Doug Diekema and Brian Morris join forces – who made the biggest mistake?

One of our not-so-favorite pedoethicists, Dr. Doug Diekema, in cahoots with our favorite punching bag, Brian J. Morris Ph.D, emeritus (or retired) professor of the University of Sydney, just published a new paper called “critical evaluation of Adler’s challenge to the CDC’s male circumcision recommendation”. Other co-authors are Beth Rivin, Anna Mastroianni, John Krieger and Jeffrey Klausner.

The paper obviously intends to be a response to Peter Adler’s  “The draft CDC circumcision recommendations: Medical, ethical, legal, and procedural concerns”, Int. Children’s Rights 24 (2016), 239–264. It seems that many publications consider Brian Morris the go-to person to review circumcision papers, which also gives him the chance to write lengthy diatribes as response to any paper that oppose the circumcision of children. That way, in the future, Morris can claim that “experts (himself and anyone willing to lend his or her name as co-author) challenged this paper”, always ignoring any response to his response. Man, he can get really tiring.

This is typical Brian Morris’ modus operandi, but recently Mr. Morris has taken to have one of the coauthors appear as the first listed author. Nevertheless, the corresponding author is Mr. Morris.

Once you read the paper, it is nothing but a rehash of Morris’ usual arguments. But before we go into it any deeper, let’s consider the meaning of having Diekema as a co-author:

  • Diekema is one of the 8 members of the AAP Task Force on circumcision that authored the AAP Policy statement on circumcision of 2012.
  • The Policy Statement and accompanying Technical Report did not make reference to any publication by Mr. Morris
  • The members of the AAP Task Force characterized the policy statement as neutral. Diekema himself said to the New York Times We’re not pushing everybody to circumcise their babies, this is not really pro-circumcision. It falls in the middle. It’s pro-choice, for lack of a better word.”
  • Recently (April 2016), a fellow member of the AAP Task Force, apparently a more rational Dr. Andrew Freedman (in spite of circumcising his own baby on his parents’ kitchen table for religious reasons), wrote: “we have to accept that there likely will never be a knockout punch that will end the debate. It is inconceivable that there will ever be a study whose results are so overwhelming as to mandate or abolish circumcision for everyone

But, when we read this new “critical evaluation”, we find a position that is far more extreme than what the AAP has ever presented. It’s difficult to understand how Diekema decided to lend his name to this paper. Let’s see how some of the typical Brian Morris’ arguments develop in this paper:

  • Adler’s criticisms depend on speculative claims and obfuscation of the scientific data

    [Morris seems to think that anyone who opposes circumcision is obfuscating data, and that the decision to circumcise depends only on data, and not on the rights, desires and interest of the patient]

  • Adler’s central argument that circumcision in infancy should be delayed to allow a boy to make up his own mind as an adult fails to appreciate that circumcision later in life is a more complex  operation, entails higher risk, is more likely to involve general anaesthesia and presents financial, psychological and organisational barriers

    [To this argument we counter that since 2007 there are some circumcision devices invented with the purpose of making adult circumcision more simple, less expensive and painful, such as the FDA approved PrePex, so it’s up to the medical community to pick up on the new technology and offer those devices – which will likely reduce the cost of adult circumcision to the same levels of neonatal circumcision. It’s likely that the medical community is reluctant to do so because of the reduced profit though. But it’s unscientific to deny that such technology exists and is available at a fraction of the current costs. Besides, a circumcision CHOSEN by one person is less likely to induce psychological harms than one FORCED upon a person when they are too young to remove themselves from the situation]

  • Benefits of male circumcision include

    [Morris’ typical lethany… ]

  • Circumcision does not impair sexual function or pleasure.

    [To claim this, one would have to define sexual function, and would have to find an accurate way of measuring pleasure. Second, science can’t claim it “does not”. At most it can say “it does not appear to”. Third, far too numerous people know that it in facts alters sexual function and causes sexual difficulties which vary with different people. Brian Morris intended to erase this with a meta-analysis a few years back, but the argument is far from over. Morris himself has said that “The foreskin is an absolute requirement for a mutual masturbation practice amongst homosexual men known as "docking", in which the penis is placed under the foreskin of the male partner” – so if the foreskin an “absolute requirement” for this, then sexual function and pleasure are impacted, at least for this population. Docking is also possible between a male and some females, as long as the male has not been circumcised, so it is not something exclusive of the homosexual population, and even if it was, it would still be within their rights to make an autonomous decision.

  • Since the benefits vastly outweigh the risks, each intervention is in the best interests of the child.

    [This statement is particularly troublesome considering Diekema’s involvement on this article; the AAP specifically said: the benefits outweigh the risks (not “vastly”), “but the benefits are not great enough to recommend universal newborn circumcision” and “The true incidence of complications after newborn circumcision is unknown”. Fellow task forcer Andrew Freedman described circumcision as having "some modest benefits and some modest risks". So how Diekema could lend his name to the previous statement is really problematic.

  • From that point on, Morris states: “Below, we summarise the scientific and legal evidence that contradicts each of Adler’s arguments”

    [At this point however, I will quote Andrew Freedman, referenced above: “there likely will never be a knockout punch that will end the debate. It is inconceivable that there will ever be a study whose results are so overwhelming as to mandate or abolish circumcision for everyone”]

  • At the end of 3.4.1. Morris claims: “As noted above, the CDC found that benefits of IMF (infant male circumcision) exceed risks by ‘100:1’

    [No, the CDC did not find that. The CDC quoted one paper by Brian Morris where he claims this number, so this is just a circular reference to himself. BTW, this number really has no meaning, it's just an emotional argument disguised as a number.]

Brian Morris is selective as always in what he presents as evidence. For example he claims that “Early circumcision also greatly reduces the risk of penile cancer (Daling et al., 2005; Larke et al., 2011) and prostate cancer (Wright et al., 2012).” On prostate cancer, Wright himself explained to Reuters: “I would not go out and advocate for widespread circumcision to prevent prostate cancer. We see an association, but it doesn’t prove causality.”  That, however, doesn’t matter to Mr. Morris.

Most of the discussion though is really irrelevant. Everyone can find a reference to support their opinion, thus leading to the belief that such opinion is “scientific”. And then ignore any other reference which opposes that opinion, as “unscientific”. But the real argument is not one of science or not. It’s one of body ownership.

Trying to contradict this argument, Morris brings up a YouGov survey: “A recent survey found 29 per cent of uncircumcised men wished they had been circumcised, compared with only 10 per cent of circumcised men who wished that they had not been (YouGov, 2015)” It doesn’t matter to Morris that this is a non-scientific, non-peer reviewed, online survey. As long as it fits his views, he will claim it. However, it is important to notice that such comparison is not symmetric, since any uncircumcised man who wishes he had been circumcised could still opt for adult circumcision, particularly demanding the medical community makes available those devices such as the PrePex which would make adult circumcision more simple and less expensive, without the requirement of general anesthesia; however, any percent of men circumcised during childhood who wishes they had not been circumcised, are largely at loss, since the medical community has nothing to offer in the sense of foreskin regeneration, which once again becomes an argument to support delaying any decision until the person can offer informed consent.

It is important to recognize that scientists, even bioethicists (such as the Benatars, Arora and Jacobs, or Diekema himself) are not immune to religious and cultural bias. The Benatars and Jacobs are of Jewish faith and they make the fact that they consider infant circumcision vital to their Jewish identity (which not all Jewish people agree) clear; Jacobs along with Arora, just like Diekema, have gone as far to defend some forms of female genital cutting of minors as parental rights, something that Morris fails to mention.

On the topic of female genital cutting of minors, Diekema defended the ritual nick explaining that “[It] would remove no tissue, would not touch any significant organ but, rather [it] would be a small nick of the clitoral hood which is the equivalent of the male foreskin – nothing that would scar, nothing that would do damage” – again, a fact missed by Morris in his decision to call Diekema to join hands in this paper.

Diekema himself wrote: “The real art of bioethics is convincing other people why something is right or something is wrong and why something shouldn’t be done or should be done. Many people aren’t going to pay attention to you if that argument is crafted purely in religious language. One of the things that I’ve had to do is craft arguments in the language of the world, which I have not found to be particularly difficult. The reality is that medical ethics has its roots largely in theological ethics, so the basic principles that many people who are not religious subscribe to actually have very strong roots in the Bible and in religious belief.” For the open minded reader I ask, are those the arguments of a scientist or a theologian?

Finally, let’s just remember a few of Diekema’s faults (see IntactWiki for references):

  • Clearing the “Ashley treatment” – where a severely disabled girl was subjected to removal of her breast buds, hysterectomy, appendectomy and growth attenuation, a treatment later declared illegal without the order of a court. Dr. Daniel F. Gunther, a doctor involved in this case, committed suicide shortly after for unclear reasons
  • Defending the AAP’s policy statement on “Ritual genital cutting of female minors” and the ritual nick.
  • Defending parents who allowed a teenage son to die without medical treatment because he believed in faith healing.
  • Misrepresenting the death of baby Joshua Haskins in a radio interview (during the presentation of the 2012 policy statement). In this interview Diekema claimed that this case “involved a very sick baby that was likely to die anyway and his parents wanted him circumcised before his death” – when in fact the parents had been fighting along with the baby for his life, and they were told that their baby was now strong enough to tolerate the circumcision – but then allowed to bleed for several hours from the circumcision site, leading to the baby’s cardiac arrest and death.
  • Diekema and fellow task force Michael Brady were shamefully defeated in a debate, by Attorneys for the Rights of the Child member Steven Svoboda and his staff, a debate in which Brady declared:  “I don’t think anybody knows the functions of the foreskin. Nobody knows the functions of the foreskin.” One of Svoboda’s staff members was able to point to his experience as intact male, and how his foreskin is part of his sexual life on a regular basis.

After the release of the 2012 statement, Intaction offered Diekema the “Mengele award”, one that Diekema didn’t make a speech for.

564120_10151091525431937_1050504135_n

Intaction member Anthony Losquadro offers Doug Diekema the “Mengele award”
Photo by James Loewen.

 

So, after all this, I don’t know who made a more questionable mistake here, Brian Morris by enlisting the questionable Doug Diekema as a coauthor, or Doug Diekema, by lending his name to extreme pro-circumcision arguments that are not even compatible with those of the Policy Statement that he and his fellow AAP Task Force members presented. What do you think?

Dr. Anthony Chin is severely biased on circumcision

Anthony Chin, MD

Anthony Chin, MD

U.S. News Healthcare published an article (“Circumcision: Why it May Be as Important as Vaccines to Your Child’s Health“) by one Anthony Chin, MD, pediatric surgeon and director of surgical critical care at Children’s Hospital of Chicago. This article is so biased and willfully blind to facts that it is not even worth the cost of the pixels used to display it on your screen.

The author claims that science is clear, that circumcision is a matter of good medicine and smart prevention. I don’t know of any other kinds of “prevention” that remove normal parts of the body without taking into consideration the wishes of the patient, particularly when there is no reason to expect any major pathology of said part (i.e. genetic reasons, preexisting symptoms, etc).

The doctor claims that as physicians “we must respect [the family's] choice“. But, why? What other reductive surgeries are performed for “family’s choice” and -again- without consideration to the wishes of the actual real patient?

He then says “we have a professional obligation to educate parents and help them make as informed and as safe as call as possible“. Well, if one is to educate a parent on the removal of the foreskin, one should be willing and able to discuss what the foreskin is and what it does. And this doctor fails at that, as we will see.

Just to compare, a recent policy for labiaplasties on teenagers, by the American College of Physicians and Pediatricians, recommends appropriate counseling, screening for body dysmorphic disorder, and recommends that the obstetrician-gynecologist be ready to discuss normal sexual development, wide variability in appearance of genitalia, nonsurgical treatment options and autonomous decision making. None of this basic elements is discussed when it comes to circumcising male children.

Then, to support the “science behind an ancient ritual“, he tells us that studies indicate that circumcised males have fewer urinary tract infections. Of course he omits that this UTIs are rare, that the “protective” effect applies only to the first year of life -while circumcision is for life-, that UTIs are generally easy to treat, that with the exception of the first year of life females have more UTIs than males and we don’t perform surgery on them, and that over 100 circumcisions have to be performed to prevent a single UTI -which again, would be easy to treat. So it is hardly proportional to what it is supposed to prevent.

He then says that circumcised males have a lower risk for sexually acquiring and transmitting certain infections. While some studies show a reduced incidence of some STDs on circumcised males, there are far more factors than the presence or absence of foreskin, such as appropriate sexual education, safe sex practices, and the specific risk groups and behaviors the individual moves in, which is why anyone promoting circumcision for STD prevention without educating on safe sex is actually endangering people. Anyone, circumcised or not, can contract an STD. Many STDs are transmitted in the semen, so circumcised or not, an infected male will transmit the STD unless a proper barrier is used.

The next predictable claim is the infamous 60% risk reduction of contracting HIV. As always, he misses the fact that this applies only to female to male transmission through unprotected penetration, that this does not apply to males who have sex with males, to unprotected oral or anal sex, or to any non-sexual form of HIV transmission. Besides, there are numerous questions about the methodology used in the African trials and about their significance in non sub-Saharan environments.

He then tells us that “the biological mechanism behind the protective effect is not entirely clear“. Well, after about 150 years of “medical” circumcision in the United States, something as simple as this is still not clear? He goes on to repeat a biological feasibility that has not been demonstrated, meaning that it is nothing but speculation.

The one good point is the acknowlegding that circumcision is no “silver bullet“, no “replacement  for practicing safe sex” etc.

Then he goes on to try to dispell some “myths” about circumcision.

The first “myth” of course is that circumcision interferes with penile sensitivity. He calls it pernicious and persistence, and says research has found that it doesn’t. I wish that was the case. For one, the 2007 study by Sorrells showed that the foreskin is the most sensitive part of the penis to soft touch. A 2016 study and thesis by Jennifer Bossio that tried to contradict Sorrells actually corroborated it – even if the author then failed to recognize it. She did write that the foreskin was significantly more sensitive to touch stimulus.

Besides, it’s simply logic. If the foreskin is alive, if it is any sensitive, removing it by definition removes any amount of sensitivity provided by the foreskin. Thus, there is a loss in sensitivity no matter what.

His second myth is that only newborns can get circumcised. He claims that the optimal time is before 3 months of age (when the individual is not competent yet so cannot refuse – ethical issue), but that children and even adults can be circumcised safely. Then he says some families “choose to defer circumcision until a child is older and can decide for himself” but he cautions these families that “circumcision later in life tends to be more emotionally scarring“. Interesting that he cautions families AGAINST respecting the individual’s  bodily autonomy. Did he even consider what he was writing?

The third “myth” is that circumcision can damage the penis. His first sentence is that “circumcisions can go bad, but they very rarely do“. But since they do, then myth has not been dispelled. How many lives does your child has? How many penises can he afford to lose? There are frequent case reports of partial and total amputations. Unsightly scarring, skin bridges, loss of too much tissue, re-circumcisions, all these happen and frequently. Dr. Chin then provides us with an optimistic rate of complications of “fewer than half percent of newborn circumcisions” developing complications. Well, 0.5% applied to 1.2 million newborn circumcisions in the United States every year amounts to 6,000 babies experiencing complications from a surgery that they didn’t need. I wouldn’t qualify that number as small. At least 2 or 3 die each year, per official estimates – some estimate a lot more. Imagine a room large enough to host 6,000 babies with complications from their circumcision.

One of the most common complications is meatal stenosis, and this is not even factored into that “half percent“.

He says that circumcision is “safe, inexpensive and relatively simple” and that it can “protect individual health, alleviate collective suffering and curb health care costs reducing the number of preventable infections“. What about the preventable complications? The preventable deaths? What is the cost of 1.2 million circumcisions? What is the cost of providing proper sexual education? What is the cost of treating 6,000 baby boys with complications, some requiring transfussions, some requiring additional surgeries…

What about the cost of violating the bodily autonomy and genital integrity of 1.2 million baby boys every year?

Jonathon Conte’s vanishing obituary

On May 9th, our friend, intactivist Jonathon Conte committed suicide. While I tried, I couldn’t bring myself to post here. I paid my respects privately and silently.

Last week we became aware that the Tampa Bay Times had published an obituary – including a guestbook. Many noticed that the obituary made no mention of Jonathon’s selfless work in pro of the rights of children – or of his surviving partner.

Jonathon Conte's obituary on the Tampa Bay Times

Jonathon Conte’s obituary on the Tampa Bay Times

Many comments were added to the guestbook- including one that I submitted. One intactivist paid a fee to keep the obituary active.

Today we learn that the obituary – and all comments- have suddenly vanished.

The link to the obituary page returns a 404 error (not found), and the link to the guestbook returns a 200 error.

The guestbook was originally set to be online until 7/3/2016 – before an intactivist paid to make it permanent. So why was it deleted? Who is censoring Jonathon’s work past his death?

Jonathon Conte's obituary guestbook

 

Animal testing versus… human animal testing. The profits of circumcision!

The other day I ran into an article by David “Avocado” Wolfe from the Body Mind Institute, about cosmetic companies that still use animal testing. I’ve always found animal testing horrific, barbaric, but I try not to get too much into animal rights activism because if something completely breaks my heart, it is to see animals suffering. And you are reading this from someone who loathes to see babies and children suffering because of medical abuse.

animal-testing-FI-759x419So, anyway, I read the article, and it was interesting. And then I found something I expected to find:

Animal testing is an incredibly outdated method that should replaced by more modern methods such as the Institute for In Vitro Sciences’ in vitro process.”

Hmm… that was a key. So I went to search for this Institute. I found their website, and then I ran a number of searches, until I ran into one document called “Evaluation of the Validated In Vitro Skin Irritation Test (OECD TG 439) for the Assignment ”. This document described a test using a trademarked product, EpiDerm.

Some more poking around and I found a product page for EpiDerm,  ”a ready-to-use, highly differentiated 3D tissue model consisting of normal, human-derived epidermal keratinocytes (NHEK) cultured on specially prepared tissue culture inserts“.

Epidermal keratinocytes… We are close. I pressed the Specs tab, and learned more about EpiDerm:

8482tnCells
Type: Normal human epidermal keratinocytes (NHEK)
Genetic make-up: Single donor
Derived from: Neonatal-foreskin tissue (NHEK)
Alternatives: NHEK from adult breast skin
Screened for: HIV, Hepatitis-B, Hepatitis-C, mycoplasma

The Institute for In Vitro sciences’ website includes an Outreach section, with a page dedicated to the Animal Protection Community. It starts by saying that “The activities of the animal protection community have had a significant role in driving the search for valid non-animal methods“, but is it really a non-animal method one that depends on the amputation of genital tissue from human babies? Is it any more humane?

Are PETA, the Humane Society of the United States, and the other listed “animal protection outreach partners” aware of the use of genital tissue removed from American babies in this “non-animal method“? Or are they so culturally ingrained in the rite of circumcision that they no longer see it as a cruel action?

So you see folks? While the intention of protecting animals from animal testing is very valuable, doing it by using harvested genital tissue forcefully amputated from non-consenting individuals (who are not yet competent to provide informed consent, but will eventually be)  is simply not the ethical way to do it.

How often do you hear that your baby’s foreskin is going to be used to test the creams and cosmetics that you are going to apply to your face later? How does it feel to feed the machine and treat our children as little more than guinea pigs? Why have we allowed the biomedical industry to turn our children’s genitals into a commodity for the cosmetic industry?

If we want humane alternatives to animal testing, they cannot be based on human genital tissue obtained from non-consenting “donors“.

Update on the Frank Wolf Int’l Religious Freedom Act (HR 1150)

It is important to clarify that HR 1150 is not a law yet. It has been approved in the House of Representatives, now it moves to the Senate.

Please contact your senator this week and express your concern. Religious freedom does not apply to another person’s body.

You can find the contact information for your state senators here: http://www.senate.gov/general/contact_information/senators_cfm.cfm

 

 

 

The Frank Wolf Int’l Religious Freedom Act (HR 1150) protects ritual abuse of babies

As a person who was once a baby, I feel offended by the idea that my body could be used as accessory to my parents’ religious beliefs, particularly if their religious beliefs call for the permanent alteration of my sexual organs.

Notice that if you are in the United States, the sex of the writer of the above paragraph would be paramount to know if the described act is legal or not. A female writer who expresses dismay over the idea of her sexual organs being permanently altered by her parents would be simply criticizing the odious custom of female genital mutilation. A male writer however, would be considered to be “whining” over the most common surgery in the world -never mind that it is one practiced without medical need- and could probably be labeled as antisemite or islamophobe for claiming ownership of his own body.

Notice also that if your family happens to be an ultra orthodox Jewish family in the North East, it is likely that an old man sucked your penis immediately after cutting part of it with his knife. And in spite of laws protecting children from the actions of pedophiles, this man did so under the guise of religious freedom – and currently protected by NYC Mayor Bill De Blasio.

Do you feel dirty now?

Well, given that some organizations such as the Parliamentary Assembly of the Council of Europe have raised concerns over ritual circumcision of male children as a procedure that violates the physical integrity of children, that numerous European medical and political associations oppose circumcision of children, that a 2012 ruling in Cologne, Germany, led to a temporary ban in circumcision of children followed by the urgent approval of an unconstitutional law to protect circumcision, our beloved American politicians have seen in the best interest of the world to create a new bill to protect religious freedom internationally. They have, of course, mixed the language including references to organizations such as ISIS.

So, this new bill, passed Monday, would broaden the definition of “violations of religious freedom” in the International Religious Freedom Act of 1998 to include the persecution of advocates of male circumcision or ritual animal slaughter. Thus, males of the future will have no resource but to surrender their most private organ to be mutilated and carved for the appeasement of their parents’ religious beliefs, enshrining the routine ritual abuse of male babies.

It remains to be seen if the aforementioned bill will extend the same courtesy to those religious groups which practice the genital alteration of female minors -even when it is not written on their main religious book, or how the bill will deal with the distinctions between religious and cultural practices, and which practices are not protected by it.

For the time being, we can thank Chris Smith, R-N.J. and a hundred or so co-sponsors (including also Marco Rubio, no surprise there), for turning the United States into the religious police of the world, and all the male minors of the world into accessories devoid of personhood, to be sexually used during the parents’ religious practice.

Additionally, in his address in 4/20/2016, Rep. Chris Smith commented on The Strategy to Oppose Organ Trafficking Act (H.R. 3694), saying “we have evidence that organs continue to be harvested without consent from some Falun Gong detainees and other prisoners in China“. Well, Rep. Smith, please let me tell you that infant circumcision allows American doctors to continue to harvest genital tissue without consent from American baby boys, for the profit of the biomedical industry. Will you do something to protect those baby boys?

Read more:

JTA - House passes bill protecting circumcision, ritual slaughter as religious freedoms

World – House passes religious freedom reform bill

 

 

 

The lies they tell, the crimes they make

South Florida based doctor Christopher Hollowell posted a video of a circumcision of a 1 year old child. During the narration, Hollowell first appears satisfied about the lower rates of circumcision (and even misrepresents it) but as the video progresses, he becomes strongly biased for circumcision.

Dr. Christopher Hollowell

Dr. Christopher Hollowell

He claims that as a urologist, he sees all the cases where uncircumcised boys have problems. He claims, for example, that the 1 year old child he is circumcising has phimosis and balanitis.

This is problematic already. Most babies are born with congenital phimosis (also known as physiological phimosis), which is a normal condition: the foreskin is not ready to retract. It takes years, for this phimosis to be overcome, with the average age being 10 and a large variance. Being non-retractable at 15-17 is still normal.

Balanitis is often claimed as a reason for non-neonatal circumcisions. However, balanitis simply means inflammation of the penis. Quite often, it’s just an ammoniacal dermatitis resulting from bacteria in the feces staying in the diaper for too long, and can be resolved with medicine and patience, without need for surgery.

The doctor claims the child has severe penile adhesions. What he is doing is patologizing a normal condition. As we have often explained in this blog, the foreskin and the glans start as a single structure, and at some point a layer starts desquamating, creating the subpreputial space. This layer is called the balanopreputial sinechiae or balanopreputial lamina, and it dissolves slowly through several years. But our doctors tend to call it adhesions. The AAP erroneously claims that these adhesions should be resolved by the 4th month of life.

At 1 year of age, these “adhesions” are in fact normal. The foreskin and the glans are still in the process of separating, and there is no need to rush them.

Dr. Hollowell then pulls the foreskin back and claims that the penis of this child has a “cobra head effect” because pulling it down causes the glans to curve downwards, pulled by the frenulum. Based on this observation, he proceeds to excise the frenulum.

Dr Christopher Hollowell cutting the frenulum of a 1 year old boy

Dr Christopher Hollowell cutting the frenulum of a 1 year old boy

Personally, I consider the removal of the frenulum of a child a criminal act. And it is also unnecessary.

It is unnecessary because at 1 year of age, the penis of this boy has not reached its adult size, so any present consideration will completely change during puberty, once production of testosterone increases and the body starts reaching its adult size. So even if the frenulum is short now, it still has plenty of time to grow. Not only that, but even if at 18 the  frenulum was still short (frenulum breve), there are non-invasive ways of correcting it. There is no need to fully remove it.

I believe that removing it is a criminal act because the frenulum carries an artery and a high concentration of nerves. The frenulum itself is said to be one of the most pleasurable parts of the penis -by those who were lucky enough to retain their full frenulum, or did not suffer total damage of it. So, to remove it before the person has attained an age of maturity seems to me a purposely damaging action which has long term effects over the sexual experience of that child.

The loss of irrigation due to cutting the frenular artery can potentially have long term effects. Some suggest that ischemia (lack of blood) is behind the common occurrence of meatal stenosis in circumcised boys. Loss of blood flow could also affect the surface of the glans, as hypothesized by Ken McGrath. Finally, loss of blood flow could be related to erectile dysfunction later in life.

Dr. Hollowell repeats several times that the foreskin is very vascular tissue, yet he doesn’t seem affected by the idea of removing it.

He says that he likes to think of circumcision as plastic surgery of the penis and that he likes to think that every man likes to have a beautiful looking penis. But, isn’t it problematic to perform plastic surgery on the genitals of a child, to think of the genitals of a child in terms of “beautiful looking” as a result of plastic surgery – particularly when performed without consent of the person?

During the procedure he marks the line where he is going to cut. It can be observed that the line is traced around the center of the penis. Now, if we consider that the foreskin is a double layered area, then the total area of tissue being removed accounts for approximately two thirds of the covering of the penis. If it was single layered, it would be one half, but since the foreskin is double layered, it counts two times, thus the total tissue removed is 2/3rds or 66% of the covering of the penis.

Circumcision removing between 1/2 to 2/3 or the penile covering

Circumcision removing between 1/2 to 2/3 or the penile covering

Hollowell says that when asked why do the procedure at one year and not at birth, his response is that he couldn’t do it before and had to try conservative measures because of the age. He then goes on an explanation about aging and bleeding that has more to do with Jewish myths than with actual science. “The foreskin we’ve learned over centuries that if you cut the foreskin before the 10th day of life you will have very little bleeding of the foreskin, so many cultures will just do it as a ceremony without any problems, however after that time, if you decide to cut the foreskin it will bleed significantly and in young boys, a little bit of bleeding can be devastating“. He says this without acknowledging that the only cultures that circumcise babies are the Jewish and the American culture, not “many cultures“, and the reasons he gives have more to do with bible myths than with any solid science. In fact, babies circumcised on the 8th day according to the Jewish tradition, may still die from exsanguination, as we have previously showed in this blog.

As he explains this, Hollowell keeps cauterizing the penis to stop any bleeding. Has anyone studied the harm caused by cauterizing all those blood vessels? If American doctors were using more recent circumcision technology, they would be able to circumcise children and adults without cauterizing the inside of the penis as if it was a piece of grilled steak.

Overzealous cauterizing of the internal parts of the penis

Dr. Hollowell zealously cauterizing the internal parts of the penis

Now, the real reason why Hollowell performs these circumcisions at 1 year of age has everything to do with insurance and little to do with medical reasons. See, for a few years, Medicaid didn’t cover neonatal circumcisions in Florida. So instead of paying the $200 to $800 out of pocket, many families waited one year at least, and then procured a referral for circumcision. Because there has to be a diagnosis code for insurance to cover it, doctors would diagnose phimosis, knowing very well that they are providing a fraudulent diagnosis because those children are perfectly normal. But at that point, because of the age, the procedure (at least in the U.S.) requires general anesthesia and becomes a more involved surgical procedure (mostly because the American doctors are not using the most recently invented devices for non-neonatal circumcision, which would greatly reduce the cost and risks of the procedure), so now the procedure is up to 20 times more expensive.

This medical fraud is what led one doctor Saleem Islam to claim that the cost of circumcisions in Florida “skyrocketed” after Medicaid stopped covering neonatal circumcisions. Doctor Islam in his paper candidly recognized that parents came asking for circumcision for their children, but didn’t mention that those circumcisions would be fraudulent because they were not based on real medical necessity – so they shouldn’t even be covered at all.

So this is the reason Hollowell is circumcising a 1 year old child over a diagnostic of phimosis and balanitis: because the parents did not want to pay the low cost of a neonatal circumcision out of pocket and preferred to seek a referral after the age of one, for a more complicated and risky procedure under general anesthesia and at a higher cost to the tax payers.

Closer to the end of the video (while suturing the penis) Hollowell goes into his litany of things that can happen to uncircumcised boys: they can have adhesions, they can have balanitis, they can develop penile cancer later, they can have urinary tract infections,  they have more risks of getting STDs… all the myths we’ve heard over and over.

And then he compares circumcision to a vaccine. “And I tell you if you could have a vaccine that gave the same results we would jump at it every time, so it is quite interesting to see where our new thought process is on what we would do to offer this to young boys again on a routine basis

The lies they say:

  • The child has phimosis
  • The child has balanitis
  • The adhesions are abnormal
  • The frenulum causes the penis to bend downward
  • Circumcision protects against STDs, penile cancer, etc.
  • Circumcision is a surgical vaccine
  • He won’t know the difference

The crimes they make:

  • Fraudulent use of insurance
  • Cutting one of the most pleasurable areas of the penis – the frenulum
  • American doctors don’t use the most recent technology for non-neonatal circumcisions – thus increasing the risks, complications and cost of the procedure.
  • Subjecting a 1 year old child to general anesthesia for a non-medical surgery (plastic surgery of the penis – give the child a beautiful penis).

Shame on you Dr. Christopher Hollowell.

 

Understanding intactivism

While in circwatch we often discuss studies, articles and publications, and point their flaws, contradictions and conflicts of interest, we are first and foremost bound to the principles of bodily autonomy and genital integrity.

Performing irreversible “elective” surgery on non consenting individuals violates the principle of bodily autonomy. It denies the person the right to provide informed consent and make an informed choice.

Removing part of the genitals of children without medical consent violates their genital integrity, part of the children’s right to physical integrity.

Both violations are ethically problematic.

Sure, there is often a discussion of whether there are benefits or harm, whether circumcision affects sexual function or sensitivity or not. But that is basically an academic discussion.

Let’s be clear. If a child was in a life or death situation, where not performing a circumcision would easily cause the child to die or be permanently impaired, it would be irresponsible to not do it. But that is not the case with neonatal circumcision or with child circumcision.

As clearly indicated by the AAP and discussed by the members of the task force, circumcision is often a non-medical decision based on cultural, religious or family factors. And that is problematic.

By performing a circumcision on your newborn child, you are denying this newborn person the right to choose, the right to make informed decisions over his own genitals, and you are depriving him of a normal part of his body. As a parent you may have the best of intentions, but you are missing this side of the issue.

Doctors should not be enabling parents. This is often perceived by parents as a recommendation, resulting in tilting the balance without regards for the future preferences or desires of the minor individual.

Even if there is a lower risk of a minor or rare condition, there is also a harm in circumcising. The procedure is irreversible and leaves permanent marks – a scar and missing parts. There are low incidence high impact risks that should be taken into consideration as well.

We are not “anti-circumcision”. We have no issue with people becoming circumcised – as long as they can provide informed consent. But we have problems with people forcing minors to undergo permanent reductive procedures on their genitalia.

Andrew Freedman, of the AAP 2012 Task Force on Circumcision, wrote: “It is inconceivable that there will ever be a study whose results are so overwhelming as to mandate or abolish circumcision for everyone, overriding all deeply held religious and cultural beliefs.” And while this is true, it should not be taken as a carte blanche to override children’s ownership of their own bodies. It should be taken to apply to your choice over your own body, not your choice over someone else’s body. You don’t own your child’s body.

Your child’s body should not be an accessory to your religious or cultural expression. Your child’s freedom of choice and bodily integrity are at stake. Please, respect the dignity and personhood of your child.

Jennifer Bossio confirmed: foreskin most sensitive part of penis

Yet she was too biased to admit it!

Bossio, Jennifer, “EXAMINING SEXUAL CORRELATES OF NEONATAL CIRCUMCISION IN ADULT MEN” is a PhD thesis which attempts to “provide a multidimensional perspective of the sexual correlates of circumcision with implications for public policy and individual stakeholders (e.g., medical professionals, parents, men).”

Jennifer Bossio validated Sorrells study and didn't recognize it

Jennifer Bossio validated Sorrells study and didn’t recognize it.

Chapter 3 is dedicated to study penile sensitivity in men who were circumcised as babies, vs. men who were not circumcised (intact). This is evidently a response to the 2007 study “Fine-touch pressure thresholds in the adult penis” by Sorrells et al.

Bossio writes (pg. 69): “we did not obtain sufficient evidence to support the notion that the foreskin of adult intact men is the most sensitive region of the penis to all forms of stimuli; however, the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested, and it was significantly more sensitive to warmth than the glans penis.” She also writes: “our results—and those of Payne et al. (2007)—differ from those of Sorrells and colleagues (2007) who found that the glans penis in circumcised men was less sensitive to touch than in intact men.”

In her conclusions, Bossio writes that “we directly assessed the assumption that circumcision leads to a reduction in penile sensitivity by testing tactile detection, thermal sensation, and pain thresholds at multiple sites on the penis” and offers one conclusion that “this study provides no evidence that neonatal circumcision decreases penile sensitivity, no evidence that the exposed glans penis in circumcised men becomes less sensitive over time, and insufficient evidence to suggest that the foreskin is the most sensitive part of the penis.” and then suggests that “if differences in sexual functioning or sexual dysfunction are related to circumcision status, these differences are not likely the result of changes in penile sensitivity resulting from neonatal circumcision

Finally, she concludes that “findings from this study can be used to inform individual stakeholders, public policy makers, medical health care professionals, and parents regarding the minimal long-term implications of neonatal circumcision on penile sensitivity.”

We have issues with the inclusion and exclusion criteria. Excluding participants over 40 years of age creates a bias. Many individuals restoring their foreskins typically started after their 40s. They also excluded individuals with history of sexual dysfunction.

Reading her paper we found contradictions to her assertions that “this study provides no evidence that neonatal circumcision decreases penile sensitivity [...] and insufficient evidence to suggest that the foreskin is the most sensitive part of the penis“.

We also suggest that Bossio missed a vital point by neglecting to study men who have undergone non-surgical foreskin restoration.

First, the assertion that the foreskin is the most sensitive part of the penis comes directly from the Sorrells study, and it is one assertion that is often misunderstood. Sorrells simply evaluated “fine-touch pressure thresholds” – nothing more, nothing less. So when Sorrells concluded that “circumcision ablates the most sensitive parts of the penis” it should be read that “circumcision ablates the most sensitive parts of the penis [to fine-touch]“. Sorrells did not make any attempt to measure pleasure or satisfaction. Only fine touch, and his findings are consistent with those of Bossio as she said it herself, that “the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested“.

So, if the foreskin is significantly more sensitive to touch, it follows that the circumcised penis, in which the foreskin has been removed, is less sensitive to touch – particularly to fine touch. Which again, contradicts her conclusion that her study “provides no evidence that neonatal circumcision decreases penile sensitivity“.

Now, we partially agree with her assertion that “if differences in sexual functioning or sexual dysfunction are related to circumcision status, these differences are not likely the result of changes in penile sensitivity resulting from neonatal circumcision“, basically because the studies are missing one important point. Static stimulation is not the main method of stimulation during sexual activity. People don’t just lie down being stimulated by touch, warmth, pain, etc. Individuals move during sex. Stimulation is dynamic.

A visual comparison between a typical intact man masturbating, and a circumcised man masturbating, yields important differences – and  this has even been observed by circumcision promoters such as Guy Cox – in a paper published with the pen name of James Badger. While Badger describes it as a difference in preference, the reality is that it is a difference in what is possible to do with the available tissue.

Most intact men masturbate by grasping the mobile penile skin and sliding it up and down the shaft. In most cases this results in the glans being repeatedly covered and uncovered, with the rim of the foreskin stimulating the glans; typically the hand does not touch the glans. In the case of males with particularly long foreskins, the glans may never be uncovered at all, and the hand stimulates the glans only indirectly, through the foreskin.

In circumcised males, the typical technique consists in moving the penile skin what little length it can be moved during erection, or when no mobile skin is available at all, the hand rubs the penile skin, in which case external lubrication (hand lotion or adult lubricant) is needed to avoid chaffing the skin. In many cases direct contact with the glans is avoided unless using lubricant.

What this indicates is that there is a mechanic component of stimulation by using the foreskin as an agent, a mobile part, which interacts with the glans. Obviously, removing the foreskin makes this action impossible, thus altering the mechanism of stimulation for the circumcised male.

We can also consider that during heterosexual penetration, the glans touches the opening of the vagina and goes through its vestibule, but once inside it is not in contact with anything else. The vagina instead is grasping the penile skin, and facilitating its gliding motion during the repeated penetrative motion. For the circumcised male, the vagina simply rubs directly against the penile skin – because there is no movement of the skin, which tends to dry the lubrication of the vagina.

So there is a change that goes deeper than simple passive sensitivity. Circumcision alters the mechanics of the penis and causes stimulation to be different, both for the male and the female.

Bossio’s paper simply moves between two contradictory positions: 1) that the foreskin is more sensitive to touch, and 2) that the circumcised penis is as sensitive as the intact penis – which is simply not possible if a) the foreskin is more sensitive to touch and b) has been removed by circumcision.

It seems to me that given the importance of Sorrells’ study as a starting point to Bossio, she missed the mark. Neither Bossio nor her reviewers understood the meaning of “sensitivity” as used by Sorrells.

Perhaps the real importance of Bossio’s paper was to superficially contradict Sorrells, as an attempt to undermine a common argument used by promoters of genital integrity, and by calling the long-term implications of neonatal circumcision on penile sensitivity “minimal” she gained enough approval from a culturally biased academic community to obtain her PhD.

Misuse of Bossio’s paper:

Annette Fenner published in Nature Reviews Urology a highlight of Bossio’s published study (on The Journal of Urology), which is related to her thesis, with the superficial headline “Circumcision does not affect sensitivity“, and the first sentence, predictably enough, reads “Neonatal circumcision has minimal effects on penile sensitivity“. Fenner misrepresents Bossio’s paper by indicating that “No differences in tactile or pain thresholds, or sensitivity to warmth and heat pain, were observed between circumcised and intact men“. This clearly contradicts Bossio’s assertion that “the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested“.

She then offers an allegedly quoted conclusion that Bossio’s data “do not support the idea that foreskin removal is detrimental to penile sensitivity.” – a quote that is really an inaccurate paraphrase, and we repeat, is deeply flawed based on the non-existent definition of sensitivity.

Fenner then offers her own conclusion, the one that everybody was hoping for, the direct contradiction to Sorrells: “removing the foreskin does not, in fact, remove the most sensitive part of the penis.”

We have already shown above how deeply flawed is this, given that the same assertion is contradicted by Bossio herself.

But that’s what Bossio’s thesis was written for: to allow culturally biased academics to contradict Sorrells’ study by quoting a paper that didn’t understand what Sorrells was writing about, and which is so poor that it contradicts itself without raising the eyebrows of any mindless reviewer.

Misleading headlines

We wrote this review back in January, but we didn’t publish it, silently waiting. Last week, however, the media picked up Jennifer Bossio’s paper, and predictably, as we have often indicated, used misleading headlines to make this look as far more conclusive than it really is. Many of the articles we reviewed, clumsily include Bossio’s contradiction without pointing it out.

Some examples of these disappointing articles:

Science Daily: Neonatal circumcision does not reduce penile sensitivity in men, study finds (New research challenges widely accepted beliefs)

UPI: Study: Circumcision does not reduce penis sensitivity. This article even says “In men with foreskin, it was more sensitive to tactile stimulation than other parts of their penises, however when foreskin sensitivity was compared to other sites intact men had no greater sensitivity than the circumcised men” – the first part obviously contradicts the premise of the headline: if the foreskin is more sensitive to tactile stimulation, removing it has to reduce the penile sensitivity (to tactile stimulation). The second part of the statement simply makes no sense and seems to be a derailing tool.

Tech Times: Getting circumcised does not shrink male organ sensitivity.

Medical Express: Circumcision does not reduce penile sensitivity, research finds.  In this article, Bossio is quoted saying “We found that while the foreskin was more sensitive to fine touch, it was not more sensitive to the other stimuli we used, and those stimuli are likely more important in sexual pleasure“. However, that sentence alone already contradicts the headline – and the whole premise of Bossio’s publication. In fact, the underlined sentence alone shows that Bossio validated Sorrells’ study, the very study that she appears to be trying to contradict.

Queens University: NEWS RELEASE – New research finds circumcision does not reduce penile sensitivity. This must be the originating point of all these press releases, as Bossio’s study was the core of her PhD thesis at Queens University. This article, just like the one from Medical Express, quotes Bossio saying “We found that while the foreskin was more sensitive to fine touch, it was not more sensitive to the other stimuli we used, and those stimuli are likely more important in sexual pleasure” – which we are getting tired of repeating, contradicts the headline and the very premise of her study.

Daily Mail: Circumcision does NOT reduce sensitivity of the penis, experts say.  Unfortunately Bossio’s sad excuse of a study made its waves all the way to England. This article is preceded by 3 bullet points, one of which states: “Findings also suggest the foreskin is not the most sensitive part of the penis“. In this article, Bossio herself is quoted saying that her study “provides preliminary evidence to suggest that the foreskin is not the most sensitive part of the penis“. This version of the article avoids saying that “the foreskin was more sensitive to fine touch“, as the Queens University press release and the article on Medical Express did. Perhaps the contradiction would have been too obvious.

Healio, Medical Daily, True Viral News, Australian Networks, The Independent, I Fucking Love Science, GCO News, Renal and Urology News, Today’s Parent and many others also mindlessly reported on this absurd study.

So congratulations Jennifer Bossio. Your nonsense fooled a lot of people. Who knows how many men will be harmed because of your sad thesis.

UPDATE: Additional problems with Bossio’s paper

  • Some readers pointed out that Jennifer Bossio’s measuring point was the outside of the foreskin (see diagram). The foreskin is not a single structure. It has an outer layer of regular penile skin, and an inner layer of mucosa. There is also a transitional area which was pointed by Sorrells as the single most sensitive area to soft touch, and there is the frenulum, joining the ridged band and the inner foreskin to the glans and the meatus. Sorrells measured sensitivity at 8 different points of the foreskin. Bossio did not take measurements on the points indicated by Sorrells as the most sensitive ones to fine-touch sensation, which are the ridged band and the frenulum. Nevertheless, she found that the outer foreskin was significantly more sensitive to touch than the rest of the penis, which is consistent with Sorrells, even if her conclusions fail to indicate that.
    This was the site used by Bossio:
    bossio1
    These are the testing sites used by Sorrellssorrells_sites
  • According to the Queens University press release, Bossio “extended the research methods in her study to include warmth detection and heat pain because these stimuli are more likely to activate the nerve fibres associated with sexual pleasure“.For one, Sorrells did not make any claims regarding fine-touch sensitivity and pleasure.Second, “extending” the method makes the results difficult to compare. For example, Bossio writes “with respect to warmth detection, the foreskin was more sensitive than the glans penis, but not the midline shaft or an area proximal to the midline shaft. Using a different stimulus modality (warmth sensation, as opposed to fine-touch punctate pressure), we partially replicated the findings reported by Sorrells et al. (2007), in that the foreskin was more sensitive than the glans penis, but—unlike Sorrells—not two sites located on the penile shaft.” This makes no sense, because since Sorrells did not take measures of warmth sensitivity, there is no way to compare the data collected to Bossio in this aspect to anything in Sorrells study. It is not correct to say that this data “partially replicates” Sorrells given that they are referring to different types of stimulus.

    Sorrells declared that the foreskin was the most sensitive part (to soft-touch and to soft-touch only). Different parts of the body specialize in different kinds of sensitivity, according to our body’s needs. For example, our eyes are probably the most sensitive part to light. Our ears are probably the most sensitive part to sound. We wouldn’t try to assess sensitivity to sound in our eyes, or sensitivity to light in our ears. If the foreskin is sensitive to soft-touch, it is likely because we need that area to be sensitive to soft-touch, and removing it is going to affect the reasons why we need that sensitivity.

    Think about it this way. Removing one person’s eyes does not make the person deaf. But that is not a reason to justify removing the person’s eyes without necessity, particularly if we don’t know if the person needs to be sensitive to light.

  • Regardless of whether the foreskin is the most sensitive part, or just as sensitive as the rest of the penile skin, or if it was not sensitive at all, removing it would still violate the bodily autonomy and genital integrity of the person. Bossio writes on BJU that her “results are relevant to policy makers, parents of male children and the general public.” This statement misses the point that the most important stakeholder is the person holding the foreskin: the male child, the future male adult, and that no matter to what extent sensitivity is affected, removing the foreskin of the child deprives the child from the freedom to choose and the right to provide informed consent – thus violating his bodily autonomy and genital integrity.

    To be fair, on her thesis, Bossio writes that “Individual stakeholders are also expected to benefit from this research program, such as medical professionals, parents of male infants, and men themselves.” For some reason, “men themselves” were omitted from the conclusion in BJU.

  • Hugh Young pointed out that the graphics on Bossio’s thesis (i.e. figure 3.2) are collapsed across circumcision status. This conceals any existing difference between circumcised and uncircumcised.Figure 3.2 basically shows that the foreskin is more sensitive than the other testing points for tactile, warmth and heat pain (this last one only by a small difference), and that the glans is more sensitive to pain. The collapsed bars fail to show any difference. Young explains: “This makes the inclusion of the bar for the foreskin absurdly different from the others, because the foreskins of the cut men are non-existent. If their measurements were shown, their bars would be infinitely tall, indicating that no amount of pressure, heat etc, would evoke a response.” Sorrells study includes figures that are not collapsed by circumcision status. Two adjacent bars show the results for circumcised and uncircumcised. In the case of the circumcised males, the bar for non-existent measuring sites is simply omitted. If Jennifer Bossio wanted her study to be comparable to Sorrells, she should have considered presenting graphics that were comparable to those by Sorrells.Bossio’s figure 3.2
    bossio_fig

    Sorrells’ figure 3

    sorrells-fig

Bibliography

Bossio, J.A.EXAMINING SEXUAL CORRELATES OF NEONATAL CIRCUMCISION IN ADULT MEN. Thesis (Ph.D, Psychology) — Queen’s University, 2015-09-18 00:15:45.183

http://qspace.library.queensu.ca/handle/1974/13627

 

Bossio, J.A. et al. Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing. J. Urol. http://dx.doi.org/10.1016/j.juro.2015.12.080 (2015)

 

Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int 2007;99:864-9.

http://www.cirp.org/library/anatomy/sorrells_2007/

Badger J. A Survey about Masturbation and Circumcision. 2000

http://www.circlist.com/surveys/badger-06.html

 

Fenner, Annette  - Male circumcision: Circumcision does not affect sensitivity – Nat Rev Urol

PY  - 2016/01/20/online

VL  - advance online publication

http://www.nature.com/nrurol/journal/vaop/ncurrent/full/nrurol.2016.3.html

Subtle language to perpetuate the fraud – by Touro Infirmary

I believe we all, regardless of whether we oppose circumcision of children, or promote it, can agree that circumcision is not a necessary procedure.

In fact, the third paragraph of the American Academy of Pediatrics’ 2012 Policy Statement on Circumcision starts: “Although health benefits are not great enough to recommend routine circumcision for all male newborns“. Then it goes on to boast the “benefits” and endorse insurance coverage of the procedure.

Nevertheless, the important point is, the procedure is considered elective. Intactivists and the medical community disagree over who has the right to “elect” the procedure, but there is no medical view that considers the procedure necessary.

Which is why it is important to see how subtle language is used to convince parents otherwise.

Touro Infirmary

Touro Infirmary, Louisiana

We were alerted to Touro Infirmary’s verbiage and had  the chance to verify it on their website. Touro, founded in 1852, claims to be New Orleans’ only community based, not-for-profit, faith-based hospital, and their “about us” page claims they have always  taken a progressive path.

But are they progressive when it comes to male newborns’ genitalia?

The “before delivery” page reads:

You may have already signed the “Consent for Circumcision” for your male child when you signed your other consents at 36 weeks. If not, this consent will also need to be signed shortly before the circumcision procedure is done.”

Notice the language: this consent will need to be signed before the procedure is done. There is no question of whether you are the parents have decided. The language presents circumcision of the male child as something inevitable, and the consent form as something that just needs to be signed so we can move forward and be done with this.

The “after delivery” page then starts with this question and answer:

“I have heard that after the birth of my baby, the baby will remain in my room, with me, rather than go to the nursery. Is this true?”
“Touro offers “rooming-in/mother-baby care” before and during the newborn’s initial bath and examination by the nurse and pediatrician. Of course, circumcisions and other necessary procedures are done in the nursery, not in the mother’s room.”

Notice the wording: “circumcision and other necessary procedures” which seems to imply  that circumcision is one of those necessary procedures. In fact, it seems it is so important that it is the first one mentioned!

The only place where they hint that circumcision is not necessary or otherwise mandatory is on their example of a birth plan, which includes this line:

“If your baby is a boy, do you want to have him circumcised?”

The website makes no attempt to educate parents on why they would want or not, to have their male child circumcised. But by using careful language,  they present circumcision as a necessity, as something that is simply done. And by doing this, they attempt to ensure the perpetuation of male infant circumcision in the United States.

Touro, shame on you.