An Open Letter to the Author of ‘How Circumcision Broke the Internet’

circumcision photo by miss pupik

Brian D. Earp believes circumcision is worth talking about. And he would like Mr. Stern and the editors of Slate magazine to know why.

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Dear Mr. Stern,

I recently read your article, “How Circumcision Broke the Internet” for Slate magazine [republished as “‘Intactivists’ Against Circumcision” in Canada’s National Post]. I understand your concern about overheated rhetoric in public debates as well as the misuse of science to support untenable positions. As a scientist and ethicist who studies circumcision professionally, I will admit that I have seen this happen on both sides of this particular controversy. I think, however, that in your hurry to admonish “the intactivists” for pushing their anti-circumcision arguments too far, you may have fallen prey to some of that very same rhetorical excess (as well as misuse of science) in your own piece.

First, when you said that circumcision used to be “practiced by most families” I’m glad that you added the qualifier, “in America at least.” This is an important point. Circumcision is extremely uncommon in most parts of the world, and about 70-80% of men globally are left intact. Over 70% of those who are circumcised come from the Muslim world where it is done as a rite of passage; it is also a rite of passage in countries like South Africa, where at least 39 young men recently died from complications related to circumcision, such as excessive bleeding from their penises. Europeans, by contrast, (including the British; as well Latin Americans, Canadians, Australians, New Zealanders, the Japanese, the Chinese, Russians, and Indians–that is, most of the developed world) very rarely circumcise outside of religious communities (if at all). A majority of doctors from these countries insist that any “health benefits” conferred by circumcision–even when the procedure is performed correctly–are dubious at best. In fact, 37 of Europe’s most pre-eminent medical authorities (along with the distinguished Canadian pediatrician, Dr. Noni MacDonald) have recently expounded on this point in the flagship journal Pediatrics:

Only one of the arguments put forward by the American Academy of Pediatrics [concerning potential health benefits for circumcision] 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.

Also, I noticed that you cite a “systematic review” by Brian Morris (and a co-author) in support of one of your claims about penile sensitivity. Your readers may not be aware that Professor Morris runs a pro-circumcision advocacy website, has founded a highly active circumcision lobby group (some of whose board members derive a substantial income from performing circumcisions), and has recently been profiled in the International Journal of Epidemiology as being engaged in systematically distorting the academic literature on circumcision:

[As] in critical letters to the editor following other recent studies that failed to support their agenda, Morris et al. air a series of harsh criticisms against our study. As seen, however, the points raised are not well founded. It seems that the main purpose, as with prior letters, is to be able in future writings to refer to our study as an “outlier study” or one that has been “debunked”, “rejected by credible researchers” or “shown wrong in subsequent proper statistical analysis.” … As these critics repeatedly refer to Morris’ pro-circumcision manifesto as their source of knowledge, their objectivity must be questioned.

Perhaps it is not much of a surprise, then, that Professor Morris’ “systematic reviews” tend to yield results that come out rather favorable toward circumcision: indeed, he has invested a considerable amount of energy in making sure that they do. In other words, it isn’t quite enough to simply dredge up a reference in support of your argument — anyone with a computer and access to the internet can do that. Instead, researchers who study circumcision more seriously have to consider that even the most basic science on the subject is as complex as it is contentious. For example, this recent analysis criticizes the methodology of the “sexual satisfaction” findings from the African studies you mentioned:

Rather than blindly accepting such findings as any more trustworthy than other findings in the literature, it should be recalled that a strong study design, such as a randomized controlled trial, does not offset the need for high-quality questionnaires. Having obtained the questionnaires from the authors (RH Gray and RC Bailey, personal communication), I am not surprised that these studies provided little evidence of a link between circumcision and various sexual difficulties. Several questions were too vague to capture possible differences between circumcised and not-yet circumcised participants (e.g. lack of a clear distinction between intercourse and masturbation-related sexual problems and no distinction between premature ejaculation and trouble or inability to reach orgasm). Thus, non-differential misclassification of sexual outcomes in these African trials probably favoured the null hypothesis of no difference, whether an association was truly present or not.

Speaking of those African trials, you write that “circumcision lowers the risk of HIV acquisition in heterosexual men by about 60 to 70 percent.” But you left out a few important qualifiers. First, the participants in those studies were adult volunteers, not infants. Second, the studies themselves have been criticized in the academic literature for being scientifically flawed, with problems pertaining both to internal and external validity. Among other issues, not one of the studies was placebo-controlled (which would be impossible to achieve in this case, but which calls for caution in interpreting the results); and all three of the trials were stopped early, which typically has the effect of overestimating the effect size of the “treatment” being studied. They also find an absolute risk-reduction of only 1.3% between the treatment and control groups, which is somewhat less impressive-sounding than the relative risk-reduction of 60% that is normally reported in the media. Of course, the studies have also been vociferously defended, by none other than our good friend Brian Morris (see above) along with his usual team of collaborators including the software engineer and “internationally recognized circumcision activist” Jake Waskett. Readers will, of course, have to evaluate both the scientific criticisms and the defenses of the original trials to get a sense of the debate in this area, and draw their own conclusions.

But let us assume that the findings from the African trials are valid. Even so, they would not apply to “heterosexual men” (as you stated) tout court. First, the studies were carried out in Kenya, Uganda, and South Africa, each of which has a very different epidemiological environment and disease profile than what is seen in countries such as the United States. For example, in Kenya, Uganda, and South Africa, the base rate of HIV transmission is very high, and the virus is spread primarily through heterosexual contact. In places like the the U.S., by contrast, the base rate of HIV transmission is very low, and the virus is spread primarily through injective drug use and gay sex. Accordingly, even if we were to accept the findings from the African trials at face value, we would have no evidence that circumcision could be useful in other parts of the worldlet alone in infants, who are not susceptible to contracting HIV (unless they are molested).

Meanwhile, females in Sub-Saharan Africa may actually be at an increased risk of HIV infection as a function of male circumcision, raising concerns about deleterious population-level effects on women.

The fact that the African trials were carried out on adult volunteers is significant. For one thing, adult circumcision is likely to have differential down-stream behavioral effects compared to infant circumcision. This is because someone who has voluntarily undergone a surgery to combat the spread of disease (versus someone who was surgically altered before the advent of consciousness) may behave quite differently when it comes to adopting safe-sex practices. That is, we cannot draw inferences about the latter sort of person based upon evidence pertaining exclusively to the former sort of person. Second, adult circumcision raises far fewer ethical concerns: not even the most fanatical of “intactivists” would argue that adult men should be prohibited from having their own foreskins removed if that is what they desire.

What about the other STIs you mention? The latest systematic review and meta-analysis on this question reaches a conclusion very different from yours:

The claim that circumcision reduces the risk of sexually transmitted infections has been repeated so frequently that many believe it is true. In studies of general populations, [however], there is no clear or consistent positive impact of circumcision on the risk of individual sexually transmitted infections. Consequently, the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision, and any policy of circumcision for the general population to prevent sexually transmitted infections is not supported by the evidence in the medical literature.

Altogether, then, your citation of studies that show only benefits for circumcision (and your facile dismissal of those that point to the possibility of any downsides) is rather selective, to say the least. In fact, it reminds me of that very same “devilishly clever sophistry dressed up as logic” you referred to in your article.

You mention the term “genital mutilation” being used to refer to circumcision, and peg it to a “vitriolic mob of commentators.” I will say that I don’t much like the use of this term myself, as nobody likes to be told that they’ve been “mutilated” (among other reasons). But it’s worth mentioning that even thoughtful, sober legal scholars as well as respected bioethicists have used the term “mutilation” in this context as well — in part, no doubt, because certain forms of genital cutting that are actually less invasive than male circumcision are unambiguously classified as “mutilations” by the World Health Organization. This includes the ‘pricking’ of the clitoral prepuce of young girls (which does not remove any tissue and does not impair function, but which is nevertheless federally banned in the United States). A fortiori, the argument goes, non-therapeutic circumcision of young males must also be a mutilation, since it removes 1/3 or more of the motile skin system of the penis.

Now, you do get some things right. The idea that the foreskin has “mythical powers” is very silly indeed. It has no such powers. But it does consist of sexually sensitive tissue (whose sensitiveness may certainly vary from male to male); it does serve gliding and lubricating functions during sex (which are eliminated by circumcision and which do not seem self-evidently unimportant); and thus it might be at least reasonable to raise a question about the propriety of removing this tissue before the person whose penis it is has had a chance to make his own decision. In medical ethics, irreversible surgeries of any kind are generally treated with great caution, especially when there is no disease or deformity present, and even more so when the patient is incapable of giving consent.

So, no, circumcised men are not all damaged goods nor condemned to having terrible sex lives: that is clearly not the case, as circumcised men will generally attest. (Incidentally, many “circumcised” females report that they enjoy their sex lives as well, despite being told how ‘mutilated’ they are by the WHO.) But some men DO feel harmed by their circumcisions, either because the operation was botched (which should be an impermissible risk for any non-consensual, non-therapeutic surgery), or because they feel violated in having had a healthy, functional, and erogenous part of their penis removed before they had an opportunity to say ‘no’.

Of course, if it were any other part of the body we were talking about in this regard, most people would find this to be a fairly reasonable emotional reaction.

Finally, you seem to misunderstand the meaning of the words “medically unnecessary” — a term you attribute to those nutty “intactivists” in reference to non-therapeutic infant circumcision. Just because some health benefits may possibly ensue from removing a part of the body (and it’s unclear that net health benefits even do ensue in the case of circumcision, as discussed above), this does not make the surgery necessary, much less ethically sound. For example, we could eliminate breast cancer by removing the breast buds of all infant girls — and that would be an extraordinary medical benefit. However, infant prophylactic breast bud removal is not only “medically unnecessary” but is quite clearly morally impermissible. Furthermore, UTIs can be treated with oral antibiotics (as they are for girls, who get them 10 times more frequently), and STIs can be prevented by safe sex practices (as they are in Europe, where circumcision is rarely performed, and where STIs are, if anything, actually less of a public health concern). Of course, if an adult male would like to get himself circumcised as a way to reduce his risk of becoming infected with an STI–despite the fact that the evidence in this area is rather murky, and despite the fact that he would have to wear a condom either way–that is certainly up to him. It’s quite a different matter, however, to remove healthy tissue from an infant based upon a rough guess about his future sexual behavior.

In the final analysis, there can be no doubting that certain “fringe” individuals take anti-circumcision arguments to extremes. But it would be a mistake to imply, as your article rather boisterously does, that the only people who are opposed to circumcision are “wacky” activists — or, I’m sorry, “wack-job” intactivists, as the Twitter manager for Slate put it in linking to your article:

Screen shot 2013-09-23 at 10.38.58 PM

Instead, respected medical organizations including the Royal Dutch Medical Association (KNMG) have come out strongly against the practice, for many of the reasons I have already discussed. The KNMG states:

The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications.

My best guess is that your views on circumcision are rather heavily informed by (and perhaps even constrained by) the default norms of American society, which sees non-therapeutic genital cutting* of boys to be an unremarkable affair. Your mostly-American readers, therefore, may happily lap up your attack on “intactivists” as being right on the money. But the US has a very strange history in adopting circumcision as a cultural norm; circumcision has become uniquely and unthinkingly embedded in American medical practice; and the rest of the developed world views us** with a mix of curiosity and disbelief. Why do Americans continue to circumcise their sons? It is not exactly crazy to take this question seriously.

Sincerely,

Brian D. Earp
Research Fellow
University of Oxford

* Apologies for my “progaganda-style” (as you put it) use of the term “genital cutting” here, rather than “circumcision”; I was looking for a synonym since I’d already used “circumcision” earlier in the sentence. Since “genital cutting” is a medically accurate as well as value-neutral term, however, I thought this should be OK; and certainly it is a more descriptive choice than the Latin-derived “circumcision” which rather euphemistically draws attention away from what it is that is actually being done.

** Although my current affiliation is the University of Oxford, I am American, and was born and raised in the United States.

About Brian D. Earp

Brian D. Earp is a researcher in psychology, philosophy, and ethics at
the University of Oxford. He is also a professional actor and singer.
For more, visit: http://oxford.academia.edu/BrianEarp/About

Comments

  1. Well done Brian. It is good to see people using logic and reason to combat the propaganda that some use in the circumcision war. It seems many would rather find proof to support their position rather than let the evidence inform their opinion.

    Have you considered submitting this letter to the National Post or Slate magazine?

  2. Joanna Schroeder says:

    Fantastic piece, Brian. Thank you so much for writing it.

    This will undoubtably be one of those articles people who want sane, intelligent resources in defense of leaving our sons intact will have bookmarked.

  3. Well done Brian, great piece!

  4. Keith Rutter says:

    I prefer the words ‘genital cutting’. It tells it as it is, and the pro-cutters can’t argue with it as they can against genital mutilation. I was genitally cut by an ignorant doctor, he reduced my penis to a urine conduit.

    • I suppose I see where you are coming from. It means one will not get sidetracked into a debate about the word mutilation.

      But the word mutilation carries a pretty important emotive heft that I think the supporters of this issue have a right to. FGM advocates do not “own” the word mutilation, and I think on some level it is important to challenge those that act like they do.

  5. “Your move, Mr. Stern.” … Brian Earp demonstrates that American intellectuals know how to read … and kick ass.

  6. It is difficult to fully comprehend the reality of circumcision, adults cutting off parts of children’s genitals. An enormous American industry built around this sick and evil practice. Those to whom it has been done often demand to do the same to their children and act horribly offended when anyone questions it.

    Mark Joseph Stern has inadvertently done a great service to the intactivist movement by writing a piece that is so short on research and slanderous of human rights activists who work hard to bring awareness of the issues around forced genital cutting of children. Stern has also inadvertently prompted this brilliant response by Brian Earp. Thank you Mr. Earp for bringing a your very sane voice to this discussion and contributing this brilliant rebuttal.

  7. Petite Poulet says:

    The Slate article by Mark Joseph Stern is the act of a desperate movement. Circumcision enthusiasts are losing the battle. It used to be that Europeans ignored the bizarre American practice of infant male circumcision, but now national pediatric organizations in Norway, Holland, Germany, Finland, Slovenia, and Sweden have come out against the procedure. The circumcision rate in the United States is falling. The rates in New Zealand, England, Canada, and Australia have already fallen. The plans to circumcise all of the men in Africa to “prevent” HIV infection has failed to gain traction, despite the money Bill Gates and Bill Clinton have thrown at it. They have lost the battle on the internet. The only refuge left is Slate and medical journals with sympathetic editors. Look at the recent articles promoting circumcision in the medical literature and you will find that it is the same 15 people writing all the articles. The HIV experts have moved past circumcision to interventions that actually work, cost less, and are less invasive (treatment as prevention, pre-exposure prophylaxis, and condoms). Bill Gates has offered prize money for a better condom, perhaps he realized that circumcision is a dead end idea. So with the walls closing in, the circumcision enthusiasts have to rally the mouth breathing Americans who have circumcised their sons with their tired rhetoric and propaganda. It is no accident in the United States that the more formal education a mother has received, the less likely she is to have her son circumcised.

    • John Anderson says:

      AVFM had an article on the circumcision blitz in Kenya.

      http://www.avoiceformen.com/updates/circumcision-in-africa-not-preventing-spread-of-hiv/

      “According to the Kenya Aids Indicative Survey released by the Health Cabinet Secretary, James Macharia, HIV and Aids rose in Nyanza and Central provinces. But central provences 3.8 per cent prevalence increase from the previous 3.6 per cent is a mere fraction of Nyanza’s 15.1 per cent up from 2007’s 14.9 per cent. Nyanza’s prevalence is big enough to double the national average prevalence. Clearly, the massive circumcision campaign is doing nothing to stem the epidemic in that country, the same country that hosted one of the famed Orange Farm studies that claimed getting circumcised reduces your risk of contracting HIV by 60%.”

      It seems to have actually backfired.

      “Even more disturbing are the reports that compensatory behavior is occurring among women when it comes to circumcised men. As the SDN reports:

      “According to Ruth Achieng, a 22-year-old accounts student in Kisumu, many of her “peers today prefer circumcised men because they are perceived to be safe and HIV-free.”

      As a result, the tendency not to use a condom during sexual intercourse is high.””

      Couldn’t that also explain the sexual satisfaction survey results. Men enjoy sex better without a condom. Since women contract HIV through unprotected sex too and we know society goes into overdrive to assist women, I’m not surprised that people are looking into actually effective ways to combat HIV transmission. I don’t think that will necessarily stop people from wanting to mutilate infant boys, but it does debunk one of their false justifications.

  8. Chrysoprase says:

    Thanks – I still can’t fathom why it’s so important for some people to chop bits off babies. That should be iffy even if there were clear tangible health benefits that could not be obtained otherwise.

    The funny bit is that the US somehow manages to have people discouraging HPV vaccination of girls because it might encourage premarital sex while at the same time advocating an intervention that might prevent male toddlers from contracting an STD from an African hooker.

  9. Lynne Haywood says:

    Circumcision and fgm are usually carried out in the name of religion.
    The only way to educate people who do this, is by pointing out that their GOD made them to the very best design specification. When body parts are in good order as intended, that is how those parts work best.
    When people change the design of their GOD, they imply they know better.
    That is blasphemy.

    • That’s rich — telling religious people you know more about what G-d wants than they do. If you’d look inside the Torah (of which I am not here to argue the validity), you’d see that circumcision is a commandment. No, not one of those pesky 10 most people know about, but an essential commandment nonetheless, one that Jews have sacrificed much for over the last, oh, 2000 years or so. The Hellenistic Greeks banned it, the Romans banned it, so did the Nazis. They are gone. We’re still doing it. And we will continue to do so, despite the belief expressed by a commentator that it is “sick and evil.”

      • That’s rich, the likes of you presuming to tell us what God wants.

        • The likes of me? Define this idiom in specific terms, please. Do you know me? What is “the likes of me” exactly?

          And I presume to do no such thing. In fact, I’m pretty sure I was responding to presumption. When an observant Jew wants to know what G-d wants, he looks to Torah. I’m not telling anyone else what to believe. When we look in Torah, as we have always done, we learn of the commandment of brit milah. The sacred covenant. You don’t have to believe it’s real, but observant Jews do. Where do I presume anything here or previously?

          • concerned cynic says:

            You presume that all Jews are Torah literalists.
            It is a raw fact that many, probably most Jews are not frum. They very deeply resent attempts, by people like you, to cast them out of Jewishness. Liberal and secular Jews are a raw and blunt fact of life. I know that fact of life because 40-50% of my university mates were liberal and/or secular Jews.
            Many European and Latin American liberal and secular Jews no longer circumcise their sons. This fact has a toehold in Israel, and there are outspoken American and Canadian Jewish critics of brit milah. A dear friend of my mother’s, now deceased and who attended a Reform temple regularly, told me 30 years ago that inn her view, bris was an outdated custom.

  10. Tiffany Greene says:

    Thank you sir for writing this! It is refreshing to see a well thought out and educated stance against RIC.

  11. Wow. Smart stuff. Thanks.

  12. Any parent wanting their son to be circumsized should be forced to watch. I have four sons, the first three circumsized. The second two both poorly done, and when I began questioning the practice, I was told it was routine and necessary, not to mention being treated like I shouldn’t dare be asking such questions. By my fourth son, I finally had to force a very reluctant doctor to give me real reasons and explain exactly how the procedure is done. To this day, I’m am sick to my stomach recalling that conversation and harbor such guilt for what I allowed to be done to my sons. Never again. Educate yourself on the practice, and not in general terms. My youngest, we thankfully left “intact”.

    • John Anderson says:

      Any parent that wants their son to be circumcised should have the procedure done to them first if it already hasn’t been.

    • concerned cynic says:

      The Jewish mother Miriam Pollack, started walking down the road to intactivism when she heard her infant sons scream while getting a bris. She cannot get their screams out of her head. The horror made her lose her milk. She feels that her deepest maternal feelings were treated with patronising contempt.

  13. Bravo Brian! You critiqued that quack that promotes the crushing of baby foreskin.

    I went ahead and shared your video so it reaches more people.
    http://www.youtube.com/watch?v=IQXBoSh2soo

    Non-consensual genital cutting of male, female and intersex infants violates Medical ethics (Do No Harm), and Human Rights under the United Nations’ Universal Declaration of Human Rights (Article 5) and the United Nations’ Convention on the Rights of the Child (Article 13).

    It is medically unethical to cut a healthy body part off a non consenting individual, Doctors have known this since the 1950’s but some continue to ignore it.

    Genital cutting is risky, painful and unnecessary, and there are modern alternatives to circumcision in most cases but a lot of Doctors are oblivious to them.

    Religious freedom ends where someone else’s body begins, the law banning Female Genital Mutilation proves this.

  14. david bradt says:

    The article this article is responding to (Mark Joseph Stern’s ‘How Circumcision Broke the Internet’) does not accept comments. Stern’s is a ‘hit and run piece’. Brian Earp’s article (above) is calm and authoritive. He sticks around and invites conversation. Good job.

    • I noticed that, David. Hit n’ run is right. Post and go, don’t listen to the other side. The point that is continually missed in the pro-cutting camp is choice. Regardless of what the science says or does not say about the foreskin, millions of intact men around the world make it through their childhoods without incident and the choice to cut or not should be left up to the person whose body is affected. Parents argue the right of choice but at the expense of their sons’ integrity.

      • Stern’s article did accept comments when it first came out, but I guess too many people debunked it and they wanted to erase the truth in the comments.

  15. L. Grossman says:

    Excellent article and “letter” on this subject. The ignorance and brutality in the United States surrounding this topic is shocking, even to someone raised amongst it. Articles like this literally change lives for the better in one of the most meaningful ways. Your work is much appreciated.

    I hope some day mutilating boys through circumcision will be as abhorrent as mutilating little girls through female circumcision. It’s up to us to speed that day’s arrival.

  16. I’m glad I did not succumb to societal pressure to have my son circumcised. Americans say they’re circumcising their sons for health reasons. However, I think the main reasons Americans do it is because everyone else in America is and because parents are afraid their sons won’t get laid if he’s not circumcised, because we’re told uncircumcised penises are yucky. Hopefully, people will realize the right to bodily autonomy trumps aesthetics and the need to fit in, especially when there is no strong medical reason to circumcise an infant. I hope your well-written response will change some minds and that eventually cutting the genitals of a male infant will seem as barbaric as cutting a female minor’s genitals.

    • John Anderson says:

      @ Anne

      “and because parents are afraid their sons won’t get laid if he’s not circumcised,”

      Even if that was true, he could still get circumcised as an adult. It’s not like they’re gonna say sorry you’re over 17 can’t do it. Personally, I think if it’s a deal breaker for your partner, you need to find someone else.

      • Not only can it be done at 17, but in infants the foreskin is stuck to the glans and has to be cut off, whereas by 17 it will be loose and much easier and less painful to remove safely.

    • Hi Anne
      What a strange argument for cutting your sons.
      On the Internet is a webpage with picture of famous American uncut men, like movie stars,dancers and other celebrities.
      They are not incels :)

      • concerned cynic says:

        The argument that intact American males are ridiculed in school toilets, locker rooms, summer camp and bedrooms is very shallow — but all too believable. Men with PhDs have told me that intact men never get blowjobs! Parents project on the boys and women of the next generation, their own bigoted insecurities. The unspoken 11th commandment of American life appears to be “You shall not suffer a Weird Dick among you.”
        This is why it is supremely important to get the intactivist message out to young women, to undo any disgust they might feel at seeing and feeling male foreskin. In my view, this part of intactivism is going quite well.

  17. And interesting bit for anyone who finds MGM and FGM incomparable:

    http://www.thepatrioticvanguard.com/article.php3?id_article=2434

    • Sorry Africans sisters , I am not convinced.

      Some quotes from this article :
      More orgasms among genital mutilate women:
      “However, most reliable, independent studies show that there are hardly any notable long-term health differences between uncircumcised and circumcised women”…..
      “in one study, the Somali women in her sample reported more experiences of orgasms than her control group – uncircumcised Italian women (with a different cultural background but fully comparable in all other characteristics).”

      • Well there is a lot of the clitoris that you cannot cut off without cutting deep into the tissue of a person, most of the clitoris is actually in the body like an iceberg of superpleasure so to speak. It’s possible that removing the external part whilst leaving the internal part alone can still lead to pleasure, but people should just leave people alone as they are born if there is no medical need to do surgery.

        Could also be that culture plays more of a role for the female orgasm vs the clitoris? I am no female so it’d be interested to know a females take on this. Does vaginal penetration alone without clitoral stimulation cause these women’s orgasms? Or is the leftover parts of the clitoris being stimulated somehow?

        • Hi Archy
          You ask
          ✺”Well there is a lot of the clitoris that you cannot cut off without cutting deep into the tissue of a person, most of the clitoris is actually in the body like an iceberg of superpleasure so to speak. It’s possible that removing the external part whilst leaving the internal part alone can still lead to pleasure, but people should just leave people alone as they are born if there is no medical need to do surgery.”✺
          BCC radio had a program this summer about reconstructive surgery on women that was genital mutilated.
          The surgeon removed the scar tissue and then she became more sensitive . There is scar tissue when they cut away the clitoris and inner and outer lips..

          ✺”Could also be that culture plays more of a role for the female orgasm vs the clitoris? I am no female so it’d be interested to know a females take on this. “✺
          I don’t understand the question Archy.
          Do you mean the sexual repression in the West?
          Or do you mean women in some cultures learn to reach orgasms with different technics ?

          “✺Does vaginal penetration alone without clitoral stimulation cause these women’s orgasms? Or is the leftover parts of the clitoris being stimulated somehow?”✺
          First you have lost the most sensible part of your body, more sensitive than the penis head. Then there is scar tissue as well.

          A doctor( GP) in UK,a women with FGM said she could have orgasm, but it was deep and happened very seldom in spite of a happy marriage.

          I can not see how also the psychological impact must have lasting effect on a persons ability to relax and enjoy sex when you have been tortured this way.
          The little baby boys also experience sever emotional trauma and pain.
          I heard a sexologist say:”Europeans are too fond of sex to circumcise children”.

          Are there some deep sex negativity in America behind all this? I mean more than the wish to curb masturbation like Kellogg’s wanted.

  18. Mr Supertypo says:

    Very good GMP, love this article.

    Thank you Brian Earp.

  19. This is a far more intelligent, mature, and comprehensive response than that ignorant hypocritical article deserved, but I thank you for posting it.

  20. The claim expressed in paragraphs two and three (copied below), that MGM is theoretically relevant in relation to preventing UTI’s is unfounded. Most UTI’s in children are caused by the overuse of soaps, particularly the popular “bubble-bath” suds in which many infants are bathed, particularly here in the USA. Soap suds get into every nook and cranny of the body, and if not rigorously rinsed clear, they tend to kill the “good”, natural strains of bacteria which normally protect the body, thus opening up those areas to infection. Naturally, scalpel-trained doctors recommend remedies that deal with cutting, when simply advising parents to bathe their children in clean, clear water only would solve the problem before it becomes a problem.

    “In fact, 37 of Europe’s most pre-eminent medical authorities (along with the distinguished Canadian pediatrician, Dr. Noni MacDonald) have recently expounded on this point in the flagship journal Pediatrics:
    “Only one of the arguments put forward by the American Academy of Pediatrics [concerning potential health benefits for circumcision] 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.”

  21. Great article.

    I didn’t realize there are forms of FGM that are less invasive than circumcision but are still classed as mutilation by the WHO.

    I tend to think of circumcision as genital mutilation, but I’ll often decline to do so in public in case of offending men who have been circumcised.

  22. Another consideration: The foreskin is valuable as spare parts. Sometime during your son’s life he may need arterial reconstruction. What he will needed is skin that has no hair roots (follicles). If hair grows in the stitches it will hemorrhage (leak) and will have to be removed. The only usable skin that has no follicles is the inside of his cheek or the underside of his foreskin. Using the foreskin for this life saving procedure is common in Europe. It is best to use his own skin because he’s body will not reject it. Just thinking of your child’s future.

  23. John A. Kennedy says:

    Brian Earp’s letter is thoughtful and respectfully puts forward one side of the circumcision debate. Those on both sides of the argument should keep in mind that legislation against infant male circumcision will be seen by most Jews as clearly anti-Semitic. While this is not seriously an issue yet in America, because of those very American attitudes Brain Earp questions, there have been a number of cases in Europe where local authorities have banned infant circumcision, at least temporarily. Also, some governmental committees there have called for such a ban. The commitment of even most secular Jews to circumcision of their sons may be considered illogical and unscientific by many, but it remains a fact. Currently, to pass such laws is the functional equivalent of banning Judaism. This would be an ironic result of what many believe to be a humanistic intent. And we can be sure that for some (we hope a very few), this is the intended result.

    • John Anderson says:

      @ John A. Kennedy

      And yet bans against gay to straight conversions of adolescents is not condemned as an attempt to ban Catholicism. Society usually takes stronger measures to protect those who are weaker except it seems when it comes to the protection of boys / men then it’s let’s get them before they can complain. No one wants to ban adult male circumcision. They just need to wait until they’re 18.

    • Banning FGM is clearly anti-islamic. Many muslim communities prcatice FGM as a matter of course, and view it in exactly the same way that we view circumsision.

      I think that there is one law for everyone, and no-one should be allowed to remove parts of their children’s genitals. People can have the operation at the age of 18, with informed consent.

  24. Hi John A Kennedy

    Unfortunate I don’t have the link to a German newspaper that I posted on GMP earlier in a debate about the same issue.
    In Germany, some Jewish religious leader speak up against circumcision of babies.
    How can that be banning of Judaism ?

    • No Jewish religious leader would speak out against circumcision. It is sacred Jewish law, and has been since Isaac was born of Abraham and Sarah (not here to argue the validity of the Torah), to circumcise a Jewish boy on the 8th day of his life. No Jewish religious leader would be considered legitimate if he/she spoke out against this law that we believe was given to us by G-d (not here to argue the validity of believing in G-d). Historically, Jews have sacrificed their own lives for circumcision. Banning circumcision is banning an essential aspect of the very code of what it means to be a Jew (including a Jewish mother, for obvious reasons).

      • concerned cynic says:

        Mr Karpel, while I detest the circumcision of minors at the request of their parents, I also do not believe the practice should be outlawed. But I predict that the sexual culture of the North Atlantic nations will evolve over the course of this century so as to deem infant circumcision as gravely anti-sexual and as controlling of another human being. And traditional Jews will, to some degree, feel outcasted by this evolution.

        Yet the issue is not so much circumcision itself, but who decides whether it is performed. Circumcision performed after the 18th birthday, on a willing subject, is not at issue. This fundamentally differentiates present day intactivism from historical attempts to forbid Jews to circumcise, from Alexander’s generals to the USSR.

        • Concerned Cynic,

          First: Thank you for your response. It’s rare in these discussions that commentators don’t resort to hysterics, name calling, and other angry ways of responding to those with a different opinion on this particular subject.

          Point by point:
          1) I agree that the movement in the North Atlantic nations is growing and will see things the way you describe.
          2) Traditional Jews already feel somewhat “outcasted” for many other reasons, and much of that is self-imposed. Traditional Jews are not the only ones following the mitzvah of circumcision, though. Jews of all stripes, even unaffiliated, continue to circumcise their sons. This is one of those mitzvahs that continues to have a significant influence on every type of Jew out there. No doubt, there are Jews looking for alternative “rites of passage.” But they are an extreme minority who are choosing not to follow one of the most important mitzvahs in the Torah.
          3) You are obviously correct when you point out the historical differences. At the same time, even banning it until 18 is antithetical to observant Judaism.

          I do not advocate circumcision for everyone. I’ve never researched as to why it became the norm and mainstreamed in American medical practice, so I have no idea why that is as it is. I also have no problem with people advocating against choosing circumcision. In fact, I cherish their ability to do so as a right, as much as I cherish my own right to defend the practice against banning it.

          • concerned cynic says:

            Mr Karpel, please appreciate that about 45% of American Jews never join a temple during their entire adult lives. For such Jews, mitzvah is not an operative term in their lives. Most of the Jews I knew in college told me that the defining commitment in their lives was not to faith and ritual, but to progressive political and familial values. It is not at all an accident that Marx, Freud, Milton Friedman, Ruth Westheimer, and Alice Miller were all of Jewish ancestry. For many Jews, tikkun olam is more important than brit milah. I recently read that a many American and Canadian Jews were medically circumcised at birth. In most western societies, most doctors will decline to circumcise an infant having no urological problems.

            In Europe and Latin America, liberal and secular Jews are often intact, but decline to wear that fact on their sleeves. Teachers in secular Israeli preschools and kindies have revealed on the internet that they see some intact boys. There is an intactivist movement in Israel, and Ha’aretz and the JP have written about it. Most Jewish children attend secular schools because most Jewish parents want their children to have the best secular education. In most countries, this means that Jewish boys will be a minority in the schools they attend. Jews outside of Israel accept that their sons should do military service with gentile men. Jewish parents living in such countries can see that a Jewish boy and man is less likely to experience anti-semitic taunts in school and in the army, if he is intact.

            The problem is not “choosing circumcision” but choosing it for someone other than oneself. Judaism gave up animal sacrifice. It has given up the death penalty for adulterous women and male homosexuals caught in the act. I am confident that all but the haredim can accept that parents who decline to circumcise on the 8th day, and who allow their sons to make a free choice after their 18th or 21st birthday, remain Jews in good standing.

            On circumcision, both as a Jewish ritual and as an American sexual obsession, I invite you to read Leonard Glick’s Oxford University Press monograph, “Marked in Your Flesh”.

  25. John Anderson says:

    I keep seeing this under editors picks and IMO it could stay there forever. I hadn’t said this and I very rarely praise comments / articles I agree with (I guess it’s my disagreeable nature) but this is one of the best articles I’ve read on GMP.

    Thanks

  26. Thank you for this!

  27. Human rights only. Don't hurt babies. says:

    International doctors’ organizations condemn the AAP’s 2012 stance on circumcision. It is now more than a year after the anniversary of the AAP’s statement on circumcision. The AAP’s statement was made on August 27, 2012. It is time to learn about the condemnation of the AAP’s statement on infant male circumcision by 38 doctors representing more than 16 international medical associations. This is groundbreaking and historic. Why? When was the last time you have heard of so many doctors and their organizations condemning another doctors’ organization?

    I am including a reference to the American Academy of Pediatrics own journal which presents the international condemnation of the AAP:

    Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision
    http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.full.pdf
    http://knmg.artsennet.nl/Nieuws/Nieuwsarchief/Nieuwsbericht-1/International-physicians-protest-against-American-Academy-of-Pediatrics-policy-on-infant-male-circumcision.htm

  28. International doctors’ organizations condemn the AAP’s 2012 stance on circumcision.

    It is now more than a year after the anniversary of the AAP’s statement on circumcision. The AAP’s statement was made on August 27, 2012. It is time to learn about the condemnation of the AAP’s statement on infant male circumcision by 38 doctors representing more than 16 international medical associations. This is groundbreaking and historic. Why? When was the last time you have heard of so many doctors and their organizations condemning another doctors’ organization?

    I am including a reference to the American Academy of Pediatrics own journal which presents the international condemnation of the AAP:

    Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision
    http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.full.pdf
    http://knmg.artsennet.nl/Nieuws/Nieuwsarchief/Nieuwsbericht-1/International-physicians-protest-against-American-Academy-of-Pediatrics-policy-on-infant-male-circumcision.htm

  29. What is in the best interest of the child? It is in the best interest of the child
    1) to become educated and aware of what the foreskin is and what its functions involve before cutting it off,
    2) to consider the stereotypes and why they exist before cutting the foreskin off,
    3) to consider if any men circumcised in infancy have been harmed by the procedure since the newborn could possibly become one of these men in the future, and
    4) to avoid cutting off any body part if other less invasive means to care for that part of the body are available.
    5) to learn the easy care of the foreskin which is healthier than circumcision. A) Do not pull the foreskin back. Let nature take its time. B) Do not use harsh soaps or bubble bath. C) Give your child a regular bath. As easy as ABC!

    It is in the best interest of the parents
    1) to think more about themselves than their child,
    2) to think more about what their parents will think than what their child might think,
    3) to think more about what other relatives will think than what their child might think,
    4) to try to please the members of their religion or community around them than protect their child, and
    5) to listen to the opinions of their doctor who stands to profit from the procedure instead of waiting to get the opinion of their child who stands to lose from the procedure.

  30. 10 times more than men… who are circumcised. Duh.

  31. The US the RIC capital of the western world, of all places that doesn’t understand body integrity. Still trying to figure out in 2014, ‘who owns your penis’ and men having to justify their right to an entire body. We were born with an entire penis, because that is the way it was supposed to be. My own real physcial problems with circumcision have made me an intactivist by default.

    • As a man who was genitally cut in an era when it was still fairly common in the UK, I am not offended to be told that I have a defective penis, I knew that already. It is the reason that I work towards the time when ALL children, regardless of gender, are legally protected against genital cutting. I was disgusted when in 1984, I was asked if I wanted my newborn son genitally cut. I retorted that if he wanted a damaged penis, he could wait until he was 18, I’d pay for it if needed, safe in the prediction that my money was safe. That very few men if left intact as children would ever want, or need, to have his foreskin cut off tells you all you need to know. Genital cutting has always been done to damage the penis and spoil sexual pleasure, And sooner or later it does. See what Dr J H Kellogg and Rabbi Maimonides wrote about it. After puberty, when I first learned from another boy what had been done to me, through married life when intercourse gradually became less satisfying, to the point where I cannot orgasm. That is why look forward to the time when genital cutting in conveyed to the garbage can of history where it belongs.

  32. You go gurl! Thank you for what you do.

  33. Lawrence Newman says:

    Circumcision is a euphemism. It is male genital mutilation. It came into existence in the West to ‘cure’ male masturbation and control male sexuality. Most of the reasons for continuing MGM have also been used to continue FGM.

    The reason everyone should be against MGM is that it is a non-therapeutic, non-medical, anachronistic act of mutilation that dramatically reduces, and in many cases destroys, sexual pleasure.

    As a 35 yr old man who was mutilated by the NHS in the UK back in 1993, I know exactly the damage it causes. From the moment I had it done, I could not feel sexual pleasure. I had not only my foreskin with the highly-sensitive ridged band chopped off, I also had my frenulum and frenular delta excised too. I am left with the glans, which is not a sexually sensitive structure, it only senses pressure and temperature. They committed an act of medical negligence on me, because it was done for ‘phimosis’. A tight foreskin never necessitates cutting off the foreskin. But I cannot sue them due to a statute of limitations on medical negligence claims, but the fact it is still legal would mean I probably wouldn’t win anyway. Neither my parents nor I provided informed consent.

    There is only ever one reason to excise a man’s foreskin–foreskin cancer, an exceptionally rare condition.

    MGM is more damaging than many forms of FGM yet FGM is illegal in all Western countries. I will most likely commit suicide soon because of what was done to me and nobody cares. If I was a woman, I would get restitution, media attention and misery memoirs written about me.

    The doctors and religious people who perform MGM are frauds, quacks, pseudoscientists and child abusers. Doctors earn money from performing MGM and make more money by seeling foreskins to Big Pharma to put in anti-ageing face creams that women feed their narcissism with by plastering it over their faces.

    Society is gynecocentric and anti-male.

    • Lawrence, how are you? Are you getting support with this? My heart goes out to you and I wish strongly that somehow this might get a fraction easier to bear over time.

      • Lawrence Newman says:

        I’m engaging with therapy, but therapy can’t cure a physical disability. The only thing that’s made a slight difference is anti-depressants, but they’ve only taken some of the anger away. I still feel like my life has been destroyed and is over effectively. Unfortunately what I’m going through will be trivialised and people will tell me there’s something wrong with me, not something wrong with what was done to me.

        If I was a woman who’d had this done to her, I’d be all over the media and I’d have misery memoirs written about me and I’d receive compensation. But I’m a male and so I am not even regarded as human.

  34. “For example, in Kenya, Uganda, and South Africa, the base rate of HIV transmission is very high, and the virus is spread primarily through heterosexual contact. In places like the U.S., by contrast, the base rate of HIV transmission is very low, and the virus is spread primarily through injective drug use and gay sex.”

    I am rather disturbed by the implication that hiv is a “gay disease”. it is not. anyone cat get it. period. it is transmitted by unprotected sex. AND unprotected sex is a real issue in the gay community. (I don’t know why it is. but I asked to be sure I wasn’t being assuming. and it is true.) so perhaps, even if the data on gay sex is true, I would have to say it is a warning on the dangers of unsafe sex not homosexuality.

    it just bothers me when I see these kinds of subtle messages. so there is my two cents.

  35. Michel Hervé Bertaux-Navoiseau says:
  36. Psychological harm to the infant maintains, perhaps intensifies as the man grows. The body “knows” that an integral function is lost and erotic/sensual issues won’t be achieved. Deep anger results, usually unnoticed, because of the time delay between cutting and erotic activities starting in adolescence. When the anger involves near unanimity as it does in the middle east, the results are obvious.

  37. J.Wilson says:

    Next to the “we don’t even question it we just circumcise” argument, I find the “surgical vaccine” argument almost as nonsensical and just as disturbing.
    The article is very well stated and verifiably accurate. I think that it may be casting pearls before swine.

Trackbacks

  1. […] some kind of surgical vaccine. When bad science kills, or how to spread AIDS | Practical Ethics An Open Letter to the Author of ‘How Circumcision Broke the Internet’ Reply With […]

  2. […] surrounding their very existence – as detailed by Brian D. Earp of the University of Oxford in a point-by-point rebuttal of Mr. Stern’s intemperate […]

  3. […] do choose to circumcise. I read an interesting piece on The Good Men Project recently, called “An Open Letter to the Author of ‘How Circumcision Broke the Internet.‘” The author is not in favor of circumcision, but his arguments are smart. They are as […]

  4. […] strategies when he does become sexually active, rather than forfeit a part of his penis. See here, here, here, here, and here for further discussion of the “health benefits” arguments for MGC. The […]

  5. […] when he does become sexually active, rather than forfeit a part of his penis. See here, here, here, here, and here for further discussion of the “health benefits” arguments for MGC. […]

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