Brave?

DSC_0879-cropThe BBC’s “Casualty” (13/04/2013) tackled the subject of female circumcision. The motives of the programme makers were laudable. Men Do Complain is in favour of the cessation of forced or coerced genital cutting of children or any other vulnerable group. The encouraging thing about this programme is that the silence is broken about a subject that has been in the past largely ignored.

tritych-a-n-e-jpgThe question is when will the BBC and other organisations pluck up the courage to recognise that boys are also admitted to casualty departments after circumcision? The writers of “Casualty” should have no difficulty in finding research material on which to base such a story. Birmingham hospitals have revealed, following a freedom of information request, that two boys a week are being admitted as casualties and one boy a month comes close to death after male circumcision.

Society through the media should be helped to understand that non-therapeutic genital modification harms all children subjected to such treatment. All mutilated children have to live with the frustration of knowing that their sexual health has been compromised and all face similar risks following any unnecessary cut through the full thickness of the skin. All children should be afforded equal protection from what is essentially an assault.

How many men do complain?

Three questions that are apparently difficult to answer. Very careful study might answer the first question. Research over time will answer the other two questions. Few circumcisions are recorded in medical notes and very few men are followed up into adult life, to see how or if circumcision has affected them.

Physical harm
That circumcision is physically damaging is now beyond doubt. Embryology shows us that the same tissue that becomes the foreskin in males develops into the clitoris in females. The anatomical work of Taylor, Lockwood and Taylor tells us that the foreskin is composed of highly specialised cells with neurological and immunological functions. The work of Sorrells and his team demonstrates that circumcision removes the parts of the penis that are most sensitive to fine touch pressure. So circumcision is only beneficial when it treats a specific and relatively severe problem.

No benefits to children
There is not a single medical association in the world that recommends the routine circumcision of children since there is no benefit to children. A child’s foreskin is physiologically phimotic, not retractable, it should be cleaned like a finger, rinsed on the outside and left alone to develop and separate from the glans naturally. When the young man has gone through puberty he may, rarely, be left with a phimotic, non retractable, foreskin but this can almost invariably be treated conservatively, without circumcision. Education and safe sex in later life will provide more than adequate protection from any of the other problems circumcision is claimed to prevent.

Psychological harm
The silence of men is mistaken for satisfaction. This site and others are collecting data that is likely to reveal that men are psychologically harmed by non-therapeutic circumcision.
One example of the psychological damage unnecessary circumcision can cause is alexithymia; a disorder where people have difficulty identifying and expressing their emotions [13]. Those affected become less able to empathize with others. Sufferers of severe alexithymia are so removed from their feelings that they view themselves as being robots. If acquired at an early age, such as from infant circumcision, alexithymia might limit access to language and impede the socialization process that begins early in life.

Cosmetic outcome
A paper titled “The long term outcome of severe hypospadias“[5] may seem unrelated but this paper is about the surgical repair of an abnormality seen at birth when the tube that should close to convey urine along the penis does not close completely leaving an opening on the underside of the shaft of the penis, through which urine can pass. The repair of the abnormality if it is severe often involves the use of the foreskin as replacement tissue. This long term follow up study asked the men for their views on the cosmetic outcome of the surgery and got the following response.

“Of those who consider their penile appearance to be ‘abnormal’, this is owing to the absence of foreskin in four cases”

The total number of men whose foreskins were used to effect the repair was 27, a small sample size, fortunately hypospadias is a rare condition,  4 men out of 27 works out at 14.8%. Fifteen percent of all the men who have been circumcised and therefore have had their foreskins removed may well feel that the appearance of their penis is “abnormal”. The resulting calculation works out as a very big number that represents a lot of men unhappy with the cosmetic outcome, never mind any other problems.

Follow up
So if a long term follow up approach was used on the male population who have been subjected to non-therapeutic excision of their foreskins what would be the results?  Sadly this work has never been done. Perhaps no one wants to know the answer.

No deaths

Circumcision never kills anyone; that is what the authorities would have you believe. In the U.K. if a child dies after a circumcision the inquest that follows will likely record the cause of death as loss of blood, septicaemia or sudden infant death syndrome (Hornsey Sept 2009 see photos).
The cause of death is never recorded as being due to circumcision. So there are no cases of death due to circumcision recorded in the literature therefore there is never a death caused by circumcision. A verdict that includes the words “following circumcision” is a verdict that satisfies all those who have standing at the inquest.

The deceased child’s parents who requested the circumcision and want to believe that the death was accidental are satisfied. The operator medically qualified or otherwise does not want to have his or her practice questioned. The authorities will never face up to the fact that if the boy in question had been allowed to remain intact his death would have been a most unlikely occurrence. The authorities fear the fuss that powerful lobby groups who have enjoyed tolerance of their practices would make if their community’s traditions were even questioned let alone altered.

When a child dies “following circumcision” the powerful ignore the few voices that would try to represent the interests of the deceased child, who of course cannot organise his own representation. The dead child can never ask the question “I had no disease, there was nothing wrong with me so why did you do this to me?” The legal system denies natural justice to the boys whose lives have been so cruelly and unnecessarily ended.

The interests of children who die after non-therapeutic circumcisions should, as a matter of course, be represented at inquests by the Official Solicitor, a guardian ad litem or other child protection agency. Until society takes the issues surrounding male circumcision as seriously as female circumcision boys will continue to suffer disfigurement, impaired sex lives and rarely, but most tragically, death.

£6 million wasted

Six million pounds, how did we arrive at that amount?
In the U.K. the number of circumcisions done for medical reasons is about 6% of the male population (F.O.I. requests are pending). The number of circumcisions in other North West European countries, performed for medical reasons is very small. A fair estimate is 1% of the male population [9].

Figures from the Office for National Statistics show that in 2010 there were 398,500 male births in the U.K. 6% of 398,500 is 23,910 which is the probable number of boys circumcised by the N.H.S. for “medical reasons”.

If the cost of an individual procedure, including after care, is taken as £300 (the cost of a circumcision to the N.H.S may well be as high as £868) then the total cost comes to £7,173,000. Reducing the rate of circumcisions to 1% would save the N.H.S. £5,977,500 each year. This takes no account of possible damages awarded to victims of this misguided policy in the future as a result of likely legal actions.

Do boys in the U.K. really need circumcision “for medical reasons” at a rate that is six times greater than the rate seen in other N.W. European countries?

Equal rights?

Do men have equal rights? When it comes to protection from non-therapeutic genital cutting the answer is a definite no. The legislation that protects women and girls is discriminatory legislation.
“Circumcision is worse for girls.” This is one of the most pernicious myths around and it is just sexist nonsense. The original legislation protecting girls from genital cutting in the U.K. was called the Prohibition of Female Circumcision Act 1985. In 2003 the Act was repealed and made extra territorial, in other words you risk prosecution if you take a girl anywhere in the world, have her circumcised and then brought back to the U.K. Along with this alteration the name of the Act was changed to The Female Genital Mutilation Act.

This simple act of spin has helped to make the circumcision of girls seem different to the circumcision of boys. The old Act’s title recognised the equivalence of the cutting of boys and girls. The change in the Act’s title reflects the widespread perception that the circumcision of boys is not harmful but the circumcision of girls is genital mutilation. If you think this is correct and justifiable, transpose the genders and ask yourself the question, is a law that protects only males from genital cutting an equitable law free from any sexual discrimination?

In the womb the baby develops undifferentiated genital tissue until later in the pregnancy when either testes or ovaries develop; if testes develop the hormones that result influence the genital tissue to form the typical male genitalia. If on the other hand ovaries develop then the identical tissue goes on to become the typical female genitalia. The original tissue forms the penis in the male and the clitoris in the female.
Also it is essential to remember that the process by which the genitals take their different forms is a subtle combination of genes and a complex system of hormones which can have variable results. This means that there are a significant number of children born with atypical genitals. Often such children can, and should be, be left intact until such time as they are able to give informed consent to any treatment or surgery, this should be the path that is followed rather than a rush to surgery.

Circumcision in either sex is excising analogous tissue. In girls the clitoris is excised to a greater or lesser extent and in boys the end of the foreskin containing the ridged band [6] is always removed. The anatomy of male genitals is very poorly taught and poorly appreciated by medical professionals and the public; but the science has been done and is convincing. The foreskin includes the most sensitive part of the penis [3]. This fact means that a man circumcised before he becomes sexually active will never know what sex is supposed to feel like, he simply has not got the nerve endings and slack skin [4] that would have given him the full sensations of sex. Is this any different to the female experience? It may be that there are subtle differences in the tissue that is excised but it is clear that a significant change is made to the genitals of any child by the act of circumcision. The ethics are clear; to hit a child and leave that child with a black eye is wrong. To hit a child and leave a cut lip is also wrong. In both cases the exact injury is not important, it is the wounding that is the important point.

Do you tell a young man who has painful erections and pain during sex because too much skin has been removed that it is worse for a woman to have had her skin taken away? Do you tell a young man that his partially or wholly amputated glans (head of the penis) is somehow acceptable?

What do you say to the baby boys [7] that will die in the United States of America this year as a result of an operation they did not need or consent to? What do you say to the uncounted boys who will die in the South African “Circumcision Schools” this year? Are you going to say dying is worse for girls?

Protection is essential. Law does work. The Family Courts and their system of prohibited steps orders can and does protect girls from circumcision. All children should be protected from unnecessary surgery, unnecessary gender reassignments and unnecessarily invasive treatments whatever their parent’s wishes might be.