To Cut or Not To Cut: The Male Circumcision Question
HEALTH, 3 Sep 2012
Parents considering male circumcision have a right to expect objective medical advice, untainted by commercial interests.
Matt Williams, an expectant father, stirred up strong debate this week in his Guardian essay on why he won’t let his newborn son be circumcised. Referring to a new edict from the American Academy of Pediatrics insisting that “the health benefits of circumcision” outweigh the negatives, Williams spoke for many parents in demurring with this conventional wisdom, expressing the many reasons for his unease.
He pointed out that this delicate decision is often mystified by conflicting advice. The studies upon which the pediatricians rely, he noted, often have to do with highly specific data: the risks in Africa of Aids transmission in uncircumcised men, for instance. And he argued, quite fairly (though he wisely does not equate them), that the pediatricians’ odd invocation of parental “religious” and cultural motivations for circumcision, and their assertion that these views should be respected quite apart from medical considerations, is a position that would be resisted if invoked by those who wanted to cut off bits of newborn girls’ genitals.
Williams is not alone. A growing movement of men has arisen to decry the practice of circumcision as a mutilation they feel they have undergone, which they say is barbaric, traumatic and sexually desensitizing. But is circumcision indeed emotionally traumatic to newborn boys? And is it, separately considered, physically damaging?
Thanks to research for my new book on the brain-vagina connection, I have a fair number of conversations these days with neuroscientists who study the data on this link. A significant body of literature does exist showing that trauma to the vagina or clitoris affects the female brain in ways far more substantial and lasting than the obvious post-traumatic one would expect from the physical injury alone.
So it is reasonable to wonder if the injury of male circumcision (though hardly comparable to female genital mutilation) could, as many claim, have some lasting emotional or psychological effect on men and the male brain – apart from, or in addition to, any physical harm from the incision.
Two neuroscientists I interviewed about potential harm from male circumcision came to very different conclusions: one, Professor Jim Pfaus, who is doing cutting-edge research on sexual neuroscience at Concordia University in Montreal, Quebec, notes that the data do not show any lasting harm from circumcision that is physical, and he agrees with the AAP that the medical benefits of the practice do outweigh the negatives. He makes a strong case that the movement against circumcision is not scientifically sound.
But the other neuroscientist, based in Midwestern university, who asked not to be named when he spoke to me (because his view is not medical orthodoxy) does indeed see harm in male circumcision that is less obvious than its potential medical consequences. He studies the effect of genital or sexual trauma on the body – a data set that now has many studies to support the assertion of strong mind-body connections. Sexual trauma in childhood specifically has lasting effects on the autonomic nervous system.
A neuroscientist who studies trauma regards emotions as physically embodied. This neuroscientist believes that the emotional experience of a newborn boy being cut in this intimate way by an authority figure, and a source of what should be love and protection, does imprint itself on the infant mind and create, potentially, a particular later orientation toward authority and risk.
“What kind of person does that trauma create?” I asked.
“Woody Allen,” he joked. (Since he himself is Jewish, I gave him a pass.)
He said he had circumcised his own sons – out of anxiety of what another less careful hand might do – and that his second son’s procedure was definitely traumatic. Apart from the baby’s experience, it is painful and counterintuitive for a new mother to witness her baby being hurt, eight days after she has given birth. Many mothers, even those who sign on for male circumcision for their child for religious or cultural reasons, find the experience traumatic. They feel that the strongly-held religious conviction in the rite of circumcision – whatever the science finally concludes – definitely sends a powerful message to a lactating mother still recovering from childbirth that she cannot protect her baby boy from the most rapacious demands of patriarchal ritual.
For these reasons, advocacy organizations for “genital integrity”, as they put it, for men are growing in number and in passion. These organizations are also gathering data to support their views.
Noharmm, for instance, collects testimonials from men who feel they have been harmed by circumcision. Most damningly, though, they offer a different explanation for the AAP pronouncement: commercial interest. Doctors Opposing Circumcision has published a detailed statement (pdf) rebutting the AAP’s advice in damning terms. Anticipating the AAP finding in favor of male circumcision, the DOP earlier stated (pdf):
“The AAP, despite its high-sounding academic name, actually is a trade association of pediatric doctors. Its primary duty is to advance the business and professional interests of its 60,000 members who are called “fellows”. The interests of its child-patients are a distant second to their primary interest.
“There is a severe and intractable conflict of interest between the financial interests of its fellows and the best interests of the child-patient. Most of its fellows perform non-therapeutic circumcisions on children and profit thereby. These members do not want anything to interfere or disrupt their steady income stream. The AAP will not publish a statement that would harm that income stream. The AAP ensures the outcome of its circumcision statements by appointing doctors who are known to have a pro-circumcision position.”
To cut or not to cut? That is very personal question, which each parent must decide for him- or herself. But parents deserve real science in making up their minds, as well as transparency from professional bodies offering what is, ostensibly, purely medical advice. Parenting comes with enough difficult challenges and hard choices already, without undisclosed conflicts of interest from a pediatricians’ organization – especially when it affects such an intimate part of a newborn child’s life.
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