Historic event in Denmark; report by Morten Frisch

HISTORIC DAY FOR CHILDREN’S RIGHT TO BODILY INTEGRITY

Today, at a meeting in Oslo, Norway, Nordic ombudsmen for children along with Nordic children’s health professionals’ organisations (a.o. pediatricians and pediatric surgeons) agreed on a resolution urging their national governments to work for a ban on non-therapeutic circumcision of underage boys.

I was extremely pleased to be invited to attend this meeting and give a talk on the aspects of pain and complications in relation to ritual circumcision and to take part in the subsequent discussions leading to the final text.

DSC_1434copy-crop320wAnne Lindboe (left at Keele University 16th Sept 2013) Norwegian ombudsman for children should be warmly applauded for this great initiative! It is my strong sense that the clear cut message from today’s meeting will be a hard one to escape for the Nordic governments in their future dealing with the issue of non-therapeutic circumcision.
The resolution in Norwegian can be seen here. My (UNOFFICIAL) translation of the resolution into English goes like this (written hastily in the flight back to Copenhagen tonight)
Resolution:
LET BOYS DECIDE FOR THEMSELVES WHETHER OR NOT THEY WANT TO BE CIRCUMCISED
Circumcision without a medical indication on a person unable to provide informed consent conflicts with basic principles of medical ethics, particularly because the operation is irreversible, painful and may cause serious complications. There are no health-related reasons to circumcise young boys in the Nordic countries. Arguments that may argue in favour of circumcision in adult men are of little relevance to children in the Nordic area. Boys can make up their own minds about the operation when they get old enough to provide informed consent.

As ombudsmen for children and experts in children’s health we consider circumcision of underage boys without a medical indication to be in conflict with the UN Convention of the Rights of the Child, article 12, about children’s right to express their views about their own matters, and article 24, pt. 3, which says that children must be protected against traditional rituals that may be harmful to their health. In 2013, the UN Human Rights Council has urged all states to end operations that compromise the integrity and dignity of children and are prejudicial to the health of both girls and boys. We consider it central that parental rights in this matter do not have precedence over children’s right to bodily integrity. What is in children’s best interest must always come first, even if this may limit grown up persons’ right to carry out their religious or traditional rituals.

The Nordic ombudsmen for children and experts in children’s health therefore want to work towards a situation, where a circumcision can only be performed, if a boy, who has reached the age and level of maturity required to understand necessary medical information, consents to the operation. We wish a respectful dialogue among all parties involved about how to best ensure boys’ self determination with respect to circumcision. We also urge our governments to inform about children’s rights and health-related risks and consequences of the operation. We ask the Nordic governments to take the necessary steps towards ensuring that boys get the right to decide for themselves whether or not they want to be circumcised.

Oslo, 30th of September 2013

Signed by
Anne Lindboe, Norwegian ombudsman for children
Fredrik Malmberg, Swedish ombudsman for children
Maria Kaisa Aula, Finnish ombudsman for children
Per Larsen, Chairman of the Danish Children’s Council
Margrét Maria Sigurdardóttir, Icelandic ombudsman for children
Anja Chemnitz Larsen, Greenlandic Children’s spokesperson

as well as by representatives of Nordic associations of pediatricians and pediatric surgeons.

Men Do Complain is deeply Grateful to Morten Frisch for reporting this news and to all those who have taken the side of children by seeking to end the practice of non therapeutic circumcision.

3rd National Conference for Men and Boys

Two stimulating days in Brighton. Lots of new friends and new information to digest.

DSC_1464copy-crop640w

One of the highlights for MDC was meeting the people from CALM that is the Campaign Against Living Miserably. CALM offers a helpline so if you are in crisis you have somewhere to turn. In the near future there will be a campaign to promote the vaccination of boys against the Human Papilloma Virus. HPV is a possible reason to advocate the circumcision of boys but in line with medical ethics the first method of treatment or prevention should be the least invasive.

HPV – human papillomavirus

Good news from Australia. A group of diseases often cited by proponents of circumcision as justification for that procedure can be prevented by the vaccine that protects from human papillomavirus. It is therefore logical, and of course, less invasive, for both sexes to be vaccinated against HPV to prevent such diseases.

BMJ-230wA recent edition of The British Medical Journal contains a report that Australia is to routinely vaccinate boys and girls with benefits for both sexes.

“The move sees Australia become the first country in the world to publicly fund HPV vaccination for boys in a bid to protect against genital warts and anal, penile and throat cancers.
Starting this month, boys and girls alike in Australia will receive three doses of the quadrivalent vaccine Gardasil at ages 12-13, as part of a national, federally funded school based programme.  A catch-up scheme will also run for 14-15 year old boys until the end of the school year in 2014.”

We can only hope that the British Government will allow the National Health Service to follow this enlightened policy instead of wasting taxpayers’ money on unnecessary circumcisions.

63 years later

DSC_0389-levels-old-pic-crop-640The photograph above was taken as part of a project for Intact America, the brief was to “find a photo of yourself as a baby and photograph yourself with the picture next to your face so that both can be seen”.

I asked my Mum if there were any pictures of me as a baby that had survived; to my surprise she said that there were pictures of me taken approximately eight days after my birth on the 6th of November 1949. My mother’s interview, below, indicates that I was circumcised the day before the picture was taken which would have been Sunday 13th November 1949.

1949 was also the year in which a landmark paper was published in the British Medical Journal on the 24th of December. The first paragraph of “The fate of the foreskin” by Douglas Gairdner contains this statement.

“It is a curious fact that one of the operations most commonly performed in this country is also accorded the least critical consideration. In order to decide whether a child’s foreskin should be ablated the normal anatomy and function of the structure at different ages should be understood; the danger of conserving the foreskin must then be weighed against the hazards of the operation, the mortality and after-effects of which must be known. Though tens of thousands of infants are circumcised each year in this country, nowhere are these essential data assembled. The intention of this paper is to marshal the facts required by those concerned with deciding the fate of the child’s foreskin.”

That is laudable aim. Sadly as the years have passed any evidence that brings the ancient practice of male circumcision into disrepute has been sidelined and ignored by the media, medical establishment, community leaders and politicians. A look at what Gairdner hoped would be studied and evaluated reveals a sorry picture.

Anatomy and function.
The anatomy of the foreskin is taught in medical schools in the U.K. however the function of the foreskin and it’s role in the sex act is almost completely ignored. Sex educators in U.K. secondary schools ignore the anatomy of the foreskin completely and never mention the foreskin’s role in the sex act; it would take a brave teacher to raise the subject.

Danger of conserving the foreskin.
The British Medical Association in their guidelines on male circumcision says:

“In the past, circumcision of boys has been considered to be either medically or socially beneficial or, at least, neutral. The general perception has been that no significant harm was caused to the child and therefore with appropriate consent it could be carried out. The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the B.M.A, that this surgical procedure has medical and psychological risks.”

This quote indicates that the B.M.A. believes there are no benefits. The section also fails to point to a single danger of conserving the foreskin, there is no cohort of men suffering from an intact foreskin.

Mortality.
There are deaths as the recent case in Manchester illustrates. Death is one end of a spectrum of harm that is glossed over by the authorities. The moment that a doctor, or anyone else for that matter, takes a scalpel and cuts a child who has no disease there is harm being done. The basic principle of medical ethics “do no harm” is ignored every time a doctor performs a non-therapeutic circumcision on a person who cannot consent.

After effects – psychological risks.
I have no conscious memory of my circumcision, though I feel there is a legacy left in my brain. I am not subject to fears or phobias yet I have an absolutely visceral dislike or dread of buttons and it’s most intense manifestation is white buttons on a bright white background. Is this a lingering image of the buttons on the nurse’s uniform as she restrained me during the procedure?

DSC_0467_buttons_crop640wFar fetched? Perhaps not; observations of premature infants in neonatal units who are subjected to several heel pricks for the purpose of obtaining blood samples are seen to be more susceptible to experiencing  subsequent pain. If so, that would imply the functioning of memory at a very early age.
Work with babies by Dr Bruce Perry has shown that babies can recognise their mother’s face within a day of a full term birth. This could mean that I might have been able to form an image at the distance between my face and a uniform.
Taddio et al in their paper “Effect Of Neonatal Circumcision on Pain Response
During Subsequent Routine Vaccination” [14] report that:

“This study showed that neonatal circumcision in male infants is associated with increased pain response in vaccination 4-6 months after surgery. The results support our previous finding of a higher pain response in circumcised than uncircumcised male infants during routine vaccination.”

The researchers then went on to say,

“It is, therefore, possible that the greater vaccination response in the infants circumcised without anaesthesia may represent an infant analogue of a post-traumatic stress disorder triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.”

This could point to post traumatic stress disorder as the source of my morbid fear. In the
Diagnostic and Statistical Manual of Mental Disorders” the factors that would indicate a diagnosis of PTSD make interesting reading;

1. Exposure to a traumatic event.
As circumcision is used as a model for the study of pain in infants it is fair to say circumcision is a traumatic event.

2. Persistent re-experiencing.
Dreams, flash backs or “intense negative psychological or physiological response to any objective or subjective reminder of the traumatic event.”

3. Persistent avoidance and emotional numbing.
Many circumcised men avoid talking about the subject of circumcision. No one knows how many men feel about their circumcision status though there is some evidence that at least 15% of men circumcised without their consent are unhappy with their status [5].

4. Persistent symptoms of increased arousal not present before.
These might be sleep difficulties, anger, inability to concentrate, hyper vigilance and an increased startle response.

5. Duration of symptoms for more than 1 month.

6. Significant impairment.
The degree to which men’s abilities to function emotionally are affected by circumcision without their consent is unknown. Anecdotally this site and others report a significant number of men whose emotional lives have been adversely affected by circumcision.

I can fit aspects of my behaviour and experience into the categories outlined above. Whether or not I am affected by an “infant analogue of post traumatic stress disorder” is open to question, however there is clearly an area of the “after-effects” that Gairdner said should be known before ablating the child’s foreskin that needs further study.

After effects – physical and functional.
With the work that has been done in neurology, physiology and anatomy it is quite easy to justify the statement that, a man circumcised before puberty will never know what the sex act should feel like. Sadly someone such as myself does not have the necessary nerves, blood vessels and skin for the complete experience.
At a population level there is work that has been done that shows there are physical and functional after effects from circumcision.
Tim Hammond’s (pictured right) survey of circumcision harm is an excellent starting point for anyone who thinks circumcision is just a little snip with a minimal downside. I warn you that the images on Tim’s site are likely to shock and educate.
The study “Male circumcision in Denmark – implications for sexual function in men and women” Morten Frisch (a reference to this will follow) shows a marked increase in orgasm difficulties in both partners where the man is circumcised.
It is important to bear in mind that if a man grows up with a foreskin that does not develop normally and is uncomfortable or painful during sex or masturbation then he may well be better off with a circumcision but it should be his informed choice having been offered all the options for conservative treatment.

Critical consideration.
Human rights was in it’s infancy when Gairdner’s paper was published, though, were he writing today, I feel he would have not been blind to the issues that the non-therapeutic circumcision of children raises. Medical ethics have been around for a long time and should be adhered to, “do no harm”.
The victims of circumcision without consent are ignored and ridiculed for wanting to see an end to the practice.img029_crop_cu_640w I have been told to move on, get over it, pull my socks up and a variety of other such phrases. So here I am sixty three years later a victim turned activist; the path to activism is my way of getting something positive out of a very complex emotional situation. I think that the baby I am looking at in the picture has already forgotten the physical pain, and apart from urinating onto an open wound which must be distressing looks relatively happy. It is the man that the baby has become who will never forget, or be able to ignore the events surrounding his birth. Men should demand that future generations are protected from what is evidently a harmful practice.

No prosecutions

No one has ever been prosecuted under the FGM legislation.
Almost all cultures that practice the genital cutting of children cut both sexes. Female circumcision will continue as long as society tolerates male circumcision.

Female circumcision and male circumcision are always compared selectively. The very worst form of female circumcision is selected and contrasted with “normal” male circumcision. Females are protected by law from even a ritual pinprick that removes no tissue and quite right too. Men Do Complain believes it is right to protect females and all children from any unnecessary interference. Sadly the argument that all children should be treated equally works both ways, those in favour of cutting females say, with some justification, that if you tolerate the cutting of  boys then you should tolerate the cutting of girls.

There are of course differences between male and female circumcision, although the tissues most commonly excised are similar in structure and function. The fixation on the differences between male and female circumcision loses sight of the greatest similarity, which is that all non-therapeutic genital cutting is an assault if there is no valid consent to the procedure. No one would argue that a black eye and a cut lip are the same; yet all would agree that if an adult hit a child in the face and left an injury then it was the blow that defined the offence not the nature of the resulting injury.

In an age where children’s rights are increasingly recognised, equal opportunities promoted, and human rights incorporated into our legislation it is difficult to see the non-therapeutic cutting of children’s genitals as anything other than a crime. All children should be protected from the inappropriate activities of adults.

 

MDC supporters took the message that no children should be discriminated against to the Department of Health. Whitehall was also the venue for another demonstration which provided a stream of people on a very cold afternoon. Ninety seven leaflets were handed out and some new friends were found among the passers by.  The young man in the picture below certainly noticed our presence and asked if he could be photographed with Richard in the bloody overalls. The general public seems to get our message it is the politicians and institutions that are so very resistant to a change that is long overdue.