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Do You Know… The History of Racism in American Circumcision?

At a time when human dignity is under assault in our nation and institutionally sponsored racial violence is escalating, I want to say that Intact America stands with those fighting for justice. I also want to talk about how racist myths and stigma have been used to justify male genital cutting — male circumcision — both historically and today, in the United States and overseas.

We know that male and female child genital cutting has been a tradition in some cultures for thousands of years. But as a medical practice, it started in English-speaking countries relatively recently. Nineteenth century Victorian-era doctors believed that sex was dirty, and that the male foreskin was the cause of much disease and of out-of-control sexuality. They thought that removing the foreskin would keep boys from masturbating. Doctors also cut off girls’ and women’s clitorises to tame their sexual impulses and to “cure” hysteria and other maladies. No group was exempt, and poor immigrants and others at the bottom of the social scale came to be targeted as needing to be cut in the name of sexual control and “hygiene.”

Black people, especially black men, were (and still are) sexualized in the American imagination, with myths abounding regarding their sexual appetite, dangerousness, and the size of their genitals. Not surprisingly, then, these myths became justifications for making black men a specific target for circumcision by a medical establishment enthusiastic to carry out the practice. (Black women have also been victimized by the medical system for decades, subjected to medical experimentation, sterilization and other abuses.)

In 1891, a prominent physician named Peter Remondino began calling for “the wholesale circumcision of the Negro race.” Remondino described black men’s foreskins as combining “the extra vitality and proliferation of the preputial tissue with the strong animal vitality of the negro,” and proposed foreskin removal as “an efficient remedy in preventing the predisposition to discriminate raping” — in other words, the rape of white women — “so inherent in that race.”

Remondino was not an outlier. He had been a surgeon in the Union Army during the Civil War and was the first president of the San Diego Board of Public Health. His articles were published in prominent medical journals of the times. His book, “The History of Circumcision from the Earliest Times to the Present,” was published in 1900 and can be found today on Amazon.

And lest you think that circumcising black men as a means of keeping their sexuality under control has died out, look no further than the anti-HIV efforts largely funded by U.S. foundations and carried out by “reputable” American academics to circumcise millions of men in sub-Saharan Africa. (Keep in mind that U.S. cemeteries are full of circumcised men who have died of AIDS since the epidemic started here in the 1980s.) These African campaigns exploit and put at risk whole populations of men who are viewed as so driven by their sexual impulses that they cannot be relied upon to practice safe sex, and also threaten the health of their sex partners.

Most American men alive today were tied down and their foreskins brutally severed when they were babies and unable to resist. The fact that perpetrators of violence may themselves have suffered violence in the past makes our work as human rights advocates both complicated and extremely important. We must break the cycle and fight injustice in every corner, under every rock, of our society.

You cannot compartmentalize justice — you can’t fight to protect babies’ bodies from being placed in four-point restraints and genitally mutilated, but stay silent when you see unresisting men or women held to the ground, kicked and beaten or suffocated to death. You cannot compartmentalize equality. You can’t fight to protect girls and women from genital cutting and rape, but turn the other way when boys and men are assaulted because our social mythology tells us that males (and even more so, black males), cannot be victims or — even worse — that they deserve it.

I am proud to lead Intact America and represent a movement that fights for human rights, personhood, dignity, liberty, and a life free from violence. I hope you will join me in fighting for freedom, exercising compassion, and demanding an end to all forms of injustice and inequality.

Intact America defends the right of every person to bodily autonomy. We deplore all forms of violence inflicted upon people because of their age, their race, their color, their language or culture, their country of origin, their sex or sexual orientation, their mental or physical disabilities, their religion, or any other personal characteristic that makes them convenient targets of oppression.

 

A silver lining to the COVID-19 pandemic?

Nurse holding a smiling Newborn baby at the hospitalIn the face of the COVID-19 pandemic, the American College of Surgeons released an advisory recommending that that hospitals, health systems and surgeons “thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations… or other invasive procedures.” In addition, the ACS called on facilities to “minimize use of essential items needed to care for patients,” among these “personal protective equipment” (e.g., sterile gloves and masks) and cleaning supplies.

Echoing the guidance from the ACS, U.S. Surgeon General Jerome Adams warned that every elective surgery could spread coronavirus within the facility, [and] use up protective medical gear as public officials worry about shortages and burden a hospital workforce who “may be needed” to respond to COVID-19.

On March 16, the American College of Obstetricians (ACOG) joined several other medical societies in issuing a similar statement, endorsing the Surgeon General’s warning.

If we applied the advice of the ACS, ACOG and the Surgeon General every day — not just in times of crises or pandemics — the “routine,” elective genital cutting of children would simply end.

Just like in the United States, during the 1930s and ’40s circumcision took hold in Commonwealth countries. Then World War II caused economic collapse in England, leading to the creation of the British National Health Service — a system where every procedure and every treatment was scrutinized for its cost and potential benefit. That’s how male circumcision there went by the wayside. Cutting out the funding of the risky, harmful and unnecessary amputation of baby boys’ foreskins ended up benefitting British boys and men for the rest of their lives, while saving resources for people with true medical needs.

It’s estimated that more than a billion dollars are squandered each year in the United States on amputating baby boys’ foreskins and repairing the most immediately obvious functional and cosmetic blunders. (If you’re thinking “only a billion,” note that this sum could buy 31,400 high-acuity ventilators or pay for 378,000 ventilator-dependent patient days.) Long-term costs of circumcision, physical and psychological, are of course much greater.

Whether in times of abundance or of scarcity, no state Medicaid program and no private insurer should be spending taxpayer or premium dollars on gratuitous medical interventions. If there is any silver lining to the COVID-19 pandemic it will be relegation to history of the nation’s most common and utterly unnecessary pediatric surgery.

 

“Born Complete”: International Hypocrisy Day 2019

by Georganne Chapin

On Wednesday, February 6, the United Nations Population Fund (UNFPA) rolled out — with much digital fanfare — International Zero Tolerance Day for Female Genital Mutilation.”

After scanning the promo, I’m inspired to suggest a few alternative monikers. How about International Zero Tolerance Day for Genital Mutilation (unless You’re a Boy, in which Case You’re Out of Luck)? Well, that’s probably too many words, so how about International Cultural Blindness Day? Or, better yet, International Hypocrisy Day? Let me explain.

On a polished new website for its “Born Complete” campaign, UNFPA decries the cultural practice of cutting girls as “reflect[ing] deep-rooted inequality between the sexes.” Really?

It’s good to hate FGM, and it’s essential to protect girls from the practice. It’s also irrefutable that many women around the world have less freedom and opportunity than their male counterparts. But to condemn FGM on the grounds that it constitutes sex discrimination is truly mystifying, given the nearly universal circumcision of boys in countries where FGM is practiced.

Particularly hypocritical and galling to me is the fact that my own country is the largest non-Muslim boy-cutting nation in the world: although the numbers are slowly falling, more than one million boys born each year in U.S. hospitals are sexually mutilated within a few days of their birth (and only a handful of those surgeries are carried out as religious rituals).

hypocrisy

Yet, the United States of America is blithely and uncritically on board with the UN’s claim that FGM constitutes sexual discrimination. This is corroborated by the current push by (mostly female) state legislators to implement laws declaring it a crime to cut only the genitals of girl children for non-medical reasons. This trend has accelerated in the wake of a Michigan court dismissing charges against a female doctor who performed minor genital-altering surgery on three young girls whose immigrant parents solicited the procedure. Incidentally, the dismissal was based on the judge’s ruling that the federal anti-fgm law is unconstitutional – NOT because it implicitly exempts boys from protection, but because it attempts to regulate activities that properly belong under the jurisdiction of the states.

I do believe it’s only a matter of time before there will be a court challenge to the state FGM laws as discriminating against boys and intersex children. I’m less sure when the international human rights establishment will start to celebrate “Born Complete” and being “intact” (am I being petty to complain that the UN appropriated this term from the American intactivist movement?) as applying to all children.

But those are topics for another day. In the meantime, hypocrisy rules!

Parents, Beware! Medical Professionals Want to Forcibly Retract Your Son’s Foreskin!

Parents, Beware! Medical Professionals Want to Forcibly Retract Your Son’s Foreskin!

Georganne Chapin, MPhil, JD

Increasingly, new parents are questioning the peculiarly American practice of “routine” infant circumcision. They’re heeding their own instincts, doing their research, and choosing to protect their sons’ bodies and right to keep the genitals nature gave them.

Unfortunately, many of these parents and their sons now face a new worry – an iatrogenic[1] epidemic of forced foreskin retraction, the result of ignorance and bias among U.S. healthcare professionals.

A new lawsuit shines a bright light on this insidious practice. On January 10, 2018, Atlanta attorney David Llewellyn filed a Complaint against a major pediatric hospital in that city, describing its disregard for current pediatric care guidelines, and its nursing staff’s systematic violation of patient rights.

Alleging battery; nursing malpractice; intentional infliction of emotional distress; willful, wanton and reckless misconduct; and negligent failure to protect the patient, Park v. Children’s Healthcare of Atlanta catalogs the actions by a nurse who – without conversation or warning – ripped away the foreskin of an intact 2-month old baby named Jude Parks, causing him severe pain, bleeding and emotional anguish. The Complaint also describes the defiant attitude taken by the nursing supervisor and other hospital staff, who insisted – contrary to fact – that the hospital’s protocol calling for the forced retraction of all intact boys’ foreskins was derived from current established medical recommendations.

Some Background
Starting in the late 1800s, Victorian-era doctors began promoting foreskin-removal  as a way to make boys stop pleasuring themselves. (It didn’t work) By the mid-20th century, routine medical (i.e., non-religious) amputation of baby boys’ foreskins had become a peculiarly American phenomenon – fueled, no doubt, by the fact that health insurers paid for it. Today, an estimated 80 million adult American men are missing a palm-sized area from their penises. Even with increased parental awareness – still, over half of all baby boys born in the U.S. are victims of a medical system that makes money from the procedure. But with the voices of aggrieved men becoming louder, and parents questioning the bogus medical claims that there’s something inherently unhealthy about the natural penis, circumcision rates continue to fall.

Most Americans, though, remain surprisingly unfamiliar with the intact penis. Parents who choose to keep their sons intact get little or – worse – the wrong information about how to care for their sons’ genitals. They don’t know that a tight or adherent foreskin (called physiologic phimosis) is normal in babies and boys, and that over time, the foreskin will loosen and separate naturally from the head of the penis. They don’t know that the average age of spontaneous foreskin retraction is actually around ten years of age, and that nobody should but the boy himself should try to hasten this process along.

Though ignorance and misinformation are widespread, the pediatric literature itself (including guidelines from the American Academy of Pediatrics) actually is clear: a baby’s foreskin should NEVER be forcibly retracted. Using force to pull back a boy’s foreskin is painful, and can cause swelling, bleeding and infection.

What Happened to Baby Jude?

According to the above-mentioned lawsuit, Jude Parks was referred by his primary doctor to Children’s Healthcare “because he had been vomiting often and the vomit was of a disturbing color.” He was accompanied by his mother Ms. Parks and his maternal grandmother. The Children’s Healthcare physician who examined Jude ordered tests for blood and urine. Nurse Sorrells (a named Defendant in the lawsuit) “took off Jude’s diaper, apparently to obtain a urine specimen, and, without comment and without asking permission to do so, forcibly tore and retracted his foreskin all the way back off of his glans, to which it was naturally attached… caus[ing] the end of Jude’s penis to become bloody. Jude started screaming. Neither his mother nor [his grandmother] had ever hear him scream like that before. Neither has heard him scream that way since.”

fingernail

When Jude’s mother told Defendant Sorrells that no one is supposed to retract and tear an intact boy’s foreskin, the nurse insisted that what she’d done was proper, and that Ms. Parks herself should be retracting Jude’s foreskin at every diaper change. A nursing supervisor subsequently appeared and told Ms. Parks it was hospital protocol to retract intact boys’ foreskins – that they did so in every case. She also said that Jude not being circumcised “leaves him open for infection.”

For weeks after the incident, the Complaint states, Jude manifested pain, and anxiety whenever his diaper was changed. The Complaint further alleges that Jude’s foreskin is scarred, and he may need surgery later on in order to be able to retract it.

The Complaint provides exhaustive evidence that the actions performed upon Jude, and the hospital protocol supporting those actions, violate current medical standards and guidelines, including those from the American Academy of Pediatrics. It further alleges that Children’s Healthcare was aware or should have been aware of these standards and guidelines. Finally, it provides a reference to a contemporary article by Adrienne Carmack, MD and Marilyln Milos, RN confirming that it is not necessary to retract a boy’s attached foreskin to insert a catheter.

While it’s too late to protect Baby Jude from this harm, it is possible to protect the thousands of intact boys like him.

If you are the parent of an intact boy:

  • Do not allow a doctor, nurse or anybody else to forcibly retract your son’s foreskin. Make a point of telling your pediatrician this up-front, and providing this information in his medical chart. If you do take your intact boy to an emergency room, let the provider(s) know that foreskin retraction is off-limits.

If your baby has been subjected to forced retraction:

  • The soreness and swelling will likely resolve on its own. Watchful waiting, and bathing him in plain warm water (no soap or bubble baths), are the best recourse for healing. If he does not improve, or if there is pus or smelly discharge, seek medical help – preferably from a foreskin-knowledgeable physician. Let the new doctor know that you will not tolerate further tampering with your son’s foreskin.
  • You are entitled (and we encourage you) to complain in writing to the doctor who performed the retraction and the facility where this battery took place. At a minimum, you should provide them with factual information, such as the Carmack and Milos article referenced aboveand this information sheet. You may also file a complaint with your state’s medical board or office of professional discipline. Finally, you may wish to explore filing a lawsuit. Should you choose to do so, Intact America can help you or your attorney with the pertinent resources. Contact us at [email protected] or write to me directly at [email protected].

Over time, as the ranks of intact American men increase, medical professionals will learn the facts and foreskin bias will subside. Until that time, it’s not simply enough to keep your son intact. Ongoing education and vigilance will remain necessary until Americans realize that nature put the foreskin there for a reason – and that it’s something we should value, rather than fear.

[1] I.e., caused by the medical system. Iatrogenesis refers to any effect on a person, resulting from any activity of a person or persons acting as healthcare professionals or promoting products or services as beneficial to health that does not support a goal of the person affected.

America’s Infuriating Double Standard on Cutting Children’s Genitals

Slightly edited version of essay published in  Huffington Post 05/03/2017 01:26 pm ET

By: Georganne Chapin, MPhil, JD, Executive Director, Intact America

Fraternal Twin Baby Brother and Sister

On April 13th, a Detroit doctor was arrested and charged with the Federal offense of removing parts of the genitals of two young girls. Meanwhile, doctors across the United States remove part of the genitals of 3,000 baby boys every single day.

How is that different?

It’s not. Too many people who object to cutting little girls have no qualms about cutting baby boys. The simple truth is that no child born with healthy genitalia should have any part of them cut, permanently altered, or painfully removed—no matter what gender they are.

I remember the first time I heard about female genital mutilation, or FGM as it’s often labeled. I was in my 20s, and not yet married or a mother. I immediately thought, “But we do the same thing to boys…, and call it by its euphemism — ‘circumcision’.”

Maybe if we called it male genital mutilation, more people would understand what it actually entails—binding the arms and feet of a newborn boy, using a metal probe to forcibly tear his foreskin from his glans penis, clamping that foreskin, and then cutting it off with scissors or a scalpel. Sometimes doctors cut off too much (causing complications too gruesome to mention here); sometimes they cut unevenly. Follow-up surgeries to correct errors and functional impairments are common. That’s no surprise. Surely, it is hard to operate on the genitals of a bucking, screaming child.

‘I Heard the Most Terrible Cries.’

Read what Elise Carin Wicklund, a mother in Parrish, Florida, wrote after she was told by her baby’s pediatrician that her weeks-old son would feel only a few seconds of discomfort.

“I heard the most terrible cries. The nurse brought me my screaming baby. They hadn’t even been able to put his onesie on all the way. He wouldn’t look at me. He wouldn’t nurse. For a long time, when I changed his diaper, he screamed.”

Without a doubt, that doctor is still out there cutting little boys. Compare this to the case of Jumana Nagarwala, a Johns Hopkins-trained female physician, charged with genital cutting of minor girls.

“Despite her oath to care for her patients, [Dr. Nagarwala] is alleged to have performed horrifying acts of brutality on the most vulnerable victims,” said Acting Assistant Attorney General Kenneth A. Blanco in a news release announcing the arrest.

Nagarwala’s case, the first to be filed under 18 U.S.C. 116, the Federal law that criminalizes female genital mutilation, has opened the eyes of many Americans, who are shocked that FGM is practiced on our soil. Perhaps it’s time they think more about what doctors routinely do to little boys.

As for the alleged health benefits of male circumcision, suffice to say that Great Britain, Europe, Australia, and other Western countries do not circumcise their boys or men, and their rates of AIDS/HIV, cervical cancer and penile cancer are comparable to or lower than ours.

The truth is that Americans circumcise their boys for the same reason other cultures circumcise their girls. We need to recognize that only tradition, bias and politics make the one okay, and the other abhorrent. Let’s acknowledge that all children deserve equal justice.

Dear Dr. Remley

CALLING THE AMERICAN ACADEMY OF PEDIATRICS (AAP)
TO ACCOUNT
 by Georganne Chapin

Just about a year ago, after an article published in the journal Pediatrics called for minimizing painful medical procedures in children, Intact America launched a petition. As of last week, more than 12,000 people had signed that petition, demanding that the AAP tell its member pediatricians to “End the Pain,” and stop circumcising baby boys.

The petition and our demand were further bolstered by an odd piece published in the April 2016 issue of that same journal, Pediatrics, by pediatric urologist Andrew Freedman. If his name sounds familiar to you, perhaps it’s because Freedman, in addition to being a member of the AAP’s Circumcision Task Force that in 2012 published the Academy’s revised policy on the subject of foreskin removal, made headlines by openly talking about circumcising his own son on his parents’ (the boy’s grandparents’) kitchen table.

Freedman’s April 2016 statement sought to “clarify” the meaning of the 2012 Report’s “benefits outweigh the risks” position. According to Freedman, the report wasn’t really talking about the medical benefits of forced foreskin removal from babies who cannot consent, but rather the overall benefits, “given the role of the phallus in our culture….” What’s important, he says, is that parents who choose circumcision for their boys should have “access” to the procedure, in the form of third-party (Medicaid or private insurance) payment (to doctors and hospitals, of course).

Clearly, there’s a lot more we could say here. But for now, we want to thank those of you who signed the petition and tell you that, together with the 12,160 signatures, it’s been forwarded to Dr. Karen Remley, Chief Executive Officer of the AAP. You can see my  letter to Dr. Remley below. We will keep you posted on the AAP’s response.

IA_logo_transparent

March 2, 2017

Karen Remley, MD, MBA, MPH, FAAP
CEO/Executive Director
The American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098

Dear Dr. Remley:

A year ago, the American Academy of Pediatrics Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine published “Prevention and Management of Procedural Pain in the Neonate: An Update” in the February 2016 issue of Pediatrics. The study prompted the AAP to call for hospitals to minimize the number of painful procedures performed on newborns.

Unfortunately, the AAP did not take the next logical step: acknowledging that the painful and medically unnecessary circumcision of baby boys should cease.

Today, Intact America is submitting to you a petition, signed by more than 11,000 men and women, asking the AAP to take that step and call for your members to stop circumcising baby boys.

For every signature we received, we know there are dozens of other Americans who believe that circumcision needlessly subjects our baby boys to excruciating pain and robs them of a part of their anatomy that is important to their future sexual health.

As the AAP itself acknowledges, routine circumcision is not medically necessary. (Source: “Should the Baby Be Circumcised?,” on the AAP’s HealthyChildren.org website.) Yet, the public perception persists that the AAP recommends the procedure—a perception refuted in a 2016 commentary by Andrew Freedman, MD, pediatric urologist and a member of the Circumcision Task Force that formulated the Academy’s 2012 statement.

“To many, especially in the lay press, [the 2012 AAP statement] was interpreted as moving the needle from a neutral stance… to being pro-circumcision,” Dr. Freedman wrote in, “The Circumcision Debate: Beyond Benefits and Risks,” published in the April 2016 Pediatrics. However, Dr. Freedman explained, the statement’s actual point was that “the procedure’s benefits justify access to this procedure for families who choose it.” (Emphasis added.)

Regarding infant circumcision, parental choice is determined more by culture than health concerns, Dr. Freedman further noted. “Most circumcisions are done due to religious and cultural tradition. In the West, although parents may use the conflicting medical literature to buttress their own beliefs and desires, for the most part, parents choose what they want for a wide variety of nonmedical reasons.”

The AAP should not be complicit in encouraging parents to make a cultural decision under the pretense of science. The AAP must publicly recognize, in an official communication, that an erroneous perception exists and that the AAP does not and has never recommended circumcision as a medical necessity. The AAP also must ask pediatricians to inform parents accordingly. We urge you to take such action.

We also ask that the AAP educate its member pediatricians about the role of the foreskin in (1) protecting the glans, and (2) sexual pleasure—two major benefits not acknowledged in the 2012 assessment of benefits and risks.

In addition, we ask that you correct the mistaken assertion in the 2012 Task Force Report that a boy’s foreskin will usually separate from the glans by 2-4 months of age; while expert opinion on the average age of spontaneous foreskin retraction varies wildly around the world, the AAP’s own HealthyChildren.org says, “Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teen years.”[1] (The Pediatric Society of New Zealand says “by age 18”[2]; the British Association of Urological Surgeons says “by age 10.”[3] A Danish medical survey found the mean age of first foreskin retraction to be 10.4 years.[4])

We believe that your members should be advised that forcible retraction of a boy’s foreskin is never indicated, because the age of spontaneous retraction is variable and might not occur until late adolescence. It is important that the AAP correct the record, because many American health professionals are unfamiliar with the normal intact male penis, and believe that it is necessary to force separation of the foreskin from the glans —potentially causing boys extreme pain and—potentially—lasting physical damage.

Finally, as our enclosed petition demonstrates, we continue to ask you to tell pediatricians to end the pain, and stop circumcising baby boys.

Both the American Academy of Pediatrics and Intact America share a common goal – protecting the health and wellbeing of children. We can and should work together toward that goal.

Sincerely,

Georganne Chapin, MPhil, JD
Executive Director

[1] https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Care-for-an-Uncircumcised-Penis.aspx

[2] http://www.kidshealth.org.nz/foreskin-care

[3] http://www.baus.org.uk/patients/conditions/13/tight_foreskin_phimosis

[4] Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? [Phimosis: Pathological or physiological?] Ugeskr Læger. 2005;167(17):1858- 62.