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Rapid Responses: Rapid Responses published:
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Not 'the same'
- Richard Hain (6 September 2000)
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Circumcision is not Mutilation
- Nasim H Naqvi (17 September 2000)
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Misconceptions about Modern and Ancient Genital Mutilations
- Avshalom Zoossmann-Diskin (30 September 2000)
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Male and female circumcision
- Martin Harris (2 October 2000)
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Richard Hain, Senior Lecturer in Paediatric Palliative Care
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I hold no brief for male circumcision, which is usually unnecessary and when done without general anaesthetic (as is still common practice in North America) frankly abusive. However, unpleasant though it is, I do not think it can be considered 'the same' as female genital mutilation, as Zoossmann-Diskin suggests (BMJ 2000;321:570 ( 2 September )). The latter results, as indeed it is intended to do, in permanent and profound sexual dysfunction. I would agree that both are quite wrong but the degree of harm done is not comparable, and suggesting that they are the same risks weakening the case against either. |
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Nasim H Naqvi, Retired Consultant Home
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Circumcision is not Mutilation Avshalom Zoossmann- Diskin, in his correspondence,1 is thoroughly confused and incapable to differentiate the issue of female genital mutilation and that of circumcision in males. His lament why male circumcision is not considered at par with female genital mutilation in Israel and US, is quite in line with the vested interest and policy of the anti-circumcision organisation he runs. Circumcision in males has been practised for over 4000 years. No doubt there are some complications, however its record of success is unsurpassed by any other surgical procedure. There are undisputed clinical benefits of this preventive operation. If this procedure is abolished, it will cause over 10000 new cases of penile cancer annually among the Muslim and Jewish population.2 Infantile circumcision also offers significant protection against urinary tract infection in male infants.3 Recently it has been reported that the low spread of AIDS in Northern Africa, Pakistan, Bangladesh and Indonesia as compared to Southern Africa, India and other countries where the population remains uncircumcised is owing to only one factor that the author of the letter has described as “mutilation.”4 The evidence for preventive protection circumcision offers due to its simple hygienic nature is overwhelming. This protection may have saved millions from a fatal, mutilating cancer and prolonged painful suffering. In this context the argument of human rights of a non consenting minor is flimsy. The basic human rights of children among poor nations for clean water and food, leaving aside the right for education and health- care, are ignored by the greed of richer nations. The good-doers should divert their attention to real issues. N. H. Naqvi ______________________________ 1 Avshalom Zoossmann-Diskin. Male genital mutilation in any society is surley abhorrent too. BMJ. 2000; 321:57. (2 September) 2 Schoen E J. Neo-natal circumcision and penile cancer. BMJ. 1996; 313:46. (6 July) 3 Winberg J, Bollgren I, Gotherfors L, Herthelius M, Tullus K. The prepuce: a mistake of nature? The Lancet 1989; i: 598-599. (18 March) 4 Short R. Circumcise call to halt AIDS virus in Africa. The Daily Telegraph. 2000 (2 August) |
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Avshalom Zoossmann-Diskin, executive director The Israeli Association Against Genital Mutilation, POB 56178, Tel-Aviv 61561, Israel
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There is no point in trying to argue against the fanatic mutilative zeal of Nasim Naqvi, suffice it to cite the very conservative statement of the American Medical Association: "Virtually all current policy statements from specialty societies and medical organizations do not recommend routine neonatal circumcision… The low incidence of urinary tract infections and penile cancer mitigates the potential medical benefits compared with the risks of circumcision." And "behavioral factors are far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status, and circumcision cannot be responsibly viewed as "protecting" against such infections."[1] What Naqvi views as a "record of success" of this ancient mutilation is actually a record of high morbidity and mortality[2-5]. Richard Hain claim that female genital mutilation and male genital mutilation are "not the same" probably stems from lack of knowledge. Removal of the male prepuce does compromise male genital function. The prepuce, unlike the glans but like the lips and fingertips, is sensitive to light touch, pain, heat and cold. The glans and the penile shaft gain excellent sensitivity from the foreskin. The foreskin appears to be an important component of the overall sensory mechanism of the human penis[6-8]. Men circumcised in adulthood report diminished penile sensitivity, less penile gratification, more penile pain and cosmetic deformity[9]. A larger study measured the degree of sexual satisfaction before and after circumcision in adult new Russian immigrants that were circumcised in Israel. The circumcised immigrants report a decrease in their sexual satisfaction[10]. Women that experienced sexual contacts with both mutilated (circumcised) and intact (uncircumcised) men report strong preference for the latter[11]. These findings should come as no surprise. Maimonides, a famous Jewish sage and a physician, wrote in the 12th century about circumcision "that one of its objects is to limit sexual intercourse, and to weaken the organ of generation as far as possible, and thus cause man to be moderate. ... for there is no doubt that circumcision weakens the power of sexual excitement, and sometimes lessens the natural enjoyment; ... It is hard for a woman, with whom an uncircumcised had sexual intercourse, to separate from him"[12]. He also wrote "that some people believe that circumcision is to remove a defect in man's formation; but every one can easily reply: How can products of nature be deficient so as to require external completion, especially as the use of the fore-skin to that organ is evident. This commandment has not been enjoined as a complement to a deficient physical creation, but as a means for perfecting man's moral shortcomings. The bodily injury caused to that organ is exactly that which is desired"[12]. Maimonides does not take circumcision lightly, "for circumcision is not like an incision on the leg, or a burning in the arm, but a very difficult operation"[12]. His serious attitude probably stems from the fact that no modern medicine was available to save the little victims from the "accidents" of circumcision. In the societies that practice it, Female Genital Mutilation exactly like Male Genital Mutilation has many alleged benefits. "The failure to relate the two types of circumcision is curious because they have probably been regarded by most Africans as being related for aeons. Both Herodotus in the fifth century BC and his Egyptian informants discussed male and female circumcision as a single phenomenon carried out for the same reasons, and this appears to be the testimony also of Diodorus Siculus and Strabo for Egypt and Eritrea in the first century BC. Two millennia later, Kenyatta writing of the Kikuyu of Kenya in the present century, fails too to make any distinction"[13]. In these societies female circumcision "was thought to be aesthetic, a protection against pelvic infection and especially sexually transmitted disease, anciently practised and hence culturally appropriate, and sometimes also a protection for the baby during its birth"[13]. Female genital mutilation has gained so much discussion and condemnation and was outlawed in some countries with only a few studies that actually examined the women to evaluate the physical harm caused by the procedure, and not only interviewed them. Among the Bedouins of Israel none of the 37 women examined was mutilated[14]. They all had only small scars on the prepuce of the clitoris and/or the upper 1cm of the labia minora near the clitoral prepuce. Upon physical examination of the other group, Ethiopian Jews, which resides now in Israel and performed female genital mutilation in Ethiopia, 63% of the women, who all claimed to have been circumcised, did not even have a scar! 20% had scars, in 7%, one square centimeter of the labia minora was removed from beneath the clitoris and only 10% demonstrated a real and severe form of female genital mutilation, total amputation of the clitoris[15]. The women seem to be wiser than the men; most of them seem to have transformed their mutilation into a nonmutilative ritual. Boys do not have such luck. Nearly 90% of infibulated (the most severe and least prevalent form of female genital mutilation) Sudanese women interviewed, but not examined, by Lightfoot-Klein said they experience orgasm (I think this is higher than the corresponding percentage among intact western women)[16]. There are two possible explanations for this surprising finding; either infibulation is compatible with orgasm, or more likely the women were not infibulated or even not mutilated at all! Avshalom Zoossmann-Diskin, PhD, REFERENCES 1. http://www.ama-assn.org/ama/pub/article/2036-2511.html 2. Crowley IP, Kesner KM. Ritual circumcision (Umkhwetha) amongst the Xhosa of the Ciskei. Br J Urol 1990;66:318-21. 3. Ozdemir E. Significantly increased complication risks with mass circumcisions. Br J Urol 1997;80:136-9. 4. Bennett J, Breen C, Traverso H, Bano Agha S, Macia J, Boring J. Circumcision and neonatal tetanus: disclosure of risk and its reduction by topical antibiotics. Int J Epidemiol 1999;28:263-6. 5. Zoossmann-Diskin A. Circumcision. BJU Int 1999;84:748. 6. Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-5. 7. Cold CJ, Taylor JR. The prepuce. BJU Int 1999;83,suppl 1:34-44. 8. Cold CJ, McGrath KA. Anatomy and histology of the penile and clitoral prepuce in primates. In Denniston GC, Milos MF, Hodges F. Eds. Male and female genital mutilations: medical, legal, and ethical considerations in pediatric practice. Plenum Press, New York. 1999;pp 19-29. 9. Money J, Davison J. Adult penile circumcision: erotosexual and cosmetic sequelae. J Sex Res 1983;19:289-92. 10. Zoossmann-Diskin A, Blustein R. Challenges to circumcision in Israel: the Israeli association against genital mutilation. In Denniston GC, Milos MF, Hodges F. Eds. Male and female genital mutilations: medical, legal, and ethical considerations in pediatric practice. Plenum Press, New York. 1999;pp 343-350. 11. O'hara K, O'hara J. The effect of male circumcision on the sexual enjoyment of the female partner. BJU Int 1999;83,suppl 1:79-84. 12. Maimonides M. The guide for the perplexed. New York: Dover Publications INC., 1969. 13. Caldwell JC, Orubuloye IO, Caldwell P. Male and female circumcision in Africa from a regional to a specific Nigerian examination. Soc Sci Med 1997;44:1181-93. 14. Asali A, Khamaysi N, Aburabia Y, Letzer S, Halihal B, Sadovsky M, et al. Ritual female genital surgery among Bedouin in Israel. Arch Sex Behav 1995;24:571-5. 15. Grisaru N, Letzer S, Belmaker RH. Ritual Female Genital Surgery Among Ethiopian Jews. Arch Sex Behav 1997;26:211-5. 16. Lightfoot-klein H. The sexual experience and marital adjustment of genitally circumcised and infibulated females in the Sudan. J Sex Res 1989;26:375-92. |
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Martin Harris, General & Circumcision practitioner Temple Fortune Health Centre, London NW11 7TE
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Dear Editor Personal View urged a stronger campaign to end female circumcision(1) . I was amazed at the BMJ editorial board decision accepting for publication such poor quality of research. The French authors interviewed 14 African women who had undergone the procedure and were living in France. Firstly, this procedure has been outlawed in this country by the 1985 Statute Act. They found that "the 14 women interviewed considered their daughter's mutilation and their sons' circumcision to be similar". Now the BMJ letters section has a heading "Ending genital mutilation" and print a letter(2) commending the Personal View authors that male circumcision is the same as female genital mutilation. In my experience as a practitioner of male circumcision including African requests, there is no similarity considered by the parents of their sons' circumcision in any way whatsoever to the notion of female circumcision; parents do not in fact equate the two. As a practitioner, this is not surprising due to the anatomical differences e.g. clitoridectomy renders the female anorgasmic and is associated with far more complications. Yours sincerely, Dr Martin Harris
B Pharm(Honours) MB BS(London) LRCP(London) MRCS(England) MRCGP
(1) Abboud P et al Stronger campaign needed to end female genital mutilation BMJ 22 April 2000 7242 p1153 (2) Avshalom Zoosman-Diskin BMJ 2 September 2000 7260 p571 |
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