy, asking for comment on Diekema’s problematic quote. I will update if I receive a response.

Brian D. Earp on the AAP’s Flawed Circumcision Policy Statement

If you read only one analysis on the AAP’s revised policy statement on infant circumcision, make it this fantastic deconstruction by Brian D. Earp. It’s almost too perfect to excerpt. This is a great sample, but his entire post is required reading.

Here they depart from their 1999 statement in asserting that (1) the benefits of the surgery definitively outweigh the risks and costs and (2) that it is therefore justifiable to perform the operation without the informed consent of the patient. This does not follow. In medical ethics, the risk/benefit rule was devised for therapeutic procedures aimed at treating an extant pathological condition, and for minor prophylactic interventions such as vaccination. It has no relevance to nonessential amputative surgery, especially when it involves the painful removal of healthy, functional erogenous tissue from the genitals, and when safer, more effective substitute strategies exist for achieving the same ends.

You may be surprised to learn that the word “condom” does not appear even once in the 28 page AAP report.

In making their risk/benefit calculations, then, the AAP simply leaves out a critical bulk of factors relevant to the equation, including the existence of a range of proven healthcare tools like condoms, vaccines (including an effective HPV vaccine), and antibiotics. If they had bothered to consider human rights and bodily integrity issues, the function of the foreskin, its value to the individual, and his possible wishes in later life, as well, their computations would quite plainly yield a very different answer.

Seriously, it’s worth the time. And share it far and wide.

The AAP Worsens Its Flawed Circumcision Position

A lot has already been said about the AAP’s revised policy statement on non-therapeutic circumcision on non-consenting male children.

More will be said today and beyond. Much of it will be uncritical regurgitations of the AAP’s revision by news organizations. There will also be analysis from those who recognize and highlight the glaring deficincies and oversights in the policy. I expect to contribute my own thoughts. For now, I’ll highlight one key aspect from my initial read-through before going into what I think is a more important consideration to this apparent-but-not-really temporary setback.

The short version of the statement ends with this (emphasis added):

Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for individual families.

That’s so close to the ethical stance. Remove families and focus on the individual and it would be ethical¹.

The way the promoted portion of the new “finding” within the revised statement differs from this conclusion is the key takeaway to challenge the supposed change from the AAP, which is really more-or-less just an exercise in urging politicians to permit circumcision on Medicaid. Here, the AAP demonstrates that its evaluation of the net benefit, that possible benefits outweigh the risks, is subjective and determined only by individuals. This directly contradicts the supposed proof based on their review of research that the potential benefits outweigh the risks (and the costs – the direct harm in every case – that they ignore). We should repeatedly emphasize that as often as necessary.

My concern is that we’ll get stuck in this low-level, short-term portion of the larger debate. It’s clear from European medical associations and courts that the eventual destination is public policy against non-therapeutic circumcision. The AAP and American society, in general, are (inexcusably) behind. But both will get there. Activists for the rights of children can make that happen sooner than it otherwise might happen.

The key is that we must give people the opportunity to save face, to avoid digging in to protect their egos. The problem is their stance, not necessarily their character. It should be obvious to them that their stance is incorrect. It isn’t. To address that, do we want to express an irrelevant, limited sense of superiority or convince others that we’re correct because facts and ethics demonstrate the case we’re making? If we impugn their motives and/or character by choosing the former, we may extend the period during which this policy statement stands or encourage people who can be influenced either way to choose the inferior stance of the AAP.

Edit note: I changed “it’s” to “their stance” to avoid possible confusion.

¹ The existing societal view treats certain basic human rights – for boys only – as a buffet from which parents may pick and choose for their own reasons. This is the problem merely expressed within the AAP’s policy statement.

Flawed Circumcision Defense: Yair Rosenberg, Part 2

In response to the AAP’s pending release of its revised policy statement on non-therapeutic male child circumcision, Yair Rosenberg repeats the mistakes in his prior analysis. He perpetuates appeals to authority, omits relevant information, and ignores inconvenient facts. One might even say he’s being obscurantist.

This isn’t just an issue of religious freedom—it’s a basic question of public health. That’s because according to the National Institutes of Health and the World Health Organization, among others, circumcision is one of the global health community’s best HIV prevention techniques. As Eric Goosby, the U.S. AIDS coordinator, has said, “Male circumcision is a highly significant, lifetime intervention. It is the gift that keeps on giving. It makes sense to put extraordinary resources into it.” To that end, anti-AIDS organizations are partnering to circumcise 20 million African men by 2015. …

Until now, the scientific consensus surrounding circumcision has driven policy in Africa, but not the United States. Today, that changes.

Individual humans make up “public health”. What is – and is not – acceptable to do to individual bodies in the name of public health is the question of ethics that Rosenberg, Goosby, the AAP, and every other circumcision advocate ignores. This is especially true because circumcision is not the least invasive or the most effective method available for reducing HIV (or any other) risk. It’s also still not particularly useful in contexts outside of parts of Africa. As I wrote in my prior post, the risk reduction is in female-to-male HIV transmission in high-risk populations. That isn’t compelling within the scope of the AAP’s focus. Context matters. Obscurantist journalists ignore that.

The importance of this [updated policy] cannot be overstated. …

It can be. Rosenberg’s post is proof.

… The AAP is a driving force behind health policy in America, and the experts involved in its new statement are already going on record in major media outlets to advocate that circumcision be covered on public health plans like Medicaid. The statement solidifies the scientific consensus behind the advisability of infant male circumcision (noting that complications are more likely to arise when the procedure is performed later in life) and places the traditional practice squarely within the realm of sound medical science.

This is only true if ethical considerations are not a part of sound medical science. It’s fine if Rosenberg or others do not wish for ethics to be applied to their own bodies. But not everyone shares that odd, limited view. Some of us appreciate the basic concept of human rights, including those of physical integrity and self-determination, and wish they had been applied to us. It’s too late for too many males, but there is never a bad time to stop violating human rights.

Also, the question of possible benefits and their applicability to any particular individual is separate from the public policy question of paying for non-therapeutic surgical interventions on non-consenting individuals. Non-therapeutic infant circumcision is an irresponsible use of funds in pursuit of subjective goals via unethical means. There is nothing good about it, regardless of how “prestigious” an organization promoting the idea is irrationally perceived to be. An organization that advocates violating human rights deserves no prestige.

This is not just good news for the United States, where obscurantist anti-circumcision groups have sought to completely ban this medically beneficial practice rather than allow families to choose whether to perform it. …

Rosenberg’s prior essay was obscurantist propaganda. Unlike his writing, I’ve acknowledged the arguments offered in favor of circumcision. I’ve explained why they’re inferior in the debate as it pertains to individuals. Mr. Rosenberg has not done the same. Instead, he offers condescending evasions:

… It’s also a powerful rebuttal to the flawed reasoning of the German court in Cologne, which ruled that circumcision generally constitutes “bodily harm,” yet made allowances for circumcisions performed for “medical reasons.” Thanks to the AAP, we can now state that all circumcisions are medically beneficial. …

The German court in Cologne ruled that non-therapeutic circumcision on non-consenting children violates their rights to physical integrity and self-determination. There is no flaw in that expression of basic human rights. The are the same rights that form the basis for prohibitions on FGC/M.

The court’s finding that circumcision constitutes bodily harm, no quotes, is consistent with permitting circumcision for medical need. The existence of a problem necessitates considering interventions. Ethically proxy consent will choose the least invasive, most effective solution. That is rarely circumcision when there is a need. But where it is necessary, the goal is an objective net benefit, that the surgery will remedy the problem. The outcome is presumed to outweigh the harm imposed to achieve it. The key is the outcome can be measured immediately and directly. Is the malady resolved?

With non-therapeutic circumcision, there is no objective net benefit because there is no malady. There is only objective harm for subjective benefits. The subjective benefits may not be valued or desired by the individual. In that case it’s objective harm to the individual for the subjective preferences of another. That is unethical. Because surgery on children involves proxy consent, medical need is required. The court was correct and consistent. The AAP is incorrect and encouraging unethical rights violations.

So, can we really state that all circumcisions are medically beneficial? Including the ones where the boy suffers a complication? If he loses his glans, is he still benefited? What about his entire penis? What about the thankfully rare instances where the boy loses his life? At least the benefits accrued over his short lifetime? Since all of these scenarios happen, even if we ignore my focus on individuals who suffer only the expected harm, isn’t it a bit obscurantist to state that all circumcisions are medically beneficial?

… If German courts continue to prosecute Jews and Muslims for practicing circumcision, then we will know that this animus is rooted not in science or fact, but in ignorance and prejudice.

I won’t say I expected his screed to end with something other than a preemptive ad hominem attack. It’s still pathetic.

Update: Walter Russell Mead uncritically endorses Rosenberg’s flawed post and makes a request:

Hopefully anti-circumcision zealots will take a deep breath and rethink their fevered stance on the issue. Beyond the fact that their bans impinge on the rights of Jews and Muslims to practice their religion as they see fit, they ought to consider that there is legitimate science pointing to the practice being beneficial to infant male health.

The only legitimate science involving infants is on UTIs, and possibly penile cancer. The former are uncommon in intact males in the first year (1%) and almost always easily treatable. The latter is more reasonably associated with other causes, with U.S. rates similar to those in mostly intact Europe. Everything else involves adult volunteers. The possibility of health benefits, or even religious benefits, does not render non-therapeutic circumcision on a child ethical.

No court in the United States endorses a right to practice one’s religion as members “see fit”. There are limits that may be imposed based on constitutional tests. Non-therapeutic child circumcision should fail that test because it is physical harm.

Doctors Aren’t Cultural Actors

I may have more to say on this story about circumcision as “the ultimate parenting dilemma. Understood, it isn’t a dilemma. But we have to deal with reality, not the world we should have. For now, this:

“You are doing a procedure on someone who cannot make a decision for himself – it’s a difficult choice for both parents and physicians,” says Dr Marvin Wang, co-director of the Newborn Nurseries at Massachusetts General Hospital, who has conducted hundreds of circumcisions.

It is, he says, more a “cultural decision” than a medical one, and therefore, for parents to decide, while he advises on the pros and cons.

Wang says most parents come in with fervent beliefs – and what a doctor says makes little difference.

“The bottom line is… they stick to their guns. They choose the pieces of information that bolster their argument and run with that.”

What a doctor says makes little difference. Having conversed with people who support circumcision for irrational reasons, I am not surprised. However, what a doctor does can make all the difference. Or, rather, what a doctor does not do. There is no obligation to participate in non-therapeutic circumcisions on minors. There is an ethical duty to not participate. If doctors refused to perform the surgeries, the numbers would decline. Not to zero, but it would signal a critical truth to parents who intend to make their son’s choice.

The Marketing Changes Again

Hospital Male Circumcision has been sold with evolving euphemisms in an attempt to hide the ethical flaw in the associated public health policies. First, it was Voluntary Medical Male Circumcision, which never meant voluntary or even medical. The only requirement was a penis with a foreskin. Then it changed to Medical Male Circumcision. That involved 50% less pretense, while retaining 100% of the ethical omission. Now, it’s changed again:

Health facilities across the country have run out of supplies for Safe Male Circumcision kits, an HIV expert has said.

It’s better that they dropped medical, but replacing it with safe is little better. First, males will suffer complications beyond the guaranteed loss of the foreskin. Most of them will be minor. Some of them will be significant. Safe will be false.

It’s also possible the word’s meaning will be misconstrued.

The medical practice is intended to prevent HIV infection but it is not 100% safe, medical experts claim.

According to World Health Organisation and United Nations AIDS (UNAIDS) trials in Uganda, South Africa and Kenya have shown that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%.

I can’t fathom a scenario in which the public health officials intended safe to describe HIV after circumcision. Yet, that’s what this reporter took from it. That does not bode well. That’s a danger of propaganda. It’s inexcusable because there are lives at stake.

The premise of the article is worth addressing, too. They’ve run out of supplies. The article implies that they’re not circumcising while they lack supplies. That’s the right answer, of course, so I hope that’s what is happening. But I’m also concerned by the description of the kits as containing “reusable and disposable supplies”. Are they adhering to that distinction? And are the reusable supplies being sterilized properly?

The Core of Public Health Circumcision Promotion

From the awful WHO Fact Sheet, “Voluntary [sic] medical male circumcision for HIV prevention” (bold added):

In line with global goals such as Millennium Development Goal 6 to halt and reverse the spread of HIV and the WHO Global Health Sector Strategy on HIV/AIDS, a five-year Joint strategic action framework to accelerate the scale-up of voluntary medical male circumcision for HIV prevention in Eastern and Southern Africa 2012-2016 was developed by WHO and UNAIDS with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Bill & Melinda Gates Foundation and the World Bank and in consultation with national ministries of health. The framework calls for an intensified response by countries and partners to ‘catch up’ with men 15 to 49 years old who were not previously circumcised and to establish sustainable services for infants and adolescents for the longer term. The framework promotes country ownership, a combination of approaches and strategic, coordinated action.

Infants and adolescents don’t consent. This indicts WHO, UNAIDS, PEPFAR, the Bill & Melinda Gates Foundation, and the World Bank. They are all directly complicit in the violation of basic human rights in Africa. They are also propagandists willing to use a word (“voluntary”) that they have no intention of following.

Procedures that Intentionally Alter or Cause Injury

In Reverse the Approach, I had in mind the numerous blog posts like this I’ve encountered:

In this installment of things that should not be compared as equal, we’ll discuss how female circumcision is not the same as male circumcision. …

There’s the subtle difference I discussed. When I make the comparison, it’s to compare male circumcision to female genital cutting. That method allows for the relevant comparison, as well as the opportunity to discuss how the comparison is limited. Trying to compare FGC/M to male circumcision hinders the goal, which should be an accurate analysis of male circumcision. Society has already assessed the ethics against FGC/M. No one wants to re-open or challenge that when using the valid, limited comparison of the two interventions.

The blogger, Lindsay Marie, finishes her introduction with more fence-sitting than her post demonstrates before moving into the comparison:

How they’re similar:
For one, they’re both called circumcision (this isn’t entirely accurate… I’ll get to that in a bit). For another, both involve cutting off a part of the person’s genitals.

Basically, yes. I wouldn’t start with the name, though. It’s semantically inaccurate for females, but it’s hardly a point to compare the two acts. They can both be mutilation while calling one mutilation and the other anything else. A consensus on nomenclature tells us something without proving anything on its own.

I would start with the principle, which she gets almost complete. Non-therapeutic genital cutting on a non-consenting individual is more accurate for what we’re describing. That applies to both females and males. There is no reasonable way to make a gendered distinction on that principle. The distinctions, which exist in practice, are relevant to punishment rather than prohibition.

She incorrectly moves on to differences at this point. As I argued, I think this results from comparing female genital cutting to male circumcision. It’s too easy to start with the most common forms, which are unfortunately also the more extreme forms. Again, that matters, but for the comparison, the validity of state intervention on male circumcision is the question for the comparison. Is there a comparison to be made between male circumcision and what the state prohibits with respect to female genital cutting? There is.

(a) Except as provided in subsection (b), whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years …

Any cutting, even that equal to (i.e. hoodectomy) or less destructive than male circumcision, is illegal. Those forms exist, although they are not the common forms. They are illegal. The comparison works on that limited scale, and points to other legal questions about the right to physical integrity and equal protection.

There’s also the comparison based on the WHO fact sheet for FGM (emphasis added):

Female genital mutilation (FGM) comprises all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons.
…

… 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.

There is no reason to exclude males from that protection of rights, even though FGC/M is almost always more physically damaging, and to a significant degree. Males suffer injury in every case, and worse in some cases, including extremes such as amputation and death. The implicated rights are the same.

There are differences, of course. I’ve acknowledged them here, to some extent, but I’ll reiterate that most female genital cutting is more extensive, with more extreme and lasting consequences. It is evil and should be eradicated as much as possible.

With that stated, she continues (language warning):

How they’re different:
In every other fucking way. Male circumcision is practiced widely in developed countries as a way of preventing specific health issues in both men and women. Male circumcision is usually performed by a trained professional (almost always a doctor, but some religious parents ask a trained Rabbi to perform the procedure) in a sterile medical setting with the latest tools and effective healing techniques to eliminate infections and reduce pain. Male circumcision is performed on days-old infants who will not remember or even realize what happened and almost always with anesthetics to reduce pain. Pardon the comparison, but breeders clip dog tails at the same age and in a similar way, and zoo keepers clip bird wings at the same age and in a similar way. I don’t agree with clipping dog tails, but if it’s going to happen it might as well happen when they’re too young to realize.

First, I don’t want to put too much emphasis on widely, but it’s confusing. If it should be attached to “as a way of”, which is how I read it upon a second pass, I disagree because most circumcision is cultural. The science is a pretty way of making people feel better about doing something indefensible they wish to do for their own subjective reasons. If widely is meant to describe “in developed countries”, that’s inaccurate. It’s widely practiced in the United States and Israel. It’s been widely practiced at some point in the past in the UK, Australia, and Canada.

To the point, where it is intended as a prophylactic, it is practiced as an attempt to prevent specific, unlikely health issues. Statistics show that most circumcisions in the developed world prevent nothing for most males because most males will not develop a foreskin-related problem. When they do, it’s usually associated with some other corresponding behavior. (e.g. Does he get HIV because he has a foreskin or because he didn’t wear a condom?) People get incorrectly impressed by the relative risk differences between intact and circumcised when the absolute risk of foreskin-related issues is small. Even the most dedicated propagandist, Prof. Brian Morris, only claims that the risk of a foreskin-related issue requiring some form of medical attention (i.e. not just circumcision) within the male’s lifetime is 1 in 2 or 1 in 3, depending on where he’s writing. (I will not provide links to his propaganda. Use Google.) Imposing the most invasive solution on a healthy individual is unethical.

As for the sterile operating theater with modern techniques and equipment, I’m unconvinced. As her post makes clear later, she wouldn’t support female genital cutting conducted in a similar setting. That’s the correct stance, but if it’s not support for one, it isn’t support for the other. As the WHO’s fact sheet states, “more than 18% of all FGM is performed by health care providers, and this trend is increasing.” Defending it for male circumcision will likely lead to further justification from proponents of female genital cutting because they’ve modernized a cultural ritual.

The “he won’t remember it” defense is also not compelling. We wouldn’t be any more convinced that a little female genital cutting would be okay if inflicted on girls too young to remember it. We must judge the act on its own. Would we excuse a punch to the face of a child who won’t remember it? It is unlikely to leave a permanent alteration. Corporal punishment for children even has a biblical basis. At some point, the rights of the individual must matter more than peripheral arguments.

With male circumcision, it’s not “going to happen”, as her defense of “too young to remember” implies, unless we take the validity of parental choice as a given. I don’t. There is a risk, as with all normal body parts, male or female. But the chance of needing circumcision are very low. Most males left with their choice never need or choose circumcision. The “he won’t remember it” defense requires an assumption that he will either need or choose circumcision eventually. If it merely assumes he wants circumcision but will be too afraid of the pain, then he values not experiencing pain more than he values being circumcised. There is no reason to assume an infant thinks differently. This is related to female genital cutting more than it may seem. Like father, like son, so like mother, like daughter?

Next, she links to a comment on Reddit that discusses the issue of intent.

… One of the best explanations for the difference between male circumcision and female genital mutilation comes from a user called superdillin:

I think the intent and damage differences between male and female genital mutilation does need to be pointed out. What we do to our baby boys, often with no medical reason, is bad. Very bad and we should stop. BUT, what was done to OP’s girlfriend was done to take away her sexuality, and to control her. It has put her life at risk at worst, and at best has taken away her most sexual pleasure organ, and it was done with the intention of her becoming a breeding cow to be used for a man’s needs for the rest of her life.

What we do to our boys is due to misinformation about health and hygiene, combined with unhealthy aesthetic expectations and tradition. What some cultures do to their girls is deliberate, controlling, life-threatening and inherently sexist. [Her emphases.]

I agree with that, which differs somewhat from the blogger’s post. And I’ve already acknowledged the damage differences in the most common forms. Beyond that experience of the mutilated women described in the Reddit thread, there is evidence that some mutilated females retain some ability to orgasm, which just suggests that the issues and how they relate are more complicated than the idea that male circumcision somehow isn’t bad because female genital cutting is usually worse. (That evidence changes nothing on the ethical question. FGC/M remains evil.)

It is not clear that the intent for each exist as polar opposites. The motivations can have certain similarities. For FGC/M a (possibly overwhelming) majority of the cutting seems to be motivated in the way the West perceives. Sometimes it’s more complicated. But even with the best intentions, which apply to almost every male circumcision, they still aren’t enough. The act matters first. Non-therapeutic genital cutting on a non-consenting individual is wrong. We can’t get past that, ethically, so everything else is important but irrelevant to the validity of prohibiting unnecessary surgery on a child, regardless of gender.

The first key fact in the WHO’s fact sheet states that FGM “includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.” (See footnote¹.) The intent that matters is the intent to act, not the intent to act for good or bad reasons. “Good” and “bad” are subjective, to some extent, anyway. Do the parents intend to alter the child’s normal, healthy genitals? Yes. It’s about the act and the objective harm that results.

Back to the word circumcision: I’ve noticed an increase in groups publicly opposed to male circumcision (part of this was seen during our recent Gay Pride parade), and some argue that male circumcision should be called male genital mutilation, to more closely align itself with female genital mutilation. Although circumcision in both sexes involves the cutting of the genitals, and both procedures can be unnecessary at best, only female circumcision can actually be called butchering because of how it’s performed and what its purpose is. It’s called “circumcision” to make it seem more acceptable and to hide what it really is. (Hell, even the Wikipedia page for female circumcision is titled “female genital mutilation.”)

I don’t believe use of the term male genital mutilation is primarily meant to more closely align the two. It does that, but the intent is to stop pretending that circumcision is so innocuous that it should remain a parental choice for the parents’ subjective, preferred reasons. Some forms of female genital cutting don’t reasonably constitute “butchering”, yet we still outlaw those forms. When does the individual who will live with the modified genitals get to offer input on whether it constitutes mutilation?

From this brief interview with Sister Fa (Fatou Diatta), a musician from Senegal who is a victim of genital mutilation.

Rebellion is in the words. You are dealing with issues such as forced marriage, female genital mutilation. How important is this for you?
“It’s more than important. But my struggle is not against Female Genital Mutilation (FGM, ed.). Me, I do not even use the word “mutilation,” because mutilate means cutting with the intention to hurt. I say ‘cutting’. I’m campaigning so that people would know that it is important that we can educate a child without going through certain practices that may harm his/her health. I’ve been a victim of this practice and I know its effect. It hurts.”

Again, this is so much more complicated than the world so many imagine we live in. The word mutilation is definitionally accurate for both genders, tied to outcome, regardless of parental intent. Whether to use the term or not is a marketing question, not an applicability question.

I wouldn’t publicly advocate one way or the other for male circumcision because there are benefits and consequences of the procedure that must be taken into consideration. I can, however, speak from the only experience I have, which is as a woman who has had sex with both circumcised and uncircumcised men. My experience taught me that male sexual pleasure has absolutely nothing to do with having been circumcised as an infant and that my own sexual pleasure had nothing to do with whether or not my partner was circumcised. However, if asked my opinion I might point out that even the cleanest of males can be less hygienic and more likely to spread a disease or infection with their foreskin intact, which from a female standpoint is a huge concern since an infection inside the vagina can be much worse than a topical penile infection. It seems to me like male circumcision has more benefits for a male’s sexual partner than for the male himself.

Perhaps, but that isn’t a defense for circumcising children. It’s a defense for encouraging and empowering women to stand up for themselves in sexual relationships and to choose their sexual partners and practices consciously. Ask the male to shower. Refuse to have sex if he won’t wear a condom. It’s also a defense for voluntary adult male circumcision.

I truly believe, when performed by a surgeon or urologist in a hospital with the proper tools, that male circumcision should be an option and that parents of sons should educate themselves on whether or not to do the procedure. But I also believe that even if female circumcision were to be performed in the exact same situations as male circumcision (on infants, by medical professionals in a sterile setting) that it would be genital mutilation. The intent automatically makes it wrong and the way a female’s body is designed opens the poor girl up to dozens of complications, many of which are life threatening. Male circumcision and female genital mutilation are not the same thing.

She’s wrong. Intent matters, but outcome matters first and most. An individual’s healthy body is permanently altered without the individual’s consent. The invasive act violates the individual’s right to physical integrity (and right to self-determination). In that core analysis, female genital cutting/mutilation and male circumcision are the same. They are both indefensible.

¹ Non-therapeutic “medical” male circumcision is a misnomer. It’s medicalized circumcision, which merely indicates that it’s performed in a modern, sterile operating theater. That is condemnable in its limited focus, but it is not enough to render the non-therapeutic surgery ethical. The patient’s consent is also necessary. The pursuit of possible benefits (i.e. reduce risk of UTIs or female-to-male HIV transmission in high risk populations) is speculative and may not be necessary for – or desired by – the individual himself. There are all sorts of interventions we could perform that might reduce the risk of some future malady. Society does not open those up to parental choice because they’re also harmful. They’re ethically wrong. Circumcision is the same.