Extenuating Circum Stances, Pt. 2: Male Genital Cutting

MGC is a medical enigma. It is the oldest known surgery in recorded history, with the oldest depictions of priests cutting the foreskins of young men being found on the walls of the necropolis of Saqqara in Egypt. These reliefs date back to 2400 B.C.E. and while they are the oldest known images of the practice, the surgery certainly dates back further in time. It remains unknown what the impetus for the practice was, but it certainly began before medical science and religious ideology were distinctly separate fields. While many may ponder on the originating factor – whether it was for cleanliness, hygiene, aesthetics, chastity, therapy, or something else entirely is the matter of an entirely different debate – perhaps the more puzzling element of the practice is its long history of pervasiveness, particularly into modern, medically advanced societies. This is particularly true considering that for much of its existence, the practice has been confusing, unnecessary, and even offensive to those who don’t practice it: the Romans forbade it; the Greeks jeered at it (they emphasized the beauty of a long prepuce in much of their art and found the exposure of the glans to signify sexual arousal); modern day ‘intactivists’ claim that it is a sex crime.

It is important to note that MGC goes far beyond the traditional notions of routine neonatal circumcision that are withheld in the U.S. The typical American idea of MGC is a removal of the prepuce only, which is often thought of as being just a little bit of skin at the end of the penis. In truth, the procedure removes a third to one half of the entire skin on the penis. In other forms of MGC practiced around the world, such as in parts of Africa, Australia, and the Pacific islands, cutting can involve making slits in the prepuce, piercing the foreskin, or even slitting the urethra in part or in whole along the ventral shaft of the penis (Bell 2005:126). Because these forms of MGC are not as common or as widely known or discussed, many people have difficulty drawing a connection between MGC and FGC. However, one commonality is clear: a variety of genital cutting forms are practiced that range in severity of cuts and medical complications.

‘A COVENANT WITH GOD’

It is estimated that 30% of men worldwide today are circumcised. Two-thirds of the total population is Muslim. The remaining one-third is comprised of men in specific geographic locations where MGC exists as a social norm: the United States, Canada, Israel, and New Zealand. It is no secret that Islam and Judaism call for MGC. As both are Abrahamic religions, the originating scripture in Genesis is interpreted literally and expressed in present day as a symbol for one’s sacrificial covenant with the Hebrew God: “Every male among you shall be circumcised, You shall be circumcised in the flesh of your foreskins, and it shall be a sign of the covenant between me and you.”[1]

Without doubt, this tradition is seen as carrying over into the third Abrahamic religion, Christianity, particularly among Protestant groups in the United States and Great Britain. Keeping the covenant, however, is not a requirement for Christians, according to the apostle Paul as written in the New Testament. Paul clearly states, “In Christ, neither circumcision nor uncircumcision counts for anything.”[2] According to the New Testament book of Luke, Jesus was circumcised, which is not a surprise to most, considering that Jesus was Jewish. For this reason, he would have kept with many, if not all, of the laws of old. What is more surprising, perhaps, is that genital cutting never appeared in any of Jesus’ teachings. This is important in understanding the drivers behind the practice as it spread in Western Europe, Australia, the United States, and Canada in the 19th and 20th centuries. It is worthy to also point out the gender bias in the Old Testament: women were left out of the covenant of genital cutting. Jesus, Paul, or the authors of the books of the New Testament may have specifically left out discussion of MGC in Christianity to include women in the new covenant, which focused largely on baptism, a gender inclusive practice.

Metzitzah b’peh, or oral suction, is the Jewish tradition whereby the mohel, or ceremonial circumciser, places the cut penis in his mouth and sucks the blood to prevent infection. This practice continues today in some Orthodox Jewish groups, including those in the U.S., and has been the source of much controversy in recent years. Opponents of the practice claim that there is an increased risk of spreading herpes and other sexually transmitted infections to the infants. Furthermore, some claim the act is sexually exploitative and is, in fact, a sex crime. Proponents argue that the practice “lowers the internal pressure in the tissues” of the penis, allowing for the wound to heal more quickly and with decreased risk of infection. In addition to these medical benefits, they claim that the practice has “deep religious significance” (Halperin 2012).

As recently as May 2013, controversies involving the practice of metzitzah b’peh (MBP) have populated the news in the U.S. and Germany. A rabbi in Berlin has been sued for performing the ceremony on his own son (Goldman, et. al. 2013) immediately on the tails of a recent court case from Cologne that nearly banned the practice of MGC for non-medical reasons entirely (Huffington Post 2012). Putting the risks associated with MGC in general aside, the New York City Department of Health has specifically linked 2 deaths and 13 cases of infant infection with herpes since 2000 with the practice of MBP (Goldman; Brady 2013). According to CNN, infant males who underwent MGC with MBP “between April 2006 and December 2011 had an estimated risk of contracting neonatal HSV-1 infection of 24.4 per 100,000 cases, [which is] 3.4 times greater than other infants” (Brady).

The aforementioned Cologne court case had nothing to do with MBP. In fact, the case involved a Muslim family that had a Muslim doctor perform the operation on their 4 year old son strictly for religious reasons. The boy’s penis began bleeding severely two days after the surgery and an investigation was launched when the admitting hospital contacted authorities. The court ruled that MGC was a violation of the child’s rights and, taking the rights of the parents and the right to religious freedom into context, decided that “the procedure was not in the best interests of the child” (Connolly 2012). Specifically, the court stated that the child’s body was “permanently and irreparably changed.” The ruling brought both Jewish and Muslim groups together to criticize the court, claiming that the court violated their religious authority and that it was “an attack on centuries of religious affiliation.”

Outside of these recent cases, MGC has been staunchly defended by religious groups, particularly Jewish and Muslim groups, for thousands of years. Dating back to early Roman, Greek, and Babylonian control over the Middle East, laws have been enacted that both ban and protect the practice. Some historians believe that the prevalence of MGC and the increased invasiveness of the procedure – initial practices only required a removal of part of and did not require the removal of the entire prepuce along with the practice of MBP – expanded to differentiate Jews from others during periods of exile.

Whatever the case, any arguments made for the medical benefits of MGC, are deeply rooted in religious and social practices dating back thousands of years. Many studies of medical benefits of MGC focused on the frequency of certain diseases and infections in Jewish populations.[3] The problem with these studies, however, is that they ignore the cultural factors that may influence the prevalence of certain medical problems more than circumcision. For example, Jewish men traditionally have fewer partners than non-Jewish European and men, who also tend to be uncircumcised. Still, it is important to understand the cultural factors at play and recognize that no discussion of circumcision is free from the influence of these complex dynamics. It is important to note, however, that even within Jewish communities, a spiritual ritual, brit shalom, has been founded that takes the place of ritual MGC, replacing it with a new ceremony complete with a naming ritual and prayers (Rosenblum 2009). Brit shalom is a way for Jews to adhere to the covenant without cutting the flesh of their children.

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[1] Genesis 17:10-11. The HarperCollins Study Bible, New Revised Standard Version. San Francisco: HarperCollins San Francisco, 1993.
[2] Galatians 5:6. The HarperCollins Study Bible, New Revised Standard Version. San Francisco: HarperCollins San Francisco, 1993
[3] See Weiss 1977; Poland 1990; Fleiss and Hodges 1996; and Laumann, Masi, and Zuckerman 1997, among others.

Extenuating Circum Stances, Pt. 1: Introduction

As the father to both a daughter and a son, I was struck by the oddity that, while I was asked by several people, including medical personnel and non-medical, interested parties, whether or not I was going to have my son circumcised, not a single person asked if I was going to have my daughter circumcised. Indeed, some people assumed that I was having my son circumcised without asking, as if leaving him uncircumcised was not an option. What is the basis for this assumption? Is it based on social, political, economic, religious, medical, or a combination of factors? And why is there not a similar assumption, or even a question, regarding circumcising our daughters? In order to answer these questions, an examination of circumcision must account for social, economic, religious, cultural, and other factors that have shaped the history and development of the practice, and the controversies that ensue, along the binary lines of gender.

While routine male circumcision is not seen as medically necessary by most medical associations in the world – more on this to come – routine, non-medical circumcision rates in the United States remain high. In fact, routine male circumcision remains the most common surgery in the United States[1] with over 1 million boys being circumcised each year. There is a decline in routine neonatal circumcision; the Centers for Disease Control and Prevention released a report in 2011 that showed a drop in newborn male circumcision from 62.5% in 1999 to 56.9% in 2008 using data from the National Hospital Discharge Survey.[2] Still, the United States stands alone as the last medically advanced nation to routinely perform this surgery on infants. In this sense, male circumcision is a uniquely American phenomenon with a complex history that intersects religious, social, political, economic, and scientific domains. The primary arguments for the widespread continuation of circumcision today tend to come from religious and social points of view, while the arguments against come primarily from scientific views, but economics also finds itself playing a unique part in the reduction of circumcision, particularly in the Western U.S., where immigration of Mexican and other Latin American individuals is high and some states have removed Medicaid coverage of the surgery.[3]

When it comes to the female genitals, however, the United States stands nearly as a whole at the opposite side of the spectrum. The majority of the world’s female circumcision occurs in Africa and several countries in Asia and the Middle East. The World Health Organization has estimated that about 101 million girls aged 10 and older have undergone female genital cutting (abbreviated FGC) in Africa alone.[4] The practice is largely encouraged for religious and social reasons, including ensuring chastity and proving the sexual purity of a girl to her husband. In the West, most opponents of FGC belie any notion of social benefits, insisting that the consequences for FGC far outweigh any possible benefits. And this is the essence of the controversy, what I refer to as “The West versus the Rest,” though, admittedly, this may not be the most accurate description. The debate over FGC is not simple by any means; on its surface it is a about female genitals, but deep down it is about culture, ideology, social status, and, indeed, gender relations.

For the purposes of remaining as neutral as possible while discussing the practices, controversies, and analysis of both male and female genital modification surgery, I have chosen to refer to both practices with the phrase “genital cutting.” While male circumcision is rarely referred to as male genital cutting (MGC), this phrase will be used to avoid confusion and to better compare it to the genital cutting practices of FGC. FGC, meanwhile, will be used to avoid underrepresenting the risks, procedures, or complications resulting from cutting female genitals (i.e., female circumcision) or overstating the horrors typically only associated with the more sever forms of FGC (i.e., female genital mutilation, or FGM). As will be discussed below, different groups prefer different terms depending on the specific cutting practice and its significance to their ideology or tradition.

[1] http://academicdepartments.musc.edu/surgery/divisions/pediatric/procedures/circumcisionhttp://academicdepartments.musc.edu/surgery/divisions/pediatric/procedures/circumcision

[2] http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm?s_cid=mm6034a4_w

[3] Bell 2005:129

[4] http://www.who.int/mediacentre/factsheets/fs241/en/index.html