Category Archives: Medical Community

Babygaga’s harmful advice on care of the foreskin – Hall of Shame

babygagaBabygaga is known for frequently posting pro-circumcision advice and improper care of the intact foreskin. The problem is, such information does not come without victims. Well meaning mothers may follow such improper advice and injure their babies.

For example, on July 18th, Babygaga published an article called “16 things nobody tells you about newborns“. On numeral 9 (“Be careful with the penis”), the faceless Bridget Galbreath claims “If he isn’t circumcised, you will have to roll the foreskin back completely to make sure that you thoroughly clean the penis with every diaper change.

Even the not-so-luminaries of the American Academy of Pediatrics have it better, when they write on their “Care for an uncircumcised penis” page:

Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teen years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until the foreskin fully separates, do not try to pull it back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding, and tears in the skin.

Trying to “roll back” the foreskin of a baby is painful and dangerous. Babygaga is recommending this against the advice of the American Academy of Pediatrics and pretty much against anyone who understands normal intact anatomy of the male newborn.

Numerous intactivists have reached out to Babygaga asking to correct this article. We will keep an eye on the article hoping for correction.

In the meantime, Babygaga inaugurates our Hall of Shame.

hall-of-shame

Fundamentals of anatomy? What’s up with Dr. Frederic Martini?

To think that the American medical community is biased for circumcision is an understatement. The most information that American medical texts provide about the foreskin is that it is removed by circumcision. That would be like describing the female breasts as the part removed by mastectomy, with no regard to function, form, and benefits of having it.

Fundamentals of Anatomy & Physiology

Fundamentals of Anatomy & Physiology

Today we received a couple of images from a book called “Fundamentals of Anatomy and Physiology“, by Dr. Frederic Martini, Dr. Judi Nath and Ed Bartholomew. On their text, the prepuce is described as a “fold of skin” with glands that “secrete a waxy material known as smegma” which “can be an excellent nutrient source for bacteria“. Because of that, “mild inflammation and infections in this area are common, especially if the area is not washed thoroughly and frequently“, but thank God for the solution, because “one way to avoid such problems is circumcision, the surgical removal of the prepuce“.

Then we are told that “in Western societies (especially the United States) this procedure is generally performed shortly after birth” and then we are told that circumcision reduces the risks of UTIs, HIV infection and penile cancer. Finally we are told that the practice remains controversial because of the risks of “bleeding, infections, and other complications“.

14225598_10154521174798385_5457800265120875240_n

Nothing else is said about the foreskin. Not a thought of describing the outer skin, the inner mucosa, the frenulum, the frenular band, the frenular delta, the dartos fascia, the meissners corpuscles, the balanopreputial synechiae, the normal development of retraction, the immunological functions of the foreskin, the gliding motion… you know, the real anatomy and physiology of the foreskin!

So, let’s see. First, they focus their description on the fact that the foreskin secretes smegma. Big deal. Secreting smegma is normal, men and women do it. Smegma can accumulate inside the foreskin of children, and that is normal. Irritations can occur, but irritations can occur on any part of the body; foreskin irritation is often the result of overzealous cleaning or leaving soap residue, or using antibacterial or scented soap, not just from having some smegma.

Removing the foreskin to eliminate smegma is really absurd. Your body will still shed cells, they just won’t accumulate, they will stick to your underwear instead. But even if this was such an important factor, it should be a personal decision, not a parental one.

We are told that Western societies, especially the United States, practice infant circumcision. In fact, it would ONLY be the United States, which hardly accounts for the totality of “Western societies“. Most of the world does not circumcise, not Europe, not Latin America, not non-Muslim Asia. In general, circumcision is limited to the United States, Israel, Philippines, South Korea, Muslim societies and some African tribes. But perhaps mentioning this wouldn’t really make such a good case as the fictitious “Western societies” described by these doctors.

Discussing the topics of UTIs, HIV and penile cancer would take pages and has been done already, here and in other places. Penile cancer, scary as it sounds, is rare, and is mostly associated with HPV infection and maybe with phimosis during adulthood, but it’s not an argument in favor of infant circumcision.

According to a letter to the AAP sent by 38 physicians heads of medical organizations from the actual “Western societies”, “only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves“.

Finally the practice of circumcision is not controversial because of the risk of pain, infection and complications. Yes, those things are problematic, but the practice is controversial because it overrides informed consent and restricts body ownership, by performing an irreversible non-medically necessary genital alteration on a person who is not yet competent to provide informed consent – but who will one day be competent. But of course, they won’t acknowledge the central human rights issue of the controversy, why would they?

So, for a book that sells new for $231 and which is used to educate medical students, we feel that this piece misleading information is a disservice to generations of medical professionals.

 

Edgar Schoen, MD passed away

Edgar Schoen, M.D., (August 10, 1925 – August 23, 2016) passed away peacefully in his sleep on August 23, at his home and surrounded by family.

Edgar Schoen was an American Jewish Physician and worked as a Clinical Professor in Pediatrics at the University of California, San Francisco. In 1987, Schoen was appointed head of the Task Force on Circumcision by the American Association of Pediatrics, where he pushed for routine infant circumcision, but the neonatologists on Schoen’s committee wouldn’t go for it. Under his supervision, the AAP released the Policy Statement on circumcision of 1989, which was greatly reverted by a new statement in 1999. Schoen angrily criticized the overriding statement of 1999 in a letter titled “It’s Wise to Circumcise: Time to Change Policy

As an enthusiastic circumcision promoter, Schoen shamelessly mixed medical, religious and cultural arguments. His bias was clearly obvious in some of his latest articles, such as “Circumcision is not only Jewish, it’s good for you” (JWeekly, 2013) or his 2009 book “Circumcision, Sex, God, and Science: Modern Health Benefits of an Ancient Ritual“.

We share a recently released video interview conducted by James Loewen in 2009, where Dr. Schoen expresses his views rather freely.

AAP 1984 – or how circumcision causes amnesia

As told by Steven Svoboda of Attorneys for the Rights of the Child, on October of 2013 there was a debate at the Medical University of South Carolina in Charleston, South Carolina, during which, Dr. Michael Brady MD, one of the 8 members of the American Academy of Pediatrics’ task force on circumcision responsible for the Policy Statement and Technical Report of 2012, declared: “I don’t think anybody knows the functions of the foreskin,” and then reiterated, “Nobody knows the functions of the foreskin.”

That is strange, because just 29 years earlier the American Academy of Pediatrics had a pamphlet discussing the “Care of the uncircumcised penis”, which included a brief discussion of some of the functions of the foreskin, and a drawing clearly showing the anatomy of the intact penis.

The first edition of this 1984 pamphlet had the word “uncircumcised” spelled incorrectly: “uncircumcized”. There was a second batch printed with this misspelling corrected, but then, when a new batch was printed in 1990, the paragraph about functions of the foreskin and the anatomical drawing suddenly went missing.

Ronald Goldman, Ph.D., of the Circumcision Resource Center, started inquiring about this curious omission on January of 1996. He contacted the AAP eight times about this change. After having been passed by four  AAP officials, he finally obtained this response in September of 1996:

The reviewers felt it was not necessary to reinstate the paragraph because the revision of the brochure included a complete reorganization of the information contained in previous editions.”

According to Dr. Goldman, a comparison of new and previous editions did not show “complete reorganization of the information” and there was no reason why the removed information would have stopped being relevant to parents.

In fact, the AAP still has a page on the “Care for an uncircumcised penis” on their website. It is not a bad page, although there are some things that could be a lot better, and the functions of the foreskin are still missing.

Perhaps if they had listened to Dr. Goldman in 1996, Dr. Brady would have been able to describe some functions of the foreskin when asked about them, during the 2013 debate.

So… what was that controversial paragraph?

The Function of the Foreskin: The glans at birth is delicate and easily irritated by urine and feces. The foreskin shields the glans; with circumcision this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, meatitis (inflammation of the meatus), and meatal stenosis (a narrowing of the urinary opening). Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life.

This is the anatomical drawing, prepared by Edward Wallerstein (author of the 1980 book “Circumcision: An American Health Fallacy“), which was included in the pamphlet:

wallerstein

It is important to note that no anatomical drawings are included in the 2012 AAP Policy Statement and Technical Report on circumcision. The word “Frenulum” (or “frenum”) does not even appear in either document.

This is a scan of the 1984 pamphlet, as shared by Dr. Goldman (click to enlarge).

AAP1

AAP2

Given these obvious omissions, it seems hypocritical from the AAP to claim, as they do, that “It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

Our conclusion is that perhaps circumcision causes amnesia. Selective amnesia. That, or they have a vested interest in maintaining high rates of circumcision for financial gain, but that would be dishonest, wouldn’t it?

Dr. Goldman’s discussion of the pamphlet: http://circumcision.org/pamphlet.htm

CIRP page mentioning this pamphlet: http://www.cirp.org/library/normal/aap/

CIRCUMSTITIONS discussion of this pamphlet: http://www.circumstitions.com/AAP-care.html

Attorneys for the Rights of the Child telling of the 2013 debate: http://www.arclaw.org/our-work/presentations/charleston-debate-marks-turning-point-movement-recognize-circumcision-human-r

AAP Current page: Care for an uncircumcised penis. https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Care-for-an-Uncircumcised-Penis.aspx

 

 

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?

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“.

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.

 

Which doctors claim that legalizing some forms of FGM will help some girls?

The most recent discussion in genital integrity forums is the publication of a paper (and related news articles) by two U.S. based gynecologysts, Kavita Arora and Allan Jacobs, of an article called “female genital alteration: a compromise solution” in the Journal of Medical Ethics. In this paper, authors Kavita Arora and Allan Jacobs reframe the discussion of female genital mutilation (FGM) as a matter of “alteration“, because they consider that the term mutilation is culturally insensitive and discriminatory towards women. They argue that mild forms of “FGA” do not constitute a human rights violation, and thus promote that some of those forms could be offered and tolerated as a “compromise” to protect children from more extensive forms of “FGA“, allowing parents to uphold cultural and religious practices “without sacrificing the health and well-being of female children“.

This is obviously a scandalous proposal, and one that is not entirely new. In May of 2010 the American Academy of Pediatrics had already suggested a similar path with their maligned “policy statement on ritual genital cutting of female minors“, a paper that was criticized by the World Health Organization as an obstacle to their efforts to eradicate FGM, and was also criticized by pro-genital integrity and children’s rights organizations such as Intact America, fearful that the American medical community may slowly reinstate the practice of FGM among Americans, a practice that persisted for at least the first half of the 20th century, before slowly falling in obsolescence. The AAP’s policy statement was retired one month later.

Both papers, the AAP policy statement and now Arora and Jacobs’ article, however, acknowledge something that most FGM activists deny: that there are parallels between FGM and the circumcision of male children. The AAP declared that some forms of FGM are far less invasive than male circumcision as practiced in the “West” (sic). Arora and Jacobs refer to the difference in the treatment of male circumcision and “FGA” as “disparate“, and recognize that a possible solution would be to proscribe both practices. They acknowledge that both practices have been criticized as a violation of human rights. However, they have already argued in a previous paper that infant circumcision is not a violation of human rights.

And here is where this new paper is a logical consequence of their previous article.

Published in 2015 in the American Journal of Bioethics, the  article, entitled “Ritual Male Infant Circumcision and Human Rights“, is a very flawed rationalization meant to deny that male infant circumcision can constitute a violation of human rights. It has been one of my objectives for several months, to write a response to this paper, but many circumstances have slowed my efforts. I will, however, summarize a few points here, so that we can better understand their mental process.

Their paper on ritual male infant circumcision pretends to appear multicultural, by using language that appeals more to an European audience.  For example, referring to infant circumcision as “ritual” is common in European circles, since it is not considered a medical practice in those places – I imagine that many American doctors would feel relatively insulted by the suggestion that they are practicing a ritual, which is what Arora and Jacobs  are doing. Through the paper, they often reinforce the fact that Muslims practice circumcision, to give the appearance of diversity. However, Robert Darby pointed that by framing their paper around infant circumcision, they are in fact excluding most “ritual” circumcision practices, such as those from African tribes, Philippines, and Muslim groups, since they occur mostly after infancy. It’s worth noting that in some languages, “infancy” refers to childhood in general, but its current use in English refers only to the pre-verbal period, so mostly the first year of life. Arora and Jacobs responded, in fact reaffirming that their paper refers to infancy only -without expressing disapproval or approval to circumcision beyond infancy, which they consider subject to a separate but related discussion, and state that Islamic circumcisions in the United States are often performed during infancy. Which leads to the basic conclusion, that their paper was not written to protect circumcision as it is performed in Africa, The Philippines or in Muslim countries, only circumcision as it is performed by Jews and Americans.

The fact that Muslims in the United States tend to circumcise during infancy is not a result of Islam, but a result of the American culture which makes infant circumcision easily available and almost normative at birth. The same argument can be made for Jewish people who allow their male babies to be circumcised by doctors before leaving the hospital; orthodox Rabbis consider circumcision performed on the second or third day of life, by gentile doctors, to be inadequate and invalid. Jewish circumcision requires a proper ceremony performed on the eighth day of life, by a trained Jewish mohel, with methods that are not the most sanitary, nor place particular interest in preventing pain for the baby. American Jews who have their babies circumcised in hospitals on the second day, do so not because they are Jews, but because they are Americans, and a similar argument could be made for American Muslims.

So once removing the embellishment and appearance of diversity, the paper is a discussion concerning American and Jewish circumcision only. Arora and Jacobs repeat a number of fallacious, obsolete and even irresponsible arguments – which we will address in a future post:

* That early circumcision is safer when performed in infancy

* That circumcision has little or no effect on male sexuality

* That circumcision causes little harm to the infant

* That the more severe complications of circumcision are of little relevance because of their low incidence – in other words, that killing or severely maiming infants is acceptable as long as it is in a very low rate.

Their paper goes into a discussion of whether genital integrity is in fact a human right, and whether the principle of open future as suggested by Darby is applicable or not. Both discussions are fallacious, and I promise I will refute them in detail later.

Finally, they propose a three step test to determine if a parental decision constitutes a violation of human rights. Predictably enough, they find that under their test, male infant circumcision is not a violation of basic human rights. The irony that they had defined the test in such a way that a favorable result would be obtained, seems to be lost on Jacobs and Arora.

But here’s the catch: under the same test, mild forms of “FGA” would also have to be considered valid parental decisions and not violations of human rights. This new paper on female genital “alteration” is just the logical consequence of such a finding.

Personally, I believe that it is sad that educated adults and physicians, whose minds should be focused on healing, spend all the time and energy they spent into rationalizing and justifying hurting babies as a valid parental decision, as long as the harm is relatively low and any catastrophic incident has a relatively low incidence. To me, the purpose this paper serves seems to be masturbatory fodder for circumcision-crazed psychopaths, and not the work of professional and empathetic physicians, thus earning them a proper space in the bookshelf, next to the works of J. H. Kellogg, Remondino, John Money, Brian Morris, the Benatar brothers and Doug Diekema.

Kavita Arora

Kavita Arora

Kavita Shah Arora is an Assistant Professor of Reproductive Biology and Bioethics at Case Western Reserve University, as well as a practicing general obstetrician/gynecologist at MetroHealth Medical Center. She received her BS with a minor in Philosophy from the Pennsylvania State University. In 2009, she graduated with both an MD from Jefferson Medical College and a Master’s Degree in Bioethics from the University of Pennsylvania. She completed her residency in Obstetrics and Gynecology at McGaw Medical Center of Northwestern University in 2013. She has served on the national ethics committees of both the American Medical Association and the American College of Obstetricians and Gynecologists.

Dr. Arora is primarily based at MetroHealth Medical Center as a practicing general ob/gyn and also serves as the Department’s Director of Quality. She is an active member of the hospital’s ethics committee. Her research interests include reproductive ethics, reproductive technology, perinatal decision making, conscience, HIV care in pregnancy, and feminist Bioethics. She is also interested in medical education, especially with the intersection of ethics education.

An existent video of Kavita Arora appears to present an idealistic, happy, young adult with passion to provide a nice birthing experience to female patients. When was this passionate healer derailed into defending the indefensible -harming babies, male and female alike? How does she get away with publishing a paper that is beyond the scope of her practice which is not in surgery, urology or pediatric care, but the care of women and their reproductive systems?

Dr. Allan Jacobs

Dr. Allan Jacobs

Allan Jacobs is Professor of Obstetrics, Gynecology, and Reproductive Medicine at Stony Brook University School of Medicine. He received his B.A. (psychology) at Cornell University, his M.D. from the University of Southern California, and his J.D. from St. John’s University. He completed his residency at Parkland memorial Hospital and his fellowship at Mount Sinai Hospital. A board certified gynecologic oncologist, he serves as Chairman of the Department of Obstetrics and Gynecology at Flushing Hospital Medical Center. He has published articles in the field of reproductive ethics in journals such as the Hastings Center Reports. He has also published in the area of health law, a current research interest. He teaches biomedical ethics and health law to medical students and residents.

As for Allan Jacobs, his religious affiliation seems to account for his bias in favor of circumcision. Note that he too, is a gynecologist, for whom the concern for the genitals of healthy male children should be zero.

To our knowledge, none of the American doctors that used to perform clitorectomies and other forms of FGM on all-American female minors, ever paid for their crimes. Not even more recent ones, those that removed the phalluses (clitorises or penises) and gonads of intersex babies, as did Dr. Dix Poppas at Cornell University or Dr. Ian Aaronson at the Medical University of South Carolina, -and then proceeded to rationalize those procedures by calling those babies “disordered” (DSD) in the 2006 “consensus“, have paid their time for performing procedures that should be proscribed by the FGM law of 1997.

 To our knowledge, a single case stands in the United States. Dr. Hatem Elhagaly, Muslim, was fired from the Mayo Clinic  for promoting a practice that is illegal in America but, in his words, “honors Islam.” Mayo Clinic however has experience with surgical treatment of ambiguous genitalia, procedures matching the definition of FGM.

 In publishing this paper arguing for mild forms of “FGA“, Jacobs and Arora have followed the logical steps established by their previous paper, but they have also put themselves at odds with the Western rejection of FGM.

Their only positive point is breaking again that “taboo” that makes most American doctors afraid to suggest any comparison between male infant circumcision and female genital mutilation. But the conclusion that those practices are not violation of human rights seems to detract from the humanity and dignity of the authors.

 We believe doctors should dedicate their efforts to serve their patients as healers, not as cultural or religious brokers defending the “parental right” to harm the child (the patient) as part of a ritual.

We hope to see Arora and Jacobs publicly retract their two papers, or follow the steps of Dr. Elhagaly.

So what happens when a baby dies after circumcision?

In my time as an intactivist, I have seen this scenario play out a few times. A parent, relative or friend of a relative posts in facebook asking for prayers for a baby who became severely ill after a circumcision. One of them kept bleeding and had seizures. Another one developed a UTI and a fever after a second procedure to try to fix an already botched circumcision.

Then the baby dies.

The intactivist community at large starts expressing sadness and grief, but they also start sharing the story, hoping that some parents will realize that there is a real danger of death when you send a baby to circumcision.

And then the family comes back… asking for silence. They claim that it was not the circumcision what caused the death. They claim that they are being attacked for their decisions and their beliefs.

What should the community do in those cases?

Accepting that their child died as a consequence of their circumcision means accepting that their child died because of a decision they took. It’s easier to go into denial. In fact, the circumcisers have an interest in keeping the family quiet, so they will likely distort the facts to make it seem as if circumcision was the only chance for the child to survive a pre-existent condition.

In the case of the baby that bled in 2013, the parents later said that bleeding gave them the only chance to fight a bleeding disorder; never mind that their baby didn’t make it.

In fact, in an amazing display of arrogance and irresponsibility, doctor Nisha Jain, M.D., chief of the Clinical Review Branch in FDA’s Office of Blood Research and Review, wrote Patients [of hemophilia] can be diagnosed as infants during circumcision”

In the case of a baby that stopped breathing shortly after a circumcision in Israel in June 2013, the Rabbis claimed a pre-existent condition and said that the circumcision had been performed “flawlessly”.

That same week, a teenage girl died in Egypt after circumcision (FGM) by a medical doctor. A health inspector report said the cause of the death was due to “a sharp drop in blood pressure resulting from shock trauma”. The doctor who performed the female genital mutilation was found guilty, but it is said he is not in jail.

But shock trauma is never considered in the case of baby boys dying after circumcision.

It is likely that hospitals offer some kind of incentive to families of babies dead after circumcisions. Families in turn will keep quiet about what happened. For example, when Jacob Sweet became severely disabled after having an infection and seizures after circumcision, and the hospital “lost” the records, the family offered a reward to anyone coming back with the records. The legal proceedings lasted for years, and the family was finally compensated. The family, that up to that point had even attended genital integrity events, suddenly became silent. When Jacob died, at the age of 26, his circumcision was not even mentioned in the obituary and related news.

But, who benefits from this silence?

The families don’t want to have their story plastered on the news and all over the internet. They want to settle and move on. The doctors don’t want the bad publicity. So, is it a surprise that the AAP didn’t find studies of mortality, only case reports, and thus didn’t provide any numbers on mortality on their policy statement on circumcision of 2012?

The majority of severe or even catastrophic
injuries are so infrequent as
to be reported as case reports (and
were therefore excluded from this
literature review)
- American Academy of Pediatrics
Technical Report on Circumcision 2012

In Canada, a baby, the son of an Iranian couple, died in 2013 after a circumcision that the parents didn’t even want in the first place, but were convinced by a doctor to have it done for medical benefits. The story remained silent for two years, until the family succeeded in seeing the doctors named. So you can see that there is an interest in keeping silence over these cases.

But, who speaks for the child? Who speaks for the one whose voice was never heard?

Genital integrity activists claim that circumcising a minor is a violation of human rights. Many medical communities refuse to accept this and frame circumcision as a parental right. But when a baby dies after his circumcision, can we claim that his rights were violated?

The World Health Organization (WHO) frames female genital mutilation as a violation of human rights, with this paragraph:

FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

We disagree that it “reflects deep-rooted inequality between the sexes” as those societies that practice FGM also practice traditional forms of male circumcision, often resulting in death and mutilation. However, in this moment, we are more interested in the last part of the paragraph:

The practice also violates a person’s rights to [...] life when the procedure results in death

Circumcision apologists claim that every medical procedure has risks. Genital integrity activists remind them that circumcision is not essential to the well-being of the child, and as such is considered an “elective” procedure – and yet the subject is not given the chance to “elect” (or refuse).

So what happens when circumcision results in death?

Who speaks for the baby whose right to life was violated?

How can we stay silent, and wait in silence for the next victim? What good is that?

Sorry families of those babies who died after circumcision. We grieve with you. We feel your pain. But staying silent is the worst form of disrespect for your lost one, and we will speak, if anything with the hope that one family won’t have to go through what you just went.