I just finished my first week back on the labor and delivery service and happened to be on call on Saturday. As we were discussing patients in the workroom my senior resident inquired if I had asked a patient whether or not she wanted her son circumcised. I replied that I had not asked and that I would not be asking that question of anyone in the future. Well sparks flew!
At this particular hospital infant male circumcision has become so institutionalized that it is treated almost as casually as a fast food worker asking, “Do you want fries with that?” “So you had a boy, huh? You want a circ with that?” On one hand we are appalled at the female circumcision that so many of our Somali patients have undergone yet we barely bat an eye at the other. Why are we so horrified by the surgical modification of female genitalia by another culture when we are so flippant about surgically modifying the genitals of our own infant boys?
So what is female circumcision anyway? It is a procedure done in parts of Africa, Asia and the Middle East where as little as the clitoral hood to as much as the entire clitoris and labia are excised. What little tissue remains after this procedure grows together (often aided by leg binding) sometimes leaving a hole so small that sexual intercourse is physically impossible. In the U.S. we code it as “female genital mutilation” but of course no such verbiage is used with infant male circumcision. Now granted, I completely understand that cutting off some penis skin is not nearly as morbid as cutting off a clitoris. But less bad is still bad! Both procedures are forcefully performed without the consent of the individual receiving it and both have permanent consequences.
Many physicians and new parents justify their decision to participate in infant male circumcision for social or religious reasons. Others speak to its public health merit in reducing the transmission of HPV (the virus that causes cervical cancer in women) and HIV (the virus that causes AIDS). Yet all of these excuses (and yes, they are excuses) fail to consider the rights of the people involved. Infant boys are clearly unable to provide informed consent. Period.
One of the four ethical principles to which we prescribe as physicians is “Autonomy” – the right of each patient to make informed medical decisions regarding his/her own care. Also within the Hippocratic oath we take is the principle “First, do no harm.” It is impossible to honor these guiding ideals while performing circumcision or any other elective cosmetic genital surgery on infants and children.
And why are OB/GYN providers doing circumcisions anyway? For a specialty that prides itself on treating women only it is quite surprising how many providers perform this little side gig on infant boys. What infant penises have to do with women’s health I’ll never understand.
So what happened with my refusal to participate? Well I met with the residency program director today who affirmed my right to refrain from participating in procedures I am morally opposed to. I will not be forced to ask patients if they want us to maim their sons. I will continue to wear my Genital Autonomy badge with honor and I will continue to throw wrenches at the gears of status quo.
- 10/19/11 – Georganne Chapin – End the barbaric cutting of baby boys
- 9/3/11 – Newborn male infant circumcision declining in U.S. says CDC
- 6/24/11 – The professional imperative for obstetrician-gynecologists to discontinue newborn male circumcision.
- 6/4/11 – End genital mutilation now
- 11/26/10 – Doctor and hospital sued for circumcision
- 9/26/10 – Are you REALLY SURE you want your OB/GYN to cut your little boy?
- 3/24/10 – Say NO to infant male circumcision!