Pediatrics
April 3, 2013
The AAP gets letters
The American Academy of Pediatrics' journal,
Pediatrics, has
published three eletters opposing its Circumcision Task Force's reply to
the 38 senior European critics of its 2012 policy statement. But it has
published them in two different places.
This one is at "
published letters"
Smoke and Mirrors
Christopher L. Guest, Co-Founder
Children's Health and Human Rights Partnership
In response to concerns raised by Frisch et al, the task force seems
reluctant to concede any meaningful sensory function to the human
prepuce whatsoever. It is astonishing that members of the task force are
able to appreciate that the prepuce is richly innervated and contains
Meissner's corpuscles, but they are "unable to speculate about the
effect that circumcision might have on sexual function or pleasure."
Surely the task force recognizes the obstinate relationship that exists
between structure and function. Structure predicts function. Function is
constrained by structure.
Histologic studies indicate that the prepuce is richly innervated and
contains specialized corpuscular neuroreceptors. During erection, the
prepuce retracts and everts to expose the erogenous internal mucosa to
external stimulation. Does this not seem like a structure whose function
is, at least in some way, related to sexual pleasure? Is it reasonable
to speculate that the prepuce is more likely related to sexual pleasure
than say, the Achilles tendon?
If members of the task force are unwilling to consider the effect
that circumcision might have on sexual pleasure, parents should ask
themselves the following question: "Do I think removing richly
innervated tissue from my child's genitals is more likely to INCREASE
sexual pleasure or do I think removing richly innervated tissue from my
child's genitals is more likely to DECREASE sexual pleasure?" It seems
rather disingenuous for members of the task force not to speculate about
the sensory function of the prepuce but at the same time sanction its
amputation. The response to concerns raised by Frisch
et al is deliberately evasive - smoke and mirrors!
Conflict of Interest:
None declared
This is published at "
early"
A goldfish knows nothing about water
Hugh P. Young, Independent researcher
A goldfish knows nothing about water. The American Academy of
Pediatrics Task Force on Circumcision is unaware of the peculiar
circumcising culture in which it is immersed. For example, characters in
American TV sitcoms may exhibit a casual vindictiveness toward the
foreskin, or the man with one, that would cause widespread outrage if it
involved race.1 American medical texts portray "normal" penises as
circumcised, and may define the foreskin as "the part removed by
circumcision".
2
This unawareness permeates the Task Force's 2012 circumcision policy.
3
Dr Frisch and 37 eminent European pediatricians, speaking for 22
pediatric associations, and for 17 countries from Iceland to Lithuania,
have accurately pointed it out. The Task Force's reply amounts to "Tu
quoque" ("You're another").
Those countries have "a clear bias against circumcision" the same way
they have "a clear bias against parentally-elective infant toe
amputation". They have no Task Forces on Leaving Boys' Genitals Alone.
The reply, like the policy itself, discounts the only study that
actually attempted to measure the sensitivity of the foreskin itself, by
ignoring its main, uncontested, finding: "male circumcision ablates the
most sensitive part of the penis."
4
The Task Force admits the role of the innervation of the foreskin in
experiencing pain, but not pleasure. Frisch et al. do not need to
"speculate" about it: they almost certainly have foreskins, or partners
who have them. Human lips also "have nerve fibers". Whose first thought
about those would be how to minimise the pain of lip-removal? Who needs
proof that the nerves of the lips are intimately involved in the
pleasure of kissing? To deny that a richly innervated structure, near
the head of the penis, with a unique rolling action, is involved in
sexual pleasure, is perverse. Impairing that pleasure was one of the
purposes of circumcision, explicit for 1900 years until "medical"
circumcision became customary and a generation had grown up that had
never experienced sex unimpaired
5
The Task Force now admits that the basic right to physical integrity
is an important one, but it ignored that important basic right in its
2012 policy.
It contrasts the harm of being circumcised (without any measure of
the worst of that harm, such as major complications and death) with a
new, undocumented and unmeasured "harm of not being circumcised", but
such harm could equally apply to failure to amputate any other
less-than-vital body parts, such as the earlobes.
The Task Force offers no rebuttal to Frisch
et al.'s
substantive case, based on the AAP's own policy, that the diseases
circumcision reduces (if the studies the Task Force cites are to be
relied on) are so rare, or of such late onset, or so readily prevented
or treated, that circumcising infants to prevent them is a bad option
compared to letting the child grow up to decide the fate of his own
genitals.
Its original claim that "the benefits outweigh the risks" was made
with no actual weighing. It is now nowhere to be seen, and goes
undefended.
References
1. Young, H. "That Thing": portrayal of the foreskin and circumcision
in popular media, in "Human Rights Under Assault: The Atrocity of
Circumcision" (Springer 2008), and online at the Intactivism Pages
2. Roberts, A. The Complete Human Body, DK Publishing (2010): Guyton,
AC, Hall, JE. Textbook of Medical Physiology Saunders (2000):
McCracken, TO ed. New Atlas of Human Anatomy MetroBooks (2001)
3. American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012;130(3).
4. Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007;99(4):864-869
5. Philo of Alexandria, Of the special laws, Book I (ii), in Works of
Philo, trans. F. H. Colson, Loeb Classical Library, 1937, Vol. VII, p.
105
Conflict of Interest:
I edit the Intactivism Pages ("Circumstitions")
[
A video version of this letter is on YouTube.]
This letter is published at both of the above sites:
Function follows form
Dennis C. Harrison, Independent researcher
The response of the AAP Task Force on Circumcision to the commentary
by Frisch et al is marred by a lack of attention to detail and a
disregard for elementary principles of biology. The Task Force asserts
that "all of the commentary authors hail from Europe," when the
affiliation of one of the authors, Noni MacDonald, MD, is listed as
"Department of Pediatrics, IWK Health Centre, Dalhousie University,
Halifax, Nova Scotia, Canada." A bit later the Task Force refers to the
stance of "The Canadian Medical Society," a non-existent organization.
The authors dismiss four histological studies of the prepuce on the
grounds that these studies "were not designed to correlate anatomic
findings with physiologic or functional roles." It is true that the
function of the prepuce has not been fully elucidated, but the link
between form and function is an axiom of biology. It is reasonable to
suppose that specialized sensory tissue at the business end of the penis
serves a specific reproductive function. In the words of Sir James
Spence, "nature is a possessive mistress, and whatever mistakes she
makes about the structure of the less essential organs such as the brain
and stomach, in which she is not much interested, you can be sure that
she knows best about the genital organs..."[1]
1. Spence On Circumcision. Pediatrics 1965;35(2):220.
Conflict of Interest:
None declared
