A large scale, comprehensive study has found that circumcised boys have a far higher incidence of urethral problems such as meatal stenosis than boys who are left genitally intact (uncircumcised). The nationwide study of over 4 million males in Denmark found that meatal stenosis (narrowing and ulceration of the urinary opening of the penis) affected as many as 20 per cent of circumcised boys, about five times the incidence of such problems in uncircumcised boys. They also experience a far higher incidence of other urethral problems. Among other observations, the authors of the article criticise the American Academy of Pediatrics for its uncritical reliance on a flawed study on circumcision complications by El Bcheraoui et al which claimed to find a negligible incidence of urethral disease among boys circumcised in American hospitals. They point out that the data in this study actually show a high relative risk for such problems. The AAP should have paid attention to a warning it published in 1984: “The foreskin shields the glans; with circumcision this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, meatitis (inflammation of the meatus), and meatal stenosis (a narrowing of the urinary opening). Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life”.** The present study is further evidence that the AAP’s 2012 claim that the “benefits” of circumcision exceed the “risks” is fundamentally false.
** This text was included in the 1984 edition of a leaflet for parents on care of the normal (uncircumcised) penis. When the leaflet was reissued in 1990 the paragraph was deleted, for reasons never explained. Relevant correspondence and a copy of the original leaflet available from Circumcision Resource Center.
Frisch M, Simonsen J. Cultural background, non-therapeutic circumcision and the risk of meatal stenosis and other urethral stricture disease: Two nationwide register-based cohort studies in Denmark 1977-2013, The Surgeon, on-line first, 22 December 2016.
The Danish Medical Association (Lægeforeningen) has recommended that no boys under the age of 18 be circumcised. The association released its recommendation on Friday, saying that circumcision should be “an informed, personal choice” that young men should make for themselves. The group said that when parents have their male children circumcised, it robs the boys of the ability to make decisions about their own bodies and their own cultural and religious beliefs. “To be circumcised should be an informed, personal choice. It is most consistent with the individual’s right to self-determination that parents not be allowed to make this decision but that it is left up to the individual when he has come of age,” Lise Møller, the chairwoman of the doctors’ association’s ethics board, said. Lægeforeningen said that male circumcision carries a risk of complications and should only be performed on children when there is a documented medical need.
In making its recommendation, the doctors’ association stopped short of calling for a legal ban on male circumcision, which is legal but relatively rare in Denmark. “We have discussed it thoroughly, also in our ethics committee. We came to the conclusion that it is difficult to predict the consequences of a ban – both for the involved boys, who could for example face bullying or unauthorized procedures with complications – and for the cultural and religious groups they belong to,” Møller said.
Danish doctors come out against circumcision. The Local, 5 December 2016
There is also a report in the New York Times, which mistakenly states that the United States Centers for Disease Control has issued a policy which follows the American Academy of Pediatrics in finding that the “benefits” of circumcision exceed the “risks”. In fact, the CDC has not issued any formal policy, merely a draft for public discussion that has been severely critcised in the journal Global Public Health.
A research report report in the Indian Journal of Case Reports advises that boys rarely need circumcision for phimosis-type problems (such as foreskin tightness or adhesions between foreskin and glans). The authors point out that most such problems can be addressed by non-surgical means, and warn that surgical interventions in children should be minimised, and circumcision performed only when absolutely necessary. The aim is to “prevent unnecessary surgical intervention under anaesthesia and keep the prepuce intact preserving its vital functions.” The abstract of the report follows below.
Objective: To assess the importance of identifying physiological preputial adhesion and pathological phimosis as different clinical entities in children.
Methods: A prospective study was done on 40 patients of presumed phimosis, referred to the paediatric surgery department, for circumcision. Patients were examined for their symptoms and classified as either having symptomatic physiological preputial adhesions or pathological phimosis. Patients in the former group underwent adhesiolysis and those in the later group underwent circumcision. They were followed up and results obtained were analysed.
Results: Out of the 40 patients referred with a presumed diagnosis of phimosis, only 5 (12.5%) patients had pathological phimosis and among these 3 were found to have balanitis xerotica obliterans. Pathological phimosis patients presented late at a mean age of 60 months. They underwent circumcision. 35 (87.5%) patients were found to have symptomatic physiological preputial adhesions and presented earlier at a mean age of 28 months. 33 (94.3%) of these could be managed by simple adhesiolysis as outdoor patients while 2 patients were non-responders and needed circumcision. Among responders to adhesiolysis, majority of the patients (29 out of 33) needed a single attempt while 4 patients needed multiple attempts at adhesiolysis.
Conclusion: Most of the patients referred for circumcision for phimosis actually had symptomatic preputial adhesions which could be managed by simple adhesiolysis. Only few patients had pathological phimosis needing circumcision. Balanitis xerotica obliterans was found to be an important cause of pathological phimosis. Proper diagnosis could prevent unnecessary surgical intervention under anaesthesia and keep the prepuce intact preserving its vital functions.
Sandip Rahul et al. Importance of Identifying Physiological Preputial Adhesion and Pathological Phimosis as Different Clinical Entities in Children. Journal of Case Reports, 30 August 2016.
The July 2015 edition of Geo magazine included a feature on the campaign to circumcise the male population of Zambia. The article, by Michael Obert (text) & Matthias Ziegler (photos) was a hard-hitting critique of the circumcision campaign, dictated to a small, underdeveloped African country by powerful international aid agencies under the effective control of the United States. The authors described the unrelenting propaganda efforts to persuade (or force) men to submit to circumcision, and the misleading advice that circumcision was “like a vaccine” that would make them immune to HIV. They also report that many men believed this advice, stopped using a condom when having sex … and became infected with HIV.
You would think that such a timely report on the realities of the most expensive medical “aid” project in history would be news everywhere, or at least that other editions of Geo would carry the story. You would be wrong: the article appeared only in the German edition and not in any English-language edition. To overcome this obvious censorship, volunteers have made a translation of the full article, which can be read on this site. The original article by Michael Obert & Matthias Ziegler was published in Geo German edition, July 2015:
Weltgeschehen: Ein Einschnitt fürs Leben? Millionen afrikanischer Männer sollen sich beschneiden lassen, als Schutz vor HIV. Sinnvolle Hilfe oder gefährlicher Irrglaube?
Compared with the problem in sub-Saharan Africa, the Australian AIDS epidemic never was much of an epidemic, but it inspired a level of fear far out of proportion to the real threat. (Remember those awful grim reaper ads?) Now there is even less reason for alarm or panic, as scientists announce that the AIDS epidemic in Australia is officially finished. As the SMH reports, “Australia's peak AIDS organisations and scientists have announced an end to the AIDS epidemic, as the country joins the few nations in the world to have beaten the syndrome. The number of annual cases of AIDS diagnoses is now so small, medical researchers and the Australian Federation of AIDS Organisations have declared the public health issue to be over.” The Chief Executive Officer of AFAO, Mr Darryl O'Donnell, said that AIDS cases have dropped to small enough numbers to no longer be routinely recorded. “AIDS is over in the way we knew it. We've got access to treatment that has had extraordinary effect, and community activism since the very early years of AIDS in the 1980s and 90s has helped the efforts to fight it.” Professor Sharon Lewin, director of the Peter Doherty Institute at Melbourne University, told the ABC that anti-retroviral medications had been crucial to the epidemic’s decline, allowing people diagnosed with HIV to live healthy, long lives. “I’ve actually seen a dramatic transformation of HIV from a universal death sentence to now a chronic, manageable disease”.
Saimi Jeong, AIDS epidemic ‘over’ in Australia, say peak bodies. Sydney Morning Herald, 11 July 2016.
Concurring with this assessment is Professor David Cooper, Director of the Kirby Institute for Infection and Immunity at the University of New South Wales. In 2010 he infamously joined the fanatical Brian Morris in declaring that more circumcision of infants was the only, or at least the best, way to combat HIV in Australia, a wild claim heavily criticised at the time. Six years later he has changed his mind: in an opinion piece for the SMH he agrees that AIDS has been beaten, and does not drop the C word even once.
The June issue of the Kennedy Institute of Ethics Journal includes a special feature on the ethics of female genital mutilation and male circumcision. The lead or “target” article by Brian Earp is accompanied by commentaries from other leading scholars in the field, including anthropologist Richard Schweder. Earp argues that the criteria conventionally used to distinguish female from male genital cutting - degree of harm, prospect of health benefit, sexism - cannot be maintained, and that there are many similarities between the rationale, procedure and outcomes of the two sorts of surgeries.
A French man has won a case against the surgeon who circumcised him as an adult. The court acknowledged sexual and ethical harm resulting from his failure to provide information on alternatives to circumcision. In early 2016 the Tribunal de Grande Instance (TGI) in Paris ruled on a dispute between a patient and his surgeon, a member of the French Association of Urology. In 2007 the patient, then aged 26, was circumcised after the surgeon made a diagnosis of phimosis. Not only did the surgeon neglect to inform him about the risks and consequences associated with this action, but he failed to propose less invasive alternative therapies. Deeply affected by the injury, especially by the loss of sensation following the removal of his foreskin, the victim of this procedure decided to sue the surgeon in court and won the case.
After an investigation which revealed that the recommendation to circumcise was made “arbitrarily”, and further that the operation had not been carried out properly, the Paris court fined the surgeon almost 32,000 euros in compensation: 5000 Eu for moral damage resulting from the lack of information given; 3000 Eu for physical and mental suffering; 250 Eu for temporary functional deficit and 3,560 Eu for permanent functional deficit; and 20,000 Eu for sexual harm because of, inter alia, “a partial loss of the ability to access pleasure.”
Full report (in French): Circumcision: French surgeon heavily fined.
It has been a bad month for circumcision advocates. On top of a series of critiques of non-therapeutic circumcision reported on this page, the American-based Journal of Law, Medicined and Ethics now publishes the full version of the paper given by Attorneys for the Rights of the Child at a conference on the American Academy of Pediatrics 2012 circumcision policy held in Charleston in October 2013 (reported here). The abstract reads as follows:
The foreskin is a complex structure that protects and moisturizes the head of the penis, and, being the most densely innervated and sensitive portion of the penis, is essential to providing the complete sexual response. Circumcision—the removal of this structure—is non-therapeutic, painful, irreversible surgery that also risks serious physical injury, psychological sequelae, and death. Men rarely volunteer for it, and increasingly circumcised men are expressing their resentment about it.
Circumcision is usually performed for religious, cultural and personal reasons. Early claims about its medical benefits have been proven false. The American Academy of Pediatrics and the Centers for Disease Prevention and Control have made many scientifically untenable claims promoting circumcision that run counter to the consensus of Western medical organizations.
Circumcision violates the cardinal principles of medical ethics, to respect autonomy (self-determination), to do good, to do no harm, and to be just. Without a clear medical indication, circumcision must be deferred until the child can provide his own fully informed consent. In 2012, a German court held that circumcision constitutes criminal assault. Under existing United States law and international human rights declarations as well, circumcision already violates boys› absolute rights to equal protection, bodily integrity, autonomy, and freedom to choose their own religion. A physician has a legal duty to protect children from unnecessary interventions. Physicians who obtain parental permission through spurious claims or omissions, or rely on the American Academy of Pediatrics’ position, also risk liability for misleading parents about circumcision.
J. Steven Svoboda, Peter Adler, Robert Van Howe. Circumcision is unethical and unlawful. Journal of Law, Medicine and Ethics 44 (2), June 2016.
The real reasons for circumcising infants have little to do with child health, and everything to do with the infant’s lack of status and his inability to resist. This is the broad argument and conclusion of a new paper surveying the health arguments for non-therapeutic circumcision and finding them to be inadequate to justify circumcision of non-consenting minors. Among the many telling points made, the author points out that cancer of the penis (prevention of which is monotonously cited as a “compelling” reason for circumcision) is actually significantly less common than male breast cancer. As he points out, if routine amputation of male breasts is not recommended as a breast cancer preventive, there is certainly no need for routine removal of foreskins as a penile cancer preventive. (In any case, it is not proven that men with foreskins are at significantly greater risk of penile cancer than those circumcised.)
Abstract: Recent restatements of the case for routine circumcision of normal male infants and boys typically base their arguments on a range of medical evidence showing circumcision to have a protective effect against certain pathological conditions. It is then assumed that this evidence leads automatically to a clinical recommendation that circumcision should either be “considered” or strongly urged. Closer analysis reveals that the recommendation of infant or child circumcision has less to do with the medical benefits than with the historic origins of the procedure, the convenience to the operator and the status of the patient. It is further suggested that it is not clear that the medical benefits of infant or child circumcision outweigh the risks and harms, and that this style of advocacy fails to pay due regard to basic principles of bioethics and human rights that are accepted in other areas of medical practice.
Source: Robert Darby. Targeting Patients Who Cannot Object? Re-Examining the Case for Non-Therapeutic Infant Circumcision. Sage Open, April-June 2016.
In a hard-hitting article that published in a leading international journal Global Public Health, Professor Morten Frisch, MD, PhD, from Statens Serum Institut in Copenhagen, Denmark, and bioethicist Brian D. Earp from The Hastings Center Bioethics Research Institute in New York, identify numerous scientific and conceptual shortcomings in the 2012 circumcision policy from the American Academy of Pediatrics (AAP), as well as the more recent 2014 draft guidelines for a national policy on male circumcision issued by the Centers for Disease Control and Prevention (CDC). With respect to the latter, Frisch and Earp make the following critical points:
In light of these serious limitations, Frisch and Earp advise that the CDC’s overall assessment of benefits versus harms (“risk”) of circumcision be interpreted with extraordinary caution. Considering the fact that exceedingly few intact boys will need a circumcision for a medical condition before age 18 years – 0.5% according to a study just published in the AAP's journal Pediatrics – Frisch and Earp conclude that from a medical and scientific viewpoint as well as out of concerns over the questionable moral permissibility of performing non-therapeutic genital surgeries on healthy minors, the best time to circumcise a boy (if at all), is when he is old enough to decide for himself.
Morten Frisch and Brian Earp. Circumcision of male infants and children as a public health measure in developed countries: A critical assessment of recent evidence. Global Public Health, on-line first, 19 May 2016
Despite what the media headlines assert, recent studies of penile sensitivity confirm that the foreskin is highly significant for male sexual function and erotic sensation. In a series of widely (inaccurately) reported papers based on limited field testing, psychology student Jennifer Bossio studied the (subjectively reported) sensitivity of the penises of 62 men aged 18 to 37, including 32 intact and 30 circumcised. Men with sexual dysfunction were excluded, however, thus making it impossible to establish whether circumcision has any effect on sexual dysfunction. The subjects were asked about their sexual functioning in five areas: erectile function, intercourse satisfaction, orgasmic function, sexual desire, and overall satisfaction. Most of the participants said they were OK, but the circumcised men could only rate their own satisfaction, not compare it with that of anybody else, or what their own experience would have been if they still had their foreskin.
The researchers also measured touch sensitivity, touch pain threshold, warmth detection and heat pain threshold on four sites, two on the shaft, one on the glans and one on the outside of the foreskin, if any. (They also made the same measurements at a point on the forearm as a control.) It is not clear why heat pain was studied. Few couples use painful heat as part of their lovemaking. They established that the outside of the foreskin is no less sensitive to the pain of pricking, warmth and heat than the other sites of the penis (or to the site on the forearm), and in most cases more sensitive (i.e., with a lower touch threshold), thus establishing that its removal must negatively impact on sexual sensation. As they write, “Tactile thresholds at the foreskin (intact men) were significantly lower (more sensitive) than all [other] genital testing sites” including the sites in circumcised men. In other words, they actually confirmed the finding of Sorrells et al that “the foreskin was the most sensitive to tactile sensation stimuli.” So how did the media get the idea that the study found the reverse? Maybe they just misread the graphs and did not realise that a the lower the bar, the greater the sensitivity.
All in all, the study adds little to the conflicted evidence in this (highly subjective) area, and certainly does not warrant all those reassuring (to circumcised Americans) headlines that circumcision “makes no difference.” Even if it did make no difference, that is not a reason in favour of routine circumcision.
Brian Earp, Does Circumcision Reduce Penis Sensitivity? The Answer Is Not Clear Cut. Huffington Post, 21 April 2016.
Brian Earp, Infant circumcision and adult penile sensitivity: implications for sexual experience. Trends in Urology and Men’s Health 7 (4), July-August 2016.
Abstract: A recent study reported that neonatal circumcision is not associated with changes in adult penile sensitivity, leading to viral coverage in both traditional and online media. In this commentary the author questions the conclusions drawn from the study and explores the relationship between objective assessments of penile sensitivity and subjective sexual experience and satisfaction. The author concludes with suggestions for improving future research.
In a landmark judgement, the High Court of England and Wales has ruled that children should not be circumcised until they are old enough to decide for themselves. The case arose when the Muslim father of the boy wanted him to be circumcised in accordance with his own religious beliefs, but the English mother disagreed. Top female Family Division judge Mrs Justice Roberts agreed with their mother’s wish to leave it for the boys, aged six and four, to make up their own minds when they are older whether they wish to have it done. The father, 36, was born in Algeria but is now separated from the 34-year-old mother. The couple met in 2006, lived together in a North London flat, and went through an Islamic ceremony of marriage in 2009 before the boys were born. In July 2012 the mother fled the flat with the boys following violent attacks on her by the father. The judge said the father came to England in 2001 on false documents, but had now been given British passport.
In reaching her decision, Justice Roberts said: "First and foremost, this is a once and for all, irreversible procedure. There is no guarantee that these boys will wish to continue to observe the Muslim faith with the devotion demonstrated by their father although that may very well be their choice. They are still very young and there is no way of anticipating at this stage how the different influences in their respective parental homes will shape and guide their development over the coming years. There are risks, albeit small, associated with the surgery regardless of the expertise with which the operation is performed. There must be clear benefits which outweigh these risks which point towards circumcision at this point in time being in their best interests before I can sanction it as an appropriate course at this stage of their young lives." She added: "Taking all these matters into account, my conclusion is that it would be better for the children that the court make no order at this stage in relation to circumcision. I am simply deferring that decision to the point where each of the boys themselves will make their individual choices”
Circumcision choice should be left until children are old enough to decide for themselves. The Telegraph, 19 April 2016
The case for circumcision has been dealt a final, fatal blow. Danish research showing that the vast majority of normal (uncircumcised) boys never experience any “foreskin problems”, and that only a tiny minority of boys with a problem require circumcision to fix it, has forced the AAP to admit the fact that the case for routine (prophylactic) circumcision is empty and bankrupt. The key facts from the paper by Ida Sneppen and Jorgen Thorup, are as follows:
What this really means is that 95% of boys will never experience a foreskin problem, and that only a tiny minority will require circumcision to fix it. The case for circumcision is dead in the water on medical and cost-benefit grounds alone.
Inadequate, inaccurate, misleading, self-interested … are just a few of the disapproving terms applied by paediatrician Professor Robert Van Howe to the circumcision policy statement released by the American Academy of Pediatrics in 2012. There were no shortage of critiques four years ago, but in a fresh analysis Professor Van Howe applies a microscope to every individual statement in the policy and background report and finds very little that deserves a tick. As he writes in the abstract:
In September of 2012, the American Academy of Pediatrics Task Force on Circumcision released its report, which concluded that the benefits of the procedure outweighed the risks. A close analysis of the report reveals the Task Force used a selective, subjective and biased bibliography to support their predetermined conclusions. The Task Force neglected to discuss the anatomy, function, and normal development of the foreskin, nor did they discuss the harm or ethical consequences associated with circumcision. The Task Force deviated from standard practices in its analysis of the medical literature thereby producing a report that falls far below the quality standards set by other AAP policy statements. The report promoted expansion expansion of the procedure as well as the revenue streams for those who perform it. Since release of the report, other national medical organizations have rejected infant circumcision as unwarranted medically and as ethically unacceptable. No organizations outside of the United States have adopted their conclusions. The report is poorly written, poorly researched, makes unsubstantiated claims, and reaches an illogical conclusion.
The full critique, “Statement by Statement Analysis of the 2012 Report from the American Academy of Pediatrics Task Force on Circumcision: When National Organizations are Guided by Personal Agendas II”, can be read at and downloaded from Professor Van Howe’s Academia.edu page.
A mother and former midwife convicted over the genital mutilation of young girls, as well as a community leader who instructed community members to lie to police, have been sentenced to a maximum 15 months’ imprisonment. Former midwife Kubra Magennis, 72, and the mother of the victims, were convicted of mutilating two sisters in separate procedures during religious ceremonies between 2009 and 2012, when the girls were aged about 7. A third offender, senior community leader Shabbir Mohammedbhai Vaziri, was found guilty of acting as an accessory after the fact by directing community members to lie to police about the practice. He was also sentenced to 15 months’ imprisonment.
The procedure, known as "khatna", involves nicking or cutting a girl’s clitoris in the presence of several female elders and is considered a rite of passage by some members of the Dawoodi Bohra Muslim community. The girls' mother had been subjected to the same procedure as a child in Kenya. Supreme Court Judge Justice Peter Johnson said these kinds of cases were “difficult to prosecute” because of their “unusual and novel circumstances”. He said the mother of the two girls requested that the former nurse and midwife carry out the procedure. “I am satisfied [Kubra Magennis] affected injury to the clitoris of each child instructed by the mother” and “used a metal instrument for the purpose of cutting”. He said Magennis was well aware of the laws and that “she abused her professional vocation”.
One of the girls told police “it hurt” when the procedure was carried out. Justice Johnson said she was “told by her mother not to discuss it with anyone ... this is a big secret.”. The judge found no significant physical injury had been inflicted on either child but there were “likely to be some adverse psychological effects”.
Jayne Margetts, Pair given jail time over genital mutilation of young sisters, ABC News 18 March 2016
In a wide-ranging commentary, Brian Earp replies to a proposal from two American gynecologists that Western societies should tolerate and doctors should perform “mild” forms of female genital cutting on girls. This is the same argument that was advanced by bioethicist Dena Davis over a decade ago and which was adopted, very briefly, as the official policy of the American Academy of Pediatrics in 2010. The argument then, as now, was that since circumcision of boys was tolerated, it was discriminatory not to permit less damaging versions of female genital cutting. If the religious rites of groups that practised circumcision of boys were respected, it was consistent to respect the cultural/religious rites of groups that circumcised girls. In reply it was pointed out that the argument could just as well work the other way: that if genital cutting of girls was rejected as an abhorrent denial of human rights, why should similar (and often more severe) surgery on the genitals of boys be tolerated?
While Davis, the AAP and the latest team argue that they are trying to even things up, other critics noticed that the situation would still be very unequal. Under their proposals, girls would still be protected from all but the most minimal and harmless scratch, while boys were still to have their entire foreskin cut off - no change, and not much equality there. It is hard to avoid the conclusion that the real aim of these proposals is not to “show respect” for cultures that practise female genital cutting, but to make it easier to defend circumcision of boys. Over the past decade or so an increasing number of bioethicists, human rights experts and independent thinkers have questioned the “quarantining” of female genital mutilation from male circumcision and argued that the two practices have much in common, socially, ethically and even physically. If cutting a girl’s genitals is a violation of her human rights, it is hard to see why cutting a boy’s genitals is not a violation of his human rights. Arora and Jacobs have already published uncompromising (though somewhat confused) defences of specifically male circumcision and clearly recognise this problem; it seems likely that their latest “modest proposal” on female circumcision is intended to make male circumcision less vulnerable to criticism as an instance of sexism and double standards, and to make it more difficult for those who oppose the practice on bioethical and human rights grounds. In other words, A&J’s real and underlying aim is not to promote female circumcision, but to defend and preserve circumcision of boys as a cultural and medical rite.
In his commentary on A&J’s latest efforts in the Journal of Medical Ethics, Brian Earp argues that all children have the same human rights and should have equal protection from non-therapeutic genital surgeries.
Abstract: Arora and Jacobs (2016) assume that liberal societies should tolerate non-therapeutic infant male circumcision, and argue that it follows from this that they should similarly tolerate — or even encourage — what the authors regard as ‘de minimis’ forms of female genital mutilation (as defined by the World Health Organization). In this commentary, I argue that many serious problems would be likely to follow from a policy of increased tolerance for female genital mutilation, and that it may therefore be time to consider a less tolerant attitude toward non-therapeutic infant male circumcision. Ultimately, I suggest that children of whatever sex or gender should be free from having healthy parts of their most intimate sexual organs either damaged or removed, before they can understand what is at stake in such an intervention and agree to it themselves.
Brian Earp. In defence of genital autonomy for children. Journal of Medical Ethics, online first, 20 January 2016.
Arora and Jacobs’ article, Female genital alteration: A compromise solution, accompanied by peer commentaries, now published in Journal of Medical Ethics 42 (3), March 2016.
Robert Darby, Male and Female Genital Cutting: A Sex-Neutral Approach? Journal of Medical Ethics Blog, 25 February 2016.
Increased medicalisation of female genital cutting in Indonesia is alarming public health officials. Writing for The Conversation, Meiwita Budiharsana, a lecturer in public health at the University of Indonesia, reports that while female genital cutting (FGC) has always been common, it is now increasingly medicalised and even performed on baby girls in maternity clinics. As she writes: “Traditional “circumcisers” have long carried out the practice, known as female khitan or sunat perempuan in Indonesia. In recent years, medical practitioners have been increasingly performing FGM, institutionalising the ritual into medical practice. Many maternity clinics now offer the procedure as part of a birth delivery package, done soon after labour, without additional charges.” The argument for medicalisation of FGM is that it is better to have trained medical personnel perform the procedure than risking severe infections if performed by traditional circumcisers. But as Ms Budiharsana points out, “medicalisation may actually be even more dangerous. Midwives tend to use scissors instead of penknives. Hence, they actually conduct real cutting of the skin. Traditional circumcisers, meanwhile, use penknives for more symbolic acts of scraping or rubbing.” As performed in Indonesia, FGC usually involves no more than a scratch or nick on parts of the female genitals, without any removal of tissue, and is thus far less injurious than the forms of female genital mutilation performed in many regions of Africa. Nonetheless, the article continues, “any form of female genital mutilation is unacceptable.” The World Health Organisation (WHO) stated in 1997 that no form of genital cutting should be performed by any health professionals in any health establishments and that the practice must not be institutionalised. Because it is performed “without the consent of the baby or little girl, and without clear health benefits or religious mandate” even this mild form of genital cutting is “a violation of human and health rights of the girl child.”
Comment: It is encouraging to see health officials taking a stand in favour of the human rights and health interests of girls, but what about boys? As many comments on the report pointed out, circumcision of boys is also very common in Indonesia, and is typically a far more extensive and injurious operation - involving excision of the entire foreskin - than the nick or scratch performed on girls. All the objections that Ms Budiharsana raises against FGC apply just as strongly to circumcision of boys: it is not required by Islamic law; it provides no clear and uncontroversial health advantage; and it is ethically dubious. Since human rights are universal and apply to everybody, irrespective of race, sex, age etc, it follows that if cutting the genitals of a girl without her informed consent is a violation of her human rights, cutting the genitals of a boy must be a violation of his human rights. That being the case, we look forward to the day when Indonesian health officials take a universalist approach to this issue and defend the rights of all children.
Meiwita Budiharsana, Female genital cutting common in Indonesia, offered as part of child delivery by birth clinics. The Conversation, 16 February 2016
Brian Earp, Female genital mutilation and male circumcision: Toward an autonomy-based ethical framework. Medicolegal and Bioethics, 2015.
J. Steven Svoboda and Robert Darby. A rose by any other name: Symmetry and asymmetry in male and female genital cutting
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