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Letter to an Unenlightened Urologist

On October 11, 2021, the New Yorker magazine published an essay by popular writer Gary Shteyngart, recounting how being circumcised when he was seven years old resulted in decades of misery and complications. On November 1, the magazine published three comments in response, mine, one from a rabbi, and one from a urologist. The post below is the follow-up letter I wrote to the urologist, Dr. Michael Mooreville.


Dear Dr. Mooreville:Georganne Chapin, Chairperson

I am writing about your letter to the New Yorker, which appeared after my own among the responses to Gary Shteyngart’s essay about his decades of suffering because of a botched circumcision. Thank you, in advance, for taking the time to read my comments below.

First, you suggest that Shteyngart’s problems occurred because he was circumcised too late, and then say that it’s easier (somehow) for a physician to know how much foreskin to remove from a baby than from an older male. My decades of working to end unconsented-to, medically unnecessary circumcision suggest this is not true. Men who have spoken or written to me, or who have spoken out publicly about their circumcision-induced penile deformities, overwhelmingly were circumcised as newborns by doctors in American hospitals. Some of them have undergone one or more additional surgeries to correct cosmetic or functional problems; others, out of parental ignorance or shame, instead have learned to live with the harm just as Shteyngart did. In none of these cases did any of these surgeries result in a better, healthier penis than the penises of men who were fortunate enough to have grown up with their natural, unaltered genitalia. As a practicing American urologist, your caseload is likely similar to that of other urologists who have told me that more than one-quarter of their medical practice involves addressing circumcision-related damage, including meatal stenosis (which occurs nearly exclusively in circumcised males), skin bridges (such as Shteyngart’s), and degloved penile shafts.

Second, I am curious about your comment that amputating a baby’s foreskin will allow his penis to “grow into a fully mature look…” (emphasis mine). Are you suggesting that the penises of men with foreskins (comprising around 75% of the world’s males) are somehow “immature”; this makes no sense. How can a penis shorn of its natural protective covering, with its nerves, muscles and blood supply be superior to the natural, unaltered penis that evolved over hundreds of thousands of years? Frankly, I’m astonished that the New Yorker’s rigorous fact-checking protocol didn’t eliminate this nonsensical statement from your letter.

Finally, I wonder if there are other healthy body parts you would suggest removing from babies or children because they “can be the source of multiple (?) medical problems in older men” (or women). The appendix (1.1 cases of appendicitis per 1000)? Teeth (prone to infection-causing decay)? Breasts (1 case per 1000 of breast cancer among American women aged 40, increasing over time), while the rate of penile cancer (which occurs in both intact and circumcised men) in the United States is 1 per 100,000. I might add here that genital hygiene is not complicated. If a boy can learn to become a teacher or chef or woodworker or tennis player or truck driver or urologist, he should be able to learn how to wash his penis.

I hope you will think about my questions, and dare to think in a more common-sense way about a forced bodily alteration that does nothing to make American boys or men healthier than their counterparts in countries where males retain the genitals they are born with.

Sincerely,
Georganne Chapin, MPhil, JD
Executive Director

Kudos to Shteyngart

This letter to the editor was published in The New Yorker on October 25, 2021.

Kudos to Shteyngart for bravely exposing the harm that can be caused by circumcision. His heartbreaking personal struggle, while extreme, is more common among circumcised men than the public has been led to believe. Since 2008, when I co-founded Intact America, an organization that seeks to change the way people in this country think about circumcision, I have heard from thousands of men who have suffered lifelong physical and psychological damage from the procedure. According to a 2019 report published in the Journal of Pediatric Surgery, in the U.S., where nearly all circumcisions take place in medical settings, eleven per cent of pediatric-surgery malpractice cases involve circumcision. Yet American doctors and hospitals keep putting babies at risk with a medically unnecessary procedure that is not routinely performed on male children in any other Western country. We must ask why we allow doctors and hospitals to profit from cutting the genitals of male children even as we fight to outlaw female genital cutting, here and abroad.

Georganne Chapin

Washington’s Pending Child Protection Legislation: Unconstitutional!

by
Georganne Chapin, MPhil, JD
Intact America
March 17, 2019

The state of Washington has a pending child protection bill before its legislature. While we share legislators’ condemnation of the activity this bill seeks to regulate, we also wish to point out the fact that the bill violates the Constitution of the State of Washington.

Senate Bill 5257, introduced January 15, 2019, would prohibit the practice of “female genital mutilation” or FGM – i.e., the culturally-based practice of pricking, incising, or cutting a minor girl’s genitals. The bill arose, in part, as a response to the November 2018 dismissal by a federal court in Michigan of a case against a physician prosecuted under a similar federal law (18 U.S. Code § 116, also known as the Federal Prohibition Against Female Genital Mutilation Act of 1996) for operating on the genitals of three young girls. In dismissing that case, the judge said that despite the heinous actions of the physician (a woman from an Indian sect that practices female genital cutting), the federal law under which she was charged was unconstitutional because the behavior it proscribed falls under the rubric of “local criminal activity,” which is properly regulated by states.

So, what is wrong with this Washington State bill prohibiting medically unnecessary genital surgery on girls? In three words: it is unconstitutional!

Washington’s Constitution contains a “equal protection” clause which states: “No law shall be passed granting to any citizen, class of citizens, or corporation other than municipal, privileges or immunities which upon the same terms shall not equally belong to all citizens, or corporations.” In other words, Washington’s laws should never favor, protect, or privilege one group over another. While the anti-genital-mutilation law summarized above rightfully protects girls from medically unnecessary surgery on their genitalia, whether carried out in a “cultural” or medical context, it denies through omission such protection to boys.

Should not all children be protected from the medically unnecessary surgical modification of their genitals? Are boys not entitled to the same rights to bodily integrity, autonomy, and self-determination as girls?

“Routine” infant male circumcision – like “female genital mutilation” – entails the removal of a normal, natural part of a boy’s genitals in the absence of any medical necessity. Sometimes – as with female genital mutilation – male circumcision is performed for “cultural” reasons (I purposely draw no distinction between “culture” and “religion,” as there is simply no justification to favor the practices of groups who can point to a written text over those with a long oral tradition). And sometimes – just as with intersex surgery – male circumcision is performed simply as a social or cosmetic procedure, justified as in the child’s best interest, helping him to “fit in,” “be normal,” or “avoid problems in the future.”

It is not known how many girls are subjected to FGM in the United States, but the number is certainly less than one percent. By contrast, more than half of U.S.-born boys – more than one million babies each year – are subjected to the brutal removal of their their healthy, normal foreskins within a few hours of days of their birth.

Until the mid-19th century, surgical amputation of the foreskin was practiced only by Jewish and Muslim people, and by some tribal cultures. Victorian doctors introduced the practice in the United States and other Anglophone countries to stop boys from masturbating. By the mid-20th century, “routine” circumcision had become embedded in American medicine, and still today, the United States is the only non-Jewish, non-Muslim country in the world where doctors routinely remove baby boys’ foreskins (South Korea and the Philippines also have high circumcision rates because of the influence of U.S. military hospitals.) In the United States, the incidence of routine infant circumcision varies widely by region. At approximately 10 percent for in-hospital circumcisions, Washington’s current circumcision rate is well below the national average.

American men of all ages are expressing indignation about having undergone the removal of their normal, functional foreskins when they were too young to either consent or resist.

Legislators from Washington and every other state seeking to redress the ethically and medically unjustifiable practices of genital surgery performed on girls must take notice, to ensure that any new laws be consistent with the “equal protection” clauses of their constitutions, and to protect all children.

Iowa’s Pending Child Protection Legislation: Unconstitutional!

by
Georganne Chapin, MPhil, JD
Intact America
March 14, 2019

The state of Iowa has two pending child protection bills before its legislature. While we share the legislators’ condemnation of the activities these bills seek to regulate, we also wish to point out the fact that both bills violate Iowa’s state Constitution.

The first bill, House File 299 (together with the related House Study Bill 115) forbids the practice of “female genital mutilation” or FGM – i.e., the culturally-based practice of pricking, incising, or cutting a minor girl’s genitals – and makes it a Class D felony. The legislation arose in response to the dismissal by a federal court in Michigan of a case against a physician prosecuted under a similar 1996 federal law (18 U.S. Code § 116, also known as the Federal Prohibition Against Female Genital Mutilation Act of 1996) for operating on the genitals of three young girls. In dismissing the case, the judge said that despite the heinous actions of the doctor (a woman from an Indian sect that practices female genital modification), the federal law under which she was charged was unconstitutional because the behavior it proscribed falls under the rubric of “local criminal activity,” which is properly regulated by states. It is safe to say that – from the perspective of public opinion – the proposed Iowa law and similar legislative activity taking place in other states are unlikely to meet with much pushback; Americans are rather unified in their revulsion toward “female genital mutilation,” sharing a presumption – even if they are not particularly well-informed about the issue – that this practice is indefensible from either a cultural or a medical standpoint.

The second bill in the Iowa child protection pipeline is more unusual in that it attempts to regulate an activity that is only now becoming a topic of public discussion. House File 576 seeks to prohibit genital modification surgery or “treatment or intervention on the [physical] sex characteristics” of “intersex” minors – defined as children “born with atypical physical sex characteristics including but not limited to chromosomes, genitals, or internal organs….” Because intersex surgery has been and remains the purview of the medical profession, the intersex bill contains extensive detail about the types of surgeries that have been traditionally performed upon children with anomalous genitalia in efforts to “normalize” the appearance of their sex organs toward either the male or female end of the spectrum of visible sex characteristics; it describes in similar detail measures that must be taken to prove medical necessity for such surgeries. The Iowa intersex bill is also noteworthy because it (a) represents only the second time a state has set out to regulate “intersex surgery (the first was California, earlier this year)” and (b) includes extensive language about the rights of intersex people to “participate in decisions about surgery and other medical treatments or interventions on their physical sex characteristics, and to guarantee [them] the rights to bodily integrity, autonomy, and self-determination.” Bravo!

So, what is wrong with these bills? Why are they unconstitutional?

Iowa’s Constitution contains a “laws uniform” clause (similar to an equal rights amendment) which states: “…the general assembly shall not grant to any citizen, or class of citizens, privileges or immunities, which, upon the same terms shall not equally belong to all citizens.” In other words, Iowa’s laws should never favor, protect, or privilege one group over another. While the two laws summarized above protect girls and intersex children from medically unnecessary surgery on their genitalia, whether carried out in a “cultural” or medical context, they deny these protections to boys.

Should not boys also be protected from the medically unnecessary surgical modification of their genitals? Are not boys entitled to the same rights to bodily integrity, autonomy, and self-determination as girls and intersex minors?

“Routine” infant male circumcision – like “female genital mutilation” – entails the removal of a normal, natural part of a boy’s genitals in the absence of any medical necessity. Sometimes – as in the case of female genital mutilation – male circumcision is performed for “cultural” reasons (I purposely draw no distinction between “culture” and “religion,” as there is simply no justification to favor the practices of groups who can point to a written text over those with a long oral tradition.) And sometimes – just as with intersex surgery – male circumcision is performed simply as a social or cosmetic procedure, justified as in the child’s best interest, helping him to “fit in,” or to “avoid problems in the future.”
“Intersex” is a condition estimated to characterize somewhere between two and three percent of the population.

Possession of a penile prepuce (male foreskin), on the other hand, characterizes nearly half of the population. Until the mid-19th century, surgical amputation of the foreskin was practiced only by Jewish and Muslim people, and by some tribal cultures. Victorian doctors introduced the practice in the United States and other Anglophone countries to stop boys from masturbating. By the mid-20th century, “routine” circumcision had become embedded in American medicine, and still today, the United States is the only non-Jewish, non-Muslim country in the world where doctors routinely remove baby boys’ foreskins (South Korea and the Philippines also have high circumcision rates because of the influence of U.S. military hospitals.) While in the United States the incidence of routine infant circumcision varies widely by region, Iowa’s rate remains among the highest in the nation, at well above 70 percent.

Just as intersex individuals are speaking out loudly against a medical establishment that overlooks individual autonomy in favor of social norms, American men of all ages are expressing indignation about having undergone the removal of their normal, functional foreskins when they were too young to either consent or resist.

Legislators from Iowa and every other state seeking to redress the ethically and medically unjustifiable practices of “normalizing” surgery performed on the genitalia of girls and intersex children need to take notice, to ensure that any new laws be consistent with the “equal protection” or “laws uniform” clauses of their constitutions, and to protect all children.

Petition to American Academy of Pediatrics: Please Sign to END THE PAIN!

Petition to American Academy of Pediatrics: Please Sign to END THE PAIN!

Last week, Intact America launched a petition to the American Academy of Pediatrics (AAP). The petition demands that the AAP follow the recommendations from its own research about infant pain, and  tell its doctors to END THE PAIN and stop circumcising baby boys. Our goal is 29,000 signatures by February 29. We need your help! Please sign this petition, and share it with your friends. Ask them to sign and share it, too!

AAP told to cut their hypocrisy, not baby boy penises.

Intact America insists that the American Academy of Pediatrics issue a new circumcision policy—one that honors and protects baby boys from harm.

The American Academy of Pediatrics (AAP) recently said that babies shouldn’t be subjected to unnecessary pain. But the AAP continues to promote “routine” infant circumcision, a painful, medically unnecessary surgery that removes a normal part of a baby’s penis.

Last month, the AAP published research showing that common medical procedures carried out on newborn babies are very painful, and that the effects of the pain can last many years. The procedures mentioned included heel sticks, insertion of IV needles, and circumcision. The AAP report also found that commonly used pain relievers are neither effective nor safe.

Infant circumcision differs from the other procedures discussed in the report in that it is an invasive surgery that neither tests for nor treats any illness, and permanently removes a natural and valuable part of a boy’s sexual anatomy – the foreskin. The pain from circumcision is intense and continues for days or weeks after the surgery.

Circumcision, originally promoted in the 19th century as a way to prevent masturbation, has become part of American medical culture. Every year, a million baby boys in the United States are subjected to this surgery, although no medical association in the world recommends it.

Some of the falsehoods currently used to support circumcision include hygiene, disease prevention, and aesthetics.

The truth is:

  • The intact penis is easily cleaned throughout a boy’s and man’s lifetime.
  • Circumcision does NOT prevent sexually transmitted diseases, including HIV. European countries where fewer than ten percent of all men are circumcised have about the same STD rates as the United States, where circumcision is common.
  • Any preference expressed by men or women for the circumcised penis is a result of cultural conditioning. Besides, as the U.S. circumcision rate declines, and the number of intact boys and men grow, the intact penis will no longer seem strange or unattractive.

Many Americans also believe that circumcision is “just a snip” – a minor, brief, and painless procedure that babies will not remember. This is FALSE, and the new AAP article on pain proves it.

Because circumcision is NOT medically necessary, and because the pain it causes is unmanageable and harmful over the long term, Intact America demands that the American Academy of Pediatrics tell its doctors to end the pain and stop circumcising baby boys.  

Help us reach 29,000 signatures by February 29, 2016.  

Please sign our petition TODAY.