6 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>In praise of the condom</h3> Sensible people that they were, the ancient Greeks believed that the good things in life â€“ olive oil, wine, music, to name a few â€“ were sent by the gods for the benefit and happiness of mortals. Had the condom been invented in that society it would also have been hailed as a heaven-sent gift, obviously intended to protect people from sexually transmitted disease and unwanted pregnancy. What could be more rational, and indeed pious, than to use it for these purposes? The society in which the condom did eventually make its debut was not, however, a rational one, but a world of religious fanaticism and increasing sectarian strife, as the forces of Reformation and Counter-Reformation contended for the hearts, minds and bodies of Europe. The Renaissance had recovered much ancient learning and literature, as well as its spirit of inquiry, but the revival of pagan sensuality was a fitful process, limited to bohemian pockets that somehow escaped the scrutiny of the inquisitors. In this context the predominant â€“ and certainly the official â€“ response to the condom was not to hail it as a gift of God, but to revile it as a snare sent by the Devil to tempt men and women from those paths of rigid chastity or fatalistic child-bearing that the Church had laid down as the only permissible courses for fallen humanity to follow. Gabriele Falloppio and de Morbo Gallico It was not, however, as a contraceptive that the condom made its first appearance. Fanciful stories about prehistoric cave drawings, gladiators and Roman ladies aside, the condom â€“ or something resembling what we understand by the term â€“ was invented by the sixteenth century anatomist Gabriele Falloppio as a prophylactic against the new and fearsome disease that was then ravaging Europe â€“ syphilis. He gave men little linen sheaths to be tied over their penis before intercourse, and he claimed that of a thousand or so clients who tried the device, not one became infected. From this point on the condom became a common accessory of the man about town (it was too expensive for labourers or servants), though it was not until the more sexually relaxed eighteenth century that we hear much about its use â€“ James Boswell complaining about the necessity for his armour, and Casanova delighting in the way it permitted his lovers to admire the abundance of his sperm, have become familiar vignettes from that libertine world. It was, indeed, the association of condoms with a licentious and promiscuous lifestyle (mistresses, prostitutes etc) that made them almost unthinkable as a birth control device for the respectably married. Preoccupied as they were with family limitation as a means of raising working class living standards and improving the status of women, none of the prominent sexual radicals of the nineteenth century (Francis Place, Richard Carlile, Robert Dale Owen, Annie Besant) recommended them for this purpose. Instead, they advocated early withdrawal or a post-coital sponge to discourage babies, while trusting to fidelity as the means of avoiding disease. The latter was not, of course, much use if either partner had been sowing or receiving wild oats before marriage, and the steadily rising incidence of syphilis and gonorrhoea throughout the Victorian period only goes to show that such admonitions were as ineffective then as they are today. George Drysdale There was one remarkable exception to the general rejection of condoms in the person of George Drysdale, whose radical views on sexual freedom made him a pariah from respectable society and suspect even among the avant garde. Although largely forgotten today, his daring manifesto Elements of Social Science (1855) had a massive underground circulation in the second half of the nineteenth century, and helped to lay the foundations for the transformation of sexual attitudes and practices that followed the two world wars. At a time when the medical profession was insisting that sexual indulgence was dangerously debilitating, and extreme moderation the only safe course (especially for men), Drysdale's counter-arguments that sex was as health-giving as it was pleasurable, and that young people should form casual attachments as soon as they became sexually mature, made him a frequent (though unnamed) target of abuse in the mainstream medical press. Doctors were equally angered by his advocacy of condoms as a simple and straightforward means of avoiding the risks implicit in his vision: venereal disease and pregnancy. Although many aspects of the sexual revolution that Drysdale foreshadowed have come to pass, at least in parts of the world not blighted by politico-religious obscurantism, his strictures against those who sought to prevent the use of condoms on so-called moral grounds remain relevant today. "By far the most certain preventive of ... venereal diseases is the condom, an artificial sheath for the penis made of very delicate membrane ... so thin as not very greatly to interfere with the venereal enjoyment." It was unfortunate, however, that the sheath was little used in Britain, mainly because it had been "proscribed by moralists as an unnatural, and therefore immoral, interference with the normal act", and it was often difficult to obtain. Drysdale looked forward to the enlightened day when society had recognized the value of the sheath as the surest means of passing "scatheless through the very midst of infection", and when disease was no longer seen as a salutary warning to sinners. "When society has become fully alive to the desire to prevent venereal diseases ... then and not till then will the great value of the sheath be perceived as a most powerful means of such protection". Meanwhile, he hoped that it would come into more general use; it was only misguided adherence to outdated notions of sin and guilt that stood in the way of "the sacred cause of the prevention of disease". [1] Condoms annoy agenda pushers As Aine Collier's history makes abundantly clear, condoms have always infuriated those wishing to enforce puritanical standards in sexual behaviour or to drive the agendas that condoms made unnecessary â€“ chastity and male genital mutilation, to name a couple. It was, in fact, the very effectiveness of condoms as a shield against infection and pregnancy that made them so objectionable, for they abolished the old argument, influentially reformulated by Thomas Malthus, that the only legitimate purpose of sex was reproduction and that venereal disease was divine retribution for sexual transgression. Throughout the nineteenth century the medical profession opposed any form of contraception and campaigned specifically against the use of condoms as a protection against syphilis. Malthus's moral views had been shaped by the teachings of William Paley (1743-1805), especially his Principles of Moral and Political Philosophy (1785), in which he argued that God had designed a world in which pleasure or pain was the reward or penalty attached to actions that were either conducive or detrimental to our virtue and happiness. In line with this outlook, Malthus wrote: <div>Natural and moral evil seem to be the instruments employed by the Deity in admonishing us to avoid any mode of conduct which is not suited to our being, and will consequently injure our happiness. If we be intemperate in eating and drinking, our health is disordered ... if we multiply too fast, we die miserably of poverty and contagious diseases. ... The uneasiness we feel from repletion ... and the inconveniences we suffer on the approach of poverty, are all admonitions to us to regulate those impulses better; and if we heed not this admonition, we justly incur the penalty of our disobedience, and our sufferings operate as a warning to others. [2]</div> This system of moral consequentialism implied that sin would produce unhappiness, meaning that happiness was best achieved by a moral course: because sexual excess would lead to disease and too many children, the sensible thing from both a moral and practical point of view was restraint. But the system of penalty and reward relied on people reaping the wages of sin. If they could somehow avoid the consequences of excess by contraception to block pregnancy or prophylactics to protect themselves against venereal disease, the punishment for immoral behaviour would vanish, and the system would break down. Thus we find a medico such as Henry Bickersteth objecting to sex education on the ground that if ordinary people had such information they might be able to evade the punishments ordained by God for sexual transgression: "it is not intended to extend these directions ... to the diseases which the Almighty has been pleased to inflict as a bitter scourge on the unlawful indulgence between the sexes". [3] In the 1860s a few diehard surgeons, such as Samuel Solly, still opposed efforts to combat syphilis on the ground that it was a scourge specifically created by God to punish illicit sex, and as late as 1900 Jonathan Hutchinson objected to regulation of and health checks on prostitutes because he felt they would reduce the penalties for fornication. Both Solly and Hutchinson were extremists, but the medical profession as a whole remained violently opposed to both contraception and prophylactics throughout the nineteenth century and until well into the twentieth, a position usually justified on the basis of this sort of Paleyite-Malthusian reasoning. Jonathan Hutchinson Despite his extremism, Hutchinson's celebrity status as Britain's leading authority on the most feared disease of the time â€“ syphilis â€“ made him a powerful force. As a devout Quaker with deeply puritanical objections to non-procreative sex, he regarded any methods of contraception with "disgust": such practices were "prejudicial to both moral and physical health". [4] His solution to the syphilis epidemic was neither condoms nor regular sex with trusted partners, but abstinence and circumcision of boys, a case he had first advanced in the 1850s and pushed strongly throughout the 1890s. In a typical lecture, "The advantages of circumcision", delivered at the turn of the century and widely reported in British and American medical journals, he contended that the strongest argument in favour of "the general practice of circumcision" was that it "would reduce the prevalence of syphilis"; in support of this view he pulled out some old statistics, "which proved" that, while gonorrhoea was as common among Jews as among Christians, syphilis was "much less frequent". This fact showed that it was not superior morality which gave Jews their "comparative immunity", but some "adventitious advantage" which could only be "the absence of the prepuce". Hutchinson assured readers that no measure for the prevention of syphilis was as efficient as circumcision, but he made no mention of safe sex alternatives such as condoms, a silence consistent with his opposition to contraception as morally unacceptable and physically harmful: any measure which made "irregular sexual intercourse less dangerous" were "injurious to decency ... and detrimental to the moral conscience of a community". Circumcision did not present this drawback: "Effected in early infancy, and with other avowed objects, it would silently become the means of preventing ... a loathsome and misery-producing disease." The value of the operation would be enhanced by its effect in diminishing the sexual appetite: <div>The only function which the prepuce can be supposed to have is that of maintaining the penis in a condition susceptible of more acute sensation than would otherwise exist. It may be supposed to increase the pleasure of the act and the impulse to it. These are advantages, however, which in the present state of society can well be spared, and if in their loss some degree of increased sexual control should result, one should be thankful. [5]</div> In other words, in controlling syphilis circumcision was preferable to condoms or health checks because it would discourage pre- and extra-marital sex. Circumcision versus condoms: An old argument Although Drysdale was keen to keep up to date with modern medical advances, he had no time at all for this particular innovation. In the 1850s genital surgeries, for both males and females, were being urged as the latest and most scientifically proven approach to the cure or prevention of many intractable complaints, particularly masturbation and nervous diseases such as epilepsy. In 1855 Hutchinson had published clinical evidence that male circumcision reduced the risk of syphilis and claimed that he had thereby established a compelling case for routine circumcision of male infants and boys. [6] Drysdale was not impressed: he condemned "the unnatural â€¨practice of circumcision, wantonly inflicted on helpless infants" as a symbol of the "spiritual" disgust at the human body that the English had inherited from the religious code of the ancient Hebrews; their numerous laws against sexual impurity were also a factor contributing to the oppression of women in his own society. "These awful cruelties, the very thought of which fills us with horror, â€¨are ... the most remarkable proofs of sexual barbarism â€¨recorded in history," he wrote. [7] Although Drysdale was sufficiently of his period to accept that masturbation was harmful, he never entertained the possibility (urged by so many doctors at that time) of circumcision as an appropriate preventive or cure, and continued to advocate sexual intercourse with a loving partner as the best alternative. Similarly with syphilis. Although Drysdale accepted Hutchinson's demonstration that circumcised men were at less risk of infection, he did not agree that widespread circumcision was the best response, much less that the operation should be inflicted on everybody. Instead, he suggested that "those who have much promiscuous intercourse might imitate this, by drawing back the prepuce, and so keeping the glans habitually exposed", thus hardening it and making it more resistant to penetration by the infectious particle. [8] Even more effective, however, was the sheath, regular use of which would be a powerful safeguard. [9] Drysdale was perfectly aware that those who did not have much promiscuous intercourse and did not patronize prostitutes were at negligible risk of syphilis, and he regarded the notion of circumcising everybody "as a precaution" as no more scientific than the Inquisition's guiding principle that it was better for a thousand innocents to be burnt than for a single heretic to escape punishment. Why don't we learn from history? It is frequently said that those who fail to learn from history are condemned to repeat it, and in no sphere does this clichÃ© seem more applicable than in contemporary American responses to STD control and sex education. The spirit of Jonathan Hutchinson seems very much to have been the animating force behind the Bush administration's policy of promoting circumcision in Africa as the strategy against AIDS and abstinence education at home as a tactic against STDs and teen pregnancy. Despite the results of three, much vaunted, clinical trials in Kenya, Uganda and South Africa, it is still too early to evaluate the usefulness, much less the acceptability, of circumcision as a prophylactic measure against HIV infection, though the approach has been attacked by the South African Medical Journal as costly, ineffective, a violation of accepted principles of bioethics and human rights, culturally insensitive and smacking of medical colonialism. [10] In the United States, however, the abstinence programs launched, with much fanfare, in 1998 have been the subject of a rigorous evaluation by Mathematica Policy Research, which found no difference at all in sexual behaviour, STD acquisition or condom use between those who had done the course and a control group who had missed out, and only a small difference in sexual knowledge. (The control group knew a bit more.) There was one small difference between the two groups: very slightly more of those who had received the education had enjoyed four or more sexual partners in the period following the course. (They had evidently learned something.) Collier quotes presidential candidate Bush stating, in his homely way in 1998, that "the folks that are saying condom distribution is the best way to reduce teenage pregnancies obviously haven't looked at the statistics"; but the facts show that it is he and his friends who have ignored the data. These results are consistent with other research which shows, contrary to the received and much trumpeted wisdom of those who assert that religious belief is the surest guarantee of restrained sexual behaviour, and thus of disease avoidance, that higher rates of STDs are found in countries that are more religious. A recent study of the world's eighteen major democracies by Gregory Paul found that the more atheistically-inclined societies tended to have lower rates of murder, suicide, STDs, abortion and teen pregnancy than the more religious, and that among the developed nations the United States was remarkable in boasting the highest incidence both of these problems and of religious fervour. Although the late twentieth century STD epidemic has been curtailed in all prosperous democracies, he writes, rates of adolescent gonorrhoea infection remain six to three hundred times higher in the United States than in the more secular democracies. The U.S.A. also experiences uniquely high adolescent and adult syphilis infection rates, while in strongly secular Scandinavia the two main curable STDs have been almost eliminated. "Increasing adolescent abortion rates show a positive correlation with increasing belief and worship of a creator, and a negative correlation with increasing non-theism and acceptance of evolution; again rates are uniquely high in the U.S." [11] It should also be pointed out that the European countries with low rates of STD infection are precisely those which do not practise circumcision, a fact which throws serious doubt on the proposition that it provides meaningful protection in the sexual minefield, and which leads the writer in the SAMJ to comment that "the social experiment of circumcision to prevent STDs, including HIV, has already failed in the USA, which has the highest rate of non-therapeutic infant circumcision in industrialised countries and the highest rate of HIV in the developed world." [12] AIDS in Africa: Human anatomy not the problem It is generally understood that the AIDS epidemic in Africa is driven by a combination of poverty, population mobility, a high incidence of transient sexual unions and prostitution (of various kinds), leading to numerous concurrent sexual partnerships and extensive sexual networks; that the problem was allowed to get out of control by the delayed response of governments; and that it is massively aggravated by a general reluctance to use condoms or practice safe sex. It is further agreed that widespread and regular condom use would go a long way to addressing the problem, as it has done in places such as Britain, Australia and western Europe. A study of Nigerian prostitutes in 1988 found that, after counselling sessions, condom use increased markedly and that even occasional condom use had a significant protective effect: of 28 women who never used a condom, only eight escaped infection with HIV; but of 50 women who used them in approximately one third of sexual encounters, 27 (54 per cent) avoided infection. [13] It is interesting to compare this with the results of the recent clinical trials of circumcision, which reported a risk reduction of between 50 and 60 per cent: almost exactly the same as the risk reduction achieved by condom use 30 per cent of the time. Yet African men remain reluctant to use condoms, a rejection abetted by the churches, which preach vigorously against them, not merely on the ground that their use is contrary to Christian teaching, but with gross falsehoods, such as the claim that condoms are impregnated with the AIDS virus and are otherwise risky or dangerous. We may laugh grimly at Vatican Cardinal Trujillo's statement in 2003 that the latex of condoms does not give full security against the AIDS virus and that governments should therefore require them to be accompanied by a health warning, like cigarettes; but similar disparagement of condoms as not totally reliable has also been heard from medico-scientific figures who wish to promote circumcision instead. [14] The sad lesson of all this is that it is the very effectiveness of condoms as a shield against both disease and pregnancy that has, at least since the time of Malthus, been the biggest obstacle to their deployment. Their use by libertines made them suspect as a birth control device, while their effectiveness as a contraceptive earned them the ire of the nineteenth century medical profession, the United States government (which made it illegal to distribute contraceptive devices or information by post) and of course the Vatican â€“ though it took a while to make an authoritative pronouncement. Falloppio does not seem to have got into any hot water for promoting his proto-condoms back in the sixteenth century, but the Catholic Church's traditional opposition to any form of contraception, originally codified by Thomas Aquinas, was reaffirmed in the strictest terms by the encyclical Casti Connubii in 1930, [15] and the Vatican continues to reject the argument that the situation is different when a condom is used for the purpose of protecting oneself or another person from disease. The most authoritative research has found that condoms are 90 to 95 per cent effective against STDs, including HIV, when used consistently, meaning that consistent condom users are ten to twenty times less likely to become infected when exposed to the virus than are inconsistent or non-users. The authors further estimate that condoms decrease the per-contact probability of male-to-female transmission of HIV by about 95 per cent. [16] Given these data, there can be no earthly reason for failing to promote their use as widely as possible, nor for preferring inferior alternatives. Books referred to Aine Collier. The Humble Little Condom: A History. New York: Prometheus Books, 2007. pp 371, index. Paper, $18.98. ISBN 978-1-59102-556-6. George Drysdale, Elements of Social Science: Physical, Sexual and Natural Religion. London: George Standring, 1855; <a href="https://books.google.com.au/books?id=jsEBAAAAQAAJ" rel="noopener" target="_blank">available on-line through Google Books</a> Christopher Trenholm et al, Impacts of four Title V, Section 510 Abstinence Education Programs, Final Report. <a href="http://www.mathematica-mpr.com/" rel="noopener" target="_blank">Mathematica Policy Research</a>, April 200 <h4>References</h4> [1]. Elements of Social Science, 136-7 [2]. An Essay on the Principle of Population [1803], ed. Donald Winch (Cambridge Texts in the History of Political Thought, 1992), Bk. 4, Ch. 1 [3]. Angus McLaren, Birth Control in Nineteenth Century England (London: Croom Helm, 1978), 80 [4]. Herbert Hutchinson, Jonathan Hutchison: His Life and Letters (London: Heinemann, 1946), 200 [5]. Jonathan Hutchinson "The advantages of circumcision", Medical Review, Vol. 3, 1900, 641-2. [6]. Jonathan Hutchinson, "On the influence of circumcision in preventing syphilis", Medical Times and Gazette, NS Vol. II, December 1855, 542-3. For a detailed analysis, see Robert Darby, "Where doctors differ: The debate on circumcision as a protection against syphilis, 1855-1914", Social History of Medicine, Vol. 16, 2003, 57-78, and A Surgical Temptation: The Demonization of the Foreskin and the Rise of Circumcision in Britain (University of Chicago Press, 2005), Ch. 12. See also <a href="http://www.historyofcircumcision.net./templates/pages/the_crotchets_of_sir_jonathan_hutchinson.html" rel="noopener" target="_blank">The Crotchets of Jonathan Hutchinson</a> on this site. [7]. Elements, 159-60 [8]. Elements, 137 [9]. Elements, 155-6 [10]. D. Sidler, J. Smith, H. Rode, "Neonatal circumcision does not reduce HIV/AIDS infection rates"; A. and J. Myers, "Editorial: Rolling out male circumcision as a mass HIV/AIDS intervention seems neither justified nor practicable", both in <a href="http://www.cirp.org/library/disease/HIV/myers2008/" rel="noopener" target="_blank">South African Medical Journal, Vol. 98, No. 10, October 2008</a>. [11]. Gregory S. Paul, "Cross-national correlations of quantifiable societal health with popular religiosity and secularism in the prosperous democracies", <a href="http://moses.creighton.edu/JRS/2005/2005-11.html" rel="noopener" target="_blank">Journal of Religion and Society, Vol. 7, 2005</a> [12] Sidler et al [13]. E.N. Ngugi et al, "Prevention of transmission of human immunodeficiency virus in Africa: Effectiveness of condom promotion and health education among prostitutes", Lancet, Vol. 332, No. 8616, 15 October 1988, 887-890. In case it is suspected that the foreskin might have been a factor here, it should be remembered that the vast majority of Nigerian men are circumcised, and that female genital cutting is also common. <a href="http://www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%234886%231988%23996671383%23456237%23FLP%23&_cdi=4886&_pubType=J&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=36c0b533779b26840c4108cc37d812e9" rel="noopener" target="_blank">Abstract of Lancet article available here</a>. [14]. For example, Brian Morris, In Favour of Circumcision (Sydney: New South Wales University Press, 1999), 51, and, along with Daniel Halperin, in numerous opinion pieces in medical journals and comments in the media. Both are insistent that circumcision should be mandatory not merely for Africa, but for the entire planet. [15]. It is interesting to note that while the encyclical did not mention condoms, it did include (Paras 70 and 71) an explicit prohibition on mutilation of bodily members. [16]. Steven D. Pinkerton and Paul R. Abramson, "Effectiveness of condoms in preventing HIV transmission", Social Science and Medicine, Vol. 44, No. 9, 1997, 1303-1312 Further reading Lawrence Green et al, <a href="http://www.futuremedicine.com/doi/full/10.2217/17469600.2.3.193?prevSearch=authorsfield%3A(green)&searchHistoryKey=193-99" rel="noopener" target="_blank">Male circumcision is not the HIV vaccine we have been waiting for</a>, Future HIV Therapy, Vol. 2, 2008 Robert Van Howe and J. Steven Svoboda, <a href="http://www.medscimonit.com/abstracted.php?level=5&icid=865808" rel="noopener" target="_blank">Neonatal circumcision is neither medically necessary nor ethically permissible: A reply to Clark et al</a>, Medical Science Monitor, Vol. 14, 2008 </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 George Drysdale: Unsung prophet of safe sex 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>British Medical Journal: A ritual operation</h2> British Medical Journal, 1949 <h3>Editorial: A ritual operation</h3> Little is known of the origin of circumcision, despite the very considerable literature on the subject. (1) At its inception the practice seems to have had an essentially religious connotation and to have arisen independently in the continents of Africa, America,* and Australia. Among the Semitic races it is probable that circumcision started as act of consecration to the goddess of fertility with the object of winning her favour and thus ensuring the birth of children. Circumcision in ancient Egypt was certainly not undertaken for hygienic reasons, and probably it served as a sanctification of the reproductive faculties and a ceremonial initiation. It is likely that the ancient Pharaohs were circumcised, the circumcised state being a necessary qualification for the priesthood. It is reported that Pythagoras had himself circumcised while in Egypt so he might be fully initiated into the esoteric religious rites of the Egyptians. Among others, notably the American Indians, circumcision was mainly adopted as an alternative to human sacrifice. Although circumcision is widespread in Moslem communities the Koran contains no specific ordinance on this subject. Mohammed is said to have been born without a prepuce, and the possession of a foreskin was regarded as a disgrace amongst the Arabs. It is reported that after one of the Prophet's battles a slain Thaquafite tribesman was found uncircumcised, and great pains were taken to prove that he was a Christian and not truly a member of the tribe. In Arab communities the operation is performed with scissors, a razor, or a split reed, and there is a tradition that Abraham used an axe and was rebuked for his haste. Some of the methods of disposal of the foreskin are more a matter for interest than emulation. The Levites during the Exodus piled their foreskins in the wilderness and covered them with earth; in parts of West Africa, where the operation is performed at about 8 years of age, the prepuce is dipped in brandy and eaten by the patient; in other districts the operator is enjoined to consume the fruits of his handiwork, and yet a further practice, in Madagascar, is to wrap the operation specifically in a banana leaf and feed it to a calf. In happy contrast to some of these macabre practices is the habit of the Bani Chams in Australia with a wooden knife and leave their victims unscathed. In Britain, while the practice of circumcision is widespread, there are rather different reasons for its performance, and, though exact figures are difficult to obtain, it would seem that more than half the male members of the population are circumcised. Many doctors have for long rebelled against the wholesale and somewhat primitive lopping of the infant foreskin which goes on in some out-patient departments and surgeries. On these occasions the technique of the operation is frequently deplorable ; sacrifice of skin is often too generous, and attendant damage to the glans penis or fraenum is not unknown. If these criticisms are valid then it may well be asked why large numbers of doctors permit and encourage a practice which so savours of the barbaric. Religious considerations apart, it is not easy to find a rational argument for circumcision in most cases, and the operation is more often performed because it is de rigueur in certain districts or a habit in some families. Dr. Douglas Gairdner's valuable study, "<a href="http://www.cirp.org/library/general/gairdner/">The Fate of the Foreskin</a>," which appears at page 1433 in this issue, will, we believe, make many readers pause for reflection. Though medical opinion about circumcision may be more conservative than it used to be, yet even to-day the attitude of the profession in general to the subject is too often based upon false ideas of the anatomy and physiology of what is a useful cutaneous appendage. Of the value of the prepuce in the first two or three years of life there is no doubt, for it has an important function in covering and protecting the glans penis. Contrary to widespread belief, non-retractability, a frequent finding, is not synonymous with phimosis. There can be little medical justification for routine circumcision of the infant, and the operation is only occasionally necessary under the age of 3. After this age operation is indicated for cases of non-retractability with true phimosis and for those with recurrent preputial inflammation or paraphimosis. Circumcision should be limited in extent: the fraenal region must not be damaged, and sufficient skin must be left to cover the very sensitive corona glandis. Although the operation of dorsal slit is unpopular with some, it is both satisfactory and simple to perform, and the ultimate cosmetic outcome is good. Apart from the local reasons for circumcision it is argued by some that it will reduce the incidence of venereal disease, cancer of the penis, and cancer of the cervix uteri. The evidence supporting the first of these contentions is inconclusive ; the second is established beyond doubt ; while the available data on cancer of the cervix do not warrant the conclusions which have been drawn by some authorities. As Dr. Gairdner points out, it is likely that lack of cleanliness is more important than lack of circumcision in the case of venereal diseases and cancer of the penis. If the latter was not a very uncommon disease in this country it alone might provide justification for widespread emulation of the Jewish custom. The Mosaic law enjoins the practice of circumcision on the eighth day, and it appears certain that this ritual circumcision affords complete protection against carcinoma of the penis. Furthermore it has been shown that circumcision between the third and fourteenth years of life does not give complete protection against penile carcinoma.** (2) In the absence of more convincing evidence about carcinoma of the cervix it is difficult to describe its low incidence in Jewesses to the circumcision of their spouses. As Kennaway (3) has pointed out, the data are inadequate, and the low incidence in certain other races cannot be explained by circumcision. It seems safe to say that if Dr. Gairdner's recommendations are accepted much circumcisional morbidity and mortality will be avoided and, further, that there is no good reason to fear increased incidence of venereal disease or genital cancer as a result of this policy. * None of the indigenous societies in the Americas (north or south) ever practised circumcision, though there is some evidence that the Aztecs had a ritual which involved nicking the penis to draw blood. ** The statement that "ritual circumcision affords complete protection against carcinoma of the penis" was generally believed in 1949, but this is now known to be false. For more information see <a href="http://www.cirp.org/library/disease/cancer/" rel="noopener" target="_blank">pages on circumcision and cancer</a> 1 Hastings J., Encyclopaedia of Religion and Ethics, 1910, vol. 3 2 Kennaway, E.L., Brit. J. Cancer, 1947, 1, 335. 3 Ibid, 1948, 2, 177. SOURCE: "A ritual operation" (Editorial), British Medical Journal, 24 December 1949, pp. 1458-9 <h3>EDITORIAL: The case against neonatal circumcision</h3> British Medical Journal, 5 May 1979 Part of the North American way of life is removal of the foreskin within a few hours of birth. Nearly two million boys are born each year in the United States and in some centres 80%-90% are circumcised, [1] using vast amounts of medical and nursing time and costing parents equally vast amounts of money. In Scandinavia, on the other hand. routine circumcision is almost unknown, [2] and in Britain it is becoming unusual. In the 1930s about one-third of British boys were circumcised, [3] but by 1949 the proportion had fallen to one-fifth, [4] and by 1963 only 10% of schoolboys in Rochdale had been circumcised. [5 In hospitals in England and Wales in 1975 the rate was about 6% [6]; this represents some 20,000 circumcisions a year. The mortality is negligible. Practice in Britain may have been affected by Gairdner's important paper, [4] published in the BMJ in 1949. He showed that while 90% of boys have an unretractable foreskin at birth by the age of 3 the proportion has dropped to only 10%. Other studies have confirmed this natural development. In over 9000 schoolboys examined in Denmark [7] phimosis was found in 8% of 5-year-olds but in only 1% of secondary pupils. Among 152 teenage English boys only one had a non-retractable foreskin, although full retraction was prevented by an adherent prepuce in 22. Most circumcisions performed on the newborn are therefore unnecessary â€“ in the sense that in time nearly all boys become able to retract their foreskin and wash underneath it. The North American arguments in favour of mass circumcision are that many uncircumcised men do not perform this toilet, that they run a risk of developing carcinoma of the penis, and that their wives may run an increased risk of developing carcinoma of the cervix. These last two arguments could be weighty ones, but some careful studies [8, 9] have failed to show any difference in the incidence of cervical carcinoma in the wives of circumcised and uncircumcised husbands. Circumcision in infancy does virtually prevent penile carcinoma â€“ there are only six recorded examples of this neoplasm in circumcised Jews. [10] Even in the uncircumcised, however penile carcinoma is rare. In Sweden, which has a male population of 3.7 million (few of whom are circumcised), there are but 15 deaths from carcinoma of the penis in a year. [2] Some 5600 men die each week in England and Wales but only two of these deaths are due to penile carcinoma â€“ only 0.14% of all deaths for malignant disease in men. [11] Surgeons who work in areas where ritual circumcision is not available are sometimes asked to don rabbinical robes on the eight day to circumcise a Jewish baby, and they may have been impressed by the lack of distress as the baby sucks on a teat containing some brandy. There is however a big difference between these rites and routine circumcision of newborn boys. Too often this is seen as an uninteresting chore to be passed to inadequately trained junior staff, which evidently is not without risk. There are many reports of removal of most of the skin of the penile shaft, injuries to the glans, circumcision of hypospadiacs, and the need to perform a second circumcision on as many as 10% of babies because inadequate removal of mucosa has been followed by secondary phimosis. [1, 12] The present day hospital nursery, often colonised by antibiotic-resistant organisms, is a dangerous place for a newborn baby with a raw penile wound â€“ as is shown by two recent papers. [13,14] These record three babies who developed staphylococcal septicaemia (one fatal) and one with spreading septic gangrene of the scrotal skin after circumcision in the first week of life. Haematogenous osteomyelitis and lung abscess have also been reported as complications. Furthermore, all babies who lose their foreskin lose the natural protection of the glans penis, which prevents it being burnt by ammoniacal urine on the wet nappy. Meatal ulceration is a painful condition and meatal stenosis a serious one. Presumably most Americans are satisfied with their present practice, and some justify it most forcefully. Others, however do have misgivings, [16] in so far as there is really no rational case for general neonatal circumcision. On the other hand, surgeons and urologists know that many men conceal a dirty mess beneath the foreskin and that in some the discomforts of phimosis make circumcision necessary, and that this is an embarrassing and uncomfortable procedure in adult life. These problems can be forestalled. Examination of the penis, as well as the testes should be a standard part of school medical inspections. This would allow the few boys with true phimosis to be treated early, and at secondary school would provide an excellent opportunity to back up or amplify parental instruction in personal hygiene. Many surgeons who are not willing to perform circumcision much before three years of age accept that after that age operation is justified for phimosis and recurrent balanitis. The parents' wishes, both for and against the operation, must be taken into account; but the operation between 3 and 5 is probably the best compromise since it avoids the discomforts of circumcision later in life. Unfortunately only one-third of the operations in England and Wales are before 5 years. [6]. Nevertheless the circumcision rate of about 6% is probably the correct proportion in a Western country today. NOTE: This editorial expresses the view that about 6% of men need circumcisions. In a later editorial, <a href="http://www.cirp.org/library/general/gordon/" rel="noopener" target="_blank">Saving the normal foreskin</a>, published on 2 January 1993, the BMJ expressed the view that "overall between 1% and 2% of boys need circumcision for medical indications. Since this was before the development of alternative effective conservative treatments for phimosis and balanitis, it may be inferred that the editors of BMJ would put the rate much lower today, perhaps at 0.1% to 0.2% or 1 or 2 per 1000 boys. This would make the arguments expressed in this paper apply with even greater force. <h4>References</h4> 1. Gee, W F, and Ansell, J S, Pediatrics, 1976; 58: 824. 2. Apt, A, Acta Medica Scandinavica, 1965; 178: 493. 3. Carne, S, British Medical Journal, 1956, 2, 19. 4. Gairdner, D, <a href="http://www.cirp.org/library/general/gairdner/" rel="noopener" target="_blank">British Medical Journal</a>, 1949, 2 1433. 5. Kalcev, B, Medical Officer, 1964, 112, 171. 6. DHSS, Hospital In-patient Enquiry, 1975, Series MB4 No 5. London, HMSO, 1978. 7. Ã˜ster, J, <a href="http://www.cirp.org/library/general/oster/" rel="noopener" target="_blank">Archives of diseases in childhood</a>, 1968, 43, 200. 8. Aitken-Swan, J, and Baird, D. British Journal of Cancer, 1965, 19, 217. 9. Terris, M. Wilson, F, and Nelson, J H, American Journal of Obstetrics and Gynecology, 1973, 117, 1056. 10. Leiter, E, and Lefkovits, A M, New York State Journal of Medicine, 1975, 75, 1520. [Note: Modern research has established the role of the human papilloma virus and smoking in the etiology of carcinoma of the penis and of the cervix. The foreskin has been cleared of blame.] 11. Office of Population Censuses and Surveys, Mortality Statistics: Cause, 1975, Series DH 2 no 2. London HMSO, 1977. 12. Leitch, I O W, <a href="http://www.cirp.org/library/general/leitch1/" rel="noopener" target="_blank">Australian Paediatric Journal</a> 1970, 6 , 59. 13. Annunziato, D, and Goldblum, L M, <a href="http://www.cirp.org/library/complications/annunziato1/" rel="noopener" target="_blank">American Journal of Diseases of Children</a>, 1978, 132, 1187. 14. Sussman, S J, Schiller, R P, and Shashikumar, V L, <a href="http://www.cirp.org/library/complications/sussman1/" rel="noopener" target="_blank">American Journal of Diseases of Children</a>. 1978, 132, 1189. 15. Dagher, R, Selzer, M L, and Lapides, J. Journal of Urology 1973, 110, 79. 16. Gellis, S S, <a href="http://www.cirp.org/library/general/gellis1/" rel="noopener" target="_blank">American Journal of Diseases of Children</a>. 1978, 132, 1168. SOURCE: "The case against neonatal circumcision", (Editorial), British Medical Journal, 5 May 1979, pp. 1163-4 </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 British Medical Journal Darby 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>Sir Daniel Whiddon: Should baby be circumcised?</h2> The Lancet, 1953 In 1953 Dr W. B. St. C. Brewer, a family physician from New Zealand, asked Sir Daniel Whiddon, celebrated British surgeon, to see Mrs. T. C. who wanted to have her baby boy circumcised. Dr. Brewer's request and Sir Daniel's classic (and often cited) response were printed in the Lancet. The reference to Sidi Bou Ali is to the allied military campaign in North Africa during the Second World War, when both doctors served in the Medical Corps. Dear Sir Daniel Herewith Mrs. T. C. who wishes her firstborn circumcised. I hope you remember me. The last time we met was at no. 4 New Zealand Field Ambulance at Sidi Bou Ali in April 1943. I have just entered a partnership of four in this town and, so far, enjoy the life of a G.P. Yours sincerely, W.B.St.C. BREWER Dear Bill I remember you well, and am glad to hear that you are happily settled. Baby C is a fine specimen. He has the long, non-retractile prepuce of the normal newborn male infant; that it is not worrying him or obstructing the flow of urine he demonstrated to his own satisfaction and the discomfiture of one of my dressers. He will be circumcised at Minor Operations on Saturday; and his mother will be satisfied. I am not; and since I have had a short morning and dealt with all letters but yours, I feel inclined to use the time, the opportunity, and the services of an expert stenographer, to send you an Essay on Circumcision. What is the prepuce and why is it there? Why does Man remove it? Does routine circumcision do any good? Does it do any harm? What should be the attitude of the doctor towards this first step in surgical handicraft? These are some of the questions I should like to answer. The mammalian penis serves the double purpose of urination and generation. For the first purpose it remains flaccid, for the second it becomes rigid and elongated. Its shape, structure, and length vary widely in different species, but in all it is contained in a sheath, within which it remains while it is flaccid and from which it is protruded when erected for coitus. The human prepuce is the representative in Man of the sheath in other mammals - a covering protecting the glans penis, which is part of the mechanism of generation. The glans belongs to the group of special sense organs. It is almost insensitive to light touch, has no sense of tactile discrimination, and no appreciation of heat and cold, and it interprets painful stimuli (such as a pin prick) only as a vaguely unpleasant contact; but under appropriate stimulation it is capable of receiving pleasurable sensations that, when they have reached a certain pitch of intensity, take charge of the whole behaviour of the individual and lead to a series of uncontrollable actions that complete the important function of the life-cycle of the individual - the act of sexual union. The preservation, undulled and undiminished, of this special sense, and guarding of the mucous membrane in which it resides from long exposure and a dulling of its sensibility, is of paramount importance from the point of view of survival of the race. That then is the biological purpose of the prepuce. A second less important purpose is in the act of coitus itself. The erect circumcised penis enters the vagina without effort or any rate without friction, the prepuce unfolding as the penis advances and each part of it remaining in contact with successive areas of the vaginal walls, till finally the uncovered glans lies at the cervix. The circumcised penis, deprived of this self-tracking mechanism, is introduced to the accompaniment of friction between penile skin and vaginal mucous membrane. It is the difference between slipping the foot into a sock that has been rolled up and one that is held open at the top. The human foreskin, then, is neither vestigial nor useless. It is part of the normal mechanism of reproduction, and without it sexual desire is to some extent blunted, and the performance of the sexual act - at any rate the first act of coitus between the virgin male and the virgin female - made more difficult. Why is the operation of circumcision practised? As well ask: why do races all over the world make symbols of the egg and hare in the spring, the bonfire in the autumn and the evergreen tree in midwinter? The origins of circumcision at least can be traced. It is part of the ritual of mutilation by which the young male, and less often the young female, is called upon to suffer and give proof of courage, by which they are admitted to the privileges of the tribe or the estate of manhood or womanhood. In this respect it must be grouped with the various forms of tribal markings by burning or incision, with piercing or slitting of other prominent folds of skin, the ears, the lips, the nostrils. It is also performed to reduce sexual desire, to make the man a better warrior for his tribe, a more faithful husband to his wife, a less frequent disturber of the harmony of the society in which he lives. In Africa female circumcision is widely practised with the intention of making the woman chaste, a faithful wife and servant to her husband. The distribution of circumcision over the surface of the globe is irregular, and can be traced to the influence of the race, the conqueror imposing the practice on his subjects. Circumcision is universal in the Semitic races, and has been taken by the Arab to all the seacoasts of Africa and by the Jew to all parts of the world. The age at which it is practised also varies. Among the Jews and Arabs the male infant is circumcised soon after birth; among the central African tribes that practice circumcision (and many do not), the rite is performed every three or four years on all males who have reached puberty since the last circumcision, and these young men pass though the various stages of tribal life - the warrior, the parent, the farmer, the statesman, the priest - as one group known by the year of their circumcision. How often is circumcision necessary on surgical grounds? Here we must distinguish between circumcision in adult life, or at any rate after puberty, and circumcision in infancy. In the adult the unhealthy prepuce should be removed, and no sentimental embryological, racial or psychological arguments are strong enough to offset the general principle that unhealthy tissue should be removed. Circumcision in the adult should be performed for phimosis, for balanitis, for venereal or other preputial warts, and for early epithelioma as the first step in a course of treatment whose main plank is radiotherapy. True phimosis - that is a non-retractable and not mere a non-retracted prepuce - is seen only in adolescent and adult life. The infant prepuce cannot be retracted without force, and should not be retracted, but retraction comes normally in the years of childhood, without any maternal or medical assistance, and by puberty the non-retractable prepuce occurs in less than one in a hundred, and true phimosis - that is the prepuce with a fibrous stricture in the orifice - in perhaps one in a thousand. The reasons advanced for circumcision in infancy are a strange mixture of taboos handed down from the dawn of history, of Bible training, of midwives' and other oldwives' medicine, and of the unthinking advice of those storehouses of unexpurgated tradition, the surgical textbooks. The baby sent to outpatients is usually accompanied by a note to say he has phimosis (I was glad to see that you did not perjure yourself to this extent). Is there such a thing as a baby with phimosis? I am old enough to have taught your father, and I have never seen one. The penis is developed as a solid bud, prepuce and all, and the urethra is formed as an infolding of its under surface. Only late in foetal life does a line of cleavage appear to mark off the future prepuce from the future glans, and at birth this plane is a visible distinction but not a free space, and the newborn baby has a prepuce projecting at least half an inch beyond the new glans and forming a little corrugated tube, like the empty oesophagus or anal canal. He passes water frequently and often. He may scream in doing so, but it does not follow that he has phimosis. Babies scream for all sorts of reasons, usually because they have a silly mother and "they know it teases". They may scream in passing water because it hurts, as it may in the urine is highly acid, but not because the outflow is obstructed at the preputial orifice. The urinary apparatus may be congenitally obstructed at the lower ends of the ureters, in the prostatic urethra, at the meatus, but never at the prepuce. The very shaky science of the arguments in favour of wholesale infant circumcision is often supported by the statement, itself unsupported by any by any scientific evidence, that the circumcised are less liable to disease, particularly that they are less likely to get venereal disease and cancer. The first statement is untrue. You were long enough in the Middle East to know that our circumcised allies were the most enthusiastic supporters of the VD departments. The second is true to the extent that cancer usually starts in the prepuce near the corona. But cancer of the penis is a rare disease. Five thousand men die every week in England, and only four of them die of penile cancer. The possible relation of the prepuce to the onset of venereal disease is that it may render the penis more liable to single or repeated trauma. But the penis protected by a normal retractile prepuce undergoes less trauma in coitus and less repeated irritation by exposure than the circumcised one. Disease is possibly commoner in the adult with phimosis than in the circumcised; but in the normal uncircumcised; it is if anything less common. Does circumcision in infancy do any harm? Undoubtedly. Firstly, like all operations that are looked on as easy, it is often very badly done. The Rabbinical method in the hands of the rabbi is safe, speedy and satisfactory; done by the Gentile working from a textbook description, it is one of the worst. Ritual circumcision depends on cutting off both layers in one sweep, and turning the cuff of mucous membrane down, when it is bandaged without sutures and allowed to unite. If the removal of skin has been inadequate, if the cuff of mucous membrane comes forward again as it often does and the two unite by granulation, the result is appalling, a half-length prepuce ending in a fibrotic ring attached to the glans half-way up. Circumcision by proper surgical technique with trimming of the surfaces to the exact length and slope required, careful arrest of all haemorrhage, and suture of the cut edges with careful delicacy gives much better results; but may be disastrous in the hands of those who are not surgeons and know no technique. Unless the prepuce is freed completely from the glans before division, the meatus can be sliced off in the cut and a stricture that can never be overcome is produced. Apart from those evil results which are due to imperfect workmanship, there are the fairly common minor troubles that follow because a stupid and unnecessary operation has been done, a normal mechanism has been destroyed, and a delicate surface exposed to air and to friction four or five years before it should be exposed. Eczema of the glans and meatus is not rare in the newly circumcised infant; it needs careful treatment with ointment and sometimes leads to scarring and narrowing of the meatus. Those are the facts. But we must not break our hearts by putting two much of them into a fruitless crusade against infant circumcision. Fruitless it will be, for the medicine of the jungle and the witch doctor, the teaching of the Bible and Koran, the traditional science of the midwife, the health visitor, and the home medical dictionary are all against us. None the less, let us keep our own sanity. When we met those who advocate this mutilation, let us ask them why they do it and why: they have seldom asked themselves. When we meet a young mother whose mind is her own and not someone else's gramophone record, let us ask her if she thinks it likely that nature would bring 1000 English children into the world every day, well formed in all respects save this one; if it is no more likely that Nature is right and the folk-medicine that tries to improve on her is wrong. And when, as we often must, we have to give way to folly for the sake of peace and mind - our own, that of the mother, that of the school doctor - let us not commit the sin against the Holy Ghost by concealing from ourselves that it is foolish. Your old friend, DANIEL WHIDDON Daniel Whiddon, "The Widdicombe file: Should baby be circumcised?", Lancet, 15 August 1953, pp. 337-8 <h3>Responses</h3> There were a number of letters in response to Sir Daniel's article in subsequent issues of the Lancet, including this one from a general practitioner. As a general practitioner I am grateful for Sir Daniel Whiddon's advice on circumcision. It is strange how a really useful medical practice like vaccination tends to die out unless people are urged to have their children protected, while unnecessary operations like those for circumcision and tongue-tie remain popular. Mr J.D. Hennessy has raised another very important issue â€“ namely, that forcible retraction or stretching of the foreskin can be harmful procedures. Some mothers are most upset if they cannot push the prepuce right back so as to clean underneath it. Others perform the operation on someone else's advice, but they dislike doing it. In my view this zeal for preputial hygiene is quite unnecessary or even harmful. More than once I have been called out to reduce an incipient paraphimosis because the mother, having exposed the glans, is unable to replace the foreskin. After all, no one ever thinks of inspecting the vulva of a small girl in order to remove the smegma. It is eight years since I returned to general practice from the Forces, and in that time I have never circumcised a small baby. I have seen only 3 cases of balanitis, and they all cleared up readily on sulphonamides and caused no further trouble. Quite apart from the danger of physical damage, I am quite sure that it cannot be good for a small boy to have his penis manipulated daily by his mother. When I examine all newborn babies immediately after birth to exclude congenital abnormalities, I always make a point of telling the mother that her son does not need circumcising. I advise her to wash and powder him well but to do no more. If then or at a later date she questions this advice, one must spend a little time explaining the protective function of the foreskin, and she must be assured that it will stretch as he gets older. In my practice the request for circumcision now hardly ever arises. C.A.H. Watts, letter, Lancet, 19 September 1953, p. 623 </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 Sir Daniel Whiddon 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"> <h1>Sore point</h1> <h3>Circumcision "a source of great anguish"</h3> Circumcision - beloved by the Victorians, crucial to two of the world's great religions, arguably a health boon - can be a cause of great anguish. Richard Johnson meets men finding ways to reverse a cut they wish they'd never had Guardian, Saturday October 29, 2005 Skin constantly renews itself. Foreskin is no different: stretch it, and it will grow. Which is why eight circumcised men are meeting in Watford town hall. They want new foreskins. "When people come to my house," says Laurie, "I don't go 'Hello there, I'm Laurie, I'm growing my foreskin', but I've often got research papers out on the table, so word gets out. I do find people are really very interested in what I'm doing." Laurie is sharing his experience of restoration, as the process of foreskin renewal is called, with fellow members of NORM-UK. In the US, where NORM was born (and where circumcision rates are somewhere around three-quarters of the male population, far higher than in Britain), it stands for National Organisation of Restoring Men. NORM-UK is about more than that, but Laurie is on a roll. And the others don't want to interrupt him - after all, in two and a half years, Laurie has achieved glans coverage when flaccid. In the world of restoration, that is major. NORM-UK meetings are small and intimate. Not usually as small and intimate as this one, but there's been a pile-up on the M1. There are a few handshakes, but otherwise little in the way of physical display - "People are always worried we're going to drop our trousers," says general manager David Smith. Laurie wouldn't be averse to the idea, to show off his stretching. Women stretch skin for reconstruction after a mastectomy. So why shouldn't men stretch a foreskin? Some men can't restore - they are too tightly circumcised and have no tissue left to grow, but others can and are availing themselves of products such as the TLC Tugger, Tug Ahoy and the Your-Skin cone. Some have found their own DIY solutions, using funnels and gaskets to stretch the foreskin, and sash-window weights to provide traction. The whole idea of restoration sounds funny, like the time that Laurie was having a go with sticky tape, the most primitive of the restoration methods. He pulled what skin he had left over his glans, and taped it down. "I only had the tape on for half an hour", says Laurie, "but it was hell. I was walking down the high street and suddenly had to dive into the nearest toilet to check my penis hadn't gone black, green or blue. Or dropped off altogether." It sounds funny, but it isn't. Not if it's happening to you. Smith remembers sitting through the scene in the film East Is East in which the father tries to catch the son and take him to be circumcised. "I remember the cinema was in hysterics," says Smith, "and they were laughing when he was wheeled into the operating theatre, but all I could hear was the boy's screams. My wife turned to me and said, 'I've got to go - I can't watch this.'" When the foreskin is removed, it leaves the glans exposed and that can be difficult - removing a protective layer and sometimes creating soreness. "I always had a problem with my penis giving me stimulation I didn't want," says Kevin, recalling how, as a boy, "I had to keep adjusting it through my pocket. I was near the climbing frame in the playground when, all of a sudden, everyone started chanting 'Kevin is dirty - he's always playing with himself'. I didn't like the feeling of being odd, of being deformed. Suicide would have been a good option." Kevin is now 56 with a fully restored foreskin. But he's left with the question, why was he circumcised in the first place? His mother read the Bible and went to Sunday school. "But I was conceived out of wedlock when she was 17. And my father was a divorcee. They wanted to get married in church, so I think I was circumcised as some kind of apology to Jesus. My father wasn't circumcised himself, so I really don't understand." And that is a feeling he shares with many members of NORM-UK. Meetings are on a first-name-only basis because members don't like to be identified. "Many men who come to meetings won't even speak to their families about the pain they're suffering - we are dealing with victims of abuse here," says Smith. NORM-UK currently has just short of 300 members. Less than one inquiry in 10 results in membership, but it isn't strictly about the numbers. "Men often want the information to restore," says Smith, "but they want to keep it to themselves. They are frightened about being found out. When they ring me up, they say, 'Please ensure that the information is in plain envelopes and don't put me on a mailing list.'" John D was like that. He felt abused because his circumcision was unnecessary - a course of antibiotics had already cleared up his urinary infection. "But my father agreed with the doctor, and told me I was going to have a minor operation," he says. "I remember the nurses giggling as I was taken off to theatre. They wore these big sickly grins, and said, 'We're taking you to be done up now. Hee hee hee.' I was eight, but suffice it to say that they knew what was happening to me and I did not ... I remember waking up," says John D, "after the general anaesthetic had worn off, and looking down. My beloved penis had been replaced with wrinkled skin, a collar of thorns - the black stitches - and an ugly great dome on top. I experienced shock at first, later deep anger and resentment. The stitches disappeared, but the mutilation didn't. My father said, 'I didn't think it would look like that.' It was misinformed consent." There are lots of horror stories about circumcision. Like the time in Baltimore in 1964 that it went so badly wrong that the doctors decided to change the child's sex. Or the time in London in 1991 when a 16-year-old was circumcised so badly that he bled all night and died. But these cases are extraordinary, and far from typical. Even for adults, circumcision is reckoned a safe and easy operation. Opponents of the procedure, however, don't see it like that. John E is blind. But it's not his blindness that keeps him from meetings. "It's the fact I feel I've been more devastated than everyone else," he says. "They've got their lives in order. And they've got sexual partners. I haven't. My life has been ruined by circumcision, although I hate that word. I prefer 'foreskin amputation'. It's not an operation - there's no medical benefit. It's a rite. A faith crime." In the Bible, circumcision was God's covenant with Abraham and the Jewish people. Of all of the commandments in Judaism, the brit milah (literally, covenant of circumcision) is probably the most universally observed. And although circumcision isn't actually mentioned in the Qur'an, it is mentioned in other Islamic texts. Most Muslims believe it's fundamental because Allah ordered Muhammad to follow the way of Abraham. Asked if NORM-UK has Jewish and Muslim members, Smith replies, "Yes we do, but it is difficult to estimate the number because if someone joins us we do not ask their religion, nor are we really interested." Religious circumcisions are frequently performed without anaesthetic, and are painful, even when performed on newborn babies. Adults can testify to the pain for themselves and can give their informed consent - but children can't. If, as opponents claim, circumcision is traumatic, and can result in lifelong damage - including psychological problems and a reduced sex drive - why are religious circumcisions still allowed? NORM-UK says, actually, they aren't allowed: the UN Convention on the Rights of the Child declares that violence to children cannot be justified on grounds of "religion, culture or tradition". Children are not the possessions of their parents to do with as they please - or submit to surgery unless absolutely necessary. We make an exception for circumcision because it's mentioned in Genesis. Dr Zuhair Zarifa, from Docklands in east London, is one of the few surgeons prepared to advertise the fact that he will circumcise males for religious or ethnic reasons. "Why not?" he says. "The operations are permitted by the General Medical Council. And they will happen whether I do them or not. It's much better for the operations to happen in my surgery under clinical conditions with anaesthetic, where I can provide all the necessary aftercare." Even nonpractising Jews tend to circumcise their sons. It was, after all, the first command given to Abraham and the defining physical mark of the Jewish people. Circumcision involves "Hatafat Dam Brit" - a drop of blood that seals a covenant. Which does, for some, suggest that removing the foreskin goes beyond what is required by God. But, according to Rabbi Dr Jeremy Rosen, that is to miss the point. "People are always trying to find rational reasons for Jewish laws," says Rosen. "They ask if our dietary laws improve hygiene. They ask if observing the Sabbath helps mental relaxation. And they ask if circumcision prevents STDs. But even if these rational reasons stood up to objective scrutiny, they wouldn't be a reason for keeping - or abandoning - our laws. One keeps to these rules out of religious commitment. I have no medical expertise," adds Rosen, who runs the London branch of the liberal Yakar Educational Foundation, "but I am convinced that circumcision is harmless, and not traumatic. But even if it is, we Jews have done pretty well on it over the years - and so indeed have Muslims." Circumcision on females was made illegal in the UK in 1985. The same protection is not extended to males precisely because it would involve taking on two of the world's great religions. Most forms of female circumcision are, certainly, more damaging than male circumcision, but the distinction in law between male and female circumcision just can't be justified objectively. It is a double standard. Circumcision was not practised in Britain until the 18th century and it really only gained popularity in the 19th century, after claims that it stopped the vile habit of masturbation. By stopping masturbation, Victorians thought circumcision would cure everything from epilepsy and hip trouble to asthma and alcoholism. In the first world war it was hailed as a defence against venereal disease, and by the second world war it had become an emblem of status; most of the middle and upper classes were eagerly circumcising their sons. Only in the late 1940s, with the introduction of the National Health Service, did numbers begin to fall - it is now estimated that around 20% of the current male population in the UK are circumcised. But whenever a new disease becomes a matter of social concern, circumcision is wheeled out as the cure. A recent paper in the British Medical Journal found a link between an intact foreskin and HIV infection - but a paper in the British Journal Of Urology found exactly the opposite. There is clear medical evidence that circumcision reduces the incidence of cancer of the penis, and of the cervix for the women whose partners are circumcised, but even this is disputed by NORM-UK. It argues that the research is out of date and that a lack of cleanliness is more important to the transmission of disease than the lack of a foreskin. The organisation doesn't want to see circumcision banned altogether. It accepts there are a few medical conditions where it is necessary. The others can be treated by simple, nonsurgical means."We need to educate the medical profession," says Smith, "because they seem unaware of the alternatives to circumcision. They are certainly unaware of the problems that it is causing." John D is typical of NORM-UK members in that circumcision when he was a young boy changed his entire persona. "I became less sociable, and I started talking to myself. I was fearful of changing rooms. I had no close relationship with the opposite sex until I was 41, and I still haven't been able to reach orgasm through sexual intercourse. Over the years, I've had real problems with depression, and I'm sure I could trace it back to that day." These are not the issues foremost in doctors' minds. Take a look at the General Practice notebook, an online medical encyclopaedia used by GPs, and its listing for phimosis - a condition where the foreskin won't retract. Most infants are born with a foreskin that can't be retracted and the foreskin is often tight until after puberty. Phimosis disappears in almost all cases given time. A fully retractable foreskin occurs on its own in 99% of 18-year-olds. But the notebook recommends circumcision. The notebook makes no mention whatever of the noninvasive solutions to the problem - such as stretching, steroid cream or a simpler operation. Similarly, there are nonsurgical solutions to balanitis, a condition where the foreskin retracts too tightly, causing the glans to swell. "It sounds silly," says John D, "but balanitis can be cured by putting the penis in a bowl of sugar. The swelling goes down, and the foreskin returns to its resting position." Zarifa isn't sure about the bowl of sugar - but he insists that doctors always explore noninvasive options first. "The truth of the matter is that stretching can be quite painful," he says. "And it's quite an undertaking for a small child. For some boys, the pain of the stretching is as bad as the pain of the circumcision. And I would say that 40-50% of boys who use steroid cream end up having a circumcision in the end. But it's always the last option." The BMA supports conservative solutions where possible. But unnecessary circumcisions are still happening. And, as the Commons health committee noted, they are happening "because doctors don't understand the natural history of the foreskin". Circumcision for babies and for older people is dismissed as "the snip", but it can still result in serious bleeding, or an adverse reaction to the anaesthetic. "And you cannot cut off normal, healthy, sexually-functioning tissue without cutting off normal, healthy, sexual functioning," says Marilyn Milos, a nurse and director of the National Organisation of Circumcision Information Resource Centres in the US. "It's a sexual issue, and it's a human rights issue." The foreskin isn't a useless flap that evolution should have got rid of long, long ago - it's skin that is rich with blood vessels, highly innervated, and uniquely endowed with stretch receptors. These contribute greatly to the sexual response of the intact male. The stretching of the foreskin over the glans activates nerve endings, enhances sexual excitability, and contributes to the ejaculatory reflex. There's no escaping it - the foreskin is sexual tissue. Laurie can laugh now, but he missed his foreskin (it was removed when he was two). He was getting on for 60, and rapidly losing the feeling in his penis. "To be honest," he says, "sex was like pushing a rolling pin in. And I'm not referring to size when I say 'rolling pin' - you can get little rolling pins. I just could not feel a thing." His glans had been badly desensitised after years of rattling around - so much so that he could have an orgasm and not even feel it. That is when he approached NORM-UK. During heterosexual intercourse with a circumcised man, the penis removes natural lubrication as it moves in and out of the vagina. "So my poor wife was buying artificial lubricant by the gallon," says Laurie. During heterosexual intercourse with an uncircumcised man, the glans moves but the foreskin stays put. And so does the lubrication. The woman doesn't feel friction at all - what she does feel is a variation in pressure. Laurie is delighted. "And so is my wife," he says. "The skin grew in jumps. I did a lot of work for a long time and nothing happened, like with the sticky tape, but suddenly I woke up one morning and thought 'Where's that come from?' " The new foreskin didn't have the nerve endings it once did, but the glans recovered all its sensitivity. "For 40 years my wife and I had to use lubrication. Not any more. We're delighted." David Smith is NORM-UK's one paid employee. He started admitting he worked for the charity only after his parents died - he couldn't bear the questions. (The Charity Commission put the organisation on probation for 12 months to ensure that it was not a cover for pornography.) Smith's wages come out of a grant from Lloyds TSB. But, apart from him, the trustees are all volunteers. Running NORM-UK is a big job: liaising with Great Ormond Street to correct the circumcision "fact file" on the hospital website, setting up meetings with the Family Planning Clinic, and doing mail-outs to midwives, recommending the alternatives to circumcision. Meet the members of NORM-UK and you'll understand that it's more important to look at the complications of circumcision, and its physical and psychological side effects. In time, campaigners hope that routine circumcision will come to be seen as yet another deluded fad, along with bleeding, electro-convulsive therapy and the frontal lobotomy. --- In response to a letter agreeing that circumcision was immoral but questioning the comparison with female genital mutilation, the Guardian published the following letter from John Dalton. As a victim of male circumcision and a subject of Richard Johnson’s article (Sore Point, October 29), I have no wish to belittle the suffering of circumcised girls. I would, however, like to respond to Catherine Long’s objection to male circumcision being compared to female genital mutilation (Letters, November 5). Male and female circumcision both remove normal tissue from normal children without therapeutic need or personal consent. The time has come for children to be protected from non-therapeutic circumcision without prejudice in respect of race, religion or gender. John D Dalton Frizington, Cumbria <a href="http://www.guardian.co.uk/weekend/story/0,3605,1639243,00.html">Guardian Weekend Magazine, 12 November 2005</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 British men seek compensation for 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"> The following article by Geoff Hinchley was published in the British Medical Journal in December 2007. <h2>Is infant male circumcision an abuse of the rights of the child? Yes</h2> Improved understanding of the normal anatomy of the infant foreskin means there is now rarely a therapeutic indication for infant circumcision, [1] and the procedure is not supported by international medical opinion. [2] Ritual (non-therapeutic) male circumcision, however, continues unchecked throughout the world, long after female circumcision, facial scarification, and other ritual forms of infant abuse have been made illegal. The law and principles pertaining to child protection should apply equally to both sexes, so why do society and the medical profession collude with this unnecessary mutilating practice? Ritual male circumcision is an ancient religious rite for Muslims and Jews, and the crux of this debate revolves around the primacy of parental religious conviction versus the primacy of the human rights of the child, the preservation of its bodily integrity, and its right of self determination. In addition to religious justification, there have been many spurious and now unsupported health claims for circumcision — including the prevention of penile cancer, masturbation, blindness, and insanity [3] — most of which, like reduction in HIV transmission identified more recently, relate to adult sexual behaviour and not to the genital anatomy or best interest of a child. There may be a case that male circumcision reduces HIV risk in sexually active adults, but the decision about whether to have this procedure should be left until the person is old enough to make his own informed healthcare choices. Male genital mutilation is not a risk-free procedure. There are potential anaesthetic risks, and the short term risk of bleeding and infection associated with any surgical procedure. [4] Longer term potential complications include pain on erection, penile disfigurement, and psychological problems. [5] A recent report shows that the non-circumcised adult penis is more sensitive than the circumcised penis, largely because the five most sensitive areas, identified in the study, are removed during circumcision. [6] This implies a reduction in future sexual sensitivity for circumcised adults. Far from being a harmless traditional practice, circumcision damages young boys. <h3>Legal protection</h3> Article 24(3) of the UN convention on the rights of the child commits all ratifying states to "take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children" and article 19(1) says: "States shall take all appropriate legislative administrative social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse." [7] UK courts have interceded in the past to protect the best interests of children whose parental belief systems have put children at risk. However, male circumcision remains lawful if both parents consent. [8,9,10] Since the Human Rights Act has been implemented, however, single parental consent has been found to be insufficient to show that the procedure is in the child’s best interest. [11] As far as female genital mutilation is concerned, in the United States the Federal Prohibition of Female Genital Mutilation Act states that in applying the law, "no account shall be taken . . . that the operation is required as a matter of custom or ritual." These terms are closely mirrored in the UK Female Genital Mutilation Act 2003. Both the US and the UK legal systems therefore discriminate between the sexes when it comes to protecting boys and girls from damaging ritual genital mutilation. The UK’s General Medical Council abdicates all responsibility for male circumcision to society as a whole, [12] but in June 2007 the BMA, which had previously offered general guidance, [13] decided that "any decision to provide medical or surgical treatment to a child, or any decision to withhold medical or surgical treatment from a child, should: consider the ethical, cultural and religious views of the child’s parents and/or carers, but without allowing these views to override the rights of the child to have his/her best interests protected.” [14] Male circumcision was not specifically mentioned, but it cannot be in the best interest of a child to be subjected, without its consent, to an irreversible surgical procedure, often without anaesthetic, which will provide no medical benefit but which has proved adverse consequences both in terms of potential complications for some and reduced penile sensation in adulthood for all. <h3>Religious perspective</h3> Some faiths view male circumcision, often done by people who are not medically qualified, as important for entering a covenant with their God. However, given the age of the children involved it cannot be said that this covenant is freely entered into by the individual concerned. In the US, elements of the Jewish community are beginning to rethink this issue. [15] They suggest bringing Jewish boys into the covenant symbolically, with the potential for the child to be circumcised when old enough to consent to the procedure himself. Muslims already circumcise boys at an older age, and further delay to allow the child to consent could equally be considered. How much stronger would that covenant be, when entered into by a fully competent young man with full knowledge of its religious implications and the potential risks involved. The unpalatable truth is that logic and the rights of the child play little part in determining the acceptability of male genital mutilation in our society. The profession needs to recognise this and champion the argument on behalf of boys that was so successful for girls. <h3>References</h3> 1. British Association of Paediatric Surgeons, Royal College of Nursing, Royal College of Paediatrics and Child Health, Royal College of Surgeons of England and Royal College of Anaesthetists. Statement on male circumcision. London: RCS, 2001. 2. Hofvander Y. Circumcision in boys: time for doctors to reconsider. World Hosp Health Services 2002;8(2):15-7. 3. Smith J. <a href="http://www.cirp.org/library/legal/smith/">Male circumcision and the rights of the child</a>. Netherlands Institute of Human Rights, 1998. 4. Williams N, Kaplia L. <a href="http://www.cirp.org/library/complications/williams-kapila/">Complications of circumcision</a>. Br J Surg 1993;80:1231-6.[Web of Science][Medline] 5. Peterson SE. <a href="http://www.historyofcircumcision.net/index.php?option=content&task=view&id=93">Assaulted and mutilated. A personal account of circumcision trauma</a>. In: Denniston GC, Hodges FM, Milos MF, eds. Understanding circumcision. New York: Kluwer Academic, 2001;271. 6. Sorrells ML, Snyder JL, Reiss MD, Eden C, Milos MF, Wilcox N, et al. <a href="http://www.cirp.org/library/anatomy/sorrells_2007/">Fine touch pressure thresholds in the adult penis</a>. BJU Int 2007;99:864-9.[CrossRef][Web of Science][Medline] 7. United Nations. Convention on the rights of the child. 8. Re J (A Minor) (prohibited steps order: circumcision). [2000] 1 FLR 571. 9. <a href="http://www.cirp.org/library/legal/Re_J/2000.html">Re J (child’s religious upbringing and circumcision)</a>. [2000] 1 FCR 307. 10. Re J (specific issue orders: Muslim upbringing and circumcision). [2000] 52 BMLR 82. 11. Re S. (Children) (Specific issue: circumcision) [2005] 1 FLR 236. 12. General Medical Council. Guidance for doctors who are asked to circumcise male children. London: GMC, 1997. 13. BMA. <a href="http://www.bma.org.uk/ethics/consent_and_capacity/malecircumcision2006.jsp">The law and ethics of male circumcision — guidance for doctors</a>. London: BMA, 2006. 14. BMA. Annual representative meeting policies, June 2007. Ethics and professional responsibilities. 15. Moss L. <a href="http://www.nocirc.org/symposia/second/moss.html">The Jewish roots of anti-circumcision arguments</a>. Second international symposium on circumcision, San Francisco, California, 30 April-3 May 1991. The author is an accident and emergency consultant at Barnet and Chase Farm NHS Trust, Enfield, Middlesex EN2 8JL. Email: <a class="__cf_email__" data-cfemail="7017151f16165e18191e13181c1509301213165e1e18035e051b" href="/cdn-cgi/l/email-protection">[email protected]</a> <a href="http://www.bmj.com/cgi/content/full/335/7631/1180" rel="noopener" target="_blank">British Medical Journal 2007;335:1180</a> (8 December 2007) </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 British Medical Journal debates ethics of non-therapeutic 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"> If passed, article 50 will ban genital cutting for boys under 18 in San Francisco, with profound religious implications for Jews and Muslims. But isn't it time to oppose all circumcision? by Neil Howard and Rebecca Steinfeld San Francisco voters will decide later this year whether, like its female counterpart, male infant circumcision should be outlawed. If passed, article 50 — the "Genital Cutting of Male Minors" — would make it unlawful to circumcise, cut, or mutilate the foreskin, testicles, or penis of another person aged under 18. The bill includes an exemption for cases of medical necessity, but not for custom or ritual, which has profound implications for the many Jews and Muslims who consider it an essential part of their religious or cultural practice. Unsurprisingly, the bill has attracted considerable controversy. Some regard it as a modern manifestation of western antisemitism, while certain feminist groups consider the idea of comparing male and female genital cutting to be both offensive and unsubstantiated. Neither the World Health Organisation nor the UN oppose male circumcision, and given that the procedure is so unquestioned that 33% of American boys still undergo it, one might think that they have a point. But is it really so simple? And are the differences between male and female circumcision really so straightforward? According to research, the sexual damage caused by female and male genital cutting can be extensive. Female genital cutting, which can involve removal of the clitoris, may reduce the likelihood of orgasm and cause complications during childbirth. Similarly, male circumcision can result in excruciating pain, nerve destruction, infection, disfigurement and sometimes death. Like the clitoris, the foreskin serves a sexual purpose, and it protects the "head" of the penis from outside elements. Both male and female genital cutting can have profound psychological consequences. Circumcised women often experience trauma, stress and anxiety, and can have relationship problems. Some circumcised men describe feelings of loss, anger, distrust, and grief, while others have reported problems with subsequent intimacy, long-term post-traumatic stress disorder, and a sense of powerlessness. With female genital cutting, the desire to control female sexuality remains key: believed to reduce a woman's libido, the practice is said to help her resist "illicit" sexual acts, thus aiding the maintenance of premarital virginity and marital fidelity. Male circumcision has similarly been associated with managing sexuality. Maimonedes, the great Jewish sage, believed it counteracted "excessive lust", while as a secular practice in the US, it was first promoted as a means of preventing "harmful" masturbation. Now, the discourse of cleanliness is crucial – and one frequently hears that "a cut man is a cleaner man". In Judaism, male circumcision, carried out eight days after birth, is essential, according to religious law; male circumcision is also practised in Islam, though the necessity of female genital cutting is contested among Muslims. Clearly, significant similarities exist between male and female genital cutting, and the question asked by those behind article 50 is: why the legal difference between boys and girls? What about the health argument, that male circumcision is "cleaner" and prevents HIV transmission? There is a body of research that claims a correlation between circumcision and reduced transmission rates, and this is not to be taken lightly, since it represents the strongest case for male genital cutting – at least in AIDS-ravaged regions. But such research is heavily contested. A 2007 study by Dowsett and Couch asserted that insufficient evidence exists to believe that circumcision does reduce transmission, while Gregorio et al's later analysis cast doubt on correlations between circumcision and transmission of HIV and STI's more generally. Wouldn't a mass information campaign represent better public health policy than widespread pre-emptive circumcision? If we favour removal of body parts to reduce risk of disease, why not remove breasts to prevent breast cancer? Or pull teeth, in the name of cleanliness, to ward off plaque? Though health and hygiene are important, less intrusive and equally successful means clearly exist to ensure them. What about religious freedom? Certainly, the ability to freely practise one's religion remains a vital component of any liberal democracy. But should this trump an individual's right to their bodily integrity? And shouldn't such a principle be extended to all those who, by virtue of their age, are too young to decide on which body parts they would or would not like to keep? Some may point to state overreach here, suggesting that a ban on child ear-piercing will be next. But it is the irreversibility of circumcision that invalidates such comparisons. Instead of dismissing article 50 as either antisemitic or anti-feminist, therefore, we suggest that it should perhaps be considered as no more than the consistent application of legal principles to both sexes. Article 3 of the European Convention on Human Rights outlaws the kind of "harm" that circumcision can cause; article 14 forbids the discrimination that prevents baby boys from enjoying the same protection of their genitalia as baby girls. In the 21st century, it is time to remember that men, too, can be victims of unjust hegemonic systems tolerated in the name of tradition, culture or religion. If we oppose female genital mutilation, has the time not come for us also to oppose male genital mutilation? Neil Howard and Rebecca Steinfeld are doctoral students at Oxford University, specialising on issues related to gender in West Africa and the Middle East respectively. <a href="http://www.guardian.co.uk/law/2011/jun/14/circumcision-ban-row-san-francisco" rel="noopener" target="_blank">Guardian (UK), 14 June 2011</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 Guardian (UK): Time to ban male 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"> <h2>Further sightings of a persistent urban myth</h2> The following is an update to Robert Darby and John Cozijn, <a href="http://sgo.sagepub.com/content/3/4/2158244013508960.full">The British Royal Family’s Circumcision Tradition: Genesis and Evolution of a Contemporary Legend</a>. Sage Open, 16 October 2013. As Darby and Cozijn report: Since this article was published we have made several further sightings of the royal family circumcision legend and related myths that we would like to bring to readers’ attention. None of them affects our argument or conclusions, and only one (not involving Queen Victoria) predates the first edition of Kolatch’s Jewish Book of Why (1981), leaving that as the earliest manifestation of the Victoria story yet identified. If any readers encounter an earlier appearance we would love to hear from them. The earliest post-Kolatch sighting is in a rather unlikely place: a sexually explicit text on the foreskin and circumcision practices by “Bud Berkeley” and Joe Tiffenbach, first published in 1983. Relying on the semi-pornographic fictions of Allen Edwardes, especially his fantasy “history” of the British in India ** (Edwardes 1966), they attribute the fashion for circumcision among the upper classes to their military service in India, but then add the familiar reference to British royalty, which “circumcised its male heirs using the finest Mohel (Jewish circumciser) to be found in all of London. Yes, the rich and the famous were shedding their foreskins in the most romantic of ways. Then came Queen Victoria.” (Berkeley 1983, 31-33; 1993, 68) It is not clear from this account whether Berkeley thinks Victoria introduced or merely followed the practice (probably the latter), and the most likely source is a garbled recollection of Kolatch or a story encountered in conversation. Berkeley goes on to make the (entirely valid) point that circumcision was generalized in late Victorian Britain as a means of discouraging childhood masturbation. Then there is Dr Terri Hamilton, who in Skin Flutes and Velvet Gloves (2002) writes: “Following the preference of Queen Victoria, male members of the royal family tend to be circumcised” (Hamilton 2002, 234) – a rather vague expression probably deriving from internet sources: as we reported, by 2002 the legend was quite widely diffused. In response to our post-publication inquiries, Marcie Jones gave Hamilton as the most likely source for her own claim that circumcision was introduced into the royal family by Victoria’s doctor, but since then she has deleted the entire conversation from her Facebook account, so perhaps she is not so sure. Interestingly, Hamilton repeats a couple of other myths involving royal penises. First she retells the old chestnut about Louis XVI, though manages to get her kings mixed up: “The French King Louis XIV, known for his licentious nature and vigorous sexual appetite, was said to have suffered from phimosis …. To relieve the condition, [he] was reportedly circumcised at age 22, following which the procedure became fashionable among European aristocracy for generations.” (Hamilton 2002, 233). As Androutsos has shown, poor old Louis XVI had anything but a vigorous sexual appetite; and while he probably did experience a degree of phimosis it was certainly not treated by circumcision. Hamilton (2002, 299-300) also embellishes the “Prince Albert” piercing legend, writing that it was so named because the Prince Consort wore such a ring “to retract his foreskin (preventing the build-up of smegma) to keep his member ‘sweet-smelling’” so as not to offend his wife. As already pointed out, the original story is an urban myth invented in the 1970s. Hamilton’s explanatory gloss here is so inherently implausible that it could have been dismissed after a moment’s thought or a little fieldwork: as anybody who has seen one in situ can report, the PA piercing has no effect at all on whether the foreskin is worn retracted or forward. Many men who get PAs these days keep them hidden under their foreskin, thus allowing them to surprise sexual partners at the appropriate moment. The Prince Albert legend, in its many variations, derives its plausibility from the myth that Queen Victoria did not like sex. As Darby (2005) pointed out in reply to a post on H-Histsex, the truth is quite the reverse. Finally, it is of interest that a quite different version of the story was presented by that master of pseudo-sexual anthropology, Allen Edwardes, who writes in his Erotica Judaica: “When Elizabeth II had Prince Charles deprepucized by Chief Rabbi Israel Brodie in 1948, an aeon of English circumcisiophobia was officially ended. Routine became the rule.” (Edwardes 1967, 217) Just about everything in these two sentences is wrong: rabbis do not normally perform circumcisions; Charles was not circumcised by Brodie; and the late 1940s marked the end of routine circumcision in Britain, not the beginning. The fact that Edwardes (writing in 1967) does not mention Queen Victoria and rather implies that it was Elizabeth II who introduced circumcision to the royal family further strengthens our case that the myth developed after the circumcision of Prince Charles, out of stories circulating orally within the Anglo-American Jewish communities, and only coalesced into its present forms in the 1990s. ** The grain of truth in Edwardes’ account is that British soldiers captured by Sultan Tipu and other Muslim rulers during the frontier wars of the 1780s were often forcibly circumcised and kept as slaves, much to their horror and dismay. For details see Colley 2002 and Darby 2003. References Berkeley, Bud and Joe Tiffenbach (1983). Foreskin: Its Past, Its Present and Its Future. No place of publication or publisher. Berkeley, Bud (1993). Foreskin: A Closer Look. Boston: Alyson Publications Colley, Linda (2002). Captives: Britain, Empire and the World, 1600–1850. London: Jonathan Cape. Darby, Robert (2003). <a href="http://www.historyofcircumcision.net/index.php?option=content&task=view&id=28">Captivity and Captivation: Gullivers in Brobdingnag.</a> Eighteenth Century Life 27 (3). Darby, Robert (2005). Comment on post, “Prince Albert revisited”, 13 October 2005. H-Histsex Discussion logs: http://h-net.msu.edu/cgi-bin/logbrowse.pl?trx=vx&list=h-histsex&month=0510&week=b&msg=GrEQmhb87Yvisyj62s5M/g&user=&pw= Edwardes, Allen (1966). The Rape of India: A Biography of Robert Clive and a Sexual History of the Conquest of Hindustan. New York: Julian Press. Edwardes, Allen (1967). Erotica Judaica. New York: Julian Press. Hamilton, Terri (2002). Skin Flutes and Velvet Gloves. New York: St Martin’s Press. </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 The myth of the British Royal Family's "circumcision tradition" 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"> <h1>Male circumcision can be worse than female genital mutilation</h1> Circumcision of boys is “significant harm” and more damaging than mild forms of female genital mutilation (FGM). This is the considered opinion of Sir James Munby, President of the British Family Court, expressed during his judgement on a case involving a girl from a Muslim family suspected of having undergone FGM. If she had been subjected to FGM, the law provides that she should be placed under care and the parents charged with a criminal offence. But since the girl had a brother who had been or was likely to be circumcised in accordance with Muslim tradition, the judge observed that the case inevitably brought up the question of male circumcision and its very different status in British law. He noted that “circumcision involved the removal of a significant amount of tissue, created an obvious alteration to the appearance of the genitals, and leaves a more or less prominent scar around the circumference of the penis.” Accordingly, it can readily be seen that while severe forms of FGM are more invasive than male circumcision, mild forms (such as Type IV in the <a href="http://www.who.int/mediacentre/factsheets/fs241/en/" rel="noopener" target="_blank">WHO classification</a>), “are on any view, much less invasive than male circumcision.” Sir James further observed that any form of FGM, no matter how mild, constituted “significant harm” – this being the threshold condition for placing a child in care under the Childrens Act 1989 – and asked what this meant for male circumcision: Mr Hayes points to the recognition, both by Wall J, as he then was, and by the <a href="http://www.cirp.org/library/legal/Re_J/" rel="noopener" target="_blank">Court of Appeal in Re J</a> (Specific Issue Orders: Muslim Upbringing and Circumcision) [1999] … that male circumcision does involve harm, or the risk of harm. Given the comparison between what is involved in male circumcision and FGM WHO Type IV, to dispute that the more invasive procedure involves the significant harm involved in the less invasive procedure would seem almost irrational. In my judgment, if FGM Type IV amounts to significant harm, as in my judgment it does, then the same must be so of male circumcision [Para 69]. The judge went on to observe that the only differences between FGM and male circumcision are that the latter is sanctioned by some religions and traditional cultures, while the former is merely a cultural tradition; and that certain health benefits are (controversially) claimed for circumcision, but not for FGM. Despite these points of similarity, the status of male circumcision and FGM in British law are strikingly different: the former tolerated and unrestricted, the latter legally prohibited under pain of severe penalties. The result is a paradoxical situation: In the present case the point [i.e. the paradox] arises in striking form. The family, as I have said are Muslims. I assume, therefore, that B [the boy] either has been or will in due course be circumcised. Yet, entirely understandably, and, if I may say so, entirely appropriately, this is not a matter that has been raised before me. There is no suggestion, nor could there be, that B’s circumcision can or should give rise to care proceedings. So, given the nature of the local authority’s case on this point, we are in this curious situation. G’s [the girl’s] FGM Type IV (had it been proved) would have been relied upon by the local authority, prior to its change of stance referred to above, as justifying the adoption of both children, even though on any objective view it might be thought that G would have subjected to a process much less invasive, no more traumatic (if, indeed, as traumatic) and with no greater long-term consequences, whether physical, emotional or psychological, than the process to which B has been or will be subjected [Para 63]. There is thus a crying anomaly in both law and custom. Although it constitutes significant harm and is more damaging than mild forms of FGM, non-therapeutic circumcision (NTC) of (non-consenting) male minors is both legally permitted and widely regarded as a legitimate aspect of “reasonable parenting”. Although the judge’s comments on circumcision in this case are strictly speaking obiter dicta (i.e. not directly related to the point being decided), they are of great importance as yet another recognition that non-therapeutic circumcision does involve significant harm, and are possibly the first such formal recognition in an Anglophone court. Sir James’ comments echo and reinforce the judgement of the <a href="https://www.circinfo.org/Circumcision_and_law.html">Cologne appeal court</a> in 2012 that NTC of minors was harmful and violated and violated the child’s right to both physical integrity and freedom of religion. It also supports the conclusion of the <a href="https://www.circinfo.org/Tasmania_law_reform.html">Tasmania Law Reform Institute</a> that NTC was sufficiently harmful (both physically and ethically) to warrant strict regulation and partial prohibition. The judge’s conclusion – – "that although both involve significant harm, there is a very clear distinction in family law between FGM and male circumcision. FGM in any form will suffice to establish ‘threshold’ in accordance with section 31 of the Children Act 1989; male circumcision without more will not" – – sends a very clear message to legislators that such a glaring inconsistency in the law cannot be tolerated indefinitely. Source (legal citation): Sir James Munby, President of the Family Division. <a href="http://www.judiciary.gov.uk/wp-content/uploads/2015/01/BandG_2_.pdf">In the matter of B & G (children)</a>. Case LJ13C00295, 14 January 2015. <h2>Further reading on male and female circumcision</h2> Robert Darby and J. Steven Svoboda. <a href="https://www.academia.edu/7104790/A_rose_by_any_other_name_Symmetry_and_asymmetry_in_male_and_female_genital_cutting" rel="noopener" target="_blank">A Rose by Any Other Name: Symmetry and Asymmetry in Male and Female Genital Cutting</a> Brian Earp. <a href="http://blog.practicalethics.ox.ac.uk/2014/02/female-genital-mutilation-and-male-circumcision-time-to-confront-the-double-standard/" rel="noopener" target="_blank">Female genital mutilation (FGM) and male circumcision: should there be a separate ethical discourse?</a> Brian Earp. <a href="http://aeon.co/magazine/philosophy/male-and-female-circumcision-are-equally-wrong/" rel="noopener" target="_blank">Is there any moral difference between male and female circumcision?</a> Aeon magazine, January 2015. Brian Earp. <a href="https://www.academia.edu/10197867/Between_moral_relativism_and_moral_hypocrisy_The_case_of_FGM">Between moral relativism and moral hypocrisy: The case of FGM</a> <a href="http://www.cirp.org/library/legal/" rel="noopener" target="_blank">Circumcision legal issues at CIRP</a> <h2>Male circumcision can be worse than female genital mutilation</h2> <h3>Report in British magazine, insideMan</h3> One of the country’s most senior judges has courted controversy by declaring that male circumcision can be more harmful than female genital mutilation (FGM). Sir James Munby acknowledged he was entering “deep waters” by highlighting inconsistencies in the law, but said it would be “irrational” to dispute the fact that male circumcision can be more harmful than some forms of FGM. The High Court judge made the comments as he passed judgment in care proceedings brought by a local authority seeking to take a brother and sister, from a Muslim family, into care on the grounds that the girl was a victim of Type IV FGM. While the case failed on the grounds that damage to the girl’s genitals was probably caused by a condition called vulvovaginitis, Munby, who is president of the family division, felt compelled to highlight the sexist double standard that the case brought to light. In summing up the judge noted that while subjecting a girl to Type IV FGM could result in that child being taken into care, male circumcision would not lead to a boy being removed from his family, even though the procedure is more harmful than at least some forms of Type IV FGM. An inconvenient truth Campaigners against male circumcision have long been hampered by the myth that subjecting girls to FGM is different and always worse than circumcising boys. The uncomfortable truth, to which Munby has now given judicial credibility, is that male circumcision is different and sometimes worse than FGM. This is particularly true of Type IV FGM which incorporates practices such as pricking, piercing and nicking the genitals, which are less harmful and invasive than removing the foreskin in it’s entirety. Male circumcision in the UK is often performed without anaesthetic, in non-medical conditions and can cause complications such as life threatening haemorrhage, shock, sepsis an in extreme cases death. In 2012 a Freedom of Information request revealed that two boys a week are admitted to the emergency department of Birmingham children’s hospital as a result of male circumcision. Society more tolerant of male circumcision However, despite Munby’s assessment that ”on any objective view” male circumcisions is sometimes worse than FGM, he also made clear that current judicial thinking is that there is no equivalence between the two practices. “In 2015 ,” he said in his judgment, “the law generally, and family law in particular, is still prepared to tolerate non-therapeutic male circumcision performed for religious or even for purely cultural or conventional reasons, while no longer being willing to tolerate FGM in any of its forms. “Given the comparison between what is involved in male circumcision and FGM WHO Type IV, to dispute that the more invasive procedure involves the significant harm involved in the less invasive procedure would seem almost irrational. In my judgment, if FGM Type IV amounts to significant harm, as in my judgment it does, then the same must be so of male circumcision.” The phrase “significant harm” is important as this is the first threshold that must be crossed before a child can be taken into care under section 31 of the Children’s Act 1989. There is another criteria which must also be considered in care proceedings and this is whether the care given to a child is “what would be reasonable to expect a parent to give”. Why the law is different According to Munby, while it can never be reasonable parenting to inflict any form of FGM on a child, the position is quite different with male circumcision. Munby argued that there are at least two important distinctions between the two practices. Firstly, that FGM has no basis in any religion, while male circumcision is often performed for religious reasons. Secondly, that while FGM is said to have no medical justification and confers no health benefits; male circumcision is seen by some people as providing hygienic or prophylactic benefits, although opinions are divided. Even taking the conflicting medical evidence on any perceived benefits into account, Munby concluded that “reasonable” parenting should be seen to permit male circumcision. And that is where UK law stands on the matter today. The Head of the Family Division of the Family Court has judged that while male circumcision is sometimes worse than FGM, it is deemed to be reasonable for parents of all backgrounds to circumcise their sons, while carrying out a less invasive and less harmful from of Type IV FGM on their daughters is not considered reasonable parental behaviour. A welcome coup for campaigners Having a senior judge acknowledge that FGM can be less harmful than male circumcision is a welcome coup for those of us who advocate for the right of every human being to enter adulthood with intact genitals, except in rare cases where therapeutic surgery is unequivocally unavoidable. The fact that our society, led by politicians and the judiciary, is still prepared to tolerate greater harm happening to boys than to girls, reveals a great deal about the sexist double standards we apply to the issues that affect men and boys in 2015. The fact that we are collectively more tolerant of the harm that happens to men and boys, than the harm that happens to women and girls, doesn’t begin and end at genital mutilation. Our shared cultural beliefs that “boys don’t cry”; that men should “man up”; that women have problems and men are problems; that females are the weaker sex and that we should always put the protection of women and girls first; is reflected in our inability to tackle a whole range of social issues that, predominantly impact men and boys, head on. Why this is a men’s issue These include male suicide; male homelessness; the high rate of male workplace deaths; men’s lower life expectancy; the expulsion of boys from school; the exclusion and marginalisation of separated fathers from their children’s lives; the way we respond to male victims of violence and the harsher treatment and sentencing of men and boys in the criminal justice system. What Sir James Munby has uncovered is an inconvenient and important truth about men, manhood and masculinity in 2015 which is simply this—while the harm that happens to men and boys in our society is different and sometimes worse than the harm that happens to women and girls, we still view any harm that women and girls experience more seriously. Munby is part of the problem he has raised, for while he acknowledges that male circumcision can be more harmful than FGM, he has essentially declared that while it’s reasonable for parents to harm their sons, it is never reasonable to harm their daughters. Glen Poole, <a href="http://www.inside-man.co.uk/2015/01/15/male-circumcision-can-be-worse-than-fgm-rules-senior-judge/" rel="noopener" target="_blank">Male circumcision can be worse than FGM, rules senior Judge</a>. insideMan (UK), 15 January 2015. Glen Poole author of the book, <a href="http://equality4men.com/book/" rel="noopener" target="_blank">Equality For Men</a>. <h3>Further discussion</h3> Brian Earp, On the supposed distinction between culture and religion: A brief comment on Sir James Munby’s decision in the matter of B and G (children). <a href="http://blog.practicalethics.ox.ac.uk/2015/02/on-the-supposed-distinction-between-culture-and-religion-a-comment-on-sir-james-munbys-decision-in-the-matter-of-b-and-g-children/" rel="noopener" target="_blank">Oxford Practical Ethics Blog, 8 February 2015</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 British judge calls circumcision “significant harm” 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"> In a landmark judgement, the High Court of England and Wales has ruled that children should not be circumcised until they are old enough to decide for themselves. The case arose when the Muslim father of the boy wanted him to be circumcised in accordance with his own religious beliefs, but the English mother disagreed. Top female Family Division judge Mrs Justice Roberts agreed with their mother’s wish to leave it for the boys, aged six and four, to make up their own minds when they are older whether they wish to have it done. The father, 36, was born in Algeria but is now separated from the 34-year-old mother. The couple met in 2006, lived together in a North London flat, and went through an Islamic ceremony of marriage in 2009 before the boys were born. In July 2012 the mother fled the flat with the boys following violent attacks on her by the father. The judge said the father came to England in 2001 on false documents, but had now been given British passport. In reaching her decision, Justice Roberts said: "First and foremost, this is a once and for all, irreversible procedure. There is no guarantee that these boys will wish to continue to observe the Muslim faith with the devotion demonstrated by their father although that may very well be their choice. They are still very young and there is no way of anticipating at this stage how the different influences in their respective parental homes will shape and guide their development over the coming years. There are risks, albeit small, associated with the surgery regardless of the expertise with which the operation is performed. There must be clear benefits which outweigh these risks which point towards circumcision at this point in time being in their best interests before I can sanction it as an appropriate course at this stage of their young lives." She added: "Taking all these matters into account, my conclusion is that it would be better for the children that the court make no order at this stage in relation to circumcision. I am simply deferring that decision to the point where each of the boys themselves will make their individual choices” Circumcision choice should be left until children are old enough to decide for themselves. <a href="http://www.telegraph.co.uk/news/2016/04/19/circumcision-choice-should-be-left-until-children-are-old-enough/" rel="noopener" target="_blank">The Telegraph, 19 April 2016</a> Jonathan Wells, Should religious circumcision be banned? <a href="http://www.telegraph.co.uk/men/health/should-religious-circumcision-be-banned/" rel="noopener" target="_blank">The Telegraph, 19 April 2016</a> <a href="http://www.bailii.org/ew/cases/EWHC/Fam/2016/849.html" rel="noopener" target="_blank">Read the full judgement</a> <h2>Analysis: Decision in circumcision case has wide implications for children's rights</h2> The decision of Justice Roberts in the case of L & B in the High Court of England and Wales has important implications for child rights and protection of children against genital surgeries desired by their parents or other adults. In a landmark judgement, the court ruled that children should not be circumcised until they are old enough to decide for themselves. The case arose when the Muslim father of the boy wanted him to be circumcised in accordance with his own religious beliefs, but the English mother disagreed. Top female Family Division judge Mrs Justice Roberts agreed with their mother’s wish to leave it for the boys, aged six and four, to make up their own minds when they are older whether they wish to have it done. The father, 36, was born in Algeria but is now separated from the 34-year-old mother. The couple met in 2006, lived together in a North London flat, and went through an Islamic ceremony of marriage in 2009 before the boys were born. In July 2012 the mother fled the flat with the boys following violent attacks on her by the father. The judge said the father came to England in 2001 on false documents, but had now been given British passport. The importance of the court’s judgement is that it confirms and extends earlier rulings that where parents disagree about whether a child should be circumcised, he or she should not be circumcised, but protected until he or she is old enough to make an informed decision. It further implies that for circumcision of a child t be lawful, both parents must give consent. This confirms the earlier ruling in the case of Re J that where the parents disagree, the best interests and possible future wishes of the child will need to be considered, which will normally dictate that the child should be free to decide for itself when older). The case represents a perceptible change towards giving priority to the child’s rights and possible future wishes, thus abandoning the old legal view of children as little more than objects in the possession of their parents. More obviously than in the <a href="http://www.cirp.org/library/legal/UKlaw/" rel="noopener" target="_blank">case of Re J</a>, the Court was receptive to the real risk of harm resulting from circumcision, largely owing to the evidence presented by the mother’s counsel, who was well versed in the recent medical literature. While noting them, Justice Roberts did not give priority to the prophylactic health benefit arguments, but rather correctly evaluated the risks and harms involved as the key factor. The vital thing is that the court accepted the primacy of the children’s right to make their own decisions about their lives. A key statement from the central argument of the judge (para 142-3): “First and foremost, [circumcision] is a once and for all, irreversible procedure. There is no guarantee that these boys will wish to continue to observe the Muslim faith ... although that may very well be their choice. They are still very young and there is no way of anticipating at this stage how the different influences in their respective parental homes will shape and guide their development over the coming years. ... I am ... deferring that decision to the point where each of the boys themselves will make their individual choices once they have the maturity and insight to appreciate the consequences and longer term effects of the decisions which they reach.” These comments are essentially consistent with the principle of the <a href="https://www.circinfo.org/ethics.html#OpenFuture">child’s right to an open future</a>. Justice Roberts also referred to <a href="https://www.circinfo.org/Brit_judge_on_FGM_and_circumcision.html" rel="noopener" target="_blank">Lord Justice Munby’s comment</a> from the Re B & G case last year: that when considering the legal questions around non-therapeutic circumcision, particularly the question of “significant harm” and comparisons with FGM, is to wade into “deep waters” - a suggestion that there is some wider concern about the tenability of this area of the law. Perhaps the most useful element of the case will turn out to be the factual findings. After hearing at length from an expert of Islamic Studies, the judge was quite satisfied that nothing in Islam requires Muslim parents to circumcise their boys or that a boy’s circumcision is obligatory at any particular age. On the contrary, she found that that even if not uncircumcised they will still be able to participate fully in their father’s Muslim culture. Given that most circumcision cases now involve Islam more than any other faiths, this finding is an important one on which subsequent cases will probably rely. </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 British court: Circumcision choice should be left until children old enough to decide for themselves 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>A new twist to the debate</h3> <h1>Circumcision: Let the owner of the foreskin decide</h1> An article in the Canadian Medical Association Journal suggests that it is wrong to circumcise male infants, but that the operation could reasonably “be offered” to boys just before puberty. This is the opinion of Dr Noni Macdonald, a professor of pediatrics at Dalhouisie University, who writes that since the “potential benefits” of circumcision kick in only after males become sexually active, it would make more sense to offer circumcision to 11-year olds than to do it to babies. “The [infant] isn’t at risk of HIV and sexually transmitted diseases, because they’re not sexually active, so why are we rushing to do it at that time?” She wonders why people are more likely to accept circumcision of a baby, who cannot give any kind of consent, and for whom the operation is of no benefit at all, than of a pre-teen, who might have at least some chance of understanding his options. Good questions, but we do not feel that Professor Macdonald has come up with the right answers. She is correct to say that it is unethical to circumcise anybody without informed consent, and also that infants cannot possibly derive any benefit from such an operation, but we cannot agree that it would be acceptable to routinely “offer” to circumcise boys at 11 or 12 years of age. If boys at that age are not considered capable of consenting to sexual relations with other people, they are certainly not competent to consent to having part of their genitals surgically removed – an irreversible step, far more radical than mere sexual activity. Another objection is that the average 11 year old does not have sufficient maturity, independence or knowledge to agree to such an operation, and is too subject to pressure from parents, relatives and peers to be able to make a free and informed choice. If circumcision provides some degree of protection against sexually transmitted infections (a contentious point), the only logical age at which a male can legally consent to circumcision would be the same as the age of consent for sexual purposes – that is, from 16 to 21 years, depending on the jurisdiction. In other words, if it is wrong to perform circumcision in infancy, it is equally wrong to perform it at any time before legal adulthood. Full details of the proposal and a critical analysis by CIA follow. <h2> <a id="report" name="report"></a>1. Report in Canada National Post</h2> A new study has reignited the ongoing debate over circumcision, with a provocative new suggestion by a leading Canadian researcher: Wait until boys are 11 or 12 before they are circumcised, and allow them a say in the decision. Dr. Noni MacDonald, professor of pediatrics at Halifax’s Dalhousie University, says that since the potential benefits of circumcision only begin to set in once males become sexually active, there may be merit in offering circumcision to young boys “rather than their baby brothers.” She makes the provocative suggestion in the latest issue of the Canadian Medical Association Journal, in response to new evidence from large trials in Africa concluding the benefits of male circumcision in cutting the risk of HIV in heterosexual men there. “The [infant] isn’t at risk of HIV and sexually transmitted diseases, because they’re not sexually active, so why are we rushing to do it at that time?” Dr. MacDonald said. “If you’re really going to do this, we need to think of the timing. Why aren’t we offering it to peripubertal boys, when it’s going to be relevant?” The Canadian Paediatric Society is in the process of trying to decide what to say about the topic. Several committees are reviewing the African data, said executive director Marie Adele Davis. The Ottawa-based group’s current position is that the benefits and harms of circumcision are so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns. Circumcision rates in Canada are falling, but it remains one of the most frequently performed surgical procedures worldwide. Dr. Neil Pollock, a Vancouver-based doctor who has performed more than 30,000 circumcisions, says routinely postponing the decision on the procedure is off the mark. “If it makes sense to do it later in life, it makes sense to do it earlier,” he said in an interview. He adds that having the surgery while in infancy makes it safer and less painful for the baby, and less costly for the medical system.“ Parents are always called upon to make decisions for their children, what they believe to be in their best interest,” he said. “If you explain to any 11-year-old what you were proposing, likely an 11-year-old would never consent to have that done.” Because Canada has a much lower HIV rate than Africa, it isn’t clear how applicable the African studies are to the North American experience. A recent U.S. analysis estimated that neonatal circumcision would reduce the 1.87% lifetime risk of HIV among men, but only by about 16%. “It’s not a huge decrease,” noted Dr. MacDonald. To those squeamish about a procedure that is deemed to be too painful and uncomfortable for a pre-teen, she says: “Why are we fine with doing it to a baby but not a young man? “It’s curious that a painful elective procedure of no major benefit to the infant until years later would ever be deemed more acceptable than the same procedure for a peripubertal boy,” Dr. MacDonald writes in the CMAJ. What’s more, unlike infant boys, older boys can give consent. “The baby gets no choice, the parents make the decision,” she said. “An 11-, 12-, or 13-year-old boy could really make a decision on their own about this.” Study says wait until age 11 for circumcision, by Sharon Kirkey and Michael Fraiman <a href="http://www.nationalpost.com/news/Study+says+wait+until+circumcision/4565003/story.html" rel="noopener" target="_blank">National Post (Canada), 5 April 2011</a> <h3>Comments from readers</h3> The comment from Simon in Toronto is of particular interest Quote from Dr Pollock: “If you explain to any 11-year-old what you were proposing, likely an 11-year-old would never consent to have that done.” That’s about as solid an argument against circumcision as anybody should need. Basically, he’s saying that the best reason to cut babies is because they can’t tell you to stop. It neatly – and brutally – clarifies the moral injustice of the practice. The African studies have already been shown to be unreliable due to lack of controls or proper monitoring of participants. Also, what in the world would any data from there have to do with anything here? Cultural and social practices, economic conditions, health care options and political difference are too large to allow for a legitimate comparison. Correct me if I’m wrong, but I’ve never heard of groups of Western men gang-raping pre-pubescent girls because they think that will cure them of/protect them from HIV/AIDS, as has been reported from parts of Africa. All of my sons are uncut. They are natural, whole and healthy. Why the heck would somebody want to subject them to the painful cutting-off of a valuable piece of an important body part? It’s time for our society to put the bizarre practice of circumcision into the dustbin of history. … as is this from Vancouver Sun Circumcision perpetuated by lack of consent Re: Circumcision best left for prepubescence, disease expert says, April 4 “Why are we rushing to do it (circumcision) at that time (infancy)?” asks Dr. Noni MacDonald. Although those with a financial or other personal interest in perpetuating routine circumcision [such as Neil Pollock, Terry Russell, Mateen Jabbar, Brian Morris etc] will never admit it, the simple reason is that infants are the most powerless human beings in our society. Circumcision proponents know very well that if restricted to cases where informed consent of the circumcisee were sought, the procedure would vanish overnight. <a href="http://www.vancouversun.com/health/Circumcision+perpetuated+lack+consent/4573216/story.html#ixzz1K9nS0idD" rel="noopener" target="_blank">Greg Depaco, Vancouver Sun, 7 April 2011</a> Reference: Noni McDonald, Male circumcision: get the timing right, Canada Medical Association Journal 2011;183(7):872. PDF available; send request through Contact form on this site. <h2> <a id="comment" name="comment"></a>2. Comment: Do we really want to see Routine Peripubertal Circumcision?</h2> Professor MacDonald makes an interesting suggestions, but her comments are marred by several mistakes, an uncritical attitude to recent pro-circumcision literature, and a complete failure to understand the rules of informed consent. To take the last point first, it is simply wrong to say that an 11- or 12-year-old boy can give informed consent to circumcision, an operation that makes dramatic and irreversible changes to both the appearance and function of the organ that probably means more to him than any other. Boys of that age are not considered capable of consenting to sexual relations with other people, and even if they agree to have sex with somebody the other party will be regarded as guilty of sexual assault. Why should circumcision be treated any differently? If “peripubertal” boys at are not considered capable of consenting to sexual relations with others, they are certainly not competent to consent to having part of their genitals surgically removed. Another consideration is that the average 11 year old does not have the maturity or knowledge to agree to such an operation, and is too subject to pressure and coercion from parents, relatives and peers to be able to make a free and informed choice. If circumcision provides some degree of protection against sexually transmitted infections (a contentious point), the only logical age at which a male can legally consent to circumcision would be the same as the age of consent for sexual purposes – that is, from 16 to 21 years, depending on the jurisdiction. In other words, if it is wrong to perform circumcision in infancy, it is equally wrong to perform it at any time before legal adulthood. <h3>Sexual coercion in tribal societies, Korea and the Philippines</h3> Professor MacDonald’s contention that circumcision at puberty provides “the opportunity for informed choice by the proposed recipient of the procedure. The boy can give assent” is contradicted by the experience of both tribal societies and of modern societies such as South Korea and the Philippines. Tribal societies have been performing initiation rites on “peripubertal” boys and girls, sometimes involving circumcision and other genital mutilations, for thousands of years, but the children have no more opportunity to decline the operation than to fly to the moon. If they object they are subject to violent coercion, and if they run away they are ostracized from the tribe and very likely to die. Circumcision of boys at around 11 years of age is pretty much universal in both South Korea and the Philippines, and in both societies the combination of social expectation, peer pressure and the fact that the boys are still children subject to parental discipline means that they have not the slightest chance of being able to say “No thanks” [1]. But unless they can decline without prejudice to their future social status, there is no possibility of an informed choice. It’s simply coercion with a velvet glove. Experience in South Korea, where circumcision was introduced in the 1950s as a result of US influence following the Korean War, and has since become an entrenched “tradition”, shows that once circumcision becomes an unavoidable social custom it is likely to persist long after the temporary medical emergency that gave rise to it has disappeared. Medical treatments can be introduced and abandoned quite easily; social traditions are far more intractable. <h3>The child’s right to an open future</h3> The principle of the child’s right to an open future, as developed by the legal philosopher Joel Feinberg and the medical ethicist Dena Davis, holds that children are adults-to be, and that it is the duty of parents to preserve and protect their options so that they can make choices for themselves in adulthood. This applies not only to affection, food, shelter and education, but also to freedom from irrevocable parental decisions, of which circumcision is a permanent, palpable and unnecessary example [2]. Some children might be able to make an informed choice about circumcision as early as age 11, but by that token it is probably also true that they could consent to sexual relations with other people –a proposition that neither law nor custom is willing to accept. In order to protect the majority from exploitation and coercion, all children must be protected from unnecessary genital surgeries and restricted from the free exercise of sexual choices until the age of consent. The practice with respect to genital surgeries should be no less strict than the rules governing sexual activity. <h3>Best interests and imputed judgement</h3> There are two tests that may be applied when decisions have to be made on behalf of those incompetent to make them for themselves, whether minors or disabled adults. The first is the best interests test. These are the long term interests of the person as a person, taking account of the society in which he/she lives, interests, skills, hopes, wishes etc, and if a minor the person’s interests in the future, as an adult. In <a href="http://www.cirp.org/library/legal/Re_J/">the case of Re J</a>, for example, an English court determined that it would not be in his best interests for a 6-year old boy to be circumcised merely because his Muslim father wanted him to be. It would, however, be in the child’s best interests to be given necessary therapeutic medical treatment, such as a life-saving blood transfusion, even if his parents were Jehovahs Witnesses, whose religion prohibited such procedures. It would also be in his best interests to be vaccinated against serious diseases, such as hepatitis B, if he was at risk of infection (say from a parent with the disease), even if the parents were philosophically opposed to vaccination. In both cases the child’s welfare trumps the parents’ wishes. When medical treatment is either necessary to save a person’s life, or provides proven and substantial benefits (such as immunity to serious diseases) without harm, loss of body parts or function, and without a significant risk of complications, it is acceptable to provide it without the informed consent of the recipient. The other test is the imputed judgement test – the option that an incompetent person would, or would be most likely to, choose for himself if he were competent to make and express an opinion. One way of establishing the answer in relation to medical issues is to ask what competent adults choose when faced with the same question. Most adults would agree to a blood transfusion if it meant the difference between life and death, and most would agree to get vaccinated against a serious disease if they were likely to be exposed to it and at risk of infection. The case of circumcision is even more clear-cut: since a negligible number of adult men in western societies elect circumcision for themselves, we may reasonably infer that if the average minor were asked whether he wanted to get circumcised he would say NO. In fact, proponents of infant circumcision recognise this perfectly well. It is precisely because they know that the average adult , or indeed any male old enough to be conscious of his body and aware of what circumcision entailed, would also say NO, that they insist that the operation must be done in infancy or early childhood, when the boy has no power to resist. In the news report printed in the National Post above, Dr Pollock stated quite openly: “If you explain to any 11-year-old what you were proposing, likely an 11-year-old would never consent to have that done.” Australia’s leading circumcision crusader, Brian Morris, similarly admits that if the circumcision choice were left to them, many boys would make the “wrong” decision. “Parental responsibility must override arguments based on the rights of the child”, he writes, “parents have the legal right to authorise surgical procedures in the best interests of their children”. When they are old enough to give legal consent males “are reluctant to confront such issues” and are neither “mature nor well-informed enough” to make the right decision for themselves. In other words, Morris concedes that if doctors waited until boys were old enough to make up their own mind, most would not consent to the operation [3]. But from an ethical point of view, as “Simon of Toronto pointed out, the fact that the average vocal adult does not wish to be circumcised is proof that it is wrong to do it to voiceless minors. Those who fail to see this can only be described as morally and ethically disabled. Indeed, when it comes to sexual activity, both law and custom regard assaults on minors far more seriously than assaults on adults, and regard interference with babies as one of the vilest of all possible crimes. But if fiddling with a child’s genitals deserves a stiff gaol sentence, what sort of punishment should be inflicted to those who cut part of them off? <h3>Whether to circumcise not the key question</h3> MacDonald deserves credit for shifting the debate on circumcision away from irrelevant quibbles about the balance of risks and benefits (the so-called pros and cons rubbish), but her own suggestion as to the key question is not much better. The “medically important question” is not at all whether circumcision should be “routinely offered to young male adolescents rather than their baby brothers”, but how we can find an effective method of giving male minors some fraction of the protection against genital cutting currently enjoyed by their sisters. <h3>Too much credence given to HIV-scare circumcision propaganda</h3> Another significant weakness in Professor MacDonald’s essay is her acceptance of a very dubious piece of research on the effectiveness of circumcision as a means of reducing a male’s risk of infection with HIV. She cites a US study by Sansom et al claiming that US males had a lifetime risk of acquiring HIV of 1.87 per cent (i.e. nearly 1 in 50), that neonatal circumcision (presumably universal) would reduce this risk by 16 per cent, and that it was therefore justified as a measure of public health. To her credit, MacDonald regards this risk reduction as too small to justify circumcision without consent, but she has apparently failed to realise that the paper she cites is fatally flawed in several crucial respects and has been roundly criticised (i.e. torn to shreds) in the same journal in which it originally appeared. Among other objections, the critics point out: <ul> <li>the 1.87% lifetime risk was a wild exaggeration; the risk was more likely to be around 0.4%;</li> <li>there was no basis for assuming that the risk reduction afforded by circumcision was 60 per cent, and in fact it is certain to be much less than this;</li> <li>evidence from Africa (where HIV is a heterosexual epidemic) was not applicable to the USA, where the disease is concentrated among homosexual men;</li> <li>the study ignores extra costs arising from complications, as well as giving zero value to the foreskin as a functional element of the genitals.</li> </ul> As the critic points also out, with suitably massaged assumptions, you can “prove” anything you like: or as the computer scientists say, GIGO: garbage in, garbage out. To read the full critique, go to <a href="http://www.plosone.org/">www.plosone.org</a>, and search for Stephanie L. Sansom et al, Cost-Effectiveness of newborn circumcision in reducing lifetime HIV risk among U.S. males. When you get the article, choose the tab for Comments, and select the first: GIGO, by vanhowe. Another critic (Hanabi) points out that Sansom’s own data show 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 42%. This suggests that there is no connection at all between circumcision and reduced susceptibility to HIV, 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.) It is interesting to note that Sansom’s article was originally offered to the US journal Pediatrics, which rejected it as unsound, forcing the authors to seek exposure in a far less authoritative on-line journal. Since the authors are associated with the American Centres for Disease Control, known be stacked with pro-circumcision zealots, we may suspect that the paper was little more than a piece of propaganda, cobbled together to support their case for universal neonatal circumcision. <h2> <a id="references" name="references"></a>3. References</h2> 1. Pang MG, Kim DS. <a href="http://www.historyofcircumcision.net/index.php?option=com_content&task=category&sectionid=5&id=70&Itemid=48">Extraordinarily high rates of male circumcision in South Korea: history and underlying causes</a>. BJU International 2002;89:48-54; also, Romeo B. Lee, Filipino experience of ritual male circumcision: Knowledge and insights for anti-circumcision advocacy. Culture, Health & Sexuality, May–June 2006; 8(3): 225–234; also Boyle GJ. <a href="http://www.cirp.org/library/disease/HIV/boyle-sti/">Issues associated with the introduction of circumcision into a non-circumcising society</a>. Sex Trans Inf 2003;79:427-8 2. 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) 3. Brian Morris, In Favour of Circumcision (Sydney: NSW University Press, 1999), 61-2 </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 Report and critique of Canadian proposal to routinely circumcise boys at age 11 darby