On the Use of Red Wine for Paediatric Anaesthetics during Ritual Genital Cutting.

Red_Wine_GlasAn ancient spiritual rite of initiation takes place. The foreskin of a newborn infant is to be removed. That area of the body that is most sensitive to touch and serves as protection to the infant’s penis it to be sliced off with a knife. It will be traumatic and will hurt the child enormously. The child may suffer complications, some life-threatening, and may curtail his sexual pleasure in the future. To calm the baby before the cut, the parents are told to bring some religious red wine and give it to the baby before the ceremony.

This is not a scenario from long ago or from a distant land, but is based on the instructions of a Surrey based doctor who is to perform the cut. On his page about pain relief, he says,

To give the baby sweet, red wine prior to the procedure. (Kiddush wine is ideal). This is very effective in calming the baby. Ideally it is given about 15 minutes before the circumcision and I will give it on arrival if you wish. You will need to provide the wine.

This is not the only pain relief option. Parents, for example may also use EMLA cream, a local anasthaetic. The label for this product makes it quite clear that the product should not be applied to the genitals of children.

This is not the only use of red wine that can be found in the rituals of circumcision.

In one form of the ceremony, the ritual circumciser cuts the boy, takes a mouthful of red wine and then places his mouth around the bleeding penis and sucks. The wine and blood is then spilled over the wound in the belief that it is the life giving force. The practice is defended as helping prevent infection. Except the opposite is true and babies can end up receiving viruses such as herpes. Neonatal herpes can kill and babies do die from this custom. One might think that this practices be stopped, but even in New York, where a law was passed to insist that parents were simply made aware of the risks of the practice, fierce opposition came forth from religious leaders suggesting that was an infringements of their religious rights. Apparently, many rabbis have said they will ignore this law and not seek informed consent.

Such circumcision rituals can be found in many faiths and cultures. It is seen as a right of passage and a mark of belonging to a particular group. Risks from ritual cutting are significant. In South Africa, boys are expected to undergo initiations which include genital cutting. The BBC reports that hundreds of boys have died in recent years. In the UK, one would think that modern medical practices prevent harms and deaths, but often the procedure is done with little medical supervision. A Manchester boy died last year after a nurse performed a home without any form of anaesthetic just using scissors, forceps and olive oil. Goodluck Caubergs bled to death. A few years previously, a Slough infant suffered a similar fate.

Deaths are just the tip of the iceberg and many complications can happen. On web sites such the Surrey doctor’s, he reports a very low complication rate in his surgery. However, researcher Laura MacDonald reports in the Guardian that complications could be very common but research appears patchy. Later in life, many researchers report that between 18 and 37% of men report sexual harm from circumcision.

Why are we not appalled by these practices and demand that parents do not inflict such practices on their children, who have no say in what happens, have to suffer the pain and problems and live with the consequences for the rest of their lives? If we had never heard of circumcision before but had found groups of adults performing this superstitious blood ceremony in our communities, there would be charges of assault, child cruelty and imprisonments, I am sure. But there are not because adults’ superstitious cultural beliefs are more important that the well-being of these children. That is the only explanation. We do nothing for fear of offending private belief.

Apologists claim that such procedures offer health benefits such as reduced HIV transmission. Such claims are disputed. But even if true, such a decision to undergo this operation should be left to consenting adults based on their own perceptions of risk, benefits and their intended behaviour. There can be no justification for forcing this on a child who cannot say no when the real intention is to perform the ritual for spiritual reasons.

In the UK, there has been focus on how no one has been charged with the ongoing practice of female genital mutilation despite legal prohibition. There is of course the problem that tightening restrictions drives these practices underground. There is no easy answer to that – but awareness of the issues is a good first step. I would suggest that one step is to see the problem as affecting all infants and children and that this is not in principle a gender issue. Ritual cutting of infants, who are unable to make their own decisions, and causes them severe pain and distress, and might harm or kill them, and is only done for their parents superstitious beliefs, is inherently wrong. And we should not be afraid to say so.

54 comments for “On the Use of Red Wine for Paediatric Anaesthetics during Ritual Genital Cutting.

  1. Catherine Flint
    February 19, 2013 at 4:16 pm

    On the notice board in my local health centre there is a “Say No To FGM(Female Genital Mutilation)” poster. Next to it is a poster advertising the Bristol Circumcision Service…

  2. February 19, 2013 at 4:23 pm

    I am myself circumcised but (luckily?) without any kind of problems. I will not circumcise my children if the case shows up because I believe this is ethically wrong. That being said, a recent review published by the American Academy of Pediatrics has been discussed by Harriet Hall in the SBM blog (http://www.sciencebasedmedicine.org/index.php/new-aap-policy-on-circumcision/). The review shows that the benefits outweigh the risks. The benefits are however smaller if basic rules of hygiene are respected. It’s important to discuss what science has to say about circumcision.

    • February 20, 2013 at 4:01 pm

      There’s a really glaring flaw in the argument that circumcision of infants can be justified by a reduced risk of sexually transmitted infections such as HIV.

      Let’s leave aside for the moment the question of how strong the evidence is that circumcision really does reduce the risk of STDs (though that would be an interesting discussion to have another day) and assume, for the sake of argument, that it is a fact that circumcision reduces the risk of STDs.

      That does not even begin to justify circumcision of infants. Infants do not have sex, so they are at spectacularly low risk of acquiring HIV or any other diseases via their penis.

      If people want to have a circumcision to reduce the risk of STDs, then they have every right to make that decision for themselves, when they are old enough to give informed consent.

      No-one has the right to impose that decision on someone who is too young to benefit from it, but will be permanently harmed by it.

  3. Laura MacDonald
    February 19, 2013 at 4:58 pm

    Sham, if you take some time to actually read that review you cite you’ll find they admit that the risks of infant circumcision are unknown. So how they can make that claim that the benefits are greater than the risks defeats me. Perhaps it may have something to do with the fact that with 1.2 million non therapeutic circumcisions performed in the US each year and a price tag of several hundred dollars a piece, this is pretty lucrative business. And the AAP is after all, a trade association.

    • February 19, 2013 at 5:00 pm

      I have just read the comments made by Harriet. I will try to take the time to read the AAP document.

  4. February 19, 2013 at 5:08 pm

    Thank you so much for this article; it’s really important to keep discussion of this subject factual and stay away from the religious angle. I was once called anti-Semitic just for suggesting that there might be a downside to ritual circumcision (and I’m Jewish!).

    There is one aspect of that doesn’t sound right to me, though: ‘many researchers report that between 18 and 37% of men report sexual harm from circumcision’. Do you have some citations? I don’t doubt that such research exists, but those numbers seem very high.

    • Laura MacDonald
      February 19, 2013 at 5:29 pm

      Ian doesn’t it say it all that you haven’t heard of these studies? This is the Emperor’s New Cock and we’re simply not allowed to say there’s anything wrong with it. Morten Frisch who’s Danish study recently found 8.5 times the rate of dyspareunia among women with a cut partner (and 2.5 times more orgasm difficulty) has talked candidly about how difficult it was to get his research published, and he’d several papers published before with no trouble (but not mentioning circ). I think there are links in my CIF article to those papers but if not I’ll look them up for you. I recommend the circumstitions page I’ve cited above, which collects info on circ.

      • February 19, 2013 at 5:31 pm

        It doesn’t say much that I haven’t heard of studies because I’m neither a medic nor an academic. I’m interested to read the sources Andy used for his article, because as I said those numbers sound high to me. Perhaps I’m wrong, but I’d like to read for myself.

        • Laura MacDonald
          February 19, 2013 at 5:42 pm

          Hi Ian, I understand but given your familial link to forced cutting you’d think this stuff might have poppped up in a conversation somewhere, no? The problem is that the negative stuff often doesn’t reach the news.
          Here are links to full articles
          http://www.cirp.org/library/sex_function/masood1/
          http://www.cirp.org/library/sex_function/fink1/
          It’s worth bearing in mind these are cases where there was a problem – the effect in a healthy individual is likely be worse. This is also intersting, and Frisch’s recent research picks up on the idea of harm to women (as does Bensley and O’Hara) http://www.cirp.org/library/sex_function/solinis2007/

          • February 19, 2013 at 6:03 pm

            You’d be surprised how little it gets discussed. Most Jews — even secular ones like me — assume it’s basically harmless (I don’t, but I’m unusual)… and only a tiny minority could cite studies. I’ll bookmark your links for further reading, but what I’m really interested in is the basis for Andy’s percentage figures above.

          • Laura MacDonald
            February 19, 2013 at 6:34 pm

            Ian, Mahmood et al found 18% of men reported penile sensation was reduced, and Fink et al found 38% reported harm. I provided the links because I thought you’d prefer to go to the source rather than just take my word for it!

          • February 20, 2013 at 10:01 am

            Both Masood and Fink are studies on adults; it’s not necessarily possible to extrapolate the results to men who were circumcised as infants.

            I think maybe the post should have read:

            ‘*For men circumcised as adults*, many researchers report that between 18 and 37% of men report sexual harm from circumcision.’

          • Seldom Seen
            February 24, 2013 at 11:13 pm

            Ian’s last point is a good one. I’m neither for or against, though circed as an infant. Interestingly, when Judaism and Christianity were competing for punters early in the first century C.E., (and both were highly proselytising religions/cults in the Mediterranean Roman regions at this time), compulsory male adult circumcision for newbie Jews may have been a bit of a turn-off for a well-to-do citizen of the empire experimenting with his spirituality and may have tipped the scales in favour of the carpenter’s son. I’ve read that Judaism, amongst wealthy Romans, was taken up more
            by women than men. It figures. [Maybe the red-wine fellatio (see article) should have been offered to men to sweeten the deal.]

          • Seldom Seen
            February 24, 2013 at 11:16 pm

            that should read ‘first millenium.’ First century was a bit of a struggle for Jesus fans.

      • Sarit
        February 21, 2013 at 9:17 am

        Do I hear penis envy echoing in the background?

  5. Catherine Flint
    February 19, 2013 at 5:08 pm

    Is this not a matter of the “science” trying to justify an existing cultural practice? I find it hard to believe that the majority of parents have their children circumcised for medical reasons but instead for reasons of culture/tradition/religion. Reviews, such as the one referred to, merely help to assuage parental guilt about putting their child through this unnecessary medical procedure. Even if, and this is a big “if”, there are some small benefits to the procedure, does that justify it? I’m sure there could be benefits if all children’s tonsils were routinely removed but it is not something that would be widely accepted as there isn’t the related cultural/religious component to removing tonsils are there is parts of children’s genitalia.

    • Catherine Flint
      February 19, 2013 at 5:10 pm

      The above comment in in reply to Sham’s post, BTW.

    • Bart B. Van Bockstaele
      May 21, 2013 at 5:11 pm

      Actually, when I was a child (in Belgium, now a bit more than 40 years ago), tonsil-removal was very much in fashion. Children were led to the operating chair (not table) like cattle being led to slaughter. They were gassed with what I assume to be chloroform, tonsils cut, and left bleeding in a rubber-clad bed for a few hours.

      It was cruel and mostly useless. I agree with your argument about the questionable justification for genital mutilation, and an extra example would make that even clearer: it is *said* that 20% of Americans have a mental disorder. I propose to remove the brains of all Americans at birth. It would immediately eliminate this rather big problem (and the rest of the world would never notice the difference anyway ^_^).

  6. Laura MacDonald
    February 19, 2013 at 5:22 pm

    Thanks Sham. You’ll find good analysis of the AAP output over several years on the excellent circumstitions website: http://www.circumstitions.com/
    This is your best source for circ news and analysis if you want to get quickly informed. It’s smart and balanced and focused on what really matters: evidence and ethics. Scroll down on the home page to see the latest news including a large sensitivity study from Belgium. More here: http://www.circumstitions.com/Sexuality.html

    • February 19, 2013 at 5:37 pm

      I’m playing devil’s advocate here… but I don’t think it’s fair to describe your website as ‘balanced’, particularly when its policy statement begins ‘This site does not pretend to be “balanced”.’

      • Laura MacDonald
        February 19, 2013 at 5:47 pm

        Hi – ok fair point, what I meant is that the evidence is analysed in an intelligent way, which I think you’ll see if you read it. It’s not reasonable to be completely neutral about forced genital cutting any more than it’s reasonable to be neutral about rape or forced marriage. But where people put up purportedly scientific evidence they deserve that to be analysed with intelligence and a degree of reasonableness, that’s all.

  7. February 19, 2013 at 5:38 pm

    thanks for your comments, links and inputs. let me make it crystal clear that I’m not advocating for circumcision here. I think this is an abuse of the child’s integrity. I was just wondering about what science has to say on the topic and Harriet Hall/SBM blog is generally a site that I trust. Catherine btw may be right when she says: “Is this not a matter of the “science” trying to justify an existing cultural practice?”. Can we compare this issue to the science backing up claims supporting the right to keep arms? Another hot topic, I don’t want to derail the topic here, just wondering.

  8. Martin
    February 19, 2013 at 7:13 pm

    There is a lot of money in circumcision. A mate of mine used to do it. He got £500 a week plus a share of the tips. He didn’t do it for long though. One day he missed with the knife and got the sack.

    Do I win five pounds?

  9. Laura MacDonald
    February 19, 2013 at 9:05 pm

    Hilarious Martin. I love jokes about gang rape too, got any of those?
    PS are you even aware how many little boys have lost their glans or even their entire penis through a slip of the knife, or in some cases through electrocautery gone wrong? The ones who lose the whole lot have tended to be castrated and brought up as girls (David Reimer wasn’t a one off). Check out what Osama Shaeer, Egyptian urologist says about this. http://www.osamashaeer.com/genitalsurgery/Shaeer.htm Hey, he seems to find it vaguely amusing too!

  10. Alik
    February 20, 2013 at 9:48 am

    Almost 30,000 voluntary circumcisions are done each year in Israel (Jews and Moslem Arabs). You can definitly say it is the most common surgical intervention with the least untoward effects.

    • Laura MacDonald
      February 20, 2013 at 11:32 am

      Voluntary? Are you referrring to those adult emigres from the former soviet union who were not cut as children and who may choose it after coming to live in Israel? Would you be aware that one in three of them choose not to get cut? Would you be aware that of those who went to California it appears most choose not to get cut..?

      It would be useful to have your reference for the claim that this is ‘definately the most common surgical intervention with the least untoward effects’. Circumcision is amputating primary erogenous tissue and the moving parts of the penis. It cannot be undertaken without an impact even if that impact is only long term keratinisation and lowered sensitivity from fewer nerves (the former President of the International Society of Sexologists, British Urologist John Dean has commented that a reduction in sensitivity from male circ is ‘almost universal’). The short term surgical complications are many and varied. In Israel there has been noted a particular risk for urinary tract infection in the week or two post circ – to do with the ritual tight wrapping of the wound. Recently there have been cases where children from both Muslim and Jewish communities had their glans amputated. It’s been noted that meatotomy is common enough post infant circ that some Jewish communities have called it ‘the second circumcision’. Recent Iranian research found a 20% rate of severe meatal stenosis in Iranian boys reviewed 5-10 years post infant circ. Do you know what was the most striking thing about this study? The narrowing of the urethra was visible, and some boys had suffered issues which had apparently tracked back to the kidneys. But no one had noticed their complication. No One Had Noticed. You are part of this problem when you come here from your circumcision google alert to insist that circ does no harm,without references, but just with a burning need to tell us there is no issue. Have you read Aesop’s fable of the fox with no tail?

      • Alik
        February 21, 2013 at 9:12 am

        Iran, Egypt – undeed…..You did not cite even one study in the manner real scientists do. You ignored the benefits proven repeatedly in the medical literature (did we mention HIV?)
        As for sex – why are Jewish husbands are so preferred in the US by gentile mothers?

        • February 21, 2013 at 9:13 am

          > As for sex – why are Jewish husbands are so preferred in the US by gentile mothers?

          Now there’s a claim for which I’d like to see some evidence.

        • Vicky
          February 21, 2013 at 12:29 pm

          Alik, Laura has cited some studies above. I also notice that you didn’t cite even one study.

          You ignored the benefits proven repeatedly in the medical literature (did we mention HIV?)

          Did you miss the part about babies/little boys not being sexually active? Adults can modify their body pretty much any way they want, and I don’t think anyone here has a problem with that.
          btw: who’s “we”? Did “we” also mention that this HIV prevention is only for men who have unprotected sex with HIV positive women and it isn’t 100% (so it’s still advisable to use condoms)? Did “we” mention that a woman isn’t protected just because her partner is circumcised (and really, how whould she: if he’s HIV positive his bodily fluids contain the virus)?

          As for sex – why are Jewish husbands are so preferred in the US by gentile mothers?

          WTF? What mothers? Mothers-in-law? (If it’s all about the circumcision: are muslim husbands preferred, too? And aren’t many non-jewish men in the US circumcised anyway? Are they preferred over uncut jewish men?)
          Also, do you really think that most (or at least many) women choose their partners based on if they do or don’t have a foreskin? (“Hey, you’re a wonderful person and I think I’m in love with you, but I could never be in a relationship with someone who has a foreskin, let alone marry him!”).

        • February 21, 2013 at 2:40 pm

          Alik, before making assertions about an article, it is always best to read it.

  11. Dave Curtis
    February 20, 2013 at 12:30 pm

    Wow. Such strong opinions. So little evidence.

  12. February 20, 2013 at 4:06 pm

    I’m uncircumcised and secular, of mixed Christian and Jewish descent; I don’t like having to say this, but in discussions like this one basically has to.

    There is no medical evidence that, in countries where hygiene is available and readily available, and where condoms are likewise, that circumcision has any particular positive medical benefit.

    And if we’re tolerating backstreet circumcisions by unqualified people (like the one that resulted in Goodluck Caubergs’s death), that is a disgrace. If there is evidence that conduct like Nurse Adeleye’s is being tolerated, that should be clamped down on with great force, like any backstreet surgery performed without proper qualifications or sterile environments.

    But that is not the same as a qualified doctor carrying out a circumcision in a proper doctor’s surgery. In that context, saying it should be prohibited seems more like a not-very-subtly veiled form of bigotry (saying “parents should be made aware of the small immediate risks and the limited evidence of negative consequences in future sex life” is not the same thing. Of course they should.)

    • Laura MacDonald
      February 20, 2013 at 4:52 pm

      John B the point is that the risks are NOT small and there is NOT only limited evidence of negative consequences on future sex life, there’s lots. All circumcisions have consequences on the person’s sensuality, and the risks of early surgical complications according to one of the world’s biggest medical indemnity providers are ‘considerable’ http://www.medicalprotection.org/uk/england-factsheets/mps-policy-on-circumcision. How on earth can we have this debate if you insist on basing your views on wilful assumption rather than evidenced truth? Babies die follow cutting by doctors – 4 apparently in England since 2006. There are also many cases recorded where boys have to undergo transfusion or intervention under GA post circ by docs http://www.cirp.org/library/complications/corbett1/. And many cases of significant surgeries following slippage of plastibell.

      On the ethical front again I have to bring you back to the issue of consent. This is FORCED amputation of an exquisitely joyful part of the body. If it’s bigotry of me to consider a boy owns his genitals, is it also bigotry for me to consider that an Afghan woman owns hers, and that the Afhgan law sanctioning marital rape is horrible? Is it also bigotry to be against forced marriage? And how about FGM which as you know so often just targets her foreskin: in South East Asia most baby girls are taken to a doctor to have her hood either slit or partially removed, following one of the hadiths in which the Prophet Mohammed appears to endorse this form of circumcision. Presumably you think that’s well within a parent’s rights and we should tolerate it? I’m sorry to be rude but FFS! There is no right to amputate a part of your child’s body – even doing it did have few complications. It’s HIS body.

      • Porta
        May 6, 2013 at 4:00 pm

        Laura, I really am very curious – why the fervor? I’m circumcised and I’m neither muslim nor jewish…heck, I know plenty of people out there in the exact same situation.
        However, I never heard about urinary tract malfunctions, erectile dysfunctions or “reduced feeling” – don’t even understand what that means. As for the sexual partner having troubles reaching orgasm, that’s completely ridiculous.
        I truly feel you blokes are just making up causes to pass time. No harm in passing time, just stop evangelizing. There’s not much difference from you and stupid fucks in the US banning evolution as a school subject at that point.

    • John H
      February 20, 2013 at 8:15 pm

      John B

      I agree with your second and third paragraphs. Para 2 is fairly obvious (and I made tha point below – which sort of overlapped) and Para 3 is effectively a no-brainer.

      I do disagree most strongly with your final paragraph. Laura seems more than capable of responding to the medical aspects so I will cover the ethical ones.

      Why should a “qualified doctor carry out a circumcision in a proper doctor’s surgery”. What is the general view of knob doctors regarding this.

      Surely doctors should only perform any procedure if there is a specific medical reason for doing so (I disregard cosmetic surgery here as that is merely a money making scam and the recipients are above the age of consent).

      Where does penile mutiliation (even if the attendant medical risks are relatively small) fit into “Do No Harm”.

      Mutilating a baby boy hardly seems to be a valid medical reason.

      Vets no longer dock dogs tails. Why should a privilege afforded to dogs not be afforded to children?

      I do not think it is a “not-very-subtly veiled form of bigotry”. Is proscribing FGM bigotry aimed at a specific group or a societal response to an appaling act perpetrated on young women. Some things are absolute. Should we allow worshippers of Quetzalcoatl to drill holes in each others skulls or rip their hearts out. Should we permit facial scarification because “it is a five thousand year old tradition”.

      Nobody is saying knob chopping should be banned totally (well I am, but that’s just me) only that it should not be done to boys under the age of consent. If you are over 18 and of a given persuasion (whatever that might be) then by all means have the end of your knob chopped off if it puts you in good standing with your deity. Personally I doubt if he gives a shit.

  13. John H
    February 20, 2013 at 7:38 pm

    I was going to make a reference to my experiment last week regarding paper transmitted H~Y as a means of potentising Pinot Noir for local anaesthesia. Efficacious as it was I felt it wouldn’t go down too well in the circumstances and given LCN’s posting.

    Chopping the end of your knob was probably a halfway reasonable idea 1-5000 years ago as a health and hygeine precaution (and I mean probably – but more probably not). I wonder why the omnipotent and omniscient gods that mandated knob chopping never seemed to have the foresight to add “until you have invented sanitation, H&C running water, showers and soap” to their edicts (or indeed why some modern interpreter of this infallible guff did not say “right, enough is enough on this one”).

    I base my usage on my fathers words. When I was about 13 I asked him why he had not had me circumcised. He said that when I left home or reached 18, whichever came first, I could have the end of my knob chopped off if I so wished. He did not regard it as his right to have me mutilated. I reached 18 and managed to pass on the idea.

    The big problem here is the rights of children in our society and the overblown respect we afford to the archaic beliefs of religionists. As others have pointed out these are not just children they are “Jewish children” or “Muslim children” and therefore subject to the whims, vagaries, mumbo-jumbo and mystical beliefs of their parents. If your sky fairy mandated knob chopping then it is a case of “off with his knob end”.

    I would suggest that knob chopping be banned until the individual was 18 but I fear that would merely go the same way as FGM. You would be able to procure it in the UK but the procedure would take place abroad, beyond the reach of any rational society.

    (And nobody will ever know the sheer effort of will I had to expend to avoid following Martin onto the naughty step)

    • Laura MacDonald
      February 20, 2013 at 8:43 pm

      Actually John H, this is another logic fail: ‘Chopping the end of your knob was probably a halfway reasonable idea 1-5000 years ago as a health and hygiene precaution.’ For that to be true the risks of having an intact penis would have to be greater than the huge risks of prehistoric surgery. Circ in ancestral conditions in Africa has a death rate of 2 in 1,000 and overall complications of 35-83% [1] But there’s no evidence that intact communities have greater health problems than cut populations, now or in the past.

      Women are more subject to all the things that male circ is supposed to suppress or prevent, particularly myconium smegmatis (incidence of which is ten times more common in the labial folds than the penis[2]) So how come you don’t suggest that razoring women’s flaps represents some kind of ancient health wisdom?

      I’ll let you off the naughty step this time. I’m not angry ….just very disappointed.

      1/ Traditional male circumcision in eastern and southern Africa: a systematic review of prevalence and complications, Bulletin of the World Health Organisation 2010;88;907-914
      2/Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83 Suppl. 1:34-44.

      • John H
        February 20, 2013 at 9:13 pm

        Laura

        I am more than happy to put my hands up to a failure of logic (having not actually made any claim to logic in the first place) and I bow to your clealry greater knowledge of the medical risks (I think I already made that point above).

        Perhaps I should have said something like “several thousand years ago it might have appeared to ignorant peasants in the desert that knob chopping offered some benefits. However, that was in the absence of any specific medical or epidemiological studies which we now know indicate no benefit and in fact carry significant risks”.

        Regarding your Para 2 I think I made my views perfectly clear on this so your point is a bit fallacious. Rather smacks of authoritarian point scoring – I have better references than you. The discussion was specifically about knob chopping so I commented on that.

        Odd though it may seem I am hardly an ardent advocate of any form of genital mutilation. I believe I made that point very clearly and with no ambiguity or room for doubt.

        • Laura MacDonald
          February 20, 2013 at 11:04 pm

          Hi John H, I’m really sorry and you’re right that was ridiculously arrogant. I hadn’t read your previous post. You pushed my button with the ancient hygiene measure hypothesis – of all the logic fallacies that prop up circ it feels the worst, particularly because it’s dispensed by such smart educated people. My best friend is an experienced archaeologist and came out with it recently – it boggled my mind. I’m also upset that we think it’s ok to joke about this subject, I do really think that like rape it should be off bounds. The trauma as you can see from this vid of a classic north american circ can be immense, the medical literature contains a case of an infant who cried so hard he ruptured his stomach, drastic rises in heart rate, and oxygen deprivation through trauma. http://www.can-fap.net/videos.shtml None of that excuses me being arsey though…I’ll go sit on the naughty step now.

  14. February 21, 2013 at 10:57 pm

    This article is truly alarming but any reasoned objections based upon research and reason will have no effect on those who feel impelled by religion to mutilate the genitals of their offspring.

    The ‘faithful’ of all faiths are, by definition, immune to reason. Being faithful, in a religious sense, means that you swallow hook, line and sinker that which your faith teaches.

    If authorities were to prosecute those who carve up their babies’ private parts, the resulting outrage would be cataclysmic and shouts of persecution on religious grounds would be deafening. The best we can hope for is that registered medical practitioners how take part in these outrages find themselves languishing in the pokey!

    David R Amies

  15. Rod.C
    February 22, 2013 at 9:10 am

    As a scientist, I too read Science Based Medicine regularly but I am convinced that Harriet Hall has got it wrong in swallowing the AAP propaganda on circumcision. This may be because of an antipathy towards ‘Íntactivists’ who gave her a hard time over her previous comments on circumcision. I am also a regular reader of Scienceblogs
    where the well known sceptic P.Z.Myers (‘Pharyngula’) writes regularly. One of his recent contributions was ‘No more mangled wee-wees’. I am happy to side with Myers over Hall on this issue if one has to weigh matters up scientifically. I regard the pro-circumcision outpourings of a certain Australian science professor with contempt, especially in view of his connections with the Gilgal Society. If you have never heard of the Gilgal Society, read about it on CircLeaks and elsewhere on internet (but only if you have
    a strong stomach).

  16. Rod.C
    February 22, 2013 at 10:04 am

    One of the reasons why I do not swallow the AAP ‘science’ is the way that the three African circumcision trials are trumpeted as being Gold Standard.For one thing, I gather that all three trials were lead by known circumcision enthusiasts. Perhaps there was a little publication bias there. More importantly, it has been shown that in 10 out of 18 African countries the rate of HIV infection is higher amongst circumcised males than the rate for uncircumcised males. Which goes to show that circumcision is irrelevant to control of STDs – whereas condom use is, but the AAP does not seem to regard use of condoms as worth promoting.

  17. February 23, 2013 at 10:38 am

    The World Health Organisation has published a manual for infant circumcision which lists techniques, risks and complications in great detail. It’s designed to encourage circumcision but unintentionally (in my opinion) makes the case against very strongly. The full manual and a commentary on it are avilable here.http://ripe-tomato.org/2013/02/16/cock-ups-happen/

  18. rita
    February 25, 2013 at 11:22 am

    “Ian, Mahmood et al found 18% of men reported penile sensation was reduced,” – but reduced from what? If they were circumcised as infants, how could they tell?

    • February 25, 2013 at 11:39 am

      Precisely my point: Mahmood is a study of men who were circumcised as adults. It may or may not apply to infants.

  19. Laura MacDonald
    March 7, 2013 at 11:18 pm

    Ian and Rita – loss of nerve endings from male circumcision is not subjective, it’s a measurable fact. Likewise loss of mobile skin from male circumcision is not subjective, it’s a measurable fact. Amputation neuromas have also been measured…. etc etc. I think it’s deeply unpleasant to argue that if a person has something taken from them in a period of lack of consciousness then that doesn’t matter. How do you feel about sex while a woman is unconscious from drugs or alcohol? More to the point how do you feel about those female newborns in places like South East Asia, the Middle East and Nigeria who have parts of their vulva amputated or incised? Does it not matter as long as they don’t know how much sensation they would have had if left uncut? Why do you think we banned FGM type IV (hood slitting) on baby girls? There are no known long term harms from this other than that it cuts into delicate primary erogenous tissue (her foreskin) and may leave a scar. Why have Israeli authorities campaigned for its ending among the Bedouin, calling it a mutilation? http://www.sciencedaily.com/releases/2009/02/090220090748.htm

    Re Mahmood and Fink if you read the original article the point I made was that these studies were on men who had medical issues with their foreskin – it was not expected that there should be such numbers expressing harm when the circumcision was done to fix something. It’s common sense that those without issues who have this highly sensory tissue amputated are more likely to suffer from sensuality effects – as Morten Frisch has shown in Denmark recently – and also the latest study in Belgium. In fact in Mahmood et al there was an overwhelming evidence of harm among the men circumcised for simple phimosis without chronic infection problems.

    Frisch’s study actually neatly backed up the Jewish sage Maimonides who thought that male circ had a particularly negative effect on female sensuality (which he considered the very best thing about it); he found a big correlation with pain/discomfort in sex for females and absence of the male foreskin as well as orgasm difficulties more likely in both sexes post male circ.

    What really disturbs me about your intervention in this debate, is why you don’t challenge your own motivation for wanting to knock down evidence of the harm of male circ. We’re talking about the removal of 10-15 square inches of mobile primary erogenous zone, packed with fine touch neuroreceptors. We didn’t need studies to demonstrate the harm of this as it’s self evident, but now we have quite a lot of research. We can’t keep ignoring inconvenient truths just because it makes you feel better.

    The point underlying all of this is: why is the burden of proof of harm placed on victims of this surgical violation? You say that sensual harm ‘may or may not’ apply to people who’ve had their genitals cut up as infants. Even if this was actually true, since when were we so cavalier with OTHER PEOPLE’S genitals?

    Chris Brand a former lecturer at Edinburgh university felt that adult sexual activity with older children may not harm them. Is he allowed to try until those children when grown up can prove otherwise?

    Can you not see that this whole debate is upside down?

    • rita
      March 8, 2013 at 9:41 am

      It was the form of the comment rather than the content on which I was commenting: there is a comparison being instituted which cannot be: i.e., between sexual pleasure in a male and what that pleasure would have been had the make not been circumcised: there is no way of knowing this. This was not a comment on the issue itself: I am not much in favour of non-consensual surgery in any form: the problem of neuronas also affects chickens, who are regularly debeaked in the exploitative process of acquiring eggs: mutilations, frequently (if not normatively) performed on various nonhumans without anaesthesia include tooth clipping, de-horning, amputations of toes or tails and a long etc: humans are apt to put their own convenience before non-consenting victims’ pain or death in so many cases, it’s not surprising they also take out their general foolishness on their own young.

  20. Andrew M
    March 25, 2013 at 1:10 am

    Speaking as a Jew, I should note that in the case of Judaism and ritual circumcision, there’s a specific teaching that the act is meant to remind us of.

    Abraham was not merely the “father of the Jews.” He was the first monotheist. All of his neighbors adhered to polytheistic faiths with deities physically represented by tangible idols and temples. And many of these religions were into ritual sacrifice… including human sacrifice. So when Abraham was told to sacrifice his son, it was so G-d could make a specific point.

    That point being that when Abraham prepared to carry out the act, G-d then informed him, “stop. I will never demand blood from My followers. You will now use that knife to circumcise yourself, and your son. And all who follow will remember that I will never, ever call for human sacrifice.”

    In other words, the specific spiritual rationale behind the act of circumcision is this: G-d doesn’t want blood. And anyone who says otherwise is lying. And when you hear a quack or a televangelist or cult leader or extremist nutjob trying to sell you on something immoral, you have a reminder stored in your underwear.

    I will also note that female genital mutilation is generally meant to control and subjugate the women; by contrast, even with a circumcised penis I am still very much capable of experiencing physical pleasure. Jews also do not circumcise women because the religon does not condemn sexuality (in fact, sex between a married couple is seen as spiritual communion akin to a prayer. That’s why Nina Hartley is regularly asked to conduct seminars at synogagues).

    Lastly, I would like to note that yes, religious parents do in fact have the right (and the responsibility) to bring their children up in accordance with their own moral beliefs. I have no right to deny a christian parent the right to baptize their child. Nor does that christian have the right to deny children (or marriage) to a homosexual. So please bear that in mind; there are far worse things that you can do to a kid than give them a physical reminder to not spill blood and call it righteous. Though I say that while fully expecting a cascade of responses about how this is wrong and sick and that we need to criminalize something that is so intrinsic to a notoriously persecuted faith that even the most antisemitic of governments never dared go that far.

  21. Loralee Parayuelos
    April 5, 2013 at 8:44 am

    You’ve heard the rumors — but now you’ve got proof. There is absolutely nothing in the world that compares to the sweet sensation of a baby’s skin. It feels good, it smells good — heck, it even tastes pretty sweet when you kiss it. But there’s a downside to that brand-new and delicious epidermis: Newborn skin is ultrasensitive to a host of potential irritants. Some might cause bumps, others a bright-red rash. Most of these baby blemishes are perfectly normal and will pass with time, especially if you know how to treat them. Here’s a roundup of the most common skin conditions that can develop in your baby’s first year,,

    My own web page
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    • April 5, 2013 at 8:45 am

      That is without a doubt the creepiest spam comment I’ve ever read.

      • rita
        April 5, 2013 at 8:46 am

        true…and I wouldn’t open that link, if i were anyone….

  22. April 7, 2013 at 10:44 am

    LCN – you might like to update your post following this story:

    http://www.dailymail.co.uk/news/article-2304793/Two-babies-stricken-HERPES-ritual-oral-blood-sucking-circumcision-New-York-City.html

    Beggars belief, including the fact that the parents won’t tell investigators who gave their kids herpes; leaving them potentially free to infect more children.

  23. May 29, 2013 at 4:04 am

    I wish to comment on your articles concerning Patrick Holford. Whilst I agree with much that you have to say about quackery, as in Scientology, and many other psuedo-scientific theories, I do feel that you have caused Patrick an injustice. As you say, his teachings on nutrition, vitamins and herbs etcetera may sound similar to Scientologists teachings, but that doesn’t mean he is sympathetic to Scientology, it simply means they have certain convictions about health and wholeness that he also promotes.

    In other words, he is not a ‘quack’ in my opinion. Of course, it is important to expose quackery, but then, if you look at the history of conventional medicine it was Henry VIII who helped give conventional medicine a monopoly over natural medicine and I might add with dire consequences in many cases. Although science and medicine are extremely important, they don’t always have it right and many deaths have been caused by chemically based products. So, be fair to people like Holford because the title of your article/articles immediately make people think he is a Scientologist and a quack, this is not so.

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