3 10 240 Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>The case of Boldt v. Boldt</h3> A long-running legal saga in the United States was finally resolved in late 2009, when courts in the state of Oregon ruled that a parent could not compel a child over which he had custody to get circumcised against the boy’s will. The case is of considerable interest in its potential to limit the power of parents to impose circumcision and similar physical alterations on children and in its implicit recognition that children have their own rights – to physical integrity and freedom of conscience and religion – independently of their parents’ belief. <h2>Background: A messy custody case</h2> The Boldt case was a custody battle, and like all custody battles, it was a complex story, but the basic facts are that the Boldts were adherents of the Russian Orthodox Church and had one child, Mikhail James, whom the mother called Misha and the father Jimmy. After a bitter divorce, custody of the boy was eventually given to the father. Some time after this the father decided to convert to Judaism and tried to take Misha (then aged 9) with him, a transition that necessarily entailed arranging for him to be circumcised. The boy’s mother obtained a temporary court injunction prohibiting the circumcision, and filed an application for custody. The father testified that Misha himself wished to convert and undergo the operation, but that even if he did not his wishes were irrelevant because the custodial parent had complete authority to make what he called “medical decisions” for a child. The mother testified that Misha did not want to be circumcised and was afraid to contradict his father. After a lengthy series of hearings and appeals, by which time the boy was 12, the Oregon Supreme Court decided that “although circumcision is an invasive medical procedure that results in permanent alteration of a body part and has attendant medical risks, the decision to have a male child circumcised for medical or religious reasons is one that is commonly and historically made by parents,” and it concluded that the custodial parent’s rights in this respect were not fettered by the views of the non-custodial parent. But because this was a custody, rather than a right to circumcise, case, the court ruled that forcing the boy to get circumcised would damage his relationship with his father, and sent the case back to the trial court to determine the boy’s own views. When Misha, by now aged 14, finally got the opportunity to express his own opinion (at a hearing in judges’ chambers in April 2009) he made it clear that he did not wish to convert to Judaism, and he most definitely did not want to get circumcised or to remain with his father. Accordingly, the court issued an order that he was not to be circumcised and returned him temporarily to his father while child custody officials worked out the details of how to return him to his mother. <h2>Involvement of Doctors Opposing Circumcision</h2> Although the original trial court ruled that a decision to circumcise was a legitimate power of the custodial parent and refused to hold a hearing on the matter, it issued a stay pending the outcome of an appeal by the mother. The Court of Appeal agreed with the trial court and refused to order a hearing, at which point the mother appealed to the Oregon Supreme Court and requested the American human rights group, Doctors Opposing Circumcision, to intervene in the case as amicus curiae (friend of the court – a role performed by those with no personal interest or standing in a case, but who can assist the court through its expertise in the technical questions raised). DOC filed two briefs in the case, one in support of the petition for review, and then, following the Oregon Supreme Court grant of certiorari (the right to appeal), a second brief on the merits. Parental and child rights were considered under the constitutions of Oregon, Washington (the child’s state of residence), the United States, and even a Supreme Court of Canada decision on parental duties under the Canadian Charter of Rights and Freedoms. DOC’s briefs were limited to arguments against circumcision on medical, legal, and human rights grounds, and did not take a position on the issue of custody. These were matched by three influential American Jewish organisations that submitted their own amicus curiae briefs in support of the father’s claim of an unfettered right to circumcise his son. At no point in their submission did they show the slightest sympathy for the plight of the child or show any interest in his preferences in the matter. They and the father claimed an absolute right to circumcise the boy under the “Free Exercise” clause of the First Amendment to the United States Constitution, which bars Congress from establishing any religion or prohibiting the free exercise thereof. Although the Oregon Supreme Court, in obiter dicta (a passing observation, not related to the legal issues that decided the case), paid deference to a custodial parent’s right to make a decision about circumcision, it remanded the case back to the trial court with an order that it should determine the view of the child. The child was then twelve years of age. <h2>Court recognises that child’s preferences must be considered</h2> The father then petitioned the United States Supreme Court for certiorari (right to appeal), which was denied, and the case returned to the Circuit Court of Jackson County, Oregon, where a hearing was held on 22 April 2009, before Judge Lisa Greif. At that time, Misha, now 14 years of age, testified in her chambers, on the record, that he did NOT want to be circumcised, he did NOT want to convert to Judaism, was afraid of his father and wanted to live with his mother. The court then issued an oral order from the bench that the child NOT be circumcised. The court then followed that with a written order on 2 June 2009, in which the court found that a substantial change of circumstances had occurred and ordered an investigation by an independent child custody evaluator for a future evidentiary hearing. In the meantime, the boy remains in the custody of his father, but under protective orders against circumcision. <h2>Significance of the Boldt case</h2> Despite the Oregon Supreme Court’s remark about the decision to circumcise a child being “commonly and historically made by parents”, the case remained a custody battle throughout, and no determination was ever made as to whether parents did in fact have the right to make such a decision, and if so with what qualifications. Since the question does not seem be as settled in law as the court’s confident words suggest, the observation may be regarded as no more than an obiter dictum. In a similar case, a divorced mother having custody of a nine-year-old son remarried, this time to a Jewish man, and sought to have the boy circumcised at the behest of her new husband. The father objected, and when the matter came to court the judge dismissed the mother’s claim of medical necessity and ordered that the boy be protected from circumcision until his 18th birthday, at which point he would be free to make his own decision. (Schmidt vs. Niznick, Cook County Illinois, 00D18272, cited in Doctors’ Opposing Circumcision, Amicus Curiae Brief on Boldt, 26) In denying that the non-custodial parent had no prerogatives with respect to medical decisions about a child, the Oregon Supreme Court certainly did not mean that the child had no say in the matter; indeed, in directing that the trial court discover Misha’s own views it implied quite the contrary. The significance of the case is in establishing a precedent that a parent’s authority to circumcise a child is not unlimited and may not even exist. Although the court took account of the boy’s age (twelve), recognising that it might be difficult to get a boy of that age to lie down submissively in a doctor’s surgery, it is hard to see why the principle of physical integrity would not apply to a child of any age. There is no obvious reasons why a child has the right to physical integrity at 12, but not at 8 years, 4 years, 6 months or 2 weeks. By the age of 12 Misha certainly knew that he wanted to keep his foreskin and was confident enough to make his views heard, and (this being the case) we may reasonably infer that if an infant or young child too young to be capable of expressing an opinion on the matter were able to do so, he would say NO, or at least ask that the operation be delayed until he was old enough to inform himself as to the pros, cons and harms of circumcision and make his own decision. A <a href="https://www.circinfo.org/news.html#chong">recent study in the USA</a> found that even if circumcision were proved to be effective insignificantly lowering the risk of HIV infection, only 0.7 per cent of adult men would be willing to get themselves circumcised. The clear implication is that if an infant or child were asked if he wanted to get circumcised, and he was capable of giving a rational answer, the answer would be “No way.” This alone is a sufficient reason why circumcision should not be imposed on minors. <h2>Age not the issue:</h2> <h3>All humans have autonomy and the right to physical integrity</h3> Some commentators on the Boldt case have suggested that while a 12 or 14-year old might be mature and competent enough to reject circumcision, younger boys and especially babies must just accept whatever their parents think best for them. This position makes no sense at all, for reasons set out clearly in the Canada Medical Association Journal a long time ago: The performance of unnecessary surgery on minors who have no say in the matter does not sit well with many people who consider circumcision a denial of basic human rights specifically an infant’s right to the respect and autonomy fundamental to Canadian law. … Removal of a normally function healthy body part without medical indication has also been viewed as a violation of the Hippocratic oath, falling under the United Nations’ definition of genital mutilation. As such, circumcision is seen as being against the Universal Declaration of Human Rights and the UN Convention on the Rights of the Child. … In BC [British Columbia], the Infants Act stipulates that a child should be accorded the same protection under law as adults: if an adult male cannot be forced to undergo circumcision in adulthood, it follows that he shouldn’t be forced to have it in infancy simply because he is too small to resist. (Eleanor LeBourdais, Circumcision No Longer a “Routine” Surgical Procedure, 152 CANADIAN MED. ASS’N. J. 1873-4 (1995) The fundamental problem with the idea that circumcision of an adult requires informed consent but circumcision of a minor can be accomplished at the wish of a parent is that childhood is a temporary condition but circumcision a permanent one. A person soon ceases to be a child, but no matter how old he gets he will not get back what has been taken away; as an adult the person has the same mark or absence that his parents were entitled to effect by the mere fact of his being a minor. There is thus no significant difference between forcible circumcision of an adult (which is illegal) and circumcision of a minor, since the result in adulthood, when the parts affected are most needed, is the same in each case. To make an adult’s right to physical integrity meaningful it must be respected in infancy and childhood, implying that irreversible bodily alterations should not be performed. By defining respect for autonomy as “requiring that persons with the mental capacity to make certain medical decisions have these decisions respected”, the parental authority school drastically reduces the scope of autonomy and effectively denies it to children and incompetent adults. This is a radical departure from accepted principles of bioethics [1] and a succession of legal judgements in the USA, Britain and Australia [2] that restrict the power of adults to make medical decisions on behalf of incompetent family members. Lack of mental capacity, neither in infancy nor in adulthood, does not negate a person’s right to physical integrity; if parents are determined to violate this right, the state is entitled to intervene in defence of those who lack the capacity to defend their own interests. <h2>Parental authority and the child’s right to an open future</h2> The following principles would also appear to have been endorsed by the outcome of this case. (1) Parental rights are an extension of, and derivative from, parental responsibilities to the child. Parental rights exist as against outsiders or strangers to the family; they are not rights of the parent against or over the child, who is held in trust during his minority. Behind every assertion of a parental ‘right’ must be a discernible concern for the independent co-relative rights and well-being of the child as a separate person and individual in his own right. (2) The child has an independent right to his own religious beliefs or non-beliefs. These rights are stated clearly in the foundation documents of the modern human rights framework: The Universal Declaration of Human Rights; the International Covenant on Civil and Political Rights; and the Convention on the Rights of the Child. These treaties give all people the right to freedom of religion and conscience and to physical integrity, irrespective of age or gender. To mark a child permanently and physically as a member of any religion deprives him of his own right to religious freedom and personal choice. To take an unfamiliar example, many Shiite Muslims believe they have the right to slit their children’s foreheads each year on the festival of Ashura, commemorating the death, by beheading, of their sainted Imam Hussein. [3] Even if performed by a doctor under sterile conditions, it is hard to believe that Western law or custom would accept this practice as an appropriate exercise of the religious freedom of the parent. (3) In his paper “The Children We Abandon: Religious Exemption to Child Welfare and Education Laws as Denials of Equal Protection to Children,” [4] James Dwyer has argued that far too often Anglophone law has abridged the child’s more fundamental rights to health and even life itself, to accommodate mere beliefs, even whims, of the parent. It is to be hoped that the Boldt case marks the beginning of a more child-centred tradition. (4) As argued by the late legal philosopher Joel Feinberg, children have a “right to an open future”, that is, one in which all options for the future development of the child as an adult-to-be are protected and retained. [5] This applies not only to affection, food, shelter, and education, but also to freedom from irrevocable parental choices of which circumcision is a permanent, palpable and entirely unnecessary example. For these reasons and many others, we should make sure that we maintain a sharp focus on the rights of the child as an independent entity distinct from his parents, one whom they hold in trust and cannot treat as property, and who is entitled to human rights of his own, of which the right to a set of intact genitals is surely one of the most fundamental. <h3>Documents relating to the case available here</h3> <a href="http://www.doctorsopposingcircumcision.org/pdf/2007-04BoldtReview.pdf">Doctors Opposing Circumcision, Brief of amicus curiae in support of the petition for review</a> (PDF, 184 kb) <a href="http://www.doctorsopposingcircumcision.org/pdf/2007-07BoldtMerits.pdf">Doctors Opposing Circumcision, Brief on the merits of amicus curiae</a> (PDF, 102 kb) <a href="http://www.doctorsopposingcircumcision.org/info/appeal.html" rel="noopener" target="_blank">Summary of early phases of case at DOC website</a> <a href="https://www.circinfo.org/DOC_Boldt_case.html">Letter from Doctors Opposing Circumcision to Journal of Clinical Ethics</a> <h2>References</h2> 1. Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics (Oxford University Press, 1977) As set out in this basic text, the fundamental principles of bioethics are: Beneficence — Does the proposed procedure provide a net therapeutic benefit to the patient, considering the risk, pain, and loss of normal function? Non-maleficence — Does the procedure avoid permanently diminishing the patient in any way that could be avoided? Proportionality — Will the final result provide a significant net benefit to the patient in proportion to the risk undertaken and the losses sustained? Justice — Will the patient be treated as fairly as we would all wish to be treated? Autonomy — Lacking life-threatening urgency, will the procedure honor the patient’s right to his or her own likely choice? Could it wait for the patient’s assent? Medically unnecessary circumcision of male minors violates every one of these principles. 2. J.S. Svoboda et al, <a href="http://www.cirp.org/library/legal/conundrum/">Informed consent for neonatal circumcision</a>, esp. 80-81, 87, 89-90; Gregory Boyle et al, <a href="http://www.cirp.org/library/legal/boyle1/">Circumcision of Healthy Boys: Criminal Assault?</a>, 7 J Law Med 301 (2000); Frank Bates, <a href="http://www.cirp.org/library/legal/bates1/">Males, Medical Mutilation and the Law: Some recent Developments</a>, 9 J Law Med 68 (2001) 3. The theory is that young men slash only their own foreheads, but there are plenty of pictures available on the web that show adults doing it to young children: see “Ashura observed with blood streams to mark Karbala tragedy” at <a href="http://www.jafariyanews.com/2k5_news/feb/20ashur.htm">Jafariya News</a> and <a href="http://atlasshrugs2000.typepad.com/atlas_shrugs/2009/01/islam-celebrate.html">Atlas Shrugs</a>. 4. James Dwyer, The Children we Abandon: Religious Exemptions to Child Welfare and Education Laws as Denials of Equal Protection to Children of Religious Objectors, 74 N.C.L. Rev. 1321 5. Joel Feinberg, The Child’s Right to an Open Future, in Freedom and Fulfilment: Philosophical Essays (Princeton University Press, 1992). See also Dena Davis, Genetic Dilemmas: Reproductive Technology, Parental Choices and Children’s Futures (London and New York: Routledge, 2001), and idem, Genetic Dilemmas and the Child's Right to an Open Future, 28 Rutgers Law Journal 549 (1997) </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource American legal precedent confirms child’s right to reject circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Why I wrote a book about circumcision</h3> <h4>Dr Leonard Glick explains how he came to write Marked In Your Flesh</h4> A number of years ago I learned that infants undergoing circumcision cry â€“ in fact, scream â€“ in an entirely distinctive manner. That ought to have rung an alarm bell in my mind; instead it just left me feeling vaguely uneasy. Yet if anyone should have understood what I now call "the circumcision dilemma," it was me. I'm a cultural anthropologist with a medical background, and I taught European Jewish history to college students. In an earlier book, Abraham's Heirs: Jews and Christians in Medieval Europe, I mentioned circumcision incidentally a few times. But its real importance only dawned on me when I came across a historian's statement that European Christians thought of the "typical Jew" as a circumcised male â€“ a genitally depleted half-man, weakened and "feminized" by this most mysterious of all Jewish practices. Had I really studied the history of Jewish-Christians relations all those years and never realized something so fundamental? Soon came another surprise: I learned that in the United States circumcision was by no means a Jewish practice alone â€“ that today a substantial majority of male American newborns are being circumcised. The practice had become popular in the early to mid-twentieth century, just at the time when childbirth was medicalized â€“ moved from home to hospital, managed by physicians, and accompanied by such now discredited practices as episiotomy, isolation of newborns from mothers, artificial feeding, and rigidly defined feeding schedules. There was more. I found that the practice had never been accepted in Continental Europe, Asia, or Latin America; that in other Anglophone nations (England, Canada, Australia) it had been adopted for a time, then largely discontinued. Finally, the clincher: I came to understand that not only is circumcision medically unnecessary, it removes the most sensitive tissue in the male genitals. Mothers don't have to be told that a normal newborn infant, male or female, is a perfectly formed little person, with nothing useless, nothing designed by nature for removal! If there can be no good reason for removal of a body part from any normal, non-consenting person, circumcision raises a serious ethical issue. Why then has the practice continued? Why are nearly 60 per cent of male infants still routinely circumcised in our hospitals, despite statements by leading medical organizations that there is no need to do this? For one thing, despite oceans of articles in the medical literature and efforts by opponents to raise public awareness, many parents take it for granted that circumcision of newborn boys is the American thing to do. It's a "<a href="http://www.cirp.org/library/legal/USA/waldeck1/" rel="noopener" target="_blank">social norm</a>" â€“ a practice that's widely accepted because people know that it's widely accepted. So physicians, whether they approve or not, let parents decide on such a sensitive issue as the medically unnecessary, irreversible removal of a normal body part â€“ surely the only situation in which anyone is permitted to make such a decision for another person. I think that's unjust, and I wrote this book to try to explain why. Marked in Your Flesh: Circumcision from Ancient Judea to Modern America was published by Oxford University Press in June 2005. I hope it will help to show why routine circumcision should have no place in American society. Originally published in <a href="http://www.compleatmother.com/" rel="noopener" target="_blank">Compleat Mother Magazine</a>, No. 79, Fall 2005, p. 25 Dr Leonard Glick, MA, MD, PhD, is Emeritus Professor of Anthropology at Hampshire College, and lives in New Salem, Massachussetts. Marked in your flesh is available from Amazon by clicking on the image to the left. <h2>A thoughtful and troubled review</h2> The following review was pubished in the Jewish American magazine <a href="https://www.forward.com/articles/3883" rel="noopener" target="_blank">Forward</a> in September 2005. <h4>A Little off the Top</h4> <h4>The Controversy About Circumcision</h4> <h4>By Jay Michaelson</h4> <h4>September 2, 2005</h4> Marked in Your Flesh: Circumcision From Ancient Judea to Modern America By Leonard B. Glick Oxford University Press, 384 pages, $30. To put it mildly, circumcision is a delicate subject. It's almost impossible to discuss the matter without cracking a joke, probably because the ritual makes at least 49% of the population wince and cross its legs. And yet, as a quick Google search will easily reveal, in the past two decades there has been a trove of writing about circumcision â€” most of it negative, and a lot of it generated by cranks. Lately, however, the debate has moved into the mainstream. That circumcision reduces sexual pleasure, and that it is fully experienced by the traumatized infant, is now well established. Jewish intellectuals have debated the practice's merits in magazines and at conferences, and even bloodless "brit shalom" ("covenant of peace") rituals have been developed to replace circumcision surgery. Meanwhile, medical professionals have cast doubt on the supposed hygienic and salutary benefits of the practice, causing the rate of circumcision to fall in America from 80% of newborn males in 1980 to fewer than 60% today (circumcision is only practiced rarely among gentiles in Continental Europe and Asia), although recent data suggesting that circumcision reduces the threat of contracting HIV may reverse that trend. Finally, Jewish ritual circumcision has even become the center of a small controversy in New York City, with Mayor Michael Bloomberg publicly urging Orthodox Jews to change the way they carry out the rite after a single mohel allegedly spread herpes to three babies he had circumcised. "Marked in Your Flesh," the new book by Leonard Glick, professor emeritus of anthropology at Hampshire College, does not add considerably to the substantive debate; it is at times insightful, and other times intensely biased. Yet a book published by Oxford University Press, by a noted Jewish anthropologist, has at least one unambiguous effect: It raises the stakes of the conversation. The anti-circumcision crowd is not just on the Internet anymore. To those who take brit milah â€” the covenant of circumcision â€” for granted, the contemporary debate around the practice may come as a surprise. Isn't this one of the foundations of the Jewish religion? And what's all the fuss about "a little off the top," as one of the multitude of circumcision jokes puts it? Well, for starters, there's the nature of the act itself. Glick is not the first to narrate the gruesome details of circumcision â€” but that doesn't stop him from piling on plenty of stretching, cutting and bloodletting detail. The first page alone includes phrases such as "piercing scream," "his foreskin pinched and crushed," "tugging, whimpering, and then crying helplessly." Few of the remaining 359 pages are any different. At least we know what we're in for: The book lets us know that it will be a polemic, and an NC-17 one at that. Still, the details of circumcision really are unsettling. It's no mere "snip, snip," as I was taught back at summer camp; as every new parent knows, it's a brutal, bloody operation that, neonatal science now tells us, is fully experienced by the newborn infant. It's trauma, it's mutilation and it's done without consent. Of course, it also may be commanded by God. What Glick tries to show in "Marked in Your Flesh" is that all the original reasons for circumcision are dubious. Religiously, he argues that Jewish circumcision "was instituted by priests as a religious practice in the 5th century BCE" as "the rite of initiation into their male-centered society." And medically, he convincingly shows how the original 19th-century introduction of circumcision â€” after centuries of contempt for the practice in Christian literature â€” was tied to outmoded concerns about fecundity and sexual expression, and how so many successive medical rationales have been adopted and discarded, in so curious and cavalier a way, one wonders about the real purpose of the practice. From controlling masturbation to healing paralysis, reducing the threat of syphilis to curbing AIDS, doctors have proposed dozens of benefits of circumcision â€” none of them scientifically proven. The trouble with Glick's book is that its author is so blinded by his own particular bias â€” a rationalistic, ethically oriented ideology reminiscent of the early Reform movement â€” that he simply dismisses the primal, nonrational and ultimately emotional reasons that many people today cling to religiously motivated circumcision. At the outset, Glick's reading of the biblical text is really more a midrash than biblical criticism; it is good speculation, but only that. Yet he takes it as fact that "P," the priestly writer of parts of the Torah, inserted the requirements for circumcision as a way of solidifying the priests' hold on ancient Israelite religion. Maybe, but that kind of argument can be applied to all sorts of practices that nonetheless became cornerstones of traditional Jewish religion, from the incest taboo to the dietary laws. Even if Glick's analysis is correct, however, his normative program requires an overly narrow view of what religion is and does. Of course circumcision is a "barbaric" ritual â€” if by "barbaric" we mean rooted in instinct and emotion â€” but since when is religion only about that which is civilized? Glick writes that "deepest significance of circumcision resides not in abstract spiritual realms but in the basic facts of social life: sexuality and masculinity, power and weakness, dominance and submission." This is a false dichotomy. True spiritual realms are never "abstract." They are, historically, exactly about the basic facts, fears and energies of human life. For better or for worse, altering the flesh of male babies' penises goes to the deepest heart of those primal fears. As an anthropologist, Glick offers insightful readings of how circumcision might have functioned in different Jewish cultures. Yet as a psychologist of religion, his analysis is impoverished. Glick offers an excellent analysis of Paul's critique of circumcision â€” it's all about the flesh, not about the spirit â€” but ironically, he repeats the same critique in his book. He seems unable to accept, despite capable readings of Lawrence Hoffman, Sander Gilman and Harold Eilberg-Schwartz, that ancient Jewish religion was about the body, not just the "soul." Notably, Glick finds himself agreeing with Martin Luther's notorious pamphlet, "On the Jews and Their Lies," which, he says, "includes a telling critique of ritual circumcision." Yes, circumcision is about the body, and it is particularistic, and patriarchal. So is much of Judaism. Occasionally, Glick's bias even leads him to historical error or lapses in reasoning â€” not to mention extreme rhetoric that is surprising to find in a book published by Oxford. For example, Glick claims that no Orthodox Jews "care much about secular rationales for circumcision.... Mystical and numerological interpretations fully satisfy their desire for explanation." Really â€” Orthodox Jews are satisfied with numerology? Glick also labels as "Orthodox" the opponents of early Reform, who did not identify in that way and who were not identified that way until decades later â€” and only then, in a derogatory fashion, by the Reformers themselves. The oddest parts of the book are toward the end, where Glick launches a combined survey of, and rant against, present-day Jewish discourse on circumcision. Glick seems outraged that contemporary Jews maintain the practice for such reasons as Jewish community, spiritual practice or Jewish continuity, since those reasons are very different from the priestly interests that Glick theorizes are behind the Torah's injunctions. Yet Judaism is all about new reasons for old practices, as Glick surely knows. Why, then, the harsh derogation of Daniel Gordis, Jon Levenson, David Zaslow and other figures who seek contemporary meaning in this ancient rite? Simply because they do not agree with Glick's reckoning of the practice's costs and benefits? Glick is no more objective when it comes to the medical evidence. Certainly, anyone who believes circumcision is harmless should read this book. Its grisly details will make most readers cringe, and the evidence of the damage done by circumcision is sound. Yet few today really claim there is no harm done; the claim is that the harm is justified by various benefits. Reading through Glick's analysis of these medical claims is intensely frustrating. Certainly, he is right that the original rationales for circumcision lie in the same neurotic literature that taught us that masturbation makes one go blind, and that oral sex leads to perdition. Glick is also quite right to observe that European males, most of whom are uncircumcised, seem to lead quite healthy sexual lives â€” and that circumcision undoubtedly causes a reduction in sensitivity. Yet Glick never quite refutes the statistical evidence that circumcision reduces the threat of certain kinds of cancer and venereal diseases; the best I could tell, from both his book and other sources, is that the jury is still out on the subject. What's more, new data corroborates the claims that circumcision reduces the risk of contracting HIV, the virus that causes AIDS. In a study whose results were released this summer (after "Marked in Your Flesh" went to press), of 3,000 South African men, those who were circumcised were 70% less likely to contract HIV from infected women than uncircumcised men. This is serious, sound evidence, and, to be fair, it was unavailable to Glick. Still, the book acts as though the impure motives of circumcision's original advocates contaminate the practice today. The most controversial part of the book is where Glick claims that Jewish doctors, and some doctors who are Christian, were swayed by their religious opinions to color the evidence in favor of circumcision. As Glick admits, he has not a shred of evidence to support this claim, other than the curious fact that, even as one rationale after another fell into discredit, the same doctors kept finding new ones. Yet the advocates of circumcision are both Jew and gentile, and so are its foes: For every Jewish doctor praising the practice, there is another one opposing it. Once again, Glick's own bias colors his analysis. Convinced that there is no rational basis for this practice, he imputes religious bias onto those who believe that there is. Even with these flaws, though, "Marked in Your Flesh" is a fascinating read. Glick has unearthed little-known Reform movement documents from the 19th century, proposing to alter or abolish circumcision â€” and similarly interesting documents, from the same movement, defending it. Equally absorbing are the 19th-century Christian documents praising Moses as a "brilliant sanitarian," and finding in the Jewish religious law â€” which, like the Jewish dietary laws, had nothing to say about health or hygiene in the Biblical sources â€” a proto-scientific worldview. Perhaps most importantly, "Marked in Your Flesh" brings together the scientific consensus that, despite the claims of some, circumcision does diminish sexual pleasure. The foreskin is itself full of sensitive nerve endings, which never can be replaced. The movement of the foreskin generates naturally lubricated sexual pleasure. And without the foreskin's protection, the glans of the penis is chafed and toughened, reducing sensitivity still more. Maimonides, as well the kabbalists and many other Jewish figures, recognized this effect of circumcision and praised it for curbing sexual desire. So did the initial proponents of medical circumcision in Britain and America. We may debate the benefits for many years to come, but at least one cost is clear: Circumcision diminishes pleasure. As these facts about circumcision become known, the practice may well become a source of controversy within the Jewish community. Every day, Jewish boys are having their sexual organs damaged without their consent â€” and even without the knowing consent of their parents, who, if they knew the costs, might well agree with Glick that the spiritual and possible health benefits do not justify them. For generations, circumcision has been seen as making a male body Jewish â€” and it has been the body, not the mind or the "soul," that is the site of holiness. But one wonders if the current wave of anti-circumcision backlash, formerly the domain of marginal eccentrics but now the purview of Oxford University Press, might cause the practice to diminish in importance. On the other hand, maybe not. Philip Roth, in a letter quoted toward the end of "Marked in Your Flesh," makes a point that Glick himself seems to miss, and that says much about the perverse appeal of a practice that is so violent, painful and irreversible. It's hard to understand, Roth writes, "how serious this circumcision business is to Jews. I am still hypnotized by uncircumcised men when I see them at my swimming pool locker room... I asked several of my equally secular Jewish male friends if they could have an uncircumcised son, and they all said no, sometimes without having to think about it and sometimes after the nice long pause that any rationalist takes before opting for the irrational." Jay Michaelson's next book is God in Your Body (Jewish Lights, 2006). He is the chief editor of Zeek: A Jewish Journal of Thought and Culture. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource An American obsession (2005) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> Colorado has become the 18th American state to drop medically unnecessary circumcision from the schedule of medical benefits under the Medicaid program. The decision comes as a result of a campaign by human rights and child protection advocates to protect baby boys from genital cutting, and in response to the budgetary crisis affecting so many American public authorities. When there is little enough funds available for necessary medical procedures, it makes little sense to waste valuable health dollars on unnecessary and harmful operations that the recipients do not want. Gillian Longley, a registered nurse in Louisville, looks at the change in Medicaid policy as a critical moment for public education surrounding the issue. She said that until recently, new parents were remarkably ill-informed of the pros and cons of circumcision. “Doctors were not giving them the information they needed to make a decision,” she said. “The usual ethical requirements for informed consent were overlooked. Circumcision was a cultural habit that was accepted as normal.” Colorado lawmakers had to cut hundreds of millions from state spending to balance the budget this year. Halting Medicaid coverage for circumcision is increasingly common across the country and is a relatively easy choice because there is no medical justification for the procedure. “The medical reasons are not convincing either way,” said Dr. Susan Pharo, director of Medicaid and External Pediatric. Research has found a “tiny” benefit in terms of circumcision reducing the frequency of urinary tract infections in the first year of life, Pharo said, “but the numbers are so low it’s not significant.” Some research has found a slight decrease in the transmission of HIV and sexually transmitted diseases among circumcised men in sub-Saharan Africa, “but that’s not really applicable here,” Pharo said, “and the evidence is not strong either way.” The risks of the procedure include relatively rare incidence of complications such as bleeding and infection and, more commonly, “poor cosmetic effect,” said Dr. Sarah Pilarowski, pediatrician at Cherry Creek Pediatrics. “We do have a lot of baby boys going in later for revisions,” she said. The No. 1 risk is pain. “We try to minimize it,” Pilarowski said, but penile nerve blocks don’t always work and numbing creams “are not 100 percent.” In fact, the greatest risk of circumcision, experienced by all victims, is the loss of the foreskin, a normal body part that plays a significant role in sexual experience. As Gillian Longley comments, “This is a normal body part,” said Longley. “We are doing our sons a favor to support them to stay whole.” Pilarowski speculates that the changes in Medicaid policies will spark changes in private insurance coverage. “Everyone is looking to cut costs,” she said. “It’s very possible other insurance companies will follow suit.” Source: Diane Cameron, <a href="http://www.healthpolicysolutions.org/2011/06/21/unkindest-cut-medicaid-wont-cover-circumcision-in-colorado/">Unkindest cut: Medicaid won’t cover circumcision in Colorado</a>, Health Policy Solutions, 21 June 2011 <a href="http://www.circumstitions.com/%24%24%24.html" rel="noopener" target="_blank">Further information about Medicaid coverage of circumcision in the United States</a> </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Another U.S. state drops circumcision from its medical benefits schedule darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Not a surgical vaccine: There is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia.</h3> In October 2010 the Medical Journal of Australia published an opinion piece by David Cooper, Alex Wodak and Brian Morris, calling for a significant “boost” in the incidence of infant circumcision in Australia in order to combat heterosexually acquired HIV infection. The editorial attracted much media attention, and so much criticism that the journal (eventually)<a href="https://www.circinfo.org/MJA_Cooper_letters.html"> published eight letters in reply</a>. A much longer and detailed rebuttal of the editorial by medical historian Robert Darby and pediatrician Robert Van Howe has now been published in Australia’s leading journal of public health issues, the Australian and New Zealand Journal of Public Health. A summary of the article follows. ABSTRACT Objective: To conduct a critical review of recent proposals that widespread circumcision of male infants be introduced in Australia as a means of combating heterosexually transmitted HIV infection. Approach: These arguments are evaluated in terms of their logic, coherence and fidelity to the principles of evidence-based medicine; the extent to which they take account of the evidence for circumcision having a protective effect against HIV and the practicality of circumcision as an HIV control strategy; the extent of its applicability to the specifics of Australia’s HIV epidemic; the benefits, harms and risks of circumcision; and the associated human rights, bioethical and legal issues. Conclusion: Our conclusion is that such proposals ignore doubts about the robustness of the evidence from the African random-controlled trials as to the protective effect of circumcision and the practical value of circumcision as a means of HIV control; misrepresent the nature of Australia’s HIV epidemic and exaggerate the relevance of the African random controlled trials findings to it; underestimate the risks and harm of circumcision; and ignore questions of medical ethics and human rights. The notion of circumcision as a “surgical vaccine” is criticised as polemical and unscientific. Implications: Circumcision of infants or other minors has no place among HIV control measures in the Australian and New Zealand context; proposals such as these should be rejected. <h3>SUMMARY</h3> 1. A conservative position To reject infant circumcision is to follow the policy of Australian medical authorities, which have discouraged routine circumcision since 1971. It was the suggestion in the Med J Aust that was radical, and far out of step with the policies of relevant medical authorities: Royal Australasian College of Physicians, British Medical Association, Canada Pediatric Society, Royal Dutch Medical Association, American Academy of Pediatrics. The timing of the editorial suggests that it was intended to influence or criticise the circumcision policy statement about to be released by the task force set up in 2007 by the Paediatric and Child Health Division of the Royal Australasian College of Physicians. This policy stated clearly that the evidence of the African circumcision trials were not relevant in developed countries and that routine circumcision was not warranted in Australia or New Zealand. 2. Doubts about the African clinical trials themselves <ul> <li>only a small protective effect – somewhere between 38 and 66 per cent, and not the mythical 60 per cent reported everywhere;</li> <li>uncertainty about why: anatomy or behaviour? No convincing biological mechanism yet found that would explain greater vulnerability of uncircumcised men;</li> <li>high drop-out rate: in some of the trials more men dropped out than were infected with HIV;</li> <li>inconsistent with epidemiological evidence from population surveys, which show no consistent pattern in HIV infection between cut and uncut;</li> <li>we don’t know how much transmission is non-sexual, probably through non-sterile medical procedures;</li> <li>even advocates of circumcision solution insist that condoms must still be used: so what’s the point of getting circumcised, with all the cost, risks, and loss of both appearance and function necessarily entailed?</li> <li>evidence from African trials might justify a modest circumcision program in high prevalence countries with high female to male transmission, as one element of a broad range of preventive measures, but not the multi-billion dollar promotion of circumcision pretty much to the exclusion of other interventions. <a href="https://www.circinfo.org/Circumcision_HIV_doubts.html#lomb">Criticism of excessive focus on circumcision</a> by report published by German Development Bank; plus Bjorn Lomborg and other leading economists at Georgetown conference, that circumcision on this massive scale is not cost-effective and bad way to tackle the problem.</li> </ul> 3. Not relevant to nature of Australia’s HIV problem <ul> <li>The WHO recommendations apply to adult men in underdeveloped countries with high HIV prevalence and a high incidence of female to male transmission via unprotected intercourse. They do not apply to the developed world, and they do not apply to children anywhere.</li> <li>Africa: high prevalence; mostly heterosexual; female to male transmission;</li> <li>Australia: low prevalence; mostly homosexual, plus a few injecting drug users – these categories get no protection from circumcision;</li> <li>no evidence that hetero transmission is increasing: only 23 new cases in 2009;</li> <li>infection from prostitutes common in Africa, but in Australia there has never been a single example of a prostitute infecting a male client;</li> <li>Australia’s HIV prevention program (condoms and safe sex education) has worked very well, and we have one of the lowest rates of HIV infection in the developed world – much less than in USA.</li> </ul> 4. Suggestion departs from principles of evidence-based medicine. <ul> <li>Trials involved consenting, sexually active adult men and did not provide any evidence that circumcision in infancy would provide protection. The trials cannot therefore be cited to justify circumcision of infants.</li> <li>In any case, infants are not sexually active, not at risk, and cannot give consent.</li> </ul> 5. Suggestion ignores harm of circumcision and underestimates level of complications. <ul> <li>Circumcision is always harmful. The foreskin is a sensitive, functional body part that many men value highly; it cannot be dismissed as nothing more than a piece of surgical waste.</li> <li>Complications are under-reported, and we have no benchmarks for acceptable risk. The bar must be set higher in cases where the surgery is not immediately necessary, and even higher when it is not elected by the individual, but imposed on him by somebody else.</li> </ul> 6. Suggestion totally ignores medical ethics and human rights. <ul> <li>But all humans have an inherent right to bodily integrity that may be violated only with very good reason. Ethics should not be dismissed as an obstacle to the roll-out of circumcision programs: if we don’t have ethical principles we cannot regard ourselves as civilized, and we shall end up in a dog-eat-dog world, without values and without respect for individual rights.</li> </ul> 7. Circumcision is not a surgical vaccine. <ul> <li>The suggestion misrepresents both the nature of vaccines and the nature and level of protection given by circumcision. It is both exaggerated and mischievous in that it is likely to give a false sense of security and encourage high risk behaviour. Already there are reports from African countries of men saying that now they are circumcised they don’t need to use condoms.</li> </ul> 8. Conclusion It is generally accepted that the rapid spread of HIV in Africa was associated with a high level of sexual activity, involving numerous concurrent but often transient sexual partnerships, widespread prostitution, both formal and informal, various forms of polygamy, and reluctance to practise safe sex or use condoms. It is also probable that a significant proportion of HIV infections are the result of non-sexual transmission, such as non-sterile medical procedures. These conditions were aggravated by poorly developed health services, the co-presence of numerous other epidemic diseases, such as malaria, tuberculosis and other STIs, and the refusal of local authorities to take action until the disease had spread through the population, provoked by the misconception that AIDS was a “gay disease”, confined to decadent developed world. This crisis situation stands in dramatic contrast to that of a wealthy, developed nation such as Australia, where effective action was taken early on, based on respect for the autonomy and agency of those at greatest risk, and an emphasis on safe sex education, needle and syringe programs, and provision of condoms. This strategy has been strikingly successful: AIDS in Australia remains a relatively minor public health problem, largely confined to the sub-cultures where it has traditionally been found. There is no heterosexual epidemic that would justify a costly, authoritarian program of the type and scale that Cooper et al propose. There is every reason to think that the strategy that Australia has pursued so successfully since the 1980s will continue to protect the vast majority of the population from this disease. Source (full text available through link): Robert Darby and Robert Van Howe, Not a surgical vaccine: There is no case for boosting infant male circumcision to combat heterosexual transmission of HIV in Australia. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2011.00761.x/full">Australian and New Zealand Journal of Public Health, Vol. 35, October 2011</a>. Full text may be downloaded as PDF here: <a href="https://www.circinfo.org/documents/VaccineANZJPH.pdf">VaccineANZJPH</a><a href="https://www.circinfo.org/documents/VaccineANZJPH.pdf"></a> Figures on the incidence of HIV and other sexually transmitted infections in Australia are available from the Kirby Institute for Infection and Immunity in Society (formerly National Centre in HIV Epidemiology and Clinical Research), <a href="http://www.med.unsw.edu.au/NCHECRweb.nsf/page/Annual+Surveillance+Reports" rel="noopener" target="_blank">HIV/AIDS, Viral Hepatitis & Sexually Transmissible Infections in Australia, Annual Surveillance Reports</a> <h3>Argument confirmed by studies since paper written</h3> Results of African trials not replicated in other countries. 1. In the USA, study by Sansom showed that that the lifetime risk of HIV to Black men was 6.23% while 73% of Black men are circumcised, yet the lifetime risk to Hispanics was only 2.88% with a circumcision rate of only 42%. This suggests that there is no connection at all between circumcision and reduced susceptibility to HIV; or that circumcision increases the risk of HIV; or that being Black in the USA is a far greater risk factor for HIV than possessing a foreskin. (This last point may be related to the disproportionate number of Black men in American prisons, where unsafe sex is rampant.) Stephanie L. Sansom et al, <a href="http://www.plosone.org/article/comments/info%3Adoi/10.1371/journal.pone.0008723">Cost-Effectiveness of Newborn Circumcision in Reducing Lifetime HIV Risk among U.S. Males</a>, PLoS ONE 5(1): e8723. doi:10.1371/journal.pone.0008723. (<a href="https://www.circinfo.org/Foreskin_owner_decide.html">And see comment by Circinfo.org</a>) 2. <a href="https://www.circinfo.org/AIDSnews.html#heff">Study of HPV and HIV in Zambia</a> (Heffron et al) found that uncircumcised men had slightly lower incidence of HIV infection – but did not discuss this finding in their paper: Heffron R. et al, High prevalent and incident HIV-1 and herpes simplex virus 2 infection among male migrant and non-migrant sugar farm workers in Zambia. Sex Transm Infect 2011; 87: 283-8. 3. <a href="https://www.circinfo.org/Circumcision_HIV_doubts.html#kids">Study by Brewer in Mozambique</a> found that men circumcised as children had a higher incidence of HIV. Suggests that this is more evidence of non-sexual transmission: Brewer D.D. Scarification and Male Circumcision Associated with HIV Infection in Mozambican Children and Youth. WebmedCentral EPIDEMIOLOGY 2011;2(9):WMC002206 Excessive focus on circumcision criticised by economists Criticism of excessive focus on circumcision by report published by German Development Bank; plus Bjorn Lomborg and other leading economists at Georgetown conference, that circumcision on this massive scale is not cost-effective and bad way to tackle the problem. <a href="https://www.circinfo.org/Circumcision_HIV_doubts.html#lomb">See news report at Circinfo.org</a>. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource ANZ public health journal: No case for circumcision to combat HIV transmission in Australia darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> The terms of the debate about non-therapeutic circumcision of minors have changed. The issue is no longer whether the so-called “benefits” outweigh the risks, or even whether the benefits outweigh the risks and harms. (As for the troglodytes who still mutter about pros and cons …) Coming on top of the <a href="https://theconversation.com/tradition-vs-individual-rights-the-current-debate-on-circumcision-10199" rel="noopener" target="_blank">judgement of a German court</a> that circumcision is bodily harm and that it violates the child’s right to religious freedom, a leading legal philosopher now argues that boys have an inherent right not to be circumcised without medical need. In a paper forthcoming in Health Matrix, Stephen Munzer argues that current norms of autonomy and bodily integrity give male minors “a moral, anticipatory right-in-trust not to be circumcised without a medical indication.” Even more remarkably, it is now conceded by a prominent defender of religious/cultural circumcision that the practise is harmful and does violate the rights of the child. Writing in the Journal of Applied Philosophy, Joseph Mazor acknowledges the physical and moral harms of circumcision and admits that the child has “a right of moderate strength” not to be subjected to “presumably harmful circumcision”. Both Munzer and Mazor go on to argue that, given the importance of circumcision within the cultural/religious communities that follow this tradition, the practice should not be criminalised. This is a fair point, far less important than the vital concession that circumcision is harmful and does violate the rights of the child to bodily integrity, personal autonomy and <a href="https://www.circinfo.org/ethics.html#recent" rel="noopener" target="_blank">an open future</a>. If it is now admitted that NTC is harmful and does violate the rights of the child, there can be no justification for medical authorities recommending the practice or “routinely” performing it on demand, or even sitting awkwardly on the fence; or for government agencies to encourage it (e.g. through health insurance coverage etc); and there is a strong argument for appropriate agencies to take measures to discourage it by removing incentives and imposing disincentives – in the same way as government programs have sought to discourage harmful practices such as smoking tobacco, without actually making it illegal. However these details are resolved, the debate now is not about whether or not circumcision should be performed, but about the best and most effective means of <a href="http://euromind.global/en/brian-d-earp-and-rebecca-steinfeld/?lang=en" rel="noopener" target="_blank">discouraging the practice</a>. In the background is a further question: whether non-therapeutic circumcision of minors is or should be illegal. <h3>Boys have a “moral right” not to be circumcised</h3> A straw – or perhaps a haystack – in the wind is a recent paper by legal philosopher Stephen Munzer giving detailed consideration to the question of whether male minors have a moral right not to be circumcised without medical need, and concludes that they do. Male minors, he argues, have “a moral anticipatory right-in-trust not to be circumcised without a medical indication.” The basis for this position rests on four key factors: (1) the permanent loss of functional tissue; (2) the “salience” of the penis in physical, psychological and cultural terms; (3) the limits on parental rights to modify their children’s bodies; and (4) the principle of gender equity. Although Munzer does not endorse criminalisation (taking account of the importance of circumcision to the cultures that practise it as a religious or cultural rite) he reaches the firm conclusion that it is morally wrong and that boys have the same right to genital integrity as currently enjoyed by girls. And if they do have such a right, society must eventually acknowledge its obligation to take action to translate that principle into practical reality. Abstract This Article argues that male minors have a moral anticipatory right-in-trust not to be circumcised without a medical indication. Based on norms of autonomy and bodily integrity, this Article’s treatment of children’s rights, parental rights, religious freedom, and tolerance offers arguments accessible to readers of many ethical, political, and intellectual persuasions. Three direct arguments rest on (1) the loss of non-renewable functional tissue, (2) genital salience, and (3) limits on a parental right to permanently modify their sons’ bodies. This Article also compares circumcision to a rare form of female genital cutting; the comparison contains the seed of an argument sounding in (4) gender equality. In current circumstances, however, it is unwarranted to treat nontherapeutic circumcision as a crime or subject it to burdens under tort, family, or administrative law. Stephen Munzer. Examining nontherapeutic circumcision. Health Matrix 28 (1) 2018: 1-77 (in press). <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3180209" rel="noopener" target="_blank">Full text at SSRN</a>. <h3>Mazor’s qualified defence of religiously motivated circumcision</h3> Abstract This article considers the question of how much weight the infringement of children's right to bodily integrity should be given compared with competing considerations. It utilises the example of circumcision to explore this question, taking as given this practice's opponents’ view of circumcision’s harmfulness. The article argues that the child’s claim against being subjected to (presumably harmful) circumcision is neither a mere interest nor a right so strong that it trumps all competing interests. Instead, it is a right of moderate strength. Indeed, even the aggregate strength of children’s rights against the practice of (presumably harmful) circumcision as a whole is not so weighty so as to always trump competing interests. The harms are not sufficiently serious to justify such a status. And the expressive wrongs associated with non‐negligently benevolent harming are much less serious than those associated with intentional harming. The debate over banning circumcision thus cannot be conducted only in terms of competing rights. Competing interests, such as those that would be set back by the departure of religious citizens, should be considered as well and might plausibly justify allowing even a rights-infringing practice to continue. Joseph Mazor. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/japp.12275" rel="noopener" target="_blank">On the Strength of Children’s Right to Bodily Integrity: The Case of Circumcision</a>. Journal of Applied Philosophy, on-line first, 24 May 2018. There will be continuing argument over how harmful these harms are; but once the reality of harm is conceded, there can be no going back to tired old clichés such as pros and cons or benefits and risks. It may be while before troglodytes such as the American Academy of Pediatrics catch up (let alone Prof Morris), but once it is agreed (as Mazor concedes and Munzer argues) that NTC of minors is morally wrong, it places pressure on government, the medical profession, regulatory agencies, bioethical watchdogs etc to take some sort of action to discourage it, and certainly to ensure that nothing is done to promote it. We are really entering new territory. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource As human rights advance circumcision advocates have nowhere left to hide darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> Excessive removal of skin and mucosa is one of the most common results of neonatal circumcision, yet the true frequency of this injury and its adverse effects on physical and psychological development have never been adequately documented. In this account, Shane Peterson tells his own story of the lifelong trauma he has suffered as a result of the "routine neonatal circumcision" to which he was subjected soon after birth â€“ an operation in which nearly all the skin of the penis shaft was removed in addition to the skin and mucosa of the foreskin. The horrific results and damaging long term sequelae of this iatrogenic injury distorted Shane's physical and psychological development, his sexuality, his perceived place in society, and his career. Doctors and psychiatrists were unsympathetic when he complained of pain and disfigurement. Reconstructive surgery to resolve the physical injury yielded such disappointing results that he attempted suicide. Eventually, Shane was able to achieve partial resolution of the psychological trauma through a combination of ongoing counselling, successful litigation against the operator, and an active commitment to public education about the detrimental effects of circumcision. <h2>Shane Peterson's story</h2> The following account was written in 2000, when the author was 27 years old and studying for a PhD at the Australian National University. <h3>Introduction</h3> I am a 27-year-old postgraduate student (doing PhD) who was badly injured by a routine neonatal circumcision performed within days of my birth. For the last nine years, I have struggled to cope with this injury and to seek legal redress for my suffering, while at the same time I have successfully pursued a career in medical science. I recently achieved a precedent-setting legal victory in Australia with an admission of liability and AU $360,000 in damages for my injury. I view routine circumcision as an act of assault and a breach of human rights, and I am dedicated to the eradication of this unnecessary and potentially disastrous procedure. <h3>Overview</h3> This article is an account of my experience of the possible, and largely unpublicized, complications that can arise from routine neonatal circumcision. Circumcision and other forms of male and female genital mutilation originated in primitive societies and have been practiced for several thousand years. Despite this long tradition of mutilation, the resulting complications, injuries and deaths have been consistently unreported. Ironically, many contemporary advocates of male circumcision claim that the historic development of this practice in primitive societies is evidence that male circumcision is beneficial to health. For example, circumcision advocates Szabo and Short [1] claim that male circumcision is depicted in a controversial relief from the Old Kingdom tomb of Ankhmahor at Saqqara, Egypt. This relief may be one of the oldest records of male genital mutilation in the ancient world, and dates from around 2400 BC. [2-3] A number of trained Egyptologists, however, doubt this claim. A number of alternative interpretations have been offered by experts in the field. Some Egyptologists argue that this is a scene of a ritual shaving, [4]while others suggest that it might be a scene of emergency dorsal slit surgery to relieve a case of paraphimosis. [5] Even if genital mutilation is depicted in this relief, controversy exists over the similarity of this practice to circumcision, and its cultural significance to the Ancient Egyptians. [6] Regardless of the type of genital mutilation depicted in the Ankhmahor tomb relief, it is apparent that one man has been forcibly restrained. This can be interpreted as involuntary genital mutilation. The relief provides evidence that, since ancient times, it has been normal for individuals to be very unhappy and distressed when forcibly subjected to an act of mutilation. All forms and degrees of genital alteration, including circumcision, have always been a phenomenon that should be a matter of personal choice. <h3>Major life events</h3> I was born and circumcised in Western Australia in 1973, but was unaware of any genital abnormality as a young child. Because I was circumcised as an infant and not informed of this fact, I was not aware that my body had undergone any surgery. I had no reason to suspect that I had a penile problem until puberty. At the age of 18, in 1992, I underwent reconstructive surgery. The outcome of this surgery was exceedingly disappointing, and I attempted suicide six months later. In 1993, six months after the suicide attempt, I underwent further surgery. Between 1993 and 1997, I concentrated on pursuing my academic career and resolving the emotional and ethical issues associated with my injury. I first sought legal advice in 1994, then commenced a legal claim for medical negligence with a Writ of Summons issued in October of 1997. This claim was finalized in 1999 with an admission of liability and payment of damages. I have since had several interviews with the media and am now dedicated to promoting public awareness of the detrimental affects of routine circumcision. <h3>Birth and circumcision</h3> My early childhood was happy. I had many interests, most especially in science. I was unaware of any complications with my circumcision. The circumcision scar was at the extremity of the penis, just below the corona glandis. Having no conception of what my penis looked like prior to circumcision, I was completely unaware that the family doctor who circumcised me had removed not only the foreskin but also most of the penile shaft skin. He then pulled up the scrotal skin and stitched it just under the corona. As an infant and young child, the excessive removal of skin was less obvious because of the lack of pubic hair. There were two reasons why my parents decided to have me circumcised. First, my father had been circumcised shortly after birth, and was unaware he had lost tissue of any value. Second, my father's younger brother was spared circumcised as an infant but was subsequently circumcised at the age of eight, allegedly due to painful adhesions, bleeding, and repeated infections. My father remembered how traumatic this experience was, and my parents wanted to spare me from suffering similar problems. From information provided later by my grandmother, it appears likely that my uncle's "problems" were actually the result of repeated, forcible premature retraction of the foreskin for cleaning during infancy. My mother had concerns about circumcision. She was a young mother of 17 years and knew nothing about how circumcision was performed, what risks were involved, and what the expected result should be. When family members suggested that she should have her unborn child circumcised if it was a boy, she sought advice from her family doctor during a prenatal check up. She was advised not to worry: "Just one little snip and it would all be over." The doctor assured her there were no risks and that it was such a simple procedure that Jewish mohels, with no medical qualifications, could perform circumcisions. Consequently, I was circumcised by this family doctor. My parents did not notice that anything was amiss during my early childhood. My mother does recall the penile skin appearing very tight during erections when I was a baby. She thought little of this, as my father's penile skin was similar. <h3>Adolescent years (1986-1990)</h3> With the onset of puberty between the ages of 12 and 13, I became aware of pubic hair growth and penile erections. These erections were very tight and painful, with the hair-bearing scrotal skin pulled up onto the penile shaft. With the onset of this pain, I suspected that my penis might be abnormal. There was, and still is, however, a lack of available, accurate information about the normal anatomy and function of the penis. Instructors for the sex education classes at school advised that it was normal for adolescents to feel concerned that the changes taking place in their bodies during puberty might not be normal. We were taught that these doubts are a normal part of growing up and there was no need for concern. Although I took this advice and tried not to worry, I still suspected that I had been born deformed. The severity of the problems increased as I progressed through my teenage years at high school. As the penis grew, the skin became tighter and more painful, and the bending of the penis to the left became more apparent. This physical deformity had a major impact on my confidence and self esteem. I was reluctant to use public change rooms after physical recreation classes and tried to avoid sporting activities. I became very shy, self-conscious, and found it difficult to interact spontaneously with other teenagers my age. Because of these difficulties, I withdrew socially and made less of an effort to make friends. Because I often appeared quiet and shy, I was susceptible to victimization. I was bullied and bashed on a regular basis. Because I did not make my interest in the opposite sex obvious in a chauvinist manner, I was, occasionally, labelled as 'gay.' This experience indicates to me that I live in a prudish society that is unable to deal competently with sexual issues. <h3>Young adult years</h3> In 1991, at the age of 17, I was relieved to escape the bullying environment of high school and commence university studies. At that time, I believed I could achieve my life ambitions by succeeding at university. Unfortunately, by this time, the severity of the erectile deformity, tightness, and pain had increased to the extent that I could no longer achieve a full erection. As a university student, I was exposed to relationship and sexual issues. Although I met people I felt attracted too, I was unable to deal with these issues because of my belief that I had been born deformed and would be rejected. At this time, I was still unaware that my deformity was due to a circumcision injury. I felt very ashamed of my deformity and was unable to seek help. This situation led to anxiety and depression, and I failed courses at university. The depression and anxiety, combined with the lack of success at university, eventually overwhelmed me. I did not know what do and regularly contemplated suicide. Although I had previously been sexually attracted to the opposite sex, at this point in my life I began to consider alternative options. During my second year at university, in 1992, I reached a crisis point. I felt compelled to confide in someone, so I told my mother. My mother was shocked and immediately suspected the deformity could be related to my circumcision. This was the first occasion that either one of my parents had ever mentioned that I had been circumcised. I made an appointment with my family doctor on 11 April 1992. This appointment was not with the doctor who had delivered and circumcised me. I had seen my family doctor regularly from the age of six months. During the examination, the physician took one look at my penis and said that whoever circumcised me had not known what he was doing. The doctor informed me that I had suffered an aggressive circumcision, and that far too much skin had been amputated. He then referred me to a urological surgeon, whom I saw on 23 April. The urological surgeon examined me more closely, but appeared reluctant to admit that my penis had been damaged. He commented that if anything was wrong, it was not obvious. After I insisted that a problem definitely existed, the urologist conceded that any potential problems would be more apparent upon an artificial erection. When I asked if the problem could be repaired, the urologist informed me that the tissue removed by the circumcision could never be replaced. I was told that I might just have to put up with the situation. This scenario was intolerable to me, so the urologist referred me to a plastic and reconstructive surgeon. I was examined by the plastic surgeon on 7 May 1992. This surgeon specialized in the treatment of severe burn victims, especially small children. Upon examination, the plastic surgeon advised that my injury would be very difficult to treat, but she believed that she might be able to improve my situation. <h3>My reaction</h3> It was difficult for me to cope with the above events, all of which took place within the space of only one month during the first university semester of 1992. I was shocked and angered to learn that I had not been born deformed, but was injured because my body had been interfered with by another person. I hated the family doctor who circumcised me, and I hated my parents for allowing it to be done. I began to feel disgust towards Australian society, which has historically maintained that routine neonatal circumcision is a beneficial practice. I also resented members of my extended family who were reluctant to believe that I was seriously injured by a simple procedure that, in their minds, removed only "the useless piece of skin on the end of a man's dick." <h3>Research findings</h3> As a university student, I was trained in research skills and had access to medical libraries. I began to research the topic of circumcision intensively in order to explore possible treatment options. The results of my research were dismaying. I was angered to find that my circumcision had been completely unnecessary from a medical standpoint. [7] I was horrified to find that, in addition to excessive skin removal, circumcision results in a range of injuries referred to as "complications." [8-11] I suspect that this sort of ruse serves to dissociate the blame of the injuries from the surgery that caused them. Such injuries include: 1. Haemorrhage [12] 2. Urinary retention [13] 3. Meatitis, meatal ulcer and meatal stenosis [14] 4. Adhesions or skin bridges [15-16] 5. Infection: including gangrene, [17] septicemia and meningitis [18] 6. Chordee [19] 7. Cysts [20] 8. Urethral injury and fistula [21-23] 9. Hypospadias and epispadias [24-25] 10. Impotence [26-27] 11. Psycho-social issues, such as schizophrenia [28-29] 12. Amputation or necrosis of the glans [30-32] 13. Total necrosis, ablation or amputation of the penis [33-35] 14. Death [36-37] I was stunned to learn that in cases of penile amputation during routine neonatal circumcision, infants have been surgically reassigned to the female gender. [38-40] There are many ways by which an unnecessary routine circumcision can destroy a man's life, and not all of them are listed as complications. Many of the most frequent complications, as in my case, are seldom listed as such. All complications, both major and minor, can exert a negative impact on the quality of a man's life. This is especially true when circumcision is imposed on an individual without his permission, as is always the case with routine neonatal circumcision. I also learned from my research that the quantity of skin removed during neonatal circumcision is highly variable between patients. [41] It is evident that excessive skin removal is one of the most common injuries. [42] Indeed, one contemporary urological textbook includes a subheading under circumcision: <div> Disasters: Too much skin removedâ€¨ Take the excised foreskin (pick it up off the floor, if necessary!) and stitch it back in place. Often, it will take as a free graft. If it does not, graft the penis with skin taken from a hairless area. [43] </div> If a victim's skin is not picked up off the floor and reattached, a far less satisfactory option is reconstructive surgery involving skin grafts to the penis in an attempt to replace the excess removed during circumcision. I also learned that the penile skin, mucosa, and nerves that are removed by circumcision can never be replaced, [44] and skin-graft recipients can be very dissatisfied with the results of such surgery. Grafted skin is not a satisfactory surrogate for the penile skin and mucosa and lacks the necessary innervation, elasticity, and suppleness. It is interesting that the highly unique characteristics of preputial tissue make it an excellent candidate for grafting to repair dermal trauma of other areas of the body, such as severe lacerations or burn injuries. [45] <h3>Life options</h3> My options in early 1992 were to endure my circumcision injury for the rest of my life, commit suicide, or try surgery. By this time, I had seriously considered suicide for more than a year. Rather than enduring the circumcision injury for the rest of my life, suicide represented an attractive option, as it would free me from my physical pain and psychological trauma. First, however, I chose reconstructive surgery as the only available option before the final resort of suicide. While reviewing the medical literature, I was interested in function more than cosmetics, and took an evidence-based approach. If a sex-change operation would yield the most functional end result, I might even have pursued that option. After assessing the medical literature, however, I was satisfied that penile reconstruction with skin grafts was more likely to achieve a functional result than a gender reassignment. The option of non-surgical skin stretching requires special consideration. Although it is likely that I lacked sufficient remaining skin to stretch, I am disappointed that I was not made aware of this alternative in 1992. Unfortunately, non-surgical options were not presented in the literature that I surveyed nor offered by my surgeons. I have observed that medical practitioners are generally immersed in a surgical paradigm and often fail to advise patients of less invasive alternatives to surgery. Surgery is one of the most invasive and high-risk forms of medical intervention. As such, surgery should always be the absolute last resort for the treatment of a condition, to be employed only after all other less invasive options have failed. <h3>Reconstructive surgery</h3> I underwent reconstructive surgery on 30 June 1992. A full-thickness skin autograft of 12 cm by 14 cm was harvested from my left thigh for grafting to the penis. The thigh was the only prospective donor site that was large enough to supply a graft of the appropriate dimensions. A split-thickness graft was then harvested from my right thigh and applied to cover the exposed subcutaneous tissue at the left thigh donor site. Overall, the reconstructive procedure resulted in two large wounds to my thighs. A full-thickness skin graft is composed of the full thickness of skin (dermis and epidermis), with the dermal surface of the graft trimmed of the underlying fat or subcutaneous tissues. [46] A split-thickness graft contains only the epidermis and a portion of the dermis. Although a split-thickness skin graft involves less trauma to the donor site, these grafts tend to be brittle and often contract when placed on unsupported tissue. My surgeons grafted a full-thickness of skin to the penis out of concern that a split-thickness graft might contract and erectile function would again be restricted. <h3>Description of penis before reconstruction</h3> Prior to reconstruction, the circumcision scar was very prominent and had migrated towards the base of the penis, due to the tethering and tension. The remnant inner preputial mucosa was stretched and distorted, with pitting and scarring evident. The shape of the glans was also distorted by the tension. The circumcision scar was highly irregular, as excision of the preputial tissue was asymmetrical, with more skin removed from the left side of the penis, than the right side. This created tethering and deviation of the penis towards the left upon erection. During erection, due to the extreme skin deficit and tension, the scrotal skin migrated more than two thirds of the distance along the penile shaft towards the glans. A damaged remnant of the frenulum remained, which was particularly sensitive. As occurs in all circumcisions, the normally moist glans mucosa underwent keratinization and has been covered by a dry layer of dead epithelium. This represents a further reduction in sexual sensitivity of the penis, in addition to that caused by excision of the preputial mucosa and erogenous nerve endings. <h3>Operative procedure</h3> An artificial erection was produced by placement of a tourniquet around the base of the penis and injection of normal saline solution into the left corpus cavernosum. The chordee (deviation) of the penis to the left was made quite evident through this procedure. Next, an incision was made along the circumcision scar. Upon release of the tension, the hair-bearing scrotal skin retreated to the base of the penis. The underlying connective tissue (Buck's fascia) was completely exposed, illustrating the severe skin deficit due to the removal of almost all the shaft skin by the neonatal circumcision. Another critical observation made at this stage of the operation was the complete absence of the dartos fascia. This abnormal situation, caused by the original circumcision, was not detected until this stage of the surgery. The dartos fascia is a delicate layer of areolar tissue that assists with the mobility of preputial tissue over the penis. [47] It should not be completely removed during circumcision, and its removal in my case resulted in painful adhesions between the remnant preputial mucosa and underlying Buck's fascia. These adhesions caused further tethering of the penis. In conjunction with the excessive and asymmetrical excision of preputial tissue, the absence of the dartos fascia and resultant adhesions would have rendered non-surgical techniques of skin stretching ineffective. The remnant preputial mucosa was subsequently excised due to adhesions to the Buck's fascia. With excision and the release of tension, the preputial mucosa contracted to one fifth of its pre-operative size. Post-operatively, I discovered that removal of this mucosa had resulted in a dramatic loss of sexual sensitivity. I could not have appreciated the significance of this loss had I not experienced it myself. This loss is made all the more significant when combined with the sensitivity lost as a result of the large amount of preputial tissue removed during the original circumcision. Therefore, having experienced a "second circumcision", I can attest from experience that circumcision dramatically reduces sexual sensation. The full thickness skin graft from the left thigh was placed around the penis. The skin graft was attached to the penis with Histoacryl tissue adhesive (Braun) with the suture line along the underside of penis in the position of the raphe. Surgery concluded with the application of a compression bandage to secure the skin graft to the penis and facilitate the establishment of a blood supply. The thigh donor sites were also bandaged. Postoperative pain was acute, and pethidine injections were given at the base of the penis at two or three hourly intervals for one week. Similar pain was also experienced in the donor sites. <h3>Short-term results</h3> The end result of the surgery was more aesthetically pleasing than the appearance when the bandages were removed, one week post-operatively. A large amount of swelling was evident, and I was surprised that any part of my body could swell to such a large size. The skin graft had an unpleasant consistency of thick, dried leather. With the topical application of vitamin E oil twice daily, the graft gradually became more supple over a period of several weeks, and the swelling subsided. Unfortunately, as the suppleness and elasticity of the graft increased, the graft contracted as it does not express the genes and hormones that instruct natural penile skin to remain loose. A series of ridges formed, which later developed into red hypertrophic scarring. The graft also developed hair due to follicles inadvertently transplanted with the graft from the thigh. The donor site wounds were very similar to burn injuries, and were treated as such. DuoDERM E, a semi-permeable polyurethane wound dressing, was worn for several weeks post-operatively to facilitate re-epithelialization and reduce pain. [48] After wound closure was complete, the thigh donor sites also developed prominent red hypertrophic scarring during the healing process over subsequent weeks. To reduce the hypertrophic scarring of the penile graft and thigh donor sites, I was advised by the surgeon to massage twice daily with vitamin E oil, and wear compression bandages on the donor sites as much as possible. Although very inconvenient and uncomfortable, I disciplined myself to massage with vitamin E oil and wear the compression bandages as directed. Although not directed to do so, I also wore condoms to compress and assist in scar reduction of the penile skin graft. Compression bandages and condoms were worn for over two years postoperatively. <h3>Electrolysis</h3> In June 1993, electrolysis was performed to destroy the hair follicles transferred with the graft from the thigh to the penis. A steroid injection was also given to assist in scar reduction for the penile skin graft. Unfortunately, the outcome of electrolysis was horrific, with extreme swelling and pain. Due to the fragility of the penile skin graft, necrosis and atrophy of tissue occurred in a radius of several millimeters around each electrolyzed hair follicle. Although these wounds have healed, dark scars and pitting remain. <h3>Long-term results</h3> The penile skin graft reduced tethering and enabled fuller erections. Upon erection, the penis became longer and the deviation to the left less severe. The remaining deviation is due to the restricted growth of the left corpus cavernosum - a permanent result of the tethering during puberty. This deformity demonstrates that penile growth and development are severely restricted when the penis is denuded by circumcision. The prominent scarring of the thigh donor sites is an unpleasant outcome of the surgery, as the damage caused by the neonatal circumcision has disfigured other areas of my body. These bright red scars were prominent while I was naked in change rooms or wearing shorts in summer. The scars have attracted attention and caused embarrassment on a number of occasions, including in the workplace. The prominent redness of the donor sites faded after approximately three years, and the raised edges of the scars were reduced by the bandages and vitamin E massage oil. The graft sites, however, are now conspicuously pale, with ridging of the skin and an absence of hair. They still attract unwelcome curiosity. Despite the application of vitamin E oil and compression with condoms, the reduction of the scarring on the penis has been much less successful than for the donor sites. Pain persisted in the graft and donor sites for many years after the surgery, but the intensity and frequency subsided with time. I now experience aches and pains only occasionally. However, since the surgery I have also experienced unpleasant or altered sensations, such as itching or tingling, and numbness. These still persist. Apart from this sensory disturbance in the underlying tissue, I have no sensation in the penile skin graft and also large areas of the donor sites. Due to the absence of the dartos fascia, the graft has adhered to the underlying buck's fascia and is not mobile like natural penile skin. The graft has also contracted and is approximately six to eight times thicker than normal penile skin. <h3>Suicide attempt</h3> There was no way that I could have been psychologically prepared for the highly invasive and extreme nature of the reconstructive surgery, and the resulting pain, trauma, and embarrassment. Members of my extended family were still reluctant to believe that I had been injured, as were a number of psychiatrists whom I consulted. A number of these professionals appeared to be biased in favour of circumcision due to their medical training, and told me that my problems were "all in my head." They advised that I should "just get over" my perceived problems and get on with my life. I felt alone and isolated. I also began to view my injury as a result of assault, and I felt that I had been mutilated. These feelings first emerged before the reconstructive surgery, and increased in intensity with the trauma of surgery. Six months after the surgery, I attempted suicide on 7 January 1993. I had concluded that the impact of the circumcision injury on my life was insoluble. With the exception of my parents and close friends, few people were willing to acknowledge the severity of my injury and trauma, and even fewer people wanted to help. I felt as though I was living in a society where circumcision was still beyond criticism and few people were willing to accept the reality that routine circumcision is a harmful and destructive practice. I could not allow myself to be a hypocrite and live silently in a society where unnecessary circumcision was still condoned and practiced. <h3>Legal action</h3> After surviving a suicide attempt, I experienced a fuller appreciation that the cause of my horrendous experiences is unethical and completely unacceptable. I realized that I could not live with myself if I did nothing to prevent the practice of unnecessary circumcision and spare others from enduring what I had suffered. I decided that I was unwilling to remain yet another victim whose silence was taken by society as an affirmation that circumcision is harmless. For several subsequent years, I concentrated on my university studies and tried to resolve the psychological trauma. This was most difficult. Overall, my Bachelor degree was delayed by four years due to the reconstructive surgery and associated trauma. During this time, I also considered the possibility of taking legal action to gain recognition of my injury and provide proof to Australian society that male circumcision is a highly destructive practice. I first sought legal advice from Dwyer Durack in 1994, but felt overwhelmed by the potential emotional trauma and financial expense of my case. Consequently, I did not proceed with an action at that time. In October of 1997, I was finally approaching the final examinations for my degree. Unfortunately, I was also approaching my 24th birthday. This birthday represented the expiry date for the Statute of Limitations for issue of a Writ of Summons against the doctor who circumcised me. I was not psychologically prepared to commence legal action in 1997, but I was determined not to miss any potential opportunity for justice with expiry of the Statute of Limitations. A writ was issued against Dr. Michael Morley in October 1997, based on the failure of Morley to fulfil his duty of care. The Statement of Claim included loss of quality of life, pain and suffering, and special damages that included a psychological component. My solicitor at Slater and Gordon estimated that I might receive between AU $50,000 to $100,000 in compensation. I replied that, after my horrendous experiences, I would accept no less than AU $500,000 and would prefer in excess of AU $1,000,000. The legal action was difficult due to a lack of similar claims and precedents in Australia. An additional disadvantage was that civil cases in Western Australia are determined by a judge only, in contrast to a judge and jury in other Australian states. Western Australia is also the most conservative state with respect to the treatment of sexual issues by the judicial system. For these reasons, I tried to avoid proceeding to trial. My solicitors found my case difficult to research, prepare, and discuss. It was necessary for me to maintain constant communication and an assertive attitude to ensure the progress of my case. I also completed as much of the research and photocopying as possible to assist my solicitors and to minimize costs. In August 1999, my claim proceeded to a pre-trial conference. I interrupted my doctoral studies at Australian National University and returned to Perth for the first conference on 30 August. As the solicitors for the Defendant requested further evidence, two more pre-trial conference sessions were held on 27 September and 2 November. My psychological health and studies suffered due to the time required for gathering additional evidence, the financial cost, emotional drain, and the associated stress and depression. I felt that I was in danger of losing my PhD candidature. A settlement was still not reached at the final pre-trial conference. Not satisfied that the Defendant's solicitors gave my injury due recognition, I directed my solicitor to issue a 24A offer. This offer gave the Defendant one final opportunity to settle before the claim proceeded directly to trial. The terms of my offer were: 1. The Defendant pay the Plaintiff the sum of AU$360,000 plus repayment to the Health Insurance Commission of AU$5,070.40. 2. The Defendant pay the Plaintiff's costs and disbursements of the action up to and including the date of acceptance of this offer, to be taxed if not agreed. 3. The Defendant admit liability. The Defendant accepted this offer in late November 1999. Although my private health insurance fund paid approximately AU$5,000 of my medical expenses, the Defendant refused to recognize or refund this money. Despite the Defendant's agreement to pay costs, I was required to pay approximately half of the legal costs involved. The admission of liability was vital to my sense of victory and vindication. I wanted public acknowledgement that I had been injured by routine neonatal circumcision. This injury was inflicted on me and has deprived me of freedom, liberty, and a normal life. For this reason, I refused to forego my freedom of speech and would not agree to a settlement that included a confidentiality clause, or a clause denying the medical practitioner's responsibility for my injury. <h3>Current status</h3> I am still in a state of shock from my experiences. I am unhappy to have endured such severe injury and trauma due to a surgical procedure that was completely unnecessary. I would never have consented to circumcision if I had received an opportunity to make the choice that was rightfully mine. Since 1999, I have focused on public awareness to help prospective parents be aware that routine circumcision is completely unnecessary and very destructive. My parents would never have consented to my circumcision if this information had been made available to them. Public awareness was most successfully achieved by an article published in Woman's Day, which included an interview with Dr David Brand, the current head of the Australian Medical Association. Woman's Day obtained an unprecedented statement: <div>The Australian Medical Association doesn't advise circumcision for many reasons. They claim the practice can lead to scarring, deformity, severe blood loss, as well as infection. [49]</div> The Australian Medical Association had never previously acknowledged to the public that circumcision could lead to scarring and deformity. <h3>What I would like to see happen in Australia</h3> Routine circumcision is a controversial issue, with no easy solution. I believe that no person has the right to surgically inflict their religious, sexual, or cosmetic preferences on another person. I contend that no parent or adult has the right to inflict medically unnecessary and irreversible surgery on a child. The Australian legal system must address this issue, as it has done for the issue of sterilization of intellectually disabled females (Family Law Council, 1994), for which Court permission is now required by a new division in the Family Law Act. [50] Likewise, Court permission should be required to perform circumcision on a child under the age of 18, or an adult incapable of giving informed consent, unless there is documented proof of the absolute medical necessity for the health of the individual to support the decision to operate without consent. Many people respect an individual's right to engage in unprotected sex with multiple sexual partners, yet maintain a mistaken belief that the risk of disease transmission may be reduced through the forcible removal of a normal and healthy body part from non-consenting babies. This view fails to recognize or acknowledge that it is solely my right to choose the sexual practices that I will engage in, and solely my right to choose which body parts I will retain or discard. It is also solely my right to choose the religious beliefs and cultural traditions I will subscribe to, and again, solely my right to choose which body parts I will retain or discard. Members of some ethnic groups claim that they have a right to dictate the cultural and religious beliefs that their children will adopt. Such views fail to recognize that children are not the property or the chattel of their parents. I contend that children require an opportunity to learn about their cultural heritage and exercise freedom of choice over the beliefs and traditional practices they will adopt. Parents have a duty to protect their children from harmful practices, and no tradition should be enforced by the permanent alteration or disfigurement of the body of an individual who is legally incapable of providing informed consent. As with many issues concerning human rights, it is difficult to convey these messages to society. The public needs to be accurately informed and educated about circumcision and its associated risks and disadvantages. My mother was shocked to learn that the "useless bit of skin" removed from me was actually rich in sensory nerve endings. [51] She now considers male circumcision the equivalent of female circumcision - a cultural practice that the majority of parents in western societies would never contemplate inflicting on their daughters. It would be beneficial to promote public awareness of the similarities in cultural origins and destructive consequences of male and female genital mutilation. I would like also like to see it become unlawful for family doctors and other inadequately qualified individuals to perform circumcision. Only a pediatric surgeon has the necessary expertise and experience to perform surgery on small children and deal with the possible injuries and complications that circumcision can cause. A step in this direction was recently taken in Israel, following the heavily publicized case of glans amputation during a ritual circumcision. [52] The Israeli Health Ministry has agreed to issue a directive to Israeli hospitals, for the first time allowing them to certify doctors to perform circumcisions. [53] It should also be unlawful for surgery of any kind to be practiced without adequate pain relief. Several ethnic groups and a number of medical practitioners have disseminated a primitive, self-serving belief that infants do not experience pain when subjected to circumcision. [54] The extreme pain and distress experienced by infants who undergo circumcision, however, is well documented. [55-56] For the less than 1% of the male population who may require circumcision for genuine medical reasons, [57] adequate pain relief should be provided, both during the procedure and postoperatively. As a means of discouraging the current widespread practice of circumcision without adequate pain relief, laws should be passed to imprison any individual who is guilty of such conduct for inflicting torture and grievous bodily harm. Rebates for circumcision should be limited on the Medicare Benefits Schedule. Rebates should not be given for routine circumcision or any other unnecessary medical intervention. The Australian public health system is currently in financial crisis. Patients with life-threatening conditions are being denied prompt and essential treatment. Public awareness of the human and economic costs of medically unwarranted circumcision, and the resulting injuries and trauma, may assist in changing attitudes towards this unnecessary and harmful practice. <h4>Acknowledgements</h4> I thank Mrs. Kerry Peterson and Dr. George Williams for their assistance with the preparation of my symposium presentation and this manuscript. I also thank all those who were present at the Sixth International Symposium on Genital Integrity (Sydney 2000), where this paper was first given . Their encouragement and support helped me to deliver this most difficult account of my experiences. <h3>References</h3> 1. Szabo R, Short RV. How does male circumcision protect against HIV infection? BMJ 2000;320(7249):1592-4. 2. Kanawati N, Hassan A. The Teti Cemetery at Saqqara. vol. II. The Tomb of Ankhmahor. The Australian Centre for Egyptology: Reports 9. Warminster: Aris & Phillips Ltd. 1997. pp. 49-50. 3. Bailey E. Circumcision in ancient Egypt. <a href="http://www.egyptology.mq.edu.au/publicationslisttext.htm" rel="noopener" target="_blank">The Bulletin of the Australian Centre for Egyptology</a>. 1996;7:15-28. 4. Roth AM. Egyptian Phyles in the Old Kingdom: The Evolution of a System of Social Organization. Chicago: Oriental Institute of the University of Chicago; 1991. pp. 62-75. 5. Spiegelman M. The circumcision scene in the tomb of Ankhmahor: the first record of emergency surgery. The Bulletin of the Australian Centre for Egyptology 1997;8:91-100. 6. See the discussion in: Hodges FM. <a href="http://www.cirp.org/library/history/hodges2/" rel="noopener" target="_blank">The ideal prepuce in ancient Greece and Rome: male genital aesthetics and their relation to lipodermos, circumcision, foreskin restoration, and the kynodesme</a>. Bulletin of the History of Medicine 2001;75:375-405. 7. Duckett JW. The neonatal circumcision debate. In: King LR, editor. Urologic Surgery in Neonates & Young Infants. Philadelphia: Saunders; 1988. pp. 291-9. 8. Broecker BH. Circumcision. In: Glen JE, Graham SD, Boyce WH, Turner-Warnick R, Brendler CB, et al., editors. Urologic Surgery. Philadelphia: Lippincott; 1991. pp. 841-4. 9. Clark P. On the penis. In: Operations in Urology. New York: Churchill Livingstone; 1985. pp. 107-112. [here, p. 111.] 10. Kaplan GW. <a href="http://www.cirp.org/library/complications/kaplan/">Complications of circumcision</a>. Urol Clin North Am 1983;10(3):543-9. 11. Redman JF. Rare penile anomalies presenting with complication of circumcision. Urology 1988;32(2):130-2. 12. Wiswell TE, Geschke DW. Risks from circumcision during the first month of life compared with those for uncircumcised boys. Pediatrics 1989;83(6):1011-5. 13. Berman W. Letter: <a href="http://www.cirp.org/library/complications/berman/" rel="noopener" target="_blank">Urinary retention due to ritual circumcision</a>. Pediatrics 1975;56(4):621. 14. Bennett HJ, Weissman M. Circumcisions: knowledge isn't enough. Pediatrics 1981;68(5):750. 15. Ritchey ML, Bloom DA. Re: Skin bridge-a complication of paediatric circumcision. Br J Urol 1991;68(3):331. 16. Talarico RD, Jasaitis JE. <a href="http://www.cirp.org/library/complications/talarico1/" rel="noopener" target="_blank">Concealed penis: a complication of neonatal circumcision</a>. J Urol 1973;110(6):732-3. 17. Sussman SJ, Schiller RP, Shashikumar VL. <a href="http://www.cirp.org/library/complications/sussman1/" rel="noopener" target="_blank">Fournier's syndrome. Report of three cases and review of the literature</a>. Am J Dis Child 1978;132(12):1189-91. 18. Menahem S. <a href="http://www.cirp.org/library/complications/menahem1/" rel="noopener" target="_blank">Complications arising from ritual circumcision: pathogenesis and possible prevention</a>. Isr J Med Sci 1981;17(1):45-8. 19. Kaplan GW. Circumcision - an overview. Curr Probl Pediatr 1977;7(5):1-33. 20. Kaplan GW. Circumcision - an overview. Curr Probl Pediatr 1977;7(5):1-33. 21. Lackey JT, Mannion RA, Kerr JE. Urethral fistula following circumcision. Jama 1968;206(10):2318. 22. Limaye RD, Hancock RA. <a href="http://www.cirp.org/library/complications/limaye/" rel="noopener" target="_blank">Penile urethral fistula as a complication of circumcision</a>. J Pediatr 1968;72(1):105-6. 23. Redman JF. Rare penile anomalies presenting with complication of circumcision. Urology 1988;32(2):130-2. 24. McGowan AJ. A complication of circumcision. JAMA 1969;207(11):2104-5. 25. Vyas PR, Roth DR, Perlmutter AD. Experience with free grafts in urethral reconstruction. J Urol 1987;137(3):471-4. 26. Hanash KA. <a href="http://www.cirp.org/library/complications/hanash1/" rel="noopener" target="_blank">Plastic reconstruction of partially amputated penis at circumcision</a>. Urology 1981;18(3):291-3. 27. Palmer JM, Link D. <a href="http://www.cirp.org/library/complications/palmer/" rel="noopener" target="_blank">Impotence following anesthesia for elective circumcision</a>. JAMA 1979;241(24):2635-6. 28. Ball JR, Grounds AD. Head injury, hypopituitarism and paranoid psychosis: Circumcision for the "Singapore virus". Med J Aust 1974;2(11):403-5. 29. Flaherty JA. Circumcision and schizophrenia. J Clin Psychiatry 1980;41(3):96-8. 30. Rosefsky JB. Glans necrosis as a complication of circumcision. Pediatrics 1967;39(5):774-6. 31. Sterenberg N, Golan J, Ben-Hur N. Necrosis of the glans penis following neonatal circumcision. Plast Reconstr Surg 1981;68(2):237-9. 32. St Margaret's Hospital for Women (Sydney) vs McKibben. Hearing before the Supreme Court of New South Wales, Court of Appeal. BC8701368. 14 May 1987. 33. Gearhart JP, Rock JA. <a href="http://www.cirp.org/library/complications/gearhart1/" rel="noopener" target="_blank">Total ablation of the penis after circumcision with electrocautery</a>: a method of management and long-term followup. J Urol 1989;142(3):799-801. 34. Hanash KA. <a href="http://www.cirp.org/library/complications/hanash1/" rel="noopener" target="_blank">Plastic reconstruction of partially amputated penis at circumcision</a>. Urology 1981;18(3):291-3. 35. Izzidien AY. <a href="http://www.cirp.org/library/complications/izzidien/" rel="noopener" target="_blank">Successful replantation of a traumatically amputated penis in a neonate</a>. J Pediatr Surg 1981;16(2):202-3. 36. Gairdner DM. <a href="http://www.cirp.org/library/general/gairdner/" rel="noopener" target="_blank">The fate of the foreskin: A study of circumcision</a>. BMJ 1949;2:1433-7. 37. Gee WF, Ansell JS. Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976;58(6):824-7. 38. Gearhart JP, Rock JA. <a href="http://www.cirp.org/library/complications/gearhart1/" rel="noopener" target="_blank">Total ablation of the penis after circumcision with electrocautery</a>: a method of management and long-term followup. J Urol 1989;142(3):799-801. 39. Money J. Ablatio penis: normal male infant sex-reassigned as a girl. Arch Sex Behav 1975;4(1):65-71. 40. Diamond M, Sigmundson K. Sex Reassignment at Birth: Long-term Review and Clinical Implications. Arch Pediatr Adolesc Med 1997;151(3):298-304. 41. Patel H. <a href="http://www.cirp.org/library/procedure/patel/" rel="noopener" target="_blank">The problem of routine circumcision</a>. Can Med Assoc J 1966;95(11):576-81. 42. Gee WF, Ansell JS. Neonatal circumcision: a ten-year overview: with comparison of the Gomco clamp and the Plastibell device. Pediatrics 1976;58(6):824-7. 43. Clark P. On the penis. In: Operations in Urology. New York. Churchill Livingstone; 1985. pp. 107-112. [here, p. 111.] 44. Taylor JR, Lockwood AP, Taylor AJ. <a href="http://www.cirp.org/library/anatomy/taylor/" rel="noopener" target="_blank">The prepuce: specialized mucosa of the penis and its loss to circumcision</a>. Br J Urol 1996;77(2):291-5. 45. Jordan GH. Grafts and flaps in urology. In: Glen JE, Graham SD, Boyce WH, Turner-Warnick R, Brendler CB, et al., editors. Urologic Surgery. Philadelphia. Lippincott; 1991. pp. 1085-97. 46. Jordan GH, Schlossberg SM, Devine CJ. Surgery of the penis and urethra. In: Walsh PC, Retick AB, Vaughan ED, Wein AJ. Campbell's Urology, 4 vols., 7th ed. Philadelphia: W.B. Saunders; 1998. vol. 2. pp. 3316-33. 47. Jordan GH, Schlossberg SM, Devine CJ. Surgery of the penis and urethra. In: Walsh PC, Retick AB, Vaughan ED, Wein AJ. Campbell's Urology, 4 vols., 7th ed. Philadelphia: W.B. Saunders; 1998. vol. 2. pp. 3316-33. 48. Hermans MH. Duoderm E in the treatment of donor sites: a report. Annals of the MBC 1990;3(3):166-9. [September 1990] 49. Stanley D. Shane's circumcision nightmare: I wish I'd never been born. Woman's Day (Sydney, Australia), (1 May 2000): pp. 24-5. 50. A report to the Attorney-General prepared by the Family Law Council. Sterilisation and Other Medical Procedures on Children. Commonwealth of Australia 1994. 51. Taylor JR, Lockwood AP, Taylor AJ. <a href="http://www.cirp.org/library/anatomy/taylor/" rel="noopener" target="_blank">The prepuce: specialized mucosa of the penis and its loss to circumcision</a>. Br J Urol 1996;77(2):291-5. 52. Siegel-Itzkovich J. Baby's penis reattached after botched circumcision. BMJ 2000;321(7260):529. [2 September 2000] 53. Siegel-Itzkovich J. Israel's health ministry ends circumcisers' monopoly. BMJ 2001;322(7277):10. [6 January 2001] 54. Weiss GN, Weiss EB. A perspective on controversies over neonatal circumcision. Clin Pediatr (Phila) 1994;33(12):726-30. 55. Taddio A, Pollock N, Gilbert-MacLeond C, Ohlsson K, et al. <a href="http://www.cirp.org/library/pain/taddio3/" rel="noopener" target="_blank">Combined analgesia and local anesthesia to minimize pain during circumcision</a>. Arch Pediatr Adolesc Med 2000;154(6):620-3. 56. Anand KJ, Hickey PR. <a href="http://www.cirp.org/library/pain/anand/" rel="noopener" target="_blank">Pain and its effects in the human neonate and fetus</a>. N Engl J Med 1987;317(21):1321-9. [19 November 1987] 57. Rickwood AM, Kenny SE, Donnell SC. <a href="http://www.bmj.com/cgi/content/full/321/7264/792" rel="noopener" target="_blank">Towards evidence based circumcision of English boys: survey of trends in practice</a>. BMJ 2000;321(7264):792-3. [30 September 2000] </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Aussie boy's circumcision nightmare darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h2>Australia's new witchdoctors</h2> <h4>Did ritual and religious circumcision arise from motives of hygiene?</h4> What do African witchdoctors and a modern zoologist like Dr Roger Short have in common? What beliefs are shared by the superstitious moon priests of ancient Egypt and a contemporary expert in molecular biology such as Professor Brian Morris? What conviction animates a Brisbane GP like Dr Terry Russell as much as it gripped a nineteenth century medical quack and snake oil salesman like Dr Peter Remondino? At what point to the ritual practices of Aboriginal elders in the central Australian desert converge with the deeply-pondered recommendations of the New England Journal of Medicine? There is a striking degree of unanimity among the traditional superstitions of ancient and tribal cultures, the nostrums of Victorian quackery and the certainties of an influential band of contemporary medical researchers and doctors on one sensitive point: that young males ought to have part of their penis cut off. The reasons offered by each category of enthusiast are slightly different: tribal uniformity and religious requirement in the first case; prevention and cure of nervous diseases and masturbation in the second, though not forgetting claims about protection against syphilis, tuberculosis, polio, epilepsy and many other problems; and in the third case reducing the risk of infection with intractable modern diseases such as HIV-AIDS (as well as cervical cancer in female partners), particularly among Third World populations. <h4>Egypt: So long ago that nobody knows the truth</h4> Surprisingly, modern medical researchers do not try to hide their continuities with the ignorant and superstitious past. Almost every article on routine male circumcision in medical journals opens with the same little mantra: that "circumcision is the oldest surgical operation known to man, practised by many ancient cultures etc", and some refer to an old Egyptian bas relief which is supposed to represent the operation on two adolescent boys. (1) Why the mysterious rites of a pre-scientific, priest-ruled culture like that of ancient Egypt should be hailed as a model for contemporary medicine is not entirely clear. Whatever its ritual significance to stone-age man and antique civilizations, circumcision as a medical procedure is a recent invention, dating from only the eighteenth century as a treatment for severe venereal sores on the penis; it was practised by relatively few pre-modern cultures; and the much-reproduced Egyptian bas relief is so eroded that it is impossible to make out even what is depicted, let alone to be sure about what is happening. There is no evidence that the ancient Egyptians practised widespread circumcision (though it does seem to have been a ritual requirement for priests and possibly court officials â€“ who were sometimes eunuchs, as the story of Potiphar's wife reminds us â€“ at certain periods), and the actions shown in the relief look more like the shaving of the boys' pubic hair than the amputation of their foreskins. (2) If it is a representation of circumcision it reveals an important aspect of the procedure which its modern advocates always gloss over: one of the boys is being forcibly restrained, suggesting that whatever is being done to him is not something he is too eager about. Are the principles of contemporary medical ethics and personal freedom no further advanced than in the days of a despotic, divine-right monarchy like that of the pharaohs? If it is surprising to see modern medical experts associating themselves with the coercive rituals of ancient priests and slave-driving kings, it is even stranger to observe the similarity of their warnings against the foreskin with the tub-thumping propaganda of a nineteenth century quack like Dr P.C. Remondino, author of History of circumcision from the earliest times to the present: Moral and physical reasons for its performance (1891), in which the foreskin is vilified at length as a malign influence and "moral outlaw". According to Remondino its removal would not only discourage boys from masturbating, but immunise them against tuberculosis, cancer, syphilis, polio, idiocy, forgetfulness, impotence, unwanted erections, wet dreams and just about any medical problem you cared to mention. <h4>Modern crusaders</h4> Australia's leading crusaders for universal male circumcision are Dr Terry Russell, a GP in Brisbane whose whole practice consists of little more than excising the foreskins of baby boys by means of the Plastibell device; and Dr Brian Morris, a professor of physiology at Sydney University, who (not being medically qualified) just likes to talk about it. Both are frequently seen in the media urging parents to have their boys circumcised, and much of their routine is just a long list of nasty diseases, designed to terrify people into seeking urgent medical intervention. Russell apparently tells parents that an early circumcision is the equivalent of immunization against venereal disease, cancer of the penis and many other problems which, he implies, boys will be likely to contract unless they are liberated from the malevolent portion of their penis. He writes that, if they had been circumcised, "a vast number of neonates would have been saved from UTI [urinary tract infections] and its consequences of renal failure, septicaemia, meningitis, hypertension and death". Circumcision "may reduce the risk of STDs (syphilis, gonorrhoea, herpes and candida) and carcinoma of the cervix of female partners. It also prevents balanoposthitis and phimosis", not to mention such "potentially fatal conditions" as neonatal UTIs, HIV/AIDS and cancer of the penis. (3) Scary. You would think though, given that only about 12 per cent of Australia boys are circumcised these days, that if these claims were true the others would be dropping like flies. Seemingly not. (In fact, the Australian Institute of Health and Welfare reports that in the twenty years since 1983, as the incidence of circumcision has plummetted, there has been a <a href="http://www.circinfo.org/news.html" rel="noopener" target="_blank">dramatic improvement in child health outcomes</a>.) A hundred years ago Dr Remondino referred to: "The tight-constricted, glans-deforming, onanism-producing, cancer-generating prepuce that is ... at the bottom of the ills ... that may affect man" (4). He reminded his wide-eyed readers that: the prepuce seems to exercise a malign influence in the most distant and apparently unconnected manner; where, like some of the evil genii or sprites in the Arabian tales, it can reach from afar the object of its malignity, striking him down unawares in the most unaccountable manner; making him a victim to all manner of ills, sufferings and tribulations; unfitting him for marriage or the cares of business; making him miserable and an object of continual scolding and punishment in childhood, through its worriments and nocturnal enuresis; later on, beginning to affect him with all kinds of physical distortions and ailments, nocturnal pollutions, and other conditions calculated to weaken him physically, mentally, and morally; to land him, perchance, in jail or even in a lunatic asylum. (5) Just as scary. Brian Morris concludes his own booklet on the necessity to circumcise all male infants with dire warnings that retention of the foreskin "confers a higher risk of death in the first year of life (from complications of urinary tract infections leading to kidney failure, meningitis and infection of bone marrow"; increases the danger of cancer of the penis; leads to "balanitis (inflammation of the glans), posthitis (inflammation of the foreskin), phimosis (inability to retract the foreskin) and paraphimosis (constriction of the penis by a tight foreskin"; and he concludes that being circumcised "will result in better sexual function" and "a penis that is generally regarded as more attractive" (6). How could he disagree with Dr Remondino's assurance that: Circumcision is like a substantial and well-secured life annuity; every year of life you draw the benefit, and it has not any drawbacks .... Parents cannot make a better paying investment for their little boys, as it insures them better health, greater capacity for labor, longer life, less nervousness, sickness, loss of time, and less doctor-bills, as well as increases their chances for an euthanasian death. (7) Professor Morris admits his affinity with the Remondinos of this world by acknowledging that "the Victorians cited many of the same medical conditions associated with uncircumcised penises as do people today", yet at the same time he denies that a major reason why they introduced it was to discourage boys from masturbating: that claim is "a falsehood that has been promoted by anti-circumcision groups". (8) Morris is very critical of the unscientific approach of such activists, but it is strange to see him endorsing the Victorian enthusiasm for circumcision as consistent with his own arguments in its favour, yet denying that control of masturbation had anything to do with the matter. Remondino was quite definite that, in his view, even the ancient origins of circumcision lay in the desire of Judaic lawgivers first to discourage the idolatrous debaucheries practised among their free-spirited neighbours in the Middle East, and masturbation specifically; and secondly to encourage procreation. Referring to the story of the circumcision of Abraham and the impregnation of Sarah, he writes: "Here we have suggestions of a preventive to onanism, and a cure to male impotence when due to preputial interference" (9). Dr Morris follows this lead closely when he writes: The Bible records that Abraham circumcised himself at age 99, along with his 13 year-old son Ishmael. Not long afterwards his wife Sarah, after many barren years, became pregnant and bore Isaac. Weiss speculates that Abraham had a foreskin problem, possibly exacerbated by the desert environment, and that this problem interfered with his sexual activity. The difficulties were solved by having a circumcision. (10) It comes as a bit of a shock to see a modern scientist treating the Old Testament as though it were literal history. No serious scholar in biblical studies today believes that the early books of the Old Testament are a factual record of history, and it is now generally accepted that they are a collection of stories assembled by Jewish religious leaders in the 6th century BCE. It follows that Abraham et al are as much mythical figures as Hercules or Oedipus, and that Weiss's "speculations" are on a par with Archbishop Ussher's calculations of the age of the earth in the 17th century. Recent research also suggests that Judaic ritual circumcision did not become routine and privileged as a sign of the Covenant until the Babylonian exile of the 6th century (at about the same time as the first five books of the Old Testament â€“ the Torah â€“ were compiled), when the rationale was the maintenance of cultural identity and racial purity in a hostile social environment by the enforcement of physical distinctiveness. It had nothing to do with "foreskin problems", protection against disease or the irritation caused by desert sands. (11) The foreskin was more likely a protection against such irritation than a source of it, as Remondino himself conceded: Nature â€“ always careful that nothing should interfere with the procreative functions â€“ had provided him [primitive man] with a sheath or prepuce, wherein he carried his procreative organ safely out of harm's way, in wild steeple-chases through thorny briars and bramble-brakes. (12) Professor Morris apparently forgot this passage when he warned that yet another drawback of having a foreskin was that it might get caught in your zipper. Allowing the myth for a moment, if it was Abraham who had the foreskin problem, why did he also circumcise his son Ishmael, followed by his servants and slaves? And if this "problem" prevented him from begetting children, how come he already had a 13 year-old son? Not surprisingly, Professor Morris' booklet <a href="https://www.darboninstitute.org/brian_morris_reviewed" rel="noopener" target="_blank">has not been warmly reviewed</a> by experts in paediatrics or sexual health. <h4>Queensland is different?</h4> Dr Russell, too, found it necessary to bolster a weak medical case by reference to religious prescription. Interviewed on the Australian current affairs program 60 Minutes in October 2000 he was caught out by the interviewer's awareness that no medical body in the world recommended routine circumcision. Interviewer: Can you point to one international medical body which doesn't say maybe you should circumcise but says definitely. Russell: Yeah, I think the American Academy of Pediatrics has said that. I've got a .... Interviewer: No they don't. Can you think of one which says you absolutely should do it? Russell: The Bible did. [giggles] No, not off the top of my head, no. (13) Unfortunately the interviewer did not press Dr Russell on why an unexplained biblical precedent established a requirement for modern-day Australians. He was presumably referring to the Genesis story also cited by Professor Morris rather than St Paul's advice that Christians should not continue to practise the many rules imposed on the Jewish people by their exacting god. It is hard to see why the rules of the Old Testament should be relevant to modern medical practice in Queensland today. <a href="https://www.darboninstitute.org/three_persistent_myths_about_the_foreskin" rel="noopener" target="_blank">Further information on the ritual/religious page</a> References 1. Robert Szabo and Roger V. Short, "How does male circumcision protect against HIV infection?", British Medical Journal, Vol. 320, 2000, pp. 1592-4 2. Frederick Hodges, "The ideal prepuce in Ancient Greece and Rome: Male genital aesthetics and their relation to lipodermis, circumcision, foreskin restoration and the Kinodesme", Bulletin of the History of Medicine, Vol. 75, 2001, pp. 375-405 3. Terry Russell, "Debate: Male circumcision remains a valid procedureâ€”Yes", Australian Doctor, 24 May 1996, p. 54 4. P.C. Remondino, History of circumcision from the earliest times to the present: Moral and physical reasons for its performance, Philadelphia and London, 1891, p. 187 5. Remondino, pp. 54-5 6. Brian Morris, In favour of circumcision, Sydney, New South Wales University Press, 1999 pp. 87-8 7. Remondino, p. 186 8. Morris, p. 57 9. Remondino, p. 201 10. Morris, p. 60, citing G.N. Weiss, "Prophylactic neonatal surgery and infectious diseases", Pediatric Infectious Diseases Journal, 1997 11. Lawrence W. Hoffman, Covenant of blood: Circumcision and gender in rabbinic Judaism, University of Chicago Press, 1996; Leonard Glick, "Jewish circumcision: An enigma in historical perspective", in Marilyn Milos, George C. Denniston and Frederick Hodges (eds), Understanding circumcision: A multi-disciplinary approach to a multi-dimensional problem, London and New York, Kluwer Academic and Plenum Press, 2001 12. Remondino, p. 8 13. "Fore and against", 60 Minutes, 8 October 2000, 9 Network (Australia), presenter: Ellen Fanning (video in possession of the author) </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Australia's new witchdoctors darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> Safety and Efficacy of Nontherapeutic Male Circumcision: A Systematic Review Caryn L. Perera, BA, Grad Cert EBP, Franklin H. G. Bridgewater, MBBS, FRACS, Prema Thavaneswaran, BSc (Hons), PhD and Guy J. Maddern, PhD, FRACS Annals of Family Medicine Volume 8, Issue 1, January/February 2010 ABSTRACT PURPOSE: We wanted to assess the safety and efficacy of nontherapeutic male circumcision through a systematic review of the literature. METHODS: We systematically searched The York Centre for Reviews and Disseminations, Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials published between January 1997 and August 2008. Studies reporting on circumcision in an operative setting in males of any age with no contraindications to or medical indications for circumcision were eligible for inclusion. The main comparator was intact genitalia. From 73 retrieved studies, 8 randomized controlled trials were ultimately included for analysis. RESULTS: Severe complications were uncommon. Analgesia/anesthesia during circumcision was promoted. The prevalence of self-reported genital ulcers was significantly lower in circumcised men than uncircumcised men (3.1% vs 5.8%; prevalence risk ratio 0.53; 95% confidence interval [CI], 0.43–0.64; P<.001). Circumcised sub-Saharan African men were at significantly lower risk of acquiring human immunodeficiency virus/acquired immune deficiency syndrome than were uncircumcised men (random effects odds ratio = 0.44, 95% CI, 0.32–0.59; P <.001). The evidence suggests that adult circumcision does not affect sexual satisfaction and function. CONCLUSIONS: Strong evidence suggests circumcision can prevent human immunodeficiency virus/acquired immune deficiency syndrome acquisition in sub-Saharan African men. These findings remain uncertain in men residing in other countries. The role of adult non-therapeutic male circumcision in preventing sexually transmitted infections, urinary tract infections, and penile cancer remains unclear. Current evidence fails to recommend widespread neonatal circumcision for these purposes. Research Recommendation Although approximately 30% of the global male population is circumcised, there is a paucity of high-quality evidence. Depending on the indication under investigation, prospective RCTs and case-control studies should be conducted to strengthen the evidence base and allow more informed conclusions on nontherapeutic male circumcision to be drawn. Although the evidence for the efficacy of adult nontherapeutic male circumcision in preventing HIV/AIDS acquisition in sub-Saharan African men is strong, it is unclear whether these findings can be extrapolated to male populations in other countries. The role of adult nontherapeutic male circumcision in preventing sexually transmitted infection, urinary tract infection, and penile cancer is less clear, whereas the role of neonatal circumcision in preventing HIV/AIDS, sexually transmitted infection, urinary tract infection, and penile cancer is not presently supported by RCT evidence. Patients who request circumcision in the belief that it bestows clinical benefits must be made aware of the lack of consensus and robust evidence, as well as the potential medical and psychosocial harms of the procedure. As the efficacy of prophylactic nontherapeutic male circumcision has not been comprehensively studied in neonates, it would be inappropriate to recommend widespread neonatal circumcision for this purpose. <a href="http://www.annfammed.org/" rel="noopener" target="_blank">Full text of the article may be read at Annals of Family Medicine</a> <h3>Comment</h3> This level-headed article comes as a welcome breath of fresh air, and confirms the policy of the Royal Australasian College of Physicians to discourage medically unnecessary circumcision of minors. The bottom line is that (routine) preventive circumcision of minors offers no significant health benefit, carries significant risks, has an adverse effect on sexual sensation, and should not be performed. There are two points that might be questioned. First, the estimate of 30 per cent of men world-wide circumcised seems too high. Even allowing that most Muslims are circumcised (and there are probably many who are not), and that circumcision is common among tribal societies in Africa, it does not seem likely that the total could be much more than 25 per cent – though of course, fuelled by American dollars and those Microsoft millions, the World Health Organisation is certainly doing its best to make Africa foreskin-free. In fact, circumcision is rapidly becoming a practice confined to the underdeveloped world, where people who do not know any better have no choice but to obey those white witchdoctors. Second, to conclude that “the evidence suggests that adult circumcision does not affect sexual satisfaction and function” suggests that the search for evidence has not been as thorough as it might have been. It is highly likely that circumcision in adulthood has a far less severe effect on sexual function and genital sensation than if it is done in infancy or childhood (for which reason maturity is a much better time to do it, if it must be done), but there are plenty of men, circumcised as adults, who report a significant loss of sexual feeling, and who bitterly regret their decision. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Australian study finds insignificant benefits of circumcision darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> Balanitis xerotica obliterans (BXO) is a rare condition in which the foreskin becomes inflamed and hardened and covered with a dry whitish film. In adults the problem can result in progressive tightening of the foreskin, making retraction difficult and painful. The condition is poorly understood and the cause(s) unknown: it could be a viral, bacterial or fungal infection or (more probably) some sort of auto-immune response (where the body’s antibodies attacks its own tissue). The symptoms of BXO are similar to those of several other minor penis inflammations, so that its presence must be confirmed by appropriate specialist advice and finally established by laboratory analysis. Where BXO is confirmed, treatment options are limited: application of of steroid medications may help, but if they do not circumcision will be necessary. BXO is one of the very few conditions where therapeutic circumcision is warranted. The most recent comprehensive survey of the medical literature reached the conclusion that, although rare, BXO may be increasing in frequency; that diagnosis is difficult and often mistaken; and that the principal treatment is circumcision, possibly assisted by appropriate anti-inflammatory medications. The abstract of the paper reads as follows: OBJECTIVE Balanitis xerotica obliterans (BXO) is a chronic inflammatory disease that is considered as male genital variant lichen sclerosis. The incidence varies greatly in different series; diagnosis is mostly clinical but histopathological confirmation is mandatory. Various treatments are described, but there is no consensus that one is the best. MATERIALS AND METHODS A literature review was made of BXO and lichen sclerosis in boys under 18 years of age, between 1995 and 2013, analyzing demographic dates, treatments and outcomes. In addition to that, we reviewed BXO cases treated in our centers in the last 10 years. RESULTS After literature review, only 13 articles matched the inclusion criteria. Analyzing those selected, the global incidence of BXO is nearly 35% among circumcised children. Described symptoms are diverse and the low index of clinical suspicion is highlighted. The main treatment is circumcision, with use of topical and intralesional steroids and immunosuppressive agents. CONCLUSION BXO is a condition more common than we believe and we must be vigilant to find greater number of diagnoses to avoid future complications. The main treatment for BXO is circumcision, but as topical or intralesional treatments are now available with potentially good outcomes, they may be considered as coadjuvants. NOTE: The reference to 35% does not mean that 35% of children experience BXO, but that the condition was confirmed in 35% of the children referred with suspected BXO. The condition itself is quite rare. Soledad Celis et al. Balanitis xerotica obliterans in children and adolescents: A literature review and clinical series. Journal of Pediatric Urology 10 (1) February 2014, 34-39. <a href="http://www.jpurol.com/article/S1477-5131(13)00288-X/fulltext" rel="noopener" target="_blank">Full text available here.</a> <h3>Advice from paediatric surgeon</h3> A paediatric surgeon has sent a letter to Circumcision Information Australia, explaining that while he is strongly opposed to routine, non-therapeutic circumcision of boys, BXO is one of the few pathological conditions where circumcision is usually necessary. Throughout my training I have always been taught that BXO was the only absolute indication for circumcision. I am aware of some reports of steroid use and covered for a colleague in the UK once who used this as the first line of treatment. My experience was that this did not work, and that the disease usually progressed rapidly, making circumcision urgently necessary. I did a quick Google search, and also a search of the Journal of Pediatric Urology, with BXO and steroid as the search strategy. The only article I found that helped much was a review of the literature and case series from UK (St George's, London) Ireland (Dublin) and Chile by Celis et al [referenced above]. The main findings were that the incidence of BXO is increasing. Also that circumcision is the main treatment, with steroids and other treatments having a supporting role. Reading through the paper a couple of things caught my eye: 1. The correlation between clinical suspicion and histological diagnosis is not great — meaning that some clinically suspicious BXO turns out to be other scaring / inflammation. 2. Steroids, if they do work at all, only work with early inflammation affecting the prepuce and no scaring. I get the impression these patients had not had their diagnosis confirmed histologically 3. In a few patients who had trial of “tissue sparing surgery” (preputioplasty presumably) in a cohort from Chile there was a 100% relapse rate, needing to progress to circumcision. 4. Reinforcement of complications of inadequately treated BXO leading to progressive disease and significant morbidity needing complex surgical fixes as a result. My summation is therefore that there may be cases of early clinically suspicious BXO which may respond to steroids, but that this probably is not BXO anyway. For those patients with established scaring the only treatment that is reliably effective is a circumcision and that failure to do this exposes the patient to considerable risk of really significant complications of progressive scaring. The role of steroids, therefore, is as a way of excluding non-BXO in patients with inflammation that has not developed established scaring, to temporise and limit disease progression until a definitive circumcision is carried out by an appropriately trained surgeon under a general anaesthetic with adequate analgesia / penile block etc. I would also use post-operative steroids to further reduce the risk of meatal scarring when the inflammation has already spread onto the glans (which I have also seen), despite adequate circumcision. It would seem that whilst histologically it shares features of lichen sclerosis, the clinical behaviour of BXO is different to the disease seen in females. Sadly, at present, I do not think the strategy of primary treatment of established BXO with topical or intra-lesional drugs can be recommended. In the present state of medical knowledge the only sure cure for BXO is circumcision — though we may hope that medical treatments will eventually be developed. The surgeon adds that he is concerned by the number of Queensland boys who have been subjected to unnecessary Plastibel circumcision in infancy. I find it distressing how many boys are still subjected to the Plastibel circumcision. I see so many incidentally in my clinic (when looking at hernia, undescended testes etc) who have obviously had the Plastibel, with their shaft skin reaching only half way up the penis; and on occasions we get children referred with other complications — including buried penis, meatal stenosis and adherent preputial remnants. In Scotland the National Health Service policy was to provide cultural circumcisions (almost entirely for the Muslim population), performed by paediatric surgeons in hospital under general anaesthetic, on the basis that the state had to respect religious/cultural beliefs and that we had a duty of care to minimise the trauma and suffering experienced by the children who were going to get the operation anyway. I do not agree however with “prophylactic” or essentially cosmetic circumcisions, and I am signed up to the international opinion of paediatric surgeons that there is no place for “routine” neonatal circumcisions in the developed world [Referenced in circinfo.org website]. On the few patients that do have persisting symptoms associated with phimosis I will discuss the alternative of a preputioplasty [a surgical operation on the foreskin that loosens it with minimal loss of tissue]. </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Balanitis Xerotica Obliterans (BXO) darby Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Robert Darby Subject The topic of the resource Circumcision history Description An account of the resource Archive of the work published by Robert Darby Creator An entity primarily responsible for making the resource Robert Darby Source A related resource from which the described resource is derived circinfo.org historyofcircumcsion.org Text A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text. Text Any textual data included in the document <div class="intro" id="intro"> <h3>Genital cutting in cultural discourse</h3> Ylva Hernlund and Bettina Shell-Duncan (eds). Transcultural Bodies: Female Genital Cutting in Global Context. Piscataway, NJ: Rutgers University Press, 2007. 373 pp. ISBN 13 978-0813540269. $34.95 (paper) Ylva Hernlund and Bettina Shell-Duncan, the editorial team from the University of Washington that produced the excellent book Female “Circumcision” in Africa: Culture, Controversy, and Change (Lynne Rienner publishing, 2000) have done it again. Transcultural Bodies marginally even surpasses their earlier compilation in originality, quality and page-turning interest. The book will come as a profound shock to those in the grip of the common Anglophone assumption that female genital cutting is so horrible and injurious that it cannot possibly be compared with male circumcision, that harmless surgical intervention on baby boys that has nearly as many marvelous health benefits as the philosopher’s stone. On the contrary, the contributors to this book argue forcefully that male and female genital cutting have very similar cultural rationales and physiological outcomes. The leading article by the two editors, surveying female genital cutting (FGC) as it relates to culture and rights, starts us off with a bang. In a far-ranging article they update us on important events and scholarship during the seven years since their first book and provide overviews each of the essays in this volume. They remark that “the debate between universalism and relativism in the field of human rights has long been premised on a fixed conception of both culture and rights.” In fact, as the authors show, both culture and human rights are continuously evolving and undergoing redefinition. The editors also contest the popular notion that human rights is a Western construct imposed by First World countries on the rest of the world, arguing that human rights has relevance and robustness to all humanity. They further argue that “a human rights culture” has become a central aspect of global culture and that cultural relativism should not be taken too far or allowed to become an excuse for abuse. But neither should human rights be allowed to privilege one culture over another, and the editors question whether FGC is best approached as a human rights issue. Support for this doubt may be found in the fact that the vilification of a practice that can follow its labeling as a human rights violation can impede or halt scholarly inquiry, as Carla Makhlouf Obermeyer shows when identifying the scarcity of medically objective inquiry into its side effects. Double standards on FGC and MGC Hernlund and Shell-Duncan draw attention to the irony and double standards inherent in the fact that a simple prick to the clitoris is probably illegal under US law while “much more invasive procedures” on males are entirely legal and socially accepted. They devote a full page to a judicious survey of the critics of American circumcision practices, singling out the much-published pediatrician Dr. Robert Van Howe repeatedly – though regrettably getting his name wrong. Next they examine the greatly expanded interest since their last book in “designer vaginas,” cosmetic operations that women in the developed world women are having performed, usually because they want their genitals to look like those of desired models in pornography and or in the belief that the alteration will enhance the sexual experience. The authors analyze in depth the consequent ironies and double standards. Toward the end of the article, male circumcision is mentioned again, when it is noted that in 1975, after the American Academy of Pediatrics issued a statement that there were “no health benefits whatsoever” in routine infant circumcision, there were no moves to outlaw the practice. Instead, “deep-seated religious, aesthetic, and cultural norms” were allowed to influence the decision to take “an educational approach” instead. Following the editors’ introduction, Janice Boddy contributes a perceptive analysis of the FGC controversy in cultural perspective. “Much popular writing on female circumcision is polemical, preachy, advocacy driven, and endlessly self-referential,” she writes. “It is the appeal to social evolutionary thought in all its arrogant certainty that is the most troubling feature of FGM texts.” By this she refers to the common conviction that eventually those unsophisticated Africans will overcome their dark, ignorant ways and adopt enlightened Western approaches. According to this bromide, “African women are mired in culture; ‘we’ hold the light of truth.” Boddy wonders why there is “no outrage remotely parallel to that which leads some women to insist that circumcised women are entirely alienated from the essence of the female personality? Is it because these excisions are performed on boys, and only girls and women figure as victims in our cultural lexicon?” Next L. Amede Obiora contributes a vibrant analysis of Ousmane Sembene’s film about FGC Moolaade. She argues that “Women give in to [FGC] presumably to gain something else for their lives, and there are substantial trade-offs.” Fascinatingly, she later observes that “the commonplace reification of culture as the prime site and source of gender oppression exhausts its usefulness at some point, and the denigration of culture implicit in such representations becomes all the more wrongheaded insofar as it obscures the attributes of culture that can catalyze desirable change.” The Norwegian anthropologist Aud Talle follows with a study of “the anthropology of a difficult issue” in which she reaches heights of poetic eloquence in describing the plight of Somali émigré women in London. “In the streets of London they are not ‘in the world’ with a perfect body as they were on the savannah in Somalia. Now they wander forward as ‘lacks’—mutilated souls in mutilated bodies. They are signs of a story they have not written themselves; in fact, their bodies have become sites of a worldwide discourse on morality.” Sara Johnsdotter examines attitudes to FGC held by Somali men and women now living in Sweden. The threat of action by Somali authorities, combined with social disapproval of FGC (as opposed to its endorsement in Somalia) and journalistic sensationalism, lead to virtually all Somalis living in Sweden opposing FGC. Johnsdotter notes that “an implicit and sometimes explicit moral discourse [is] attached to the issue of female circumcision,” rendering reasoned discussion very difficult, since “Almost anything about the horrifying consequences of these practices can be alleged in the public discourse without evidence to support it.” She remarks that a symbolic pricking to satisfy Somali cultural requirements removes no tissue and “is far less invasive than what is done to male infants at Swedish hospitals during male circumcision.” Thus, “In a strictly medical sense there is no reasonable motive to forbid pricking of girls’ genitalia while permitting male circumcision. The reason for allowing … male circumcision at hospitals while forbidding female symbolic sunnah circumcision is purely ideological.” Australian legislation against female circumcision Juliet Rogers follows with a trenchant critique of Australian legislation against FGC. Women are described as “mutilated” and “represented as objects to be managed.” In the passing of anti-FGC legislation in Victoria, “the authority of law [was represented] as essential to protect Australia from ‘barbarous practices’ and simultaneously constructed ‘others’ as barbaric and as ‘mutilated’ social agents who were not entitled to the rights of citizenship.” Like the other authors in this volume, Rogers points to feminism’s focus on the clitoris as problematic, and suggests that it is “the representation of the clitoris as a singularly universally understood and experienced entity that is precisely the problem.” An ironic aspect of the double standard in Australia is that while the Commonwealth health insurance scheme, Medicare, provides a rebate for circumcision of boys, it is specifically prohibited from covering any cutting procedures on the female genitals, no matter how old the owner. It has been pointed out that this restriction may breach the Sex Discrimination Act, which provides that each gender must receive equal treatment in the provision of Commonwealth benefits and services. Charles Piot checks in with a brief yet perceptive analysis of the Kasinga case, in which the United States granted political asylum to a Togolese woman on account of her alleged fear of FGC. Corinne A. Kratz next provides an in-depth review of both Kasinga and the other precedent-setting US asylum case based on fear of FGC, Abankwah. She demonstrates that both cases involved substantial fraud by immigrants whose main aim was to secure permanent residency in the USA! Kasinga was actually from a Togolese group that does not circumcise females, while the very name of “Abankwah”, as well as nearly everything else she said about herself, turned out to be fabricated. Nevertheless, in accordance with legal principles, her award of asylum still stands as good law and a precedent in the USA. Kratz wonders whether “political lobbying and media outrage short-circuit judicious reasoning?” Kratz’s analysis gives substance to the editors’ discussion of the sexist bias inherent in the fact that fear of circumcision is a ground for seeking asylum only by women; the assumption seems to be that males are expected to take what’s coming to them without complaint. Michelle C. Johnson contributes an interesting case study of the interactions of culture, religion and FGC among the Mandinga people of Guinea-Bissau and Mandinga immigrants living in Portugal. She shows that Mandinga women affirm what they see as “the fusion of ethnicity and Islam by inscribing it onto their bodies.” Mansura Dopico provides us with a study of the sexual experiences of the infibulated women of rural Eritrea and in Australia, demonstrating the great variety and unpredictability of their sexual responsiveness. Johnson argues that, contrary to common belief, “there is some evidence that removal of the clitoris cannot inhibit either arousal or orgasm.” And that “the relationship between FGC and lack of sexual satisfaction had been grossly exaggerated.” R. Elise B. Johansen writes about Somalis and infibulation in Norway. Her chapter relates to broader topics than FGC (such as the Somali construction of female virginity and the contrast between the Western tendency to fake orgasm and the Somali tendency to hide female sexual pleasure), and it is all the more fascinating for the breadth of her approach. She makes intriguing counterpositions of Western and Somali views on sexual matters and comments that “The practice of genital cutting itself suggests that inborn genital differences are not considered sufficient to constitute proper men and women.” Next comes the irrepressible iconoclast Fuambai Ahmadu, who told the story of her own circumcision during a visit from the US to her childhood home in Sierra Leone in the editors’ earlier collection. Her unusual status as an African-born, Western-educated academic on the topic of FGC who voluntarily returned to her homeland to be circumcised gives her a uniquely authoritative perspective on the huge cultural prejudices that constitute beams in the eye of the West. She suggests that “the potential psychosocial damage of negative FGM campaigns on teenage girls and women could be far worse than any impact of the physical act of cutting the clitoris.” She refuses to accept her definition by enlightened others as “mutilated,” forthrightly affirming that “I have not experienced any change, either elimination or reduction, in sexual response following my own initiation.” Male and female circumcision compared The best essay in the collection is left for last. Henrietta L. Moore contributes a magisterial and far-reaching meditation on culture, difference and power, gender and agency, drawing together all the other authors in an integration that transcends the FGC issue and embraces topics of concern to all humanity — culture, justice, gender, and understanding difference. “The West, it turns out, has culture just like everyone else,” she reports. “The very idea of a rooted, native culture was the product of a traveling, comparative Western gaze.” It is so obvious and yet so rarely mentioned that Africans in circumcising cultures “may have both positive and negative feelings toward female genital operations” – just like Americans with respect to male circumcision. Moore writes that “a curious resonance is established between Western discourses of liberated female sexuality and the relationship of the clitoris to sexual pleasure and agency and more ‘local’ male discourses about the importance of removing the clitoris in order to bring sexuality under the woman’s control as a means to ensure successful, socially reproductive sex.” She observes that the political asylum cases discussed in earlier chapters “relied to a significant extent on reifying and ossifying culture … What characterizes the globalized world is everyone thinks they know about culture and about the difference that cultural difference makes.” In fact, however, new “forms of hybridization, cosmopolitan consciousness, and emerging secularism … are everywhere accompanied by new forms of cultural fundamentalism, nationalism, and religious intolerance.” Regrettably, well over a score of typographical, grammatical and reference errors not present in Shell-Duncan’s and Hernlund’s earlier volume mar this production. I also spotted one substantive error that should have been caught and corrected by fact the checkers, concerning the organization of the (now renamed) Immigration and Naturalization Service. Such imperfections do not undermine the validity of the authors’ conclusions, though they do indicate a degree of laxness, or perhaps haste, that should have been avoided. Transcultural Bodies makes an important contribution to critical thinking about genital cutting, human rights, anthropology, feminism and culture, offering a broad-ranging plurality of perspectives and topics that is all too rare these days, yet remaining focused on the unifying topic of female genital cutting. It is so well-done that it transcends its seemingly narrow subject matter and (as Moore suggests) offers a broad and stimulating perspective on our increasingly globalised world. Reviewed by J. Steven Svoboda, Attorneys for the Rights of the Child, San Francisco <h3>One American woman's experience of genital mutilation</h3> Patricia Robinett. The Rape of Innocence: One Woman's Story of Female Genital Mutilation in the U.S.A. Eugene, Oregon: Aesculapius Press, 2006. 112 pages. $20.00. Available from Amazon or <a href="http://www.aesculapiuspress.com./" rel="noopener" target="_blank">direct from the publisher</a> Patricia Robinett has written a truly remarkable account of her personal story. The author was a victim of genital surgeries performed on her when she was a girl. She describes the events fairly objectively though not without passion, and of course strong anger particularly at her mother who arranged the procedure. Patricia proves herself that rarest of writers who can write a memoir as her first book and maintain a focus and an objectivity that is genuinely admirable. She writes movingly, stunningly, about events arising from her own incredible experiences while leading the reader through her emotional roller coaster ride rather than, as is more common and much easier, essentially strapping the reader into the car and leaving them to handle the rough ride themselves. More impressively, Patricia simultaneously manages to achieve a paradoxical distance and perspective that places her life events in a larger societal context relating to the paradox that is genital cutting in the US. Some of us know that the nineteenth century craze for medicalized male circumcision was accompanied by a passion for the corresponding female procedure. Medical justifications were virtually identical, the general idea being that moral hygiene and personal hygiene mirrored each other and that both could be advanced by reducing the incentive, ie., the pleasure produced by youthful masturbation. Female circumcision appears never to have numerically matched the cutting of boys. The practice gradually died out in the 1950's. Articles advocating female circumcision were published in medical journals and popular magazines (including Cosmopolitan) even into the 1970's in the US. As the author states on the back cover of her book, Blue Cross Blue Shield paid for clitoridectomies until 1977. Ever since medicalized circumcision first developed one and a half centuries ago, we have lived in a profoundly wounded culture, which in turn has found an almost limitless number of ways to harm individual boys and girls. Patricia's story is a horribly sad one. It is bad enough that her labia were cut in a misguided attempt to prevent urinary tract infections (UTIs) but as she relates, she was forced to undergo a second genital cutting. Chillingly, "it appears it was not necessarily [performed] for medical purposes." According to the author, she and her mother never bonded and a sort of power struggle was partly to blame for her repeat surgeries. Sadly, though of course completey understandably, the author is a bit fixated on seemingly trivial childhood events such as her kindergarten sweetheart (whose name she won't tell us), her strict principal who may have been the one who recommended the clitoridectomy to her mother, etc. I dare say any of us who endured what the author did might have learned to survive through similar psychological defense mechanisms. In her twenties, Patricia took an important step in her path of self-discovery and recovery when she started volunteering as a counselor at an institution called White Bird. She describes White Bird as "a surreal environment where all the Ph.D.s wore plaid, flannel shirts and were paid minimum wage, including the CEO." In one pivotal session, a previously suicidal client of Patricia's turned over to her all the razor blades the client had previously used to cut herself. In the author's words, "The unspoken message was clear. 'I don't need to cut myself any longer.'" As she gained maturity and perspective from her work and from her path of healing, "My world view became less judgmental. I saw that there are no good guys, there are no bad guysâ€”there is only fear and love." The author does make one basic mistake when she incorrectly states that a reduction in UTIs from two in a hundred boys to one in a hundred boys would be a 100% reduction in UTIs whereas of course it is actually a 50% reduction. Nevertheless her point remains valid: relative percentage reductions can be high even when the actual overall reduction is small. Luckily, the author was able to find some poor redemptive value in relating her story to others and moving on, transforming the pain and working to protect others from it. This short book is an essential one for anyone interested in genital mutilations, or indeed for anyone who cares about humanity, love, and survival. Fair disclosure: Although I do not believe this affected my opinion of her book, Patricia is a friend of mine. Reviewed by J. Steven Svoboda, Attorneys for the Rights of the Child, San Francisco <h2>Female Circumcision: Multicultural Perspectives</h2> Female Circumcision: Multicultural Perspectives. Edited by Rogaia Mustafa Abusharaf. Philadelphia: University of Pennsylvania Press, 2006. 287 pp. $19.95. Long-time Sudanese-American activist against female genital mutilation (here referred to as female genital cutting – FGC) Rogaia Mustafa Abusharaf has edited Female Circumcision: Multicultural Perspectives. For better and for worse, this book exemplifies the strengths and weaknesses of edited volumes. Some contributions (those at the beginning and end of the book) are highly engaging and enlightening, while several of the middle chapters add little to the existing literature or to our understanding. Things start off very promisingly indeed. Following a well-written (if somewhat pro forma) overview of the chapters to come written by the editor, Egyptian-American anthropologist Fadwa El Guindi provides us with a fascinating and laudably free-thinking overview of FGC among Nubians in Egypt. El Guindi’s title, “Had This Been Your Face, Would You Leave It As Is?” suggests that her mission is to re-examine practices in a manner as free from cultural biases as possible. Her extensive experience as an activist is evident. “Over forty years ago … [Charles] Callender and I argued for the significance of the notion of the cultural equivalence of male and female circumcision. I argue now that this cultural equivalence extends analytically as a structural equivalence: that is, the two gendered rituals play equivalent roles in the transition of male and female children to adulthood … mark[ing] a transitional phase between birth and marriage.” El Guindi trenchantly notes that “Americans who express concern about female circumcision in other places do not campaign against [nose jobs, facelifts, and breast enlargement] with equal fervor, despite the known health risks involved.” Subsequently she expands on the analogy. “The phenomenon deceptively called ‘breast enhancement’ could well be called ‘breast mutilation.’ Culturally, it amounts to substituting men’s sex pleasure in women’s breasts for their maternal function.” Accordingly, she points out that “Cross-cultural discussions about these matters should employ a single standard, not apply different standards to boys and girls or to Americans and Arabs or Africans.” Cruelty of male circumcision El Guindi finds lack of choice and absence of ritual to be the two most pungent problems with male circumcision (male genital cutting – MGC): Choice is not brought up in relation to men who undergo very severe circumcision in various parts of the world, or the male babies in America who are operated on involuntarily. I find the cruelty of American male infant circumcision to lie in two dimensions: the absence of choice, and the absence of ritual. … Why do not activist feminists care about men’s circumcision? Their agenda is narrowly focused on women in Africa and the Middle East, who can be presented as inferior, less advanced, or more oppressed than Western women. … Most interventionist debate … assumes that women in non-Western societies are childlike and helpless, passive victims of their men, who must be saved by Western missionaries and feminists. This stance is arrogant and ethnocentric. El Guindi’s conclusion is highly sympathetic to current efforts to bring discussion of male circumcision within a regular ethical framework: “In considering circumcision, we must include male and female forms in the same discussion.” In the chapter following this extremely promising start, the Swiss-Palestinian academic Sami A. Aldeeb Abu-Sahlieh criticises “a tendency to exaggerate the harmful sexual effects of female circumcision and to underestimate those of male circumcision.” In the end, he finds that it comes down to human rights. “The right to physical integrity is a principle. We must accept or reject genital cutting in totality. If we accept this principle, we must refrain from cutting of children’s genitals regardless of their sex, their religion, or their culture.” I found Aldeeb’s contribution to include a rather more detailed review of religious doctrine than necessary, and yet one cannot help but welcome the perspective of the author of the excellent book Male and Female Circumcision Among Jews, Christians, and Muslims: Religious, Medical, Social and Legal Debate (Shangri-La Publications, 2001). Double standards rule Following this stellar beginning, the quality of the chapters in the succeeding section on African programs to eradicate FGC declines sharply. Asha Mohamud, Samson Radeny, and Karen Ringheim address “Community-Based Efforts to End FGC in Kenya,” and in the process reveal that have never met a male foreskin they liked, and are probably the record holders (no mean feat!) for the number of times they blithely assert the incomparability of MGC and FGC. Methinks they protest too much! Moreover, reading between the lines, it is evident that they are twisting their respondents’ words to make them conform sufficiently with their sexist shibboleths. The degree to which the three authors are weighted down with dogma is ironic, given that the two principal programs they are reviewing (Maendeleo Ya Wanawake Organization – MYWO – and Program for Appropriate Technology in Health – PATH) have helped reduce FGC while remaining culturally sensitive by retaining a balanced perspective that permits ceremonial, non-mutilating rituals to continue. I also wonder why these three musketeers mention but fail to respond to “critics [who] questioned the priority given to eradicating FGM I light of other prevalent health problems, such as malaria.” Most alarmingly, the authors assume that men (apparently by themselves) are forcing FGC upon girls to control their sexuality, whereas it is typically the mothers and grandmothers who are the primary continuers of the practice – as Havelock Ellis noticed over a century ago in his pioneering studies of sexual practices (Studies in the Psychology of Sex). Amal Abdel Hadi tells a happier tale about Deir El Barsha, a Christian village in Egypt, which discontinued FGC in 1992 as a natural outgrowth of development efforts that promoted women’s participation and equality. The next two chapters, respectively by Nafissatou J. Diop with Ian Askew, and Hamid El Bashir, are more conventional and do little to advance the ongoing dialogue about reconciling opposition to FGC with concerns about cultural imperialism. Shahira Ahmed’s review of the work of Sudan’s Babiker Badri Scientific Association for Women’s Studies and the Eradication of Female Circumcision is even worse, uncritically parroting the attempts by Muslim clerics to justify their opposition to FGC yet simultaneous support for MGC. The next chapters improve greatly. Raqiya D. Abdalla, who nearly thirty years ago published the groundbreaking book on FGC, Sisters in Affliction, concludes the section on African anti-FGC programs by providing us with several heart-rending first-person accounts by women who survived infibulations. Female circumcision in Canada The final section, on debates in immigrant-receiving societies, is more even-handed and engaging. Audrey Macklin discusses attempts to use the criminal law to combat FGC in Canada, showing the potentially counterproductive outcomes of overly paternalistic approaches. Intriguingly, she observes that the argument for outlawing MGC was actually stronger than it was for the action the Canadian government took in explicitly criminalizing FGC when that practice had already been pronounced illegal under existing laws against assault: From a purely doctrinal perspective, it would have made more sense to create an exemption from the law of assault for male circumcision, a common cultural and religious practice in North America. ... The fact that no one seriously fears criminal prosecution for circumcising a male child speaks to the power of dominant cultural norms to supersede the letter of the law and determine what the law is “really” about. After lengthy investigation, Macklin discovered, to her astonishment, that the primary impetus to criminalize FGC in Canada “emanated from women in immigrant communities who inserted themselves directly into the legislative process.” Macklin contradicts herself on at least one point, stating on p. 216 that no one has ever been charged in Canada with an FGC-related offense, and then asserting four pages later that a Sudanese couple was charged in 2002 for performing genital cutting on their daughter. Charles Piot checks in with a brief yet perceptive, provocative and brave analysis of the Kasinga case in the United States, in which political asylum was granted to a Togolese woman based on her alleged fear of FGC. I could not help but notice that this appears to be an earlier version of his similar article in Bettina Shell-Duncan and Ylva Hernlund’s superlative collection Transcultural Bodies: Female Genital Cutting in Global Context (2007). Nevertheless, Piot is so good at what he does that I enjoyed rereading his even-handed review of this woman’s fraud-filled story and of the systemic biases and crude anti-African prejudice (among the court and the public alike) that contributed to her eventual victory. The unfailingly brilliant Nigerian-American scholar L. Amede Obiora concludes the book with an afterword ostensibly reviewing and integrating the contributions to this volume. Much as I enjoy Obiora’s writing and her commitment to a mode of FGC scholarship that is free from groupthink and committed to balancing culture and rights, I was disappointed by her failure to even mention Sami Aldeeb’s contribution to Female Circumcision. Despite the efforts of several contributors to grapple with MGC, and the double standards that necessarily get raised when analysis of it is quarantined from FGC, Obiora focuses exclusively on FGC. Female Circumcision: Multicultural Perspectives ends up as bit of a mixed bag, but a reasonably-priced book whose opening and concluding chapters amply repay the reader’s attention and financial outlay. Reviewed by J. Steven Svoboda, Attorneys for the Rights of the Child, San Francisco </div> Dublin Core The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/. Title A name given to the resource Book reviews on FGC darby