News about circumcision from Australia

and around the world : 2018

 

 

Genital autonomy and sexual wellbeing

 

All children - male, female and intersex - have an interest in “genital autonomy”. In a wide-ranging, deply-researched essay, Brian Earp and Rebecca Steinfeld argue that this means all children should be protected from medically unnecessary alterations to their genitals, but that adults should be free to undergo such surgeries if they have given informed consent. These rules are necessary not merely because surgical operations such as circumcision, female genital cutting (FGM) and intersex genital cutting (”normalisation surgery”) violate accepted principles of bioethics and human rights, particularly the child’s right to an open future; but also because such surgeries harm the child by removing erogenous tissue that makes a major contribution to sexual function. The authors point out that a person’s genitals are a particularly significant and uniquely intimate part of his/her body, and thus that in normal circumstances any unwanted touching in that area may constitute sexual assault. The various “health” and “cultural” justifications that have been offered for such procedures are the focus of intense controversy, but even if there was consensus on the “benefits” they would not outweigh the risks involved, nor the long term harms arising from the loss of significant bodily tissues.

Abstract. Purpose of review: To survey recent arguments in favor of preserving the genital autonomy of children—female, male, and intersex—by protecting them from medically unnecessary genital cutting practices. Recent findings: Nontherapeutic female, male, and intersex genital cutting practices each fall on a wide spectrum, with far more in common than is generally understood. When looking across cultures and comparing like cases, one finds physical, psychosexual, and symbolic overlaps among the three types of cutting, suggesting that a shared ethical framework is needed. Summary: All children have an interest in genital autonomy, regardless of their sex or gender.

The authors conclude: “Western societies, if they wish to be consistent, may soon face a choice between two courses of action. Either they must consider tolerating at least some relatively mild forms of “culturally motivated” nontherapeutic female genital cutting (FGC) performed on minors—so long as they do not cross an arbitrary threshold of presumed harmfulness—or they must consider a less tolerant attitude toward “cosmetic” female and intersex surgeries as well as medically unnecessary male circumcision performed before an age of consent. Although each approach has advantages and disadvantages, a benefit of the latter approach is that it would prioritize the genital autonomy of all vulnerable children, regardless of their race, religion, sex, or gender, thus eliminating concerns about fair treatment and equal protection.”

Brian Earp and Rebecca Steinfeld. Genital autonomy and sexual well being. Current Sexual Health Reports, in press. Full text available here.

More important than gender neutral language:

A gender-neutral policy on child genital cutting

In an earlier paper prepared for the European Parliament the same authors argue that the old genital cutting paradigm - circumcision good or OK, FGM bad and unacceptable - is outmoded, and should be replaced by a new paradigm based on gender neutrality. Under the new paradigm, all children - male, female and intersex - should be protected from medically unnecessary alterations to their private parts. This would not necessarily mean heavy-handed attempts to criminalise or otherwise legally prohibit circumcision and other forms of genital cutting, as such efforts are likely to fail in the teeth of popular resistance. In countries where FGM is entrenched as a cultural practice, laws against it have had little impact. Far more effective are efforts to discourage such practices through community education programs and the elimination of financial and other incentives, such as health insurance rebates.

The abstract reads as follows: “Moral and legal opposition to the non-therapeutic cutting of children’s genitals has traditionally focused on female children. In recent years, however, a growing movement of scholars, activists, and individuals affected by childhood genital cutting have argued that all children, regardless of sex or gender, should be protected from such intimate violations. By drawing attention to the overlapping harms to which female, male, and intersex children may be exposed as a result of having their genitals cut, this movement posits a sex and gender neutral—that is, human—right to bodily integrity and genital autonomy. This article introduces and outlines some of the main arguments supporting this perspective.”

Conclusion: Policy Implications

What are the implications of the foregoing discussion for policy? At a recent WHO-sponsored conference on female NGC held at Geneva University Hospitals, we argued that a gender-inclusive approach—based on an individual’s capacity to provide informed consent to NGC—is not only better supported by the available evidence, as explained above, but also carries several practical advantages:

  1. It neutralizes accusations of cultural imperialism by applying the same standards to medically unnecessary genital cutting practices primarily affecting white minors in North America, Australasia and Europe (i.e., medicalized routine or religious male circumcision, intersex genital normalization surgery, adolescent female cosmetic genital surgery) as it does to such practices primarily affecting minors of color in Africa, the Middle East, and Southeast Asia (i.e., male and female peripubertal initiation ceremonies and other customary forms of childhood NGC).
  2. It clarifies the moral confusion that is introduced by Western-led efforts to eliminate only the female “half” of childhood NGC practices in communities that practice both male and female NGC in parallel.
  3. It weakens accusations of sexism by recognizing that boys and intersex children are also vulnerable to non-therapeutic genital alterations that they may later come to seriously resent.

Adopting such an approach, however, does not necessarily entail “banning” all pre-consensual NGCs. History shows that the enactment of strict legal prohibitions prior to cultural readiness can backfire, creating intense resistance among those who are dedicated to the practice, often driving it underground. Prohibition of childhood female NGC, for example, has been largely unsuccessful in many countries, and recent attempts to criminalize childhood male NGC have either been blocked or overturned. There are many “levers” society can pull to discourage harmful practices: the law is only one among them, and not necessarily the most desirable or effective. Some authors have proposed step-wise regulation of childhood NGCs, along with community engagement and education, as alternatives and/or supplements to formal prohibition. Whatever specific policies are implemented, however, what is clear is that fundamentally different treatment of female, male, and intersex children—with respect to the preservation of their bodily integrity—will become increasingly difficult to justify in the coming years.

Brian Earp and Rebecca Steinfeld. Gender and Genital Cutting: A New Paradigm.

Circumcision “not justified”: Canadian urologists

 

In a major statement based on a comprehensive survey of the medical literature, the Canadian Urological Association has concluded that routine prophylactic circumcision of male infants and boys is not justified as a preventive health measure. The statement is of particular interest because it reaches this conclusion on the basis of a very narrow calculation of medical benefits, costs and risks, pays little attention to the harms of circumcision (such as effect on male sexuality, moral harm of denying choice etc) and largely ignores bioethical and human rights issues. The statement emphasises that the results of clinical studies in underdeveloped regions with acute health and social problems cannot be mapped onto developed nations with quite different epidemiological and social environments, and point out that “The effect of MC has to be analyzed at the individual and societal level.” The statement is at pains to point out that the evidence as to the benefits and risks of circumcision is contradictory and inconclusive, and that much of it is of poor quality, especially studies claiming to show that circumcision has little impact on sexual sensation and function. The final conclusion is that while circumcision does offer some advantages, they are small, can be achieved by other, non-surgical means, and are outweighed by the risks and harms. This being the case, routine circumcision is not justified as a health measure and cannot be recommended.

Source: Sumit Dave, Kourosh Afshar, Luis H. Braga, Peter Anderson. CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants. Canadian Urological Association Journal 2017 Dec. 1; Epub ahead of print. http://dx.doi.org/10.5489/cuaj.5033

 

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