VICTORIA B.C.: Human Rights group criticises CPS policy

Children's Health and Human Rights Partnership (CHHRP)
September 9, 2015

Canadian Children's Rights Group Questions New Circumcision Policy

VICTORIA, BRITISH COLUMBIA-- A just released policy on infant male circumcision by the Canadian Paediatric Society (CPS) was judged today by the Children's Health & Human Rights Partnership (CHHRP) to be a step in the right direction, but was "nevertheless 'predictably inadequate' with respect to several specific issues."

CHHRP Medical Director Dr. Christopher Guest, MD, FRCPC, said the new policy is consistent with international paediatric associations that affirm infant boys should not have their healthy foreskins routinely removed.

Citing the position of the CPS that recognizes the unique sensory functions of the male foreskin, Dr. Guest asserted that, "A growing number of medical associations now recognize that an intact penis with a foreskin contributes to sexual pleasure for the male and his partner." According to Guest, in 2010 the Royal Dutch Medical Association concluded, "the foreskin is a complex erotogenic structure that plays an important role in the mechanical function of the penis during sexual acts."

"Circumcision alters the structure of the penis, which inevitably alters function. Long term harm to men from infant circumcision has never been studied" Guest said. Despite this, Guest says men are reporting long-term adverse consequences at the Canadian-based online Global Survey of Circumcision Harm. Although the CPS failed to include it, Guest says scientific evidence has emerged that supports these men's claims. In 2011, Dr. Morton Frisch published findings in the International Journal of Epidemiology showing that in Denmark, where circumcision is rare, 'circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in their female partners, notably orgasm difficulties, dyspareunia [difficult or painful sexual intercourse] and a sense of incomplete needs fulfilment.'

Guest faulted the CPS for inclusion of  "convenient untruths, "most notably a discussion of HIV being lower in circumcised men. He says such claims are based on methodologically weak African trials, which contradict global HIV trends, for example the United States, which has a high circumcision rate, yet a significantly higher rate of HIV infection than Sweden and Japan where circumcision is rare. "Even if the African trials were scientifically valid, they cannot be used to justify infant circumcision because infants are not sexually active persons," he said. "Soap and water and safer sex practices, including condoms, can prevent disease."

According to Guest, the CPS failed to include crucial information from a 2012 report by the International NGO Council on Violence Against Children, which CHHRP sent to the CPS in 2014. The report stated that "non-consensual, non-therapeutic circumcision of boys, whatever the circumstances, constitutes a gross violation of their rights, including the right to physical integrity, to freedom of thought and religion and to protection from physical and mental violence."

"Medical associations in the Netherlands, Finland, Sweden, Norway, Denmark, Germany, and others confirm that there is no justification for circumcising infants in the absence of medical urgency," Guest stated. "The CPS is out of step with those medical associations, who also urge an end to the practice due to ethical and human rights concerns."

Although the CPS concluded that routine infant circumcision is not recommended, and that the benefits of the surgery do not outweigh the risks (contrary to a 2012 claim by the American Academy of Pediatrics), Guest contends that the position statement is still insufficient due to its ambiguity in leaving the decision up to parents. "Parents are not physicians. They do not have the medical knowledge to decide if surgery is medically indicated for their child," Guest asserted. He went on to say that, "Leaving a decision about medically unnecessary surgery up to parents is an ethical failure on the CPS' part. Where else in medicine do physicians place this burden on parents, in order to obviate their own professional responsibility?"

"Preservation of bodily integrity is a basic and universal human right that the CPS must articulate clearly in future statements," Guest said. "We Canadians, as well as our institutions and government, have an obligation to protect that right for all citizens, regardless of gender or age."

The Children's Health & Human Rights Partnership was established in 2012 as a partnership of professionals in the fields of medicine, ethics, and law to further public education regarding non-therapeutic genital surgery on Canadian children.


Earlier story

ILLINOIS: The AAP gets letters

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

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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 unimpaired⁵

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.]

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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