Tuesday, June 1, 2010

Gender Bias and Circumcision

This is a presentation done by Yvonne Hightshoe and used with permission.  Read to the end to find out how her professor and classmates reacted!  (Also, if this confuses you, Google the definition of 'satire')

Every year in the United States many newborn baby boys are blessed with a circumcision which will benefit both their physical and mental health for the length of their lives.   While the American Academy of Pediatrics doesn’t endorse routine infant circumcision for every baby, they do recognize that there are potential benefits of removing the foreskin (American Academy of Pediatrics).    Removing the foreskin, also called the prepuce, is said to create a cleaner penis by stopping the collection of smegma, and reducing the rate of urinary tract and yeast infections (Christakis).   Contraction of some STD’s such as HIV has in addition been found by some research to be drastically reduced by amputation of the prepuce (Auvert).  Girls also have a prepuce on their genitals, and are sometimes circumcised in other countries; however the federal government has made this medical procedure illegal in the United States (Federal Prohibition of Female Genital Mutilation Act of 1995). While female circumcision is unused due to cultural bias, it could benefit the mental and physical health of society, and not allowing both sexes to benefit from infant circumcision is an undeniable form of sex discrimination.

            First and foremost, let me be clear on the type of female circumcision I am endorsing as there are four categorical types of circumcision and some are more severe than others (World Health Organization).  The most poignant form, Type III also called infibulation, removes the clitoris and labia minora, sewing together the labia majora and only leaving a small hole for urine and menstrual flow.  Other types, such as clitoridectomy and excision, remove the clitoris and labia minora.  Forms of female circumcision that do not fit into these categories and are less severe are usually categorized as Type IV female circumcision.  I am by no means suggesting removing the clitoris, or any other severe form of genital cutting in the least bit more severe than its male counter-part.   My proposal is to remove the female prepuce, also known as the clitoral hood, and to trim the labia minora on female infants. 

            American Federal Government as of 1996, made female circumcision of a minor in any form a federal crime, stating: “Whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than 5 years, or both.” (Federal Prohibition of Female Genital Mutilation Act of 1995).  This seems ironic considering that somewhere between seventy-five and ninety percent of men in the United States are circumcised, most of whom were circumcised during the neonatal period (World Health Organization).   In fact, at least sixty-one percent of newborn boys were recorded in 2000 to be circumcised before even leaving the hospital after birth (World Health Organization).    On April 26th 2010 The American Academy of Pediatrics released a statement regarding female genital cutting which alleges that mutilation is an inflammatory term that disregards the self image of women whom have undergone the procedure, suggesting female genital cutting, a more culturally sensitive term, instead (Commitee On Bioethics).   The statement went on to say “...the ritual nick suggested by some pediatricians is not physically harmful and is much less extensive than routine newborn male genital cutting.” Proposing an amendment to federal law to allow for type IV female circumcision for cultural and religious reasons.  

Certainly if it benefits the male sex to have their prepuce removed, it makes sense that there could also be benefits to removing the female prepuce.  Unfortunately, due to cultural bias regarding the morality of the procedure, there is little to no research specifically regarding whether or not circumcision benefits women and much of the research that has been done usually involve much more severe forms of female circumcision, because of this my research is largely based upon knowledge regarding how the female genitals work and research concerning female health complications of the genitals.   

While men benefit from circumcision, women suffer considerably more from health problems regarding their genitals, and because of this have a greater possibly for health benefits.  The clitoral hood and the foreskin have virtually the same function, to cover the most sensitive part of the genitals, on men the head of the penis, on women the clitoris.  An important factor in the similarity between male and female genitals is the sebaceous glands.   While the sebaceous glands are present all over the body, except the hands and feet, they are the most plentiful on the face and anogenital surfaces, producing an oily substance called sebum which is associated with conditions such as acne and dandruff (Stollery, Youn).  The function of sebum is still ardently debated by scientists, as some believe it to be a functionless evolutionary left over, while others believe it to be an important protective substance (“Human Skin”).  The foreskin, clitoral hood, and labia minora all release high levels of sebum, and when sebum is allowed to accumulate in the genital region it creates a nasty looking white cheesy substance called smegma  (“Human Reproductive System” ).   Usually when someone mentions smegma a person will more often than not think of an uncircumcised penis and shudder with disgust; however, that white substance that accumulates around the female genitals and under the clitoral hood, is also smegma. 

If smegma is not cleaned frequently it can harden and become a painful irritant to both the female and male genitals.   The clitoral hood, even more so than the foreskin, often proves to be very difficult and even painful area to clean under, particularly so for parents with small children that will not allow them to clean their genitals.  I know this from personal experience as my daughter will not allow anyone to clean anywhere near her genitals and will scream like a banshee if you try to touch her there; as a result she often has accumulated large amounts of smegma around her labia.  The accumulation of smegma can result in genital adhesions.   Baby girls are particularly notorious for having their labia fuse during infancy and because of this every time we take our daughter to her “well baby” checkups her pediatrician always checks for adhesions.   Because the clitoral hood is particularly difficult to clean under, smegma often accumulates here and can result in complications such as clitoral hood adhesion, similar to adhesion of the foreskin which occurs on uncircumcised males.   While there is research being done and new experimental procedures attempting to stretch the clitoral hood to ease the pain and discomfort of a clitoral hood adhesion, the only treatment to truly cure clitoral hood adhesions is partial or total circumcision (Paniel).  Doctor C.F. McDonald became interested in the health benefits female circumcision when he noticed that many girls suffered the same genital complications as uncircumcised males, stating in a 1959 medical journal, “The signs and symptoms caused by contaminated smegma, retained smegma or smegmaliths usually clear up when the cause is removed. The same reasons that apply for the circumcision of males are generally valid when considered for the female.”   As the labia minora is responsible for the most signifigant amount of sebum production on females and the levels of sebum excretion are the highest during the neonatal period and puberty, certainly we could avoid all these complications later in life, if we routinely removed both the prepuce and trimmed the labia minora of infant girls. 

Male circumcision boasts the benefits of lowered urinary tract and yeast infections, but women are more prone to yeast infections and thirty times more likely to develop a urinary tract infection (Cunha).    In fact, a study from the Department of Pediatrics, Brooke Army Medical Center, found that the declining rate of male circumcision may be changing the male to female urinary tract infection ratio during the first three months of life, weighing it more evenly than previously (Wiswell).   While it is generally accepted that women get urinary tract infections more easily than men because the female urethra is shorter, these infections cannot happen without the introduction of bacteria to the urethra.    It is common knowledge that hygiene plays in important role in avoiding urinary tract infections, and as I have already covered keeping the female genitals clean can be a daunting task.  The labia and clitoris are in close quarters with the urethra, and smegma that is allowed to remain in these areas can lead to bacterial growth, also referred to as contaminated smegma.   If a women doesn’t wipe from front to back bacteria from the anus can contaminate the genital region and eventually make its way into the urethra.   The labia minora is very moist, and yeast thrives in moist areas.  While often female yeast infections do originate as an imbalance of natural yeasts within the vagina often due to antibiotics, they can also occur on the labia minora and around the clitoris in infections such as vulvovaginal candidiasis and vulvovaginitis (Eckert). Clearly if we remove all this excess moist tissue where bacteria and yeast is allowed to grow in infancy, these infections would be avoided for many girls throughout their lives. 
Cancer is a serious threat in today’s society and circumcision plays an important role as a preventative measure against penile cancer (Maden).   Consider this: in 2006 penile cancer claimed the lives of 280 men in the United States; however, vulvar cancer resulted in the death of 880 women that same year (American Cancer Society).  Common sense tells us that if we remove this unnecessary tissue ahead of time, it cannot develop cancer.   Research has also been done which has found smegma to be carcinogenic; of course it’s totally irrelevant that many of these studies were done over fifty years ago by injecting human and sometimes horse smegma into the genitals of mice (Howe).   There is speculation that smegma may be responsible for many cases of cervical cancer, and in addition is an agent for the spread of sexually transmitted infections (Heins).  Based on all this evidence you can see, female circumcision could save the lives of hundreds of women every year.    Not too long ago doctors routinely removed other nonessential organs such as the tonsils and appendix to avoid the possibility of infections, potentially saving lives.  It’s a shame they don’t do that anymore. 

Interestingly enough, while studies in Africa have found a significantly reduced risk for HIV infection, most of the research appears to show the opposite effect for women.  However, if you look at the research more closely you will notice that infection is often associated with complications in the healing process due to poor hygiene, and use of unsterile equipment during the procedure (Brandy).  Also what is not considered is that uncut women are more likely to have young sex partners where as cut women are more likely to have older sex partners, and the older men have a higher rate of HIV infection (Yount).  There was, however, a study done in Tanzania where the researchers were shocked to find that circumcised women there were at a decreased risk of HIV infection, even with all possible factors adjusted for (Stallings). 

The medical benefits aside, circumcising our daughters after birth could also benefit them in their social, emotional and sexual life. While female genital cutting is not currently culturally normal, as is male genital cutting, wide spread implementation of female infant circumcision could benefit our daughters’ emotional well being.  Remember a century ago male circumcision was not common in the United States either, so we could easily make circumcised female genitals just as commonplace and socially acceptable (World Health Organization)!  Many teenage girls suffer from poor body image; they should not have to also worry about whether or not their genitals look normal.  I worry everyday about whether or not my daughter will grow up to feel that her body is not good enough.  What if she goes to school and other girls in the locker room tease her because her labia are longer than theirs?  She could be emotionally scarred for life.   If all infant girls had their genitals cut in the same way, then they would all look alike and have no reason to tease each other.  All we have to do is circumcise about 90% of females in one generation and all of the generations to follow will believe it is culturally normal and acceptable as well. 

Certainly even her future sexual partner(s) would greatly appreciate her having tidy, clean and sexy genitals, preferring them over an intact woman’s dirty and messy looking saggy lips.  It is estimated that thousands of women are turning to plastic surgery procedures such as labiaplasty, also called labial reduction or labial beautification, and hoodectomy, also called clitoral unhooding, to obtain the ideal female gentitals.  While some have the procedures done because of their labia causing them discomfort and hygiene problems, the vast majority of women who undergo the procedure cite cosmetic appeal for their reasoning (Cormier).  Doctor Bernard Stern, a labiaplasty surgeon in Florida, claims that the procedures he performs can save marriages and change lives.  Why not save our daughters the mental anguish of having to live their lives not feeling their genitals are good enough, and have these procedures performed on them when they are infants?  This way they will be too young to even remember the painful healing process of the procedure and will not have to undergo such hardships as an adult.

Whether male or female, circumcision is an extremely personal choice unique to each family.   I’m the parent and if I believe that this is what is best for my daughter then I should be able to have my daughter circumcised.  Other parents put their infants through the painful process of having their ears pierced, which has no health benefits, for cosmetic and sometimes social reasons.   As I have already proven, circumcision has the potential to benefit our daughters’ mental and physical health the same as it does our sons.  Even though it’s irreversible and it’s her genitals I’d be having cut and not mine,  I’m the parent and I feel this choice is my right to make for my daughter, the same as it’s another mother’s right to choose it for her son. We claim cultural reasons for circumcising our sons, and yet ignore the cultural reasons of other cultures wishing to circumcise their daughters’ in the way their religions require.  For Federal law to condemn female genital cutting of minors, and yet allow it for males is incredibly sexist and done solely because of cultural biased surrounding female circumcision."

Less than a month after the American Academy of Pediatrics issued their new policy statement regarding female genital cutting, they retracted it. Their president, Dr. Judy Palfrey, stated in an interview with Mothering, “The AAP is steadfast in its goal of protecting all young girls from the harms of FGC” also stating “We are absolutely against any form of harming young girls.” I cannot help but wonder why they do not also protect little boys?

I presented this topic in power point form for an oral presentation in my Critical Thinking class. I went in very nervous about how receptive people would be on the topic. While there was some giggling when I started talking about smegma, I felt it was received well and the reactions for most people were very reflective. Several people even opened up to me more about how the subject affected them personally. My professor’s response was actually to ask if it was it was still a common practice. She mentioned to me after class that her father had thought it was a barbaric practice, so I would assume since it wasn’t normal in her family, she had no idea they still did it.

An older woman in the class, whose children are grown up now, told me about how traumatizing it was for her that her ex-husband forced her to have her son circumcised when he was three months old. She told me she had always felt as if she has mutilated him, and that it still haunted her today.

The guy that has sat next to me all semester started talking to me after class about the topic. He told me he has no idea they did that to girls before I had mentioned it in the class. He went on to tell me that his mother has had both he and his brother snipped because she had heard that it was cleaner. It wasn’t something that bothered him and he didn’t consider himself “mutilated”, but he had always wondered why they would cut off a piece of a baby’s penis.

While I did sense skepticism from some of my audience, who didn’t believe that female and male circumcision, were comparable, many people remarked during or after class “Wow. I never thought of it that way before.”

Works Cited

American Academy of Pediatrics. "American Academy of Pediatrics: Circumcision Policy Statement."       Pediatrics 103 (1999): 686-693.  Web. 8 May. 2010
American Cancer Society. "Cancer Facts and Figures 2006." 2006.  Web. 9 May. 2010
Paniel, B.J. and R Rouzier. Ridley's the Vulva. Ed. Fiona Lewis Sallie Neill. Vol. 3. Hoboken: John Wiley and              Sons, 2009.  Web. 12 May. 2010
Bertran Auvert, et al."Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of                 HIV Infection Risk: The ANRS 1265 Trial." PLoS Med (2005): 2.
BRADY, MARGARET. AIDS Patient Care and STDs. DECEMBER 1999, 13(12): 709-716.          doi:10.1089/apc.1999.13.709.  Web.  17 May. 2010
Christopher Maden, et al."History of Circumcision, Medical Conditions, and Sexual Activity and Risk of Penile Cancer." Journal of the National Cancer Institute 85.1 (1993): 19-24,.
Commitee On Bioethics. "Policy Statemen Ritual Genital Cutting of Female Minors." Pediatrics (2010): 6.               Web.  8 May. 2010.
Cormier, Zoe. "Making the Cut." Shamless. 2005. Web.  8 May. 2010.
Christakis, Dimitri A., et al.""A Trade-off Analysis of Routine Newborn Circumcision." Pediatrics. 105        (2000): 246-249. Web.  13 May. 2010.
Cunha, Burke A., MD, “Urinary Tract Infection, Males”  emedicine.  WebMD.  2009.  Web. 8 May. 2010
Eckret, Linda O. MD. et al."Vulvovaginal Candidiasis: Clinical Manifestations, Risk Factors, Management                 Algorithm." Obstetrics & Gynecology 92.5 (1999).

Federal Prohibition of Female Genital Mutilation Act of 1995. Pub. L. 104-208, div. C, title VI, Sec.               645(b)(1), Sept. 30, 1996, 110 Stat. 3009-709.  Web.  10, May. 2010.
Heins HC, Dennis EJ, Pratt-Thomas HR. “The Possible Role of Smegma in Carcinoma of the Cervix”. Am J                Obstet Gynec. 1958: 76; 726-735. Web. 9 May. 2010.
“Human Reproductive System." Encyclopædia Britannica. Encyclopædia Britannica, 2010. Web.                 16 May. 2010                
"Human Skin.”  Encyclopædia Britannica. Encyclopædia Britannica, 2010. Web. 16 May. 2010    
Howe, Van, RS, Hodges FM. “The Carcinogenicity of Smegma: Debunking a Myth”. J Eur         Acad Dermatol Venereol 2006;20(9):1046-54.  Web.  16 May. 2010         
McDonald, C.F., M.D. “Circumcision of the Female “ Milwaukee, Wisconsin GP, Vol. XVIII No. 3, p. 98-99,               September, 1958. Web. 9 May. 2010.
Stallings R.Y., Karugendo E. “Female circumcision and HIV infection in Tanzania: for better or for worse?”                 International AIDS Society. 2004.   Web. 17 May. 201.0
Stollery, Nigel. "Independent Nurse: Clinical - Top 50 - Seborrhoeic dermatitis." GP: General Practitioner               (2005): 111-115. Health Source: Nursing/Academic Edition. EBSCO. Web. 16 May 2010.
Thomas E. Wiswell, et al."Declining Frequency of Circumcision: Implications for Changes in the Absolute                Incidence and Male to Female Sex Ratio of Urinary Tract Infections in Early Infancy." Pediatrics       79 .3 (1987): 338-342.
World Health Organization. "Eliminating Female Genital Mutilation: An Interagency Statement." 2008.    World Health Organization. 10 May 2010           <http://whqlibdoc.who.int/publications/2008/9789241596442_eng.pdf>.
World Health Organization.  "Male circumcision: Global trends and determinants of prevalence, safety and acceptability." 2007. World Health Organization. Web. 12 May 2010.
Yount KM, Abraham BK. “Female genital cutting and HIV/AIDS among Kenyan women.” Department of                Sociology, Rollins School of Public Health, Emory University. June 2007.  Web.  17 May 2010.
Youn, S.-W., et al. "Does facial sebum excretion really affect the development of acne?." British Journal               of Dermatology 153.5 (2005): 919-924. Health Source: Nursing/Academic Edition. EBSCO. Web.        16 May 2010.


Jessi said...

Very well put together.

Though, I did giggle at "smegmaliths".

JLynnRN said...

BRILLIANT! Thank You! Signed...Mom of 2 intact boys (and 2 intact girls)

Rachel said...

I have 2 girls. I have never considered circumcision an option...ever. Sometimes I wish I had a boy just so I had more of an excuse to tell people about why I would not choose circumcision. When I became pregnant with my first child, I told my partner that over my dead body would a knife ever come near my child's genitals. He was shocked at my reaction. He had never really given much thought as to why he was circumcised. He had just accepted it as a part of life. I began to give him information to read on the subject of male circumcision. He soon became as horrified as I was about the thought of cutting off a piece of your perfect newborn child. He even began to feel some resentment toward his mother for doing this to him. I do feel some satisfaction that he was willing to listen and consider that the dogma he had come to accept as fact was actually fiction. I have also helped a friend who has a 2 year old boy decide not to circumcise. When I initially asked her about it, she like most others was just gonna go with the flow (Doctors are the experts, right?) and now she has a completely intact little boy. Stories like this, and education are the key to spreading the enlightenment on this barbaric, and completely useless practice. Don't be afraid to speak up.

Adele said...

I wish you cared as much about baby boys and girls that die in their mother's womb due to abortion, as much as you do boy's foreskins.
It is so hypocritical to care about the foreskin, but forget that they are killed in the womb.

Anonymous said...

No one is more hypocritical than the anti-abortion crowd.

Their interest in defending the rights of infants ends as soon as the baby is born.

I know because I've debated several of them and they just don't care.

Anonymous said...

Great article. I am a nurse and a mother of two healthy INTACT boys. I believe it is important that we continue to educate parents about the importance of keeping our babies' bodies whole! Thanks, and keep speaking up!

Anonymous said...

Good post and this post helped me alot in my college assignement. Say thank you you for your information.

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