infocirc

[41] Cutting Culture: Tuskegee Redux? Legal and Ethical Problems of the Ramp Up to Male Circumcision in Africa

2012-01-21T00:52:00.000Z

Travis Wisdom, a student of Women's Studies at the University of Nevada, Las Vegas, organized a daylong conference on male circumcision and the issues surrounding identity and body ownership. The second speaker of the day was John Geisheker of Doctors Opposing Circumcision, who discussed the dubious nature of the 3 African studies that are now being used to promote circumcision in the name of HIV prevention. Here is a recording of the presentation, and a transcript follows.

Transcript
(slightly modified)

Eliyahu Ungar‑Sargon

From the White Letter Productions studios in Los Angeles, California, I'm [Eliyahu] Ungar‑Sargon, and this is The Cut Podcast.

Christina Hernandez[?]

Our next presenter, John [D.] Geisheker, is the Executive Director and General Council of Doctors Opposing Circumcision. [He] is a powerful ally in the medical field, promoting awareness of and mobilization against [non‑therapeutic neonatal] circumcision. Please join me in welcoming him.

John Geisheker

Thanks very much.

Many of you will have read—because it's become a commonplace meme in the American journals of all kinds—that HIV can be solved in Africa by circumcision. The [risk reduction] number that's commonly [claimed] is 60% [to] 63%. [However], you probably don't know the backstory [behind those figures], and I'm going to give it to you now.

Now, you'll have to be a little tolerant of this; it's a little "word heavy", it's a little abstract, and it's a little statistical—and I'm not a stats expert, but I kind of know bad statistics when I see them by instinct. So, what I've done here is distill the work of Dr. Robert Van Howe, the pediatrician in Marquette, Michigan, who has done extensive [analyses] on the 3 African RCTs, as they're called: The Random[ized] Controlled Trials in Africa, [which have been used to promote circumcision].

First, the nature of the crisis, so you understand it: HIV is indeed a scourge in Africa—there's no doubt about it.

15 million Africans have died since the beginning of HIV, which by the way, extends all the way to the 1930s when the virus first crossed from the monkey community into the human community. So, we have lost 15 million, and probably many more actually, because no one knew what the disease was in the 1940s and 1950s.
1.3 million Africans die each year [due to HIV].
22.5 million of them are living with AIDS currently.
That leaves 14.8 million children who are orphans or who have lost at least one parent.

Currently, only 25% of [infected] Africans get what's called the antiretroviral therapy. The highest number is [in] South Africa, which has switched from being a country where they were very slow to get started on this, to being the country that's the most aggressive about fighting HIV in Africa (and you'll see why in a second); so, 37% of infected South Africans get the antiretroviral therapy—which by the way, [is a therapy that] not only saves your life, [but also] makes [it] virtually impossible [for you] to transmit the virus to a partner, which is a very useful feature of the ARTs.

Look at the graph of what's happened since 1988 in Africa; you can see that [the HIV prevalence starts around] 1%-to-5%, [and then later], it goes up to 5%-to-10%, and here in 1998, you can see especially in South Africa and [various] areas [that] it's beginning to [rise to] 20%-to-30%. There are regions of Africa, where the [prevalence] is 40%! [It's] unbelievable if you think about it. Here's a graph showing the [prevalence]. Notice it's flattening out a little bit; it actually has slowed down in its virulence in Africa.

Here's the U.S. situation by contrast. Now, these numbers are high, but they are a tiny percent of what's happening in Africa.

We have 0.5 million people who have died since the early 1980s when it was first discovered in the U.S.
About 1 million people are infected, and 20% of those are unaware that they are infected.
54 thousand people acquire the infection each year, but we have a country of 350 million people, so that's not exactly a huge epidemic at this point.
The [prevalence] is 0.6%, which means 6 people in a thousand in the population [have] HIV, and we have a high ART [usage]—a [large number] of people [are] covered by antiretroviral therapies.

There are hotspots like Washington, D.C., which for cultural reasons [has an incidence of] 3% and even towards 6% in the poorer regions of Washington, D.C.
It's disproportionately, alas, a disease of men having unprotected sex with other men, and of people who inject illegal [intravenous] drugs.

Now, since 2005 ([with] the beginnings of the studies in Africa), the notion that HIV can be stopped by circumcision has sort of risen on our cultural radar. It's in the form of a meme. How many of you know the term "meme" or use it casually? A meme is a unit of culture—I think the term was invented by Richard Dawkins in his various books on [evolution]. [A] meme is a unit of culture that gets transmitted from person to person [in a folkloric way] without the backup analysis of why that might be the case. It is, in a sense, a free‑floating idea or belief.

Here are the RCTs and the individuals responsible for them:

In Rakai (Uganda) in 2005, Ronald Gray began a study of some individuals (we'll see in a second how many).
In Kisumu (Kenya), Robert Bailey ran a study

Those are both [mid‑east African] countries. [Lastly]:

In Orange Farm ([South] Africa), Bertrand Auvert, who is a French epidemiologist, ran another study.

The Ugandan study had almost 5000 participants, [the one in] Kenya [had] almost 3000, and [the one in] South Africa [had] a little over 3000.

I want to thank here Dr. Van Howe [for his] statistical [analysis], and also Hugh Young, a fellow New Zealander (I'm from New Zealand)—an aside by the way: New Zealend abandoned circumcision; New Zealand's rate of circumcision in [the] 1950s went to 99.9% (nobody escaped; very few escaped. Maoris did by the way; the indigenous polynesian people escaped completely, because they have very strong beliefs about having to need [the] entire body [throughout] life, [which] is very sensible in my opinion). [Nevertheless], they dropped circumcision in the 1960s like a hot potato! There have been no infant circumcisions in New Zealand since mid‑1960s; it's amazing, and yet, a whole generation of grandfathers are completely circumcised. The fathers are sort of hit and miss, and the sons wonder: What happened to their poor fathers and grandfathers?

OK. Here's the method they used in Africa to do this study: They took groups of HIV‑negative men and divided them randomly into 2 groups:

A control [group].
An experimental group.

The control group was offered an immediate circumcision (and we'll talk later about the problems [with] that), and the experimental group was promised a free circumcision later on, perhaps 2 years later (but it never quite got there, actually). Then the [numbers of] seroconversion[s] [within the groups]—that is, the number of [people who became] infected [with HIV]—were compared[.] Now, here's a little warning for you about statistics (I love this quote):

The American mind seems extremely vulnerable to the belief that any alleged knowledge which can be expressed in figures is in fact as final and exact as the figures in which it is expressed.

Richard Hofstadter, Anti‑Intellectualism in American Life

Also, there's a common statistical thing you will all notice, and that's the deep decimals: [If] somebody says something happens 10.003% of the time, you're inclined to think that just because there's a thousandth of a percent in there [(".003%")], that somehow that suggests the accuracy of the statistic, but statistics can lie gloriously, as we know.

So, here [are] the results:

The number of men who were circumcised [as part of the control group], [and] who got infected [with HIV] after 12 months was 1.5% of the [group]—I've combined the stats to make [conveying the information] easy, but the studies were very similar.
The intact [group]—that is, the men who were not circumcised—their infection rate was higher: 3.38% of their group.

So, the absolute risk reduction you could argue [that cirucmcision provides] is 1.8%. This is the stat you should be reading in your newspaper, not this 53%, because that's the relative risk reduction—comparing the 2 little groups. So, one of the commonest [tricks] in statistics is for people to jack up their results by talking about relative changes and not talking about absolute changes.

I sometimes joke that I could protect you by 1000% from being hit by a meteorite by insisting you live in a coal mine, and you'd say:

"But geeze, I don't really have a very high risk of getting hit by a meteorite—"

"But listen to me! I'm talking about protecting your life! 1000%! Are you not interested in that?"

and, of course, you really shouldn't be [interested in that].

All right, here's what the graph looks like if you do an honest graph of the difference between the absolute benefits between circumcision and not‑circumcision. It's pretty unimpressive, isn't it?

Here's another way of looking at it (the green are the HIV‑negative people): A good number were lost from the study, and the HIV‑positive is the small red group at the bottom; once you look at the overall picture of the number of people, and the number of people who actually seroconverted, it doesn't look very impressive—it certainly has nothing to do with 60%.

Here's my favorite cartoon on the subject (this is courtesy of Hugh Young, a fellow countryman):

"Thanks to circumcision, HIV has decreased 60%!"

and I love the comment:

"Question. Are you asking a room full of engineers to be excited about a big percentage decrease over a trivial base!?"

It's a good question! Then the final panel:

"[Answer]. You leave me no choice but to call you an anti‑circ zealot; nobody listens to them."

So, that's great.

All right. Now let's go through the flaws. This gets a little statistical—hang in there; it'll get interesting. It is interesting.

Flaw number one: Over half the infections were non‑sexual. One of the biggest secrets of the RCTs in Africa is that an awful lot of African HIV infections are caused by physicians!
- Reusing one‑use medical supplies.
- Not autoclaving the equipment.
- Attending people who have HIV, but not worrying about the next person who might get HIV from the tools they just used on the first person.
So, iatrogenic transmission of HIV is itself a huge and scandalous event in Africa. If you remove all the non‑sexual infections—that is, those that came from blood transfusions and medical care—all the Africa RCTs disappear, because [then] their results are not statistically significant.

Here's my favorite quote on this; it comes from Dr. Jennifer Vines up in Oregon:

In the article by Auvert et al regarding incidence rates of HIV infection in circumcised versus uncircumcised men, the finding of 60% fewer infections among the former group is compelling [1]. I must echo the comments submitted by others and question these findings in light of the fact that the authors did not control for other sources of HIV transimission such as blood transfusions or exposure through infected needles. While the literature supports sexual (primarily heterosexual) activity as the main route of HIV transmission in South Africa, the behavioral factor of "Attending a clinic for a health problem related to the genitals," initially reported by approximately 10% of both the intervention and control groups, corresponds to a significantly elevated HIV incidence rate. It is plausible that these men presented with urogenital complaints that resulted in antibiotic or other therapeutic treatments administered with unsterile needles. This could represent a significant confounder in that the uncircumcised men, if indeed more prone to sexually transmitted infections (STI), were more likely to present for STI care and become infected through the health care setting rather than through unprotected sexual intercourse. Controlling for this route of infection could result in a smaller difference between HIV infection rates in the circumcised versus uncircumcised groups, indicating that circumcision may not be as effective at decreasing HIV transmission as the article suggests.

"Reader Response" to Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, et al. (2005) Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 Trial. PLoS Med 2(11): e298.

I would say "Indeed."
Flaw number two: Researcher expectation bias.

Remember, these can't be double‑blind studies; I mean, you know if you've been circumcised, and the doctor knows if you've been circumcised. There's no sense [in] pretending. You can't [explore] a placebo effect in this kind of a study.

[The researchers are] known [to have been] proponents of male circumcision prior to HIV. In a sense, I have [just] said—it's a bit cynical—that the HIV crisis in Africa was a gift to male‑circumcision proponents; their claim is that there is sufficient evidence to recommend universal circumcision, which is frankly what they're really looking for.
Flaw number three: Participant expectation bias.

What did the participants in the trial[s] expect? Well, they were told that circumcision [is] protective, which [is information] that would affect their behavior. There was a lack of blinding, [as just described], and there was a desire for circumcision.

Why an African man would submit to circumcision without being campaigned on this subject (if he's an adult) is an interesting question. Remember a lot of African cultures have already existing traditions of bush circumcision, which are both dangerous and painful, and I can see a 16 year old African man saying [to himself]:

"Geez, do I want to have a circumcision that at least provides anesthesia and has a semblance of Western medicine to it, or do I want to go to the bush and have one of those initiation rites that my friends tell me are horribly painful?!"

Well, I know the choice that I [(and most of you)] would make.

The RCT authors created a demand for male circumcision among unemployed young men by bribing them, frankly. Participants were interested in the promise of a free male circumcision and other benefits—and we'll get to that in a second.
[Flaw number four: Statistical overpowering.]

[This] is a bit tough to understand. The study, claims Van Howe, was overpowered; that is to say, it was big enough (at more than 10 thousand individuals) that you could find some correlation between something.

If you gave me 10 thousand people, I bet I could prove that people [who] own brown hats have small dogs, because there would be enough people [in the group] that [I could find a sizeable number of them for whom that correlation is true].

So, the more individuals you have, the more you can data mine for your particular conclusion (if you work at it). [Dr. Robert Van Howe] says this is large enough to find identifiable differences that are clinically unimportant; in other words, you could do a gigantic drug study and still find correlations that don't mean anything medically.

[This can be seen in the frequent flip-flopping with which we are all familiar]. You know: Butter is bad [for your health], butter is good, butter is bad, butter is good. You have to read a newspaper to see what [the "consensus"] is today.
Flaw [number] five: Selection bias.

Only men interested in male circumcision were included [in the study], so that automatically excludes others who might have been at lower risk [of HIV infection] because of behavior or genetics—we don't know. So, that's a flaw of this study itself.
[Flaw] number six: [The participants] were well paid.
[Most] were unemployed [and living in the Orange Farm]—Orange Farm, South Africa, is a horrible horrible slum with an employment rate of like 50% and worse, and frankly, the young men were desperate, and [joining the study there was a way that]:
- They would get cash.
- They would get a free circumcision.
- They would get free healthcare for a year or 2, which in the U.S., would be like giving you 12 thousand dollars.
So, just the very structure of these studies makes them unethical in the U.S., but you can get away with it if you can work it in black Africa.
[Flaw number seven]: Now, here's the geographical bias.

This is intriguing to me. No studies were done in:
- Ghana
- Cameroon
- Tanzania
- Lesotho
- Malawi
- Rawanda
- Swaziland
[These are] places where circumcised men are more likely to be [HIV infected]. Just look at Ghana and Cameroon to make it easy:
- The HIV prevalence in Ghana among circumcised men is 1.6%; [among] intact men, it's actually lower.
- Now, Cameroon is interesting, because the HIV prevalence [among] circumcised men is like more than 3 times the [prevalence among] intact men!—exactly the opposite of the claims of the RCTs.
and so on. Each of those countries has the same problem, which is: How do you explain that [in these places], circumcised men actually have more HIV?
Flaw number eight: Ethical problems.

We've already hinted at these. South African men were not told their HIV status. The claim of the people who did the studies was that the men are from cultures where being HIV positive would stigmatize [them], and so [the researchers] didn't want to tell the men that they had HIV, because that would be embarassing [and problematic] for them.

[So], as a "practical" matter, they sent men home to infect their partners, and that's exactly the problem that we had with Tuskegee. Some of you may know the history of Tuskegee; I know that my colleagues here do. In [the] 1930s, the CDC in conjunction with [the U.S. Public Health Service] designed a study of syphilis among black males and didn't tell them [when] they had syphilis, because they wanted to see what would happen long‑term.

So, hundreds and hundreds of people got tertiary syphilis—which, by the way, is not just the genital disease; it eventually affects your brain, and is a horrible way to go at the end. [This incident] is the gold standard for unethical behavior in medicine and bioethics, and precisely that same condition happened in the RCTs in Africa, and they haven't been called to account for it!

There was no full disclosure with informed consent. Basically, it was a scanty consent, as you can imagine; the men were circumcised that same day. Certainly, they were never ever told the sexual effects of the kind that Marilyn so articulately described for this surgery.

So, in other words, if you were doing a lawyerly analysis of the accounts here, it would be that the participants were placed at risk in a study with built‑in biases, which guaranteed the investigators the results they wanted, and the benefits were coerceive and unethical.
[Flaw number nine]: Lead‑time bias.

This is an interesting one; it requires a little thinking for a second. The [group circumcised in the beginning] were told to avoid sex for 4 to 6 weeks, so what happened was if you compare the results over 1 year, somebody got a 2 month head start; the men who were circumcised early [on] got a 2 month head start where they didn't have sex, so they weren't put at risk [for sexually transmitted HIV during that time], and that affects the result entirely. The [bias-based] overestimate according to [Dr. Robert Van Howe] is on the order of 10%, which wipes the whole studies out.

Yes mam?

Woman

It was suggested in a—

John Geisheker

In the 3rd study they adjusted it somewhat.

Woman

Yeah, it was suggested the men themselves might have gotten longer because of the effects of the circumcision, too.

John Geisheker

I hadn't heard that, but I'm not terribly surprised. Mind you, it could also be counter balanced by men who were desperate enough to have sex when they still had something of an open wound, and you know, that would kind of counterbalance the notion, but in any case, it's not a very good study if you're looking for purity of results.

[Flaw number ten: Cultural differences].

In [the] South Africa study, the 2 groups differed by age, religion, and tribe (and that tribe makes a big difference in Africa). There was no attempt to reconcile that.
[Flaw number eleven: Loss from study].

For every participant infected, a huge number were lost [from the study]. At the highest, 7.4 for every individual that was [infected] was lost. You have to wonder what would have happened had those people stayed in the study. For every sexually transmitted infection of HIV, up to 17.6 particpants were lost. Small differentials in the loss group could negate these [RCT] findings, too.

All of these flaws are cumulative! The more flaws you have in the study, the more the results of the study (especially when they're small) are called into question.

Now, here's my favorite quote about ignoring dropouts, and it comes from Bad Science by Goldacre (drug studies are an example):

People who drop out of trials are statistically much more likely to have done badly, and much more likely to have had side-effects. They will only make your drug look bad. So ignore them, make no attempt to chase them up, do not include them in your analysis.

Bad Science by Ben Goldacre, Fourth Estate, London (2008), p. 209

That's a great quote. That's a great way to run a drug study—and by the way, there's a scandal that just came out this week about how Africa is being used by Big Pharma and big American institutions like Johns Hopkins University of Illinois, etc., to do studies that they couldn't run ethically in the United States. They're [basically using] Africa as a guinea pig for whatever drugs and whatever procedures they can come up with. I think [this] is a huge scandal; it's definitely going to hit the wall.

Woman

They can't run [such studies] ethically there either; they just do it anyway!—

John Geisheker

Well, they do it, because they can get away with it. Frankly, there is so much money free‑floating [in Africa] (provided by the Gates Foundation and others) that local African officials who are poor—and even if they're the honest chief medical officer of a small African colony, country, or tribe, they can't turn down scads of American money, which they could use for other kinds of things. So, of course, they're going to say "Yeah! Let's start a circumcision campaign!", so they can get the money into their system, so they can use it for useful things (we're hoping they'll use it for more useful things), but you can't blame poor countries for being attracted by American cash. You simply cannot.

[Flaw number twelve: Unequal crossovers].

This is a bit abstract, too, but let's hit it:
- The number of men [randomly] assigned to be circumcised who were not, and
- The number of men [randomly assigned] to wait [to be circumcised], but got circumcised early for whatever reason (maybe they elected to)
[were] not equal[.] [That suggests that] the men who did not receive the immediate, free [circumcision] they wanted dropped out. So, that affects the accuracy of the study as well.
Flaw [number] thirteen: [Unequal Treatment].

(Are you getting saturated on the flaws here? Have I convinced you!?)

Men [who] were [randomly assigned] to early circumcision had follow up visits. Now, I actually think this is very criticial; if I were [Dr. Robert Van Howe], I would put this on the front end, because I think it's the biggie (along with the relative/absolute [percentages] problem).

Men [randomly assigned to] early circumcision had follow up visits, [and] this allowed the staff to influence them—to urge them, to provide safe sex advice, etc., etc. So, they were continually being educated, which [surely affected] their behavior.
[Flaw number fourteen]: Early termination.

The proponents quit the study after one year, saying it would be unethical to continue it because the results were so overwhelmingly positive in favor of circumcision that even waiting would be unethical.

Well, isn't that convenient?

If the study had been big and long, maybe the benefits they saw would have roughened out, and [maybe] the stats [would have] come to nothing at the very end, but that's not exactly the result they wanted.

[Ending the study early] also amplifies the lead‑time bias. If you have a short study, that 8‑week lead time [which] the men who were circumcised got [is] a bigger percentage of the [study time]; if you run [the study] out 2 years, [a 2‑month lead time] is only one twelfth [of the study time]. If you run the study for only a year, that lead time is a full one sixth [of the study time]—quite a difference.

So, here [are] some anomalies for you:

Why did participating increase risk?
- Medical exposure? (asks [Dr. Robert Van Howe]).
- Or [was it a] self‑selected population at a higher risk to begin with? That's certainly possible, too.
In South Africa, the intervention was not consistent between tribes, for probably cultural reasons.
In Kenya, the intervention was effective for one group of young men, but not [for] the 18 year olds. Why is that? We don't know.

Facts that don't make sense:

Why is HIV [prevalence] higher [among circumcised] men than [among] intact men in South Africa?
Why is the [prevalence] of heterosexually transmitted HIV so much higher in the U.S. than it is in Europe? The answer could be that Americans don't like condoms because they're circumcised. There are lots of different things you could ask about that.
If the increase in protection [provided] by a 90% circumcision rate (which they'll never get to in our lifetime) can be undone by a 5% decrease in condom usage, then what's the point [of the circumcision]?
If antiretroviral therapy—which, remember, prevents seroconversion even between what's called discordant partners ([one of them is infected, while the other is not])—and treating STDs [are together a] more effective, less costly, and less invasive [way to prevent HIV than circumcision], then why bother with circumcision?

Here are [some contradictory] studies—including 3 by the authors of the African RCTs! [These are] studies, in other words, that show that the effect [of circumcision] is not as good as [they] would hope, or (and we'll talk about it in a minute) [circumcision] endangers women! There's a remarkable number of them; we won't go through [all of] them, but they're available to you if you want to look; [they are] fully explained in a wonderful website you should know about called Circumstitions (once again by Hugh Young, the guy [who] did the Dilbert cartoon).

[Dr. Michel Garenne] authored:

Long-term population effect of male circumcision in generalised HIV epidemics in sub‑Saharan Africa.

Michel Garenne, who is at the Institute Pasteur in Paris, says:

In most countries with a complex ethnic fabric, the relationship between men's circumcision status and HIV seroprevalence was not straightforward, with the exception of the Luo in Kenya and a few groups in Uganda. These observations put into question the potential long‑term effect of voluntary circumcision programmes in countries with generalised HIV epidemics.

Well, it's worse than that, Dr. Michel, because it's not going to be "voluntary" circumcisions. That's what they talked about in 2005 and 2006, but I have watched very carefully (so has Marilyn, so has Gillian, [etc.]) as they've gone from "voluntary" circumcision for men to semi‑voluntary circumcision for young men, to involuntary circumcision for infants, which is plan C, and was, I think, the plan all along.

Here's my comment on this. This is epidemiology and anthropology 101. First of all, the biggies:

The risk avoidance by confident, [circumcised] men.

A lot of health officers in Africa are themselves concerned that young men are cheerfully lining up for circumcision so they can avoid using condoms, and so they can tell women that they're HIV‑negative and will stay so because they're circumcised. In other words, they're going to use their circumcision status to give up on the only thing[s] that [prevent] HIV:
- Abstinence
- Condoms
So they are putting themselves and their partners at risk, and the risk to women is substantial, because here what I haven't mentioned and could have mentioned upfront: All the RCTs only say that the male is protected from an infected woman; she is not, however, [necessarily] protected if he's HIV. In fact, she's even more at risk, according to the Wawer study.

Does that make sense?

So this is the most sexist plan for almost a billion African people that you can imagine. This is just a recipe for a gigantic epidemic disaster.
The other thing is [that the] 60% protection [for men], even if it's true, is not 95% (the gold standard for all immunizations). It is what I call viralette—viral roulette; you're basically just playing with time, and infection will occur eventually. It just may take longer.
We should mention is that the effort against HIV in Africa is a zero‑sum game. Male circumcision, which is expensive (95 times more expensive than condoms would be), is draining the dollars away from more effective programs.
Bush circumcisions (in other words, circumcisions [outside of a sterile, medical environment]) of men are not going to be [performed] by doctors, because there aren't enough doctors to [circumcise] 900 million black Africans; they're going to be done by traditional "healers".

I was in Mexico in 2008, and I talked to people who were proposing this program, and they freely admit [that] there aren't enough doctors, that they're going to have to train locals to do one procedure only [(namely, circumcision)], and there's going to be no follow up! The van pulls [into] town, they [circumcise] the whole village, and [then] drive away! There's no follow up, and there [are] plenty of opportunies for iatrogenic HIV infection.
Condoms have other uses, too!
- Preventing pregnancy.
- Preventing HPV (which we've already mentioned is one of the vectors for cervical cancer), and other sexually transmitted infections.
Now, something you may not know is that this idea (a white‑people's invented idea) that circumcision solves the HIV problem in Africa has been pitting tribes against tribes; in Kenya, for instance, the Luo (which is the tribe of Barack Obama and his father), do not circumcise, and haven't historically.

[However], the Kikuyu—anybody see the movie Out of Africa? That's the tribe that's featured in there, the Kikuyu. They do have a long standing tradition of circumcision.

[The Kikuyu] have been accusing the Luo of being the problem, because they've been told that uncircumcised—intact—men transmit HIV, so they've been capturing—waylaying—Luo men who are found alone, and [then] circumcising them traumatically right in the street, as kind of a tribe against tribe [act of domination].

By the way, there's probably pretty good odds that—this is an aside, of course—there's probably pretty good odds that Barack Obama is himself intact.
- His mother was a hippie atheist.
- His father was an upperclass Luo.
So, it's very likely that [his mother] either honored his request (or he insisted) that the boy be left intact, but we're not going to know until he's retired.
Cutting as a first line disease control defense always strikes me as dodgy. The human body has evolved for many hundreds of thousands of years, and if we take the notion that the way to solve disease is to start lopping parts off, there [is] no [end] to [the number of] surgies you could invent that solve problems [in that way].

I mean, I don't have any tonsils, because some doctor made a car payment in 1958 off of them. I mean, it was fantastic fraud in the 1950s; play this game sometime at a party: Ask all the people who have had tonsillectomies to put up their [hands], and you will find that everybody [who raises his or her hand] is [in his or her] 50s and 60s. Almost nobody in [his or her] 20s and 30s is without [tonsils]. It's interesting. It was just the "fashion" of the day!
Male genital‑cutting and female genital‑cutting traditions are self‑sustaining; the cut become cutters. This is an anthropology rule—a fixed rule. Once someone has had a genital mutilation, [he or she seems] to have some embedded, psychosexual need to have the next generation [undergo] that same initiation right (or that same limitation). There are thousands of explanations for this; I'm fantastically beyond my pay scale by even speculating on any of them, but I leave you with that thought, in any event.
This is [Dr. Robert] Van Howe talking about how circumcisions is a wasteful distraction. This is Hugh Young's illustration; if the African studies are correct—if everything I've said about their flaws is inconsequential, and [these studies] are correct—it's still going to take 56 circumcisions to prevent one HIV case per year, and it will [still] fail to prevent one—not much of a gain, and that's true in Uganda, [where there is] a 4% HIV [prevalence]; we have a 0.6% HIV [prevalence] in the U.S.—6 in 1000. Statistically, it would take 380 circumcisions to stop one HIV case—so, at huge expense.

To give you a flavor of the professionalism that surrounds the RCTs in Africa, [consider] these quotes:

"We're hacking away. Those foreskins are flying!" That's Robert Bailey [of the] University of Illinois, quoted in the New York Times barely a month ago. It's amazing to me; I can't see how a man could possibly have that casual an attitude toward a surgery that serious on so many people and be able to keep this in his head. It just appalls me to my core.
The other [quote] that struck me was one from Dr. Renee Stein [of] St. John's Emergency Medical Center in St. Louis talking about their circumcision rate there: "We whack 'em all!" she said. Wow. What a treat. You can imagine how cold I was when I saw that in the Times.
Here, one of my colleagues, David Llewellyn of Atlanta, Georgia, went to a meeting at the CDC in Atlanta. [One of] the presenters to the CDC on how circumcision should be proposed for Africa made fun of intact men (David is intact and proud of it) by using this slide, showing the man as an elephant. So, question of taste? Do you think there's any taste problem there?
Here's Israeli Inon Shenker (whom I met in Mexico in 2008) with the Zulu chief, Goodwill Zwelithini kaBhekuzulu. I talked to Inon Shenker for quite a long time in Mexico, and frankly, I said to him:

You're Israeli, and you"re calling your [plan to circumcise Africans] "Operation Abraham"? Why didn't you call it "Operation Sterile Procedure" or "Operation HIV Prevention"? Why did it get called "Operation Abraham"? It has a slighly religious connotation for some of us.

and [his response was that] he was offended by that, [and] it wasn't his choice, [and so on]. He generally thinks that this is an opportunity for the Israelis because his claim is that Israelis have a unique expertise in adult male cicumcision, because they did them wholesale to Russian immigrants to Israel in the 1970s when there was a huge outpouring of Russian Jews into Israel. So, he's on a quest for the business, as it were.
Now, here's a picture I found:

"The operation is a good chance for safe sex education"

One of the things that Shenker and colleagues talked about in Mexico in 2008 when I met them was that the circumcision procedure itself [is] a marvelous opportunity for the man to have "a quiet reading moment", where he could read about safe sex [in] brochures they were going to him read.

Well, I don't know what your attention span is like during surgery—even surgery with a decent local anesthetic—but I don't think I'd be reading much. At the time, it struck me as a very thin reason to perform a procedure—you could also put him up on a table, all stand around, not cut him, hand him the brochure, then have [a test afterward] to see if he read the material, and you [would] get the [same] benefit.
Here's a billboard on the Ethiopian–Sudan boarder, showing that you should get circumcised, and there's a ton of these in Africa—tons and tons of them, put up by the local health authorities and by individuals who have much to gain.
Here's Orange Farm in South Africa:

The young men have flocked by the thousands to this clinic for circumcisions.

...

"I’ve done 53 in a seven‑hour day, me, myself, personally," said Dr. Dino Rech, who helped design the highly efficient surgical assembly line... for cutting off foreskins.

...

Well, I submit to you that if you do 53 procedures in a day, your first one might be decent, but I wonder about your 53rd. I think I'd want to be the mid‑morning appointment—somewhere where you're back in the swing of it, but [aren't] yet exhausted, do you know what I mean? I mean, it's just insane to think you can do 900 million circumcisions in Africa without a single problem. We have hard enough problems doing circumcisions to a decent standard in U.S. hospitals that are first rate, let alone in bush clinics and vans all over sub‑Saharan Africa.

So, thanks very much.

I actually have 2 more slides. This is me sailing rather than talking about penises [laughter], and this is my houseboat out in Seattle, which I built.

Thank you. Any questions?

Woman

Can you explain how you calculate the absolute reduction in risk vs. the relative reduction?

John Geisheker

Well, they're not my numbers for a start (they're [Dr. Robert] Van Howe's), and I will happily give you his handout, which he would be delighted if we shared. In fact, I thought I had given it to Travis to reproduce. Is it here? Ah! That's excellent. Why don't you check those numbers in there.

Marilyn Milos

[NOTE: Marily Milos previously threatened legal action for transcribing her words. Therefore, they have not been reproduced here.]

John Geisheker

Oh, relative and absolute?—

Woman

Well, just how are they calculated in general? How does one calculate an absolute risk versus a relative risk.

John Geisheker

Well, let me give you an example off of the RCTs, which is a bit closer to home.

One of the claims of people who propose circumcision is that it solves urinary tract infections for boys under 1 year [of age]. But, the actual rate—and even this I think is questionable for reasons I may mention in a minute—the absolute rate, if you believe it, of UTIs in [male] infants is 1% (1 boy in 100). Now, the proponents [of circumcision] claim that if you circumcise boys, only 1 in 1000 will get a urinary tract infection. So, rather than saying to a parent:

You know, he has only a [1 in 100] chance of having a UTI, [but] we could marginally improve on that by circumcising him, so then it will go down to 1 in 1000.

Instead, what they do is they say:

Circumcision confers a 10 times protective effect!

So, they use the relative difference between 1/100th and 1/1000th, and [they sell circumcision using] that [relative] scale, rather than using the absolute, which is the 1 in 100 that you should be talking about as the "high" risk side.

Does that make sense to you?

Woman

Yeah, but—

John Geisheker

The same thing is happing in the RCTs.

Woman

Right. It just [seems] like the absolute reduction was really low then. It was like 1.8%, and so in a population when HIV is so much more prominent, it just seems like it [is] a strange number. So, I was just curious how they kind of got that.

John Geisheker

This is the slide you're talking about, right?

Woman

[Yes]

John Geisheker

Yeah, well, see, [among] those who got a circumcision [early on], out of every 100, a little over 1.5 of them got HIV, whereas [among those not circumcised until later, out of every 100, a little over] 3.3 [of them got] HIV, and it's the [proportionality] between those 2 that gives you your big number if you're dishonest about it.

Yeah, I'll stick with [the word] "dishonest", because I frankly think these studies are rankly dishonest, and they have been marketed at their highest point of possible [benefit], and none of the shades—none of the nuances—have been [discussed]. [Unfortunately], [their results] are so deeply embedded now, you could walk out on Marilyn's street here, stop a cab, and [the driver] will tell you [that circumcision confers a] "60% protective effect". You know, it's deep; it's in place.

Marilyn Milos

[NOTE: Marily Milos previously threatened legal action for transcribing her words. Therefore, they have not been reproduced here.]

[NOTE: The audio ends abruptly here.]

[40] The Cut Podcast: Cutting Culture: Circumcision, An Overview

2012-01-07T18:11:00.000Z

Travis Wisdom, a student of Women's Studies at the University of Nevada, Las Vegas, organized a daylong conference on male circumcision and the issues surrounding identity and body ownership.

The first speaker of the day was Marilyn Milos of NOCIRC, who gave an overview of the history of circumcision and its effects on the sexual experiences and psychology of men, women, and society at large. Here is the recording, and a transcript follows.

Transcript
(slightly modified)

Eliyahu Ungar‑Sargon

From the White Letter Productions studios in Los Angeles, California, I'm [Eliyahu] Ungar‑Sargon, and this is The Cut Podcast.

Travis Wisdom

Well, good morning everyone! [It would be great] if [you] could come on back down a little [farther]; we are having this recorded, so we're going to play a little trick and make sure [the auditorium] looks fuller than it really is! So, if you could fill in the empty seats, that would be good. Thank you!

All right. First, let me say that I apologize for all of the delays that happened in the morning. We're all here; thank you very much for attending.

My name is Travis Wisdom, and I am a UNLV alumna, and I will be your conference chair for this morning.

A brief note on how this project started: While I was completing my final internship program for my bachelors degree in Women's Studies here at UNLV, after several conferences abroad, I was asked to provide a film screening as a requirement for the project. I wanted to do something on [a] larger scale; [I wanted to] offer an academic conference [where] we would have people who could speak to the students as well as have a lecture [along] with a film screening. So, over [a] period of several months (with the help of NOCIRC, which is the National Organization of Circumcision Information Resource Centers), I have been able to put together this [conference today] with a variety of speakers.

Now, today, each of you will have the opportunity to listen to a variety of people present their work surrounding male circumcision. Our scholars (who have traveled abroad for this event) [and] UNLV students will discuss historical underpinnings to explain how male circumcision began and how it became medicalized and later normalized.

You'll have the opportunity to hear about its role in public health, and the role of the foreskin in male health.
Our speakers will analyze how circumcision has become an intricate part of Western culture, and we will discuss how we have become a cutting culture.
You will learn about the concept of genital integrity (or genital autonomy, which [is] synonymous), and we will examine the implications of law and society in relation to body ownership.
The final session of the day includes a film screening, which will offer an insight into circumcision and an inquiry about Jewish identity and [its] intersections with circumcision.

Whatever you know—or think you may know—about circumcision, I assure you, you will learn something today; you will leave this conference with new knowledge and awareness, and [you will] be better informed and more equipped to address the issue of circumcision within your own communities. You will be challenged, and you will be asked to think critically.

At this time, before I welcome Karoline Khamis to offer a few words, let me first [direct] you to the programs inside your packets; inside [each] packet is [a] program, and this offers detailed information about the itinerary as well as [about the] people who are here today in addition to our sponsors.

I want to first apologize for the variety of embarassing typos that you are more than likely going to see. So, just go ahead and overlook them as you are navigating the [content] of the pages. So, at this point, thank you for attending, and I'll turn it over to Karoline Khamis to speak.

Karoline Khamis

Well, I'm very honored that Travis asked me to help in the planning and the content of this conference.

I currently run the Campus Advocacy Resource Empowerment 24‑hour, 7‑days [per] week hotline. We respond to information, needs, [and] reporting of crimes of sexual violence. My position before that was Violence Prevention Coordinator and working with our peer-education team to provide presentations about anti‑violence on our campus.

So, when I saw Travis's research praxis[?] last semester, [I] thought: Hey, we've been fighting violence against women as a certain kind of context and trying to draw men into our peer-education group and to our mission. This [topic of male circumcision] is kind of a missing part of what we've been talking about [with regard to] bodily property. So, I began to let that sink in, and then luckily [Travis] contacted me later in the summer with a very real opportunity to bring this [subject] to our campus and our students.

Students like Travis and this kind of research are really going to change the face of our practices—not only medically, but personally, religiously, and in our education structure that we pass on to our other students as we become educators ourselves. So, thank you, again, for coming to this very important conference, and for seeing the necessity of that link of bodily property between all genders.

So, I'm going to introduce our first speaker: Marilyn Fayre Milos is the co‑founder and executive director of NOCIRC, which is the National Organization of Circumcision Information Resource Centers, one of our sponsors and one of our amazing participants as well. She's going to give us kind of an overview of circumcision and some information that we need to know.

[NOTE: Marilyn Milos threatened legal action. The transcript based on her speech has been removed according to her wishes.]

Eliyahu Ungar‑Sargon

That's our show; if you have any questions, comments, or suggestions, please email them to us at:

cutdocumentary AT gmail (.) com

If you like what you heard today, please support us by buying our film at:

www.cutthefilm.com

[36] The Cut Podcast: Circumcision and HIV: A Conversation with David Wilton

2012-01-04T20:45:00.000Z

Eliyahu Ungar‑Sargon interviews David Wilton about the nature of the push to circumcise Africa, how this has affected the controversy over circumcising completely healthy infants, and in what ways the Intactivist Movement needs to evolve its organization. Here is the recording, and a transcript follows.

Transcript
(slightly modified)

Eliyahu Ungar‑Sargon

From the White Letter Productions studios in Los Angeles, California, I'm [Eliyahu] Ungar‑Sargon, and this is The Cut Podcast.

Welcome back to another special edition of The Cut Podcast. I'm very happy to be sitting here with David Wilton. David, why don't you introduce yourself and explain to our audience a little bit about how you come to this subject.

David Wilton

Well, I came to this subject probably as a teenager when I first realized what circumcision [is] and [then] began to understand and realize the differences between intact and circumcised [penises].

At that time, there wasn't a lot of [Intactivist] activity going on; most of it was on the West Coast, and I was in Texas, so I wasn't really able to participate—and [I] was really not mature enough at that time to partipate, [anyway]. It wasn't really until 2006—probably 10 or 15 years later—that I began to really get involved [in the Intactivist Movement].

That's when I started living in San Francisco and participat[ing] in the activities of the Bay Area Intactivists, which are in the East Bay for the most part, and it was sometime [around then] that I [first] attended [in Seattle one of the International Symposia on Genital Integrity], the ones that are put on by Marilyn Milos and sponsored by NOCIRC (and are now beginning to be sponsored by Intact America).

That incidentally was the same year that HIV and circumcision began to be associated with each other when the 3 African RCTs ([Randomized] Controlled Trials) were published, allegedly showing [that circumcision has] a protective effect against infection with HIV. [Consequently], it was that year that I began the blog Male Circumcision and HIV, a blog that is named exactly as what I intended to write about when I first started it, [but it] has now evolved into [what] I would say [is] more of an Intactivist site than just a site that's focused on HIV and how it's impacted by circumcision.

Eliyahu Ungar‑Sargon

Yeah, absolutely. One of the main reasons that I wanted to have this conversation with you is because—as I touch on in [my] film, [Cut], and [as] anyone who is familiar with the history of circumcision in the United States knows—every generation has a new medical rationale for continuing the practice of male circumcision, and without a doubt, the rationale—the medical rationale—of our age is prevention of HIV.

As you mentioned: In 2006, we started to see some studies being done in Africa around this [rationale]. I want to get into a little bit more detail about these studies, and [it would be great] if you could share with our audience how that started, who the main players are, etc.

We should also mention that you are a lawyer by training.

David Wilton

I'm a lawyer; I began practicing law in 2000.

My area of focus has not been in the area of circumcision or anything like that. I know there are some lawyers who have done a lot of lawsuits on circumcisions around the issue of consent and botched circumcisions and that kind of thing [(see the interviews with Peter Adler, Zenas Baer, David Llewellyn, and Paul Mason)], [but] my focus has been criminal defense for the most part.

[However], I've consulted a little bit on these issues [of circumcision] with The Attorneys for the Rights of the Child, [of] which I was just recently invited to be a member of the board; so, I've joined their board at this point. I've also consulted a little bit with some of the issues related to the [MGMBill] ballot measure that ocurred this summer here in San Francisco.

[So], yes, I'm a lawyer, but [in that capacity I] have not focused that much on the issue of circumcision until more recently.

Eliyahu Ungar‑Sargon

We'll come back to some of the events of the summer, because I think you have a unique perspective that will be [really] interesting; you can give us a blow by blow [account] on what happened around the legal battles surrounding the ballot initiative.

[However], let's start with the recent push around circumcision and HIV. How did this start? Who were the players involved? Tell our audience a little about the randomized [controlled] trials, where they ocurred, what they said, etc. We'll go into some analysis of them in a little bit, but [it would be great] if you could just [provide some background] for someone who is unfamiliar with the recent history of this: How did things happen?

David Wilton

Well, for many years, circumcision has been touted as a kind of procedure that could at least slow down the infection rates of HIV. That, I believe, has been in the literature since the 1980s, but all of those studies and papers and discussion of that has been primarily through observational data.

It wasn't until some time in the early 2000s that there were a number of people who got some grants to do some studies in Africa; those were:

Bertrand Auvert, who is a French [epidimiological] researcher.
A guy named Robert Bailey, who is an American up in Illinois
Another gentleman by the name of Daniel Halperin, who I believe at the time was working at the Department of Public Health here in San Francisco and [then] at Harvard's School of Public Health; [he] eventually consulted somewhat with UNAIDS, as well.

So, these 3 individuals (along with their coauthors) began to work towards getting grants to do [randomized] controlled trials in Africa. By roughly 2003, they had gotten the grants, they had designed the studies, and they had gotten all of the various parts in place to begin [in] 2003 [to follow men in]:

South Africa
Kenya
Uganda

By 2006, they had reached the point where they felt like they had enough data—incidentally, without completing the studies [as designed]—to go ahead and publish [their results].

So, that's really kind of the background of how these studies got from the idea popping up in the 1980s with the observational studies showing some countries with lower rates of HIV among the circumcised and higher rates among the intact, [all the way] to the point of actually doing the [RCTs that were published] in 2006.

All of these people that have been involved, they've been involved from the beginning: Daniel Halperin has been quoted in media basically discussing this issue back when he didn't have the grants in place, talking about how it was a travesty that the HIV/AIDS community was not jumping on [circumcision]; even at that time, before the [RCTs] were done, he believed that circumcision would have this huge impact on the rates of HIV, particularly in Africa.

So, that's kind of a very short background on where this came from.

Eliyahu Ungar‑Sargon

What did their studies show? Also, you mentioned they didn't actually finish them, so why didn't they finish them?

David Wilton

The way they set it up is like any [randomized] controlled trial: They had one group of men [on whom they performed circumcision at the beginning], [and] another group of men [on whom they delayed performing circumcision]. Supposedly and allegedly, they gave [both groups] equal amounts of instruction on safe sex practices and avoidance of HIV, [and] provided them with unlimited numbers of condoms. [Then, they] circumcised one group, left the other group intact, and sent them out to the world with periodic followups (I believe it was every month they would come in); [the researchers] would keep track those of who seroconverted and those who didn't.

Again, it's been a couple years since I've read and re-read these studies, so I may have the numbers off a little bit, but I think there was one [study] where there [were] 3000 [men] in one [group] and 3000 [men] in the other [group], and then there was another [study] where they had 1500 [men total] and [they were] divided up [such that] roughly 800 [men were] circumcised [at first] and the other 700 were not.

The studies [had] different [numbers of] people involved who were subjects of the studies, but they were operated as any standard [randomized] controlled trial is. [However], [the studies] weren't double‑blind [in nature], because they couldn't be; if you're circumcised, you're going to know it, [and] if you're [left] intact, you're going to know it. [Nevertheless], they were [randomized] and they were controlled (they had a control group, and they had an experimental group, the experimental group being those who were circumcised).

Typically, across all 3 studies, the reduction [in HIV acquisition supposedly due to circumcision] was somewhere between 50% and 60%, which translated into—again, I don't have my numbers [exact]—something like 20 and 25 seroconversions more in [the intact] group than [in the circumcised group]. So, you might have had, let's say, 3000 people in [each] group, [and] 70 of them seroconverted in the intact group, and 50 of them seroconverted [in the circumcised group]; you had a difference of roughly 20 actual seroconversions in this group of 6000 men.

So, when you look at it like that, the actual reduction [in HIV due to circumcision] was somewhere in the single percentile; I mean, [circumcision provided maybe] a 1% or 2% actual reduction [in HIV infection], as opposed to this 50% to 60% [relative] number that they were throwing around, which had to do with relative changes. So, that's kind of how the studies were done and conducted. [See this analysis and this analysis.]

Now, the reason they stopped [the studies early] instead of going the full 22 months (in the case of one of the studies, they stopped it at 18 [months]) was because they said [to themselves]:

Well, our results have been so great and so wonderful and this prevention "technology" has been so successful that it would be unethical to go to the 22 month period, because at that point, all these other [uncircumcised] men are going to seroconvert, and if we can circumcise them now, [then] they won't seroconvert. Therefore, we [must] stop the study now and circumcise everyone who wants to be circumcised.

Eliyahu Ungar‑Sargon

I'm sorry, it just sounds so ridiculous, especially [the notion that these researchers] grow a conscience at that point, as if the people who had seroconverted before for their experiment—like who cares about them! It's just so twisted.

David Wilton

Right. Right.

Yeah, I mean it's crazy, and the funny thing about all of this is that the re‑interpretation and the churning of the data that's ocurred after the studies were stopped in 2006 [have] done nothing but [make] the numbers [suspiciously] better and better and better and better [in favor of circumcision].

[There has been] no accounting for such things as non‑sexual transmission [of HIV], loss to follow up—there were several hundred participants who were lost to follow up [from both groups]; [we] don't know what happened to them! [According to this analysis, it would require only less than 25 seroconversions among the circumcised men lost to study in order to render the results insignificant.]

With such small numbers—a number of 20 actual men [in] difference (that's not a huge number), and if you've lost 300 people to follow up, you don't know what happened to those people—you really can't say with any certainty what's happened.

Eliyahu Ungar‑Sargon

What's their hypothesis as to a mechanism of action? Why is it that cutting off the foreskin in their view [could even reduce] the transmission of HIV?

David Wilton

Well, in the studies themselves, they are very careful to say that they didn't know why the circumcised group had lower rates of seroconversion versus the intact group, but in follow up commentaries, [the authors] have often resorted to speculation, [such as]:

The keratinization of the [tissue remaining after circumcision] makes it tougher for HIV to penetrate the skin
The [destruction] of Langerhans cells (cells that they say are particularly vulnerable to HIV) [creates] less of an entry point [for HIV].

They speculate.

What's interesting about the Langerhans cells is that roughly at the same time that the RCTs were published, there was a Dutch group that published a paper on Langerhans cells saying that [they] are very effective at destroying HIV. The thing about it is [the Dutch researchers] postulated that the reason that men—and women, who also have Langerhans cells in their genital mucosal tissue—are still vulnerable is because [these] cells are [overwhelmed] by the sheer number of HIV viruses [to which] they are exposed [during sexual transmission]. It has nothing to do with them being [inherently] vulnerable; it has to do with [the fact that these cells by themselves] are just not up to the task of creating the barrier [to HIV] that would be needed. [Condoms, on the other hand, are extremely effective as barriers against sexually transmitted HIV.]

So, there's contradictory research out there, and of course the circumcision advocates are not particularly interested in addressing that [fact], and to my knowledge, [they] really haven't addressed that very well, although I will say that they have actually often times conformed their message to the objections that they've heard in the research community—and also just among layman (on the various Intactivist [web] sites). A good example of that is [the worrisome reality of] risk disinhibition; [pro‑circumcision researchers] have done several studies in Africa [supposedly] showing that men who are circumcised do not become [more likely to forgo] condoms and other [safe sex methods].

So, they've been very careful to go out and look for studies and to design studies—mostly questionnaire studies, where they give a little bit of [a] speech on what's [safe] sex, and then go out and question people at various intervals about [whether they are in fact] practicing safe sex. They've actually published some studies saying there is no risk disinhibition [due to circumcision], but [that belief stems from] questionable [data] in my opinion, because they obviously already have quite a bias towards trying to get new data that supports them and supports what they're doing, which has become a very lucrative area of research and HIV prevention programming and whatnot.

Eliyahu Ungar‑Sargon

It's true also—if I'm not mistaken—that in the studies, they speak of circumcision in their conclusions as a form of "surgical vaccine". Is that right?

David Wilton

We have heard that quite frequently; they talk about [circumcision] as a vaccine with a 50% to 60% efficacy, and they like to think of it that way, but of course it's not, because vaccines typically don't become less effective the more you're exposed [to some pathogen], and circumcision definitely does not help if you're practicing unsafe sex [regularly]; the more times that you engage in unsafe sexual practices, the more likely you are to be infected with HIV, and that doesn't matter whether you're intact or circumcised (they are [actually] very careful to point that out in the original studies).

So, [circumcision] doesn't really fit that [analogy of a vaccine]. I think they often times hedge their language; they use very precatory language, where they say "This is like a vacine"—they don't say "This is a vaccine", but they say "This is like a vaccine", [implying that] it behaves like one [and that] it has the kind of result that is sort of like a vaccine, but I think often times they are careful not to say that it is in fact a "surgical vaccine". But, you know, once you put that vision out there—that idea—it takes on a life of its own; the media, of course, [runs] with it, and a lot of journalists who aren't experts in this area take that [kind of statement] and [misinterpret] it [when] they write their stories.

I think that's calculated, too; I think that [misinterpretation is] something that the people who are involved in these studies would like to be out there.

Eliyahu Ungar‑Sargon

Now, what's their motivation? It would seem from all the things we're talking about, they went out and did something that I think is ethically questionable to begin with—this sort of randomized controlled trial on a group of unsuspecting native Africans; in my estimation, I don't know [whether] that sort of study would ever pass an ethics board in [the United States]—

David Wilton

Unlikely—

Eliyahu Ungar‑Sargon

So, there's something ethically questionable going on there. According to what you're saying, [the researchers] had a sort of predisposing bias to suggesting that circumcision [is] important, and it seemed almost like they were going out to prove an idea that they had, and not really approaching this as objectively as they might have.

But, I mean, it's not just these researchers we're talking about; the Bill and Melinda Gates Foundation now has glommed onto this notion that circumcision is an important tool [for defeating HIV]—they're more careful with the way they talk about it: They say it's an important tool, [and that] of course, you also need to teach safe sex practices and use condoms and all that, but [they are still throwing their name behind the notion that circumcision] is an important sort of adjunct tool.

So, what would the motivation for doing this be? Why are they doing it?

David Wilton

Well, I think it's important to be very careful about divining the motivations behind why someone has an interest in a particular area of research; it's hard to know unless the people involved actually tell you, and I don't think we have any definitive statements from the pro‑circumcision side.

[However], I think we can speculate a little bit: I think it depends on who we're talking about; the fact that most of these researchers are Americans and the United States is a majority‑circumcising society (it is a country where circumcision has become part of the culture) has something to do with it.

I think when you look at a guy like Robert Bailey, well [he] is an American researcher (I don't think he's Jewish); I think he's a guy who has gone on record saying that he circumcised his own son; I'm aware of one conversation where he mentioned to an Intactivist who had approached him and spoke to him at one point, and I think he said there were at least a dozen or more reasons why he circumcised his own son. I mean, clearly if you're emotionally invested in a procedure, and you are for whatever reason in a position to [promote] that procedure, you're going to do it! In a way, I think it's just a cultural thing.
When it comes to Bertrand Auvert (another one who was behind one of these RCTs), he approached [our Intact America booth] when we were at the International AIDS Conference in Rome this last summer, and he asked us if we were circumcised—there were 3 of us there at the table—and I was so taken aback [by that question] because it didn't seem relevant to our discussion, so I asked him "Are you circumcised?" and Bertrand Auvert said no he wasn't; so what is his motivation? I have no idea what it could be, but I suspect it has something to do with careerism; it might have something to do with his view that circumcision is an acceptable practice in a place like Africa—he's from the "First World", and he's swooping into the "third world" (or into an underdeveloped world) where he can sort of be someone's savior. I don't know what his motivations are; we just don't know. But, clearly, there's something going on there, and it would be nice to have some answers as far as that goes.
[As for] Daniel Halperin, the only thing I can really say about him is that he has actually stated—on the record in a media report around the year 2000—that he feels that it is his lot in life to go out and spread the practice of circumcision, something that [he believes his] forebearers as Jewish men introduced to the world! (At some point, all of that's not true; I think circumcision has popped up in a lot of different cultures, but that is what he said!) He said his grandfather was a mohel and this has kind of become a motivating factor for him.

So, we've got sort of an answer from Daniel Halperin, but [as for] the other 2, we really don't know other than what we can speculate.

Eliyahu Ungar‑Sargon

These people are using the data that they collected from the randomized controlled trials to promote routine infant circumcision? Is that correct?

David Wilton

Well, that has been the next step. When UNAIDS and the WHO came out and said:

We are now recommending circumcision

for adults
under sterile conditions
with informed consent".

and all of that, they were very careful to say that [circumcision] is something that should be applied to adult males—men who are sexually active. They said nothing about infant circumcision.

Well, most of us in the Intactivist community—being skeptical as we have been sort of trained to be with this issue—knew that this was going to start moving in [the] direction [of infant circumcision, anyway]; it wasn't [even] a couple of years [later] that they started talking about how we should do this to infants:

We should incorporate [routine circumcision] into prenatal care and postnatal followup; we should make [circumcision] something that is like vaccination, where we go [into a community] and vaccinate and circumcise, and where men don't have to be convinced (which is code for saying "[where] we don't have to worry about informed consent".

[The rationale is that pushing circumcision] becomes so much easier [when infants are the ones being put under the knife].

They often say that [circumcision is] "safer" for infants—which is news to the roughly 100 [or more] infants [who] die every year in the United States from circumcision! But, still, they say [infant circumcision] is safer.
They say it's programmatically easier [to implement than adult circumcision].

They have all of these things that they say. So, this last summer, when we were in Rome with Intact America, there was a guy there who had just been hired by Johns Hopkins in their programming arm—it's part of the university, but it's essentially their programming arm that goes into Africa and rolls out these various HIV programs, including [a] circumcision program. He's from Eritrea (and he [has] a name that I couldn't pronounce much less remember precisely, so I won't offer it, but I can find it for you if you need it), and he said that he had been hired specifically to begin to roll out infant circumcision—to get the programs in place, to begin to incorporate them into the prenatal and postnatal programming of the various countries in East Africa (where circumcision is fairly uncommon except in parts of Kenya).

So, yeah, I mean this infant circumcision thing is really starting to be pushed [as policy], and they're starting to create the programs that are going to be at the forefront of this effort. I think what's really happened is that they've found that it's very difficult to circumcise adult men; it's going to be very hard to convince the majority of adult men to be circumcised. Yeah, they may be doing hundreds of thousands of [adult circumcisions per] year [in Africa], but we're talking about tens of millions of men [whom they want to target], so [with] a hundred thousand every year, you're just not going to get [where you want if you're in the pro‑circumcision lobby]; you're going to have to be doing a lot more than that, and so I think what they've decided—and [what they use as] one of their selling points—is that infant circumcision is the way to go if you're really going to cover vast numbers of people.

Eliyahu Ungar‑Sargon

I think one of the most remarkable and disturbing things to me about this—I mean, we'll get into some of the flaws with the randomized controlled trials in a little bit here, but just [for] this move from the RCTs to infant circumcision, there is no evidence [of which] I'm aware—direct evidence—that circumcising infants reduces HIV anywhere.

In fact, we have quite a bit of evidence to the contrary if you look on a population basis; if I'm not mistaken, the UNAIDS report from 2009 looked at 18 countries, and [in] a majority of those countries, the inverse was true! The cultures in which infant circumcision [is] a norm (or a more normative practice) tended to have higher rates of HIV, which would tend to suggest that as a public health measure, [circumcision is] a complete failure.

So, not only do we not have any direct evidence that infant circumcision prevents the acquisition of HIV later in life, [but also] we have quite a bit of evidence to the contrary!

I mean, it's just—

David Wilton

Right. Right. Yeah.

If you start from their [pro‑circumcision] perspective, what they are saying is that if we circumcise these infants, [then] by the time they get to the point of sexual debut, they will already be prepared without any other interventions; [men circumcised as babies will] already have that protective—whatever it is—in place.

[However], the fact of the matter is [that] between the time a child is born and the time a child enters the age of sexual debut [is] a lot of time to acculturate and teach and educate and kind of prepare [boys] (and girls as well) to avoid HIV. I mean, it's not like circumcision at that age will sort of obviate the need to do the education part of it.

But, [I think the pro‑circumcision lobby has] this idea that with very high rates of HIV—let's say anything over 6% is considered epidemic levels—that [genital surgery is going to be more effective than education]. At the same time, if you're talking about trying to bring down those levels to "First World" levels, then you're right: Circumcising a person as an infant doesn't have any kind of—there's no evidence to prove or to show or to support doing it at that age.

I think a more sort of apples‑to-apples comparison would be the United States [compared] to Europe: [In Europe], the rate of circumcision is quite low and so is the rate of HIV. [In comparison], [in] the United States, we have the highest rate of circumcision and (comparatively) we have higher rates of HIV.

[Looking] at Africa, take a country like Malawi or Zimbabwe versus some other country that has higher rates of circumcision like South Africa, and I think you'll find that in those countries you've got lower rates of HIV among the intact than you do [among] the circumcised.

[However], I don't want to sort of overstate the case [or] sort of confuse the issue, because this is a very complicated area. I'm not entirely clear in my own mind exactly where the evidence is and exactly what the justifications of circumcising infants versus adults are (except for just the shear ability [to force it on infants] versus not being able to do it as [widely] among adults). There [are] a lot of issues that [do] need to be explored and studied and [considered].

Eliyahu Ungar‑Sargon

Yeah. To my eyes, and to anybody who is sensitive to the history of circumcision in the United States, this just seems like another sort of rationalization for continuing what really is a cultural practice more than anything else.

David Wilton

I totally agree, [but] I think we can't discount the role of money.

I mean, this is all about programming! This is all about going into a community and trying to provide them something they allegedly don't have—a level of healthcare, a level of attention to a particular disease. There's lots of grant money available for [such "services"], and if you're trying to work on microbicides [to thwart HIV, you're just not going to get the money as easily].

For example, in a study, they were giving girls money to delay sexual activity, and testing that approach to see whether or not it [could reduce] the rates of HIV. [Well], that actually worked! They had a study [where] they actually gave girls money [to turn down] sex until a certain age, and they showed that [it] reduced the rates of HIV.

Is that something that's really going to get a lot of grant money to implement? I mean, it seems like kind of a welfare approach to HIV reduction, and it's something that doesn't seem to me would appeal much to the powers that grant these kinds of large chunks of money [to implement prevention]; it's not as sexy [as surgery]; there's just something about it that's not quite as exciting as giving money to mobile circumcision units that are going to roll into a community and throw parties and encourage boys to come in to be circumcised.

So, I think we can't discount also the role of money.

[Also], to say we're going to implement an infant circumcision program, and we're going to cover 90% of all baby boys born [is a notion that leads to dubious metrics for success]: You can't measure [such a program's impact on] HIV until 15 [or] 20 years later when [the boys] become sexually active, so the measurement or metric becomes:

[The number of] circumcisions performed

[rather than the actual intended outcome]:

The [number of] cases [of HIV] prevented.

So, there's a lot of stuff going on [here]; this is a very complex [subject].

Eliyahu Ungar‑Sargon

What are some of the problems that people have pointed out with the way that this data was collected? I've heard many people (Ryan McAllister, among others) look at the methodology of the randomized controlled trials and they've offered a number of criticisms. What are some of the central criticisms of these studies and their conclusions?

David Wilton

Well, some we've mentioned.

One was loss to follow up: I don't think they took adequate account of the loss to follow up to be able to determine whether their numbers are solid or not.
Another is selection bias: All of these men who participated in these trials were of a mind that they wanted to be circumcised at some [point], and they all went into it with the promise that at the end of the trial that they could be circumcised if they wanted to be.
There was 6 weeks [worth] of [unaccounted] healing time: [This] gave the intact group a head start in terms of the actual amount of time that they could be exposed to HIV.
There was researcher bias that was often talked about: Researchers have interpreted the data in such a way as to support their hypothesis.

These are some of the big ones. [Again, see this analysis and this analysis.]

Eliyahu Ungar‑Sargon

There was also some follow up, and if I'm not mistaken, one of the things they found was that the partners of the men who had participated in these studies had higher rates of HIV after the circumcision. I think that some of the researchers chalked this up to "Oh, well, they had sex before their wounds had healed" or something like this, but that's also a very troubling trend.

David Wilton

Right, and that's the other thing I was thinking that kind of went out of my mind. I think that was unaccounted for and it was kind of glossed over as being not that important, but I think what a lot of critics [pointed out] was an indication that some of these infections were not [sexually transmitted]; they weren't related to sexual activity. In fact, they were [possibly] related to surgical and other types of medical intervention like getting shots and whatnot—iatrogenic infections that [were the unintended result of some] medical treatment.

So, as I understand it (again, [we're] dealing with so many numbers in these studies and in subsequent studies, it's hard to keep them all straight), there were a number of individuals who seroconverted in both groups [but] reported no sexual activity, [and yet] they were included [in the results]. So, it's kind of like that implicates one of 2 things: One, it implicates that [circumcision] does not account for all of [the] infections, or what [the participants] were reporting is not reliable. So, [there are] a lot of questions there, [and] I think that probably accounts for what you're talking about, where the partners were infected more frequently after the circumcisions or there were more infections after the circumcisions among partners than there were prior.

Eliyahu Ungar‑Sargon

It seems clear to me that you're taking this practice [of circumcision] into a culture, you're not fully educating them—I know that the people who were involved in these trials supposedly got safe sex education, but the folk wisdom around [circumcision] now is that if you're circumcised, you don't need to wear a condom when you're having sex, [which] is extremely dangerous and very much counterproductive [with respect to] the other efforts to educate [people] about safe sex and that sort of thing.

David Wilton

Absolutely. I agree.

I think it's kind of like you've got a message with nuance: Circumcision is protective, BUT it is not 100% protective, and you still have to take measures to protect yourself. That's a message with a very fine nuance to it; I mean, how do you tell people who are not that well educated—who do not have access to the kinds of information flows that we have here in the West—that [they] are to undergo this surgery that is going to change [their] sexual experience, that is going to be painful in its own right, and yet [they] still [must] where condoms! You're not fully protected! I mean, anyone who submits to circumcision who is convinced to do it as an adult is going to have to really believe in [the vast protective properties] of this procedure, and [he is] going to really have to have some kind of emotional investment in going under the knife.

That, to me, seems to be something that would just obliterate all nuance in the message that [circumcision] is not a 100% preventative measure. I think we've got a lot of anecdotal evidence now coming out of Africa—we've seen a number of reports where men have said:

Well, I'm circumcised. I don't have to wear a condom!

You know, even if they say "I'm circumcised, and I don't have to wear a condom as often", we've still got an issue! You're right, it very much could counteract any of the other messages put out there that [say]:

You [must] wear a condom every time.
You've got to be faithful to [your partner].
Know the status of [your partner].

and all of these other messages that [people have been] putting out there. Circumcision really complicates [those messages].

Eliyahu Ungar‑Sargon

It occurs to me also that a big part of what's going on now with this push to circumcise African men—and babies now—is a symptom of a kind of desperation around the AIDS epidemic; we thought we'd have a vaccine by now; we thought we'd have the magic bullet by now, and we just don't, and maybe I'm optimistic, but I think that in my lifetime we will have something like that, and—I wonder how we'll be looking back at this push [for widespread destructive genital surgery] in light of an actual vaccine. What do you think about that?

David Wilton

Well, a couple of things: One, in 2003 (when these studies were getting rolling), I think that there was a lot of frustration in the research community about vaccines and prevention, and the programming that they already had going didn't seem to be working as effectively as they thought it would; there [developed] this idea that any prevention technology that could come along in combination with other prevention technologies would achieve this goal of getting [HIV] into kind of an endemic stage—that is to say, where it's stable, [and] not growing.

As time has gone on since 2006 (we're 5 years later), the whole scene has become much more optimistic; we've actually [cured somebody]—we've had a guy in Germany who was cured through a bone marrow transplant. Now, that's not something that can be rolled out to everybody, but it is a kind of an idea that possibily could lead to other therapies. We've had this real push to find antibodies that are very effective against HIV that's had a lot of promising developments in the last 2‑to‑3 years.

I mean, we've had a lot of stuff happen in those 5 years, and I think now what we have is a situation coming up where circumcision in fact could be something that maybe is not as attractive to the [funding] donors. [Unfortunately], the result from that has been these same researchers coming up with papers based on the same data that say that HPV is reduced among the circumcised—you have lower rates of other types of STDs, and all these other things. I think that as you look at the data out there, as you look at the literature, you're seeing that these [pro‑circumcision] researchers are starting to compensate for these positive developments in the HIV research community, [in order] to try to bolster circumcision as being still relevant.

We saw a lot of that in Rome; we saw a lot of studies showing that men [are] less vulnerable to certain STDs—and on top of that, [these men who were circumcised are portrayed as being] more satisfied with their sex [lives], and [their] women liked it more, and we had all these things that [don't] seem to be really related to HIV, but were being presented [nonetheless].

[So], what you're talking about in terms of a desperation, I think that was very much the case 5 years ago, [but] I think that's less the case today, and it's kind of what we were all sort of saying when these studies came out: You may think this is a good idea now, but in a few years—call it a decade—we may have a vaccine, and then what? All of these men have been circumcised, and now it has become part of the culture, and now it's a sponge for resources because men think of it as essential (if you believe the studies) even when at that point it may not be essential any longer.

Yeah, I agree in some respect, but I think the landscape is changing—I think it's changing fairly rapidly.

Eliyahu Ungar‑Sargon

Just a final point on this: It's so interesting to me that there isn't a single one of these researchers who would ever talk about the loss of sexual function as a side effect—it's just not even on their radar, and that to me is also ethically problematic; I mean, you get into issues of informed consent here, because you're pushing this on [an] adult population and there's just no mention whatsoever of the sexual function effects of circumcision.

David Wilton

Right, and well, I wouldn't quite agree to say it's not on their radar; I think they've in some sense gone out of their way to show or to argue that [circumcision] has no sexual effect; [I recall] there have been a number of papers published by these same researchers, saying that sexual function is not affected and that satisfaction levels [after circumcision] have [actually] gone up!

[However], these papers typically do not talk in any way, shape, or form about the function of the foreskin; they just talk about [subjective satisfaction] before and after [circumcision], and so they don't say "The gliding mechanism of the foreskin during intercourse is somehow compensated for by the provision of lubricants" or something like that. [Also, nobody mentions that because circumcision alters a man's sensory input, it also alters the way he performs the sex act such that he naturally makes less contact with a woman's clitoris and tends to dry out her vagina, thereby reducing her pleasure.]

Actually, we talked to some people in Rome [who said they are telling men that] "If you come in to be circumcised, we'll provide you with unlimited amounts of lubricants". There was a woman [in Rome] who was in charge of a program [where] that was actually one of their selling points: We will provide you with unlimited amounts of lubricants. [I mean], this is unbelievable!

I think you're right that the function of the foreskin is not even on their radar; they don't understand it—they're not really even interested in it. [However], I do think they are sensitive to the argument that [circumcision] does change the way that [a person] experiences sex, and they've gone out of their way in taking great pains to [state] that "No. [Sex] is even better after you've been circumcised!"

Eliyahu Ungar‑Sargon

Right. The satisfaction number that they publish: 87%—I mean, some crazy, completely implausible numbers about sexual satisfaction. I mean, there are 2 problems I see here:

All of this sort of sexual satisfaction data that I've read is very fuzzy; what is sexual satisfaction? How does a person know [whether he is more] sexually satisfied before or after [circumcision]? The person is actually going to go through [with having] surgery; how reliable is [his] testimony on [his] sexual satisfaction or the function?

I recently had a conversation with Glenn Callender in Vancouver, [Canada], and he was telling me that [even] as an intact guy, it wasn't until he became really aware of his foreskin that he could even appreciate what it was contributing to his sex life and to his sexual satisfaction. So, all of these [things] combine into a sort of very unreliable soup of supposed data.
I take your point that [these researchers] see it as part of their rhetorical function to demonstrate in some way "scientifically" that there's no detriment to sexual experience, but in a very loose and non‑scientific way—to my eyes, in any event.

David Wilton

I agree.

I can't really think of a more subjective area of human experience than the perception of one's sexual satisfaction. The shear variety of sexual tastes and acts [about which you may] readily [read] if you were to google any of it is an indication that [sexuality and sexual satisfaction and sexual tastes are] such a difficult things to measure. Because of that [fact], I [only] feel comfortable saying that an adult [should choose for himself whether or not to undergo destructive genital surgery].

I mean, you know, it's not the case that Intactivists or that I personally believe that circumcision has got this inherent evil to it; you know, it's not that! [Rather], it's that [something like circumcision should be] an individual's choice, an individual's decision. To complicate [that choice] with these claims that [circumcision] is going to protect you from HIV is just wrong! It's being dishonest!

You know, the satisfaction studies that they've done—and of course the—Intactivists can point to other studies that have been done that support our side as well—I mean, frankly, both sets of studies are what they are, and that is the measurement of a given group of people who participated in that study, and it's like a lot of the studies having to do with circumcision and disease and whatnot: There are studies that support both sides, and it's because the researchers are individuals, and they bring researcher bias into this very difficult, complex, highly nuanced area of human experience.

So, I just don't think that it's a good thing to make absolute claims about a person's satisfaction [after or even before] circumcision; I think that's just hard to make that into a science [or] to give it any kind of solid metric.

I think the real issue here for me is that to circumcise infants is essentially to rob them of their basic human right to make this decision for themselves.

Eliyahu Ungar‑Sargon

So, switching gears a bit: Can you share with our audience a little bit of a blow by blow [account] of what happened this summer in San Francisco? This was a very eventful summer here for this city and for Intactivism in general.

David Wilton

Yeah. Well, this summer, we had a ballot measure added to the city ballot, [which] was applicable only to the city of San Francisco. It was a proposition to make circumcision of infants a misdemeanor, and I believe I got the numbers right: [Performing circumcision on a completely healthy minor would be] punishable by a $1000 fine and six months in county jail, and it had one exception: Medical need. It had no exception for religion.

Several different individuals here in town, namely Rick Carillo, Lloyd Schofield (who was the [principal] proponent), and a few others were involved in getting this thing organized, collecting and submitting [the required] signatures [of the citizenry], and complying with all of the different rules and regulations that apply to putting something on the ballot. They collected signatures all through the spring, submitted the ballot measure in (I believe) May or June, and it was accepted a week or so later; they had 12 500‑odd signatures, of which [the government] verified 7500 [and of which the government only required] 7100 (something like that).

So, the [proposition] was put on the ballot, and then very shortly [thereafter], we had all kinds of backlash in the media and elsewhere. A coalition of Jewish groups and medical groups here in the city got together and eventually filed suit to remove it from the ballot based on business and professions [legal] code, section 460, subsection B, which is a statute that essentially preempts any regulation of the so‑called "healing arts", which includes the practice of medicine, of which [circumcision] was considered a part. Ultimately, that lawsuit ended up being decided in late July against the proponents, so that the ballot measure was removed from the ballot, and [that decision] was based solely on 460B of the business and professions code. It wasn't based on any of the religious objections, which were all part of the petition. That's kind of how it went down.

There's a whole bunch of [nuanced] detail that [I would be] happy to go into—

Eliyahu Ungar‑Sargon

Yeah. Let's do it—

David Wilton

Of course, I have my opinion of whether this was a good thing or a bad thing.

When I first heard about this [ballot initiative], I was initially approached to be the proponent, and I felt like I couldn't do it; it had to be someone living within the city and county of San Francisco; I felt like I couldn't be the proponent at the time—not because I had any objection to going this legislative route, but because I felt like for me to be the proponent would put me at odds with a lot of people [with whom] I work—and not just Jewish colleagues, but others as well. My fear was that this could have a real detrimental effect in undermining my business, a very selfish reason why I decided I didn't want to be the proponent, but one I felt like I had to [accept] to protect my income—my livelihood.

So, they got Lloyd Schofield to be involved, and he lives here [in San Francisco]; he's retired, so [he] doesn't have that issue—the issue that I had. He stepped up right away: "Fine! I'll do it!" So, he and Rick got together (and Jonathon Conte, I believe was also involved) in collecting some of these signatures; they consulted somewhat with Matthew Hess of mgmbill.org (down in San Diego), although I don't think Matthew was that involved in terms of the day‑to-day collecting of signatures and whatnot.

At that time, you know, I guess I didn't think about it very deeply, because at the time I thought "Well, OK, let's see what happens." So, they get this thing on the ballot, we had this backlash, and [then] I began to have some doubts; I began to think this could have a lot of [negative] impact on the work that we [Intactivists] have been doing for years, in that it could bring a lot of kind of negative feeling down on us, and it was right about the time when I was sort of mulling this over—not in a [really] serious way, but just thinking about it—that [the second edition of Matthew Hess's comic], Foreskin Man, happend upon the scene.

[At the time, this] latest issue of Foreskin Man was about "Monster Mohel" and all of that, and we started getting all of this press about how this was a very anti‑Semitic move and [thus all] the people involved [must be] anti‑Semitic, and all these things. There was even a rabbi—I think he's from back east somewhere—who somehow decided that I was deeply involved in this and was linking to my website and saying "See, here he is! He's part of this as well!" and I tried to engage him a little bit online, [but] he wouldn't really engage with me; I was shocked, because I really wasn't part of this—no more than just being in town and encouraging [the ballot initiative] and everything else, but my name [had] never really [come] up, [and yet] all of a sudden, I was sort of a minor target in all of this. I was just thinking: Wow, this is something that could really do a lot of damage to us.

[However], somewhere in Rome (when I was there at the International AIDS Conference), I was talking to some of the people [with whom] I was [working], I began to think:

You know, we've been stuck at [a] 60% circumcision rate in [the United States] since the 1990s; maybe [even negative publicity] isn't such a bad thing:

It's getting a lot of press.
We're on the nightly news.
It's getting into major newspapers.

I mean, people are [finally] talking about this [issue]. This is really an important development; it has become a national issue, whereas before, it was a very kind of local or personal issue, and it was an issue that wasn't getting so much attention in the national press.

Then, when the lawsuit happened; our side was completely unprepared, and the result was that—

Eliyahu Ungar‑Sargon

Did you just not see it coming?

David Wilton

You know, this is very touchy, because there are a lot of feelings involved with some of the participants, and I want to say that this is my belief—this is my thought: The people who were really behind this [ballot initiative] (who were really doing the footwork and the legwork, who deserve lots of credit for the courage and the financial investment and the time investment) did not think this through; they didn't consult anybody other than themselves, which is not uncommon in the Intactivist Movement.

I think a lot of [Intactivists] do their own thing—and that's laudatory; I think it's the only way that a lot of this work would have ever gotten done (people were just [individually] willing to do it). That's how they approached this ballot measure: What they [and I] didn't foresee is that when you start trying to make illegal something as touchy as [circumcision], there is going to be an inevitable backlash, and that backlash often translates into litigation, and we didn't have anybody lined up [for our legal defense]; we had no attorneys on board—it was one guy consulting up in the North Bay, who is an attorney who [already] had a full‑time job working for the state (a super smart guy, very intelligent, very engaged, lots of good advice), but [he] couldn't put his name on anything.

We had a situation where there was no time to respond. [In comparison], the law firm [of our opponents] was Morrison Foerster, an international law firm that was doing this pro‑bono and had a partner involved in writing up the petition and filing it. They had a full‑time associate working on it.

What did we have? We had a bunch of part‑timers who weren't even really involved, and no one wanted to put [his or her] name on anything because [we] were all afraid, including myself! Ultimately, I did put my name on an amicus bief that I signed and filed for DOC (Doctors Opposing Circumcision), but the fact of the matter is that we just were not prepared for the backlash, ultimately.

You know, whenever we bring this [up]—whenever I have brought it up—with people [who have] a vested interest in it, it's a very difficult, touchy issue, because when you put your ass on the line and you expose yourself to not just abuse, but real threats—I mean, Lloyd had people coming to his house, knocking on his door—it's hard to take [the] criticism [that] "Well, we [should] have done this differently."

The real question that I was asking was what are the lessons? This happened. Fine. What are the lessons for the next time we try to go this route or we try to do something else? An idea that I thought was interesting: How about just a referendum on the issue?

Do you believe [cutting children's genitalia] is a good or a bad thing?

In California, we can put these things on the ballot; they often do for things like the [wars in Iraq and Afghanistan]. "We as a city don't support this or do support this." Berkeley has had this [sort of thing] on their ballot; why couldn't we do this for circumcision? [With such an approach], no one's ox is gored, so to speak; no one's [supposed] rights are infringed; no one is told what [he or she] can or cannot do. It's just a way of getting media attention, which is really initially what we were all thinking: "[The ballot measure] is not going to pass, but we're going to get people talking about this issue."

Eliyahu Ungar‑Sargon

You know, a lot of this centered around Foreskin Man—

David Wilton

Yeah...

Eliyahu Ungar‑Sargon

What's your take from that whole thing?

David Wilton

Well, on the one hand, [one obviously thinks] "What horrible timing!", and on the other hand, I mean, how sort of tone deaf can you be [to publish something like that?] In my heart, I don't believe Matthew is any kind of anti‑Semite; I think he is genuinely an arch enemy of any advocate of circumcision—it doesn't matter whether it's from a Jewish perspective or just a plain old redneck American perspective (which is kind of my background).

The fact of the matter is he should have known better; I mean, what can you say about it? The first [installment of Foreskin Man] is about the medical profession [involving "Doctor Mutilator"], the second one is about mohels, [and] the third one is about [African] tribal circumcision [(including female circumcision)]. I mean, yeah, OK, but there are levels and layers of sensitivity about this practice in different contexts, and you just have to be sensitive to it.

You know, all of [us have the] objective to reduce the level of [forced] circumcision in society—to try to reduce this act on unconsenting babies. If that is our objective, then we ought to be very careful about how we approach it, and we shouldn't have any kind of sort of rigid agenda [to go] after all people equally.

You know, there was a big, almost angry kind of discussion about whether there should have been a religious exemption in the ballot measure. My view is why not? There were a number of people who said:

Religious exemption is out of the question, because it wouldn't work; everyone [must] be protected, or no one is protected.

If the equal protection argument is going to work, then it's got to be applied to everyone; you can't say you've got to have equal protection for girls and boys but exclude certain boys.

[To me], that's perfectly logical and it makes great legal sense, but does it conform with the real world? I mean, ultimately if we were able to get something on the ballot—and keep it on the ballot—and it got this discussion going without triggering these accusations of anti‑Semitism, ultimately the result, the fallout, the outcome is a reduction in [forced] circumcision, because you're bringing people into the conversation [who] maybe have not been part of the coversation before, and some of those people are going to take your side, and that is the objective:

Bring down the number of [forced] circumcisions of infant boys!

So, to me, if that's our objective, it's easy to say "Yes! We [should] put in a religious exemption!" But, there were a lot of detractors [of that position]. A lot of people felt like that's just unacceptable.

Eliyahu Ungar‑Sargon

Do you believe that had there been a religious exemption, things would have played out differently?

David Wilton

Yes. I do.

I think the religious exemption would have undercut the idea that anyone's religious beliefs or practices were being tread upon. That likely would have made it less likely, I think, that we would have this coalition come together to file suit. Maybe they would have filed suit anyway. I mean, who knows? But, at least it would have made their argument a lot less plausible. I mean, ultimately, the reason they took it off the ballot was based on this preemption statute—it wasn't because the religious stuff—

Eliyahu Ungar‑Sargon

It had nothing to do with the religious stuff—

David Wilton

Yeah. So, [it's true that] the grounds [on which it was struck down would not have been affected]. But, to say that it doesn't have any impact I know is just not true, because that's not how law works; I mean, law is highly subjective, and in all of the [legal] practice [that] I've done (in criminal law), the statutes are most of the time a kind of guide.

If there's a particular objective or outcome that someone wants to [achieve], he can probably legally reason his way to that objective, and I'm thinking that this is no different. But, you know, again, we're second guessing, and that I think upsets some people—to second guess what the outcome could have been. But, I don't think we would have been second guessing ourselves so much if we had had a kind of planning period, and a kind of period where we had brought in people who could think this through [and] try to come up with various scenarios that might play out [so that we could have been] prepared for it.

Eliyahu Ungar‑Sargon

If you could talk to the Intactivist world now, what would your advice be?

David Wilton

Well, I have opinions on that, and I have opinions [at] an even broader overview of the Intactivist Movement. What I think in terms of a ballot measure or any kind of discrete effort [to change], let's say, the law or the practices of hospitals (how they promote or don't promote or carry out the procedure of circumcision on infants)—whatever it is you're trying to change that has a very discrete, definable objective, I think [it] needs to be thought out.

I think that there needs to be a period of reflection that would allow us to anticipate what's going to happen, and if you can anticipate what's going to happen, [then] you can have mechanisms and people in place to respond. I'm not saying it's going to change the outcome—it may or may not—but the point is that if you've got some way to fight back—if you're going to stand a fighting chance—you've got to have thought about it prior, and you've got to plan.

This whole period of Intactivism of the last 30 years [has] been ad hoc; it's all been individuals just working on their own little projects—which is fine and is important and needs to continue. [However], we have to mature out of that [phase]; we have to get into a period where we are actually working in concert with each other, taking advantage of each of our strengths and dividing the labor.

We've got those who are working on the legal side.
We've got those working on the legislative side.
We've got those working in the arts.
We've got those working in media.
We've got those working in grassroots.

We've got all these bases in areas and places where you can fit in and you can come to Intactivism and say "What do I want to do? Where do I fit?" and then choose an area and work towards that. [We need to think about] formalizing our efforts and channeling them into defined institutions in a way, and that gets to the larger issue: For years, this has been a kind of pay-as-you-go, self‑financed, activism‑from-the-heart, highly personal, highly emotional approach to making [a] world where infants are not subjected to circumcision any longer, and I think [that nature of our approach has] got to change.

I think we are at a point where we've got enough critical mass of interested people—people with energy, talents, resources—so that we've got to start to make the business of Intactivism pay in some way; so, when people are out there doing this work, they aren't doing it evenings and weekends, [but rather, they are] doing it as their day jobs.

Believe me! [There are] lots and lots of people doing [some] kind of non‑profit work (or doing it and being paid for it), and we have got to be the same way. Whether it be disease eradication (such as the HIV/AIDS efforts in the world), whether it be alleviating hunger or malnutrition among children, whether it be getting vaccines to the developing world—whatever it is, the mechanisms and the institutions—the path to success in those efforts has grown up in a defined, understood, and received way, so that when [people] go into this [work], they know how to do it; they get their degrees in "Public Health" and they go out into the field, and they join the NGO that does that kind of work. We've got to do the same thing.

When we were in Rome, we saw all these people arrayed against us, [and] we're there on our own dime! You know, we are paying for our own way on donations and out of our own pockets to be there to say "You can't be circumcising the world and expect HIV to stop in its tracks! You can't do that!", and all these people are coming up to us and they're part of UNAIDS, they're part of WHO, they're with universities, they're with all these different groups, and their airfairs were paid, their lodging was paid, [their admission to the] conference itself [was paid], [and these people are] on salary—I mean, we cannot compete with that any longer! We just can't!

If we're going to have an effect long-term—if we want this to be more than just a ragtag bunch of people (admittedly with our hearts on [our] sleeves), we've got to start to formalize what we're doing, and I'm hoping that's starting to happen.

Eliyahu Ungar‑Sargon

David Wilton, thank you so much for joining us on The Cut Podcast. Where can people learn more about your work?

David Wilton

Well, my work is all through my website:

circumcisionandhiv.com

That's kind of my platform, and so if you want to know what I'm doing at any given moment in Intactivism, that's where you can go.

Eliyahu Ungar‑Sargon

That's our show; if you have any questions, comments, or suggestions, please email them to us at:

cutdocumentary AT gmail (.) com

If you like what you heard today, please support us by buying our film at:

www.cutthefilm.com

[33] The Cut Podcast: A New Sexual Revolution

2011-12-04T09:22:00.001Z

In Vancouver, BC, Eliyahu Ungar‑Sargon interviewed the unique Glen Callender, a performance artist who makes live demonstrations about the wonders of his foreskin. He also founded the pro‑foreskin advocacy group CAN-FAP to help usher in a new Sexual Revolution that will give men the confidence to explore their own sexuality. Here is the recording, and a transcript follows.

Transcript
(slightly modified)

Eliyahu Ungar‑Sargon

From the White Letter Productions studios in Los Angeles, California, I'm [Eliyahu] Ungar‑Sargon, and this is The Cut Podcast.

Well, welcome back to another special edition of The Cut Podcast. I'm very happy to be sitting here with Glen Callender in Vancouver, British Columbia—that's Canada, for those of you south of the border—

Glen Callender

It's Canada for people north of the border, too, actually!

Eliyahu Ungar‑Sargon

So, Glen, why don't you introduce yourself and tell us a little bit about how you [came] to this subject of circumcision and intactivism.

Glen Callender

Well, I'm Glen Callender. I'm the founder of:

The Canadian Foreskin Awareness Project

[which is] Canada's newest and feistiest pro‑foreskin advocacy group. The Canadian Foreskin Awareness Project promotes foreskin education, appreciation, and stimulation, and [it] advocates for the human right of all children—male, female, and intersex—to grow up with intact genitals.

I am intact. Yes, I'm intact, and yes, I've enjoyed my foreskin [since] a very early age; [I] was an orgasmic kid quite young. Anyway, I was [maybe] about 9 or 10 [years old] when I [first] learned of circumcision. I mean, I had seen circumcised penises at the community pool (and places like that); I remember being perplexed at how many of the other men and boys could keep their foreskins "pulled back" [permanently] without using their hands! I didn't know what was going on there.

Eventually, I learned that they had had their foreskins cut off! When I learned of this (and I think I read about it initially), it really made my blood run cold; I was absolutely shocked to the core of my being [by the fact] that many boys [had] had their foreskins cut off—it was an immensely upsetting thing for me to learn, because at the time, I already had a great relationship with my foreskin. So, it was absolutely shocking and upsetting—and frankly, that feeling of shock has never gone away for me; to this day, there's part of me that's absolutely horrified at the thought that this is done to little boys.

In the last few years, that's when [this issue has] really come forward for me. About 2008 was when I started to have the series of ideas that led to what is now the Canadian Foreskin Awareness Project and my current act as a performance artist, where I demonstrate my foreskin to people—to demonstrate why foreskin is fabulous and why circumcision is harmful.

Eliyahu Ungar‑Sargon

So, one of the things [on which] I really want to get your perspective (and [in which] I think a lot of circumcised men are very interested) is what [it is] that the foreskin contributes to male sexual experience. I think you have a very powerful story on this front, because you're not only intact, but you are [also] aware of your foreskin in a way that maybe [even] some intact men aren't.

Again, this is difficult, of course. We're talking about the content of human experience; it's very difficult to talk about this in purely objective terms, but [it would be great] if you [could] be as explicit as possible—just share with our audience what it is about the foreskin that is so important. I think the cultural belief out there is [that] whether you have a foreskin or not doesn't really make a big difference to male sexual experience.

Glen Callender

Well, I'll start by saying [that] one of the reasons why I [educate] people about foreskin is [what] I call my "revenge" on [what was] the sexual education curriculum of British Columbia in the [1980s]; when I went through sex ed in junior high, there wasn't a foreskin on the diagram of the penis that they gave us to study.

Even to this day, you can go to the bookstore [and] get books off the shelves—published this year [or] last year (primarily in the USA, [of course])—that still [don't] have the foreskin on the diagram [of the penis], or [at least] it won't be labeled and it won't be discussed, which is absolutely crazy! It's absolutely insane that there's this incredible level of enforced ignorance about the foreskin.

The truth of the matter is, of course, that the foreskin and the inner foreskin contain most of the nerves of the penis—the most sensitive parts of the penis; the fine‑touch nerves, [which are] the most erogenous parts of the penis, are [located] there.

Based on the fact that the cultural emphasis is on the head of the penis, the idea we get is [that] the foreskin is just a cover for the head of the penis. [Folk knowledge states that] the head is really the focus; it's where the action is, and I would say that I—as many intact men—more or less bought into that belief for a really long time.

Looking back on it now, I understand that much of the pleasure that I experienced from my foreskin [was pleasure that] I [erroneously] attributed to the head of my penis; I thought it was coming from the head of my penis, but it wasn't. It was actually coming from my foreskin—my inner foreskin area.

As I [have] become more educated about the anatomy of my penis, I have learned to discern the sensations that I get from different parts of my penis, and focus on them. When I was younger—unaware of really my [own] anatomy and the [subtleties of the] pleasure—it was like there was a [nebulous] haze of pleasure coming from my penis, which I believed was mostly [from] the head of the penis, but now I know [this] isn't the case: [The pleasure originates] mostly from my inner foreskin, [and] the head of the penis is a relatively minor player in my sexual experience.

Eliyahu Ungar‑Sargon

That's really interesting, because one of the things [which] that suggests—and of course, I think there are many data points that can [corroborate] this insight—that there's a large degree of your psychological expectations playing into your experience of your body [and] your experience of your sexuality (in a sort of feedback mechanism). Can you give a little more detail on that side of things?

Glen Callender

The analogy that I use is whiskey tasting: When I was younger, I didn't know much about whiskey; I didn't know how it was made, etc. So, when I tasted whiskey, [my experience] was just WHISKEY! That was the flavor—just this [monolithic] taste.

Then I went to Scotland, and I went to distilleries, and learned about the components of the flavor of whiskey—the grain that they use, how they malt it, what the effect of that is, the type of peat moss that they use (they burn peat moss, so there's [a taste of] smoke), [and] they put the whiskey in wooden barrels of different woods to mature, and [all of these things] flavor the whiskey. You learn these things, and they give you whiskey to taste [as you learn], so that you can actually start to take apart the flavor. Now, I can [discern] these [contributions to the flavor]; I can taste the smoke, for example.

I would say that my sexual experience is the same: Before I had really learned much about the anatomy of the penis, there was [only a nebulous, monolithic] haze of pleasure coming from my penis, [which] I generally assumed was [coming from the] head of my penis. But, as I was researching the anatomy of the penis—[really] just in the last few years—I kept reading over and over in the intactivist literature—in the science of the anatomy of the penis—that most of the [pleasurable] nerves are in the inner foreskin:

The frenulum.
The ridged band.
The soft mucosa.

At the time, I of course knew that my foreskin [feels] good—I was aware [and] never imagined cutting it off—but I thought to myself:

Well, I don't really seem to feel like I'm getting this enormous amount of pleasure from my foreskin. I'm getting plenty, but not as much as the literature would suggest!

If these [parts of the foreskin really] are the specific areas where the nerves are concentrated, [then] if I were to isolate those areas in terms of masturbation and [exploration] of my own body—if I [were] to stimulate them separately from the rest of my penis—then interesting things ought to happen.

So, I started experimenting with that, and Lo and Behold! Interesting things did happen; in fact, I have found now that I am capable of multiple orgasms from stimulating just my ridged band; I have the capacity to do that all along my frenulum, from [where the frenulum meets] the ridged band all the way up to the head of my penis—I [hadn't known] that until I actually stimulated it in isolation from the rest of my penis.

Going back to the whiskey analogy, what this has enabled me to do is take apart the sensations that I feel; now when I have sex, I'm conscious of the different parts of my penis and the different sensations that are coming from it—I can feel [what sensations are coming from] the head of my penis, I can feel the ridged band, I can feel the different sensations; I can take it apart in a way that I previously couldn't, and it has been an incredible experience for me, because it has fundamentally changed my sexual experience and how I enjoy my penis and sex.

Eliyahu Ungar‑Sargon

Now, when you say "multiple" orgasms, is this sort of the kind of multiple orgasms that people who think off talk about—that's not coupled with ejaculation?—

Glen Callender

Like the tantric type [of] thing?

No, this is not [some] New Age—I'm very skeptical of those [ideas]; I've known men [who] have said "Oh, I can orgasm for hours!" and I say:

Yeeeaaaah... sure you can, Mister Rainbow Waterfall Crystal-Up-Your-Ass guy. I don't think so. I think you are committed to this idea that you have mystical sexual energies and blah blah.

No. We're talking about actual orgasms with ejaculations that are readily observable. In fact, I'm right now in the process of creating visual demonstration clips of these different orgasms, so that I can teach intact men their anatomy and what the potential of their anatomy is—this is not something that is taught right now.

My point of view is that this is exactly following the feminist position—which has been stated many times over the last 50 years—that women aren't enjoying sex as much as they should because they weren't taught their anatomy and how to enjoy their bodies; they were [instead] taught shame:

"Don't touch that!"
"Don't look at that!"

It wasn't so long ago that the act of taking a mirror and looking at one's own vagina was [considered] a revolutionary concept! Before [that] time, women would live their entire lives without even having a single good look at their own genitals ever. This greater openness has led to women learning about their G-spots, and when a woman learns about her G-spot—learns how to locate [it] and how to stimulate [it and] get to know it—her chances of having G-spot orgasms go up enormously.

My position is that men are actually significantly behind women in this regard. The actual anatomy of the penis is far more intricate and laden with literally orgasmic organs than is currently known by most people, and I really believe that intactivism will go hand‑in‑hand with almost a new Sexual Revolution—this time on the male side of the equation—where men will learn the truth about their anatomies.

At the moment, our culture is very shy to talk about the merits of the foreskin and the immense erotic contribution the foreskin makes to both the man and his partner—specifically because it means [facing up to the fact] that a lot of men have had these parts taken away [from them].

I know from direct experience that I have several different ways of orgasming, and most of them would be taken away if were circumcised. The parts that I have ([and] that circumcised men don't have) are fantastic parts, and one of the reasons I'm an activist is because I really enjoy my foreskin, and when I do, I simply know in my heart that it is a crime to take that experience away from somebody; when people understand the truth about the anatomy of the penis, it will have a massive impact on the circumcision debate.

Eliyahu Ungar‑Sargon

You were just talking about some of the things that you discovered through masturbatory practices. Can you talk a little bit about the effects that your foreskin have had (especially as you [have] become more aware of it) on sex with women and—in your case, [as] you are bisexual—with men also. What role does the foreskin play?

Glen Callender

Well, I would say that in terms of my own experience, a lot of the fun is because I'm in possession of fairly unique knowledge about the anatomy of the penis, and I should say that the concept of foreskin awareness—the title of my group is the Canadian Foreskin Awareness Project—is about more than just circumcision‑related issues; it's about actually being aware of your own foreskin and the parts of it.

One thing that happens to me is whenever I have a partner, I have to teach [my partner]—it's very instructional, because I'm dealing with people who don't know this stuff, and so certainly my sex has become a lot more communicative, because I have to really show people:

OK, this is the ridged band; here it is; here's how you can see it; here's how you can feel it; here [are] the different things you can do with it...

and that's just one little area! [Next]:

Here are things you can do with the frenulum, [etc.]

So, sex has become very explorative for me—I'm still learning new things.

In terms of the difference between men and women [as my partners], well, in terms of oral sex, there's not much of a difference!—and oral sex is really where the bulk of [my] information comes in handy, because with your mouth and your fingers, you're capable of manipulating the penis in ways that are more [subtle and specific] than during intercourse.

[Of course], the [information] certainly does make a difference during intercourse. As I said, I can now feel very acutely the component parts of the sensation; a lot of the sensation of penetration is the inner foreskin stretching backwards, and there are nerves there that detect [stretching], so there's a very exquisite sort of sensation of the skin rolling back—which is really most of the experience of penetration for an intact guy: That experience of the inner foreskin moving. A cut guy [can't] have that experience.

One thing I talk about in my show—and bring to women's attention in particular—is that the texture of the shaft of the intact penis is significantly different from [that of] the circumcised penis, in that a circumcised penis is often very tight, [while] in the case of the intact guy, it's wrinkly and soft.

I tell people about the ribbed condom and how [it] is a [partial] simulation of a foreskin. When a circumcised man wears a ribbed condom, he's wearing essentially an artificial foreskin, because for millions and millions of years before anybody started chopping off the foreskin, the vagina [had] evolved to be stimulated by the foreskin and the slack skin of the shaft [of a complete penis].

So, I tell people to pay attention to these things, and once they pay attention to them, it's the same thing as when I can take apart the components of my sexual experience: A woman [can] become [increasingly] aware of the component parts of her experience—the different ways that a penis stimulates the vagina; there are different sensations.

Eliyahu Ungar‑Sargon

You know, we hear a lot about how the foreskin has this sort of natural back‑and‑forth motion during intercourse that obviates the need for artificial lubrication. Is that true? Do intact men use lube? Do they use it less than cut men? What's your experience with this?

Glen Callender

Well, in terms of masturbation, I certainly do use lubricant when I feel [the need]—there are different things you can do with extra lubrication.

[However], it's certainly not necessary; intact men in general have no difficulty masturbating without lubricant because [of] the sheath of skin—I mean, the penis is supposed to be a self‑stimulating organ, and the moving sheath of skin and the various stretchable organs in the foreskin don't require outside lubrication at all to function perfectly.

So, I [hadn't used] lubrication ever until probably my early 20s [when I first] tried it; it was recommended to me by another intact guy [who suggested interesting things could be done with it and that] "It's a whole other thing"—and I did [try it] and thought "Oh! It is!" It's a different experience.

Now adays, [I enjoy] both; I routinely use lubricant, and I routinely don't use lubricant—it's entirely based on [the kind of] orgasm [for which] I'm looking. Now when I spend a little time with myself, I have a menu of orgasms [from which] I can choose, and [for] some of them I use lubricant and [for] others I don't.

Eliyahu Ungar‑Sargon

What about with a partner? Is [lubricant] something that you find yourself using?

Glen Callender

In my life, I've only had one female partner who required additional lubrication for unprotected sex, and she did certainly have medically deficient lubrication of her own body.

[Other than her], I've never had any problem with [not using lubricant during intercourse]. In fact, I've certainly had cases where I [am] with [a woman], [we] have [been doing] the foreplay and I want to get into it—you know, penetrate—and she say[s]:

Well, you know, I don't think I'm ready!

and I say:

Don't worry about it!

and [then proceed to insert myself] and she [goes]:

Oooh!

[because she's realizing how easily my intact penis is able to enter her due to the gliding action of the foreskin.] This is one of the problems with circumcised sex: It requires more foreplay; you've got to get the vagina really lubricated in order to stick a dry penis in there.

[This is not really a problem with] an intact guy. Penetration is easier if you actually push the foreskin over the [head of the] penis (not pull it back) before you penetrate, because the foreskin leading the way allows you to pump inside: If there's any [dryness], [it is] the foreskin [that comes into] contact [with it], and then the moist and slippery head of the penis can travel [back and forth] inside without any issues; [the foreskin acts as a buffer between the sliding shaft and the vaginal walls, which avoids irritating friction—the vagina is mainly stimulated by pressure, not friction.]

So, [the foreskin] really aids in penetration; the bottom line is that certainly the [gliding, rolling action] of the foreskin contributes a great deal to sex. I've certainly been with many women for whom I was the first or one of the first intact men [with whom] they [had sex], and they certainly noticed the [benefit].

Eliyahu Ungar‑Sargon

Is that also the case with homosexual encounters?

Glen Callender

Well, I would say queer men are already ahead on the issue of circumcision by virtue of the fact that queer men do interact with penises other than their own; they do find out pretty quickly that the guy with a foreskin has more fun, so they're conscious of that.

[As far as penetration is concerned], [the foreskin] certainly [provides the same benefits] for anal intercourse, as well—especially because the anus doesn't self‑lubricate in the same way that a vagina does. [Yes, the foreskin] certainly makes a significant contribution there, as well, [regarding] the ease of penetration—and stimulation [too]: The anal ring [is] stimulated by the wrinkles on the intact shaft just like a vagina is.

Eliyahu Ungar‑Sargon

Now, you've had experience with men who were circumcised. So, in a way, you're in this very unique position of understanding also what it takes to stimulate a circumcised man versus what it takes to stimulate an intact man.

A few weeks ago, I had a conversation with Aubrey Taylor, who was talking about this from the heterosexual female perspective. What has your experience been, and has this contributed to your understanding of the effects of circumcision?

Glen Callender

Well, at least in terms of oral sex—fellatio—a straight female's perspective and mine [are] going to be very similar. Obviously, you know [immediately] that on a circumcised male, you do [have to] work harder, and he feels significantly less in terms of a hand job, for example.

Again, you can easily get an intact guy off without lubrication. Of course, during fellatio, there's usually a certain amount of hand activity (you know, moving around the shaft), so the immobility of the skin of a circumcised penis is a real drag compared to [the gliding, rolling action] you have with an intact penis.

You can do so much more with [the foreskin] just by yourself—without recourse to lubrication or even your mouth. Just by moving the foreskin back and forth on the penis of an intact guy, you're [already] giving him a lot of pleasure right there; you're simply facilitating the penis's self‑stimulating function, and you provide essentially the stimulation of having your mouth on the penis without having your mouth on the penis [because] of the enclosure of the foreskin—it's warm, it's moist, it's slippery, and it stimulates the [pressure‑sensitive] head.

You just don't have that in the case of a circumcised guy. You [could] lubricate your hand and [then] massage the head of the circumcised penis with the palm of your hand (of course, you can do that with an intact guy, as well), but you certainly notice with an intact guy that he [feels] much more [subtle stimulation]; you can do much more gentle things with an intact male, and you immediately see that he is affected by that—he enjoys it.

So, yeah, there's a lot less that you can do with a circumcised penis. Yeah, you do work harder—you're more likely to get a jaw cramp going down on a circumcised guy than an intact guy. [Sexual interaction with a circumcised man] tends to be more violent, and I find it interesting that one of the [justifications] that people give for circumcision is:

[Sex with a circumcised man] lasts longer.

Well, that's not necessarily a good thing!—not if your vagina is sore because you finished and he still hasn't had his fun yet, and certainly not for oral, [which] is [definitely] not necessarily better [when it lasts] longer. You want [sexual interaction] to be good [and] enjoyable, [not just some extended] mechanical, [violent] process—working and working and working just to get him off!

A lot of circumcised men say to me that they don't feel a lot until they orgasm; they don't really enjoy the [journey] so much. I've certainly had the experience where I [had to be] concerned more with keeping [my circumcised partner] hard and getting him off [rather] than so many of the other things that you can do with an intact penis.

If the [man has a] foreskin [that] is long enough to cover the head of the penis when erect, there's a whole [bunch] of really fun stuff you can do with the [overhanging portion of] the foreskin, [playing] with your fingers, with your lips, with your tongue—and it's exquisite! It feels fantastic! I love it when it's done to me, and it's impossible to do that for a circumcised guy.

Eliyahu Ungar‑Sargon

This brings us to the catch‑22 about sharing this information with the world, and it also comes back to some of the things we were talking about at the beginning, where psychological expectations play such an important role in your experience of sex. I think a lot of circumcised guys are going to hear this conversation and they're going to be—first of all, they're going to be pissed off about what they don't have—

Glen Callender

They should be!

Eliyahu Ungar‑Sargon

That might have a negative impact then on the way they experience their sex lives. So, what advice could you give to a circumcised man who is listening to this, feeling immensely jealous and starting to get maybe a little angry about what [was taken from him], and maybe despairing even of the future?

Glen Callender

This is the thing: For a man, your psychological expectations or your confidence could well have more impact on your sex performance than whether or not you're circumcised.

I can easily [believe] that a man who [was] circumcised and [who] has a superiority complex ([who] believes that he's better as a result of [having been circumcised]) could actually perform better and have better sex and enjoy himself more than a man who has a foreskin ([who has] got everything) but [who] is ashamed of his foreskin—he has an inferiority complex—because he's been shamed or bullied or taught that he should be unhappy with his foreskin or that his penis is less pleasing to women because of the fact that he has a foreskin, [etc.].

[In this sense], it's really ultimately the [man's] confidence that [determines] whether he gets an erection and enjoys himself sexually, rather than whether he has foreskin. [After all], it's true that most circumcised men do have satisfying sex lives; [I mean], they've lost out on an enormous amount of [pleasurable] experience, but most of them are satisfied. So the question is:

Will learning about the fact that they lost most of the nerves of their penises—lost out on these various [experiences]—actually cause them to lose confidence? to become unhappy with their sex?

I can certainly say I know men for whom this has been the case, [and] I would say [that an] important [safeguard against that outcome] is not to ruminate excessively about it, because ruminating about the fact that you [were] circumcised and that [it] sucks won't just ruin your sex life; it can ruin your entire life if you do it too much. [it's] not constructive to ruminate continuously about it.

The reality is that everybody has [his own] bag of hammers—bad things have happened to all of us in various ways, and yeah, if you [were] circumcised, yeah, your penis was irreparably damaged when you were a kid and you have limited options as to what you can do, but the truth of the matter is: You can still be OK!

You can have a good sex life and enjoy yourself—[I mean], my penis has taken some damage! I'm intact, but mine's taken a little damage over the years! That's life. It's just something you shouldn't dwell on too much; it's better to get a little angry about it and [then] focus that on something constructive like working towards making sure this doesn't happen to anybody else.

[Nevertheless], circumcision is an extremely bad thing; it does a lot of damage to the penis—that is a bad thing, and it's ridiculous that it's happening today in the time of modern medicine, and [men who were circumcised] should be pissed off about it! They should do something about it.

If you give circumcised men a false assurance that [having been circumcised] is great, [then] that [only] leads to more kids being cut, and that is unacceptable—we can't have that! This BS idea that it doesn't make a difference [whether] you have a foreskin or not is extraordinarily harmful.

I would like to think that men can handle [facing these facts]—especially [men] as [a group]—as this issue becomes [increasingly] mainstream, [and] as people realize [the seriousness of this issue]. [Of course], I don't have the answers to this because [I wasn't] circumcised. I think circumcised men are the ones who are really going to determine for themselves what the optimal way to address the issue is in a way that isn't harmful to their sexual enjoyment or their sexual confidence, but at the same time leads them to contribute in a meaningful way to changing our social attitude towards this [issue].

Eliyahu Ungar‑Sargon

What do you think about foreskin restoration—

Glen Callender

I find as soon as circumcised men realize that they're missing something [valuable], they immediately wonder about what they can do to get it back, and [foreskin restoration] is a very healthy thing to consider.

Eliyahu Ungar‑Sargon

Great!

Glen Callender, thank you so much for joining us on The Cut Podcast. Where can people learn more about your work?

Glen Callender

Well, you can go to the Canadian Foreskin Awareness Project's website:

can-fap.net [or canfap.net]

The site is pretty bare‑bones right now, but in early 2012, it's going to be blossoming with some pretty interesting [content]. So, do keep an eye on it. Check the events page; the Foreskin Awareness Booth may be coming to a city near you!

Eliyahu Ungar‑Sargon

That's our show; if you have any questions, comments, or suggestions, please email them to us at:

cutdocumentary AT gmail (.) com

If you like what you heard today, please support us by buying our film at:

www.cutthefilm.com

[19] The Cut Podcast: The Psychological Consequences of Circumcision

2011-11-22T04:50:00.001Z

Eliyahu Ungar-Sargon conversed with Dr. Ronald Goldman, a psychologist and published Intactivist, about the psychological consequences surrounding the practice of circumcision. Here is the recording.

Transcript
(slightly modified)

Eliyahu Ungar-Sargon

From the White Letter Productions studios in Los Angeles, California, I'm [Eliyahu] Ungar-Sargon, and this is The Cut Podcast.

Welcome to another special edition of The Cut Podcast; I'm very happy to be sitting here with Ronald Goldman, and we're going to be having a conversation today about some of the psychological aspects of infant male circumcision.

This is a field [into which] I've been a little wary to wade; I think when I talk to people who don't necessarily agree with my position on this subject, I find it much easier to talk about things like Meissner's corpuscles—the hard scientific stuff [to which] I can just sort of point, [and for which] we have hard data; my impressions—and I would love to get your reaction and your opinion about this—is that when it comes to the psychological data, just by virtue of where we are in our understanding of the human brain and the human mind, it's a little trickier to get hard data on these questions. Is that right? or is this a misperception [that I have]?

Ronald Goldman

Well, I agree with you; part of the problem is there's a resistance to doing these kinds of studies. Most of the researchers who do the studies on circumcision are looking for benefits, not potential harm. They happen to be medical doctors for the most part, so they're starting with what they're familiar with, which is the physical body. Studying behavior is a lot more complicated. You can't so much put it in a box and put it under a microscope [to examine] it that way. So, human behavior requires a different kind of research, and we haven't had the will to do that for the most part.

Eliyahu Ungar-Sargon

If you could talk a little bit about your professional qualifications [and] your academic background. Where are you are coming from on this issue?

Ronald Goldman

I have a Ph.D in psychology. I've written 2 books on circumcision:

These books have been very well received by professionals in the field. The first book is endorsed by dozens of professionals in mental health medicine and social science. The second book is endorsed by 5 rabbis, among others.

Eliyahu Ungar-Sargon

Let's kick off our conversation by having you share with our audience how it is that you came to this subject in the first place; this is a taboo subject to a large extent, [so] I'm always interested in learning how people first came to thinking about this critically. So, what [is] your story?

Ronald Goldman

In the 1980s, I attended a [relative's] ritual Jewish circumcision in a home. I was reluctant to go. I felt uncomfortable with this kind of procedure. When I was there, I felt extremely uncomfortable during the circumcision; the infant cried I would think at the top of his lungs for over 20 minutes; I felt distressed. I wanted to get away. I noticed other people feeling very uncomfortable. The parents were crying—

Eliyahu Ungar-Sargon

Was this the first bris you had ever attended, or was there something about this particular bris that made it memorable or traumatic or difficult for you?

Ronald Goldman

It was the first, and it was the last. I vowed to myself [that] I will never attend one of these [again], because I felt like a silent accomplice to this circumcision, and I didn't like that feeling, and I don't want to be part of this—and as I learned more about [circumcision], my feeling of wanting to raise awareness about circumcision became stronger, and I will never attend another bris.

Eliyahu Ungar-Sargon

I'd like to come back to the Jewish side of your activism a little later, but first I want to deal with what I see as the fundamental core issues related to the psychological [impact] of circumcision.

Is there any evidence that infant circumcision has psychological effects on the person being circumcised, and if so, what are these effects, and where does this data come from?

Ronald Goldman

There [are 2] answers:

The [immediate] effects on the infant.
The long-term effects on the adult [whom the infant becomes].

There have been studies on behavioral changes in infants; we can't ask infants "What are you feeling now?", but they're pretty good at expressing themselves or withdrawing, as the case may be. So, there have been studies that show [behavioral] changes for infants who have been circumcised as compared to infants who have not been circumcised.

The medical journals [frequently] use the term irritability; I think that's a [euphemism] for "Hey, they're upset!"—a little more than "irritable" [as we might] use the term in descriptions of adult behavior.

There's also anecdotal evidence. I've talked to many mothers of circumcised infants [who] report, for example, [that] their infants were calm and content before the circumcision, [yet] after the circumcision, they would cry for hours every day for months. [On the other hand], sometimes the infants become quieter and withdrawn after the circumcision [for a significant period of time]. My interpretation of that: It took them that much time to work out the trauma of the cirucmcision experience. Again that's the response of some infants, but not necessarily all infants.

There's also information based on studies that showed changes in mother–infant interaction after circumcision: The observed changes include less eye contact from the infant with the mother, and also difficulty in feeding. So, again, this is something that has been observed [by] comparing infants who [were] circumcised and infants who [were] not circumcised.

[These things] affect the bond between the mother and child

I will also say that in talking with mothers of circumcised boys, some mothers are very distressed either from having witnessed the circumcision or learning [more] about it later, or just dealing with the infant's behavior after circumcision. This is something that's very much overlooked. I'm not aware of any studies on this, but I hear about this a lot from individual mothers: [Mothers] can become very distressed about having to deal with a baby [who is] crying hours at a time every day. Their own emotional state can be affected; they can have doubts about [whether] they are [being good mothers]. This [infant] behavior is labeled "colic" by some pediatricians, and that diagnosis [entails] a lot of misunderstanding and a lack of [knowledge on] how to treat it; [pediatricians are] really guessing at what causes this kind of behavior.

There was a significant study that showed changes in pain response of infants [up to at least six months after circumcision] when they were [being] vaccinated; [the researchers] found that the circumcised infants had a stronger response to pain during vaccination than the infants who [had not been] circumcised, and the investigators concluded that this [is] a sign of lasting neurological effects. They also believe that this was a symptom of early trauma—post-traumatic stress disorder (changes in behavior 6 months after the event).

Eliyahu Ungar-Sargon

Can you talk a little bit more about this idea of the pain response, because I see this in the literature, and I'm not entirely certain—and I don't know that our audience is clear on what [it means]. What does it mean that there's an increased pain response, and what are the consequences of that?

Ronald Goldman

The pain response to the vaccination refers to the [behavioral] response of the infants when they are vaccinated; circumcised infants cried longer and louder. So, from the same stimulus, they found a significant difference in the 2 groups:

Circumcised
Not circumcised

They actually measured the cry and how long they cried, and they found that the difference between the 2 groups [suggests] a relationship with the circumcision status—

Eliyahu Ungar-Sargon

How does that work? What mechanism is at play here—

Ronald Goldman

What the investigators were concluding is [that] the original trauma—the circumcision—changed the neurological [response] of the infant; in other words, it changed the way pain gets transmitted and [processed]. As a result, [less signficant] trauma [becomes] overwhelming.

The way we deal with [trauma] is sometimes [behavioral] (withdrawal, for example) and [sometimes] physical (neurologically speaking); so, [in circumcised boys] that physical change became perminent—at least lasted 6 months. Because of the change in the neurological structure in the infants [who were] circumcised, they were more sensitive to pain later on.

Eliyahu Ungar-Sargon

We touched on this a little bit, but [let's] go a little more in depth into the psychological effects of this practice on the parents, and is there variability [among parets] at all?

Ronald Goldman

Well, there is variability; some parents simply want to believe that they did the right thing, and that's a defense against feeling the discomfort and emotional pain of recognizing that maybe they made a mistake in judgment here ([a judgment] based on either not enough information or misinformation). So, [there is] the denial aspect:

It's OK.
We did what was best.
There are potential health benefits.

The other side of the response is regret. Sometimes, if [circumcision of an infant] is a ritual that's observed, then the parents are actually seeing what's being done to the infant and how the infant responds; observing the infant's response can be very distressing, particularly for the mother. I've talked to mothers who wanted to stop it, [but] were just frozen—couldn't respond—either by saying something or doing something; they were just frozen and in some sort of shock from witnessing what was happening to their [babies].

Eliyahu Ungar-Sargon

[Let's] talk a little bit about the people who perform circumcisions, and the ways in which they allow themselves to do this.

One of the things that I've noticed—and you see in my film actually, very clearly: Dr. Phyllis Marx (who's the mohelette) talks about circumcision at the beginning:

You know, it's not the circumcision that causes the baby pain; it's the mucking. Anything I can do to reduce the mucking helps.

and then, of course, at the end of the film, you see she's doing the circumcision and the baby is completely calm until she starts [cutting], and then the baby is screaming. What occurs to me is that—and I think Dr. Paul Fleiss has talked about this a little bit—[it] is remarkable that the people performing the circumcisions may literally not hear the baby's crying.

Can you address this? How does that happen? What [psychological] mechanisms are at play here?

Ronald Goldman

I've heard that also, and that's part of the defense mechanisms of practitioners—to protect [themselves] against the conflicting feelings and the recognition that they are causing harm. So, some of these feelings are so strong that they require equivalent strength in the defense mechanism to protect the [practitioner] from having these strong feelings.

So, for example, denial can prevent an individual from hearing what everyone else might hear, seeing whatever everyone else might see, and recognizing what might be obvious—particularly to parents—that this infant is in severe distress, and sometimes even the language [practitioners] use [is very telling]: In the [medical] literature, they are very unlikely to describe the infant's response to the stress of circumcision as "trauma". So, the language tends to minimize the effect of this practice on the infant [and thus on the practitioner].

I've spoken to doctors who [have told] me about when they were in medical school and they [did] their first circumcision[s], and there is a lot of pressure on them to comply with this training and do what they're being told to do. So, [while] they may have an instinct not to do a circumcision, they're required to do this (for the most part), [and] they have to protect themselves psychologically so [that] they can follow through with what's being asked of them. That protection gets to be sort of habitual in the way they recognize what they're doing and what's happening as a result of that.

The other thing is they want to [perform] the best circumcision they can—this is a very delicate procedure, of course—so, their attention is focused on doing the procedure; their attention is ignoring what the baby is experiencing; with that focused attention, they're less likely to recognize what's going on.

I spoke to one doctor who did not recognize the infant's response, and then he watched someone else do a circumcision, and he was horrified at what he was seeing with the infant's vocal [and] behavioral response[s]—obviously in agony—and he decided he would not do anymore circumcisions and he would not have his own son circumcised. So, these are very powerful psychological mechanisms that protect people from recognizing what's going on.

Eliyahu Ungar-Sargon

I think also one of the things that I've seen—and I often say that this is one of the most bizarre points of this sordid tale, to me—is this belief that took root in the medical community—and I think [that] to a large extent, some doctors [still] honestly believe this—that babies don't feel pain. This myth—that anyone in posession of sense could very easily disprove by just observing a baby being circumcised—is actually deeply believed.

Then, the sort of corrollary to this is that if you give [these babies] a little sugar‑infused water, somehow that would have some kind of anesthetic effect.

These beliefs seem to be to me without any foundation in either just direct experience or—even at this point—in the scientific literature.

Ronald Goldman

That's less common now than it used to be, but it's still out there. That's another indicator of a defense mechanism to prevent individuals from recognizing what's really happening. So, what happens with [this psychological] defense is that people will adopt beliefs to support their defensive belief that [they're not causing harm].

This [was] addressed directly back in 1987 when some parents were discovering that major surgery was being done on their young infants without pain medication, and they complained to the medical profession about this, and as a result of a series of complaints about this, a couple of investigators decided to go through the literature on newborn infant pain and write a review article that got published in the New England journal of Medicine, in which they concluded quite clearly that newborn infants not only feel pain at least as much as adults, but probably more so—[there is] lots of data and research to back up that conclusion.

[However], that's a huge shift in what was common belief and practice for decades preceding. So, some doctors who have been doing circumcisions for decades had a difficult time accepting [it]. Again, denial comes in: They would not believe that result, or have a little difficulty in adapting their own belief to [it]. For a long time, circumcisions continued to be done without pain medication. Then, back in the 1990s, there was more research [into] the best form of pain medication to give an infant [during circumcision], and one of the options they were testing was [indeed] sugar water, passifiers—sure, if you put a passifier in a baby's mouth, it's a lot more difficult [for that baby] to cry!

Some of the researchers have a bias going into their research; they're looking for a particular result. This is a great problem on this topic. What they concluded in a lot of this research was that injecting pain medication into 2 spots on the penile shaft was the most effective way of reducing the pain experienced by the infant, but it did not eliminate the pain, and occasionally it was not effective at all, either because the way the practitioner did the injection or some other factor, so there is no guarantee that any pain medication today [would] eliminate the pain [experienced by] an infant during circumcision.

Eliyahu Ungar-Sargon

Of course, in addition to the pain of the actual procedure itself, once that anesthetic has worn off, there's pain for at least a week after—

Ronald Goldman

That's true. It takes at least that much time to heal, and anesthetic wears off after hours.

Eliyahu Ungar-Sargon

[Let's] move onto talking about some of the psychological mechanisms involved in preventing men from dealing with this issue. Let's actually talk about the long‑term effects [of circumcision]. Are there any consequences that extend beyond infancy or beyond childhood even? What evidence do we have of this?

Ronald Goldman

Well, again, there's little research on this. To do this kind of research requires a will and resources; we're in short supply of both in mainstream medicine and psychology.

There was just a study that was published in the International Journal of Men's Studies [in which] the investigators conducted a survey of 300 men who were self‑selected (something was posted on a couple of websites, inviting men to take [a questionnaire on their feelings]), and [researchers] found a significant difference between the circumcised group and the non‑circumcised group: The circumcised men had greater difficulty identifying their feelings and expressing their feelings.

This is consistent with what I wrote about in my book Circumcision: The Hidden Trauma, particularly in the chapter on post‑traumatic stress disorder and long‑term psychological effects; a common long‑term effect of trauma [in general] is [a] reduced [ability for] emotional expression; this is a way individuals can defend against the pain of the earlier trauma: They become less responsive emotionally; if they're more sensitive emotionally, then they're more likely to connect with feelings that go back to their early trauma, [which] is extremely painful.

So, it's a defense [mechaninism that is psychological and physical]. The tension of repressing these feelings [affects] the body and affects personality. In a way, with circumcision being so common here in the United States, some behavioral traits of men like having difficulty expressing feelings are assumed to be normal male behavior. Here, at least, we have a preliminary study that shows that there is some connection between a lack of emotional expression and having been circumcised.

[Feelings expressed by men] who are dissatisfied [with having been] circumcised, include:

Anger.
Shame.
Grief.
Distrust.

Those are some of the feelings that are very common among men who are dissatisfied [with having been] circumcised. How do they become dissatisfied when other men are not dissatisfied?—

Eliyahu Ungar-Sargon

Exactly—

Ronald Goldman

That's the significant question.

Well, it's based on individual experience:

I talk to [these upset] men, and they say [something like]:

Well, when I was 4 years old, I was playing with a friend of mine—a peer—and we were examining the genitals of each other, and I saw that he had this skin over his penis and I didn't, and I've been upset about that ever since—the rest of my life; later on, I asked about it and I found out that this was cut off of me, and I could never understand that!

So, when they're aware that they are missing something, they feel inadequate, and this can be part of [their feelings of] shame, and it can affect their self-esteem.
For another man, it might have been an incident when he was in the showers in junior high‑school, looking around and seeing boys who have foreskins—whose penises looked different [from] his—and very often, boys don't talk about this; it's uncomfortable for them. Maybe they don't want to hear what the answer is going to be. No one has ever talked to them about it, so they adapt to the silence that goes on around them in the culture: This is something that people don't talk about—"circumcision", "penises", etc. So, they're left with not understanding:
Why am I missing this piece of skin [from] the end of my penis?

So, there's a silent denial going on here.
Other men maybe don't have such experiences or ignore [them]—again, they have to come up with their own ideas and beliefs. If they see somebody with foreskin, they may [think]:

That kid's gotta strange looking penis! There must be something wrong with him! I'm the one's who is OK.

Then, if they see that [a large number of their peers] are circumcised, they think [the minority of] guys who aren't circumcised [are the ones] who have the problem.

Boys and young men come up with different beliefs to explain some kind of experience—either it helps to protect them from feeling discomfort, or triggers the discomfort that never goes away.

Eliyahu Ungar-Sargon

In our culture (which is largely a circumcising culture), I think a lot of people listening to this—and I encounter this on a regular basis—[we look] at someone who complains about [his] circumcision as if there is something wrong with [him]. Because it's such a pervasive practice, and because there are so few people who speak out about this, I think there's a sense that there's something psychologically wrong with the people who do speak out about it. So, could you address that perspective a little bit?

Ronald Goldman

That's true, and that's the way the majority defends its own belief that circumcision is OK. If somebody is going to threaten that belief, someone who has believed that deeply for decades is going to defend that belief, so that's where the conflict comes in.

It's going to be painful for somebody who believes in [the goodness of] circumcision to question [it]. If it's a man, then he may be questioning his own circumcision status, which is likely to be painful if he hasn't questioned it before, because for a man to recognize that he's missing part of his penis is very significant—it's a realization that can completely change his feeling about himself and his sexuality. What man wants that psychological disturbance? So, rather than have to deal with that, most men just deny and defend [circumcision].

There's also the factor of conformity here—being like what you see around you. People are much more comfortable conforming to their culture and what they observe to be normal. People are less comfortable questioning what they observe to be normal behavior and appearance. So, understandably, there's going to be some defenses here to protect the status quo, the cultural belief, the cultural bias that circumcision is OK.

Eliyahu Ungar-Sargon

I think, also, there's a spectrum of response among men when they're exposed to information about circumcision, [which] sort of goes all the way from complete denial [on one end] to apathy [in the middle] to feeling that they've been harmed [at the other end].

I don't know how one would answer this question, but what is it that [makes these differences]? Are there personality types that come into play here? [Are] certain personality types more prone to apathy, and [others] more prone to denial, and [yet others] more prone to feel the trauma that was [imposed] on them? How does that play out?

Also, [for] the people who do really feel harmed by [having been circumcised], what do you think characterizes them as group? Is there anything that sort of connects them as a group?

Ronald Goldman

I think what is going on here is individual differences—lots of psychological aspects. Some people are more open to feelings—[as in] the result of the study [to which] I referred [earlier]. Some people have difficulty with feelings, and some people are more open to them. So, if people are more strongly [defensive psychologically], [have] less emotional expression, [are] suffering from more or stronger symptoms of post‑traumatic stress disorder as a result of their circumcision[s], [then] they are more likely to be either apathetic or just to simply deny this information and say: "Well, look! We've got all these medical studies to say [circumcision] is wonderful!"

So, I agree [that] there is a spectrum depending on personal experience. If [a] person had an experience when he was a kid, for example, [then] that would affect a later experience: Either [that later experience] confirm[s] the feeling he had as a kid, or [it is] in conflict with what he assumed to be true (and he would still deny the evidence to the contrary of his existing belief).

You know, some younger men in their 20s and 30s who are circumcised will say:

If I felt any more pleasure [during sex], I couldn't stand it!

I've heard that—which reminds me that circumcision may be associated with a limited ability to feel—as we talked about before. Now, feeling is not just limited to bad feelings; [there are] also good feelings! So, if you have a limited capacity for feeling [in general], that could be associated with a limited ability for feeling sexual pleasure; if your capacity to feel sexual pleasure is limited—is less than it might otherwise be if you weren't circumcised—[then] when you reach that limit, you're feeling as much as you can stand, because the limit is lower. [However], if the limit were higher, and you had your foreskin, you could [possibly] feel more pleasure.

Eliyahu Ungar-Sargon

So, you mentioned the alexithymia study that recently came out. What other kinds of evidence do we have of the long‑term psychological consequences of circumcision? What kind of data exists? I understand that there's not much, but what is the data that does exist? [Also], I know that you have famously gone on record as suggesting that there may be severe social consequences to circumcision, so could you address that?

Ronald Goldman

Well, again, there are not a lot of data about psychological effects. All we can do is survey men—actually, there was a survey published in the British Journal of Urology in 1999 [in which over 500 men were interviewed by self‑report]—a [survey on harm], if you will. The results of that survey showed some of the feelings I referred to earlier: shame, grief, anger, distrust, sexual anxieties, low self-esteem, avoidance of intimacy, and (for some men) depression.

So, we don't know how these symptoms would show up if we had done, for example, a [randomly sampled] national study [rather than one that is self‑selected]; I seriously doubt that [such a survey] will ever [be performed], because of the [lack] of will and resources to do something like that (it would cost a lot of money). However, I would say [that what we have is still] significant: Here we have hundreds of men—understandably self‑selected—who are reporting some serious psychological difficulties that they connect with cirucmcision.

There's [also a kind of] clinical evidence: There are ways of psychotherapy being conducted that are outside the mainstream, [which] get into some very interesting approaches to [confronting] early experience [in life]; there are practitioners out there [who] can support their clients in actually re‑living early experience. This is controversial—no question about it—but again, this is a situation where the mainstream, conventional wisdom (so to speak) wants to believe that only certain things are possible psychologically and anything outside of [the current understanding] is viewed with great skepticism without any open‑mindedness [to finding out] what's going on here. For example, some of these clients have re‑lived birth, and then when the session is over, the client [says something like]:

Well, you know, the [umbilical] cord was strangling me.

Now, an adult walking around wouldn't remember that—most of us don't remember much before 4 or 5 [years of age]. So, then [the clinician] checks with the obstetrician's records, and there it is: The cord was wrapped around the baby's neck. There [are] many examples of that correlation between what's reported in the clinical session and [what's reported in the obstetrician's] report of a birth decades earlier. So, that's pretty strong evidence that this is reliable.

If you observe what goes on with a client re‑living birth—I mean, nobody can act that out; the cry sounds like a baby, the movements look like a baby's—obstetricians have observed these sessions [and agree to the bizarre realism].

So, if all of these people—and this is [a] world-wide [phenomenon]—[can actually] re‑live [their births], [then it should be possible for some people to re‑live their circumcisions]. So, it certainly supports the idea that circumcisions can be remembered, and how [such events are] remembered is in the body—not in the conscious mind; this becomes repressed memory.

There have been sessions [during which] clients re‑lived their circumcision[s]—and this isn't something [for which] they go into a session saying "Oh, I think I'll work on my circumcision today!" It happens spontaneously, because the body is ready to experience it; it's not going to happen in your first session; this is a body‑oriented psychotherapy; it's geared towards the questions:

What is the body saying?
What sounds are coming out of your mouth?
Are you breathing?
Are you moving?

and these kinds of sessions are very powerful and have resulted in significant changes for people after they have:

re‑lived these experiences.
expressed the repressed feelings that they've been carrying around for most of their lives.

It can be very effective for some people.

Eliyahu Ungar-Sargon

So, this comes from the Freudian idea that making the subconscious [become] conscious has a healing and salutary effect on the individual. Is that right?

Ronald Goldman

Well, it's connected, and at the same time, it's not a cognitive‑approach, it's a body‑approach. So, where Freudian therapy is very much a conversation with a therapist, this is not a conversation; it's an experienced person supporting a client in letting the body express itself, and again, that can be vocal—it usually is vocal—but it's also movement. Sometimes, for example, in re‑living the birth, the practitioner may set up with pillows (or some such thing) [a simulation of a] birth canal for the client to work himself or herself through as the client is re‑living the birth.

Eliyahu Ungar-Sargon

I'm trying to understand why someone would want to re‑live [his] circumcision!

Ronald Goldman

Well, why do you see any mental‑health practitioner? You're having some difficulties psychologically (or behaviorally) [with which] you want to get some help. [For some people], this would be the last thing they want to do if they're dealing with their psychological issues—

Eliyahu Ungar-Sargon

I guess I'm trying to understand the theory of how it helps. If I've gone through a trauma, in what way does re‑living the trauma help me overcome the effects of that trauma?

Ronald Goldman

Well, there's a physical change because the trauma is repressed with body‑tension holding back these feelings, so the way the body‑oriented therapy works is it weakens the defenses against the feelings that are held back, so when the feelings are released, you release the tension, [and] you in some sense can accept yourself more:

Hey! It's not an accident that I happen to be scared of whatever it is [of which] I'm scared; this is connected with something that happened to me when I was 2 years old, and now I've released that fear, so I'm not walking around with that fear anymore, and I'm more opened to my present experience, because I'm [no longer] being affected by my past [experience].

I mean, [the issue] is physically and emotionally resolved at the same time.

Eliyahu Ungar-Sargon

So, [it's] almost a catharsis—

Ronald Goldman

Yeah. Right.

Eliyahu Ungar-Sargon

That's very interesting.

So, not only are you a psychologist, Ronald, [but] you're also Jewish—

Ronald Goldman

That's correct!—

Eliyahu Ungar-Sargon

which puts you in very rare company in terms of people who are opposed to circumcision; I know there are some vocal Jews out there—myself included!—who are against this practice, but it's not the norm in our ethnic or religious community, and that poses a whole host of unique challenges.

So, how have you navigated those challenges, and do you see a contradiction between your views on circumcision and your cultural, religious, and ethnic heritage?

Ronald Goldman

Well, it depends on how I would define the contradiction; certainly, I'm advocating something that is in conflict with what the Torah says, but I don't accept everything the Torah says—[a stance that] is consistent with the great majority of Jews, by the way. Generally speaking, it's mainly the Orthodox community that accepts everything the Torah says as the literal word of God, so there is a distinction there.

So, I don't approach Jews who are [circumcising boys] strictly for religious reasons in terms of "God commanded this"—it's very clear to me that [such a position is based on] a belief [from faith rather than evidence]—those [who] have that belief don't view it as a belief; they think it's [an absolute truth]—it's Truth for them, and I accept that, [but] there are many Jews out there for which that is not their Truth. So, other things being equal, they are more likely to be open‑minded to hearing new information, for example.

The Circumcision Resource Center [website] has a section called the Jewish Circumcision Resource Center, which seeks to raise awareness among Jews about the practice of circumcision. As I said earlier, there are some rabbis who are questioning or opposed to circumcision, so it's not necessarily a function of how observant one is; one can be observant, and still question circumcision—not the norm by a long shot, but then again, in this country, a very high proportion of Jews are secular, and circumcision may be the only thing they do that is connected with their Jewish identity.

To me, [this] gets back to [the] trauma [aspect]: Another very important article in the psychological literature is about the compulsion to repeat trauma; what the investigator found was that when trauma is experienced—particularly in childhood—it increases the likelihood that when that child grows up to be an adult, he or she is more likely—not necessarily [guaranteed], but more likely—to inflict that same trauma on his or her children.

Eliyahu Ungar-Sargon

Hence, the very popular [reason for circumcision]: Wanting Junior to look like Dad.

Ronald Goldman

Yeah. Again, that's the belief that someone would use to defend or excuse [circumcision], but underlying that—beyond awareness—would be a compulsion to repeat the trauma that was done to the father.

There have been surveys on this in the medical literature: The father, if he's circumcised, is the one who more likely wants the circumcision of the son, so he's the one who wants to pass on the compulsion:

[My] trauma is now going to be my [son's trauma].

Again, we have to rationalize behaviors to make sense to us as adults; whereas the psychology is below awareness, what is in awareness is the cultural belief system: The cultural belief is [that circumcision] is "cleaner", "has medical benefits", "[the boy] won't get teased", "he'll look like his father", on and on and on... I mean, there's a website out there that's got hundreds of these beliefs and excuses that have been used over the decades to justify or defend circumcision in this country—some of them can be quite humorous, stretch[ing] the imagination.

But, hey, when adults make decisions, they have to believe something [to answer] "Why am I doing this?" If they don't know the underlying psychological motivation, they'll come up with a belief to defend it.

Eliyahu Ungar-Sargon

What are some of the unique psychological challenges that a Jew might face in resisting this central practice?

Ronald Goldman

Well, certainly, a lack of social support in the Jewish community. That can be difficult to deal with. By that, I mean: Say you're Jewish and you're expecting a baby boy, and you're talking about not having him circumcised; if you start talking to grandparents and cousins or [whomever], they are very likely to be dismayed that you would even be thinking that. So, making a decision not to circumcise is done for the reason that the parents sincerely believe it's best for the child.

People have different psychological influences [that guide] their behavior, and as I said before, conformity is a very strong influence for a lot of people—actually there's a study [in which] they had a person come into a room [where] there were [other people, and they were all supposed to describe what a certain illustration looks like]. This newcomer—the test subject—walks into the room, listens to these [other] people say [what they see] and clearly [what they say] is not what's there [in the illustration], so the test subject looks at what's there and three-quarters of the [time agrees] with what the other people reported that they saw even though it wasn't true. So, three-quarters of the people agreed with the majority [about a false description] of this illustration. I mean, there's scientific evidence that shows people will deny what they see in order to be accepted and to conform with what other people say and do. So, that's a lot of what's going on here.

Eliyahu Ungar-Sargon

I think [that] also on that same line—and this is obviously a much more radical sort of side—I've been thinking a lot about the Stanley Milgram experiments lately, because a lot of people who are against circumcision (and there are some people who [understand our position] immediately), they don't understand how it is that people could do this [sort of thing] to another human being. So, for that reason, I've been having a lot of those discussions with people who say:

How is it that this goes on?

[This is] especially [true of those individuals] from a culture that doesn't circumcise, and they come here and they learn this [fact about our culture]; we just had an experience last night with someone who's from another country and was completely unaware that this [is] the norm here [in the United States], and [for them], [the idea of widespread circumcision] sort of strains credulity [and] boggles the mind. I've been sort of referring people to the Stanley Milgram experiments to understand that given the right environment [and] conditions, [seemingly regular] human beings are capable of horrible—horrible—things.

Do you think that [this] applies? Do you think it's too extreme to bring those experiments up?

Ronald Goldman

Sure [it's applicable].

For those who aren't familiar, it's an experiment about following the direction of an authority [who is telling you to do something hurtful to someone else]. The experiment involves subjects being told to inflict [an increasing] degree of pain on [someone else], and so they're finding out who agrees with the direction of the [authorities] and who decides not to follow the instruction [to press] a button [that supposedly shocks the other participant, causing that fake participant] to scream in pain.

[Interestingly], most of the [subjects] complied with the instruction to inflict the pain [again and again to extreme levels]. To me, it gets back to how we perceive authority in this culture: Most of us accept what authority has to say without question—and the key thing here is [the] "without question" [aspect]. Independent thinking is not a strong component of our culture; [most of us] don't raise children to be independent thinkers. [Children] are pretty much raised to be like and to think like everybody else, and it's the minority of people [who] question cultural beliefs and practices.

In the Jewish community, for example, we have [90% or more] circumcising; it's very difficult to put yourself at odds with that [kind of majority]—

Eliyahu Ungar-Sargon

and yet, this is largely [how I'm basing my position against circumcision] firmly in the Jewish tradition: It's a very strong Jewish value to question and to challenge authority, and so for me, that's the Jewish value that trumps circumcision, and I think it's an authentic Jewish move to question circumcision for that reason.

Ronald Goldman

Yeah. It's not unusual for a culture or a group to have conflicting values—and then [people] pick the value that fits the situation at the time! That's what being human is; it's very common behavior—whatever fits the situation.

So, it's the minority that will point out [flaws], and as the size of the minority increases, that helps the folks who are dependent on conformity to see that [a minority view is worth consideration]:

Well, [this minority view is not held by] just this one person. I'm seeing this all over the Internet now—I'm seeing it in videos, and in articles, and on the front pages.

People get a little more comfortable with the idea of questioning circumcision the more they see [others out there questioning circumcision]. So, that's why we're continuing to put it out there in different ways, trying to reach different audiences—just [trying to plant] the seeds all around, so [that] the next time they see it, it won't be the first time.

Eliyahu Ungar-Sargon

Ron Goldman, thank you so much. This has been a wonderful conversation.

Where can people learn more about your work?

Ronald Goldman

Visit our Circumcision Resource Center website at circumcision.org and the companion website for the Jewish community is jewishcircumcision.org.

Thank you very much!

Eliyahu Ungar-Sargon

That's our show; if you have any questions, comments, or suggestions, please email them to us at:

cutdocumentary AT gmail (.) com

If you like what you heard today, please support us by buying our film at:

www.cutthefilm.com

Dr. John Warren: Awakening to the Damage of Circumcision and the Value of Foreskin

2011-11-14T18:41:00.001Z

Dr. John Warren (MB, BChir, DCH, FRCP), founder of NORM-UK, discusses his personal discoveries regarding:

The harm of Circumcision
Foreskin "restoration"
The movement to protect the genital integrity of all children.

Transcript
(slightly modified)

There were 3 stages in my becoming an intactivist, starting from the age of 4 [years].

I'm the youngest of 3 children; I have an older brother and an older sister. My dad was a doctor (I never knew him, because he was killed in the Second World War [(WWII)]). When I was about 4 or 5 [years old] and having a bath—mother bathing me and my brother—I noticed that his penis was different from mine, and obviously—as you do—I thought there was something wrong with his penis, so I asked my mother why it was like that. She explained to me that I had had an operation [wherein] a piece of skin [had been] removed from my penis because it was "a bit tight", and that [my brother] hadn't had this done [to him]. Then she added:

Your father didn't approve of it.

Even though I was a very young child at the time, I've always remembered that ever since; it's always been in the back of my mind—that it was something which I suppose I sensed was controversial even then. I didn't think much more about it—quite a lot of the boys [back then] were circumcised (I think it was about 50%).

I took up medicine like all the other people in my family. One of my teachers in Cambridge was a man called Douglas Gairdner who had written a paper published in 1949 (many years before I met him) called:

Fate of the foreskin: A study of circumcision

which was very influential on the history of circumcision in at least Britain—perhaps also [in] some other English-speaking countries, [namely New Zealand and Australia]. [I think that] as a result of his studies, [routine] circumcision was not taken up by the National Health Service in Britain when it was set up.

I went on to be a junior doctor, and I did some surgery. I wasn't destined to become a surgeon, but in the training system, you had to do 6 months of surgical training [in] whatever branch of medicine you were going [to practice]. So, one day, I was in an operating theater as the most junior person there with all of these more senior people to meet, and they [wheeled] in a child —[perhaps a 5-to-7 year old boy]—anesthetized, and they [said]:

Oh, this boy is going to have a circumcision.

and they tell me I am [the one who is going] to do it. So, I carried out the circumcision, being told what to do by the senior surgeons there:

You cut here.
Put a stitch in.
Do this.
Do that.

and this was the first time [that I had really] seen a foreskin; [we] completely unraveled it to see how big it was, how much tissue there was, etc.

This was, I think, my next epiphany or awakening after the moment in the bath. Seeing [that the foreskin in this case] was perfectly normal healthy tissue—I could see that! (it wasn't diseased in any way)—I thought we shouldn't really be doing this. I didn't say anything to my senior colleagues, obviously; you didn't argue with them—not in those days!

I thought very hard about what I was doing; I didn't like it—I was thinking all the time:

Somebody did this to me!

I think I had a few sleepless nights after that; I had seen lots of other operations and all the common things ([appendectomies, herniotomies], and all this), and they hadn't bothered me, but this circumcision really upset me. We were doing this [destructive act] to this normal looking boy's penis. It struck me that it was a bit like taking a little rose bud that hasn't opened [yet] and peeling off all [of its] petals and so on—just spoiling it; that I never forgot, and I never did another circumcision.

Then, the next job I did after the [surgery rotation] was in pediatrics. That was in 1968, and I was studying for a pediatric exam. So, I was reading all the literature as it appeared in the library, going through back copies of the pediatric journals. In the summer of 1968, in the latest copy of:

Archives of Diseases of Childhood

appeared a paper by a Danish doctor named Jakob Øster:

Further Fate of the Foreskin: Incidence of Preputial Adhesions, Phimosis, and Smegma among Danish Schoolboys

It was a continuation of the study which had been done by Gairdner, who [had] only studied what happens with the development of the foreskin up to about the age of 4 years; this Danish doctor pursued the fate of the foreskin—how it develops—right through to age 18 [years] (virtually to adult life).

Whereas Gairdner's paper had shown that at the age of [around 4 years old], about 10% of foreskins could still not be retracted, Øster continued to observe these Danish boys beyond that [age] and did not intervene [with the inability to retract]—they weren't circumcised—and [he] showed, as far as I recall, that [only] about 1% [of the boys] were still not able to retract [their foreskins] by the age of 17 or 18 [years]; in other words, of the 10% that Gairdner perhaps thought were abnormal, the vast majority of them actually did continue to develop [normally]. [NOTE: In 1999, Shankar and Rickwood published the following 2-year study:

The incidence of phimosis in boys

which found that:

The incidence of pathological phimosis in boys was

0.4 cases/1000 boys per year, or 0.6% of boys affected by their 15th birthday,

a value lower than previous estimates and exceeded more than 8-fold by the proportion of English boys currently circumcised for 'phimosis'.]

I read [Øster's] paper in 1968 and thought:

Well, that's a very important finding!

[Now people will see that] it [isn't] necessary to do all these circumcisions like the one I had [to do] a few months earlier. You don't need to do that [to] boys this age! If you just leave them alone, they'll come around. Circumcision will obviously disappear now after this [finding]. It's not necessary.

I was getting middle-aged, and I became aware that I really had very little feeling in my own penis—that it was very insensitive, [and] that during sex, I didn't really know what was happening down there; [I] couldn't feel much at all, and I thought:

This can't be right! The [head] of the penis, which is [commonly thought of as being so sexually sensitive] really has no sensation.

Why is this? Nature [couldn't] have intended that!

Then, of course, I thought back:

Oh yes, well... circumcision. That's the reason—it must be; it can be the only explanation that I have no feeling in the glans [or "head"] of the penis, because it's so insensitive.

Other parts of the penis were a bit more sensitive, but the front end really had no feeling in it at all [NOTE: See the above link]. I got quite upset about this, and [wondered]:

Does anyone know this? Are people aware of this?

I started to look in the medical literature. [At that point in time], it was very difficult to find much being published about the [purpose of the] foreskin, about feeling in it, or anything like this. It was just around that time (1993) [that] I opened my ordinary daily newspaper one day [to discover] a review by the medical correspondent:

They took my foreskin, and I want it back

Some men feel their circumcision at birth was an assault. Now they can be 'uncircumcised' without surgery, writes Cherrill Hicks.

[The article was] about a book which was being published in California:

The Joy of Uncircumcising: Restore Your Birthright and Maximize Sexual Pleasure

By Jim Bigelow, Ph.D.
Forward by James L. Snyder, M.D.

[The book is] about "foreskin restoration", and [the article says] there [are] many in California who [were] circumcised and [aren't] happy with this result, and I think [the article] probably [talks] about sensation and that [men are] stretching their skin to get it to cover the glans again.

I thought this was of great interest. [I acquired the book]. I didn't know quite what to expect—I thought [that] maybe this is some [crackpot] thing ("This will be nonsense!"), but when I opened the book, I immediately saw that [it is] a scholarly work, properly researched [and] referenced, written by a man who had obviously thought very deeply about this [issue].

[The book] really echoed my own feelings, which I had thought privately for some time—that the foreskin [is] an important organ, that it [produces useful] sensation, [and] it [is] there for a purpose.

I am a great [proponent of the theory of] evolution; in my study of the human body, [I discovered that] there's always a reason for a structure being present—it has a function. Sometimes, scientists are not always [certain about] the reason, but I'm sure there is a reason [for whatever structure might be in question]—[the process of] evolution doesn't [allow for keeping around many] stupid mistakes.

Obviously, the foreskin is there for a reason, and if it isn't in the medical textbooks, [that's] just because it hasn't been discovered, or investigated, or reported, but surely it has a function. I [had] been thinking this for a long time:

Obviously, its function [has] to do with sensation as much as anything [else].

Then, when I read this book by Bigelow, it echoed my thoughts—it expanded them; there was a lot more [information] there [about which] I hadn't thought, [such as the revelation of] the rolling action of the extra [tissue provided by the foreskin]—when I say 'extra' [tissue], I mean 'normal' [tissue] on the penis (of course, I had never experienced [this]).

So, [reading this book] was [my] third and final awakening.

I was so intrigued by this book that I contacted Mr. Bigelow and had lengthy trans-Atlantic telphone calls [with him]. [Eventually], I said:

Well, you know, I think I need to come over to California and meet you, because there's nobody in Britain who is aware of what you're doing.

A few months later I did [go] over to San Francisco—it was the first time I had been to the United States. I met Jim Bigelow and a number of other people involved in [the Intactivist Movement] and the Foreskin Restoration Movement. I became aware of the important work which was going on [in San Francisco] with regard to preventing circumcision and helping men who had been circumcised. When I left, I said:

Look, if you get other British men contacting you about this subject, by all means, put them in touch with me; I'm a doctor, [and] I'm quite happy to take calls about this sort of thing.

So, gradually over the next few months, I started getting letters and telephone calls from men—not very often, but they were coming through—and I would have these men saying:

I've never talked to anybody about this before. I was circumcised when I was a child, and this is how it has affected me...

They had never talked to anyone before, and yet all their stories to a large extent overlapped—they were consistent with one another; there was obviously what we might call in medical terms a sort of post-circumcision syndrome—symptoms, which I kept hearing again and again.

They were complaining [about] loss of feeling—usually loss of sexual feeling.
Some men would say that clothing [rubs on the exposed glans penis, constantly producing] an unpleasant sensation.
They lacked normal, enjoyable sensations from the penis during sex.
Others would say they were so ashamed—they were deeply ashamed—of the fact that they had been mutilated. They felt mutilated. They were so ashamed, they wouldn't undress usually in front of other men (they were [often] more ashamed in front of other men than women), though some would say they were ashamed in front of any person and were quite unable to have any sort of sexual contact because they were so deeply ashamed of what had been done to them. Many would say:
I won't go in a changing room—I stopped doing sport; I can't risk anyone seeing me in a shower or anything like that, because [I'm] so ashamed of [my] mutilated genitals, really.

I contacted these people, and [asked whether they] would like to come to a meeting about circumcision, because there [were] quite a number of men now who [had] been contacting me. This meeting took place, and I think we had about 20 men there, and I just let each man tell his story around the room, and it was a very moving experience—I had heard their stories before, but of course they hadn't; it was just an electric atmosphere in the room—I had never seen anything like it, really. Out of this, I said at the end:

Shall we have another meeting? Do you want to talk about restoration?

Of course, most of them did! So, that's how NORM-UK was born.

We ran support groups for men who wanted to restore, but of course, [we] couldn't just confine [our] activities to foreskin restoration; all [participants] wanted [to discuss how we could stop this assault from happening to the next generation].

Paul Mason: Male Circumcision is increasingly being recognized as a Violation of Rights

2011-11-14T03:20:00.001Z

Paul Mason, Family & Children's Lawyer (and Former Commissioner for Children of Tasmania), discusses children's right to bodily integrity and the context of that right in the history of social progress.

Transcript
(slightly modified)

In 2003, the Queensland Law Reform Institute arrived at the conclusion that the consent of parents to medically unnecessary circumcision of a boy [is] an assault.

An assault is [one of]:

The uninvited physical touching of a person without [his or her] consent.
The threatened use of force against a person—not in the sense of [military action] or something like that, [but rather] force as in a touching [about which] the other person can do nothing.

The fact that a [kind] of assault has been happening for a long time does not [inherently] make the assault legal; take, for instance, family violence by men against women: As recently as 1973 in Australia, a man [who assaulted and injured] his wife [was acquitted] by a Victorian county court judge who described [the assault] as [merely] "quite rougher than usual handling".

[However], times have changed [since then]; 1973 was a [very] long time ago. I expect that [progress] accelerates as it proceeds, and I would hope that a court looking at [the question of circumcision] in the future in the English common law system would not only take into account what has happened before [as is customary in law], but would also look at new obligations [and expectations] that have been created in society about the sanctity of the person—about the right to bodily integrity, which is enshrined in:

The United Nations's Declaration of Human Rights (1948)

Either that [concept] has meaning or it doesn't. I think [that] increasingly, common law courts [will] be invited to accept that [it's] a fundamental principle of law that applies not only to adults but also to children.

One thing [about the issue of domestic violence] that I come across a lot is people saying:

That's illegal, isn't it?

These are young mothers [and fathers] in [their 20s and 30s], and they say:

Well, we don't hit our children because [that's just something] you're not allowed to do!

I'm afraid I do go around [correcting that stance]:

It's OK to hit children, because the law says you can.

and people are surprised about that. So, in some ways, culture is ahead of the law; social pressure and peer expectation between parents is ahead of the law. So, it may be that the male circumcision rate is dropping at a faster rate than the judges and the lawyers are [learning to appreciate in law the rights of children], which I hope is true.

There have been mainly private family law cases (like the Bott[sic?] case) where one parent wants [a child circumcised and] the other doesn't. The courts [in such cases] have generally [blocked the circumcision], but the reasons have been very contorted and have basically come [down] to saying:

Well, we want the child to maintain a relationship with both parents; we want both parents to remain involved with the child.

If the procedure [were allowed], that may harm the prospects of the child having a [healthy] relationship with both parents.

which I think is a good valid reason, but a bit of a squid. The courts haven't been, as I say, challenged to make a [solid] decision about the validity of the parental consent [for the circumcision of a completely healthy child].

One of the documents [at which] I hadn't looked very closely before I came into this job was:

The United Nations's Convention on the Rights of the Child

which was approved by the General Assembly of the United Nations in 1989. Every country except 2 on the planet have signed up to that convention:

Somalia
The United States of America

So, those 2 countries have more in common than either of them probably like to think.

[That] convention is an aspirational document. It's been [adopted] by a lot of countries [with] different religious and historical backgrounds; there are [adoptive] countries [where there is the practice of] sharia law, which would seem to be [in conflict with] some of the aspirations in the document, but even those countries have agreed that we should aim for a planet where children are respected [as individuals] and not abused.

Article 12 relates to the voice of children—that children (because they are human beings) should be listened to. If they say they want free ice cream, we have to say "Well, there [are] limits to how much ice cream you can have", but generally [children] don't ask for free ice cream; when you ask them about a serious question [about issues] like:

Cyberbullying
Education
Public transport or planning

[children] will give you serious answers from their perspective, and their voice helps us as a community. Part of that voice is their right to their own belief systems; if a child believes in the Tooth Fairy or Santa Clause, we must respect that belief. If they choose to believe in the Blessed Virgin Marry, or the Prophet Mohammed, or any other source of spiritual comfort or belief, we respect that, and [this principle is] also enshrined in the convention:

We must respect the religious beliefs of the child—not of the child's parents!

You have to wonder, really, whether a child is ever born [as]:

a Muslim
an Animist
a Daoist
a Buddhist
a Christian—a Lutheran, a Protestant, or a Catholic, [etc.]
[a Jew]
[etc.]

They become those things over time—as they become adults. Again, part of [protecting a child's voice] is giving [him or her] the voice to choose [his or her] religion.

Marking your child's body according to one religion may have the tendency to limit that choice; it may mean that [the child feels] unable to choose a different religion from [his or her] parents when [he or she grows] up, and that limits [his or her] freedom of religion, [a freedom] which is enshrined not only in [the Children's Convention], but also [in] the Declaration of Human Rights. [In addition], the Children's Convention refers to rights that are specific to children:

They have a right to education.
They have a right to safety in the home (and I've referred to that in terms of physical punishment in the home).
[They] have a right to protection from cruel and degrading treatment.
[They have a right to] protection from traditional practices which are harmful—that's a particularly relevant one [with regard to the issue of male circumcision].

Article 26 says that states' parties must take steps to eradicate traditional practices that are harmful to children; that [tenet] was originally developed in the drafting of the convention [in order] to relate to the cutting of girls' genitals, but another article in the Children's Convention—and in [the Declaration of] Human Rights—talks about the need to abolish discrimination—[and] discrimination between boys and girls is, [I think], one of the strongest arguments that intactivists can use [to argue against male circumcision]:

If girls are entitled to certain protection, so are boys.

The history of the last 40 years [of fighting] discrimination has been [focused on] the subjugation of women by men. [However], the principles are not there for the benefit of women, [but rather] for the benefit of people.

Women don't want to be put in a better place than men; women want to be equal with men, treated equally, given an equal voice, and women—[whom] I've met—want men to have the same voice as women. I think that's a strong tool for intactivists to use:

What is good enough for the goose is good enough for the gander!

[10] The Cut Podcast: David Llewellyn: the Harm of Circumcision is Hidden because the genitals are hidden

2011-11-13T04:40:00.001Z

Eliyahu Ungar-Sargon, the director of the documentary film Cut, interviews lawyer David Llewellyn about the legality of forced male circumcision, genital-injury cases, and his motivations for taking part in the Intactivist Movement. Here is the recording.

Transcript
(slightly modified)

Eliyahu Ungar-Sargon

From the White Letter Productions studios in Los Angeles, California, I'm [Eliyahu] Ungar-Sargon, and this is The Cut Podcast.

I'm sitting here now with David Llewellyn, so thank you so much for joining us. Why don't we jump off by having you explain to our audience what it is you do.

David Llewellyn

Well, I'm a trial lawyer in Atlanta, GA, and the majority of my work is now—and has been for several years—in the area of genital injury litigation, by which I mean cases where [men or babies] have been damaged by circumcision or circumcised against their or their parents' wishes—and I know that sounds strange, but I've actually had a case where an adult [who was] having other genital surgery was assured that he would retain his foreskin and did not because of a mistake (apparently on the part of the resident, who did not know how to do this surgery without removing the foreskin).

I also do a variety of other cases, but I do these cases all across the country; I would be happy to do a case involving mutilation of female[s] too, which does occur upon occasion either through malpractice or intent.

Eliyahu Ungar-Sargon

How is it that you came to practice this kind of very special brand of law?

David Llewellyn

Good question!

I'm intact myself; I was born in 1950 and I was a premature infant, [so] they refused to circumcise me [(presumably on the grounds that it would be too dangerous)], so I grew up knowing the difference.

When [my wife and I started having] children, we read Edward Wallerstein's book on circumcision, and determined that circumcision [is] a bad thing and [that] we would not do it to our sons—I have 2 adult sons.

I started doing some parental education; I needed some information to pass out, and I had read about:

The International Symposia on [Genital Integrity]
Marilyn Milos
NOCIRC

I called Marilyn (whom I did not know), [and] I had a long discussion with her. Eventually, she got me involved in a case in Montgomery, Alabama, [in which] she was going to appear as an expert witness; a child had been circumcised against his parents' instructions, and we got a verdict which—at that time—was a record: $65 thousand for that child, just for the loss of the foreskin—now, I don't mean to minimize that, but that's how it was considered, so that sort of success puts you on the road to other cases.

Another one in Montgomery.
One up in New York.

and then it sort of snowballed to the point where I probably do more genital-injury cases than anybody else in this country—or frankly any place else.

At the moment, the law in every state is that parents—one parent—[may] consent to the circumcision of an infant; I do believe that legally [this] is an incorrect proposition—[I believe] that a parent [may] consent only to medically necessary procedures. With the exception of perhaps one or two people around the world, I don't think anyone would argue that circumcision is medically necessary; there are those who of course believe that [circumcision] is medically beneficial or at least beneficial in the long-run. I can think perhaps of one person who has called for mandatory circumcision world-wide, and that would be Brian Morris in Australia, but otherwise, I can't think of anyone who has made that claim.

Eliyahu Ungar-Sargon

[Mandatory circumcision is] a really fringe position even in the medical community—

David Llewellyn

I would agree!

[It's a fringe position] even among pro-circumcision activists (and there is a small group that I would identify as such; they might not agree, but that's how I would view them [in] my opinion). I would [definitely] say that is an outlying position, and [it] would be one that would be very hard to justify [on] a public health basis and [on] an individual rights basis; I think [it] could probably never be adopted here in the United States—not with present law that we have.

[However], it's more problematic to argue that parents can't consent at all [to the circumcision of even a completely healthy child]. [Personally], I think that no parent [may legally] consent—it's proxy consent: Children, in the view of modern law and certainly the law of [the United States], are not just objects [with which] the parents [may] do whatever they want; parents have responsibilities to [their children], and they [only] have a responsibility to consent to medically required treatment (it seems to me, at least when there's a permanent body modification).

Eliyahu Ungar-Sargon

Is there a statute of limitations on circumcision as injury?

David Llewellyn

Well, yes.

It depends upon the [laws of a particular] state—we have 50 states, and all of them have different statutes of limitations for different things.

Some of them have specific statutes of limitations for medical cases—even for infants. [For a certain period of years after he has come of age], a lot of states allow someone who has become an adult to bring an action [to court as long as it has] not been brought on his behalf before that time.
[However], there are states that limit even children's rights, such that the parents [must be the ones] to bring the cause of action within the same period of time as they would for themselves.

So, that varies from state to state, and [it's] a constant challenge to keep up with it; I generally tell the folks who call me that I will give them a general idea, but since I'm not a lawyer in [their particular] state and can't practice law in that state without being admitted for a particular case, they'll have to talk to a lawyer in their state about the specific statute of limitations.

Eliyahu Ungar-Sargon

Now, is it legal for [people who are not medical professionals] to perform circumcisions?

David Llewellyn

At present, the answer is probably "Yes".

If you're talking about criminal law, it's an interesting question. I think that the present controversy arising out of the effort in San Francisco to [age-restrict] circumcision has raised some interesting issues.

I know of no law that says it is all right for [someone who is not a medical professional] to cut the flesh of any child, but the law [usually] follows society—the law rarily leads society; the only time I can think of in my lifetime where the law has actually led society is in the area of sex and race discrimination—the Civil Rights Acts from the 1960s. That did lead society, but even that didn't occur until a substantial section of society agreed that society needed to go there.

At the moment, I would say that in all 50 states, a doctor [may legally] perform a circumcision [in the sense that it would be extremely difficult to prosecute him under the present interpretation of the law]; a religious functionary such as a mohel [may] legally perform a circumcision.

Now, [may an untrained] parent legally perform a circumcision even if done in a sterile manner? The answer is probably ["No"], but certainly the parent could make that argument. There have been several cases recently where parents attempted to perform circumcisions on their children and have been punished criminally—I don't know [whether] they have raised in those cases the similarity between what they [did] and what is done religiously in Judaism or Islam; I think the difference in those cases, though, is there was no sterile technique used (they were certainly not [using] standard instruments and this sort of thing).

The interesting [case] would be if a parent wished to circumcise [an infant] for whatever reason and used the same techniques that are commonly used by doctors [and mohels]. Would that be permitted? I really don't have the answer to that; I don't do criminal law, [but] I think it would be defensible simply because it's allowed to others.

[However], I think most judges and prosecutors would view that as being wrong and that it would be criminal to do that, which then of course creates an anomaly in the law; you're making an exception in saying:

You don't have to be a doctor; you can do it religiously, [but even though] there are no standards for training, we won't let [just any parent] do it.

So, I think it's a gray area that really has never been addressed because the problem until very recently has just never presented itself.

Because of the work I do, I know a number of [mohels]. The ones who have appeared as expert witnesses for me:

are trained medical doctors,
use sterile technique [to perform circumcision],
and do it the same way as [some] would do it in a hospital setting (with the exception of the religious portion).

In fact, a lot of [these mohels also perform circumcisions] in hospital settings; I think probably most of them [perform circumcision] for so-called "medical reasons", so if a [secular] parent or an adult wants it done in a hospital setting, they'll do it [in that setting].

One [such mohel of which] I'm thinking is a urologist, and of course, as a urologist, [he] has [performed circumcisions on both children and adults]—not just religiously.
Another is an obstetrician; I expect that he probably [performs circumcisions] at the hospital as well as on the eighth day [according to Judaism].

[Nevertheless], I have had 2 cases involving [mohels], in which both of them were [not] doctors. The second case—an extraordinarily tragic case—resulted in a judgment against Mogen Circumcision Instruments for [around $10.7 million] in New York (once again, funny enough, in the eastern district); in that case, the mohel had been trained by another mohel who was also not a physician (I believe that's correct)—I have a suit pending against the trainer at the moment. [The mohel in question] had done a number of procedures [as a matter of training], but I would contend not nearly enough [to be considered properly trained].

He used a Mogen clamp and ended up severing the entire glans penis [(the head of the penis]) of a child, which luckily was noticed by [a] physician who was at the bris [(ritual Jewish circumcision ceremony)]; reattachment was attempted, [but] that was not particularly successful, regrettably.

Yes, I think [the] training of mohels is an issue that really hasn't been addressed by the law except perhaps in these cases that I've brought [forward], where I've contended [that the mohel] was not well trained; he settled with us—I think I'm on my 6th case involving a full or partial [severing of the penis] with the Mogen clamp [which is commonly used by Jews]—

Eliyahu Ungar-Sargon

Which brings me to this very important point: When talking about the risks and complications of circumcision, [the medical professionals] tend to minimize them.

I don't want to get into the numbers, because that's a whole other subject (it's very difficult to know [the statistics exactly; it depends largely on how you define a complication).

[However], you're seeing all of the complications; you're seeing a lot of these issues—

David Llewellyn

Correct—

Eliyahu Ungar-Sargon

Do you think [the practice of routine circumcision can be considered responsible medicine]?

David Llewellyn

Well, I think it's really irresponsible of the doctors not to face up to how many botched circumcisions there are.

If you talk to any labor and delivery nurse, [that nurse is going to tell] you there are lots of them.
If you talk to any honest pediatric urologist, he is going tell you there are lots of them.

I had an interesting experience some years ago: One of the more common [complicatins of circumcision is] either taking off all the shaft skin (on top or the bottom), or taking off too much shaft skin and leaving too much inner-foreskin lining.

It's hard to explain verbally how this can happen, but one [difficulty of circumcision] is [that] the foreskin is not [just] "skin"—it has skin on it, but it is a five-layered structure, which includes a muscle layer called the dartos fascia that starts behind the scrotum, surrounds the scrotum, and runs straight down the shaft of the penis all the way to the end of the foreskin. On top of [it is the] skin (epidermis and dermis) and underneath it [is] a supporting layer called lamina propria and then inner mucosa.

This [tissue system] is flexible, and whether or not the dartos fascia is tightly bound to what's called Buck's fascia makes a lot of difference in the end result of [a] circumcision.

I think a lot of physicians don't understand the penile skin system; in fact, I feel quite confident that they don't.

They don't understand that [during a circumcision], they need to push back on where the skin joins the scrotal skin so [as to make sure the tissue is properly] spread out.
[They don't understand] that they've got to be very careful about how much [and which kind of tissue they amputate or leave behind]; shaft stripping is really common.

I think if you ask any pediatric urologist, [he or she is going to tell] you that [he or she sees] at least on a weekly basis (if not more often) some damage beyond the damage of circumcision itself—whether it's injury to the glans penis, whether it's shaft tripping; whatever it is, they see it [regularly].

David Gibbons, who is the director of pediatric urology at:

Georgetown University Medical Center

[remarked about this] a couple of times. He publisehd a letter in one of the urological journals and then also in an online comment [in] a popular magazine, [discussing] how many [cases of unintended] damage he has seen; he has certainly seen one [per] week, if not 2 [per] week, and I think that's pretty typical.

I don't know how many pediatric urologists there are (there used to be few, [but] there are more now); there are maybe 300 in the United States, and if you figure 2 [cases] per week times 52 weeks—[let's say 100 cases] per year—times 300, [that is 30 thousand boys per year who receive damage needing correction on top of the damage of circumcision itself], and all of these [problems] are hidden because the genitals are hidden.

Eliyahu Ungar-Sargon

I want to transition into a discussion of some of the basic legal issues surrounding this practice.

One of the arguments that's often made by intactivists [against this practice] is that ever since female genital cutting [NOTE: including just a pin prick of the clitoral hood!] was outlawed in [the United States]—there are federal laws against it on the books now—we are in a situation of gender inequality: Boys do not enjoy equal protection from genital cutting under the law.

Can you address that? Does that argument have any merit in your opinion?

David Llewellyn

Well, equal protection analysis is one of the more difficult areas of constitutional law. First of all, the federal statute [against female genital cutting] is a criminal statute, and I believe [it] only applies where federal criminal law applies:

The high seas.
Federal reservations.
Perhaps federal hospitals.
On federal land.
[etc.]

So, [the federal statute] really doesn't outlaw [something that] happens within the boundaries of a state [and] that is not affected by federal criminal law; in other words, it may affect what happens in the Chattahoochee National Forest, on military reservations—and because I don't practice criminal law, I don't want to be definitive about this, but I don't believe that [this] statute actually covers what happens in hospitals in the various states; that's covered by state criminal law, and it's one of the anomalies of our system [of law]: The states have different laws.

Do we have an equal protection problem? Well, I have not researched the issue, and I'm always careful about offering legal opinions until I have [done so].

Does it seem to me that it is unfair to outlaw ([at least federally]) all genital cutting of females—even the cutting which is the anatomical equivalent of male circumcision (which would be removal of the [clitoral hood] or clitoral prepuce [or] the clitoral "foreskin")? Is it anomalous to say we'll outlaw it for girls when it is no worse (and arguably less invasive) than the circumcision of a boy?

Yes, it is wrong.

Now, whether or not anyone can challenge [this situation] under any particular [legal] circumstances is another question; it is quite possible that the only one who would be able to challenge it is somebody who's being prosecuted under the [federal law in question; such a defendant] would argue [that the law is unconstitutional for the reason of inequality]; it's not quite as simple as saying:

Well, it violates the constitution to do this.

That analysis is unfortunately simplistic—it sounds right, but I'm not sure who is in a position to challenge the statute.

You can't positively create a right; in other words, I don't believe a court is ever going to say [that] we've outlawed it for girls, so therefore it's outlawed for boys. It really doesn't work that way; it's more like you would be able to strike down the statute as being unequal.

Eliyahu Ungar-Sargon

People have varying degrees of knowledge of what happened this summer—this was a big summer for this issue. I was wondering if you could give us a run-down of the time-line of events that happened, and then we can get into some of the analysis.

David Llewellyn

Well, I have not been involved in any of those efforts, so this is sort of what you would call rank hearsay. [However], as I understand it, for some years, there has been an effort by at least one individual to pass what is known as The MGM Bill:

The Male Genital Mutilation Bill

which essentially mirrors the federal statute [that outlaws all] female genital cutting. There have been several means by which that effort has been put forth. One is to convince legislators to introduce the bill within various [state and federal] legislatures.

Massachusetts has a [legislative] process whereby a citizen [may get] his legislator "to sponsor" a bill within the legislature; a gentleman managed to [get The MGM Bill proposed this way, but] it did not make it out of committee, and as I recall, it was somewhat derisively treated in committee.
Then, someone else (not directly connected with a particular organization) decided after having attended a conference on circumcision (held last summer in Berkeley, CA) that he would [use the San Francisco legislature to propose an ordinance using similar language. To do so], you have [to collect a large number] of signatures [from citizens].

Lloyd Schofield (who is the individual) decided that circumcision [is] wrong and he [and a group of others] solicited signatures throughout the city of San Francisco. Interestingly, a number of [those who were collecting signatures are] Jewish, I believe. At any rate, they solicited [more than] enough signatures to get [an age-restriction for circumcision] on the ballot.

When there were enough signatures to get this on the ballot and this [fact] became [widely publicized], a number of groups (some [of which are] religious) sued for an injunction [to prevent the measure from appearing on the ballot]; the judge granted [the injunction] using somewhat broad language, but the essence of the [judge's thinking is]:
- State law says the local communities [may not] regulate the practice of medicine.
- Circumcision is the practice of medicine.
- Therefore, on this basis alone, I'll issue the injunction, [and] if I didn't issue [a total] injuction—if I just limit it to doctors—then it becomes religiously discrimatory [because the religious] are the only [other] people who are doing it, and therefore it would violate the first amendment [of the United States' Constitution].
[NOTE:
- The state law in question was meant to keep lawmakers from prohibiting the practice of declawing cats; that law was written in very vague language, allowing proponents of circumcision to extend its meaning to include the circumcision of completely healthy boys.
- The religious (e.g., Orthodox Jews) do not consider circumcision to be the practice of medicine.]

Eliyahu Ungar-Sargon

Lately, I've been hearing a lot of people suggest that any attempt to pass a law against circumcision would be a violation either of the first amendment or of the establishment clause, so I was wondering if you could address those legal issues, and [give us] your opinion.

David Llewellyn

As I said earlier, the law follows society, and the law in regard to constitutional interpretation is very much [whatever] the courts say that it is.

Generally, the Supreme Court has held that belief is protected, and [that] you cannot regulate belief, but [that] you can regulate behavior. There was a case which made this pretty plain:

Prince v. Masachussetts

As I recall, that's the case that says parents are able to make martyrs of themselves but should not be able to make martyrs of their children.

It had to do with [refusing] blood transfusions, as I recall; the Jehovah's Witnesses do not believe in receiving blood transfusions, and the question was: Could a parent deny that to the child?

Whatever the facts of that case, that is the general feeling of the court. So, in my opinion, a statute that [outlaws] all [medically unnecessary] circumcision of males under the age of 18 [years] would not be unconstitutional; such a law could be passed, and under what I understand [of] the prior precidence of the Supreme Court, [it] would be entirely legal and constitutional, because it would treat [everybody] the same, and the fact that certain religions require or encourage circumcision would not be an impediment to the passing of that law, because circumcision is the changing of the natural body.

Having said that, I think it is unlikely that any legislature is going to pass that within the foreseeable future, and it is certainly not impossible that a religious exception would be made if such a statute passed. In other words, [the Supreme Court might] hold that [a restriction that impacts religion is] unconstitutional because [circumcision is] such a basic issue in certain religions (Judaism in particular).

I don't think the court has ever quite been presented with an issue that would be quite so inflammatory, and I say that because:

[There is a] long history involving Jews and Christians in the Western world.
The sanction [that] the scripture (at least in the Old Testament) gives to circumcision is a little bit different than a view [like that on blood transfusions] that is held by far fewer folks and that is of relatively recent origin.

Now, I can only speculate what a court would do [with such a case], but I do think that [one cannot blanketly say]:

The first amendment prohibits any legislature from prohibiting circumcision of minors for [medically unnecessary] reasons.

I don't believe that is true under the present interpretation of the law. Now, what a court would do with that in the end, I don't think anyone can predict. It would certainly be an interesting case, and I can't really say in the end what would happen, but I think I can say that you cannot make the blanket statement—as was made by a number of folks in California recently—that the first amendment prohibits the passage of such a law.

At any rate, the judge [in San Francisco] issued the injuction [against The MGM Bill ballot measure], and to date, [that decision] has not been appealed. I really don't know enough to know whether the time for appeal has passed, but [this case] brought a lot of attention [to the issue] world wide.

Eliyahu Ungar-Sargon

As a person who's opposed to routine infant circumcision, what is your assessment of the strategic wisdom of what people did in San Francisco this summer?

David Llewellyn

There are differing opinions about that. The effort itself has been useful in the sense that it has raised people's awareness.

It was certainly well intentioned. From what I know of the people who are directly involved in that effort, it certainly was not meant to attack Judaism (or any particular religion). I know [that] some of the people who were involved are Jewish; they just believe circumcision [of non-consenting minors]—whether it's religious or non-religious—is wrong.

I really don't know of anyone who opposes an adult [choosing for himself] to be circumcised; there may be people out there who feel that shouldn't happen, but I don't know of anybody who thinks that ought to be prohibited.

There are those within Judaism (as well as without) who feel that regardless of religion, parents ought not to be able to consent to the circumcision of a minor. After all, we don't know what religion the minor will [choose for himself as an adult], and [circumcision] is a permanent body modification.

There are others, of course, who feel that [cutting up the penis of somebody else] is so central to [their own beliefs] that it ought to be permitted, and this is [the crux of] the [debate].

Was this strategically wise? I'll leave that to others to decide. It certainly has aroused a lot of passions, and perhaps it was not the wisest thing to do, but I think it was well intentioned. I think it's unfortunate that those who viewed it as a threat viewed it as opposition to their religion in general, which I certainly don't think it is.

There is no central command [in the Intactivist Movement]! This [is a] very loose movement of those of us who think that circumcision is unwise. I got involved in this because I thought that the doctors [are] essentially continuing to pervert medicine—they [are] making arguments that [are] bad from a medical standpoint. They [are] ignoring the harm [of circumcision].

[While there are papers that show the harm of circumcision], the harm should be intuitive to folks; certainly The Rambam (Maimonides, [the beloved Jewish scholar) understood that there [is] harm, and I think generally it was accepted up until about [the early 1960s] that circumcision [lessens] you in some sense sexually—but that was considered a good thing!

It wasn't until the Sexual Revolution happened that suddenly [people became adamant that circumcision] doesn't cause any difference at all—which intuitively is [nonsense]; I mean, you cannot cut [a sizable portion of] normal, functional tissue off the body without making some change to [physiology].

My involvement really came about because I thought that doctors weren't being honest about [circumcision]—I still think many doctors are not being honest about it.

We have a [societal] situation where PEPFAR (the President's program for [HIV/AIDS] relief in Africa) is now encouraging the circumcision of infants all over Africa—without any discussion whatsoever; I have seen no discussion [whatsoever] coming out of Africa about the function of the foreskin—its protective [and] sexual purposes. Instead, we're getting [laughably] astounding studies—one that came out the other day [essentially said]:

100% of the adult men who have been circumcised in Africa are satisfied with [being circumcised], and most of them love it!

Maybe that's what that study shows, but I find [such figures] to be an astounding proposition just given the number of men who have complained to me that they do not like being circumcised—

Eliyahu Ungar-Sargon

I liken [that] to an election in Iran where you have 99% of the people [voting] for the incumbent.

David Llewellyn

Well, it would be astounding to think that 100% of any group [having undergone] any surgery were happy with [the results]!

Ron Goldman, who runs the Circumcision Resource Center in Boston and is Jewish, has said numerous times [that] before we discuss circumcision, everybody needs to declare [his or her] status:

Are [you] or are [you] not circumcised?
Have [you] ever circumcised somebody?
[What are your religious beliefs on circumcision?]
[Is your sexual partner circumcised?]
[etc.]

Why [is this necessary]? It clears the air! That's why I don't mind [anymore] saying [that] I'm intact—[I mean], I'm 60 years old [and] I'm too old to worry about whether people know I'm intact or not, but I think it's fair that people know that [fact], because then they can say:

Well, your status colors your opinion!

Does it? Probably!

At the same time, if you could show me [convincing evidence] that circumcision really [is] worth [something]—really [does] something that [is] worthwhile—and that there [is] overwhelming evidence that it [does] something good to a person—whereby [a circumcised man] would not acquire a disease that could be acquired just by being in a room with [an infected individual], because that's what we vaccinate against; we vaccinate against diseases that can be gotten by mere touching, by a sneeze, by something that is easily communicable rather than by theoretically reducing [the] incidence [of] a disease I can get by having sex voluntarily with an infected person [NOTE: Circumcision has been hailed as a "surgical vaccine" even in developed countries, based solely on the rather dubious data of a few poorly conducted trials in third-world, HIV/AIDS-riddled Africa.]

[If you could show me that], then you might convince me that circumcision is something that ought to continue, but I haven't seen that evidence yet.

I do think bias does affect studies and does affect the issue—it's almost impossible [for bias not to factor into the debate because we are all flawed] human beings, but we all ought be able [to recognize this fact openly and then] look at this [issue] dispassionately rather than being so passionate about it.

Eliyahu Ungar-Sargon

David Llewellyn. Thank you so much for joining us. I really appreciate it, and I look forward to having you at the screening [of Cut] tonight.

David Llewellyn

Well, I look forward to seeing [your film] again—it's a wonderful film.

Eliyahu Ungar-Sargon

That's our show; if you have any questions, comments, or suggestions, please email them to us at:

cutdocumentary AT gmail (.) com

If you like what you heard today, please support us by buying our film at:

www.cutthefilm.com

Zenas Baer: the Medical System and the Judiciary ignore the illegality of Circumcision

2011-11-11T18:42:00.001Z

Zenas Baer (J.D.) discusses the events that led him to study the legal issues surrounding the circumcision of children.

Transcript
(slightly modified)

I am circumcised.

My first child was born in 1989—a son—and we had a birthing plan which basically said "No circumcision". I really had no stake in [that particular decision]; my wife [had done] the research, [and she] said there is no reason for it, so I just went along for the ride—it didn't bother me one way or the other as to whether or not my son was circumcised. So, [the issue] hadn't come up on my consciousness's level. All three of my sons were [not] circumcised.

Then came along Jody McLaughlin and Duane Voskuil, early pioneers in [the Intactivist Movement]. They asked me to review a case against the state of North Dakota, [where legislators] had just adopted the [ban of] female genital mutilation [(FGM)] in 1996; [they] asked me to sue the state based on equal protection [(based on the fact that a girl's genital tissue is protected, but a boy's genital tissue is not]).

It was a novel approach. Initially I [was uncertain of the idea]. I talked to some of my brothers about it, and they were sort of indifferent [and thought it is] "a weird issue". I reflected on it some more, and I thought it really is a classic violation of equal protection, so I went for it, and that's how I became involved in the issue, and I have become more and more convinced that [circumcision] is a barbaric procedure that serves no medical purpose. As a human right, [a male] needs to be able to make that decision when he reaches the age of majority.

The foreskin is a natural covering for the penis; it is part of a human being. The Constitution of the United States at least guarantees that no property will be deprived of an individual without due process of law; the basic human right is the right to bodily integrity, which is guaranteed by a number of international conventions and the United States' Constitution, and the constitutions of most of the [individual] states, as well. So, it is that basic human right that is impacted by routine circumcision [(that is, by the circumcision of a completely healthy child)].

Personally, I don't have an ax to grind; I don't have any anger—that I'm aware of, at least—other than my disappointment that the legal system does not honor the constitutional rights of [a] one-day old infant—[the powers that be] allow the parents' discretion and the medical doctors with their surgical intruments to trump that one-day old infant's constitutional rights.

I subscribe to a library service for lawyers called Westlaw, and [when] I [do a search for]:

circumcision informed consent

5 of the first 20 cases that pop up are my cases; the first case that I find is:

Fishbeck v. State of North Dakota

That was the initial, landmark challenge to the FGM statute which had been recently adopted in the state of North Dakota, through the efforts of Jody McLaughlin and Duane Voskuil to sue the state of North Dakota for not protecting the baby boy who was born and cut with the consent of the father over the objection of the mother; that case was dismissed out of hand without [even] a hearing, on the basis that there was no standing: Mrs. Fishbeck could not get the foreskin back (the foreskin was gone), so there was no "remedy"—[thus], there was [supposedly] no case or controversy (I should point out that courts [many times] use this Article III "standing argument" to avoid making decisions).

So, I think it's necessary for [the Intactivism Movement] to take repeated runs at the Judiciary [in order] to force them into [this] absurd position of saying a person who has had the most sensitive part of his body removed—without any process at all, let alone due process—is not entitled to challenge a statute that protects female genital tissue but allows medical doctors and parents to diddle and cut off genital tissue [from] baby boys.

In the cases that I've handled, my experience has been that parents (who are the ones [eagerly] anticipating the birth of their child) [have their joyous occasion] interrupted by [being told by a medical professional that they face an immediate need to make a decision about circumcision]. Most of the parents [with whom] I have discussed [this] issue state that a nurse came into the room, asked them to sign a form or asked them "Have you made a decision on circumcision?"; if the parents [consent], they sign the form, or [the medical personel] just take the child away and circumcise [him]. So, there's very little discussion, at least according to the parents [to whom] I have talked.

Now, that may have something to do with [parents'] inability to remember everything that is said, but I suspect that it is ingrained in the [medical] system; circumcision has developed as a procedure that is [regarded as a] parental choice [beyond even the question of medical necessity], and the medical system—whether it be the hospital or the doctor—is there to please the parents:

Do you want fries with that [burger]?

This is the hospital's way of delivering this good to increase the revenue that the hospital gets [via] reimbursement from insurance companies or medicare/medicaid. So, [routine circumcision] is a revenue-driven procedure that is promoted by the hospital staff.

[Until the birth, many] parents don't know what gender their baby is going to be, so they don't know whether they have to make that decision; they're asked to make a decision on circumcision within a short window of time. I have had parents who have told me that the nurse came into their [hospital] room and [casually] asked "Have you made a decision on circumcision?" The parents looked at each other and said: "I guess...", and [their child was taken away] and circumcised. These parents later told me that they had no clue that circumcision even [involves] the cutting of skin; it's a procedure [about which] at least these parents had no concept—they had never seen or had experience with an intact penis, and they [told] me that they would never have consented to the procedure if they [had] known there [are] risks:

meatal stenosis
skin bridges
loss of sensitivity
loss of functioning tissue
[death]
etc.

I've always been troubled by the federal (and some state) statutes that ban [female genital mutilation], because they're gender-specific; at least the [peoples] who [practice FGM actually practice genital cutting] on a gender-neutral basis: males and females [are] treated equally.

Now, I'm not suggesting that females ought to be altered and have their genitalia modified in any way—I think it's abhorrent to the individual rights of the person to whom it's being done—but I think we as a society are cultural snobs [when we confront] these tribes [who have] these customs that actually alter female genital tissue—[when we] make a hue and cry out of that procedure, yet turn a blind eye to the genital cutting that is [happening] on a daily basis [to] one-day old baby boys in our hospitals [at the hands of] medical doctors in white coats [who] are supposed to be caring for the children.

[This brings us to the debacle surrounding the failed attempt in 2010 by the American Academy of Pediatrics (AAP) to encourage doctors in the U.S. to help certain African and Muslim communities perform a ritual nicking of just the clitoral hood of a young girl as part of a religious rite]. I understand it was an attempt to accomodate the religious views of those people who [think] it is [an] important [part] of their belief system to have a ceremonial nick in the genital tissue of females. [Even though the AAP tried to avoid outrage by officially noting that such a nicking would be far less extensive than male circumcision], the AAP apparently got an earful of objections to the throught that they would tolerate any cutting of [female] genital tissue—[criticism] which I think they ought to review and adopt for boys as well; unless there is [an immediate medical necessity, such genital cutting] should not be done.

I have reason for optimism.

I think part of my optimism stems from the fact that the foreskin is always going to be there—it is always going to be [viewed] in the eyes of the cutters [as] a nuisance that nature has put on your penis, [but] the genes are not listening to the cutters; that foreskin will always be there. [Eventually], those people in authority [will hear our remonstrance] that it is wrong to violate the individual rights of that baby boy to the [extreme] extent of cutting [away] the most erogenous tissue of that [person's] body.

Peter Adler: Circumcision is illegal under any aspect of law

2011-11-11T15:09:00.001Z

Peter Adler discusses the events that led to his Intactivism from the aspect of legality.

Transcript
(slightly modified)

I have a master's degree in philosophy and a law degree from University of Virginia.

After my son was born, he was nursing with my wife, and a doctor came into the room and addressed me:

"Have you decided whether or not to circumcise your son?"

I was really taken aback because we had never even ever talked about it; I had never discussed circumcision with anybody. [NOTE: Why should a parent discuss performing destructive genital surgery on a completely healthy child?]

My wife is a doctor, so I wanted to involve her in the discussion; she said [to me]:

"Well, no, you are a man, you have a penis, you decide."

That's exactly what she said.

Interestingly, being a doctor, she has made every medical decision in our family for our children [since that time]—I'm not even in the loop. So, [at the time], she was clearly distracted from having given birth, and I realized later that in the circumstances, she just wasn't thinking clearly, because that isn't like her at all. [NOTE: In many cases, doctors in the U.S. seek parental consent to perform circumcision by having the exhausted mother sign papers; currently, only one parent must consent.]

So, then [our] doctor continued to talk to me. He got my attention right away; I hadn't thought about it, so I was completely on the spot, but as a lawyer, I realized [that] I better really pay attention to him. Yet, at the same time, he's a doctor (he had the Harvard logo on and he looked impressive in his white coat), so I really wanted to listen to him.

"What's this all about?"

"Well, do you know what the foreskin is?"

"Not really."

He described it a little bit to me, but he made it sound as if [foreskin is unimportant and circumcision is extremely minor]. You know, he certainly didn't tell me that the foreskin is fused to the glans [in infants and must therefore be ripped away before circumcision can even begin].

He [did say] that [the foreskin] has some protective functions, and [that] according to the [American Academy of Pediatricians (AAP)], it isn't necessary to circumcise a child, and that the AAP doesn't recommend it but that it's up to the parents to decide whether to circumcise a child or not; he gave what I later learned is the exact language of the AAP policy:

"It's up to parents to decide for religious, cultural, or personal reasons."

"Well, I'm not religious."

I should tell you [that] my grandmother was Jewish and, accordingly, my father was Jewish; he was born Jewish in Baltimore, but he was sent to England, went to private school, and was raised Anglican, and then he wasn't religious after that.

"What do you mean by cultural?"

"Well, in some cultures, it's common to circumcise children."

and I was thinking: Well, I'm not sure what culture I'm part of, but it didn't seem like a good reason to me.

"What do you mean by personal reasons?"

"Well, some fathers want their children to look like them."

and I was thinking: Well, those all seem like terrible reasons [to perform destructive genital surgery]; I didn't say that to him.

"Well, could this affect my son's sex life?"

I remember this from 1987; I can tell you exactly what he said:

"The studies are mixed as to that."

"Couldn't my son decide for himself when he grows up?"

"Well, it's best done at birth."

He started to explain why, but by that time, I hadn't heard any good reasons why to circumcise my child, [and] I had made my decision, so we decided to keep [our son] intact.

I really didn't think about the conversation until after the year 2000. Then, one day, I was thinking [about] how odd a conversation it had been, because as a lawyer, you're taught the first week of [studying torts (wrongful or injurious acts for which a victim may seek compensation)]—literally the first week, [and] perhaps the first day—that if you touch somebody without [his or her] consent, it's a battery under the law (not a trivial touching, but certainly a wounding).

The removal of a body part would certainly be a battery—unless it's made valid by parental consent; so, the doctor [had been] telling me that according to the AAP, it's legal for parents to decide for any reason to circumcise their children, [but] it just occurred to me that [such a stance makes] no sense whatsoever—[it just] couldn't be [valid] law! In other words, it seemed extremely unlikely that [parental consent could be] valid [in the case of circumcising a completely healthy child].

I thought about what [the doctor] had said about the studies being mixed as to whether it [affects a man's] sex life to remove a part of the penis. The presumption on my part is that it [does] have an effect, and it couldn't possibly be good; it could only do harm. So, I began to research both the legal side and the factual side.

The more I read, the more I found that circumcision is highly illegal under any aspect of law [at which] you might look, [and] as to the facts [that the doctor had given me], I would say that he had misled me, because he made [circumcision] sound like "a little snip"; he didn't say that there were any risks, whereas it turns out that [circumcision] can kill you (if I'd [consented], my son could've died during the operation). I learned that:

[Circumcision is] excruciatingly painful [for infants]—pain medications are not effective.
The complication rate is very high; the [American Medical Association] says [that] the complication rate is somewhere between 0.8 and 1.8 percent (something to that effect), but they're only talking about complications during the surgery—and I doubt that they're all reported. The general literature says the complication rate is perhaps 2 to 10 percent (that's the number that's often given); it seemed to me that [these figures are] probably low—that probably most people who are circumcised have complications and problems from the surgery. [Indeed], the more I learned, [the more it seemed that my assumption] is correct: Probably 50 percent or more [of circumcised men] have some kind of [unintended] damage.

I submitted two pages of testimony to the Massachusetts legislature arguing that circumcision is illegal on numerous grounds. After submitting that, I decided to [expand my testimony] into a law review article; I've been working on the article [from April] to the present in July, [and] I finished a draft of it. [Because I'm fairly new to the movement], I'm discussing it with other lawyers [who are affiliated with]:

Attorneys for the Rights of the Child
Doctors Opposing Circumcision

I hope to publish [the article] in a law review; the title is:

The Circumcision Debate is Over: It is illegal under common, civil, constitutional, statutory, criminal and international law

Blackstone was an English jurist, and he summarized law in Britain; he stated the common law of England at that time, [and] that [very] common law became the law of America. He essentially said that the primary purpose of law [is] to protect people and property—and of those, the more important [is] "people".

He said that the law of England is that the body is sacred and that people have an inviolable right to their security of the person. So, that's really the origin of the concept that people have a right to genital integrity—[where] "people" means girls, boys, women, and men (without differentiation among them).

[Blackstone] also said that parents have duties toward their children; he did not talk about "parental rights". There's a [nebulous] concept that [parents] have rights with respect to their children—as if [children are] chattels, as it's called in the law: cattle or things. [On the contrary], under the law, parents have duties, and the principal duty is to protect their children from harm.

The common law was adopted in the United States—and, actually, the common law was incorporated [into Massachusetts's] constitution, which I believe preceded the United States' Constitution. [In fact, Massachusetts's] constitution [adopts] the concept of security of the person and [says] that every person is entitled to:

Life
Liberty
The pursuit of happiness
Security of person
A right to property
A right to be free from unreasonable searches and seizures.

So, in the article, I argue that circumcision violates the common law, [and] that it violates the constitutional law (particularly the 5th and 14th [amendments'] right to security of the person and to the related concept of autonomy); you have a right to be left alone and your person to be left alone, so that you can make your own decisions about your own body as an adult when you're able to [do so with fully informed consent].

So, adults are free to make such decisions as they think are best, but there's an inviolable right that children [have] to security of the person. [The circumcision of a healthy child also violates] statutes in every state that prohibit child abuse.

Brigman wrote an article in the mid 1980s, saying that circumcision is child abuse.
Shea Lita Bond wrote an article in the late 1990s after female genital mutilation was banned, saying that under the equal protection clause of the 14th amendment, every person has a right to equal protection of the law; there's a law protecting women from female genital mutilation, [so] then boys [likewise] have a constitutional right to equal protection of the law—that's clearly the case, and if the matter came to the Supreme Court, they would have [to rule that] boys [do indeed have] similar rights, or [otherwise] strike down the female genital mutilation law as unconstitutional.

I argue, as others have, that circumcision is also a violation of the criminal law; it's plainly an assault and battery to hold an infant down on a circumstraint so that he can't move and then violate his body and wound it. It unquestionably qualifies as an assault and battery under the criminal law.

[09] The Cut Podcast: The Effects of Circumcision on Sexuality

2011-11-04T00:59:00.000Z

On Tuesday, September 13, 2011, this recording was made of a conversation between Eliyahu Ungar-Sargon and Aubrey Taylor, whose intacativist work can be viewed at the YouTube channel whatUneverknew.

Transcript
(slightly modified)

Eliyahu Ungar-Sargon:

From the White Letter Productions studios in Los Angeles, California, I'm [Eliyahu] Ungar-Sargon, and this is The Cut Podcast.

I'm sitting here with Aubrey Taylor in Atlanta, Georgia. Aubrey was responsible for organizing the Atlanta leg of The Cut Tour, and she's a very prominent intactivist in her own right.

So, I just thought it would be a really good opportunity to talk to you about some aspects of this issue that don't often get talked about, and I think you're a very interesting person to provide that perspective.

So, why don't we start with you explain[ing] to our audience how you came [to be involved in] this issue, because I find your story to be very interesting and different.

Aubrey Taylor

Of course, you can watch my video (I Love Foreskin), and hear my story there.

I just always intuitively knew [that something about circumcision is bizarre], and then one day when I was about 20 [years old], I found out how [boys actually get circumcised] and the whole reality came crashing in.

I didn't even know how to use a web browser, [but I managed to happen upon information about] circumcision [by] searching; the first thing that came up on the screen was [something like]:

Find out if [the screen name] you want is taken [already]...

or some weird thing like that, so I was like "Circumcision?" I just didn't even know what I was doing, [but] I found circumcision quotes through some [circuitous] back way. My connection was [very slow] dial-up, and [while] I had no access to the video [of a circumcision provided by one site], the audio came through, and [it was just horrendous]—I cried all night. It was horrible and sad.

So, literally, I was [determined] to end [this injustice] before I even knew that there was anybody else out there who cared—[the Intactivist Movement]. I remember talking on the phone with a girlfriend of mine [about it]; I [was] acting on my instinct, telling people:

Yeah, [this circumcision thing is] not really cool; I mean, it's a normal body part! Why do you want to cut that off?

[Unfortunately], I didn't have any [powerful knowledge] or anything to back me up, and people [just disregarded me].

One guy early on told me [foreskin is] just dead skin, [which I found to be just a baffling and obviously ridiculous response]. So, I was really passionate about it before I had any experience or education or anything; [my activism has] always been just because I am that kind of person—I see something that's messed up, and I'm all about fixing it.

Eliyahu Ungar-Sargon

Now, you talk in your video about how your experience of men—both with foreskin and circumcised—helped to reinforce your views on this. Can you talk a little bit about that and how that came about and what that meant.

Aubrey Taylor

Yeah, [the first intact man I experienced] might have been my third penis exposure, [and] it was literally like all the pieces of the [sexual] puzzle just [fell] into place—the realization was immediate; I stroked his penis and I thought:

Oh my god! I know why I [have been] uncomfortable—[what has been missing from sex]!

It was just so natural and so exactly what needed to be there that there was no question to me [that circumcision is damaging]; it was amazing at the same time to think:

How can anybody else not see the obvious?

Eliyahu Ungar-Sargon

Yeah. I mean, the reason I'm sort of bringing this up is there's a perception out there—especially [in American] culture—that women prefer circumcised men. So, it's just striking to hear testimony from a woman who really doesn't have that view.

So, I was wondering if you could just talk a little bit about that. Now, of course, it's sort of on a [lower] order than the sorts of [detrimental effects] that people talk about from a male perspective, but it does seem to be a peripheral effect that [circumcision does negatively] affect the sexual experience of [a circumcised man's] partner—

Aubrey Taylor

Right. Definitely. I think it does.

I mean, I understand that I am a particularly sensitive person, and I'm a particularly attentive person, and not everybody is that way and that's fine but I do get a little baffled when women say that they have experienced both and either they think it's fine either way or whatever.

Of course, I've met lots of women who say they prefer foreskin, but for your average woman who's like:

Ewww! [Foreskins are] nasty!

I think that's really just [a matter of] experience—for a lot of people, what's considered to be normal has kind of a hold on them and the way that they allow themselves maybe to think about things. So, [that kind of reaction is really] just a mix of inexperience and the way that our society is; [people] fit into the [existing] groove and go with what's there.

I don't blame [such] women for their attitude, because it's just like, you know, if you saw somebody walking down the street without eyebrows, you'd be like "What the [heck]?" You know, you'd kind of be taken aback, and it would be abnormal to you. So, that's what [a complete penis] is to them.

Of course, I [speak] out against allowing that reaction [to justify cutting] a part off of somebody else's body—that's just not acceptable.

Eliyahu Ungar-Sargon

So, you think [such women's attitude is] just a matter of there [being] fewer intact men than circumcised men [in the United States], and it's just a matter of familiarity?

Aubrey Taylor

I think it's totally all about that—exposure. Mona Lisa was beautiful in her time—[but she] had no eyebrows! So, you know, it's just what you know and what you're comfortable with. [While this aspect] may be something that people [bring up] right away when they are defending circumcision, I don't think [that it's] the real stronghold for when it comes right down to the decision making.

Eliyahu Ungar-Sargon

Right, but it may actually affect a man's decision when [he] know[s] that there are women out there who actually do prefer the foreskin and that there are sexual benefits to having sex with a foreskin.

Can you talk a little bit about that. You know, you say you love the foreskin—

Aubrey Taylor

I do. I love the foreskin—

Eliyahu Ungar-Sargon

So, just talk a little bit in more detail about [that]—we'll earn our explicit tag on this podcast!

Aubrey Taylor

I love foreskin for a lot of really subtle, intimate reasons.

I'm sure it's physical, but a lot of it is psychological. Of course, so much about sex is psychological; I was listening to your other podcast, and you said something that [you found to be an amazing thought is the notion of] the internalization of the penis—that [a complete penis is] more feminine, and that circumcision really externalizes and masculinizes [the penis]. [Well], there is this soft, subtle [aspect to] the intact penis.

It's more intimate
it's almost vulnerable.
It's softer.
It has a more organic smell.

It's knowing that it's an internal structure—and of course, I'm the kind of person who totally dissects [her] psychology, so maybe other people will not know what I'm talking about (or maybe never recognized it), but [sexual intimacy with an intact penis makes it] like you're dealing with a very fragile thing; to me, intimacy is a delicate thing—not to say that it can't be wild and crazy! but an intact man is just a little more subtle—you can't be rough [with his penis] the way you are with [a man who was circumcised]—the way you [almost] have to be sometimes with a circumcised penis—because [a complete penis has] more delicate tissue; it hasn't been keratinized, so you can't just take your dry fingers and rub on an intact glans, because [the man would respond with]:

Aaahh! What are you doing? Stop!

It's like you have to treat an intact penis the way you would treat your clitoris—you don't just go on with dry fingers and start rubbing on it; you treat it softer.

Truly, I think, in my experience, intact men are a lot more responsive; the [subtlest] things that you do make him respond, whereas with a circumcised man, you kind of have to really do something to kind of get a reaction. So, what [having a complete penis] does, I think, is it slows everything down—and of course, you've heard that [sexual] advice "to do everything half as fast and twice as soft" or something; so, [having a complete penis] slows everything down. It's just softer, more subtle—

Eliyahu Ungar-Sargon

Well, if I can just jump in here, it's really something I've always wondered about: You circumcise most of the guys in a country, and then there's this [artifically imposed difference] between male sexuality and female sexuality—

Aubrey Taylor

Yes—

Eliyahu Ungar-Sargon

And, again, we're in a realm that science has yet to really dissect properly—and I want to be very clear about that: We're not on firm empirical ground here; we're speculating, [and] that's all right, because this is a podcast, and that's what podcasts are meant for!

Aubrey Taylor

Right, and this is my personal experience.

Eliyahu Ungar-Sargon

That's right; exactly.

I've always wondered [whether] a lot of the differences between male and female sexuality that you see in popular culture—that are sort of assumed [to be the natural dynamic]—are actually the difference between circumcised sexuality and intact sexuality.

Aubrey Taylor

Absolutely! I agree with that 100%.

In my opinion, if you cut off part of someone's sexual organ, you're going to create a sexual dysfunction. The underlying automatic assumptions that we have [in our society] about what men prefer [sexually] and what women prefer [sexually], I think, are really just reactions [to the consequences of circumcision]. Maybe [men] don't like different things because they're men; maybe they like different things because they are circumcised.

[We hear about how] women always want [men] to slow the hell down [during sex], but [that's not an issue] when you're with an intact man; I mean, [an intact man has] probably never been barked at about that kind [of thing]—I don't mean to say [that's] 100% [true], but yeah, I think when you do [something like circumcision to most of the men in a society], you have these problems—not only do you have the problems, but then you have the assumptions that come after the problems, and then you have the assumed proper solution to the problem; it's just layer upon layer of effect that you have. [For instance]:

We've got an automatic assumption that the woman is supposed to supply the lubrication—not necessarily so! Intact men supply a lot of [liquid and mechanical] lubrication, something people [in our culture] really don't know about.
[We] have the automatic assumption that men are always going to want rougher sex, and because of that, women have grown this sort of psychological [coping mechanism]: [They] feel like they're being the pleaser—you know, they're stepping up to the plate—if they're the kind of girl [who] likes rough sex—I'm not saying [such an attitude is necessarily] disingenuous, but I'm saying there's an automatic underlying response that to be a [sexy] kind of chick, you [must be interested in various fetishes] or you [must like] your sex a little rougher, and [somehow] that makes you the more sexually attractive kind of woman.

So, there [are effects], and then there's the woman's response to all of these effects. I think [circumcision] really does draw us further and further away from what might really be making us happier as far as our sexual relationships go.

Eliyahu Ungar-Sargon

That's really interesting; what we're talking about essentially right now are the ripple-effects of what culturally we might think is a very small change to [the] form [of the penis]—of course, those of us who are familiar with the effects of circumcision on the penis know that it's not (it's a pretty radical change)—but what [cultural attitudes tell us should be] a small change [in fact] has a [very] large ripple-effect.

You're getting now into some very interesting territory: What are the cultural impacts of that [ripple-effect]? I think this point that you bring up about women and what they think they need to be in order to be sexually attractive—

Aubrey Taylor

Whereas normal sex is here, circumcised sex is [there], and so women feel like:

OK, I'm gravitating as if this were normal sex; I'm going to be this way [in order to be sexually pleasing].

It has an effect on everybody's perception, because sex is kind of a public [topic]—I mean, there are some public awarenesses and underlying assumptions that everybody has [about sex], [which] come from conversation or whatever. So, if a woman is used to treating a [circumcised] penis a certain way, and then she goes and interacts with an intact man, she might be too aggressive or something.

I had to learn that myself. Well, it didn't take me much to learn it—I kind of knew it instinctively—but there was definitely an adjustment to be made in the way that [I handled] the two different [types of penis].

[Also]—and it's not a guarantee, [as] everbody is different—[an intact man], too, I think has a subtle understanding about the way that he needs to treat a woman's genitals, because he does have internal genitals himself. [In contrast], a circumcised man treats his genitals rougher, so he's [maybe] not really realizing [that, for example, using dry fingers is] not really the best [for a woman]. An intact man knows you don't put dry skin on mucosal tissue, because it's irritating. So, it's just a tiny, subtle, thing; maybe they don't even realize that they're aware of it, but—

Eliyahu Ungar-Sargon

That's very interesting too, because it would seem then [that] you're suggesting that a lot of what happens in sex comes from a sort of reflection on what feels good to [oneself]—

Aubrey Taylor

Yeah, totally—

Eliyahu Ungar-Sargon

and if you're a person who has altered genitals, what feels good to you is not what's going to be the same thing as what feels good to someone who has unaltered—intact—genitals.

Aubrey Taylor

Exactly.

Of course, like I said, I think a large part of sex is psychological. So, [there's] not just the [worry about the] ripple-effect of the physical action and how [sex] changes, but [also] I truly believe that causing a very young infant to go through an extremely traumatizing experience has a real effect on his abilities:

to trust.
to be open.
to be vulnerable.

There's a certain connection—not [with] your basic one-night-stand that is all about the physical pleasure, of course, but I mean a real connection with your lover that is supposed to occur, because you're putting your internal, vulnerable body part inside the other person—their internal, vulnerable place. So, I think it's supposed to be a place where you let everything go, and you let down your guards, and you connect with that person in a place where you don't have fronts and whatever.

If you have a wound imposed on you in that place at a very developmentally sensitive time—I mean, I'm no science major or whatever; I'm no psychologist, but it just seems [obvious] to me that [something like forcible, traumatic, destructive genital surgery often without any pain control] is going to interfere with that natural process of bonding and letting go when it's there in the back [of your mind], in a place you can't even reach—that real subconscious place, where you [don't] even know how your patterns have been set and altered.

I don't know about divorce rates in other countries, but to me, it seems like [circumcision] would make it harder [for 2 people] to connect, and I've found that I have had a harder time connecting in that real intimate way with men who are circumcised.

[Of course], sure it could be my predisposed ideas about how circumcision ruins everything, but you know, I've spent a lot of time thinking about it, and honestly, I have had that experience. So, I don't think it's just me wanting to blame everything on circumcision.

Eliyahu Ungar-Sargon

Do you have any advice for intact men in [the United States]? From your perspective, [do you have] any advice for them on how they should go about going through life as what is an anomaly in our society?

Aubrey Taylor

Yeah. I think it's unfortunate that a lot of intact men feel shy; [often] they've kind of prepared for women to say something nasty about their genitals, and that's terrible. It may very well happen, so be prepared, but I think confidence is, as usual, the best advice for anybody—be confident!

Really, I think, if you are the one to decide how the woman is going to perceive your genitals, I think she will respond [positively]; I think if you're confident about your foreskin and you know why [you can be confident], it's good. You come across a woman, and whatever her reaction might be, she's going to perceive your level of confidence there and respond [accordingly], [so] come to the [bed] with:

I've got the best!

which is difficult, but [it's important to know] that there's [really] a reason why you've biologically evolved to be this way, and [to understand] that her [preconceived] perspective is one that's been given to her essentially because she's been denied [exposure to a complete penis] and she's been fed these ideas from society—that she's going to respond in some way to your genitals, but [that] you set the tone. You decide that you know why things are the way they are and that it is good, and I think things will be smoother.

Eliyahu Ungar-Sargon

A lot of guys are going to be listening to this who are cut—circumcised men—and some of them may not be completely in touch with the anger that some feel about this [issue], but as they become exposed to this information, they may become [angrier]—become more despondent and feel sexually inadequate as a result of it. Do you have any advice for those men?

Aubrey Taylor

I do. Take your time. Don't feel like you're being pressured to feel any particular way about your personal situation; everybody has a different reaction, everybody absorbs the information in their own way, in their own time. Some men get mad right away. Some men understand and are a little more stoic.

Intactivism is full of angry people—and rightly so—but it's unfortunate that anger can kind of get in the way, and it kind of makes people feel like they're being pressured to feel a certain way. So, just absorb [the information] the way that you can, and be prepared that you might have a negative reaction once you accept the facts.

[However], I truly was saved that night when I was crying and totally distraught because I actually found a web page about foreskin restoration that same night, [which gave me hope]—just knowing that men have the option to take some action [and] to make something different. Even if [restoration doesn't] affect their sensitivity in any way, it's still just for their psychological state:

I can have my body the way I want it.
I can do something about this.
I can at least have a physical covering over my penis the way it was intended.

I mean, [this hope] just saved me—I mean, I was just so distraught, and that was like one tiny little glimmer of light, and so if it does that for me, I would imagine that it would do that for a lot of men. So, even if you think it's hokey—even if you think it's something that only the crazy fringe do, or whatever—have a poke around the Internet. Google "foreskin restoration" and just read what other men have had to say about it, because it's not just the physical thing, I think; it's truly about saying:

It's my body, and it will be the way I want it (or it will be the way I was born, etc.).

Maybe you'll look and decide that you don't want it, but at least you've been there and you know that [you may still have some kind of choice].

The reason that foreskin amputation is wrong is not necessarily about everybody's opinion of what's good or what's bad or whatever; it's that you ought to have the choice [over your own body.]

Eliyahu Ungar-Sargon

Aubrey Taylor, thank you so much for joining us on The Cut Podcast.

Where can people find your work?

Aubrey Taylor

Well, I am Aubrey Taylor on Facebook, [and] I do have a YouTube channel, whatUneverknew.

Eliyahu Ungar-Sargon

That's our show; if you have any questions, comments, or suggestions, please email them to us at:

cutdocumentary AT gmail (.) com

If you like what you heard today, please support us by buying our film at:

www.cutthefilm.com

Aubrey Taylor: a Circumcised Penis means Circumcised Sex

2011-11-04T00:54:00.000Z

Aubrey Taylor is an intactivist based in Atlanta, Georgia. She runs the YouTube channel whatUneverknew.

In the following video, Aubrey expresses the fact that circumcision can diminish the quality of sexual intimacy for both partners, and that plenty of women love foreskin—even in cultures where circumcision is currently prevalent (like in Aubrey's country, the United States).

She continues this conversation with Eliyahu Ungar-Sargon.

Transcript
(slightly modified)

I wrote something really personal, and usually I kind of stay away from that [sort of thing]. As far as my [YouTube] channel goes, I don't really bring my opinion or my personal life into what I'm trying to do here, because it doesn't matter; when it comes to respecting equal rights, nobody's opinion matters—rights are decided by equality, [while] opinions are [inherently] different for everyone.

[However], I know that there is sort of this idea out there that if a man has foreskin, he won't be able to get laid or [get] a blow job or whatever. So, the reason that I'm going to read this personal thing that I wrote is not to make anybody feel good or make anybody feel bad (though, if you feel good, that's great! and if you feel bad, I'm very sorry). The purpose is to dispel [some myths]:

The myth that foreskins are nasty and all women hate them.
The myth that [circumcision doesn't change] the penis or sex.

[This personal account of mine] was published on [Restoring Tally's blog].

This is how it goes:

I LOVE foreskin. I wish that were all I [have] to say. Unfortunately, there's a comparison to be made; it isn't [the case that the foreskin is part of just] one of two different naturally occurring [types of penis]; if it were, I wouldn't bother to tell people why I [like] one and not the other. But, because there is force involved [in circumcising people]—I'm campaigning against the forced circumcision of infants—I must also say that I can't fully enjoy circumcised sex, and why.

This is my personal opinion—not something that anyone has to agree with in order to understand that forced circumcision is wrong; it is just another example of how forcing amputation on one body affects more people than just the one who [is] cut.

When I first became sexually active, I wasn't comfortable touching my boyfriend's [circumcised] penis; something was just wrong about it. Even though he said he enjoyed it, I felt that what I was doing must be painful; I didn't know how hard my touch should be, and the friction creeped me out in a way I didn't even understand.

All it took was ONE stroke of an intact penis—[a penis with foreskin]—and I understood everything! There was no hesitation or worry that I was doing something wrong; it was sexy and fluid. I realized that there [is] a big difference and I started paying attention. I've been lucky that a good percentage of my lovers have been intact, and this is what I've learned about myself and both types of [penis].

Feeling connected is what I enjoy the most about sex. In fact, it's probably 80% of my arousal. Intimacy is the point; the physical acts are just how I get there. So, if I don't feel connected, the physical act is literally less pleasurable.

I am really oral [with my sexuality], meaning [that] using my mouth is a huge sexual turn on for me. There is something incredibly intimate about it (this is why I cannot date a smoker; kissing should be deep and sexy, and the taste of unhealthy lungs really gets in the way of that).

When I am giving head, I am not performing a service for the sole purpose of stimulating the penis. I am connecting, and making love with my mouth. I am right there, enjoying everything in the moment: I love to look at it, and smell it, and feel it, and taste it—I'm engaging in a dance with lots of different moves. If the foreskin is gone, my dance has fewer moves; that's less enjoyable, but not actually the problem.

I'm a very compassionate person. That's why I speak out against violating human rights. I see a crime against someone's rights almost as a crime against myself. I'm sensitive, and the idea of pain causes me distress. The idea of a baby being forced to endure pain... well, you get the point.

When I discovered how a circumcision [is] achieved, I was VERY disturbed ([I] cried all night). After that, when I gave head to a man who had been circumcised, the physical proof of the torture he [had] endured as an infant (a scar instead of a foreskin, and possibly other damage) was an immediate mood kill. How could I connect with that?

[In order to enjoy circumcised sex], I quite literally had to regress myself to an immature place—I had to [become the person I had been] before I understood how circumcision [is] done.

I had to forget what I had learned for a little while.
I had to forget what I was seeing when I wanted to connect [visually].
I had to forget what I felt when I wanted to feel.

This was like a numbing of my senses—a wall against reality. [Nevertheless], it worked, and I was able to feel connected and enjoy myself, but I was pretending to be a different person. It wasn't [I who was] connecting; it was the [I] of a few months or years before.

As I [have been] further removed from that person by time and change, that task has become harder and harder. The intimacy in that moment is about being fully immersed in the other person's body. Trying to connect with a constant reminder of parts being forcibly removed from a screaming infant is impossible. Finding [that naive self] inside me who can [ignore these facts] is now so difficult [that] I'm tired of trying.

The changes [that] circumcision brings to sex are drastic and vast. I won't state them all here, but I'll go over the mechanical ones that affect me the most.

The foreskin has tens of thousands of nerve endings. When it is pulled back, the man has sensation down his shaft, so his strokes [during coitus] are deep and short, which keeps the partners close and intimate. [In contrast], a circumcised man usually wants to stimulate [the pressure sensitive head of his penis] by pulling it out to the tighter vaginal opening, because [the head] is the most sensitive part of the penis after the foreskin is removed; these longer strokes create a feeling of being further away, and can cause air to be pulled into the vagina (something I hate). [NOTE: This observation is corroborated by this study:

Respondents overwhelmingly concurred that the mechanics of coitus was different for the two groups of men. Of the women, 73% reported that circumcised men tend to thrust harder and deeper, using elongated strokes, while unaltered men by comparison tended to thrust more gently, to have shorter thrusts, and tended to be in contact with the mons pubis and clitoris more, according to 71% of the respondents.]
One little difference that I've noticed between circumcised men and intact men is that the intact man tends to have way way way more pre-cum; I can't imagine why that would be. I've only met one circumcised guy who had copious amounts of pre-cum, and very rarily have I engaged with an intact man who didn't have a lot of pre-cum. I've never found anything out as to why that would be, so I don't really have a guess, but it is something that I've noted: [A good amount of pre-cum] is something that really aids in sex—for a man to bring his own lubrication is a big deal.
Once the man has [fully] penetrated [the vagina], the [foreskin] is pulled back to the base of the penis; when there's outward motion, [it is] the foreskin (NOT the vaginal [tissue]) that slides [with respect to] the penis. This [buffer between the sliding penis and the vaginal walls] keeps the [wetness] inside [the vagina]; without the foreskin, [the wetness] is dragged out with every movement and exposed to the air where it dries.
Not only is there a risk of drying [during circumcised sex], but there's [irritating] friction, too; the sexually responsive nerves in the vagina are pressure sensitive, not friction sensitive. So, while some women may find friction to be a psychologically arousing sensation [because it] draws their attention to what's going on down there, I find it distracting and often painful.

When I am distracted by all of these uncomfortable sensations and worries, then I am not really connected; I'm not really there. I'm dealing with the stress of the situation in my head instead of being intimate. So, since intimacy is a big part of what makes my sensations pleasurable, then I'm just not feeling as good (sometimes to the point of [sex] not feeling good at all)—and don't forget: All of these differences remind me of WHY—and I'm back again to screaming babies.

It breaks my heart to think that what I have to say would make a man feel bad—discovering the truth was a pretty dark and painful moment for me, but luckily I found out about foreskin restoration that same night (see TLCTugger.com and NORM.org). It gave me the tiniest bit of solace to know that a man who feels this loss can do something about it—I know it's not a perfect fix, but when I have to be the bearer of bad news to a man who doesn't know what he's lost, I'm so grateful that I can give [that news] to him wrapped in the bright side: It can get better!

Naturally, there's [variation] in all men (circumcised or not) and there are lots of other things that make sex good or bad. I am not saying that all intact men are fantastic lovers or that all circumcised men are terrible lovers. What I'm saying is that all other things being equal, this is what I find to be the difference.

For a lot of women, the issues here may not affect them as much—or at all. [However], I have to honestly say that as the genital integrity movement grows, more and more women are realizing why they have at times found sex to be uncomfortable or painful. I'm sharing this because it's the truth, and because it obviously needs to be said; there [are these myths] out there [that need] to be dispelled. It needs to be shown that the pain of circumcision isn't momentary or [even] exclusive to the circumcised.

So, PLEASE do not amputate part of your son's penis because you believe that foreskin will have a negative impact on his sex life. [In fact, amputating his foreskin might well be the thing that actually has a negative impact on his sex life].