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Circumcision

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Posted (edited)
3 hours ago, RevTestament said:

As for your statement about Muslim female circumcision being just a nick - that appears to be very much dependent upon local culture and traditions.

I did a bit of reading on this topic over the past few days. The number that was quoted in what I read (from the WHO, I believe) is that 80 per cent of female genital cutting in the world is merely drawing blood from the female foreskin (clitoral hood) or removing it altogether, i.e., something much less than or exactly analogous to male circumcision in nature. Where I live, parents who allow this to happen to their daughters overseas are prosecuted upon their return. But these same parents can take their sons off without a worry and allow a man to tear away and then cut off their foreskins with a pair of scissors (according to my former Young Men) or pay large sums of money to have it done in a private hospital, and everyone seems to think this is fine. And if anyone dares question it, that person is often mocked or accused of overreacting or 'whining'. The hypocrisy of the double standard is alive and well even in many non-circumcising nations.

Edited by Hamba Tuhan
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Posted (edited)
2 hours ago, Hamba Tuhan said:

l can't grasp your distinction here between 'religiously indicated' and 'purely cultural reasons'. Isn't a religious justification really just a cultural one? I don't think anyone would argue that point in the case of, say, Muslim commitment to female genital cutting.

There certainly is some overlap between culture and religion.  The distinction as I see it is that one is a religious rite and the other is not.  For example, some Latter-day Saints practice circumcision for cultural reasons and not religious reasons, and I hope this will be outlawed someday.  Whereas Jews practice it as a religious rite - a rite which is as old as Abraham - this should be a protected right/rite.  One should be protected under religious freedom, the other should not. 

2 hours ago, Hamba Tuhan said:

Regarding circumcision being 'medically indicated', I asked our now former Relief Society president about this earlier this year. She works as a general practitioner, and she said our medical establishment here doesn't circumcise for 'medical' reasons as a rule because pretty much every genuine medical issue that Americans might be tempted to fix by simply amputating the foreskin has a non-surgical fix. And in the rare cases where a foreskin may need a non-surgical fix, that problem is never going to be present when a boy is newly born.

I think there are some potential genuine medical conditions where circumcision might be indicated, like paraphimosis.  Maybe it is pretty uncommon, I don't know, but certainly as circumcision becomes less and less popular, cases of paraphimosis will only increase.  This might be evident at birth, but can still happen at a fairly young age and may be needed correction before the child is old enough to make his own medical decisions.  For cases like that, I think the benefits can outweigh the risks, but it should be taken on a case by case basis.  But I think you are right, I can't think of any medical indication for circumcision at birth. 

2 hours ago, Hamba Tuhan said:

By the way, I haven't seen the film you watched, but did it note that most problems with foreskins that need to be fixed later are actually caused by people (parents or doctors) messing with them when the boy is still young? When a child is born, the foreskin is firmly fused to the glans in the exact same way that a fingernail is fused to its nail bed. This is why the first step in infant circumcision always has to be forcibly tearing the foreskin away from the glans -- like ripping a fingernail off. People who have been taught erroneously that there's something inherently dirty about an intact penis and therefore start retracting a young boy's foreskin actually create the tearing/bleeding/adhering that are likely to create problems later in life. It's essentially like pulling a fingernail back, allowing it to begin re-adhering and then doing it again.

No one needs to worry about cleaning inside a boy's foreskin since there is literally no 'inside' until much later in life. Separation occurs naturally around the time of puberty (almost as if someone designed it that way!). In my case, I was 13 years old when it happened.

If I remember right, I think they did go into that a little.  I hope circumcised parents are receiving a good education from their pediatricians before leaving the hospital.  That is something that will be greatly needed as we are becoming a culture that is moving away from routine circumcision.  Most circumcised males are pretty clueless about it coming from generations of circumcised males. 

Edited by pogi

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Posted (edited)
1 hour ago, pogi said:

There certainly is some overlap between culture and religion. The distinction as I see it is that one is a religious rite and the other is not ...  One should be protected under religious freedom, the other should not. 

Are you willing to extend this protection to the Muslim parents of daughters then?

Quote

Whereas Jews practice it as a religious rite - a rite which is as old as Abraham - this should be a protected right/rite.

Except that, as I've explained above, the current Jewish practice of denuding the glans dates to around AD 200.

Quote

I think there are some potential genuine medical conditions where circumcision might be indicated, like paraphimosis.  Maybe it is pretty uncommon, I don't know, but certainly as circumcision becomes less and less popular, cases of paraphimosis will only increase.  This might be evident at birth, but can still happen at a fairly young age and may be needed correction before the child is old enough to make his own medical decisions.

Paraphimosis occurs when the foreskin is retracted before it is loose enough. This can't occur in a young boy unless someone has forcibly torn it away from his glans first.

In any case, though circumcision may be the 'obvious' fix in America, it's not recommended here. I take the following straight from our health department (emphasis added):

Quote

Paraphimosis can usually be corrected without surgery:

  • Give oral pain killer and reassure the patient.
  • Wrap a firm compression bandage over the swollen area, starting at penile tip.
  • Leave bandage for 10--15 minutes.
  • Remove bandage and attempt to reduce foreskin over the glans. If unsuccessful, repeat bandage for further 15 minutes and re-attempt.
  • If manual reduction fails, obtain urgent surgical consult.
  • Circumcision is not indicated.

Note that even if surgery is necessary to reduce the swelling, that surgery won't be circumcision. 

Quote

I hope circumcised parents are receiving a good education from their pediatricians before leaving the hospital.

I hope so too! Considering how thoroughly Americans have been taught to fear normal male genitalia, the 'leave it alone' message needs to be loud and clear.

Edited by Hamba Tuhan

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Posted (edited)
15 hours ago, Hamba Tuhan said:

Are you willing to extend this protection to the Muslim parents of daughters then?

FGM is generally not considered a religious rite or obligation in Islam, as far as I understand.

Quote

It is usually initiated and carried out by women, who see it as a source of honour and fear that failing to have their daughters and granddaughters cut will expose the girls to social exclusion

For example, they do not practice it at all in Saudi Arabia, and it has been banned in other Islamic countries like Egypt.  The decree in Egypt was written by a committee of 15 Muslim religious scholars and medical practitioners. Some Muslims took a case to court stating the ban is unconstitutional. In 1997 the courts upheld the ban, stating:

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“Since circumcision is a surgical procedure for which Islamic law does not provide a rule making it obligatory, it should basically not be carried out except with the aim of medical treatment. Any surgery, regardless of its nature and extent, which is carried out without having the cause of its permissibility with all of its conditions in their entirety is considered a forbidden (haram) action from the Islamic and legal point of view, holding fast to the general basis upon which the human right of bodily integrity is ensured and to the criminalization of any action which is not legally sanctioned and leads to the encroachment of that integrity”

https://www.sciencedirect.com/science/article/pii/S1110570413000313

If Muslims here in the states could demonstrate in court that FGM is obligatory in Islamic law, then they absolutely should be extended this religious protection.  I just don't see that happening if they were unable to demonstrate as much in a Muslim country like Egypt. 

15 hours ago, Hamba Tuhan said:

Except that, as I've explained above, the current Jewish practice of denuding the glans dates to around AD 200.

Still, that is over 1,800 years of religious practice.  Ideally, the original practice of circumcision would be observed, but with such a long history of denuding the glans, I think it would be upheld in courts as a protected religious right. 

15 hours ago, Hamba Tuhan said:

Paraphimosis occurs when the foreskin is retracted before it is loose enough. This can't occur in a young boy unless someone has forcibly torn it away from his glans first.

In any case, though circumcision may be the 'obvious' fix in America, it's not recommended here. I take the following straight from our health department (emphasis added):

Note that even if surgery is necessary to reduce the swelling, that surgery won't be circumcision. 

Thanks for the info, that is interesting.

 

 

Edited by pogi

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4 hours ago, pogi said:

FGM is generally not considered a religious rite or obligation in Islam, as far as I understand.

That is certainly how it is viewed by some practitioners of Islam, in my experience, but the point remains that you would privilege the religious right over the right to bodily integrity when those rights clash. Is that correct? I've struggled back and forth with this one -- and it doesn't help that one of my good mates is a rabbi! -- but at this point I'm not sure it would make me feel any better if I were a circumcised man to know that my parents thought removing half the flesh from my genitals without my permission was OK because of their faith.

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41 minutes ago, Hamba Tuhan said:

but the point remains that you would privilege the religious right over the right to bodily integrity when those rights clash. Is that correct?

I think that strictly from a legal standpoint, religious liberty is a protected constitutional right in the US, whereas bodily integrity is not - which is why circumcision is legal today in the states. 

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The United States Constitution does not contain any specific provisions regarding the rights one has with respect to his or her physical body or the specific extent to which the state can act upon bodies.

Quote

 

...the Supreme Court avoided declaring bodily integrity a substantive due process right within the Fourteenth Amendment ...

https://scholarlycommons.law.cwsl.edu/cgi/viewcontent.cgi?article=1277&context=cwlr

 

 

57 minutes ago, Hamba Tuhan said:

I've struggled back and forth with this one -- and it doesn't help that one of my good mates is a rabbi! 

Me too.  I think bodily integrity should be a protected right, but at the same time this is a highly sacred and ancient rite with a strong scriptural injunction in the Torah and Bible.  This is a practice that we both believe was instigated by God.  The only difference is that the Jews don't believe that Jesus fulfilled the law (naturally), that is their right.  To not allow Jews to practice this ancient covenantal rite would be one of the most sever violations of religious liberty that I can think of.  It is one of the earliest rites and covenants mentioned in scripture by which one enters the Abrahamic covenant and house of Israel.  I do recognize that the practice has changed over time to include the removal of the whole foreskin instead of a small snip, but either way it was practiced, it would still be considered a violation of bodily integrity.  Apparently God was OK with that in this particular case.  The legal prohibition of this ancient religious rite would not stop the practice. Religiously observant Jews would simply practice it underground as FGM is practiced in many nations under less than ideal conditions.  I place religious liberty high up on the totem poll of rights, and feel obligated to defend the rights of other religions just as I would defend my own religious practices.  I may not understand it.  I may not agree with it.  But if it is not in violation of other constitutional rights, I think religious liberty should be privileged in this case. 

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41 minutes ago, pogi said:

I think that strictly from a legal standpoint, religious liberty is a protected constitutional right in the US, whereas bodily integrity is not - which is why circumcision is legal today in the states. 

An interesting approach for someone like me who lives in a nation with no constitutional bill of rights.

Are you aware that several European nations have been moving in the direction of a ban of all non-consensual genital cutting? So far, these attempts have been stalled by vehement opposition from both Muslims and Jews. It will be interesting to watch.

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4 minutes ago, Hamba Tuhan said:

An interesting approach for someone like me who lives in a nation with no constitutional bill of rights.

Are you aware that several European nations have been moving in the direction of a ban of all non-consensual genital cutting? So far, these attempts have been stalled by vehement opposition from both Muslims and Jews. It will be interesting to watch.

That will be interesting to watch indeed!

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52 minutes ago, Hamba Tuhan said:

An interesting approach for someone like me who lives in a nation with no constitutional bill of rights.

Are you aware that several European nations have been moving in the direction of a ban of all non-consensual genital cutting? So far, these attempts have been stalled by vehement opposition from both Muslims and Jews. It will be interesting to watch.

Germany moved in that direction. There is a documentary on Amazon Prime, Circumcision - the battle for the foreskin. I watched after participating in this thread. It is worthwhile to watch and has a balanced exploration of the topic. You will find several pieces of information that conflicts with what has been presented here. The discussion is not black and white as most activists would have us believe. Still don't feel like I have a horse in this race and have not been convinced that I need another soapbox in my life. Cheers

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58 minutes ago, Storm Rider said:

There is a documentary on Amazon Prime, Circumcision - the battle for the foreskin. I watched after participating in this thread. It is worthwhile to watch and has a balanced exploration of the topic.

Thanks, mate. No offence to you personally, but I'm disinclined to watch a movie that places a demonstrably false claim in its two-sentence synopsis: 'An everyday religious and hygienic practice that wasn't bothering anyone, that is until the judgement of the Cologne District Court changed everything'.

Quote

You will find several pieces of information that conflicts with what has been presented here.

Based on the above, I would be surprised if this were not the case. Cheers.

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Posted (edited)
On 1/3/2019 at 5:47 PM, Storm Rider said:

Germany moved in that direction. There is a documentary on Amazon Prime, Circumcision - the battle for the foreskin. I watched after participating in this thread. It is worthwhile to watch and has a balanced exploration of the topic. You will find several pieces of information that conflicts with what has been presented here. The discussion is not black and white as most activists would have us believe. Still don't feel like I have a horse in this race and have not been convinced that I need another soapbox in my life. Cheers

I noticed from the Amazon listing the video got nine reviews averaging 1 1/2 stars out of five stars. 

Not saying how reliable that is, but if anything, I would expect the reviews to skew toward favorability, as overtly partisan material such as this tends to attract a sympathetic audience. The fact it was so roundly panned is remarkable, tycker jag. 

Edited by Scott Lloyd

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3 hours ago, Hamba Tuhan said:

Thanks, mate. No offence to you personally, but I'm disinclined to watch a movie that places a demonstrably false claim in its two-sentence synopsis: 'An everyday religious and hygienic practice that wasn't bothering anyone, that is until the judgement of the Cologne District Court changed everything'.

Based on the above, I would be surprised if this were not the case. Cheers.

It is in German with subtitles. The easy deduction is that it was produced by Jews and Muslims that felt attacked by Germany's proposal to ban circumcisions completely. 

It never "smells" good when others immediately reject any resource, without review, and declare it of no worth. This is the kind of activism I despise mightily regardless of where it is found. I thought better of both of you. Cheers, I am done with this topic. 

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Posted (edited)
On 1/2/2019 at 5:22 PM, Hamba Tuhan said:

I did a bit of reading on this topic over the past few days. The number that was quoted in what I read (from the WHO, I believe) is that 80 per cent of female genital cutting in the world is merely drawing blood from the female foreskin (clitoral hood) or removing it altogether, i.e., something much less than or exactly analogous to male circumcision in nature. Where I live, parents who allow this to happen to their daughters overseas are prosecuted upon their return. But these same parents can take their sons off without a worry and allow a man to tear away and then cut off their foreskins with a pair of scissors (according to my former Young Men) or pay large sums of money to have it done in a private hospital, and everyone seems to think this is fine. And if anyone dares question it, that person is often mocked or accused of overreacting or 'whining'. The hypocrisy of the double standard is alive and well even in many non-circumcising nations.

That isn't what I've read while looking up information. The stats I found on WHO clump type, 1, 2, and 4 of FGM together for their stats. (Type 4 would be the version that you are describing, I think). Another group called human rights watch states that the most common versions of FGM are Types 1+2. This accounts for 85% of all FGMs

For those wondering, these are the definitions for all 4 types from the CDC:

Quote
Type I Partial or total removal of the cl*toris (clitorectomy).
Type II Partial or total removal of the cl*toris and the labia minora, with or without excision of the labia majora.
Type III Narrowing of the vag*nal orifice with creation of a covering seal by cutting and appositioning the labia minora and/or majora (infibulation), with or without excision of the clitoris.
Type IV All other harmful procedures to the female genitalia for nonmedical purposes (e.g., piercing, incising, pricking, scraping, and cauterizating)

 

For the record, I'm not a fan of any form of Circumcision. I'm not planning to have any of our future sons circumcised. My husband, who is from Peru and a culture with no to little circumcision finds it stupid besides. But I do think that the parallels to FGM is a little too broad brushed here, that I've read in this thread. Even if you were to take the most direct anatomical parallels in procedure (ie. the removal of the foreskins in both cases), it would likely not have the exact same consequences. I appreciate your anectdotes from your community and the experiences there. Male teen circumcision is unheard/rare of here, so it does give an interesting view as to the potential effects of the procedure. But if a female was to have the exact same procedure to remove foreskin, the results would likely be more extreme, since the amount of nerve endings on the tip of a cl*toris is about double the number than on the glans of a P*nis. Which means there would likely be more sensitivity, irritations, and s*xual dysfunctions. But that's likely not what's happening entirely, since the majority of FGM cases entail a larger variety of vulval tissue than is occurring to most men. To be blunt,  type 1 would be similar to clipping or removing the glans of the P*enis, not just the foreskin. And type 2, doesn't have a good direct equivalent, but the labia minora's removal would likely increase problems with sexual/reproductive/menstrual functioning, rates of infections, etc (as mentioned by the WHO previously cited).

One can believe the process is problematic or even barbaric....but I think it does a severe disservice to the very serious problems surrounding FGM when insisting that it is a direct parallel. The severity of surgery and the long-term effects are just not on the same level.

 

As I mentioned I'm not a fan of circumcision. All of my mother's son's (6 of them) were circumcised. I didn't enjoy the seeming discomfort and work it took to care for the wound and it seemed unnecessary. The potential benefits are at best minimal and have some problems at times with methodology in the research. It didn't make sense to me. That said I don't think my brothers are seriously harmed either. Obviously, it's all that they know, but the effect on their sexual development just isn't there and none of them or my friend's children have experienced immediate or long term harm. I haven't had a man come in with concerns about circumcision and sexual functioning and it doesn't impede any of my clients from having a healthy and mutually happy sexual relationship. My husband likewise has no adverse effect for a lack of circumcision as well. Pogi, in the case of long-term effect, I think you're fine not to worry/feel guilty as much. Though I think the doctor definitely overstepped and should have given you guys more space to feel confident in your decision. I've been slowly watching the documentary. And though I've enjoyed it, I've also noticed a heavy bias in presentation that makes me skeptical about what's being said.  

 

With luv,

BD

Edited by BlueDreams
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2 hours ago, BlueDreams said:

One can believe the process is problematic or even barbaric....but I think it does a severe disservice to the very serious problems surrounding FGM when insisting that it is a direct parallel. The severity of surgery and the long-term effects are just not on the same level.

Hi BlueDreans.  Thanks for chiming in.

I don't think anyone is saying FGM is not a problem, but I think that not comparing the two procedures does a disservice to the very serious problems surrounding MGM, because they are comparable on many medical and ethical levels which I will discuss a little below.  The problem arises when we try to group FGM and MGM into one type, which you rightly distinguish FGM into different types above.  What is often failed to note however, is that MGM is equally not a monolith. 

Several graphic cringe-worthy depictions of different types of MGM are described in a paper before the following comment is made:

Quote

By now it should be clear, as Debra DeLaet (among others) has argued,81,i that both male and female forms of genital alteration fall on a wide spectrum, and that the harms they may entail substantially overlap.21 That this is not commonly understood in the popular discourse is most likely due to the fact that when Westerners hear the term “FGM,” they tend to think of the most extreme forms of female genital cutting, done in the least sterilized environments, with the most drastic consequences likeliest to follow (since these are the forms to which they will typically have been exposed, due to their disproportionate representation in the media and in other popular accounts).49 When people hear the term “male circumcision,” by contrast, they are much more likely to think of the least severe forms of male genital cutting, done in the most sterilized environments, with the least drastic consequences likeliest to follow, largely because this is the form with which they are culturally familiar.11,82

However, as the anthropologist Zachary Androus has noted, this way of thinking is misleading: “The fact of the matter is that what’s done to some girls [in some cultures] is worse than what’s done to some boys, and what’s done to some boys [in some cultures] is worse than what’s done to some girls. By collapsing all of the many different types of procedures performed into a single set for each sex, categories are created that do not accurately describe any situation that actually occurs anywhere in the world.”83

https://www.dovepress.com/female-genital-mutilation-and-male-circumcision-toward-an-autonomy-bas-peer-reviewed-fulltext-article-MB

 

2 hours ago, BlueDreams said:

But if a female was to have the exact same procedure to remove foreskin, the results would likely be more extreme, since the amount of nerve endings on the tip of a cl*toris is about double the number than on the glans of a P*nis. 

We really should be comparing the foreskin (clitoral hood) of the clitoris to the foreskin of the penis (they are homologous) and not the glans of the penis.  The foreskin is way more sensitive then the glans of the penis and way more of it is removed in males than females - putting them at greater risk for infection and other complications.  

Here is a more detailed description of the different types of FGM:

Quote

 

FGM Type 1 – This refers to the partial or total removal of the clitoral glans (the part of the clitoris that is visible to the naked eye) and/or the clitoral prepuce (“hood”). This is sometimes called a “clitoridectomy,”28 although such a designation is misleading: the external clitoral glans is not always removed in this type of FGM, and in some versions of the procedure–such as with so-called “hoodectomies”–it is deliberately left untouched.33 There are two major sub-types. Type 1(a) is the partial or total removal of just the clitoral prepuce (ie, the fold of skin that covers the clitoral glans, much as the penile prepuce covers the penile glans in boys; in fact, the two structures are embryonically homologous).34d Type 1(b) is the same as Type 1(a), but includes the partial or total removal of the external clitoral glans. Note that two-thirds or more of the entire clitoris (including most of its erectile tissue) is internal to the body envelope,35 and is therefore not removed by this type, or any type, of FGM.

FGM Type 2 – This refers to the partial or total removal of the external clitoral glans and/or the clitoral hood (in the senses described above), and/or the labia minora, with or without removal of the labia majora. This form of FGM is sometimes termed “excision.” Type 2(a) is the “trimming” or removal of the labia minora only; this is also known as labiaplasty when it is performed in a Western context by a professional surgeon (in which case it is usually intended as a form of cosmetic “enhancement”).33 In this context, such an intervention is not typically regarded as being a form of “mutilation,” even though it formally fits the WHO definition. Moreover, even though such “enhancement” is most often carried out on consenting adult women in this cultural context, it is also sometimes performed on minors, apparently with the permission of their parents.11,36 There are two further subtypes of FGM Type 2, involving combinations of the above interventions.

FGM Type 3 – This refers to a narrowing of the vaginal orifice with the creation of a seal by cutting and repositioning the labia minora and/or the labia majora, with or without excision of the external clitoris. This is the most extreme type of FGM, although it is also one of the rarest, occurring in approximately 10% of cases.11,37 When the “seal” is left in place, there is only a very small hole to allow for the passage of urine and menstrual blood, and sexual intercourse is rendered essentially impossible. This type of FGM is commonly called “infibulation” or “pharaonic circumcision” and has two additional subtypes.

FGM Type 4 – This refers to “all other harmful procedures to the female genitalia for non-medical purposes” and includes such interventions as pricking, nicking, piercing, stretching, scraping, and cauterization.32 Counterintuitively for this final category – which one might expect to be even “worse” than the ones before it – several of the interventions just mentioned are among the least severe forms of FGM. Piercing, for example, is another instance of a procedure – along with labiaplasty (FGM Type 2) and “clitoral unhooding”33 (FGM Type 1) – that is popular in Western countries for “non-medical purposes,” and can be performed hygienically under appropriate conditions.11,38–40

https://www.dovepress.com/female-genital-mutilation-and-male-circumcision-toward-an-autonomy-bas-peer-reviewed-fulltext-article-MB

 

The equivalent of circumcision as performed in the states would be parallel to FGM type 1(a), or "hoodectomy".  So, what prevents us from comparing these two forms of circumcision from an ethical and medical perspective other than one is much bigger than the other?  Why is one illegal and unethical, and the other almost routine and encouraged when both are elective, medically unnecessary procedures of homologous genital tissue?  You don't see an ethical discrepancy here at all?  

Quote

 

In the first section of this essay, I call into question the claims upon which these distinctions are typically premised. Specifically, I show that at least certain forms of FGM (or female genital alteration [FGA]),21 including forms that are legally prohibited in Western societies, are demonstrably less harmful than the most prevalent forms of male circumcision. I also show that certain forms of male circumcision (or male genital alteration [MGA]), including forms that are common in parts of Africa and elsewhere, can be at least as harmful as the most extreme forms of FGA as practiced in any context. I will also question the claims that have been made on the point of health benefits, with respect to both types of genital alteration.

...

The harm-based argument, then, does not turn out to be sufficient to draw a strict moral distinction between male and female forms of genital cutting practices. The consequence of this conclusion can be stated as a conditional: if the degree of harm vs benefit commonly attributed to male circumcision is seen as being compatible with its permissibility in Western societies, then forms of female genital cutting that result in a similar degree of harm vs benefit must also be considered permissible on these grounds.c Yet many would resist this conclusion. Indeed, the official position of such influential bodies as the World Health Organization and the United Nations is that any kind of medically unnecessary, non-consensual alteration of the female genitalia – no matter how minor the incision, no matter what type of tissue is or is not removed, no matter how slim the degree of risk, and no matter how sterile the equipment used – is by definition an impermissible “mutilation.”

https://www.dovepress.com/female-genital-mutilation-and-male-circumcision-toward-an-autonomy-bas-peer-reviewed-fulltext-article-MB

 

Please, please read the whole article.  

Here is the abstract:

Quote

Abstract: The non-therapeutic alteration of children’s genitals is typically discussed in two separate ethical discourses: one for girls, in which such alteration is conventionally referred to as “female genital mutilation” (or FGM), and one for boys, in which it is conventionally referred to as “male circumcision.” The former is typically regarded as objectionable or even barbaric; the latter, benign or beneficial. In this paper, however, I call into question the moral and empirical basis for such a distinction, and I argue that it is untenable. As an alternative, I propose an ethical framework for evaluating such alterations that is based upon considerations of bodily autonomy and informed consent, rather than sex or gender.

I can't agree more with the proposal. 

 

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5 hours ago, BlueDreams said:

Pogi, in the case of long-term effect, I think you're fine not to worry/feel guilty as much. Though I think the doctor definitely overstepped and should have given you guys more space to feel confident in your decision. I've been slowly watching the documentary. And though I've enjoyed it, I've also noticed a heavy bias in presentation that makes me skeptical about what's being said.  

Thanks for your concern.  Truly.

As I have mentioned previously, I don't worry about long term effect so much.  Having said that, I can't help but feel some guilt for what I see now as an ethical violation.  Long-term consequences or not, I put my son through unnecessary pain which affected him for many days (he would not take a swaddle and was almost lethargic for several day after, I should point out - which is very common), and unnecessary risk (I thank God that nothing serious happened). I did not defend his right to bodily integrity and instead made an irreversible decision for him to deform his genitals in a way which I should not have been allowed to do.  That should not have been my choice to make.  I can't take it back.  I feel guilty in the same way that I would and should feel guilty for performing a hoodectomy on my daughter, even if everything went ok with no long term negative consequences.  It just is not right.

The fact is, most FGM procedures that are not of the severe types, especially when performed by competent medical professionals, have no long term negative consequences either.  Yet we all view these procedures, no matter how minor they may be, as serious ethical violations.  To not compare the ethical implications between male and female genital mutilation doesn't seem right.  Not to down play FGM, but to acknowledge that male genital integrity should be equally protected. 

I should also note that I too noticed the bias in the movie, and also felt some skepticism.  The video piqued my interest to research the topic more - both sides, including the CDC, APA, and WHO. So far, the most convincing argument for me ethically has been the one I linked to above.  But also, the following link has some very good information as well that I would highly recommend checking out:

https://www.doctorsopposingcircumcision.org/

It is almost impossible not to find bias when it comes to FGM and MGM, but all arguments are still worthy of consideration when backed by solid evidence. 

I find it an oddity that we are one of the last developed nations that are defending the practice.  What are we not getting?  The only reason that some developed nations have not banned it outright is the fear that it will be pushed underground.  That is a reasonable fear, and that is why I think there should be a religious exception. 

Should being born a healthy male be an indication for surgical correction? 

Edited by pogi
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On 1/4/2019 at 4:04 PM, pogi said:

Hi BlueDreans.  Thanks for chiming in.

I don't think anyone is saying FGM is not a problem, but I think that not comparing the two procedures does a disservice to the very serious problems surrounding MGM, because they are comparable on many medical and ethical levels which I will discuss a little below.  The problem arises when we try to group FGM and MGM into one type, which you rightly distinguish FGM into different types above.  What is often failed to note however, is that MGM is equally not a monolith. 

Several graphic cringe-worthy depictions of different types of MGM are described in a paper before the following comment is made:

I read the article you quoted and I have similar concerns to it as I do the netflix video. It's proving a point and is weighing resources on such topics in a way to form and maintain an argument. I also noted that there are few to no actual numbers when describing the complications in an international context about circumcision. Looking things up, this could be in part due to a lack of information/research on this area....but the article doesn't mention this, using whatever they do have to compare a bleak picture of male circumcision v underplaying the female circumcision...in my opinion. Some of their descriptions tied to female s*xuality irks me in how it is portrayed to downplay female circumcision. Or describing certain elective plastic surgery procedures such as labioplasty in a way that underplays the controversy around said procedures or their fairly unstudied consequences. I'm not saying this would be their intent, but again, the level of long-term effect, percentage-wise, for male circumcision v. female is likely very different due to the prevalence in societies where there are more sterile environments/procedures and better cleaning practices. In other words the percentage of boys/men having severe complications or lifetime effect would likely be smaller than girls/women. 

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We really should be comparing the foreskin (clitoral hood) of the clitoris to the foreskin of the penis (they are homologous) and not the glans of the penis.  The foreskin is way more sensitive then the glans of the penis and way more of it is removed in males than females - putting them at greater risk for infection and other complications.  

This is a problematic comparison. Research on the foreskin sensitivity seems to be very mixed on this area. My guess is some of the mixed results are tied to 1.) bias  of researchers one way or another 2.) the subjective nature of sensitivity and what is considered s*xually arousing  3.) a tendency toward small scale studies. Also sensitivity doesn't necessarily translate to increased s*xual pleasure. Without going into detail, I asked my husband what he thought was more tied to s*xual pleasure and he laughed at the notion that it would be the foreskin. I assumed as much considering my work and just how little the foreskin comes up. But I'm also not a dude :P.  I wouldn't usually give anecdotal evidence as the sole proof....but finding actual research consensus as opposed to singular (and often bias-laden) studies not pointing in conflicting or statistically marginal directions was really really hard. I found a couple of interesting dry reads. Such as this or this. But it's generally understudied. The other problem with this is that with most people that you will be discussing it with, it isn't a dramatically large amount of tissue removed and the risks are small or with minimal consequence according to this WHO report . The 15 sq inches only applies to adult/post-adolescent males. In the US, jewish populations, and other populations the vast majority of circumcisions happen to young babies. Plus much of this research assumes direct parallels between male and female genital function/effect. 

Quote

Here is a more detailed description of the different types of FGM:

The equivalent of circumcision as performed in the states would be parallel to FGM type 1(a), or "hoodectomy".  So, what prevents us from comparing these two forms of circumcision from an ethical and medical perspective other than one is much bigger than the other?  Why is one illegal and unethical, and the other almost routine and encouraged when both are elective, medically unnecessary procedures of homologous genital tissue?  You don't see an ethical discrepancy here at all?  

You could try to directly compare the two....my problem was paralleling them as having similar consequence and concern. Even type 1's have been shown in studies to increase significant long-term risks. But the comparisons can also lead to unwanted conclusions when looking at varying areas of research. For example, in societies where male circumcisions is normal, most can see it has little direct effect, and they like the practice for whatever reason using what will be seen as extreme examples, may not be as effective as one would hope. Having it compared to foot binding or FGM's (with no/little distinctions....which was happening on this thread) can be off-putting and viewed as overdramatic.....especially when they see no long-lasting problems from the procedure and they wanted it for their child.  And the majority of them will fall into that category in nations where trained professionals with sterile tools are used.  One can talk about shards of glass and barbers doing a sketchy procedure...and what that will say to those in favor of male circumcision is "thank heavens we don't live there...we should encourage clean and safe medical procedures to reduce/remove these adverse effects. Comparing minor FGM procedures can also change the double standard in the opposite direction...which has already happened to some extent as the documentary mentions somewhat. Since male circumcisions are fine and dandy maybe there are forms of female circumcisions that are fine and it's more about procedure or extreme measures that causes the problems....plus only hearing extreme cases. And type 4's do have very minimal consequence that are usually short-lived (minor infections, inflammation, etc). Lastly in comparing it can still lead to pushback by using the same comparison where the current general method of circumcisions in developed nations has minimal consequence and some potential long-term benefits (that are marginal, sure....but still have research to back it up), the same cannot be said about female circumcision at even the type 1a level. There are no known benefits and there are consequences that are long term (even if at times only with slight increase of risk. 

I never said I don't an ethical concern....there is if you believe that any form of change to a child's body before consent is wrong. And at first glance that seems right...until you think of things like ear piercings of infants or other demarcations of culture that cause some pain or change to the body, isn't medically necessary, but is culturally proscribed/enforced. Are these inherently wrong?.... even if they cause minimal to now long term effects except in extreme cases? What makes them wrong?  And if there are religious edicts tied to them, what suddenly makes them okay? These are more rhetorical, since depending on our current beliefs and practices our answers are likely to change. Which is the problem with leaning into the ethics side of it. What makes something ethically right will also depend on one's cultural and personal perspective. It is far less concrete that medical research and even there, the research still cannot escape personal, cultural, and national biases.

 

Like you, I've been looking into the research, perspectives, etc. I don't expect this to convince you per se one way or another to anything. I just wanted to respond to what you'd given me. 

 

With luv,

BD

Edited by BlueDreams
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For the record, I would object to ear piercings of infants on the same ethical grounds as I would routine neonatal circumcision: that for purely cosmetic reasons, it amounts to the infliction of pain,  discomfort and bodily alteration on one incapable of giving informed consent. 

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38 minutes ago, Scott Lloyd said:

For the record, I would object to ear piercings of infants on the same ethical grounds as I would routine neonatal circumcision: that for purely cosmetic reasons, it amounts to the infliction of pain,  discomfort and bodily alteration on one incapable of giving informed consent. 

What about a child born with an extra finger (i.e., polydactylism)? 

Seems like cold comfort to tell your daughter that she has to spend her entire childhood looking like one of the bad guys from the Princess Bride because you didn't want to inflict pain upon her for purely cosmetic reasons. 

 

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2 hours ago, BlueDreams said:

I read the article you quoted and I have similar concerns to it as I do the netflix video. It's proving a point and is weighing resources on such topics in a way to form and maintain an argument.

I just don't know if you are going to find an argument for or against circumcision that doesn't do this - even in the medical research.  I don't necessarily see the problem with it either, so long as it is well cited.

The difference between the movie and the article is that one was created by a bachelor of arts graduate and filmmaker, the other was peer-reviewed and published in a respected journal by a PhD ethicist and was very well cited/referenced:

Quote

Brian D Earp is a scientist and ethicist. He holds degrees from Yale, Oxford, and Cambridge Universities, including an M.Phil. degree in the history, philosophy, and sociology of science and medicine, focusing on male and female genital altering surgeries. Brian has served as a Guest Editor for the Journal of Medical Ethics, editing a special issue on the topic of childhood circumcision, and has published widely in the leading journals in his field.

2 hours ago, BlueDreams said:

...using whatever they do have to compare a bleak picture of male circumcision v underplaying the female circumcision...in my opinion. 

I just don't see this happening at all in the paper.  The point was that most people, when comparing MGM to FGM many people compare the most extreme forms of FGM performed in the least sterile environments to less severe forms of MGM performed in the most sterile environment. The paper did not downplay FGM at all, it simply correctly pointed out that MGM is not a monolith either so when we compare the two, we who have to look at the whole picture of what is going on. 

2 hours ago, BlueDreams said:

 I also noted that there are few to no actual numbers when describing the complications in an international context about circumcision. Looking things up, this could be in part due to a lack of information/research on this area...

 You are right, it is because it is not required for providers to report adverse events with circumcision.  We don't really have a good idea of how dangerous it may be... We do have actual case studies and do know that the rates of botched circumcisions may be fairly high based on anectdotal reports of pediatric urologists.  We do know that death happens, we just don't have a good idea of how often.  We don't know how frequent serious infections may occur, but they most certainly occur more freuently than UTI's in uncircumcised people.  The point is we don't really know...and THAT is an ethical problem, because without that information, informed consent - an important medical ethic - is impossible.  That alone makes it an unethical medical practice!

2 hours ago, BlueDreams said:

This is a problematic comparison. Research on the foreskin sensitivity seems to be very mixed on this area. My guess is some of the mixed results are tied to 1.) bias  of researchers one way or another 2.) the subjective nature of sensitivity and what is considered s*xually arousing  3.) a tendency toward small scale studies. Also sensitivity doesn't necessarily translate to increased s*xual pleasure. Without going into detail, I asked my husband what he thought was more tied to s*xual pleasure and he laughed at the notion that it would be the foreskin. I assumed as much considering my work and just how little the foreskin comes up. But I'm also not a dude :P.  I wouldn't usually give anecdotal evidence as the sole proof....but finding actual research consensus as opposed to singular (and often bias-laden) studies not pointing in conflicting or statistically marginal directions was really really hard. I found a couple of interesting dry reads. Such as this or this. But it's generally understudied. 

The fact that we are even questioning the sensitivity of the male foreskin without giving equal consideration to the female clitoral hood shows a double standard. We equally lack the same research on the clitoral hood, so why do we automatically conclude that the clitoral hood is highly sensitive and important to female sexuality and therefore unethical to remove, yet conclude that the foreskin is more dispensable when they are homologous tissue?  It don't see the same mixed research that you do.  The only ones who claim mixed results (that I have seen) are from proponents of circumcision who seem to be intentionally taking things out of context.  It is not hard to prove.  Any uncircumcised male can tell you that the foreskin is more sensitive than the glans or underlying tissue.  Even circumcised males will feel more sensitivity on the line where the foreskin connects and was excised.   How that converts to s*xual pleasure is equally subjective in females.  So, why should we assume that the female foreskin (clitoral hood) is more important for sexuality than the male foreskin?  This seems untenable. 

2 hours ago, BlueDreams said:

The other problem with this is that with most people that you will be discussing it with, it isn't a dramatically large amount of tissue removed and the risks are small or with minimal consequence according to this WHO report

It is still more tissue removed in males than females - way more. I flat out reject the WHO report.  How can they say that there is "minimal consequence" while simultaneously admitting that the data is extremely limited?  Is losing your penis from a botched circumcision a minimal consequence?  Is death from infection a minimal consequence?  We know these things happen, we just don't know how often, which is an ethical problem when it comes to informed consent. 

2 hours ago, BlueDreams said:

Plus much of this research assumes direct parallels between male and female genital function/effect. 

To assume that the female foreskin is more important than the male foreskin without any evidence is equally problematic.   We know they are homologous tissues that can be erogenously stimulated in both sexes, so why should we assume they are that different in terms of s*xuality?  We know that people can receive s*xual pleasure with or without it in both s*xes, so what evidence gives us the right to privilege and place the female foreskin on a pedestal while placing the male foreskin on the chopping block?

I can't respond to everything right now...

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5 minutes ago, pogi said:

The fact that we are even questioning the sensitivity of the male foreskin without giving equal consideration to the female clitoral hood shows a double standard.

And one that so many women seem completely blind to. I honestly can't wrap my brain around it.

Quote

Any uncircumcised male can tell you that the foreskin is more sensitive than the glans or underlying tissue. 

I can absolutely verify this. But then it's not just about sensitivity, even. It's also about having a self-gliding mechanism that completely eliminates all friction. And then it's also about being protected not just from friction but also from heat and cold, physical discomfort and everything else. And then it's about possessing all of my sexual anatomy and not having to wonder why I don't.

Quote

It is still more tissue removed in males than females - way more.

Yep, and to argue that it's not 'a dramatically large amount of tissue removed' from a small baby when it results in an adult male missing approximately 100 square centimetres (15 square inches) of his penis seems disingenuous at best. 

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2 hours ago, Scott Lloyd said:

For the record, I would object to ear piercings of infants on the same ethical grounds as I would routine neonatal circumcision: that for purely cosmetic reasons, it amounts to the infliction of pain,  discomfort and bodily alteration on one incapable of giving informed consent. 

I hate when I see babies with their ears pierced as well, poor things.

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1 hour ago, Amulek said:

What about a child born with an extra finger (i.e., polydactylism)? 

Seems like cold comfort to tell your daughter that she has to spend her entire childhood looking like one of the bad guys from the Princess Bride because you didn't want to inflict pain upon her for purely cosmetic reasons. 

 

Given how much we use our hands and how everything is made for five digits, an argument for non-cosmetic removal could be made. 

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13 minutes ago, Tacenda said:

I hate when I see babies with their ears pierced as well, poor things.

Same. But then I feel a bit comforted knowing that nothing has been removed and the holes can often heal over if that's what the body's owner wants. Imagine seeing babies with their outer ears cut off!

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13 minutes ago, Tacenda said:

I hate when I see babies with their ears pierced as well, poor things.

Having had mine pierced and getting infections and seeing how babies and kids play with their ears with dirty hands...not a good idea imo. 

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1 hour ago, pogi said:

I just don't know if you are going to find an argument for or against circumcision that doesn't do this - even in the medical research.  I don't necessarily see the problem with it either, so long as it is well cited.

The difference between the movie and the article is that one was created by a bachelor of arts graduate and filmmaker, the other was peer-reviewed and published in a respected journal by a PhD ethicist and was very well cited/referenced:

I just don't see this happening at all in the paper.  The point was that most people, when comparing MGM to FGM many people compare the most extreme forms of FGM performed in the least sterile environments to less severe forms of MGM performed in the most sterile environment. The paper did not downplay FGM at all, it simply correctly pointed out that MGM is not a monolith either so when we compare the two, we who have to look at the whole picture of what is going on. 

 You are right, it is because it is not required for providers to report adverse events with circumcision.  We don't really have a good idea of how dangerous it may be... We do have actual case studies and do know that the rates of botched circumcisions may be fairly high based on anectdotal reports of pediatric urologists.  We do know that death happens, we just don't have a good idea of how often.  We don't know how frequent serious infections may occur, but they most certainly occur more freuently than UTI's in uncircumcised people.  The point is we don't really know...and THAT is an ethical problem, because without that information, informed consent - an important medical ethic - is impossible.  That alone makes it an unethical medical practice!

The fact that we are even questioning the sensitivity of the male foreskin without giving equal consideration to the female clitoral hood shows a double standard. We equally lack the same research on the clitoral hood, so why do we automatically conclude that the clitoral hood is highly sensitive and important to female sexuality and therefore unethical to remove, yet conclude that the foreskin is more dispensable when they are homologous tissue?  It don't see the same mixed research that you do.  The only ones who claim mixed results (that I have seen) are from proponents of circumcision who seem to be intentionally taking things out of context.  It is not hard to prove.  Any uncircumcised male can tell you that the foreskin is more sensitive than the glans or underlying tissue.  Even circumcised males will feel more sensitivity on the line where the foreskin connects and was excised.   How that converts to s*xual pleasure is equally subjective in females.  So, why should we assume that the female foreskin (clitoral hood) is more important for sexuality than the male foreskin?  This seems untenable. 

It is still more tissue removed in males than females - way more. I flat out reject the WHO report.  How can they say that there is "minimal consequence" while simultaneously admitting that the data is extremely limited?  Is losing your penis from a botched circumcision a minimal consequence?  Is death from infection a minimal consequence?  We know these things happen, we just don't know how often, which is an ethical problem when it comes to informed consent. 

To assume that the female foreskin is more important than the male foreskin without any evidence is equally problematic.   We know they are homologous tissues that can be erogenously stimulated in both sexes, so why should we assume they are that different in terms of s*xuality?  We know that people can receive s*xual pleasure with or without it in both s*xes, so what evidence gives us the right to privilege and place the female foreskin on a pedestal while placing the male foreskin on the chopping block?

I can't respond to everything right now...

Why does it need to be compared to what is done or not done to females anyway?  Either it is right or wrong on its own.  

 

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