Last week, Intact America launched a petition to the American Academy of Pediatrics (AAP). The petition demands that the AAP follow the recommendations from its own research about infant pain, and tell its doctors to END THE PAIN and stop circumcising baby boys. Our goal is 29,000 signatures by February 29. We need your help! Please sign this petition, and share it with your friends. Ask them to sign and share it, too!
Intact America insists that the American Academy of Pediatrics issue a new circumcision policy—one that honors and protects baby boys from harm.
The American Academy of Pediatrics (AAP) recently said that babies shouldn’t be subjected to unnecessary pain. But the AAP continues to promote “routine” infant circumcision, a painful, medically unnecessary surgery that removes a normal part of a baby’s penis.
Last month, the AAP published research showing that common medical procedures carried out on newborn babies are very painful, and that the effects of the pain can last many years. The procedures mentioned included heel sticks, insertion of IV needles, and circumcision. The AAP report also found that commonly used pain relievers are neither effective nor safe.
Infant circumcision differs from the other procedures discussed in the report in that it is an invasive surgery that neither tests for nor treats any illness, and permanently removes a natural and valuable part of a boy’s sexual anatomy – the foreskin. The pain from circumcision is intense and continues for days or weeks after the surgery.
Circumcision, originally promoted in the 19th century as a way to prevent masturbation, has become part of American medical culture. Every year, a million baby boys in the United States are subjected to this surgery, although no medical association in the world recommends it.
Some of the falsehoods currently used to support circumcision include hygiene, disease prevention, and aesthetics.
The truth is:
- The intact penis is easily cleaned throughout a boy’s and man’s lifetime.
- Circumcision does NOT prevent sexually transmitted diseases, including HIV. European countries where fewer than ten percent of all men are circumcised have about the same STD rates as the United States, where circumcision is common.
- Any preference expressed by men or women for the circumcised penis is a result of cultural conditioning. Besides, as the U.S. circumcision rate declines, and the number of intact boys and men grow, the intact penis will no longer seem strange or unattractive.
Many Americans also believe that circumcision is “just a snip” – a minor, brief, and painless procedure that babies will not remember. This is FALSE, and the new AAP article on pain proves it.
Because circumcision is NOT medically necessary, and because the pain it causes is unmanageable and harmful over the long term, Intact America demands that the American Academy of Pediatrics tell its doctors to end the pain and stop circumcising baby boys.
Help us reach 29,000 signatures by February 29, 2016.
Please sign our petition TODAY.
The media overlooked an important story late last month that should dramatically change how doctors and hospitals treat newborn babies. On January 25, the American Academy of Pediatrics (AAP) announced a study updating its recommendations on avoiding, minimizing, or treating pain in infants. The AAP statement cites research showing that many “routine” interventions are extremely painful and that there are both short- and long-term consequences of babies’ exposure to painful stimuli.
Now that the AAP is asking health facilities to implement “a pain-prevention program … minimizing the number of painful procedures performed” on newborns, we need to ask again why doctors continue to circumcise nearly a million baby boys a year in the United States. Unlike other painful stimuli the AAP cites, including heel punctures or IV insertion, circumcision is a protracted surgery that does not diagnose or treat any illness, but rather subjects tiny boys to extreme pain for a medically unnecessary procedure.
Until recently, circumcisions have been carried out with no pain relief at all. Instead, practitioners used only physical restraints. Even today, it’s estimated that as many as half of circumcising doctors do not employ analgesia, and that the methods used the rest of the time are only partially effective, if not outright dangerous. (“EMLA,” a topical anesthetic cream widely used in U.S. hospitals, is specifically contraindicated for use “on the genitals of children” in the United Kingdom.
Unfortunately, as the AAP statement acknowledges, it’s nearly impossible to manage pain in infants, given their small size and vulnerability to chemical interventions – even the questionably effective and widely used sugar pacifiers. Implicit throughout the AAP statement is the fact that the safer the analgesic, the less effective it is in eliminating pain.
The next step
Now that the AAP has gone on record to affirm that babies feel and suffer the consequences of pain, and should not be subjected to painful procedures if they can be avoided, the logical next step is for the AAP to call unequivocally for doctors to stop circumcising babies. In its 86-year history, the AAP has never recommended circumcision and has always held that it’s not medically necessary. But, recently, as more and more parents opt out of the procedure for their boys, the trade association’s enthusiasm for circumcision has only increased. In 2012, while admitting that the complications and risks of infant circumcision have never been studied systematically, the AAP took the regrettable position that the operation’s benefits outweigh the risks.
Medical experts from around the world disagree. In response to the AAP’s 2012 statement, a large group of European physicians and ethicists wrote, “Cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report’s conclusions are different from those reached by physicians in other parts of the Western world… [Their claims of] health benefits… are questionable, weak, and likely to have little public health relevance in a Western context.”
Notably, far fewer than 10% of adult men in Europe are circumcised, compared to 75% of the adult male population in the United States.
Now we have a systematic study about the short- and long-term risks of pain inflicted upon infants. This is all we need to know in order for the AAP to stand up and say to its members: “Removing a boy’s foreskin is not medically necessary, it is painful, and the pain may compromise his neurological development for years hence. The AAP recommends that the circumcision of male infants cease.”
In my experience, the more you know about circumcision, the more you oppose it. One important fact is that the foreskin is not “extra skin,” but a natural, necessary part of the male anatomy that protects the head of the penis, provides natural lubrication, and enhances sexual pleasure for men and their partners. In 2011, a study published in the International Journal of Men’s Health found that circumcised men have a 4.5 times greater chance of suffering from erectile dysfunction than intact men.
As an activist, bioethicist, attorney and, most importantly, a mother, I feel a glimmer of hope when I read the AAP’s new policy statement. I see a medical organization increasingly boxed into a corner as it tries to escape the inevitable: infant circumcision is not medically necessary, it is unethical, and it has no place in legitimate medical practice. The organization, which pledges its commitment to “the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults,” thus has no legitimate path other than to tell its physician members to stop circumcising baby boys.
February 13, 2016
His Body His Rights Button
With another Thanksgiving upon us, I have a long list of people and organizations that I want to thank. Here goes.
To Amy, Jennifer and Ted – your day to day support means more to me than you’ll ever know.
To Marilyn – my humble thanks for trusting me to carry on the work you and others began.
To the informal but dynamite Intact America steering committee, whose members contribute their expertise, opinions, criticism, labor and love to this movement – I am sure you know I use you all for brains and strength.
To the kick-ass intactivist community, growing in number, depth, insight and commitment – you know we’re winning, right?
To Intact America’s donors and action-takers – keep it up!
To Dean Pisani – on behalf of the boys and men you are helping, thank you for your generosity. And thank you for your trust in me.
To the American Academy of Pediatrics – thank you for issuing a report so blatantly self-interested and unethical as to reveal your true colors as a money-grubbing trade association that wants to ensure that its members continue to get paid for carrying out painful, risky surgery on children who do not need it and cannot consent.
To the New Orleans Police Department – thank you for the respect. discipline, and guidance you showed with regard to Intact America’s demonstration in front of the Ernest N. Morial Convention Center, during the AAP convention. Thank you for telling the AAP representatives who asked you to make us go away that we were within our rights to protest, and that we were not breaking any laws. And thank you for your interest in our message; we were so privileged to share it with you.
To members of the press whom I will NOT name here, but who have moved from the “skeptical” or even “hostile” column to the “hmm, maybe they’ve got a point column,” and now to the “intactivist sympathizer” if not the “flat out intactivist” column – thank you for being open-minded, and for listening.
To my immediate family – Pablo, Ernesto, Hank, Julia, Chip, Nick and Paul – and to my extended family and friends who have inspired, in one way or another, my passion for this all-important human rights issue.
Above all: To the men who are speaking out, claiming the stage to express their pain and outrage at having been violated as children – it takes a brave man to defy the cultural bias that, first, applies a sexist double standard to genital mutilation and, second, denies the legitimacy of boys’ and men’s protests. I am honored to be at your side.
Thank you all. Again, you know we are winning, right?
I need your help.
Last week, the Huffington Post published “First, Do No Harm,” an article I wrote in response to the American Academy of Pediatrics’ recent endorsement of routine infant circumcision. I am so grateful for the supportive and heartfelt feedback I’ve received from so many.
Judging from the dozens of comments posted publicly and sent to me privately, it seems that my statement calling circumcision a “human rights violation on a massive scale” was a consciousness-raising tipping point for both readers new to the issue, and those already familiar with it.
I want to ask all of you— if you haven’t already done so—to share your thoughts directly on the Huffington Post’s website, which reaches millions of readers. In addition to me wanting to know what’s on your mind, it’s really important for the media, Huffington Post in this case, to see firsthand the breadth of conviction and the diversity of support that exists for keeping baby boys intact. Of course, your positive comments also serve as important information and validation for casual readers who are newcomers to the intactivist cause.
After you’ve commented, I’m hoping you’ll show your support in another way: by donating to Intact America. On October 20, I will be flying to New Orleans with Intact America staff members Amy Callan and Joe Jensen to join other intactivists for the AAP’s annual conference.
We’re working on an Open Letter for the New Orleans Times Picayune, which costs beaucoup bucks, as well as educational handouts and fliers, banners, and much more.
We need your help to carry all of this off. Thanks to a matching pledge from a prominent intactivist, all gifts will be matched dollar for dollar, up to $10,000. This means your donation will have twice the impact. I know money is tight—but it is really critical that we have a strong presence in New Orleans.
Both the Intact America booth inside the Convention Center and the activities taking place outside promote the intactivist message in a whole new way, featuring the photos and stories of brave men who are speaking from their hearts about how circumcision has affected them. Here is the awesome, 10-foot banner that doctors will see when they walk by our booth. To those men who sent photos for this (ongoing) project: thank you, thank you, thank you!
This is why we have to be in New Orleans—to give voice to all the babies who are at risk of being cut, and to protect the bodies and rights of these babies and the men they will become.
Thank you so much.
On August 29, Intact America launched an email campaign, inviting our followers to tell the American Academy of Pediatrics what they think about the new Circumcision Task Force’s Technical Report on Circumcision. The Report, which concedes that the purported health benefits of infant circumcision are not great enough to justify recommending it, and that the risks of circumcision have not been adequately documented, somehow concludes that the “benefits” outweigh the risks. The Report also states that the decision to circumcise baby boys, who cannot consent to have this unethical, medically unnecessary surgery performed on their bodies, should be left to the parents, and, that parents’ non-medical decision to have their child’s genitals unjustifiably altered should be abetted by having Medicaid and private insurance companies pay doctors to do the cutting.
Here’s my letter:
Dear AAP Leadership,
What were you thinking?
How can you approve a report that extols the benefits of removing the foreskin, a normal body part, without one single word devoted to the function of that body part, or why it’s there in the first place? How credible is such a report, which neglects to mention that the vast majority of the world’s men are intact (or as the report says, “uncircumcised”), and that these men do just fine?
What were you thinking when you deputized as co-author of the report a doctor who has openly boasted about circumcising his own son? The American Medical Association’s code of ethics (AMA E8.19) states: “Physicians generally should not treat themselves or members of their immediate families” … “In particular, minor children will generally not feel free to refuse care from their parents.” In 2009, the AAP’s own Committee on Bioethics clearly stated that pediatricians who treat their own children “violate a fundamental professional obligation.”* How can we trust the neutrality or the ethics of a Task Force member who so flagrantly violated his own organization’s bioethical principles?
What were you thinking when you named a specialist in adult sexually transmitted diseases to chair a Task Force to examine infant circumcision? Babies and children don’t have sex, and thus they are not at risk of contracting an STD. It seems to me, by selecting this individual as chair, the Task Force already knew what it was looking to conclude.
Would it not have been relevant for the Task Force to mention the limitations of its recommendations? Specifically, even if circumcision were to confer some protection from HIV for adult heterosexual men, as claimed by the studies cited, it was found to confer none for women, or for men having sex with men, or for intravenous drug users. And, again, it confers no protection for babies and children. Furthermore, shouldn’t the Report have mentioned that if or when an adolescent or adult becomes at risk, there are other nonsurgical ways of avoiding sexually transmitted diseases? Shouldn’t the words “safe sex” or “condom” or “abstinence” have appeared at least once in the Report?
Given the Task Force’s unequivocal conclusion that the “health benefits of newborn male circumcision outweigh the risks,” are you not concerned by the Report’s utter failure to address the risks? Specifically, how do you justify the contradictions and doublespeak in the following statements?
The true incidence of complications after newborn circumcision is unknown, in part due to differing definitions of “complication” and differing standards for determining the timing of when a complication has occurred (i.e., early or late). Adding to the confusion is the comingling of “early” complications, such as bleeding or infection, with late complications such as adhesions and meatal stenosis…. (p. 772)
Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the severity of complications. (p. 775)
The majority of severe or even catastrophic injuries [such as] glans or penile amputation, … methicillin-resistant Staphylococcus aureus infection, urethral cutaneous fistula, glans ischemia, and death are so infrequent as to be reported as case reports (and were therefore excluded from this literature review). (p. 774)
Did you not notice any potential liability problems for the AAP and for pediatricians who circumcise that might arise as a result of the Report? For example, while discussing the Mogen clamp in its review of complications from particular circumcision techniques and tools, the Report says:
There were no specific studies of complications … because complications are rare; thus, one can only rely on available case reports of amputation. (p. 775)
No note is made of the fact that the manufacturer of the Mogen is bankrupt, due to lawsuits resulting from these “rare” complications and amputations, and that any doctor sued for an adverse outcome from a Mogen will be on his own (unless, of course, he can implicate the AAP for failing to inform him of the facts). Also, the review of techniques and tools neglects to cross-reference a mention elsewhere of “devastating burns” that can occur when electrocautery is used in conjunction with the metal Gomco clamp. Sloppy, at best.
Did anybody think to ask why no data has ever been found in the developed world showing a correlation between circumcision and disease? Since when is sub-Saharan Africa, with high rates of poverty, illiteracy, and disease, the gold-standard comparison population for American pediatrics? Did anybody wonder how it can be that Europe, where very few men have been circumcised, has lower rates of STDs and HIV than the U.S. and better overall health status, along with lower per capita health expenditures?
Has the leadership of the AAP, knowing that a Task Force was preparing recommendations about infant circumcision, noticed that medical associations in European countries are increasingly calling for doctors to refuse to perform this surgery, on the basis that it is risky, medically unnecessary, and a violation of the child’s rights? How can you completely ignore the principles and actions of your learned colleagues in other countries?
Did anybody ask the Task Force to make sure its Report was consistent with other AAP policies, including the statement by the AAP’s own Committee on Bioethics on “Informed Consent, Parental Permission, and Assent in Pediatric Practice”? The policy, still in effect, states in part:
Proxy consent poses serious problems for pediatric health care providers. Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses… [The] pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent. (p. 315)
In placing the burden of deciding whether to circumcise their sons squarely on the shoulders of parents (who are not medical professionals), is the Task Force Report on Circumcision contradicting this statement on Informed Consent? By referencing religion and culture as valid elements in parental decision-making (p. 759), is the Report attempting to give doctors a free pass? Religion and culture (in the American context) generally lead to circumcisions, but human rights, medical ethics and the mandate to doctors to do no harm clearly lead to leaving a boy intact.
Most important, have you not noticed the growing outcry among parents, complaining that they were duped by doctors into agreeing to allow harmful surgery to be performed on their baby boys? Are you ignoring the growing body of complaints from adult men protesting that they were robbed of an important part of their sexual anatomy, without their consent?
Are any of these considerations not relevant to the pediatrician who would strap down a helpless, screaming baby and cut off part of his penis?
I look forward to your response.
Georganne Chapin, MPhil, JD
* Committee on Bioethics, Pediatrician-Family-Patient Relationship: Managing the Boundaries. Pediatrics 124(6), Dec. 1, 2009: 1685-88.