Tag Archives: Intactivism

Advocating for personal choice (also known as autonomy) with regard to elective genital surgeries. The following are examples of unnecessary genital surgeries that are usually performed without the consent of the person receiving it: female circumcision (female genital mutilation), infant male circumcision (male genital mutilation) and “cosmetic” genital surgeries for infants and children with intersex/DSD conditions.

Georganne Chapin – End the barbaric cutting of baby boys

Georganne Chapin, NYDailyNews.com, reports that the deranged bill banning the ban on newborn circumcision was recently signed into California state law by governor Jerry Brown. This a powerful whack-a-mole response from overzealous legislators with regard to a ballot proposal floated earlier this year (see my related post, End genital mutilation now). It wasn’t enough that a Superior Judge ordered the initiative off the ballot. Legislators too wanted their chance to thumb their noses at California public opinion and succeeded. Screw the populace!

In her piece, Georganne takes on several of the common excuses people throw around to condone and continue the archaic disfigurement of infant genitalia. Is it really so hard to see that circumcision is at best a cosmetic procedure performed in the absence of patient consent? The foreskin has a role in the health of the body and circumcision quite literally RIPS IT OFF. While severe complications including penile amputation and infant death are rare, it cannot be said loud enough that EVERY CIRCUMCISION IS DESTRUCTIVE.

It is truly a sad day for Californians that their collective voice has been silenced with regard to this issue. Apparently their legislators feel that they are either too ignorant or too profane to permit public debate.

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Newborn male infant circumcision declining in U.S. says CDC

Centers for Disease Control and Prevention reports that newborn male circumcision (NMC) is on the decline in the U.S. as evidenced by 3 separate studies: the National Hospital Discharge Survey (NHDS), the Nationwide Inpatient Sample (NIS) and the Charge Data Master (CDM). Incidence of NMC decreased from 62.5% in 1999 to 56.9% in 2008 in NHDS (AAPC = -1.4%; p<0.001), from 63.5% in 1999 to 56.3% in 2008 in NIS (AAPC = -1.2%; p<0.001), and from 58.4% in 2001 to 54.7% in 2010 in CDM (AAPC = -0.75%; p<0.001).

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Medical misogyny

Girls can wear jeans
And cut their hair short
Wear shirts and boots
‘Cause it’s OK to be a boy
But for a boy to look like a girl is degrading
‘Cause you think that being a girl is degrading
          – Madonna, “What It feels Like For A Girl”

I am a bit of a news junkie and because of my habit I am repeatedly angered by the ongoing abuse of women around the world: rape for “correction” or as a “weapon of war”, mutilation and honor killings are but a few examples. However a couple of topics in recent weeks have actually made my jaw drop, not because the harm sustained by the affected women was any greater but because of the misuse of medicine and surgical skill to further misogynistic schemes. In India, the selective abortion of female fetuses is nothing new but in select locations and for the right price parents can find physicians who will surgically change their little girls into boys. In the US, the rights of the fetus seem to be surpassing women’s rights given that women have become prisoners within hospitals, undergone surgery without their consent and have even been charged with murder over fetal well-being. These cases demonstrate the pervasiveness of misogyny and the degradation of medicine by its collaborators.

Girls to men

Baby boys naturally outnumber baby girls by around 6%; in other words, for every 100 girls born there are 106 boys that accompany them. Perhaps this is a good thing given that nearly everywhere people seem to prefer boys over girls. Clara Kim, Time NewsFeed, reports “Contrary to the stereotypical notion, girl bias or boy obsession isn’t limited just to Asia. A Gallup poll shows that such a mindset is prevalent in the U.S., too and has been for at least 70 years. The poll asked 1,020 American adults, if they could have only one child, which gender they would prefer. Forty percent of the participants said a boy, while 28% answered a girl. This is not much different from the first poll results in 1941, which were 38% and 24%.” But while Americans are for the most part content to raise whichever gender comes their way, other cultures take a more active role in increasing the rate of male births.

S V Subramanian, a Professor at Harvard School of Public Heath, published in 2009 that “according to the most recent census, for every 1000 males, there were only 933 females, and the corresponding ratio for ages 0–6 years was 927 girls for every 1000 boys. The disproportionate distribution of sexes, at least in more recent years, has been surmised to be driven largely through the use of medical technologies by physicians and prospective parents to determine the sex of fetuses followed by selective abortion of female fetuses. This explanation was initially suggested in the 1980s, and has gained considerable acceptance since then. Some 10 million female fetuses are estimated to have been aborted over the last two decades in India.” By these numbers it appears that there are around 8% more boys than girls among the youngest generation of India and that 2 of every 100 pregnant women with female fetuses choose to abort based on fetal sex alone.

And now there is another way to ensure male offspring. Amrita Kadam of Hindustan Times, India reports that “Girls are being ‘converted’ into boys in Indore – by the hundreds every year – at ages where they cannot give their consent for this life-changing operation. This shocking, unprecedented trend, catering to the fetish for a son, is unfolding at conservative Indore’s well-known clinics and hospitals on children who are 1-5 years old. The process being used to ‘produce’ a male child from a female is known as genitoplasty. Each surgery costs Rs 1.5 lakh [~$3400 US dollars]. Moreover, these children are pumped with hormonal treatment as part of the sex change procedure that may be irreversible. The low cost of surgery and the relatively easy and unobtrusive way of getting it done in this city attracts parents from Delhi and Mumbai to get their child surgically ‘corrected’.”

Dean Nelson of The Telegraph, UK reports that “Indian doctors have been accused of conducting sex change operations on young girls whose parents want sons to improve the family’s income prospects.” It’s not just a preference for boys that is driving the femicide, it is also money. “People don’t want to share their property or invest in girls’ education or pay dowries.” Regardless of parental motivation there remains the doctors’ compliance and lives destroyed by it.

Contrary to Dr John Money’s debunked theory that gender identity is flexible to the whims of social upbringing, medical observation as well as experimentation have proven that gender identity is not malleable. David Reimer was one of Dr Money’s greatest success stories until the truth about his life became known. David’s story began with a botched circumcision that destroyed his infant penis followed by his parents decision to follow Dr Money’s advice to surgically reassign his sex and to raise him as a girl. Unfortunately, David never accepted his forced female gender role and began living as a male at the age of 15. He continued to suffer years of severe depression, financial instability, a dissolving marriage and eventually committed suicide in 2005. His tragic story is catalogued in the bestseller biography: “As Nature Made Him: The Boy Who Was Raised as a Girl” by John Colapinto.

Similarly in Palestine, teenage girls with an intersex/DSD condition that masculinizes them at puberty may be forced to change their clothes and present themselves as boys but their core identities do not change. “‘Only my appearance, my haircut and clothing, makes me look like a boy,’ Ahmed says, gesturing with his hands across his face. ‘Inside, I am like a female. I am a girl.'”

Modification of body parts by physicians without medical indication and without the consent of the person receiving it is tragic and should be criminalized. This is especially true of the sex organs given that at best, surgery permanently alters cosmetic appearance, sensitivity and sexual function. At worst, surgery can result in horrific disfiguration and/or death. Given these risks I strongly believe that non-medically indicated genital surgeries, including circumcision, should be banned for all minors.

Fetal incubator

As if unemployment, home foreclosures and ongoing wars in Iraq and Afghanistan weren’t enough to keep our legislators occupied, the Republican War on Women continues to escalate. According to the Associated Press as reported by MSNBC:

  • “In 1987, a Washington, D.C., judge ordered a woman who was dying of cancer to have a C-section, which she had refused, to save her fetus. The baby died within two hours of delivery and the mother died two days later. An appeals court later ruled the judge should not have ordered the C-section.
  • “In 2003, prosecutors in Salt Lake City charged an acknowledged cocaine addict who had a history of mental health problems with murder when she refused to have a C-section for two weeks before finally agreeing to the procedure. One of her twins died in the womb during the delay. Through a plea deal, the charge was later reduced to child endangerment.
  • “In 2004, a hospital in Wilkes-Barre, Pennsylvania, obtained a court order to force a woman to have a C-section because her seventh baby was oversized, but the order was too late. The mother, whose first six children each weighed nearly 12 pounds (5 1/2 kilograms) at birth, went to another hospital and delivered a nearly 12-pound girl naturally.
  • “Also in 2004, a judge in Rochester, New York, ordered a homeless woman not to get pregnant again without court approval after she lost custody of several neglected children.”

In 2009, Wikipedia records that “Samantha Burton, a mother of two, was twenty-five weeks pregnant in March of 2009 when she experienced a premature rupture of membranes and displayed signs of premature labor. At the urging of her obstetrician, she sought care at Tallahassee Memorial Hospital. She found not to be in labor, but ordered to remain on bed rest. Her obstetrician, Dr. Jana Bures-Forsthoefel, refused to allow her to leave the hospital to garner a second opinion and then obtained a court order from the Circuit Court of Leon County which required Burton to undergo “any and all medical treatments” that her physician, acting in the interests of the fetus, deemed necessary. The Court held the hearing by telephone with Burton being required to argue her case from her hospital bed without the assistance of an attorney or independent medical opinion. Three days into her court-ordered confinement, Burton underwent an emergency C-section, at which time the fetus was found to be dead.”

In 2010, a law was enacted in Utah that criminalizes unacceptable forms of miscarriage. According to David Usborne of The Independent, UK, “While the main thrust of the law is to enable prosecutors in the majority-Mormon state to pursue women who seek illegal, unsupervised forms of abortion, it includes a provision that could trigger murder charges against women found guilty of an “intentional, knowing or reckless act” that leads to a miscarriage. Some say this could include drinking one glass of wine too many, walking on an icy pavement or skiing.” The 17-year-old whose case ignited the discussion that led to the law is currently defending herself before the Utah Supreme Court.

In 2011, NARAL Pro-Choice America reports that “We are tracking 470 anti-choice bills in 2011 — nearly three times as many as last year.”

And finally, according to MoveOn’s Top 10 Shocking Attacks from the GOP’s War on Women:

  1. Republicans not only want to reduce women’s access to abortion care, they’re actually trying to redefine rape. After a major backlash, they promised to stop. But they haven’t yet. Shocker.
  2. A state legislator in Georgia wants to change the legal term for victims of rape, stalking, and domestic violence to “accuser.” But victims of other less gendered crimes, like burglary, would remain “victims.”
  3. In South Dakota, Republicans proposed a bill that could make it legal to murder a doctor who provides abortion care. (Yep, for real.)
  4. Republicans want to cut nearly a billion dollars of food and other aid to low-income pregnant women, mothers, babies, and kids.
  5. In Congress, Republicans have a bill that would let hospitals allow a woman to die rather than perform an abortion necessary to save her life.
  6. Maryland Republicans ended all county money for a low-income kids’ preschool program. Why? No need, they said. Women should really be home with the kids, not out working.
  7. And at the federal level, Republicans want to cut that same program, Head Start, by $1 billion. That means over 200,000 kids could lose their spots in preschool.
  8. Two-thirds of the elderly poor are women, and Republicans are taking aim at them too. A spending bill would cut funding for employment services, meals, and housing for senior citizens.
  9. Congress just voted for a Republican amendment to cut all federal funding from Planned Parenthood health centers, one of the most trusted providers of basic health care and family planning in our country.
  10. And if that wasn’t enough, Republicans are pushing to eliminate all funds for the only federal family planning program. (For humans. But Republican Dan Burton has a bill to provide contraception for wild horses. You can’t make this stuff up).

Summary

The abuse of women is atrocious in any form but utterly unacceptable within the medical community. It is incomprehensible that physicians would tinker with the genitalia and sex of rearing of innocent little girls given the scientific evidence we already have regarding gender identity formation and durability. It is also unacceptable for physicians to debase women to the level of fetal incubators. End genital mutilation and no wire hangers, ever!

The professional imperative for obstetrician-gynecologists to discontinue newborn male circumcision.

The professional imperative for obstetrician-gynecologists to discontinue newborn male circumcision.

Smith JF, Department of Obstetrics and Gynecology, New York Medical College, Westchester Medical Center, Valhalla, USA
Am J Perinatol. 2011 Feb;28(2):125-8. Epub 2010 Aug 10.

Abstract

Newborn male circumcision has been practiced for millennia for a variety of medical, social, religious, and cultural reasons. Indications for routine circumcision remain controversial, with proponents and dissidents arguing their sides vigorously. Popular in the United States, it has persisted in the scope of practice of obstetrics and gynecology, a field specializing in the opposite gender. To excel in women’s reproductive health, we should no longer passively accept or actively maintain this procedure in our specialty. Steps are suggested to remove the residual and improper inclusion of circumcision from the scope of practice of obstetrics and gynecology.

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End genital mutilation now

Ever hear about genital mutilation? Well it happens every day to babies and children around the world including the USA. According to the 2011 US bill, the Genital Mutilation Prohibition Act submitted to the US Senate and House of Representatives, “genital mutilation” is defined as circumcision, excision, cutting or mutilation of “the whole or any part of the labia majora, labia minora, clitoris, vulva, breasts, nipples, foreskin, glans, testicles, penis, ambiguous genitalia, hermaphroditic genitalia, or genital organs of another person who has not attained the age of 18 years or on any nonconsenting adult.” In line with the 2003 UK Female Genital Mutilation Act that protects girls only, this bill has been written so that all minors may likewise be protected.

Individual communities are also starting to recognize the fact that genital mutilation of children, regardless of sex, is wrong and should be stopped. The Huffington Post, Los Angeles reports that “A proposal to ban the circumcision of male children in San Francisco has been cleared to appear on the November ballot, setting the stage for the nation’s first public vote on what has long been considered a private family matter.” Even a comic book, Foreskin Man, has been created to raise awareness of this long accepted gross violation of the human rights of personal autonomy and self preservation. A pdf of the comic’s first issue can be found here or by clicking on the image above. Unfortunately, the second issue is considered by many to be anti-Semitic, which I do NOT endorse nor desire to be associated with, so I have not provided any other links.

Removing body parts without medical indication and without the consent of the person receiving it is tragic and should be criminalized. This is especially true of the sex organs given that at best, surgery permanently alters cosmetic appearance, sensitivity and sexual function. At worst, surgery can result in horrific disfiguration and/or death. Given these risks I strongly believe that non-medically indicated circumcision should be banned for all minors. Adults who choose to be circumcised for religious or other reasons, such as Jews and Muslims, can surgically alter their bodies after they have reached the age of consent.

David Reimer is one such infant victim whose penis was destroyed by circumcision in 1966. Following the medical advise of Dr John Money, a prominent psychologist and sexologist of the time, David’s parents elected for him to undergo sex reassignment surgery to raise him as a girl. Unfortunately, David never accepted his forced female gender role and began living as a male at the age of 15. He continued to suffer years of severe depression, financial instability, a dissolving marriage and eventually committed suicide in 2005. His tragic story is catalogued in the bestseller biography: “As Nature Made Him: The Boy Who Was Raised as a Girl” by John Colapinto.

Horrific medical complications of male circumcision are NOT a thing of the past. Review of peer reviewed medical journals reveals that present day complications continue to include poor cosmetic outcomes; excessive bleeding; necrosis of the penis and/or surrounding structures; lymphedema; keloid scar formation; skin bridges; buried penis; urethral stenosis, obstruction or fistula; penis shortening; decreased sensation; partial or complete destruction of the penis, amputation and death.

Doctors too should be wary of offering this “service”. Not only are surgical “mishaps” a legal liability but even culturally acceptable outcomes incur an ever increasing risk of malpractice accusation and lawsuit.

In conclusion, it is high time that we recognize infant male circumcision for what it is: a far-too-long accepted tradition of male genital mutilation. All infants and children deserve better than this. Click on one of the banners below to learn more and to find out how you too can help protect children and end genital mutilation now.






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Are you REALLY SURE you want your OB/GYN to cut your little boy?

Circumcision remains highly marketed at the hospital I mentioned in an earlier post. Although there were at least 3 of us who did not want to perform circumcisions at the beginning of my residency, I remain the only one who has stood my ground. Many residents do not want to do them but do not have a “moral objection” and thus feel they must so as to not shift their work onto other residents. New medical students rotating through labor and delivery are expected to ask new mom’s if they want their sons to be circumcised and to chart it in their notes. There is no discussion about the controversial nature of this procedure nor the option stated that they have the right to opt out. Medical students in particular are less likely to rock the boat because they know that their grade depends on it. It is quite frustrating to me to see how resistant people are to change and how easily people cave-in to peer pressure.

I am especially frustrated that OB/GYN residents and providers continue to feel that they are competent to perform the procedure.The tradition of OB/GYN physicians performing male infant circumcisions began many years ago when they used to deliver babies in the homes of their patients and was born out of convenience; after delivering the baby it seemed appropriate to go ahead and perform the desired circumcision as well. Nowadays the vast majority of deliveries by OB/GYN physicians occur in the hospital with pediatricians and other specialists readily available so convenience is no longer an valid argument. Moreover, OB/GYN residents in general receive scant education in the anatomy and pathophysiology of the penis. Those that choose to perform circumcisions are essentially performing the “simple” procedure without the associated medical knowledge required of all other surgical procedures. And unlike other surgical procedures, the postoperative follow-up and management of complications are performed by pediatricians and other specialists instead of the OB/GYNs who performed them.

A recent article by Dr Brian Le, MD found that while the majority of 27 respondent obstetric-gynecology residents “planned to perform neonatal circumcision when in practice, 44% had no formal training in circumcision and most were comfortable performing routine neonatal circumcision. Overall respondents were less comfortable evaluating whether the a newborn penis could undergo circumcision safely. When presented with 10 pictures of penises and asked to determine whether the neonate should undergo circumcision, 0% of respondents correctly identified all contraindications to neonatal circumcision with an average of 42% of contraindications identified correctly.” (Le B. Mickelson J. Gossett D. Kim D. Stoltz RS. York S. Sharma V. Maizels M. Residency training in neonatal circumcision: a pilot study and needs assessment. Journal of Urology. 184(4 Suppl):1754-7, 2010 Oct.)

I recently performed a Medline Ovid search (looking for primary literature) and found that while there are over 50,000 articles in OB/GYN’s two most respected journals — Obstetrics & Gynecology (aka the Green Journal) and the American Journal of Obstetrics & Gynecology (aka the Gray Journal) — only 43 of these articles address male circumcision. Thus OB/GYN physicians write only 1.1% of the articles relating to male circumcision and represent only 0.076% of the articles they produce. Finally, the American Congress of Obstetricians & Gynecologists (ACOG) continues to reject exhibition of circumcision dissident materials by Intact America at their national conferences because ethical consequences of this procedure are apparently “beyond the scope of the practice of obstetrics and gynecology.”

In summary, while  OB/GYN physicians have a long tradition of performing male infant circumcision and many continue to be more than happy to take a whack at infant penises, there is mounting evidence that they are deficient in the medical knowledge required to do so safely, they are uninterested in learning how to improve their skills and they do not contribute to respected literature to perfect techniques. Are you REALLY SURE you want your OB/GYN to cut your little boy?

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Doctor and hospital sued for circumcision

Doctors may think that parental consent is all they need to surgically modify the genitals of infant boys but they can still be held liable for malpractice when those little boys grow up. Leave our penises alone and end circumcision now!

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Say NO to infant male circumcision!

Newborn male circumcision is the most common surgical procedure performed in the U.S. Many people believe that there are tangible health benefits to male circumcision but, the truth is no medical society in the world recommends it. In fact, the American Medical Association calls the surgery “non-therapeutic.” What’s worse, over 100 babies die as a result of complications from circumcision in the U.S. each year.

The Centers for Disease Control (CDC) is developing public health recommendations for the U.S. on male circumcision – ignoring the serious risks such as hemorrhage, infection, surgical mishap, and death – in favor of highly debatable and inconclusive research.

The CDC is the foremost expert on public health in our country and, as such, has a responsibility to share the truth about circumcision.

I just took action, signing a petition to the CDC, demanding the organization release a truthful statement on the harms and risks of circumcision.

If you believe as I do, that we should protect newborn babies from harmful and unnecessary surgery, then say NO to infant male circumcision!

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Throwing wrenches at the gears

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.

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