Foreskins are not Clitorises

“I was genitally mutilated at the age of ten. When the operation began, I put up a big fight. The pain was terrible and unbearable… I was badly cut and lost blood… I was genitally mutilated with a blunt penknife. After the operation, no one was allowed to aid me to walk… Sometimes I had to force myself not to urinate for fear of the terrible pain. I was not given any anesthetic in the operation to reduce my pain, nor any antibiotics to fight against infection. Afterwards, I hemorrhaged and became anemic. This was attributed to witchcraft. I suffered for a long time from acute vaginal infections.” -Hannah Koroma, Sierra Leone (Amnesty International Website)

        Recently, the American Academy of Pediatrics suggested the nicking (cutting) of the clitoris as a compromise to help prevent more serious grades of female genital mutilation. The suggestion was met with outrage and the AAP subsequently withdrew their statement. Female genital mutilation (FGM) is the ritual practiced by some Muslim communities that often entails complete removal of the clitoris and labia and stitching up of the raw wound allowing a small hole for menstrual flow and urination. According to the World Health Organization (WHO) surveys, prevalence of the practice varies widely. The prevalence is 85% in seven of the 28 countries identified by the WHO. As usual, whenever the subject of female genital mutilation comes up, the anti-male-circumcision brigade rear their ugly heads (pun intended) and claim, “it’s all mutilation!” Those who draw parallels between male circumcision (MC) and FGM tend to fall into two groups; the moral relativists who contend that both FGM and medical circumcision is genital mutilation and the anti-circumcision deniers who deny any evidence that medical neonatal male circumcision has health benefits. Those against medical male circumcision claim the procedure is barbaric, forced upon children and is mutilation of the genitalia. One would never think it necessary to state an obvious fact that foreskins are not clitorises, but alas, there is a proliferation of misinformation and view points that suggest a warrant for a full explanation. There are no parallels to be drawn between medical male circumcision and female genital mutilation.

        It is impossible to argue with moral relativists who claim that referring to FGM as “dehumanizing” is a valued judgement. We cannot pass judgement because there are no universal rights or wrongs. This is the usual wishy-washy mantra of the moral relativist. Fortunately, we do pass valued judgements which is why the WHO published in 2008, Eliminating Female Genital Mutilation: an interagency statement. The practice of FGM violates numerous international human rights treaties listed in the statement. FGM is dehumanizing, because it violates the rights of a child. According to the WHO statement, “One of the guiding principles of the Convention on the Rights of the Child is the primary consideration of ‘the best interests of the child’.” FGM hardly serves a child’s best interests, which is protection from harm that inevitably has dire and irreversible physical and mental health consequences. FGM interferes with a woman’s body in a way that causes extreme pain, denial of sexual pleasure, serious health risks some of which include, recurring urinary tract infections and child birth complications that endanger a mother and her baby’s life (this is assuming she reaches child bearing age.) Another problem arises when the moral relativists refer to male circumcision as “mutilation.”

        Male circumcision as part of a non-religious medical procedure is not mutilation. Removal of the foreskin does not interfere with a man’s physical or mental health. The clitoris is analogous to the glans penis or head; not the foreskin. When we start lobbing the heads off penises, then we will have the equivalent to FGM in the male. We do not lob heads off penises for solely religious practices. We do not lob heads off penises at all. We remove foreskins. Foreskins are not clitorises. Unlike FGM, there is strong evidence of health benefits to MC.

        According to the Center of Disease Control, male circumcision has numerous health benefits including lowered risk for penile cancer, and less risk of infection from STIs and growing evidence that circumcision may reduce the risk of HIV infection by 60% in heterosexual men. The evidence of health benefits is overwhelming. This has spurned an increased effort by the WHO and its agencies to increase male circumcision rates in countries (mainly African nations) where there is a high prevalence of and greater risk of disease. However, evidence is not required for the belief system of the deniers.

        Anti-circumcisers deny or refute the evidence of health benefits. They follow the same format as the anti-vaccination, anti-climate change, holocaust deniers, anti-evolutionists and so on by denying or refuting evidence that comes their way. Anti-evolutionists deny the fossil record, the anti-vaccination crowd claim “big pharma” conspiracies, holocaust deniers claim a Jewish conspiracy to set up the state of Israel and so on. Deniers generate their own facts from opinion and seek not truth, but misinformation that confirms their bias. In psychology this thought process is called, conformation bias. It is true that scientists can have the same problems with confirmation bias. Hence the need, for double blind studies and a peer-review process. Examining evidence would negate and therefore dismantle the deniers’ belief systems. Instead of accepting evidence that disproves their views, they systematically resort to straw man arguments or draw upon over-generalizations like equating medical MC with FGM which is false. Equating the two procedure is false because the evidence refutes any suggestion of equality between the two procedures.

        Medical male circumcision is a procedure with the intent to provide added health benefits in as painless and humane way as possible. It does not marginalize a male in anyway whatsoever. FGM is exclusively a religious ritual that has no health benefits. FGM continues solely because of its cultural significance in some Muslim communities. Amnesty International state that, “It is a human rights abuse that functions as an instrument for socializing girls into prescribed gender roles within the family and community.” Such an abuse does not in anyway compare to MC.

        The road to behavior and changes in attitude within these cultures is a long one. Political correctness in the form of moral and cultural relativism will delay progress and expose more young girls to abuse. It is quite rightly considered by the world as a form of child abuse. To draw parallels with any form of Female Genital Mutilation and Medical Male Circumcision is nothing short of being ignorant of the facts and misogynistic.

Advertisements

7 Responses to “Foreskins are not Clitorises”

  1. Robert Says:

    This is an eloquent post, but it avoids several realities in order for you to make your point more emphatically. For example, you suggest that everyone who opposes male circumcision is either a moral relativist with no good scientific reason for his beliefs, or a denier of facts akin to a Holocaust denier. What you seem not to recognize is that there exists a cadre of educated, scientifically-minded persons who understand the peer review process quite clearly, and who are not satisfied that the studies in Sub-Saharan Africa should inform CDC policy (or world policy, or even policy for the rest of Africa).

    There is no doubt that female genital mutilation carries with it horrendous risks and zero benefits. It’s outlawed in the USA as it should be, and the AAP’s backward attempt at allowing a ‘ritual nick’ was rightly retracted. But we all need to be careful when evaluating the scientific literature, and even more careful when allowing the AAP, CDC, and WHO to evaluate it for us. The Lancet retracted their publication of the alarmist paper linking vaccines to Autism, yet many believe the evidence of health benefits of MC is overwhelming, a viewpoint probably most influenced by the two Lancet papers on circumcision in Uganda and Kenya.

    As you obviously know, science needs to proceed by continually testing hypotheses before making irresponsible blanket statements. I would therefore discourage you from saying things like, “Removal of the foreskin does not interfere with a man’s physical or mental health.” or “It does not marginalize a male in anyway whatsoever.” Those who understand the embryonic homology (not analogy) of the genital organs would never compare the male foreskin to the glans of the clitoris. We would compare it to the clitoral prepuce, however, and ask why it, or anything else for that matter, should be removed from an infant. Education and safe sex practices should be used to reduce rates of STDs, not prophylactic surgeries.

    • neandergal Says:

      Robert,

      I appreciate your response and taking the time to provide feedback. Thank you. Hopefully, I can clear up some points you addressed:

      “For example, you suggest that everyone who opposes male circumcision is either a moral relativist with no good scientific reason for his beliefs, or a denier of facts akin to a Holocaust denier.” I did not suggest EVERYONE that opposes male circumcision was either a moral relativist or denier. I did qualify that, by making the point that it was those that drew a parallel between male circumcision and FGM. That was the thesis of my article.

      Indeed I am aware that there are a large number of people in the scientific community that do not subscribe to neonatal male circumcision. My topic did not address that group, because they generally do not draw parallels between MC and FGM. For example, the UK NHS explicitly questions research by the USA that does show health benefits (but provides no evidence to the contrary and neglects to mention other benefits). Scientists disagree. No doubt about it. It is not just the sub-Saharan Africa studies that informed the CDC or WHO that drives USA or world policy on MC. It is countless other studies that show medical neonatal male circumcision reduce UTIs, HPV, Herpes Simplex Virus Type 2. Here are two studies just for starters:

      Male circumcision for the prevention of acquisition and transmission of sexually transmitted infections: the case for neonatal circumcision. http://www.ncbi.nlm.nih.gov/pubmed/20048246

      This study is a projection on the Cost-effectiveness of newborn circumcision in reducing lifetime HIV risk among U.S. males. http://www.ncbi.nlm.nih.gov/pubmed/20090910

      The Wakefield paper to which you are referring was just one bogus piece of research and was disproved by the scientific process of peer review. The ones on MC confirm each other. They are unanimous on their findings. Insofar as “discouraging: me from making blanket statements, I will stand by my statement that “removal of the foreskin does not interfere with a man’s physical or mental health.” Is there evidence that it does? I’ll concede that I should have qualified that statement by adding, “…in the same way as FGM does.” I was specifically addressing medical circumcision. Certainly non-medical circumcision performed without anesthetic would be traumatic and cruel. Again, medical MC does not marginalize a man in the same way as FGM.

      I was clearly describing the anatomy of the glans penis and clitoris at the fully grown stage, not during the embryonic stages of development. I wasn’t sure about your point in bringing up embryonic homology?
      Certainly everyone, including myself, would advocate education and safe sex practices to reduce rates of STD’s, etc. Advocating MMC does not negate or reduce the importance of education and safe sex, etc. If MMC also contributes to reducing disease, then why not use it?

  2. Robert Says:

    To address your last question first, I’ll reference an example that you’ve probably heard, but here it is: we can tell kids to wash their faces and not share goggles in the swimming pool to reduce risk of conjunctivitis. If removing the eyelids at birth would also reduce this risk, why not do that as well? It’s very faulty, shaky logic to recommend amputation of a body part as a pre-emptive strike against a disease that you don’t even know a person will be exposed to.

    I’m also confused by your use of the term Medical Male Circumcision. By medical, do you simply mean “performed in an operating room”? This certainly differs from therapeutic intervention that may be indicated in severe cases of balanitis or phimosis. As far as I can tell, so-called “medical” circumcision is largely performed on healthy babies who need no intervention. It’s aimed at preventing diseases which, again, may not even present a risk.

    My point about homology is this: amputating the glans penis will have the same horrifying effects as amputating the glans of the clitoris, as they are derived from the same embryonic precursors. Similarly, amputation of the male prepuce will have the same effects as removing the clitoral hood (prepuce). Not as traumatizing as removing the glans, but still a horrific and usually unnecessary act. People who say “It’s all mutilation!” are right, but unfortunately they often lack the anatomical facts to support what they say, and they end up wrongly comparing the glans clitoridis to the male foreskin. What they should be comparing is prepuce to prepuce.

    As for the “countless” studies that support the medical and financial “effectiveness” of neonatal male circumcision, many (like the two you referenced) are re-hashed manipulations of the data from the African studies that present one facet of the data and conveniently omit others. In the Uganda paper (Lancet 369(9562): 657–66), the authors announce that for every 67 circumcisions, one case of HIV is likely to be prevented. What they fail to report clearly, however, is that for every 29 persons who underwent circumcision in their study, one had a moderate or severe complication. In some cases this necessitated medication or additional surgery. Hence the threshold for harm is much lower than that for treatment, and this is clear evidence that circumcision affects the physical well-being of males. As for mental health, I don’t know the psychology literature very well, but I would point to the foreskin restoration movement and suggest that these folks certainly experienced some psychological trauma, otherwise why would they try to reacquire a lost body part?

    You asserted that, “Certainly non-medical circumcision performed without anesthetic would be traumatic and cruel.” I wholeheartedly agree with this statement. And that’s what is done in hundreds of operating rooms across the USA every day. It’s performed on babies on their first day of life, without anesthetic, and without the child’s consent. To get a child to go along with this operation, they strap his body to a “circum-straint” (do a Google image search on that one) and give him a sugar-flavored pacifier. Some doctors actually subscribe to the idea that “there aren’t many nerves in there” even though histological studies demonstrate otherwise (see refs in “Male and Female Circumcision”, Denniston GC, Hodges FM, Milos MF eds). They irreversibly sever a portion of the child’s genitals, and then bill the insurance company up to $600. And why? So he can look like his dad? Because the scripture said so? Or because of the arrogance of the parents, the physician, and the society that suggest they can predict the future and are actually “saving” him from a worse fate. These are all equally unacceptable reasons for cutting any part off of any baby.

    • neandergal Says:

      Apologies for a delayed response.

      As for “shaky logic” your example exemplifies the argument fallacy of a false analogy. The fact of the matter is that the reason for not removing eyelids at birth is because eyelids obviously have the distinct function of lubricating and protecting the eye ball. You may as well have used the same argument, “well we’re born with two kidneys, but we can function well on one so let’s remove a kidney at birth.” which think we’d both agree that would be equally as silly.

      There does not seem to be a single definitive term for “Medical Male Circumcision”. By using the term, I mean a proactive surgical procedure performed by a medical doctor in a hospital or clinic with the sole purpose of the disease prevention. Generally speaking, most papers refer to medical male circumcision as a “surgical procedure.”
      Your statement, “It’s aimed at preventing diseases which, again, may not even present a risk” again ignores the evidence that I have previously presented to you. You’ve yet to present evidence in the form of data that shows that it does not reduce risk of disease. The onus is on you to present evidence, since you are claiming that it “may not present a risk.”

      “My point about homology is this: amputating the glans penis will have the same horrifying effects as amputating the glans of the clitoris”
      This goes without saying, except that we don’t remove the glans penis. So why draw up a point when we don’t remove the glans penis?

      Your statement, “People who say “It’s all mutilation!” are right…”

      The very reason I wrote this article was to refute the above statement. Language is a powerful tool. Using the term “circumcision” draws a parallel between the two procedures whereas the term “mutilation” emphasizes the inequality and brutality of FGM. I have clearly stated why there is no parallel between the two procedures. Language emphasis is precisely the reason that “WHO” uses the term “mutilation” rather than “circumcision” when referring to FGM. It is outlined in their booklet on page 22 – Annex 1 on Terminology: “…The word mutilation establishes a clear linguistic distinction from male circumcision, and emphasizes the gravity and harm of the act. Use of the word “mutilation” reinforces the fact that the practice is a violation of girls’ and women’s rights, and thereby helps to promote national and international advocacy for its abandonment. See the link below.

      http://whqlibdoc.who.int/publications/2008/9789241596442_eng.pdf

      In reference to the studies that you referred me to (Lancet 369(9562): 657–66) the report suggests that male circumcision did indeed help prevent HIV prevention. The “moderate to severe complications occurring in the 84 men to which you refer were all resolved with treatment. Obviously, there is an element of risk with any surgical procedure. What is an important consideration is whether or not the risk outweighs the benefit. This 2007 report and subsequent studies show that it does:

      “Moderate or severe adverse events occurred in 84 (3.6%) circumcisions; all resolved with treatment. Behaviours were much the same in both groups during follow-up. INTERPRETATION: Male circumcision reduced HIV incidence in men without behavioural disinhibition. Circumcision can be recommended for HIV prevention in men.”
      http://www.ncbi.nlm.nih.gov/pubmed/17321311

      As for you your comment about the “foreskin restoration movement” we both know that anecdotal evidence is testimonial and cannot form a basis of fact any more than the anti-vaccine movement based primarily on the autism-vaccine myth and so-called personal observations of parents claiming that their children became autistic after acquiring the MMR vaccine.

      As you suggested, I did look at the piece of equipment called the circumstraint; it appears that it is used for various procedures such as blood transfusions, x-rays and other procedures that require the child to be as still as feasibly possible. I haven’t found any literature that claims a child undergoing medical circumcision without any form of numbing or anesthetic. You mentioned “some doctors” claim “there aren’t many nerves in there.” Really, I am extremely skeptical that a medical doctor would make such a claim since the penis is extremely rich in nerve endings.

  3. Robert,

    I understand your passion on the subject of male circumcision, but it differs from FGM in a profound qualitative way.

    Let us stipulate that FGM DID have some proven health benefit, such as improved resistance to STD’s (which no one has suggested). The cost in terms of side effects and sexual handicaps would still far outweigh the benefits.

    Compare that to male circumcision. At worst, based on current information, it represents low risk but low benefit. At best, it is a useful health tool with low risk. This is not a difference of degree. This is like comparing a hair cut with a trepan.

    I strongly disagree with your use of the word “mutilation,” which is clearly associated with damaging an organism’s functioning or common standard of appearance. The deliberate removal of a functioning organ is clearly mutilation. How about punching a hole in an infant’s organ (like the ear)? Or scarification? Or infant gender assignment? Technically they are all mutilation. I would never compare them to FGM.

    Perhaps most significant, I don’t see a single piece of evidence that
    suggests male circumcision is detrimental to a male’s health or sexual well-being. You decry the procedure for being applied to males “as a pre-emptive strike against a disease that you don’t even know a person will be exposed to.” And yet you pre-emptively oppose circumcision because someday the hypothesis of its benefits may (or may not) be disproven. Using that logic, we should immediately discontinue all preventative medicine, which may (or may not) someday be shown harmful.

    Again, I understand that there are legitimate opponents of male circumcision. But comparing it to FGM benefits neither side.

    • neandergal Says:

      Exactly, there is not a single similarity between the two procedures. The practice of FGM exists and continues solely for no other reason than 7th Century cultural and religious significance. It is the same dogma that uses other forms to debase and dehumanize women such as stoning and forcing women behind veils.
      Fortunately, the WHO and Amnesty International and many nations condemn such practices.

      • “Exactly, there is not a single similarity between the two procedures.”

        This is such an extreme, absolute, and incorrect statement that I initially took it for sarcasm. Yes, there’s not a single similarity… except for the myriad of similarities. Both involve forcefully removing the genital tissue of minors for reasons that may include tradition, religious requirement, hygiene, insurance of desired sexual conduct, social integration, aesthetics, health, and rites of passage. FGM is never practiced where circumcision isn’t, and FGM is mostly performed and advocated by women (surveys show that men in some of these cultures tend to be ambivalent).

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: