Tuesday, January 27, 2009

My Child's Genitals Are Not Up For Discussion

So mostly I talk about silly stuff my kid or my husband says, or something funny I saw on the internet, or something I'm eating (or would like to eat.) Occasionally I get a little maudlin and talk about politics or something else that I take seriously, usually in regards to how it relates to me or my family.

This is a little bit like that. But not really. But sort of. I'm deadly fucking serious right now.

There is a lot of talk out there on the internet about circumcision, especially among parents or about-to-be parents. Especially right now, in light of the Momversation webcasts.

I would like to go on the record and say that I think all of the participants made excellent points. I think some of them made them in ways that left something to be desired, but people have strong points of view on circumcision. I understand and respect that.

However, some of the commenters on some of the participants' sites have left a bad taste in my mouth. Because I left the last comment on Mighty Girl's blog before she closed the comments, I am concerned that a lot of wind might blow in this direction, so I would like to fully articulate my position on the subject.

  • I have a son, so obviously, the topic of circumcision has come up between my husband and I.
  • I am pregnant again, and for that reason, I anticpate that the subject will come up again.
  • Male circumcision is a personal choice, typically made by a parent or parents.
  • Male circumcision is not the same as female circumcision, also known as female genital mutilation. They are comparing apples to oranges.
  • My son's penis is the business of expressly no one but myself, his father, and his pediatrician, should need arise.

For the record, I very much resent on the behalf of parents who have made or will make the decision to circumcise their sons the implication that female genital mutilation is comparable.

Here are some facts about this practice:

Female Genital Mutilation (FGM) is the partial or total removal of the female external genitalia. External genitals include the clitoris, labia, mons pubis (the fatty tissue over the pubic bone), and the urethral and vaginal openings. (Source: World Health Organization, 1995. "Female Genital Mutilation: Report of a WHO Technical Working Group". )

The practice of FGM is often called "female circumcision" (FC), implying that it is similar to male circumcision. However, the degree of cutting is much more extensive, often impairing a woman's sexual and reproductive functions. (Source: Toubia, N., 1993. "Female Genital Mutilation: A Call for Global Action." New York: Women, Ink)

Female Genital Mutilation is practiced globally.

FGM is practiced in at least 26 of 43 African countries; the prevalence varies from 98 percent in Somalia to 5 percent in Zaire. A review of country-specific demographic and health surveys shows FGM prevalence rates of 97 percent in Egypt, 94.5 percent in Eritrea, 93.7 percent in Mali, 89.2 percent in Sudan, and 43.4 percent in the Central African Republic.

FGM is also found among some ethnic groups in Oman, the United Arab Emirates, and Yemen, as well as in parts of India, Indonesia, and Malaysia. (Source: Toubia, N., 1993.)

FGM has become an important issue in Australia, Canada, England, France, and the United States due to the continuation of the practice by immigrants from countries where FGM is common. (Source: Ibid.)

In 1995 the World Health Organization classified FGM into four broad categories. They are as follows:

Type 1
Excision (removal) of the clitoral hood with or without removal of part or all of the clitoris.

Type 2
Removal of the clitoris together with part or all of the labia minora.

Type 3 (infibulation)
Removal of part or all of the external genitalia (clitoris, labia minora, and labia majora) and stitching and/or narrowing of the vaginal opening leaving a small hole for urine and menstrual flow.

Type 4 (unclassified)
All other operations on the female genitalia, including:

  • Pricking, piercing, stretching, or incision of the clitoris and/or labia;
  • Cauterization by burning the clitoris and surrounding tissues;
  • Incisions to the vaginal wall;
  • Scraping (angurya cuts) or cutting (gishiri cuts) of the vagina and surrounding tissues; and
  • Introduction of corrosive substances or herbs into the vagina.

Type I and Type II operations account for 85 percent of all FGM. Type III (infibulation) is common in Djibouti, Somalia and Sudan and in parts of Egypt, Ethiopia, Kenya, Mali, Mauritania, Niger, Nigeria, and Senegal.

Complications arising from FGM are frequent and often serious.

The highest maternal and infant mortality rates are in FGM-practicing regions.

The actual number of girls who die as a result of FGM is not known. However, in areas in the Sudan where antibiotics are not available, it is estimated that one-third of the girls undergoing FGM will die.

Conservative estimates suggest that more than one million women in Centrafrican Republic (CAR), Egypt, and Eritrea, the only countries where such data is available, experienced adverse health effects from FGM.

One quarter of women in CAR and 1/5 of women in Eritrea reported FGM-related complications.

Where medical facilities are ill-equipped, emergencies arising from the practice cannot be treated. Thus, a child who develops uncontrolled bleeding or infection after FGM may die within hours.


Immediate physical symptoms may include the following:

Intense pain and/or hemorrhage that can lead to shock during and after the procedure. A 1985 Sierra Leone study found that nearly 97 percent of the 269 women interviewed experienced intense pain during and after FGM, and more than 13 percent went into shock.

Hemorrhage can also lead to anemia.

Wound infection, including tetanus. A survey in a clinic outside of Freetown (Sierra Leone) showed that of 100 girls who had FGM, 1 died and 12 required hospitalization. Of the 12 hospitalized, 10 suffered from bleeding and 5 from tetanus. Tetanus is fatal in 50 to 60 percent of all cases.

Damage to adjoining organs from the use of blunt instruments by unskilled operators. According to a 1993 nationwide study in the Sudan, this occurs approximately 0.3 percent of the time.

Urine retention from swelling and/or blockage of the urethra.

Sound pleasant? Not so much.

Let's talk about male circumcision now.

Male circumcision is the removal of some or all of the foreskin (prepuce) from the penis. The word "circumcision" comes from Latin circum (meaning "around") and c├Ždere (meaning "to cut").

This is an operation as old as mankind, highlighted today by Jewish and Muslim tradition in which all males are typically circumcised as a part of their faith and culture. It is performed worldwide by many tribes and cultures as an initiation rite and, despite some aggressive opposition, it is routinely done at birth for the majority of boys in the USA as well as many in Australia, Canada, New Zealand, South Africa and much of the English speaking world. Overall it is estimated that a quarter of the male population is circumcised - about 750 million males.

Benefits to circumcision:

(I freely acknowledge that this information is appended from a source who is pro-circumcision. Not being in posession of a penis of my own, I have to rely on secondary sources.)

1. Many older men, who have bladder or prostate gland problems, also develop difficulties with their foreskins due to their surgeon's handling, cleaning, and using instruments. Some of these patients will need circumcising.

2. Some older men develop cancer of the penis - about 1 in 1000 - fairly rare, but tragic if you or your son are in that small statistic. Infant circumcision gives almost 100% protection, and young adult circumcision also gives a large degree of protection.

3. Cancer of the cervix in women is due to the Human Papilloma Virus. It thrives under and on the foreskin from where it can be transmitted during intercourse. An article in the British Medical Journal in April 2002 suggested that at least 20% of cancer of the cervix would be avoided if all men were circumcised.

4. Protection against HIV and AIDS. Another British Medical Journal article in May 2000 suggested that circumcised men are 8 times less likely to contract the HIV virus.

5. As with HIV, so some protection exists against other sexually transmitted infections. Accordingly, if a condom splits or comes off, there is some protection for the couple.

6. Lots of men, and their partners, prefer the appearance of their penis after circumcision, It is odor-free, it feels cleaner, and they enjoy better sex. Awareness of a good body image is a very important factor in building self confidence.

7. Balanitis is an unpleasant, often recurring, inflammation of the glans. It is quite common and can be prevented by circumcision.

8 Urinary tract infections sometimes occur in babies and can be quite serious. Circumcision in infancy makes it 10 times less likely.

In comparison, the WHO and every other recognized health, human rights, and civil rights organization who have addressed it have acknowledged that there are few, if any, health or social benefits to FGM, and the drawbacks are numerous and severe.

I am aware that a cost-benefit analysis when it comes to circumcision is not necessarily appropriate. Lots of people have very strong feelings one way or another, which, as I said before, I understand and respect. However, let me say that the research that I've seen against circumcision mostly deals with the fact that it is unnecessary.

At this point, I would like to make something perfectly clear, so sit down, put away your righteous indignation, and listen very carefully, because I am going to say this probably multiple times before anyone listens to me. You can save yourself some time by catching on right now.

Circumcise your son, don't circumcise him. Do it as an infant, do it as a child, let him make the decision for himself later on as an adult. Do it for medical reasons or social reasons or religious reasons. I honestly don't give a tiny rat's ass about your kid's schwantz. I have enough to do, teaching my own son responsible penis usage, without worrying about yours.

One of the things that has truly shocked me as a parent is other parents' willingness to mind my business for me. I would never be so presumptuous as to inquire about a stranger's intent to circumcise their child, or not; and yet I was asked by no fewer than six when I was pregnant and when my son was an infant.

I politely declined to answer that question, the reason being that I certainly hope no one is discussing my genitals with strangers behind my back, and I think it's an inappropriate topic of conversation. Max may have that conversation with anyone whom he chooses to once he is old enough to do so appropriately, at which point, it will no longer be my business.

I don't care whether your son is circumcised. Please don't ask me whether mine is. It's not your business.

As Maggie points out in the Momversation video, why is it so necessary for people to convince others that they are wrong in order to believe that they, themselves, are right? The tenor of this discussion has gotten way, way, way out of hand and I am insulted on behalf of people who have the temerity to make their own decisions.

Do not tell me how to raise my child. Do not tell me he is too young for potty training or too old to be wearing diapers. Do not tell me why I should have nursed Max longer or gone back to work sooner. I am a full-grown adult, and I will handle that decision for myself. Please feel free to do the same for your child. I will do you the small courtesy of not judging you.

And finally: I welcome vigorous discussion and debate on the topic, but one thing I will not change my mind about is that my son's penis is his business, not yours. By all means, let's talk about it, a lot, but you won't change my mind on that topic. Also, I won't tell you you're wrong, even if I disagree with you, but you also won't change my mind on the fact that circumcision and female genital mutilation are, in fact, not the same thing. Let's just assume that I'm actually quite bright and don't try.

55 comments:

Anonymous said...

Would you allow a labiaplasty to be performed on an infant girl? Or even tolerate a pin prick to her private parts? Then why could you turn such a blind eye to your son's suffering?

Treen said...

Oh my lord seriously? People honestly compare these two concepts? I'm so glad I do not have children, because catty, meddling, overbored mothers are not something I have the energy or patience to deal with.

At least you had the guts to back up your statement without feeling the need to attack people anonymously. Max seems to be turning out just fine to me.

A said...

Molly,

You are exactly right when you say "my son's penis is his business, not yours."

In fact, any boy would (if asked) say that, eventually, to his own parents.

Therefore you are mistaken when you contradict your own wisdom, saying "My son's penis is the business of expressly no one but myself, his father, and his pediatrician, should need arise."

Boys have a right to not be unnecessarily circumcised unless they make a different choice for themselves.

NotStyro said...

Great post. Bravo.

Sums the whole male circumcision v FGM and benefits of male circumcision without distorting the facts for pro/con.

Unfortunately you are probably going to get an earful (comment section full?) from the militant anti-circumcision members as you failed to proudly state that your sons is intact, and that omission is something they cannot tolerate.

May Max live a long, happy & prosperous life.

Molly said...

NotStyro: Thanks. And I don't mind taking the earful from people who are pro or con. I'm proud of the decisions I make on Max's behalf, regardless of what strangers will tolerate. I'm used to the militant whatevers disagreeing with me, since I tend to not be particularly militant about anything except for this one thing: my kid, my choice. Period.

thordora said...

Personally, not a fan of cutting anything off of anyone, and we had decided we wouldn't if we had a boy.

We had a girl.

I hate the concept. I hate it. But, your son ain't mine, and if it's legal, what can I say?

Gridlock Reigns said...

Molly,

I liked your blog post. Don't let anyone tell you otherwise. My parents made the circumcision yea or nay decision for me a long time ago. I don't know why they made the decision they made. I know and trust my parents to have acted in what they believed was my best interest. Case closed there.

I'm amazed at the people who wrote negative comments. Perhaps if they look about 35 light years to their left, they might be able to see your point if they squint really hard and use a powerful telescope.

I don't know much about the vagina (although I am a fan). FGM is done for a handful of reasons. None of those reasons are for the health and well-being of the child. Those of you who are already screaming that circumcision doesn't benefit a child either, just shut up for a minute....listen for a change. Those of you who are staying your opinion until the end of my point, thank you for actually having a brain.

Circumcision can reasonably claim to have health benefits. FGM cannot. I won't conclusively say that circumcision is beneficial. I'm not a doctor and I don't play one on TV (forgive me for aging myself). Those who will yell, one way or the other, about your decision are fools. They can claim what they want but you have effectively taken the, "You are mutilating your child," argument off the table with your post. I can see a few have already missed it.

I trust you made the right decision for your son, whichever it was.

Respectfully,
Grid

P.S. I confess I feel sorry for "A" who thinks a toddler should be making medical decisions for themselves. A child's body is mom and dad's business while they are too young to make decisions for themselves. Or did your child skip vaccinations because the needle hurts?

A said...

P.S. I confess I feel sorry for "A" who thinks a toddler should be making medical decisions for themselves. A child's body is mom and dad's business while they are too young to make decisions for themselves. Or did your child skip vaccinations because the needle hurts?"

Gridlock Reigns, circumcision is done for cosmetic or cultural reasons, not medical reasons (except in rare cases). The AAP makes that clear. Young children depend on their parents to make medical decisions for them, and to protect them from unnecessary surgeries.

Vaccinations are known to be have overwhelming benefits to both the individual and the society, and fortunately there is no need to remove healthy body parts to get these benefits.

Gridlock Reigns said...

A:

You said: Gridlock Reigns, circumcision is done for cosmetic or cultural reasons, not medical reasons (except in rare cases). The AAP makes that clear.

No, they don't. In point of fact, the AAP says,

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child."

From: http://aapnews.aappublications.org/cgi/content/abstract/15/3/10

Your statement that the AAP says there's no medical reason for circumcision is untrue.

But back to my point, which you missed by the way.

You said: You are exactly right when you say, "my son's penis is his business, not yours."

Parents make decisions for their infant children, not the AAP, and not you. If the AAP is allowing parents to, "...determine what is in the best interest of the child," then so can everyone else. If a parent wishes to have their child circumcised for, "potential medical benefit," then that is their choice, not the AAP's, and not yours.

A said...

Grid,

The AAP explicitly states (in the quote you cited) that they do not recommend circumcision for medical reasons. Later they state: "It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. If there were compelling medical reasons to do it, they would recommend it, like they recommend vaccinations. Parents may believe that they are basing a decision to circumcise on medical grounds, but the medical evidence does not support their decision on those grounds.

I understand that in your opinion, parents should get to decide whether a boy gets to keep his whole penis. I am on the opposite side of that philosophical divide. I'm with the group who believes it should be an individual choice. We can debate this philosophical difference if you want, but I doubt it will get us anywhere.

Gridlock Reigns said...

A,

You omitted the word "routine" from your argument, which makes the quote support your assertion. I left it in the quote because it supports my assertion that there is medical evidence but not enough for them to say every single, solitary child needs one.

You completely ignored the part that says, "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision;...." If a parent believes that the, "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision," is sufficiently convincing, then we're back to acting in the best interest of the child.

You are right about one thing. We could debate this until there are regular snowball fights in hell and won't get anywhere. I just want to make sure you read the whole quote. Don't parse it to support your argument. The word routine does change the quote if it is omitted.

A said...

Grid,

The AAP statement is deliberately an exercise in fence-sitting. Among its aims are to avoid admitting they were mistaken when they recommended circumcision in the past (admitting potential liability), placate their members who continue to earn income from the practice, and still try to accurately reflect the science. It's no accident that either side can parse the statement in a way they find agreeable.

But you and I agree, anyway, that it's not the AAP who should be making this decision for a young boy. After that, we part ways on whose decision it should be. I support individual right to control one's own body.

Gridlock Reigns said...

I'll stick with what the AAP SAYS, not what you THINK they had in their mind when they wrote it, unless you'd like to cite a source or, in the alternative, prove to me that you're Vulcan or Betazoid.

I didn't parse the statement, you did. I didn't ignore a word (routine, in case you forgot) in order to change its meaning. I never said circumcision was necessary or even preferable. I say what the AAP says (and you are the one that brought them up in the first place) and then left the decision where it belongs.

I enjoyed your part about, "control over one's body." You try to put this argument on the same holy ground as abortion. Now I'm supposed to cease and desist. Well, if that's they way you want it, where the hell were you when I was getting all those medical and dental procedures I didn't want when I was a kid but my parents made me have anyway? I didn't want those warts removed when I was 10. That hurts! I sure as hell didn't want that root canal when I was twelve. Where was the control over my body then? I had great facility with the English language by the time I was 10. Where was my right to control my own body?

What about my dad? He had his tonsils out when he was a child. He didn't want that procedure. It wasn't life threatening. They hurt from time to time. They were a nuisance. Where was my dad's right to control his own body?

If control over one's body is what you really want, then in for a penny, in for a pound. No more parental decisions about a child's body. If they don't want a procedure, they don't have to have it unless a medical professional can perform it without prior consent. That rule goes for spouses, siblings, significant others, and whoever else I'm forgetting too.

See how stupid, "control over one's body," really is if it is misapplied?

A said...

Grid, no medical association in the world, including the AAP, recommends circumcision. You cannot parse their statements to avoid that fact.

Parents are responsible for the medical care of their children. That is why they can give consent, by proxy, for medical treatments. You misapply the notion of controlling one's own body by including legitimate medical treatments on minors. Removing normal body parts from a child is outside the scope of parental rights unless it is necessary for the child's health.

If you want to argue that parents have the right to cut normal body parts off their children when there is any medical benefit, then you will need to explain why a parent shouldn't be allowed to cut off a finger to prevent a papercut or a melanoma which could later emerge. They are free to cut off their own finger for such misguided reasons, but not those of their children.

If you want to debate all this, that's fine, but you'll find your ethical arguments are inconsistent when applied equally to the male foreskin and other body parts.

Gridlock Reigns said...

Where did I say any medical association recommends circumcision? Quote me. Perhaps you can omit a word or two from one of my sentences too.

Cite your source that there is _no_ medical benefit. Don't use my quote. It doesn't say that no matter how much you want it to. My quote says that there potentially might be. That's why I said in an earlier post that circumcision can reasonably claim to have health benefits in my first post. The AAP says there potentially might be.

One more time. I didn't parse their statement. You did. You're laboring under the misconception that I favor circumcision. I don't care one way or the other. What I really need from you is to look at this sentence...

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision."

and admit that when you omit the word, "routine," it changes the meaning of the sentence. If you're wondering when you did it, it's in your 9:50pm post.

It would also be nice if you'd notice that the sentence does not say there is no medical evidence. There may not be medical evidence. I don't know, but that sentence doesn't say that. It just doesn't.

One more time. I didn't parse the sentence. It's there in its entirety. And I cited it in an earlier post so you can't get me for plagiarism either.

A said...

Grid, despite your increasingly unamiability, I'll address what you've written point by point.

You did not say any medical association recommends circumcision, and I did not claim you did. I did not claim circumcision has no medical benefits, because any time you amputate a body part there are some potential benefits such as the impossibility of an absent part ever becoming infected or cancerous.

You speak much of potential benefits, but not one word of risks. When the AAP weighs the potential benefits and the risks, they choose not to recommend circumcision. Clearly they do not believe the potential benefits are worth the risks, as they do with vaccinations.

You parsed the AAP statement without knowing that you did, probably because you don't know the meaning of the word. When you examine the words and structure of a sentence, you are parsing it. There's no need to deny it, it's not a bad thing.

The sentence you want me to look at, including the word "routine," says quite simply that the existing medical data does not justify a blanket recommendation for circumcision. By contrast, they do recommend routine vaccinations, meaning that in general, in the vast majority of cases, they advise it. The sentence would have about the same meaning without the word "routine."

Once again, the sentence indicates that whatever medical evidence of potential benefit exists, they find such evidence insufficiently compelling to recommend the procedure in general.

It's unfortunate that instead of getting to the heart of either the ethical or medical issues, we're barely sorting out what has or has not been said by whom.

Once again, the fundamental philosophical divide seems to be this: Some people (such as myself) believe that in the absence of compelling medical need, normal body parts should not be cut off children. Other people believe doing so is a parental right, if (and only if) the body part is the male foreskin.

What's problematic about that position, though, is that the principle is not applicable to other body parts. That should set off alarm bells, and for an increasing number of people it does.

Gridlock Reigns said...

I have been unamiable since the beginning. Did I miss a point of netiquette? Was I supposed to call you a name?

This discussion is growing wearisome since you keep missing my basic points.

1. Your argument is poorly supported by my quote. Go find a better one and use that one. The fact that we are even having this discussion is evidence.

2. Adjectives do actually serve a funtion in a sentence.

Not recommended for _routine_ neonatal care means that it should not be done as a matter of course.

Not recommended for neonatal care means they oppose it.

The word routine does change the meaning of that sentence.

Parse means, "to resolve (as a sentence) into component parts of speech and describe them grammatically." I suppose I am parsing although I think reciting would be a better since I'm using all the words of the sentence and you're not.

I'm addressing the issue I'm addressing. I'm not missing the heart of any issue. I don't care to discuss circumcision with you. I have no personal vested interest in the argument. As I said, I'm not agreeing or disagreeing with you, I'm saying your argument is poorly supported. Go find a different quote. One in which you can use all the words.

I will stand by my original conetention that circumcision and FGM is two different things done for different reasons, whether those reasons are valid or not.

Anonymous said...

Gridlock,

I am interested in the circumcision discussion, which is why I clicked on the comments to begin with.

However, I find your arguments to be wordy, poorly presented, and frankly, just plain boring.

I stopped reading a long time ago.

Don't bother writing back--I won't be back.

Signed, doctor and mother of two uncircumscised daughters.

Anonymous said...

PS I'm a ped--cliche, right? I should be an orthopedic surgeon, I know, but I like kids. I have seen boys with intact genitalia with many, many problems, UTIs, etc.

I certainly would have circumsised a son. There wouldn't have been any question about it at all in my mind. I would have made sure that he had adequate anesthesia, though.

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