Circumcision, cultural bias, and the question of consent

"My penis was cut without my consent and without good reason. This will not happen to our son." My husband speaks with clarity and conviction.

Long before we became parents, my husband carefully researched the subject of male genital cutting, commonly called circumcision. His opposition to the practice is two-fold. First, there is the question of consent. Small children -- let alone infants -- have no capacity to consent to the surgical removal of sound body parts. Secondly, there is no compelling medical need to cut off healthy genital tissue. The cutting of male or female genitals is a socially constructed practice often linked to group identity or religious doctrine.

"He doesn't need to look like me," he continued. "I want him to remain as nature intended."

Initially, I wasn't sure how to respond to my husband's stance on the subject. In high school, I read about female genital cutting with profound shock. I remember being moved to tears upon discovering that such a thing even existed. Yet, the practice of infant male circumcision was woven thoroughly into the culture around me. I never met anyone who questioned it.

Many Americans think of male circumcision as an issue of hygiene. Yet, this is not the case. The vast majority of men throughout human history have kept their intact penises clean without any extraordinary effort. Many Americans think that the foreskin, which is removed in a circumcision surgery, is useless skin. This is also untrue. It seems that with the acceptance of the routine cutting of infant penises, we also have cut the function of the foreskin from our consciousness. In an intact adult male, the foreskin is the most sensitive and erogenous 12-15 square inches of his body and it contains 10,000-20,000 fine touch nerve endings. It is not useless skin.

Commonly held beliefs regarding medical benefits of circumcision are also flawed. Recent studies analyzed by the Centers for Disease Control and Prevention show that circumcised men infected with HIV are not less likely to transmit the disease to female partners and studies examining the rate of an increased transmission to male partners are mixed. There is a "substantial protective effect" when it comes to circumcised men contracting the disease from an infected female partner. Yet, the fight against HIV won't be won by cutting the penises of newborn boys. Rather, sexually active adult men, whether intact or circumcised, should be educated to minimize the risk of spreading/contracting HIV, or any sexually transmitted disease. In 2012, the American Academy of Pediatrics argued that the medical case regarding circumcision isn't strong enough to universally recommend it.

In an interview with BBC World News, Dr. Marvin Wang, co-director of The Newborn Nurseries at Massachusetts General Hospital, affirms that infant male circumcision is a "cultural decision." In his experience, the most commonly stated reasons to circumcise infant boys come from fathers. While a growing number of American men share my husband's sentiments, many circumcised fathers want their sons to "look like them." Having witnessed the teasing of uncircumcised peers, they are also afraid that their sons, should they remain intact, would be ridiculed. The reality of today's circumcision rates, both at home and abroad, do not correspond to such fears.

Today, 70% of men worldwide live out their lives with a penis formed as nature intended. Their foreskins are intact. In the US, 75% of adult men live out their lives sans foreskin. Within their first few days of life, a healthy part of their penises was surgically removed.  Commonly this was done without any anesthesia. At the time of my husband's birth, 90% of infant boys in the US were circumcised; today this rate has dropped significantly. According the Centers for Disease Control and Prevention, 56% of US male infants were circumcised in 2012. In some western states, the rate of genital cutting for boys falls below 20%. In eighteen US states, Medicaid no longer covers the procedure. It is the circumcised male who is the minority in our globalized world.

For those who oppose the cutting of healthy genitals, these statistics are encouraging. Yet, one should not make ethical decisions based upon an appeal to tradition or popular trends. Parents, in particular, are obligated to research the subject from multiple angles and come to their own conclusions based upon the light of clear reason and the sensitivity of a loving heart.

I remain grateful to my husband who encouraged my research the subject. Today, our two-year-old son is intact. While we have the legal right to schedule a circumcision for him tomorrow, I believe we are morally obligated to refrain from such an action. An examination of gender, religion, and human rights reveal why.

Gender

One can learn a great deal about cultural bias when comparing the traditions of male and female genital cutting.

Imagine an infant girl placed onto a cold, hospital table specifically designed to restrain her small body. She is naked. Her flailing arms and legs are strapped down. A medical professional places a sharp tool to the girl's genitals and prepares to cut off her labia or clitoris. The practice is said to keep her vulva clean and reduce the spread of HIV and other sexually transmitted diseases. The tissue is cut. The infant girl's face contorts with pain. Blood. Shrill screams pierce the room. She is given sugar water in an attempt to pacify. Later, parents are provided careful instructions as to how to care for the wound. They are told their daughter won't remember the event. They are told that no harm was done. Following the procedure, hospitals sell the discarded tissue for profit commercially. Imagine that this occurs every 30 seconds in America.

Now, imagine that the baby is a boy.

There is not one state in the US where the cutting of a girl's genitals is legally allowed. In fact, female genital cutting is a federal felony. True, there are women in the US who have been cut. Some have come here seeking asylum from the practice in their home countries. A few have been cut on American soil in religious or traditional ceremonies held quietly in immigrant homes. Yet, female genital cutting remains illegal and culturally condemned. Most Americans shudder at the thought of forcibly removing the labia or clitoris of girls.

Is the cutting of infant male genitals so very different?

According to Georgetown University Professor Ryan McAllister, we should examine our "imperialist" bias when it comes to condemning female genital cutting abroad but promoting male genital cutting at home. In both cases, McAllister argues that the cutting is "completely unnecessary" and "entirely harmful" to children. In addition to impacting future sexual function, complications due to the circumcision of both males and females can be very serious.

Moreover, our collective acceptance of male genital cutting profoundly impacts how we speak about, or envision, normal male and female bodies. Consider the term "uncircumcised." McAllister argues that the use of this term implies that circumcision is the biological norm.

"We don't call women who have breasts unmastectomized," he states.

Imagine a medical professional saying that he takes great care to cut the labia so as not to harm the vulva. Or, that she removes the elbow quickly without harming the arm. Or, that the nipple is carefully excised so as not to cause damage to the breast.  These sentences stand as an affront to reason. Yet, medical professionals warn parents that one of the risks of circumcision is "injury to the penis" -- as if the foreskin wasn't a part of the organ at all.

The foreskin is a part of the penis. Like the labia and clitoris, the foreskin evolved for biologically sound reasons. To remove healthy parts of any infant's genitals is a practice we are wise to question.

Religion

A person may believe God wants the index finger of the left hand removed as a sign of obedience to divine power. An adult may choose to cut his offending hand based on this conviction. If the religion becomes popular, doctors may develop methods of removing fingers so home surgeries don't result in infection. Insurance companies may even cover the procedure. Yet, do parents have the right to have their children's hands permanently altered to conform to their own conception of divine will?

I am a scholar of comparative religion and philosophy. I study the world's wisdom traditions and have taught courses on the subject for nearly two decades. I defend the right of each person to approach the Big Questions of life as guided by her or his conscience. Each one of us has the right to study, reflect, meditate, and pray in a way that most opens the heart to wonder and love. We can teach our children about our traditions and encourage them to follow in our footsteps. Or, we can encourage our children to embark upon their own unique and often arduous journey for truth.  The choice is ours. We have many rights when it comes to religious freedom. Yet, our right to religious freedom ends when actions deemed divinely ordained cause significant harm to another, even if this other is our own child.

It is difficult to write this. I have many beloved Jewish and Muslim friends. A small minority may agree with the stand taken in this article. Most will not. I worry that some will question whether I carry a bias against their faith traditions writ large. Let me say this plainly. Just because I condemn one action done in the name of a religion, doesn't mean I hold negative feelings towards the religion overall. I disagree with the current LDS stand against gay marriage, but this doesn't mean I hold animosity in my heart against the religion of my youth. Even a cursory study of history reveals that both beautiful and offensive things have been done in the name of God. It is up to us to question, ponder, meditate, and reflect upon actions that cause harm -- especially to children -- in the name of religion.

Human Rights

In 2010, the Royal Dutch Medical Association argued that the circumcision "conflicts with a child's right to autonomy and physical integrity." In June 2012, a German court ruled that circumcision was "harmful" and a "violation of a child's right." One could argue that these rulings only apply to European children. The majority of European men are intact. For example, it is estimated that only 8% of British men are circumcised. Do these rulings simply reflect European attitudes on the subject? Or, do these sentiments speak to universal rights?

Thus far, 193 countries are party to The UN Convention on the Rights of the Child -- making it the most widely supported treaty on human rights in history. The US, South Sudan, and Somalia are the only UN members yet to ratify this convention. I realize the ratification of a UN Convention by the US government is a complex and multistep process. Nonetheless, the fact that we stand alone in the developed world on this point leaves little room for pride. Is the question of a child's human rights so contested in our society?

Does an infant have the right to physical integrity? Do parents own a child's body?

A parent may dearly want to tattoo a vista of majestic mountains onto the back of her four year old, but does she have the right to do so? Only an adult fully conscious of the nearly permanent impact of tattooing can legally choose to alter his own body in this way. No tattoo parlor in the US would accept a child as a legitimate customer even if the parents were intending to pay for the most beautiful design imaginable. If this is true with tattoos, why is it not true for something far more medically risky, something that permanently alters the most private parts of a child's body?

Those who originally advocated for universal male circumcision in the US knew that the procedure would significantly decrease a male's sexual experience of pleasure. At the time, the Victorian-era medical model viewed excess sexual energy as the cause of a range of diseases from epilepsy to depression. We know today that the presence of a foreskin has no bearing on epilepsy or mental illness. Do human beings have the right to genital integrity?

My husband and I humbly embrace the responsibility to care for our son's body, mind, and heart. Our son was entrusted into our care by a wondrous grace far greater than my own understanding. I wake each morning fully cognizant of the weight of this responsibility, and the depth of my joy, as I undertake the task of mothering with wisdom, kindness, and love. Gratefully, my husband and I agree that we don't have the right to cut off a healthy part of our child's body -- even if religions justify the practice or cultures affirms it. We also agree that informed consent is the central moral value to uphold when considering the surgical altering of healthy human tissue. Should our son want to be circumcised in the future, at least he will have that choice.

View Professor Ryan McAllister's lecture on male genital cutting.