Circumcision: cut the crap

‘Intactivists’ who claim that being circumcised abused their human rights, and ruined their sex lives, should get a grip.

Nancy McDermott

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Topics Politics

Reading Ethan Epstein’s arguments on spiked against the Centers for Disease Control (CDC) proposal to push routine male infant circumcision on the American public I was reminded why I so hate The Circumcision Discussion.

As the mother of two sons, and the moderator of a parenting list serve here in New York, I have been party to The Circumcision Discussion far more often than anyone who isn’t a paediatrician or a mohel should be. When the topic comes up – often in the context of a family looking for someone to perform a circumcision – discussion becomes instantly polarised.

It tends to start out relatively civil, usually with duelling research studies showing the supposed risks and benefits on either side, but then ends badly, with accusations of child abuse from one side and charges of twisting the scientific data or thinly veiled anti-Semitism from the other.

The main problem with The Circumcision Discussion in general, and with Ethan Epstein’s article in particular, is the appeal to Science with a capital S to validate what is essentially a personal decision for parents. There isn’t really overwhelming evidence for or against infant circumcision, which makes this issue quite unambiguously a matter of preference, and more so than some other issues such as breastfeeding or vaccination where the scienctific research is abundant.

But that hasn’t stopped Epstein from trying to use Science to support what is essentially his own particular set of prejudices. In the end, his attack on infant circumcision is not based so much on evidence but rather on a degraded notion of personal autonomy that is contemptuous of parents and reduces the whole parent/child relationship to the matter of a few inches of skin.

Epstein is right to point out that we should be sceptical of the impulse to politicise intimate aspects of our personal lives. As we’ve seen in discussions around breastfeeding, official recommendations based on scientific research are often less evidence-based than they appear.

Epstein’s criticism of the CDC’s rationale for changing its recommendation is also essentially right. Routine circumcision probably isn’t a particularly useful strategy for preventing the spread of AIDS in the United States. There’s also not enough evidence to say definitively that it offers significant health benefits in other areas. The problem is that, having undermined the CDC’s dubious case for routine circumcision, Epstein then goes on to erect his own equally shaky case against it.

Take for instance his attempt to establish – or rather to assert – that male infant circumcision is on a par with ‘female circumcision’. It’s a comparison that defies even a basic familiarity with human anatomy. ‘Female circumcision’, or Female Genital Mutilation (FGM) as it is usually called, involves the removal of some or all of a woman’s external genitalia and is associated with side effects like intense pain, infection, haemorrhaging, infertility and urinary incontinence. Comparable surgery in a man would involve the removal of most of the penis and the scrotum. But male circumcision as it is currently practiced consists of the removal of the foreskin and nothing else. Statistically it is a very safe procedure with few complications (in some cases, there may be minor bleeding or a local infection) (1).

In comparing FGM with infant male circumcision, Epstein is seeking to establish a moral equivalency between the two. FGM is not just, as he writes, ‘an article of faith for international development agencies’; it’s also a moral absolute he want to cash in on, even to the point of referring to it by the outmoded term ‘female circumcision’ so that it sounds comparable to male circumcision. If FGM is seen as a violation of the human rights of women and girls and male circumcision is, as Epstein would have it, just the same, then anyone who circumcises their son is violating his human rights.

Epstein doesn’t do much better when he tries to show evidence for psychological trauma and sexual dysfunction as a result of circumcision. He relies on a 2002 paper written by self-proclaimed ‘intactivists’ which indicates that some men enjoy sex less after circumcision. Had he more objectively investigated what he says is ‘quite evidentially true’, he might have come across any number of studies that show the opposite. My favourite is a large-scale study from 2008 (with over 4,500 participants) in which an overwhelming majority of Kenyan men reported no difference in sexual satisfaction or function after their circumcisions (2).

The results of circumcision are at the very least far from universal. Like the CDC’s rationale for promoting circumcision, the ‘Science’ at the heart of Epstein’s argument is less straightforward than it appears.

It is striking that midway through Epstein’s article the CDC’s proposal to ‘promote’ infant circumcision mysteriously transforms into a plan to ‘mandate’ infant circumcision. This is not a slip and it’s not just that Epstein has got his facts wrong (although he has). Rather he makes this change in terminology because he isn’t really talking about the CDC at all any more. He’s talking about parents. For anti-circumcision activists, all infant circumcision is mandated in the sense that infants do not consent to it.

On one level Epstein is right. It is of course impossible for an infant to consent to anything, and parents make decisions large and small on behalf of their children all the time. Some of these decisions affect their future and many are far more difficult than the question of whether or not to have your infant circumcised.

I’m reminded of a friend whose daughter was born with a birthmark that covered her left eye and much of her face. It could be treated with laser surgery, but it would require multiple procedures and it would be painful. My friend and her partner agonised over the decision. Would having the surgery feed into a sense that there is only one way to look? Would it make their daughter’s life easier not having a disfigurement? How much would it hurt her? Their friends urged them to go ahead and in the end they did opt to have the birthmark removed. Flash forward to the birth of the couple’s son a few years later. Their friends balked at their decision to circumcise their son even though it was important to them as Jews and it would be over and done with very quickly. My friend told me she couldn’t help but think it ironic that her friends who were anti-circumcision ‘didn’t think there was anything wrong with burning the skin on my child’s face, repeatedly, as long as it made [the birthmark] go away’.

Many of the choices we make as parents profoundly affect our children. But when we look back at our own lives it is often things that didn’t concern us directly at all that had the greatest impact – things like parents’ decision to divorce, to change jobs, or to emigrate. As children we rarely have any say and yet we manage to adapt and often to flourish. One of the major reasons we are able to develop this resilience is because we can depend on our parents. It is the parent/child relationship – each one unique and dynamic, a complex mix of love and trust, and mutually crazy-making – that creates the sense of inner confidence that helps us learn shape our own destinies.

By counterpoising the ‘personal autonomy’ of an infant to the judgment of his parents, Epstein and others who campaign against circumcision reduce the relationship between parents and their sons to one moment; a moment that forever defines the child as victim and the parent as victimiser regardless even of what the boy himself thinks about it later in his life. Once a victim, always a victim.

There are all sorts of reasons why parents do or don’t circumcise their sons. For some it is the embodiment of their faith, for others it is simply custom. For some the thought of subjecting their child to any unnecessary pain or alteration is unacceptable. The important point is that the choice takes place within the context of the parent-child relationship. The CDC is not, as Epstein implies, planning to circumcise every male infant in the United States, but the change in its recommendation, just like every other official pronouncement about the right way to raise children, should be greeted with scepticism. Not because, as Epstein argues, it might lead parents to make a wrong choice, but because it questions their right to make choices in the first place.

Nancy McDermott is a writer and mother based in New York. Nancy gratefully acknowledges Dale Rosenberg for her generous contribution of time, stories, references and insights.

A STRANGE ATTACHMENT, by Nancy McDermott

It wasn’t a long ago that The Circumcision Discussion wasn’t a discussion at all. I conducted a quick poll of every Gentile woman from my mother’s generation I could get hold of and asked them how they had made the decision about whether to circumcise their sons. I discovered they almost universally couldn’t remember. As my mother told me: ‘It’s just what we did back then.’ Were they concerned about masturbation or promiscuity, the classic justifications the Victorians offered for routine circumcision? ‘God, no! I’m not sure I even knew what masturbation was back then’, admitted one lady.

The origins of the custom are notorious – it started with the Victorians who believed circumcision could ‘cure’ everything from paralysis to masturbation. But by the 1960s, when 90 per cent of boys in the US were circumcised, it was ‘just what we did’.

In light of the present panic about the CDC’s recommendations to introduce routine infant circumcisions it is ironic that it was physicians who first began to reassess this custom in the 1970s. They reconsidered their position not in response to an outcry from the public but because new evidence became available that undermined the procedure’s perceived health advantages.

In 1975, the American Academy of Pediatrics concluded that there were no valid indications for introducing routine circumcision of infants but added that ‘traditional, cultural, and religious factors play a role’ in parents’ decisions. The job of the physician, it said, was to present parents with ‘factual and informative medical options regarding circumcision’. However, ‘the final decision is theirs [parents’], and should be based on true informed consent’.

By the mid-1980s, however, infant circumcision had transformed from a matter of a parents’ choice to a human rights issue championed by a network of non-governmental organisations and a coterie of militant ‘intactivists’. The anti-circumcision movement grew out of several important trends in American society: feminist disenchantment with the mainstream medical establishment with regard to reproductive issues; the rise of the gay rights movement; the popularisation of infant determinism and new research into brain development.

In the late 1970s and early 1980s, an important strand within feminism eschewed obstetrics as an unnecessary medicalisation of the natural process of childbirth. If epidurals and Caesarean sections were deemed largely unnecessary, circumcision, for which there were no clear medical justifications, was simply beyond the pale.

As for the gay liberation movement, it was concerned, almost by definition, with the free exercise of masculine sexuality. Infant circumcision was perceived as an actual and symbolic external constraint on the rights of the individual in relation to his intimate life.

Finally, and most importantly, the rise of infant determinism in tandem with new theories of brain development gave rise to the notion that people could be profoundly negatively shaped by events that occurred in childhood (even if they cannot consciously remember them). Infant determinism took this Freudian idea to the extreme, focusing on developments in infancy or even before. New research into brain function seemed to explain how early events like circumcision could result in the ‘perinatal encoding of the brain with violence’.

It was a small but important step because it seemed to imbue opposition to circumcisions with an air of moral authority derived from science. It meant that circumcised men bore the neurological scars of the procedure whether they knew it or not, whether they felt them or not.

It was a compelling idea for many. Psychologists began to ‘discover’ post-traumatic stress disorder from infant circumcision and a small subculture of men have genuinely come to believe that their circumcision as infants has negatively affected everything from their sex lives and relationships to their academic performance and career choices. Some have even gone as far as electing to endure foreskin ‘restoration’, a lengthy process involving tape.

If it hadn’t been for the rise of the parenting expert and parenting lifestyles, intactivism might have remained a quirky subculture with its lists of ‘intact’ and ‘restored’ celebrities and silly slogan T-shirts (‘May the Forceskin be with You’ or ‘I Wish I Was Intact’ – featuring a graphic of a sad penis).

Since the days of Dr Spock’s Baby and Childcare, there has been an explosion of experts offering advice on childrearing. The net effect has been to make parents more self-conscious about how they bring up their children than ever before. Parenting lifestyles – such as attachment parenting or holistic parenting – hold out the promise of a shared philosophy for bringing up children, and of a life in which even the smallest decisions we make are imbued with moral import. From that perspective, intactivism and parenting lifestyles seem made for one another. For intactivists you are your foreskin; with attachment parenting, you are your son’s foreskin, too.

Previously on spiked

Ethan Epstein argued that the US proposal to cirumcise every infant male on health grounds was illiberal and harmful. Dr Michael Fitzpatrick showed how the AIDS epidemic was a glorious myth. Stuart Derbyshire argued that the UN was making AIDS in Africa worse. Ann Furedi wrote that chlamydia is the new medical justification for not having sex. Or read more at spiked issue Health.

(1) See The Center for Disease control Factsheet on circumcison.

(2) Adult Male Circumcision: Effects on Sexual Function and Sexual satisfaction in Kisumu, Kenya, by JN Krieger, SD Mehta, RC Bailey, K Agot, JO Ndinya-Achola, C Parker and S Moses, Department of Urology, University of Washington, Seattle

To enquire about republishing spiked’s content, a right to reply or to request a correction, please contact the managing editor, Viv Regan.

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