Originally posted at http:\/\/aeon.co\/magazine\/philosophy\/male-and-female-circumcision-are-equally-wrong\/<\/p>\n
Malaysian boys wait for their turn during a mass-circumcision ceremony at the Tuanku Mizan Army hospital in Kuala Lumpur on December 5, 2014. Photo by Manan Vatsyayana\/AFP\/Getty<\/i><\/p>\n Brian D Earp<\/i><\/a> is a scientist and ethicist. He holds degrees from Yale, Oxford, and Cambridge universities and is an advocate for children\u2019s rights<\/i><\/p>\n I try not to talk about my research at dinner parties. I\u2019ll say \u2018medical ethics\u2019 if pressed, which will sometimes trigger an unwelcome follow-up: \u2018But what about medical ethics? That\u2019s a pretty big field.\u2019<\/p>\n \u2018I study lots of things,\u2019 I\u2019ll say \u2013 and that\u2019s true, I do. \u2018But I focus on medically unnecessary surgeries performed on children.\u2019<\/p>\n \u2018Like what?\u2019<\/p>\n Like what, indeed. It\u2019s rarely a smooth ride from there.<\/p>\n The truth is: I study childhood genital surgeries. Female, male and intersex genital surgeries, specifically, and I make similar arguments about each one. As a general rule, I think that healthy children \u2013 whatever their sex or gender \u2013 should be free from having parts of their most intimate sexual organs removed before they can understand what\u2019s at stake in such a procedure. There are a number of reasons I\u2019ve come to hold this view, but in some ways it\u2019s pretty simple. \u2018Private parts\u2019 are private. They\u2019re personal. Barring some serious disease to treat or physical malfunction to address (for which surgery is the most conservative option), they should probably be left alone.<\/p>\n That turns out to be extremely controversial.<\/p>\n In the 1990s, when the Canadian ethicist Margaret Somerville began to speak and write critically about the non-therapeutic circumcision of infant boys, she was attacked for even addressing the subject in public. In her book The Ethical Canary<\/i>, she says her critics accused her of \u2018detracting from the horror of female genital mutilation and weakening the case against it by speaking about it and infant male circumcision in the same context and pointing out that the same ethical and legal principles applied to both\u2019.<\/p>\n She wasn\u2019t alone. The anthropologist Kirsten Bell has advanced similar arguments in her university lectures, provoking a reaction that was \u2018immediate and hostile \u2026 How dare I mention these two entirely different operations in the same breath! How dare I compare the innocuous and beneficial removal of the foreskin with the extreme mutilations enacted against females in other societies!\u2019<\/p>\n There\u2019s a problem with these claims. Almost every one of them is untrue or severely misleading<\/i><\/p>\n It\u2019s easy to see where these reactions are coming from. One frequent claim is that FGM is analogous to \u2018castration\u2019 or a \u2018total penectomy\u2019. Put that way, anyone who tried to compare the two on ethical (or other) grounds would be making a serious mistake \u2013 anatomically, at the very least.<\/p>\n You often hear that genital mutilation and male circumcision are\u00a0very different<\/i>. FGM is barbaric and crippling (\u2018always torture\u2019, as the Guardian <\/i>columnist Tanya Gold wrote recently), whereas male circumcision is comparatively inconsequential. Male circumcision is a \u2018minor\u2019 intervention that might even confer health benefits, whereas FGM is a drastic intervention with\u00a0no health benefits, and\u00a0only causes harm. The \u2018prime motive\u2019 for FGM is to control women\u2019s sexuality; it is inherently sexist and discriminatory and is an expression of male\u00a0power\u00a0and domination. That\u2019s just not true for male circumcision.<\/p>\n Unfortunately, there\u2019s a problem with these claims. Almost every one of them is untrue, or severely misleading. They derive from a superficial understanding of both FGM and male circumcision; and they are inconsistent with what scholars have known about these practices for well over a decade. It\u2019s time to re-examine what we \u2018know\u2019 about these controversial customs.<\/p>\n The World Health Organization (WHO) defines FGM as any \u2018non-medical\u2019 alteration of the genitalia of women and girls. What this is likely to bring to mind is the most extreme version of such \u2018alteration\u2019, which is the excision of the external part of the clitoris followed by a narrowing of the vaginal opening, sometimes using stitches or thorns. It is rarely understood that this notorious form of FGM is comparatively\u00a0rare: it occurs in a subset of the practising communities, and makes up about 10 per cent of cases worldwide. More prevalent, but much less frequently discussed in the media, is a range of less extensive alterations, sometimes performed under anaesthesia by medical professionals and with sterile surgical equipment. These include, among other interventions, so-called ritual \u2018nicking\u2019 of the clitoral hood (common in Malaysia), as well as non-medically-indicated labiaplasty and even piercings that might be done for perceived cosmetic enhancement.<\/p>\n Male genital cutting is performed at different ages, in different environments, with different tools, by different groups, for different reasons<\/i><\/p>\n It should be clear that these different forms\u00a0of FGM are likely to result in\u00a0different degrees of harm, with different effects on sexual function and satisfaction, different chances of developing an infection, and so on. And yet all<\/i>\u00a0forms of non-therapeutic female genital alteration \u2013 no matter how sterilised or minor \u2013 are deemed to be mutilations in \u2018Western\u2019 countries.\u00a0All<\/i>\u00a0are prohibited by law. The reason for this, when you get right down to it, is that cutting into a girl\u2019s genitals without a medical diagnosis, and without her consent, is equivalent to criminal assault on a minor under the legal codes of most of these societies. And, morally, I think the law is correct here. I don\u2019t think that a sharp object should be taken to any child\u2019s vulva unless it is to save her life or health, or unless she has given her fully informed permission to undergo such an operation, and wants to take on the relevant risks and consequences.<\/p>\n In that case, of course, she wouldn\u2019t be a \u2018child\u2019 anymore, but rather an adult woman,\u00a0who can make a decision about her own body.<\/p>\n The story is very different when it comes to male circumcision. In no jurisdiction is the practice prohibited, and in many it is not even\u00a0restricted. In some countries, including in the United States, anyone, with any instrument, and any degree of medical training (including none) can attempt to perform a circumcision on a non-consenting child \u2013 sometimes with\u00a0disastrous consequences. For a recent example, look up \u2018Goodluck Caubergs\u2019 on the internet; similar cases happen every year. As the bioethicist Dena Davis has pointed out, \u2018States currently regulate the hygienic practices of those who cut our hair and our fingernails \u2026 so why not a baby\u2019s genitals?\u2019<\/p>\n Just like FGM, however, circumcision is not a monolith: it isn\u2019t just one kind of thing. The original Jewish form of circumcision (until about AD150) was comparatively\u00a0minor. It involved cutting off the overhanging tip of the foreskin \u2013 whatever stretched over the end of the glans \u2013 thereby preserving (most of) the foreskin\u2019s\u00a0protective and sexual functions, as well as reducing the amount of\u00a0erogenous tissue\u00a0removed. The \u2018modern\u2019 form is much more invasive: it removes between one-third and\u00a0one-half\u00a0of the movable skin system of the penis (about\u00a050 square centimeters\u00a0of\u00a0richly innervated tissue\u00a0in the adult organ), eliminates the gliding motion of the foreskin, and\u00a0exposes\u00a0the head of the penis to environmental irritation, as it rubs against clothing.<\/p>\n Male genital cutting is performed at different ages, in different environments, with different tools, by different groups, for different reasons.\u00a0Traditional Muslim circumcisions are done while the boy is fully conscious, between the ages of five and eight, and sometimes later. American (non-religious) circumcisions are done in a hospital, in the first few days of life,\u00a0with or without\u00a0an anesthetic. Metzitzah b\u2019peh<\/i>,\u00a0done by some ultra-Orthodox Jews, involves the\u00a0sucking of blood\u00a0from the circumcision wound, and\u00a0carries the risk\u00a0of herpes infection and permanent brain damage.<\/p>\n Subincision, seen primarily in aboriginal Australia, involves slicing open the urethral passage on the underside of the penis from the scrotum to the glans, often affecting urination as well as sexual function. And circumcision among\u00a0some tribal groups in Africa is done as a rite of passage, in the bush, with\u00a0spearheads, dirty knives, and other non-sterile instruments. Similar to female genital cutting rites performed under comparable conditions (and often by the very same groups), these operations frequently cause hemorrhage, infection, mangling, and loss of the sexual organ. In fact, between 2008 and 2014, more than half a million boys were hospitalised due to botched circumcisions in South Africa alone. More than 400 lost their lives.<\/p>\n But even \u2018hospitalised\u2019 or \u2018minor\u2019 circumcisions are not without their risks and complications, and the harm is not confined to Africa. In 2011, for example,\u00a0nearly a dozen infant boys\u00a0were treated for life-threatening haemorrhage, shock or sepsis as a result of their non-therapeutic circumcisions at a single children\u2019s hospital in Birmingham, England. Since this figure was obtained by a special freedom of information request (and otherwise would not have been public knowledge), it has to be multiplied by orders of magnitude to get a sense of the true scope of the problem.<\/p>\n When people talk about \u2018FGM\u2019 they are usually thinking of the\u00a0most severe<\/i>\u00a0forms of female genital cutting, done in the\u00a0least sterile<\/i> environments, with the\u00a0most drastic\u00a0<\/i>consequences likeliest to follow \u2013 even though research suggests that these forms are\u00a0the exception rather than the rule. When people talk about \u2018male circumcision\u2019, by contrast, they are (apparently) thinking of the\u00a0least severe<\/i>\u00a0forms of male genital cutting, done in the\u00a0most sterile<\/i>\u00a0environments, with the\u00a0least drastic<\/i> consequences likeliest to follow \u2013 perhaps because this is the form with which they are culturally familiar.<\/p>\n One recurrent claim, recently underlined by the US Centers for Disease Control (CDC), is that male circumcision can confer a number of health benefits, such as a small reduction in the absolute risk of contracting certain sexually transmitted infections. This is not typically seen as being the case for FGM.<\/p>\n However, both parts of this claim are misleading. Certainly the most extreme types of FGM will not contribute to good health on balance, but neither will the spearheads-and-dirty-knives versions of genital cutting on boys. What about other forms of FGM? Its defenders (who typically refer to it as \u2018female circumcision\u2019) regularly cite such \u2018health benefits\u2019 as\u00a0improved genital hygiene\u00a0as a reason to continue the practice. Indeed, the vulva has all sorts of warm, moist places where bacteria or viruses could get trapped, such as underneath the clitoral hood, or among the folds of the labia; so who is to say that removing some of that tissue (with a sterile surgical tool) might not reduce the risk of various diseases?<\/p>\n One relevant harm would be the involuntary loss of a healthy, functional, and erotogenic genital structure<\/i><\/p>\n Fortunately, it\u2019s impossible to perform this type of research in the West, because any scientist who tried to do so would be arrested under anti-FGM laws (and would never get approval from an ethics review board).\u00a0So we simply do not know.\u00a0As a consequence of this, every time one sees the claim that \u2018FGM has no health benefits\u2019 \u2013 a claim that has become something of a mantra\u00a0for the WHO \u2013 one should read this as saying, \u2018we actually don\u2019t know<\/i>\u00a0if certain minor, sterilised forms of FGM have health benefits, because it is unethical \u2013 and would be illegal \u2013 to find out.\u2019<\/p>\n By contrast, a small and insistent group of (mostly American) scientists have taken it upon themselves to\u00a0promote\u00a0infant male circumcision as a form of partial prophylaxis against disease. Most of these diseases are rare in developed countries, do not affect children before an age of sexual debut, and can be prevented and\/or treated through much more conservative means. Nevertheless \u2013 since it is not against the law for them to do so \u2013 advocates of (male) circumcision are able to conduct study after well-funded study to see just what kinds of \u2018health benefits\u2019 might follow from cutting off parts of the penis.<\/p>\n Many European medical experts dispute these studies, and detect more than a whiff of cultural bias in favour of circumcision due to its peculiar status as a birth ritual in American society. The recent statement by the CDC is a case in point. This otherwise august organisation contends that the benefits of circumcision outweigh the risks, where by \u2018risk\u2019 they apparently mean \u2018risk of surgical complications\u2019.<\/p>\n But in medical ethics, the appropriate test for a non-therapeutic surgery performed in the absence of disease or deformity is not benefit vs \u2018risk of surgical complications\u2019 but rather benefit vs risk of harm.<\/i> In this case, one relevant harm would be the involuntary loss of a healthy, functional, and erotogenic genital structure that one might wish to have experienced intact. Imagine a report by the CDC referring to the benefits of removing the labia of infant girls, where the only morally relevant drawback to such a procedure was described as the \u2018risk of surgical complications\u2019.<\/p>\n It is often said that FGM is designed to \u2018control\u2019 female sexuality, whereas male genital cutting is less symbolically problematic. But as the sociologist Lisa Wade has shown in her research, \u2018attributing [the] persistence [of female genital altering rituals] to patriarchy grossly over-simplifies their social, cultural, and economic functions\u2019 in the diverse societies in which they are performed. Throughout much of Africa, for example, genital cutting (of whatever degree of severity) is most commonly performed around puberty,\u00a0and is done to boys and girls alike. In most cases, the major social function of the cutting is to mark the transition from childhood to adulthood, and it is typically performed as part of an elaborate ceremony.<\/p>\n Indeed, in nearly every society that practices such coming of age rituals, the female half of the initiation is carried out by women (rather than by men) who\u00a0do not typically view it as being a consequence of male dominance, but who instead see their genital-altering practices as being beautifying,\u00a0even empowering, and as an important rite of passage with high cultural value. The claim that these women are all \u2018brainwashed\u2019 is anthropologically ignorant. At the same time, the \u2018rite of passage\u2019 ceremonies for boys in these societies are carried out by men; these are done in parallel, under similar conditions, and for similar reasons \u2013 and often with similar consequences for health and sexuality (as illustrated earlier with the example of South Africa).<\/p>\n Every parent who requests a genital-altering surgery for their child \u2013 for whatever reason under the sun \u2013 thinks that they are acting in the child\u2019s best interests<\/i><\/p>\n In the US context, male circumcision was adopted by the medical community in the late 1800s in an effort to combat masturbation, among other dubious reasons. It has since persisted as a rationalised habit, long past the time when it was effectively abandoned by other developed nations. Of course, it is probably true that most contemporary Western parents who choose circumcision for their sons do not do so out of a desire to \u2018control\u2019 their sexuality, but this is also true of\u00a0most African parents\u00a0who choose \u2018circumcision\u2019 for their daughters. As the renowned anti-FGM activist Hanny Lightfoot-Klein\u00a0has stated: \u2018The [main] reasons given for female circumcision in Africa and for routine male circumcision in the United States are essentially the same. Both promise cleanliness and the absence of odours as well as greater attractiveness and acceptability.\u2019<\/p>\n Given that both male and female forms of genital cutting express different cultural norms depending upon the context, and are performed for different reasons in different cultures, and even in different communities or individual families, how shall we assess the permissibility of either? Do we need to interview each set of parents to make sure that their proposed act of cutting is intended as an expression of acceptable norms? If they promise that it isn\u2019t about \u2018sexual control\u2019 in their specific case, but rather about \u2018hygiene\u2019 or \u2018aesthetics\u2019 or something less symbolically problematic, should they be permitted to go ahead?<\/p>\n But this is bound to fail. Every parent who requests a genital-altering surgery for their child \u2013 for whatever reason under the sun \u2013 thinks that they are\u00a0acting in the child\u2019s best interests; no one thinks that they are \u2018mutilating\u2019 their own offspring (whether female or male). So it is\u00a0not the\u00a0reason\u00a0<\/i>for the intervention that determines its permissibility, but rather the\u00a0consequences<\/i>\u00a0of the intervention for the person whose genitals are actually on the line.<\/p>\n As the social anthropologist Sara Johnsdotter\u00a0has pointed out, there is no one-to-one relationship between the amount of genital tissue removed (in males, females, or indeed in intersex people), and either subjective satisfaction while having sex, or a feeling of having been personally harmed because one\u2019s \u2018private parts\u2019 were altered before one could effectively resist. Medically unnecessary genital surgeries \u2013 of whatever degree of severity \u2013 will affect different people differently. This is because each individual\u2019s relationship to their own body is unique, including what they find aesthetically\u00a0appealing, what degree of risk they feel comfortable taking on when it comes to elective surgeries on their reproductive organs, and even what degree of sexual sensitivity they prefer (for personal or cultural reasons).\u00a0That\u2019s why ethicists are beginning to argue that individuals should be left to decide what to do with their own genitals when it comes to irreversible surgery, whatever their sex or gender.<\/p>\n This article is adapted from a longer piece originally published at the University of Oxford\u2019s Practical Ethics website. Links to supporting research can be found in the original essay, available <\/i>here<\/i><\/a>.<\/i><\/p>\n 13 January 2015<\/i><\/p>\n Read more essays on <\/i>bioethics<\/i><\/a>, <\/i>medical ethics<\/i><\/a> and <\/i>sexual health<\/i><\/a><\/p>\n","protected":false},"excerpt":{"rendered":" Boys and girls alike An un-consenting child, an unnecessary, invasive surgery: is there any moral difference between male and female circumcision? by Brian D Earp 2,800 words Originally posted at http:\/\/aeon.co\/magazine\/philosophy\/male-and-female-circumcision-are-equally-wrong\/ Malaysian boys wait for their turn during a mass-circumcision… <\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12,10],"tags":[8,19,20,16,17],"class_list":["post-968","post","type-post","status-publish","format-standard","hentry","category-human-rights","category-news","tag-circumcision","tag-ethics","tag-fgm","tag-human","tag-rights"],"_links":{"self":[{"href":"http:\/\/circinfosite.com\/index.php\/wp-json\/wp\/v2\/posts\/968","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/circinfosite.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/circinfosite.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/circinfosite.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/circinfosite.com\/index.php\/wp-json\/wp\/v2\/comments?post=968"}],"version-history":[{"count":6,"href":"http:\/\/circinfosite.com\/index.php\/wp-json\/wp\/v2\/posts\/968\/revisions"}],"predecessor-version":[{"id":975,"href":"http:\/\/circinfosite.com\/index.php\/wp-json\/wp\/v2\/posts\/968\/revisions\/975"}],"wp:attachment":[{"href":"http:\/\/circinfosite.com\/index.php\/wp-json\/wp\/v2\/media?parent=968"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/circinfosite.com\/index.php\/wp-json\/wp\/v2\/categories?post=968"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/circinfosite.com\/index.php\/wp-json\/wp\/v2\/tags?post=968"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"Boys-await-circumcision\"](\"http:\/\/circinfosite.com\/wp-content\/uploads\/2015\/02\/Boys-await-circumcision.jpg\")
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