A study by Bossio et al published in the Journal of Urology in June 2016 was widely misreported as showing that circumcision made no difference to the sensitivity of the penis. Even leaving aside the vagueness of this measure (do they mean sensitivity to pain or to pleasure? what about other measures of sexual functionality and satisfaction?) the reports seriously misrepresented the findings of the study, which actually showed that men with foreskins had a lower threshold of sensitivity and circumcised men a higher threshold – in other words, that men with foreskins were more sensitive to touch, and circumcised men less sensitive. As the authors admit in their reply to criticisms of their article published in a later issue of the journal, “the foreskin was observed to be most sensitive to fine touch pressure thresholds.” Of course, there are other issues to be taken into account, some of which are raised in the letters criticising the paper, but there is not the slightest basis for media and other reports that circumcision “makes no difference” to sexual experience.
Figures from Medicare show that circumcision incidence in Australia continues to decline and is now at the lowest rate since records were kept. Between Financial Year 2009/10 and 2015/16 the number of circumcisions of boys under 6 months of age fell from 20,246 to 14,880 – a decline of about 30%. The fall was particularly dramatic in New South Wales (down from 8750 to 5923) and Queensland (down from 5611 to 3145). There were small falls in South Australia, the Northern Territory and the Australian Capital Territory, and slight rises in Victoria and Western Australia – where, however, the figures remain well below NSW and Qld (2943 and 1361 cases respectively). See Table 1 for details. These figures are based on claims under Medicare item 30653, circumcision of a male under 6 months of age, and may not include all circumcision operations performed in Australia – those carried out as part of a childbirth “package”, for example, or by community operators, such as Mohels servicing the Jewish community. On the other hand, it is not likely that parents who arrange circumcisions with GPs and so-called specialist clinics would fail to claim the rebate, so it is likely that the figures give a reasonable approximation of the true picture. Even if they understate the incidence, the declining trend is obvious.
The harm of circumcision is highly subjective, extends more broadly than mere surgical complications and can be as much psychological as physical. These points are only part of the argument of a detailed and comprehensive discussion of the harms of non-therapeutic circumcision of male minors, and the question of whether it should be regarded as ethically and legally permissible. The paper was published as a contribution to a forum on recent events in Germany, where an appeals court determined that medically unnecessary circumcision of a minor was unlawful because it violated his right to physical integrity and self-determination. In response to am angry reaction by Jewish and Muslim organisations the decision was subsequently overturned by special legislation in the German parliament, but the issue remains unsettled and debate continues. The controversy has highlighted the striking contrast in attitudes and policy between female genital cutting (FGM), on the one hand, and male genital cutting (circumcision) on the other. At the very moment when the Bundestag was enshrining the legality of circumcision of boys (up to the age of 6 months) it was increasing the penalties for any form of female genital cutting, no matter how mild or symbolic, and irrespective of age. As Shahvisi has argued, this sort of inconsistency not only discriminates against males and treats them as second class citizens, but infantilises and restricts the autonomy of adult women who may wish to modify their own genitals in accordance with the traditions of their culture or for aesthetic or other personal reasons. As the authors comment, this situation is inconsistent with the trend towards gender equality and creates an ethical and legal anomaly that is likely to be the focus of controversy for many years to come.
The abstract of the paper follows. It is one of several responses to a detailed discussion of the German court decision and subsequent controversy by Steven Munzer.
Surgically modifying the genitals of children - female, male, and intersex - has drawn increased scrutiny in recent years. In Western societies, it is illegal to modify the healthy genitals of female children in any way or to any extent in the absence of a strict medical indication. By contrast, modifying the healthy genitals of male children and intersex children is currently permitted. In this journal in 2015, Stephen R. Munzer discussed a controversial German court case from 2012 (and its aftermath) that called into question the legal status of non-therapeutic male circumcision (NTC), particularly as it is carried out in infancy or early childhood. Whether NTC is legal before an age of consent depends partly upon abstract principles relating to the best interpretation of the relevant laws, and partly upon empirical and conceptual questions concerning the degree to which, and ways in which, such circumcision can reasonably be understood as a harm. In this article, we explore some of these latter questions in light of Professor Munzer’s analysis, paying special attention to the subjective, personal, and individually and culturally variable dimensions of judgments about benefit versus harm. We also highlight some of the inconsistencies in the current legal treatment of male versus female forms of non-therapeutic childhood genital alteration, and suggest that problematically gendered assumptions about the sexual body may play a role in bringing about and sustaining such inconsistencies.
Earp, B. D., & Darby, R. Circumcision, sexual experience, and harm. University of Pennsylvania Journal of International Law, 37(2) 2017, online symposium.
The paper is also available to download from Brian Earp’s Academia page
Circumcision has a an adverse impact on male health and causes significant harm, not merely in the short term or when surgical complications occur, but over the long term of a male’s life and as an inevitable result of the surgery. This is the finding of an article in the International Journal of Human Rights, based on a survey of over 1000 men, and which argues that the harm of circumcision is great enough to warrant further detailed investigation and to place a big question mark over the continuation of this practice. The abstract of the paper follows:
Amid growing bioethical and human rights concerns over non-therapeutic infant male circumcision, calls have been made to investigate long-term impacts on the men these infants eventually become. The present inquiry attempts to identify factors contributing to concerns of men claiming dissatisfaction with or ascribing harm from neonatal circumcision. This large sample size survey involved an online questionnaire with opportunities to upload photographic evidence. Respondents revealed wide-ranging unhealthy outcomes attributed to newborn circumcision. Survey results establish the existence of a considerable subset of circumcised men adversely affected by their circumcisions that warrants further controlled study. Empirical investigations alone, however, may be insufficient to definitively identify long-term effects of infant circumcision. As with non-therapeutic genital modifications of non-consenting female and intersex minors, responses are highly individualistic and cannot be predicted at the time they are imposed on children. Findings highlight important health and human rights implications resulting from infringements on the bodily integrity and future autonomy rights of boys, which may aid health care and human rights professionals in understanding this emerging vanguard of men who report suffering from circumcision. We recommend further research avenues, offer solutions to assist affected men, and suggest responses to reduce the future incidence of this problem.
Tim Hammond & Adrienne Carmack. Long-term adverse outcomes from neonatal circumcision reported in a survey of 1,008 men: an overview of health and human rights implications. International Journal of Human Rights, on-line first, 21 February 2017.
This is a highly significant study that confirms much previous evidence and tightens the screws on the diminishing band of circumcision advocates and practitioners. Over the last century or so, defenders of circumcision have repeatedly stated that if circumcision was shown to be harmful, they would stop doing it. Some authorities even went to far as to propose that if circumcision was harmful the state should step in to protect boys by regulating or even prohibiting the procedure. In 1896, for example, the German Jewish doctor Abraham Glassberg published a defence of circumcision in which he argued not only that it was necessary among Jews for cultural reasons, but that it was equally desirable – even to the point of legal compulsion – among non-Jews, for reasons of health. Glassberg’s only concession was that if circumcision were shown to be harmful there would be a public interest in legal regulation and restriction of the practice.** He did not set out any criteria or benchmarks for this proof, however, and so confident was he that no such proof would ever be found that he did not realise he was leaving a hostage to fortune whose moment of truth has now arrived: Glassberg’s chickens have come home to roost, circumcision has been proven to be harmful. It is now up to the defenders of circumcision to admit that their own case for stopping the practice has been made and to give it up as Glassberg promised.
Leonard Glick, Marked in your Flesh: Circumcision from Ancient Judea to Modern America (New York: Oxford University Press, 2005), p. 134-6.
A couple of years ago Brian Morris drew a certain amount of attention to himself with the claim that the benefits of circumcision outweighed the risks by 100 to 1. At the time child health authorities ridiculed the claim as scientifically baseless, exaggerated, implausible, frankly preposterous and just crazy. His additional suggestion that circumcision was just like vaccination and should be compulsory was described as the dumbest idea ever. Undeterred by these harsh words, our fearless anti-foreskin warrior has now published a further article in which he claims that the benefits of circumcision outweigh the risks by 200 to 1, and that 50 per cent of all uncircumcised men will experience medical problems as a direct result of their regrettable genital anatomy.
This means that the danger to health posed by the foreskin has doubled in only 2 years, and should imply that boys and men all over the world (but especially in Europe, Britain and Australia) should be swarming into hospital emergency departments with crippling foreskin-related diseases. If the risk continues to soar at this rate, it will not be long before uncircumcised men are dropping like flies in the street. The fact that none of this is happening, however, does lend a certain air of unreality to Professor Morris’s alarmism, and perhaps explains the fact that, while his earlier (2014) claim met with ridicule and refutation, his latest anathema against the foreskin has left health authorities dumbfounded and speechless with amazement.
The 100 to 1 claim was made in a respectable journal as an aside to an article that was really a speculation on the possible effects of the American Academy of Pediatrics 2012 circumcision policy on United States circumcision incidence. It is noteworthy that Professor Morris’s 200 to 1 claim appears in the very obscure Chinese-based World Journal of Clinical Pediatrics. Despite its grandiose title, this is a recently established, low-ranking organ that was included in Beale’s list of predatory open access publishers. It had, in fact, already been the target of a speeding ticket from Retraction Watch for dodgy publication practices – in this case, failure to ensure objective peer review. Still, one can’t blame Morris for that: if you are going to make claims as outlandish as those made by him and his coterie at the Circumcision Academy of Australia it is not surprising that you have to scrape the bottom of the barrel.
Current laws against female genital mutilation are both sexist and racist. This is the contention of a powerful article by Arianne Shahvisi, who argues that the law is racist insofar as it infantilises adult women from non-Western cultures by denying them the right to seek genital modification if they desire it, and also sexist because it ignores boys and gives them no protection against circumcision, whether they want it or not. As she writes in the international journal Clinical Ethics, despite its good intentions, the law in most Western countries is “marred with sexism and racism, since the legislation devalues the consent capacities of racialised adult women, whilst the lack of legislation around male circumcision amounts to a failure to protect the bodies of male children.” The author goes onto discuss the parallels between male and female genital cutting and to argue that there is no valid reason for regarding them as radically different: “Both are performed on the healthy, protective, erogenous tissue of children who cannot consent. Neither has any proven health benefit, while both have some associated risk, and carry implications for later sexual potential.”
Shahvisi argues that the total ban on female genital cutting, even for competent adults, and the open slather of circumcision of male infants and boys, are inconsistent with the basic principles of medical ethics as formulated by Beauchamp and Childress – autonomy, non-malevolence, benevolence and justice: “Respect for autonomy rules that patients who have capacity must have their autonomy respected provided they have been adequately informed of risks; beneficence demands that patient safety and wellbeing be prioritised, in full consideration of long-term risks and outcomes; non-maleficence urges that clinicians minimise harm, whether short-term or long-term; considerations of justice require that benefits, risks and costs are distributed equitably, and that medically equivalent patients are treated in equivalent ways.” She goes on to suggest that “a clinician considering the four principles of medical ethics would undoubtedly maintain the view that no child may have non-therapeutic modifications made to her/his body, especially those that are irreversible (i.e. involving tissue damage/removal).
In conclusion the author proposes that the existing laws against female genital mutilation “be extended to include all forms of nontherapeutic genital surgery for all children. A ‘genital mutilation act’, dovetailing with broader child protection legislation, could apply to the bodies of all those below the age of consent, including: FGM, male circumcision, and even non-therapeutic intersex genital surgeries.”
Arianne Shahvisi. Why UK doctors should be troubled by female genital mutilation legislation. Clinical Ethics, online first, 15 December 2016.
Note: Shahvisi is referring to the law in Britain, but Australian laws against FGM (part of the Crimes Act in each State) similarly make it illegal to perform genital modification surgery on adult women even if she consents, unless deemed medically necessary. This qualification had the unintended effect of allowing Graeme Reeves, “the butcher of Bega”, to escape conviction at his first trial for excising a woman’s clitoris and labia. (See full account here.)
For a discussion of the law against FGM in Australia, see Christine Mason, Exorcising Excision: Medico-Legal Issues Arising From Male and Female Genital Surgery in Australia.
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