Petition to the AAP Taskforce on Circumcision
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The following information has been screened and fact-checked for accuracy. We will only cite peer-reviewed studies published in reputable publications as supporting evidence, or statements made by professional health organizations. Please email us immediately if you spot any errors, our email address is admin [at] inaapt.com.
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In response to record-low hospital circumcision rates in the US, the American Academy of Pediatrics has indicated that it is about to become the first professional medical organization to recommend infant circumcision in history by the end of this month, August 2012. This statement, if made, will be based on a myopic and one-dimensional analysis of available science; while one analysis may indicate circumcision carries preventative properties for men in high-risk countries, studies have consistently shown that the procedure severs a part of male anatomy that is embedded with tens of thousands of sensitive nerve endings, and studies among men in non-high risk countries have generated highly variable conclusions regarding its efficacy in preventing STD transmission. Some studies even argue that the foreskin contains some of the the most erogenous tissue in male genitalia.
- The College of Physicians and Surgeons of British Columbia (2009) have written that the foreskin “is rich in specialized sensory nerve endings and erogenous tissue. Circumcision is painful, and puts the patient at risk for complications ranging from minor, as in mild local infections, to more serious such as injury to the penis, meatal stenosis, urinary retention, urinary tract infection and, rarely, even hemorrhage leading to death.”
- The Royal Dutch Medical Association (2010) argues that the human foreskin is “a complex, erotogenic structure that plays an important role in the mechanical function of the penis during sexual acts, such as penetrative intercourse and masturbation”, and doesn’t stop there. The organization also states “circumcision of male minors is a violation of children’s rights to autonomy and physical integrity.”
- Another statement by the Royal Dutch Medical Association (2010): “That the relationship between circumcision and transmission of HIV is at the very least unclear is illustrated by the fact that the US combines a high prevalence of STDs and HIV infections with a high percentage of routine circumcisions. The Dutch situation is precisely the reverse: a low prevalence of HIV/AIDS combined with a relatively low number of circumcisions. As such, behavioural factors appear to play a far more important role than whether or not one has a foreskin. (…) Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.”
- A study published by the Oxford International Journal of Epidemiology (2011) concluded that “circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia [pain during intercourse] and a sense of incomplete sexual needs fulfillment.”
- A paper in The Austrian Journal of Health Psychology (2002) argues “the complex innervation of the foreskin and frenulum has been well documented, and the genitally intact male has thousands of fine touch receptors and other highly erogenous nerve endings.”
- A study in the Indian Journal of Sexually Transmitted Diseases (2010) states “there is no medical justification for routine circumcision in neonates or children. It should be performed only for established medical reasons and should not be universally recommended.”
- The British Journal of Urology International (2007) published a study that reads: “the glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis.”
- Another study published by the British Journal of Urology International (2007) concluded “there was a decrease in masturbatory pleasure and sexual enjoyment after circumcision, indicating that adult circumcision adversely affects sexual function in many men, possibly because of complications of the surgery and a loss of nerve endings.”
- The Finnish Medical Association (2004, translation courtesy of Wikipedia) ‘opposes circumcision of infants for non-medical reasons, arguing that circumcision does not bring about any medical benefits and it may risk the health of the infant as well as his right to physical integrity, because he is not able to make the decision himself. The association emphasizes that according to the Finnish constitution, the parents’ freedom of religion and conscience does not produce the right to violate other people’s (children’s) right to physical integrity.’
- A study published in the Journal of Public Health in Africa (2011) states “there is no scientific reason to believe that the [African Randomize Controlled Trial] results would necessarily apply to the general population. It is quite likely that applying research results from a high risk population to the general population will lead to failure.”
- An analysis of the African Randomized Controlled Trials in the Journal of Law and Medicine (2011): “the trials were compromised by inadequate equipoise; selection bias; inadequate blinding; problematic randomisation; trials stopped early with exaggerated treatment effects; and not investigating non-sexual transmission. Several questions remain unanswered. Why were the trials carried out in countries where more intact men were HIV-positive than in those where more circumcised men were HIV-positive? Why were men sampled from specific ethnic subgroups? Why were so many participants lost to follow-up? Why did men in the male circumcision groups receive additional counselling on safe sex practices? (…) any long-term benefit in reducing HIV transmission remains uncertain.”
- The American Journal of Preventative Medicine (2010) published a study titled ”Male circumcision and HIV prevention insufficient evidence and neglected external validity”.
- The authors of one of the African Randomized Controlled Trials (2005) have stated “This study has some limitations. It was conducted in one area in sub-Saharan Africa and, therefore, may not be generalizable to other places.”
- A study by the Naval Health Research Center (2004), which conducted multiple separate logistic regressions to evaluate the role of circumcision in the acquisition of HIV and STI determined circumcision “is not associated with HIV or STI prevention in this U. S. military population (…) Although known HIV risk factors such as inconsistent condom use, history of STI, multiple partners, and anal sex were found to be associated with HIV in this military population, there was no significant association with male circumcision.”
- The French National Council on AIDS (2007) has stated “The same measures are not applicable to the Northern countries. The recommendations of the WHO state that this strategy is aimed at countries with high prevalence, and not at countries with low prevalence or in countries where it relates specifically to one part of the population such as in France or the United States.”
- A paper in the Journal of Medical Ethics (2010) found ”the [analysis of African Randomized Controlled Trials] noted that further research was required to assess the feasibility, desirability and cost-effectiveness of implementation within local contexts. This paper endorses the need for such research and suggests that, in its absence, it is premature to promote circumcision as a reliable strategy for combating HIV.
- A study in the Journal of Sexual Medicine (2012) among Carribean men reflects that “compared with uncircumcised men, [circumcised men] have accumulated larger numbers of STI in their lifetime, have higher rates of previous diagnosis of warts, and were more likely to have HIV infection (…) Findings suggest the need to apply caution in the use of circumcision as an HIV prevention strategy, particularly in settings where more effective combinations of interventions have yet to be fully implemented.“
Up until now, the AAP has only acknowledged one study that concluded the foreskin contains sensory tissue (this one, a study from 1996 with a sample size of 22 adults). It’s time to inform them that many other studies have concluded the foreskin contains sensitive, erogenous tissue. This is no longer up for debate; there is an ample amount of evidence that suggests this, and citing one study does not sufficiently represent available scientific data.
This is not the first time the AAP is under heat for a stance regarding genital cutting. In mid-2010, the AAP advocated for allowing female genital mutilation in the form of “pricking”, in fear that parents of immigrant daughters may opt for a more severe form of genital mutilation for their daughters. Not surprisingly, this position was met with a great deal of resistance, and the AAP shortly withdrew their statement.
Circumcision may not be akin to female genital mutilation to its most severe extent (clitoridectomy and infibulation); it is still however an unnecessary procedure, and no civilized society should ever recommend any permanent non-therapeutic alteration of genitalia. Contrary to popular belief, Female Genital Mutilation does not refer to the removal of the clitoris. It is defined by the World Health Organization as “all procedures that involve partial or total removal of the external female genitalia, or other injury to the female genital organs for non-medical reasons”. This includes removal of the clitoral hood (warning: graphics of human anatomy), which for women is embryonically homologous to the male foreskin. No amount of studies could or should ever legitimize Female Genital Mutilation, in any capacity.
You can pre-empt many problems by severing off human body parts (mastectomy, for instance comes to mind), but in a civilized society, we typically refrain from enacting this type of behavior on an infant or child, unless indicated as medically necessary. Circumcision can be safely performed in adulthood.
There is, quite irrefutably, a presence of complex nerve receptors in the male foreskin which are severed by circumcision. If the AAP Task Force on Circumcision decides the benefits outweigh the negatives, the decision will reflect that the AAP is willing to cherry-pick the scientific studies they chose to examine, showcasing an embarrassing myopia to available scientific data.
The foreskin is not a birth defect. It is neither a congenital deformity nor genetic anomaly akin to a 6th finger or a cleft. It is also not a medical condition like a ruptured appendix or diseased gall bladder, or a dead part of the body, like an umbilical cord, hair, or fingernails. The foreskin is not “extra skin”; the foreskin is normal, natural, healthy, functioning tissue, with which all boys are born. It is as intrinsic to male genitalia as the clitoral hood is to female genitalia (both of which are actually embryonically homologous).
Unless there is a medical or clinical indication, the circumcision of a healthy, non-consenting individual is the destruction of normal, healthy tissue. It is the permanent disfigurement of normal, healthy organs, and by very definition, a violation of the most basic of human rights. Without such medical or clinical indication, the AAP has no business recommending such surgery on a healthy, non-consenting individual.
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