Danish poll on circumcision; results reported

According to a poll reported in CPH Post online nine out of ten Danes would support a ban on the circumcision of boys under the age of eighteen years.
intact-denmark-logo150wLena Nyhus, the chairwoman of Intact Denmark, is quoted as saying:
“For us, it is important to ensure the individual’s right to decide over his body and his genitals”.

Thornhill Clinic protest

The last of the blinds were being drawn as we arrived and the normal opening hours were altered from the afternoon to the morning.

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Our biggest protest yet, including candidates for the political parties Justice for Men and Boys (and the women who love them) and the Green Party.

The campaign to protect boys, and all children from the unnecessary medical interventions of powerful, vociferous adults is growing. Cutting the genitals of any child, boy, girl or intersex without an immediate medical imperative is being seen by more and more people as an abuse of children’s rights, minds and bodies, which indeed it is.

Faith based assaults

P1150590_320wIntroduction. This post is based on a talk given by Richard from MDC to the Charles Bradlaugh Society at the Museum of Northampton where Charles Bradlaugh was the local Member of Parliament in the mid nineteenth century. Bradlaugh was also an atheist, freethinker and ingenious campaigner.

Bradlaugh’s commitment to secularism lead to the Act of Affirmation which permitted those who held no religious belief to sit in Parliament without having to pledge an oath to a god they did not believe in.

Faith based assaults

Although I will be considering legal, ethical and scientific concepts I am not a lawyer, ethicist or scientist but I am concerned with issues that affect us all as was Charles  Bradlaugh who was not afraid of controversy if it was where a rational argument should prevail. So I hope what I manage to do is to shed some light onto a very dark area with the help of those who do have that expertise.

The protection of children from the inappropriate activities of adults is something that society takes very seriously – and quite rightly so.
Take for example – the Tattooing Of Minors Act. The act protects children under the age of eighteen from tattoos. A tattoo involves no loss of tissue but it is irreversible. The tattooing of a child is treated as a criminal offence with or without consent of the parents or the child. Another example relates to body piercing. There is no specific law, in England, regulating body piercing, but if it is carried out on the genitals of a child under sixteen or on the nipples of a girl it would be likely to be prosecuted as an indecent assault.

There are also several faith or culturally based practices which are likely to be treated as assaults in law one example would be the scarification permanent scarring of the face. This is not surprising because when you look at what constitutes a common assault you will see that a simple touch without permission can be treated in law as such an assault. It has been argued that even baptism is an assault – and that is obviously faith based. The basic ingredients are all there in baptism, a child cannot consent so no permission has been given. The reaction to cold water on the forehead is often not welcomed by the child and is clearly outside the normal handling of children.
The rights and wrongs of baptism are not however the focus of this talk. I am going to talk about a much more serious type of assault usually based on faith or culture – and that is the cutting of children’s genitals.

I am a victim of genital cutting, turned activist; the details of my own personal journey are not relevant except that those events do provide part of the motivation that has lead me to campaign for the rights of all children, boys, girls and intersex, to grow up free from any non-therapeutic genital cutting or modification. The other source of motivation that I draw on is the courage of the others I have worked with in this area, people who have faced difficult issues and “come out” if you will forgive the phrase.

Movements that have changed our culture in my life time are the struggle for the decriminalisation of homosexuality and then for gay rights and I think that for campaigners in my situation we can learn a lot from these. To change the law in an area that was riven with issues of religious belief, taboos and cultural mores has many parallels with the struggle for a child’s right to grow up intact.

This talk is focused on children’s rights. The rights of children are no different to the rights of any other human living in the UK or EU today. The European Convention on Human Rights – long taken notice of by the UK courts was brought onto our statute book as the Human Rights Act 1998. The UN Convention on the Rights Of the Child, and the UN Convention on Civil and Political Rights are given weight in our law; and these together provide the shared values that hold society together and are manifested in our conduct towards one another.

When it comes to cutting the genitals of children it is fair to say that most cultures that cut boys also cut girls. Take Egypt for example the rate for cutting the genitals of both sexes is high. In the UK we have a law protecting girls from Female Genital Mutilation. In the UK we also have equal opportunities legislation and in the mind of the population that means equal treatment, but this equality of treatment can be seen as discriminatory by people from other cultures who regard cutting children’s genitals as a legitimate activity.

The Dogon tribe of the Niger river basin have a creation myth that says the sexes must be differentiated to avoid confusing the creator (who is involved in all creation not just at the beginning of the world), therefore boys must have a simple pole and girls must have a simple hole. The Dogon people remove the foreskin from boys and the external parts from girls, to achieve this differentiation. See the paper by George Wald a biologist who won the Nobel Prize for his discovery of Vitamin A in the retina of the eye and explained it’s purpose. His paper on the Dogon is up on the Men Do Complain website.

I am obviously in favour of the FGM law. It is valuable but it has a discriminatory aspect to it. After all we don’t have female murder or male murder, nor do we have male bodily harm or female bodily harm. Why do we build in such discrimination when it comes to the cutting of children’s genitals? The answer is almost certainly partly strategy, partly ignorance and partly cultural sensitivity. The damage caused by FGM is sometimes made very obvious when a woman who has been cut tries to give birth. There is no such function for the male genitals. That is not to say that males are not damaged by genital cutting. There are deaths in both sexes as a result of genital cutting. There are lifelong complications in both sexes as a result of genital cutting. The damage in both sexes occurs along a spectrum of harm. The damage to females is widely and graphically reported but the damage to males is seldom mentioned but it is an extensive list.  It was easier therefore and less contentious to get a gender specific law onto the statute book and start to protect at least girls and women.

Very often when what I do comes into a conversation I am questioned on the religious aspects of circumcision. “What about the Jews and Muslims?” Sometimes I am faced with the accusation that I am anti this or anti that faith group.

Nothing could be further from the truth. It is that I am concerned with the rights of all children irrespective of their parents’ beliefs. It is encouraging that there are groups within various faiths that campaign for the cessation of cutting children’s genitals. Brit Shalom is a Jewish organisation that provides an alternative Jewish ritual to welcome boys into their parents’ community – and the ritual does not involve cutting.  Quranic Path are an Islamic organisation that argues with some merit  that circumcision is not a ritual in Islam or indeed in the Quran and is simply a cultural practice which could be abandoned.  Both these organisations are examples of the diversity that exists in those two particular faith groups. Also the people who join us on demonstrations and support our organisation are often from these groups.

There would be those who cried foul if I were  to recommend that a law be drafted that protected only children of certain groups and did not afford the same protection to others. Can you imagine the outcry if it was legitimate for one community to inflict corporal punishment on their children and for another community it was not?
When a High Court judge came up with that suggestion recently the NSPCC had this to say:

“Children need to be protected irrespective of cultural sensitivities. Different practices are no excuse for child abuse taking place in this country and the law doesn’t make that distinction. Every child deserves the right to be safe and protected from physical abuse and the courts must reflect this.” Independent 10/06/15

That sounds like everything I could wish for but many including the NSPCC have a blind spot when it comes to the cutting of boys’ genitals. The reason for this is cultural sensitivity the very point that the NSPCC have identified, yet they are not prepared to take a stand on the issue. We have tried to open their eyes by protesting outside some of their events but to no avail. We have received support from individuals in the organisation but the organisation itself lacks the courage of it’s stated convictions.

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Human Rights

The Human Rights Act 1998 brought into English law a set of rights that had been taken into account by the courts for some years.
Some articles of the Human Rights Act are fundamental to this issue.
Article 3
Article 3 Prohibits torture. The wording is as follows:-
“No one should be subjected to torture or inhuman or degrading treatment or punishment.” The state is under a positive duty to protect children from chronic neglect and abuse – so where the authorities know and fail to take any action the state is likely to be found in breach of Article 3 of The Human Rights Act. This raises the question of whether the UK is in breach of Article 3 as a result of failing to legislate or take action under the existing law in relation to male children. In addition The Offences Against the Person Act, is commonly used to charge assaults of all sorts against perpetrators and if used would have a deterrent effect to protect boys from genital cutting and it’s after effects. This practice amounts to degrading treatment and it has long term aspects which include for example, feelings of inferiority capable of humiliating and debasing the victim, as well as the shorter term effects of pain to the child. All these consequences of abuse physical and mental are covered by Article 3.

Article 8
What if a parent  was to say “I have the right to respect for my private and family life” and quoted Article 8.  He or she might say that right included the performance of certain rituals or ceremonies within their culture and that the state had no right to interfere. In this situation it is written into Article 8 (amongst other things) that the state may not interfere unless it is for the protection of health  or for the protection of the rights and freedoms of others. There is a balance to be struck here and the European Court has decided that if the child’s rights and the parents rights are in conflict the child’s rights must prevail (Yousef v The Netherlands application number 33711/96). So if the child has rights under Article 3 they cannot be trumped by the parents’ rights under Article 8.
Article 9
Suppose a parent were to argue “I have a right to freedom of thought conscience and religion under Article 9” That right is however a qualified right as is Article 8 and so again it is subject to the limitations based on the protection of health and the rights and freedoms of others. Once again the child’s right to protection is paramount. This has yet to be tested in relation to male circumcision but it is hard to see how the child’s rights under Article 3 would not prevail.
Article 14
Just to add Article 14 – the right to freedom from discrimination is not a free standing right but it does say that the provision of the Human Rights Act must be applied without discrimination and that all should have equal access to those rights – this article could not therefore trump the Article 3 rights of the child not to be tortured.

It comes as a surprise to some people that parents do not have rights regarding their children but only have duties and responsibilities towards them. A duty is not a carte blanche  for parents to do as they wish to their children against the child’s interests, even if motivated by genuine religious belief.

The key thing to note is that Article 8 family life and Article 9 religious freedom are qualified rights in that you can not use your rights as an individual to override the rights of another person even if that person is your child.

Science

The science of genital cutting is an essential part of any talk on this subject.

The anatomy and function of male genitals is poorly taught. There is little public understanding that the foreskin contains important erogenous tissue necessary for a complete sex life. I have printed out some copies of a peer reviewed scientific paper by two Canadian pathologists that shows down to the cellular level that the foreskin is specialised tissue and not just a flap of spare skin.

In every generation there is a big scare story to encourage, excuse or promote the cutting of children’s genitals.

It is nearly two centuries since the medicalisation of male genital cutting and in that time there have been a great variety of claims made for the benefit of removing the foreskin. Some have deserved serious consideration and others seem plain mad. Amongst other things circumcision was said to prevent alcoholism, rectal prolapse and many other conditions and diseases. All those claims have fallen by the wayside and the British Medical Association’s website currently says:

“The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks (see section 4.4). It is essential that doctors perform male circumcision only where this is demonstrably in the best interests of the child.”

One thing to note is that in some areas of the country the NHS still provides non-therapeutic male circumcision and also cares for those damaged by circumcisions performed in the community. The cost of this and the necessary remedial care and treatment, (although I have no up to date figures), amounts to millions of pounds each year.

HIV AIDS
As far as excuses for circumcision go the current favourite scare is HIV AIDS. It is often the way with health stories that a good statistic with plenty of grabbing power makes the lead in the media. For example “Circumcision provides 60% protection against AIDS”.
The three studies that have given rise to this headline vary between 38% and 66% hence the exaggerated headline of 60% protection. There is continuing debate however about the validity of these studies; the levels of protection provided and the statistical basis used.

Other studies have shown a lesser level of protection and also that  circumcision status has no statistical effect at all. Even if that 60% figure is correct it means that at best the protection offered is only partial. Six out of ten. Not great odds.

So no responsible doctor would advise engaging in sex with an unknown partner without a condom given those odds of six out of ten. The question then is if you have to wear a condom even after circumcision then why bother to circumcise in the first place?

I don’t want to dwell on the science but just to add that if the USA, a country with one of the highest rates of male circumcision in the developed world also has one of the highest rates of HIV infection in the developed world then it looks as if there must be factors other than circumcision with a greater effect.
One final point on this bit of science. Children are not sexually active so why not wait until they reach a level of maturity when they can understand what is involved and the consequences of circumcision or remaining intact? They can then consent to circumcision or refuse to be circumcised as they wish.

Is there any advantage to circumcision in infancy? The procedure carried out on a neonate is very difficult. The tissue involved is going to grow and develop until puberty so it is impossible to measure accurately how much tissue to take and what the effect on the developed penis will be. Also there is the difficulty of anaesthesia, it is risky to anaesthetise an infant – even a local anaesthetic can have devastating effects and will be only partially effective. There is evidence that the trauma of the operation is significant and possibly long term.

Work on short term pain has been done and published in the paper –
The Effects Of Circumcision On Serum Cortisol And Behaviour”  by Gunnar et al.

This was published in1981 in the journal Psychoneuroendocrinology.
The paper is complex and analyses the child’s behaviour before during and after circumcision, serum cortisol is a stress hormone and it’s levels increase during any physically painful experience, the paper says:

“Neonatal circumcision is performed without anaesthesia and it is clearly stressful for the infant.”

If you are in any doubt that this is the case search online for a video of an infant circumcision and you will see that this is a bit of an understatement.

Things have moved on since 1981. The abstract for the 2003 paper published in the journal of Health Psychology – “Male Circumcision: Pain, Trauma and Psychosexual Sequelae” by Boyle et al. reads as follows:

“Infant male circumcision continues despite growing questions about its medical justification. As usually performed without analgesia or anaesthetic, circumcision is observably painful. It is likely that genital cutting has physical, sexual and psychological consequences too. Some studies link involuntary male circumcision with a range of negative emotions and even post-traumatic stress disorder (PTSD). Some circumcised men have described their current feelings in the language of violation, torture, mutilation and sexual assault. In view of the acute as well as long-term risks from circumcision and the legal liabilities that might arise, it is timely for health professionals and scientists to re-examine the evidence on this issue and participate in the debate about the advisability of this surgical procedure on un consenting minors.”

Unfortunately society’s attitude to the cutting of boys’  genitals is one of tolerance. The word “circumcision” along with the expression “the snip” are comfortable euphemisms that hide much of what is going on.

The Oxford English Dictionary gives the definition of the word mutilate as:
1 a deprive (a person or animal) of a limb or organ b destroy the use of (a limb or organ)
2 render (a book etc.) imperfect by excision or some act of destruction.
I don’t think we are wrong to use the word mutilate in connection with the cutting of any child’s genitals that is done without a medical imperative.

The education currently provided for males about their natural anatomy and it’s function is woefully inadequate. This lack of education is an area that should be corrected because it perpetuates the old myths surrounding male genital cutting. Since the start of the women’s liberation movement much has been written about female genital anatomy and the value of intact female genitalia is widely understood. It may come as a surprise to many in this room that some parts of male genital anatomy were only identified and described in the 1990s. There is still work to be done on the exact role that some parts play in the lives of men. The work of Cold and Taylor, pathologists, who I referred to earlier, working at the cellular level identified nerve cells in the foreskin and conclusively showed that the foreskin is not just a flap of spare skin, it contains a structure rich in nerve cells called the ridged or frenar band which is a band of nerves extending from the frenulum on the underside of the base of the head of the penis right around the lips of the foreskin.  The foreskin is arguably an organ or specialised tissue in it’s own right.

This ridged band is the most sensitive part of the penis. A study conducted by Sorrels et al “Fine-touch pressure thresholds in the adult penis” was published in the BJU International in 2007. The study looked at the sensitivity to fine touch pressure in circumcised and intact men. They concluded that circumcision removes the most sensitive parts of the penis and decreases the fine touch pressure sensitivity of the glans penis.

The first definition of the word mutilate to “deprive a person of a limb or organ”, starts to look like a correct definition. Also the second definition “render imperfect by excision or some act of destruction” begins to look appropriate too. Indeed circumcision is sometimes referred to in the literature as the “non-therapeutic excision of the foreskin”.

We have seen that there are no convincing benefits from circumcision that warrant the removal of healthy tissue from non consenting children. We now know that the foreskin is essential for a complete sex life so to call circumcision male genital mutilation is clearly  justifiable.

Munby judgement
In a Leeds City Council case this January Sir James Munby President of the Family Division sitting in the High Court delivered a judgement. – The reference is [2015] EWFC 3 – It was a complex care case involving the possibility that a girl had been subjected to a form of FGM. There was also a boy in the case and the President identified that male circumcision caused significant harm and compared to some types of FGM which are criminal offences – male circumcision caused greater harm. He said however that given society’s current general tolerance of the practice of male circumcision he was unable to go further and decide that a parent inflicting this harm on a child was acting unreasonably. He did not have to open this can of worms and for him to recognise the physical harm caused by non-therapeutic foreskin amputation is to be applauded. The puzzle expressed by the President and the degree of irrationality identified by him was that the harm caused by male circumcision  even though greater than the type of FGM involved in the particular case was considered acceptable by society and not specifically prohibited by the criminal law. – so he was left with the uncomfortable situation that the greater harm was seen as acceptable and the lesser harm as unacceptable in family law.

Criminal law

The criminal law has little to say about circumcision and what it does say is not helpful – in 1993 in R v Brown a criminal case concerning adult sadomasochists Lord Templeman said in a passing remark that circumcision is “assumed to be a lawful activity” along with boxing and a variety of other brutal sports. There is of course no statute that specifically permits or prohibits male circumcision. However as we have seen the circumcision of a non-consenting child for non-therapeutic reasons would appear to be a crime under the Offences Against the Person Act. In fact a cut through the full thickness of the skin is regarded as a wounding – a far more serious assault under that Act. Circumcision is certainly a cut through the full thickness of the skin. The question is why has there not been a prosecution under the act? The answer is probably a fear of upsetting certain faith groups and cultures. This is surprising considering the current rigour that is applied to protecting children from harm and abuse in other areas. A prosecution under the Offences Against the Person Act would provide a deterrent signal for those considering harming a male child by non-therapeutic genital cutting and should not be seen primarily as a punitive measure. Because there has been no attempt to protect boys there would seem to be a discriminatory element in the authorities’ approach to the protection of boys.

The after effects of cutting a boy’s genitals can be many and varied some men are content with their private parts missing a bit. Some men are not content and many suffer in silence. The subject of sex, sexuality and any feelings of inadequacy are incredibly hard for men to talk about. But in extreme situations it does happen.

Since we started Men Do Complain we have been contacted by men who have been circumcised later in life and have consequently known sex in both states, with a foreskin and without a foreskin. So far all have requested anonymity and we respect that. They come to us seeking guidance on legal redress, because they have been told beforehand that they will notice a “change in sensation”  or that it will make “little difference” to their sex lives. When they have healed after the operation they find there is a substantial difference and have used phrases like “it is as different as night and day” and “there is nothing there”. Perception is often at it’s most extreme immediately after a change, take putting your foot into a hot bath, at the first touch, ouch. on the second dip not so bad perhaps a similar thing goes on after circumcision I have no evidence one way or another except to say that some of these men are contacting me a year or two down the line after they have sought help or sympathy elsewhere. So for some men there is a significant loss when the foreskin is removed.
Do visit our web site, Vimeo or Youtube channel and see Tim Hammond’s presentation of the findings from the Global Survey of Circumcision Harm where the issue of harm is explored in much greater detail than I can here.

What of the the future? An encouraging development in recent  years has been the recognition that Intersex children have a right to be protected from unnecessary interventions. The UN Special Rapporteur on Torture has taken the issue seriously and this year Malta has banned such interventions on intersex children. The reason is essentially simple. If you use irreversible surgery to assign a gender to a child and the child grows up to identify with the opposite gender then there is no remedy. It is for a similar reason that boys should be allowed to grow up intact. If an intact boy is unhappy with his status then he has a remedy. If a boy’s foreskin has already been removed he has none.

I would like to see the FGM law working in a gender neutral manner. This may not be straightforward because it would be fairer to ensure that anyone capable of giving his or her informed consent who wanted to have their genitals cut to manifest their religion or the custom of their community had the right to do so.  If the FGM Act were to apply equally to men then such a man would not be free to exercise his right to freedom of religion and custom as the FGM act only has a mental and physical health exemption, not a religious or cultural exemption. It may be necessary for a new non discriminatory piece of legislation to be devised to recognise that these freedoms are available to those people who are capable of giving informed consent.

Will we eventually look back on this situation from a different viewpoint?
I am optimistic. In the 10 years I have been involved in this work there have been a lot of changes. I can remember seeing the first Masters thesis by a student on the subject of male circumcision. There is an increasing amount of academic work being done in this area. The significance of such work is important and the President of the Family Division in his judgement that we looked at earlier referred to the important work of both Christopher Price a solicitor and Brian Earp a philosopher. This year the first political party to take MGM seriously has emerged Justice for Men and Boys (and the women who love them). The Scottish Socialists have also expressed an interest and I feel more political parties will follow. I am also now convinced that anyone seriously taking on this work in the UK is not committing professional suicide.

I feel we can be confident that Charles Bradlaugh as a courageous secularist would have backed our campaign for the rights of children to be free to grow up without having their bodies altered to suit the beliefs of their parents.

Mentioned in Hansard?

Our demonstration in Parliament Square for International Men’s Day attracted a lot of attention. A debate inside the House on male suicide resulted in Male Genital Mutilation being mentioned in the Commons. At the end of his speech opening the debate Philip Davies said this:-

There are so many other areas where men are being discriminated against, or are suffering more than women. Unfortunately, I cannot go through them all now. If they are not raised by other Members today, I hope we will have similar debates in the future, so that I can highlight the further problems faced by men. Some of the issues that I do not have time to get to include: male circumcision and its effects on some men; the fact that men suffer from anorexia and bulimia, too; the health effects of men not seeking help early enough to prevent their conditions from getting worse; the fact that men tend to live shorter lives than women; and the fact that boys underachieve in school.

We had a lot of support from Justice for Men and Boys (and the women who love them) and representatives from, 15square, Healing Men and others working with men and boys. Thank you to all who turned out and braved the weather, it never really got dry or light!

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