To more recent news
(More recent items first)
Rallying in the Name of the Unkindest Cut?
Sharp Rhetoric Abounds In Circumcision Debate
In the shadow of the nation's most recognizable phallic symbol, they gather and march. There are about 50 of them, all ages, both sexes, nearly all white, smiling, quiet, enjoying the sun as they make a slow loop in front of the White House with their signs of protest. Their mounted photos of pink squealing babies make the event look, at first glance, like an anti- abortion rally.
But look closer at the squealing baby photos and see why they're squealing.
On second thought, don't. Just read the big black sign with bold white
These people are intactivists. As in, activists who want male genitalia kept intact. As in, people who want a federal ban on male circumcision for newborns. [Not necessarily. Not all want one. Some say male circumcision is covered by existing law, properly interpreted.]
A herd of eighth-graders ...
There is, of course, a serious, disturbing side to this. Leading the pack are two 21-year-olds, Jason Siegel and Zachary Levi Balakoff, who are on Day 3 of a hunger strike. They say they won't eat until genital mutilation is exposed. Go ahead, ask them why. They'll tell you, for many minutes, about the "entire realms of exquisite feeling" they are missing by not having foreskins and the corresponding nerves. The "giant monstrosity" of circumcision "envelops" their entire lives.
"If we have to die, then that's what's necessary," Balakoff says. They say they'll sit in front of the Capitol until they starve.
The other marchers just want people to keep the clamps and knives away from infants. They just want society to respect the bodies of everyone, with no disrespect to any religion. They just want men to know what they're missing, so maybe they won't choose to do the same to their sons. They say their message is reaching a wider audience. Circumcision rates are way down from their peak of 85 percent in 1965. The foundation Intact America started six months ago to direct the message to the mainstream. The goal is a male genital mutilation bill.
The march nears the Capitol. An open-air trolley packed with tourists trundles past the signs. The tourists can't help but look. The guide's voice is audible over the speakers as the trolley rolls by.
"You know what? This is America," the guide says, and it's hard to tell if she means it as a celebration or an excuse.
Atlanda Injury Law blog
Jury Returns $2.3 Million Verdict for Botched Circumcision
Posted by Robin Frazer Clark, Fulton County, Georgia
A Fulton County, Atlanta, Georgia jury has just returned this afternoon a verdict in the amount of $2.3 Million in a medical malpractice case involving a botched circumcision. The trial [was] on March 16, 2009, and the jury deliberated from 10:30 a.m. yesterday until about 1:45 p.m. today, when they returned a verdict in the amount of $1.8 million for the minor child, and $500,000.00 for the mother.
The case involved an alleged botched circumcision, in which the young male child involved (who was 2-days old at the time of the incident), had about five millimeters (or about one-third) of his glans penis negligently removed during a circumcision procedure on November 6, 2004. This is obviously a significant permanent injury that will go with the child the rest of his life.
Defendants not only contended they had committed no negligence, and that any injury was an accepted risk of the procedure, but also somewhat surprisingly contended that the incident did not even occur, asserting that the child was suffering from a congenital deformity of the penis. I guess the jury just didn't buy that argument. There are some detractors of the Georgia Civil Justice System who might decry this verdict as excessive, but my guess is those who do have 100% of their penis. [On the contrary, men with 100% of their penis will say their foreskin is worth $2,300,000.] Bless this Fulton County jury for taking into the consideration the emotion[al] toil this unnecessary deformity will have on this child as he grows into a young man...something he will have to live with every day of his life, all due t[o] no fault of his own.
[David J. Llewellyn of Johnson & Ward, Atlanta, Georgia and Craig T. Jones of Edmond, Jones & Lindsay, LLP, Atlanta, Georgia were the plaintiffs' attorneys.]
Enthusiasm for circumcision seems to go by nationality - and the reporters' own status?
Call for higher circumcision rate
Circumcision should be routinely considered as a way to reduce the risk of sexually transmitted infections, argue US experts.
They spoke out after research found circumcision significantly cut the risk of infection with herpes and the cancer-causing human papillomavirus.
Circumcision is known to sharply reduce the risk of HIV infection.
But the study, featured in the New England Journal of Medicine, failed to convince UK experts.
The research, carried out by scientists in Uganda, involved nearly 3,500 men and monitored their sexual activity over a period of up to two years.
The researchers, from Johns Hopkins University, found circumcision reduced the risk of herpes by 25%, and human papillomavirus (HPV) by a third.
HPV causes cervical cancer in women, and genital warts in both sexes.
Circumcision rates have been declining in the US and are lowest among black and Hispanic patients - the groups with the highest rates of HIV, herpes and cervical cancer.
Writing in the journal, Dr Matthew Golden and Dr Judith Wasserheit, from the University of Washington, said: "These new data should prompt a major reassessment of the role of male circumcision not only in HIV prevention but also in the prevention of other sexually transmitted infections."
Dr Wasserheit went on to say: "All providers who care for pregnant women and infants have a responsibility to assure that mothers and fathers know that circumcision could help protect their sons from the three most common and most serious viral sexually transmitted infections, all of which cannot currently be cured."
However, research has suggested that a man with a damp penis has a greater risk of being infected by HIV.
Various reasons for this have been put forward, including wetness allowing viruses to stick more easily to the penis, or creating tiny ulcers on the surface of the penis through which a virus might enter.
Dr Colm O'Mahony, a sexual health expert from the Countess of Chester Foundation Trust Hospital in Chester, said the US had an "obsession" with circumcision being the answer to controlling sexually transmitted infections.
He said: "Sure, a dry skinned penis is a bit less likely to contract HIV, herpes and possibly genital warts but it will get infected eventually."
Dr O'Mahony also said pushing circumcision as a solution sent the wrong message.
"It suggests that it is women who infect innocent men - let's protect the innocent men.
"And it allows men who don't want to change their irresponsible behaviour to continue to sleep around and not even use a condom."
Keith Alcorn, from the HIV information service NAM, also warned against a knee jerk reaction.
He said: "We have to be careful not to take evidence from one part of the world and apply it uncritically to others.
"Male circumcision will have little impact on HIV risk for boys born in the UK, where the risk of acquiring HIV heterosexually is very low.
"Girls can be vaccinated against HPV and so protected from cervical cancer, and condoms protect against herpes."
A flurry of similar stories - without the British scepticism - has appeared worldwide.
Wall Street Journal Health
Circumcision Decreases Risk of Contracting STDs, Study Says
By PHILIP SHISHKIN
Circumcision significantly reduces the risk of contracting herpes and human papillomavirus, says a new study that adds to the growing scientific evidence that the procedure helps stem the spread of some sexually transmitted diseases.
Circumcised heterosexual men are 35% less likely to contract human papillomavirus (HPV) and 25% less likely to catch herpes than their uncircumcised counterparts, according to the study, published in this week's New England Journal of Medicine.
The study, led by scientists from Johns Hopkins University and Makerere University in Uganda, relied on data from the same randomized control trials in Africa that already showed that circumcision cuts in half the risk of contracting human immunodeficiency virus (HIV), which can cause AIDS. [... and so has the same faults as them.]
The researchers hope the latest findings on HPV and herpes will help turn circumcision into a more widespread medical procedure. "The scientific evidence for the public-health benefits of male circumcision is overwhelming now," says Aaron Tobian, a pathologist at the Johns Hopkins Hospital and one of the study's authors.
In the study, researchers randomly assigned 1,684 men in Africa to undergo circumcision and tracked their health against a control group of 1,709 uncircumcised men over the course of two years ending in 2007.
HPV and herpes are among the most common sexually transmitted diseases in the U.S., far more common than AIDS. HPV can cause genital warts and cervical cancer. There are no cures for herpes and HPV. [The immune system is quite able to deal with HPV.]
Just over half of male newborns in the U.S. get circumcised, according to research published earlier this year in the American Journal of Public Health. The percentage has declined over the past decade, in part because the American Academy of Pediatrics said in 1999 that the evidence is "not sufficient to recommend routine neonatal circumcision."
Opponents of circumcision say the procedure isn't medically essential and causes unnecessary distress to the baby. They add that proper hygiene and safe sex can prevent disease. [But most of all, non-essential surgery on a non-consenting person of any age is a human rights violation.]
[So the circumcisionists have finally come out in the open. This was never about preventing this or that disease, always about bringing back infant circumcision in the US.]
Catholic News Service
In one Kenyan diocese, an alternative rite of passage for girls
By Liz Quirin
MERU, Kenya (CNS) -- A Kenyan diocese is giving girls a chance to grow up without participating in the traditional tribal rite of female circumcision, a practice that carries the risk of disease or death.
Catholic workers in the Diocese of Meru developed "An Alternative Rite of Passage," pulling elements from the traditional rite referred to as female genital mutilation.
In other areas of Kenya, programs to stop the circumcisions were tried and failed. Meru diocesan officials decided to begin slowly. They began by talking to each group of what they described as "stakeholders" in the practice and educating them about the dangers of female circumcision.
Joseph M'Eruaki M'Uthari, the diocesan social development director, and Martin Koome, program coordinator, said they spoke with community leaders, members of the councils of elders, parents and the girls themselves to make sure they knew the diocese did not condemn the people's culture.
Diocesan literature defines the traditional rite of passage as "a range of practices involving the complete or partial removal or alteration of the external genitalia for nonmedical reasons. The procedure may involve the use of unsterilized, makeshift or rudimentary tools."
The traditional rite is practiced on girls ages 12-17 or even younger, depending on the parents' wishes, since girls can be ready for marriage at these ages. Girls are taken into seclusion for about one week, taught about courtship, marriage and relationships. Then they are cut by a circumciser and given a few days to heal before returning home.
By 2001 Kenya had outlawed the practice of female circumcision, but the fines and penalties were minimal: 150 Kenya shillings (US$2) and/or three months in jail. The circumcisions continue because families believe this is the only way to find a husband for their daughters.
"The cut is harmful, but part of the (traditional) seclusions were good," M'Eruaki said. "They gave the girls education in responsibility, respect and life skills."
To date, the diocese has facilitated five programs -- also called seclusions -- with diocesan and parish staff and two women from the community attending each session to keep false information from circulating.
The alternative rite is ecumenical, and members of other faiths and their pastors have been invited to participate, M'Eruaki said.
At St. Peter's Parish in Kajuki, one mother, Jane Kiura, said she had been circumcised as a young girl.
"I was told by my granny, my aunts, my mother, that this was a good thing before I did it," she said. "Everybody encourages you and says it's not a problem."
Kiura did not want her daughters to go through the pain and subsequent problems -- including the risk of disease and/or death and potential difficulties with childbirth -- that could occur as a consequence of the rite.
Kiura said when her daughter, Gertrude, returned from the diocesan seclusion, "she sat down and went through the curriculum with her older sisters," who were very interested in what she learned. The diocese has initiated quarterly support forums for the girls who attended the alternative rites so they have the opportunity to discuss issues that arise. Girls who attended the alternative rite faced criticism from girls who had participated in the traditional seclusions, and they faced the possibility that their families would receive no dowries because they were uncircumcised. Elizabeth Mwangi, justice and peace-building officer for the U.S. bishops' Catholic Relief Services in Kenya, explained that female circumcision dates back hundreds of years in Kenya and many African countries. "In older days, it was also used to better ensure the fidelity of wives," she said. One 16-year-old identified only as Ranky went to the parish's first alternative seclusion and said she felt different afterward. "The girls who have passed through the female circumcision tried to talk us out of the alternative rite of passage, but the teachers and our parents supported us," she said. The girls who participated in the diocese's seclusions said they are talking to all of the local women and girls about the alternative rite. "We are encouraging them (women) not to circumcise their children," Ranky said. Regina, also 16, said she learned about the alternative seclusion at church and wanted to know more about it. "I wanted to go into (the diocese's) seclusion," Regina said. "I knew about the cut, and I didn't want to do it. I knew the effects of female circumcision." Diocesan leaders also invited government officials in the local area to learn about the alternative rite. Simon Maingi, senior chief in the area and a member of St. Peter's, said he was convinced the diocese's seclusion would work after he learned about the program and the curriculum that had been developed. The diocese has facilitated the alternative rite with 641 girls, and an additional 87 also went through the program when one parish facilitated its own seclusion. St. Peter's pastor, Father Joseph Majau, said he strongly supports the alternative rite of passage. "Some parts of the curriculum have become parts of our sacramental preparation for the sacraments of initiation," he said. Father Majau said he also participated in the rescue of six young girls who were among 19 girls taken for circumcision. "The circumcisers had hidden them in various places, and Jane (Kiura) kept her eye on them through telephone conversations with friends," Father Majau said. The pastor called the chief district officer and, with nine armed guards, they found the six girls. "We took them to church for prayer," he said. The other 13 escaped but later were circumcised. Father Majau said the alternative rite is replacing old traditional values with education and a chance to grow up without abuse. "It's a slow process," he said. "It will take more than one generation" to change.
Contrast this with the medicalisation of male circumcision by the Presbyterian Church in Kenya, presented as "eradicating" it.
The Times Online
Thousands of girls mutilated in Britain
The NHS is offering to reverse female circumcision amid concerns that there are 500 victims a year with no prosecutions
The NHS is to advertise free operations to reverse female circumcisions, with experts warning that each year more than 500 British girls have their genitals mutilated.
Despite having been outlawed in 1985, female circumcision is still practised in British African communities, in some cases on girls as young as 5. Police have been unable to bring a single prosecution even though they suspect that community elders are being flown from the Horn of Africa to carry out the procedures.
The advertisement will appear from next month on a Somali satellite TV station much viewed in Britain. It features Juliet Albert, a midwife who does the reverse operations, and promises, in English and Somali, confidentiality for victims of female genital mutilation.
The advertisement was expected to help to undermine demand for girls to be circumcised, and to popularise the reversal procedure, Ms Albert said. Thousands of such operations have been carried out at specialist clinics and hospitals around Britain and demand is growing slowly.
Female circumcision, which is done for various reasons, such as religious and cultural traditions, can cause severe health complications including infections and psychological problems. The procedure, predominantly carried out on girls aged between 5 and 12, can range from the removal of the clitoris to the removal of all the exterior parts of the vagina, which is then sewn up. [It can also range downward to purely tokenistic and symbolic "operations".]
A study by the Foundation for Women’s Health, Research and Development (Forward), estimated that 66,000 women living in England and Wales had been circumcised, most before leaving their country of origin. The government-funded research also found that more than 7,000 girls were at a high risk of being subjected to genital mutilation in Britain.
Sarah McCulloch, of the Agency for Culture Change Management UK, said that every year more than 500 British girls were having circumcisions. “A lot of them are done in the UK, but some still travel overseas,” she said.
She said that a code of silence in Britain’s African communities had allowed circumcisions to continue and prevented arrests. The unqualified female elders, known as “house doctors” because they act in secret in a family home, are flown into the country.
While Scotland Yard is understood to have made investigations into female circumcision in the UK, and offered a £20,000 reward for information, no one has been successfully prosecuted for carrying out the procedure.
It is illegal to take a person abroad for the operation but no one has been prosecuted for this either.
Ms McCulloch said that girls were brainwashed into believing circumcision to be a cultural, and, in some cases, religious obligation that should be kept secret. “It is something they simply do not discuss — if they do they’d be seen as betraying their family and their community and culture,” she said. “I know many girls who want to accuse their parents but can’t. They don’t want to take their parents to court.”
Ms McCulloch said that men were becoming more vocal in opposition to female circumcision. “I’ve talked to some fathers who’ve made clear to their wives that they don’t want this done to their daughters — only for them to go out and come back to find their girls circumcised,” she said.
Lynette Parvez, head teacher of Kelmscott School in Walthamstow, northeast London, said that several teachers there would soon be trained to detect victims of female circumcision, and pupils at risk. Experts believe that most of the procedures are done during summer holidays when the girls have enough time to recover without suspicion about their absence.
And this is the recommended anaesthetic for circumcision ...
Topical anesthetics linked to serious side-effects: Health Canada
Serious side-effects such as seizures and difficulty breathing have been reported among people using products that numb the skin before cosmetic procedures such as laser removal of body hair, Health Canada says.
In an advisory released Thursday in collaboration with AstraZeneca Canada Inc. and Smith & Nephew Inc., the department warned of side-effects related to topical anesthetics such as EMLA®, AMETOP Gel™ and locally compounded products.
The reported side-effects include:
In rare cases, the side-effects have resulted in deaths.
Topical anesthetics are approved for numbing the skin before vaccinations and minor skin surgery. The products are also being used, often without direct medical supervision, to numb large areas of skin before cosmetic procedures.
Adults who showed the serious side-effects used very large amounts of the topical anesthetics, and then usually covered the area with plastic wrap to boost the effectiveness of the drug.
Air-tight dressings can be used with some topical anesthetics, but consumers who are unsure about how much to use or how to apply it should check with a doctor, pharmacist or other health-care professional.
Serious side-effects are more likely if the products are applied to irritated or broken skin.
Some infants and children who experienced serious side-effects used amounts that were near the recommended dose, the advisory said.
Anyone using a topical anesthetic who shows signs of weakness, confusion, headache, difficulty breathing, discoloured skin or any other sign of being unwell should seek immediate medical attention. [And a newborn will tell you of weatkness, confusion or headache - how?]
Circumcision no barrier to HIV
REPORTS of successes against HIV of male circumcision trials in Africa have understandably raised concerns in parents as to whether baby boys born in Australia [or the USA] should be circumcised.
There has even been commentary recommending the procedure as a means of reducing HIV risk ("Circumcision can curb HIV rates", Weekend Health, January 10-11).
Male circumcision is a promising intervention in countries in Africa, where levels of HIV infection can exceed 20 per cent of the adult population and where infection is spread predominantly through heterosexual sex.
In these countries HIV testing is not routinely available. Given that finding out you are HIV-positive will not provide access to antiretroviral therapy but will often make you an outcast from family, friends and society in general, it means that there is a large number of HIV-infected individuals who do not know they are infected, who do not modify their behaviour and for whom their risk of HIV transmission is therefore high.
General levels of other sexually transmitted infections and hygiene issues also contribute to high rates of HIV transmission.
Lack of access to antiretroviral therapy, HIV testing, the unavailability of successful vaccines and microbicides mean that the only measures available to people in these countries are preventative ones such as lowering risk behaviour, use of condoms, and male circumcision.
The interest in male circumcision, perhaps unduly so, is understandable given that it is a once-only treatment and requires no further thought [if it's not botched]. Our own research has estimated that male circumcision can substantially lower HIV prevalence in that setting. [There have been no field trials of circumcision to prevent HIV.]
However, the situation is very different in Australia and other developed countries. Access to HIV testing and anti-retroviral therapy is almost universal, so that the number of HIV-infected individuals with undiagnosed infection is much lower. Hygiene is considerably better and prevalence of sexually transmitted infections is also lower.
So in Australia the general population risk of HIV infection is significantly less, although something not to be complacent about.
The highest HIV risk groups are also very different here. In 2006 in Australia there were 854 new HIV diagnoses for men, of which only 77 (9 per cent) were for men who were infected through sex with women.
If you are still worrying about this risk factor for your newborn son you will have plenty of time to advise him to be careful; the average age of men newly diagnosed with HIV through heterosexual contact in 2006 was 46 years of age. No man under the age of 24 was diagnosed with HIV from heterosexual contact in that year, while 10 men over the age of 60 were. Rather than thinking of circumcising your new son to reduce his risk of heterosexual HIV infection, you should instead be lecturing your father about safe sex!
By far the largest number of HIV infections in men in Australia occurs through homosexual transmission. In 2006 in Australia, 726 of the 854 (85 per cent) new HIV diagnoses occurred in homosexual men. Whereas circumcision will lower the risk of becoming infected through heterosexual sex, it has little protective benefit for homosexual men since the greater risk of HIV infection occurs when someone is the receptive partner, rather than the insertive partner, and circumcision has little benefit in that situation.
[Actually, the study he is referring to found no benefit:
"... we found no association between circumcision status and infection by insertive U[unprotected ]A[nal ]Intercourse]. In addition, men who had seroconverted despite no reported event of UAI were also no more likely to be uncircumcised. These data strongly suggest that the foreskin is not the main source of HIV infection in homosexual men who become infected by insertive UAI ... Our data showing that there is no difference in the circumcision status of men infected by receptive or insertive UAI, in a population with a circumcision prevalence of approximately 75%,suggests that circumcision is not strongly protective against HIV infection in homosexual men."
"... we found no association between circumcision status and infection by insertive U[unprotected ]A[nal ]Intercourse]. In addition, men who had seroconverted despite no reported event of UAI were also no more likely to be uncircumcised. These data strongly suggest that the foreskin is not the main source of HIV infection in homosexual men who become infected by insertive UAI ... Our data showing that there is no difference in the circumcision status of men infected by receptive or insertive UAI, in a population with a circumcision prevalence of approximately 75%,suggests that circumcision is not strongly protective against HIV infection in homosexual men."
In 2001 in Australia there were an estimated 180,000 homosexual and bisexual men out of a total male population of 9,270,000. Benefits of circumcision have been observed to occur only in approximately one-third of these men who were predominantly the insertive partner. [It is not at all clear where this claim comes from. Another study, of 2245 US men of colour who have sex with men also found no protective effect.] Approximately 8 per cent of homosexual men are HIV-infected, and combining all of these factors leads to 0.05 per cent of the Australian male population who may be at lower risk of HIV infection due to being circumcised.
Obviously new parents don't know at the outset whether their sons will grow up to be one of the 0.05 per cent of the population at risk of HIV who will be gay and predominantly the insertive partner. The decision about circumcision as protection against HIV in this regard can therefore be left to the son at a later time, especially since the benefits of circumcision have to be weighed against complications arising from the procedure which, although small, are not non-existent.
Moreover, circumcision does not protect a man from HIV infection even if they are heterosexual or homosexual but insertive: it only reduces the risk (by approximately 60 per cent [that is the maximum protection claimed]). In that case, you have to ask yourself whether the prospective benefits against HIV, virtually only for babies who will grow up to be gay and always insertive, outweigh the risks of the circumcision procedure for all newborn male babies.
So although there is no room for complacency about the HIV epidemic in any country, male circumcision of newborns will have little impact on HIV risk in Australia. Male circumcision of infants may be considered on a number of grounds, but protection from HIV should not be one of them.
John Murray is associate professor in the school of mathematics and statistics at the University of NSW and the National Centre in HIV Epidemiology and Clinical Research.
Because of a nail, a shoe was lost...
The Dispatch Online (South Africa)
Maimed teen desperate for rehab funding
DOCTORS have made a passionate plea to a medical aid scheme to help a Selborne College pupil get the rehabilitation he needs to recover from a botched circumcision.
The circumcision left 17-year-old Qiqa Simbi from Mdantsane with his left leg below the knee and the toes on his right foot amputated.
The medical aid, which initially turned down the request, is now reviewing its decision.
Simbi was admitted to Frere Hospital in December last year after suffering complications at circumcision school. He developed septic arthritis.
Simbi’s grandmother, Nontuthuzelo Njezula, said the infection spread and he was transferred to Life St Dominic’s Hospital in January. He is now losing feeling in his arms.
Physiotherapist Balungile Mtiya said if Simbi did not receive immediate “intensive rehabilitation” he would be permanently disabled. “He needs rehab now and if he doesn’t get that, he is going to be (further) disabled. His condition is most unfortunate ,” Mtiya said. ...
New York Times
New Web Site
All in all, it's just another crack in the wall
Uganda Health News: Health Ministry calls for more research on circumcised men
Uganda’s Ministry of Health has called for more sophisticated analysis before conclusively determining that circumcision reduces the risk of HIV transmission.
This is because although circumcised people have been found to have lower chances of getting infected with HIV/AIDS, some ethnic groups in Uganda, which have circumcision as their custom, have higher HIV prevalence rates.
According to the HIV/AIDS Sero-Behavioral Survey 2004/2005 report released this month, although most ethnic groups have lower HIV prevalence rates, among the Lugbara/Madi, Bagisu/Sabiny and Alur/Japadhola have higher HIV prevalence rates among circumcised men.
For example among the Bagisu of eastern Uganda, there is 4.3 percent HIV prevalence rate among those [
Previous researches have shown a protective effect of male circumcision on the transmission of HIV. Lack of circumcision is considered a risk factor for HIV infection, in part because of [
[Here is the table from the survey (page 117/201). Population groups in which circumcision has not protected men against HIV are highlighted. (The figure in the first column is equal to or greater than the figure in the third column.)
Human Rights Group Denounces Latest Circumcision Promotion as a Dangerous Distraction in the HIV Battle
West Lafayette, IN (PRWEB) February 26, 2009 -- In response to the launch of a new website, www.malecircumcision.org, by Family Health International, WHO, UNAIDS, and AIDS Vaccine Advocacy Coalition to promote male circumcision as a prevention for HIV, the International Coalition for Genital Integrity (ICGI) issues a renewed warning to the world health community that male circumcision is the wrong approach to curb the HIV epidemic in Africa and elsewhere.
"We are gravely concerned that the push for mass circumcision in Africa will have detrimental consequences, including placing women at greater risk of HIV transmission, creating a false sense of security in circumcised males, and leading to increased risk-compensation behaviors such as no longer using using condoms. Circumcision campaigns will result in huge numbers of circumcision complications. This will severely strain the already burdened healthcare infrastructure," says Dr. John Travis, MD, MPH, and ICGI advisor. "Furthermore, these campaigns will cause the re- direction of money that could be better spent on more effective HIV prevention strategies such as condom distribution and education campaigns."
The recent push for male circumcision has resulted primarily from three studies on adult males in Africa that showed a decrease in HIV in circumcised males during the study period. The studies were conducted in a highly controlled and medicalized environment, were terminated early, were not double blind, and condoms and other safe sex practices were heavily promoted. Consequently, it is unsure if their results were from the surgery, wearing condoms, education, or some other factor. There is no evidence these studies can be extrapolated to the general population. The results of these studies have since been contradicted by other studies from Africa and in the Americas.
"Obviously, the world is desperate for any solution that might help stem the HIV crisis. Unfortunately, circumcision is being treating like popping a pill. This is surgery. It carries the risk of major surgical complications. Male circumcision is not the answer to the HIV crisis," warns Travis. "We find it especially troubling that infant circumcision is also being promoted. This is a severe human rights violation. To surgically remove a part of an infant´s body for a possible benefit, if any, 15-20 years from now when he becomes sexually active, is simply wrong-especially when there are more effective methods available."
For more information on why male circumcision is a dangerous distraction in the battle to fight, health policy leaders and other concerned individuals can go to www.icgi.org/aids or www.circumcisionandhiv.com to learn more.
"Free to choose" - but who, and for whom?
The Patriotic Vangard (Sierra Leone)
Statement by African Women Are Free to Choose (AWA-FC), Washington DC, USA
It is with great concern that we, members of the newly formed African Women Are Free to Choose movement, regard recent situations in Sierra Leone, immediately stemming from the press release issued on Feb 6th by the U.S. Embassy in Freetown.
We are concerned about recent accusations of the Sierra Leone Association of Journalists (SLAJ) made against an important and valued female institution in Sierra Leone, the Bondo sodality of women. Though we do not condone the use of violence or intimidation we are also deeply affected by the inflammatory impact of language such as Female Genital Mutilation (FGM). We declare categorically that this language is offensive, demeaning and an assault against our identities as women, our prerogatives to uphold our cultural definitions of womanhood including determining for ourselves what bodily integrity means to us African women from ethnic groups that practice female and male initiation as parallel and mutually constitutive processes in our societies. [When "bodily integrity" means having part of your genitals cut off, a lot of dictionaries will need to be rewritten. And "constitutive"?]
We declare that thus far the representation of female circumcision (FC) - its social and ideological meaning in terms of gender and female sexuality and impact, if any, on reproductive health and psychosexual wellbeing has been over the last thirty years dominated by a small but vocal number of African women that make up the Inter-African Committee (IAC) with the enormous backing, if not outright instigation of powerful western feminist organizations and media personalities. Through aggressive use of the media to portray African women as passive and powerless victims of barbaric, patriarchal African societies, their efforts have succeeded in influencing and tainting the objectivity of such institutions as WHO and UNICEF, among other international organizations that have taken the lead role in promulgating anti-FGM policies and legislation worldwide.
Through political pressure from first world countries on whose aid they continue to depend as well as internal political expediency, several African countries have introduced anti-FGM legislation over against the full knowledge, participation and desires of the majority of affected women. This will not happen in Sierra Leone.
Thus far, the negative medical or health claims about various forms of FC have been disputed as grossly exaggerated by several independent medical researchers and practitioners. The claims that various forms of FC reduce or eliminate sexual desire and feeling in women have also been disproven by affected women themselves, the researchers who relentlessly question them and medical doctors who examine and treat them. We can provide ample references for anyone who is interested in any of this work. [The same question applies as for circumcised men - what can they compare with?]
That FC was designed by men to control women’s sexuality is a western feminist myth constructed in a disturbing dismissal of African gender models of male and female complementarity and of our own creativity, power and agency as adult women in the social world. The assertion that FC violates the rights of children falters in the face of WHO’s promotion of routine neonatal male circumcision (MC) to protect against HIV infection in Southern African. Incidentally, circumcised African women also have some of the lowest rates of HIV infection among women in the world, so why the double standard?
We remind the world that all what is being said today about FC - barbaric, dangerous, reduces sexual pleasure, parochial - has also been said about male circumcision by its detractors, usually and conveniently, by those who are themselves uncircumcised. [That is not true. Circumcised men are at the forefront of the Intactivism movement.] Just as racist remarks were made and aggressive legislation to criminalize practitioners (sometimes with the threat of capital punishment) were introduced by host countries or cultural outsiders to abolish MC with the support of some prominent male Jewish insiders, so too such negative actions are taken against practitioners of FC with the zealous support of some cultural insiders. Just as the bulk of Jewish men resisted and openly defied these edicts so too do the bulk of circumcised African women daily and openly resist global eradication policies and continue to define and celebrate their heritage. Just as MC has not ended and is even now seen [by some] as desirable with health and aesthetic benefits, so too FC has not ended and is even desired and being repackaged as vaginal cosmetic surgeries or “designer vaginas” by affluent segments of the very population of western women that today condemn us as “barbaric”.
We recognize the legitimacy of claims of the minority of circumcised African women who view their experiences in a negative light. Like the minority of circumcised men who have organized anti-circumcision campaigns, they emphasize their experiences of unnecessary pain and suffering and see their genital surgeries as an attack on their gender identities. We have no problem with these women, just as their male counterparts, organizing to seek change or even referring to their experiences and their own bodies as mutilated. However, these women, like their male counterparts, must take their case to the bulk of others who are circumcised and convince them of their worldview through peaceful, democratic and lawful means. [They would not have to, if the surgery was delayed until they could give informed consent to it - in both cases.] If, where and whenever they fail to convince the majority, the minority must respect the choices and freedom of the bulk of practitioners to positively define their own experiences and bodies. [Sure, but not those of non-consenting minors.] This is a key cornerstone of any modern liberal, democratic and plural society. While we respect and do not support the coercion of the minority to uphold a tradition they find offensive, we certainly will not allow the minority to impose their will and worldview on the majority of women who are circumcised and their prerogatives as parents to make this decision for their children, both male and female. [There's the rub. How are African Women Free To Choose not to be circumcised, if the decision that they be circumcised has already been made "for" them?] The minority of uncircumcised women in Sierra Leone, as elsewhere in Africa, must have the freedom to remain uncircumcised if they so wish (and many do request circumcision); and, for those already circumcised who wish to abandon the practice, we advocate for and stand with the Government in protecting their rights to not circumcise their own children. This is true, non-coercive abandonment. [No, true, non-coercive abandoment would include protecting the right of children not to be circumcised.]
As a newly formed association, Free to Choose will not accept attempts to delegitimize the positive experiences of most circumcised women and any attempts to deny African women, circumcised or not, our rights to self-determination. Further, most of us are not fooled by the substandard research evidence - anecdotal and those purporting to be objective science - to manipulate and coerce circumcised women into submission, that is, to give up a practice that is culturally meaningful to many African women. We question the appeal to a common sisterhood by our western feminist sisters who pretend they do not have a stake in seeing their own uncircumcised bodies as “normal”, “healthy”, and “whole” and therefore morally superior to our own supposedly “mutilated” African bodies.
Therefore, we call on restraint and respect on all sides. To the Soweis and Sokos of Bondo - you are mighty and need no other justification than that which we your daughters have just given you. No amount of western education and modernization can replace our ancestral rites and rights so we are with you. In that small place in Kenema you are showing the world that ours is not just about training women to be good wives and mothers (another myth constructed by our feminist critics and oft repeated from our own culturally ignorant western educated mouths) but that ours is a militant African feminist indigenous institution equipped with a hierarchy and election process that was set in place long before the very western feminist organizations that ridicule us now came into existence and won the right for their own women to vote in their male constructed and dominated social worlds. While our Bondo women warriors fought and died together with our Poro brothers in revolts against colonial injustices, where were our western feminist sisters who are today so interested in the intactness of our genitalia?
As we honor and carry on that militancy in our communal female spirit, let us seek ways to (re)educate our critics and to correct their misunderstandings and biases about female sexuality in particular and gender in general. We have ample intellectual, scientific and religiously grounded resources to do this. Let us also stand strong and united as our female ancestors have in the past against any attempts to allow the vilification of our own practices while our critics overlook or turn a blind eye to their own. Let us be united as African women to stand against any attempt to deny us our cultural rites and rights as adults equal to any other adult in the world whatever their religion, race, and country of origin. My sisters, mothers and grandmothers in Kenema, continue your peaceful protests, you are an exemplar to other so-called oppressed third world women who are portrayed as so passive and ignorant that they need western women to interpret their experiences and speak for them on the world scene. We stand with you in your resistance.
To SLAJ, while we support you in condemning any form of violence against journalists or any other civilians in Sierra Leone for that matter, we too are watching you. We will not allow the media in Sierra Leone to be hijacked and used to spread inflammatory language and messages in a country in which the bulk of women are members and strongly support Bondo. You do not need to use the term FGM, unless you state explicitly that the M refers to Modification and not Mutilation. You can use the term excision, which describes the procedure that can be associated with most women in the country. You can contact us and we will be happy to advise on culturally sensitive approaches. We can also provide you with lists of independent (i.e. non-activist) researchers and experts who are prepared to address any issues you have concerning FC as it pertains to health, human rights, cultural meanings and so on. We support the free flow of information so that women can be informed on both sides.
What we will not support and will expose is deliberate provocation by any member of the press of an international crisis to create a perception of Bondo as archaic, barbaric and unlawfully persecuting that very symbol of modernity, the innocent journalist in a truth-seeking mission to correct social injustice. If someone is itching to receive an international journalist of the year award and a free trip to the UN in New York, it will not be at the expense of our culture and our bodies.
To the U.S. Embassy, we recognize that you are following U.S. Policy. As Americans (some of us born, others naturalized) and permanent residents, we are proud of our great nation and commend your office. We are particularly thrilled that you represent the President of the United States, a man born to an African immigrant. Many of us are African immigrants or first generation African-Americans. We are also especially proud that the US President is of Kenyan descent, given the role of Jomo Kenyatta, the first President of Kenya and nationalist hero, who championed the practice of female circumcision among his ethnic group, the Kikuyu, in his stance against colonialism during the struggle for Kenyan independence from British rule. President Obama’s father was a Luo, as we are told, an ethnic group that does not practice either male or female circumcision whose members are sometimes persecuted by neighboring groups because of this as well as forcefully circumcised. Thus, this is perhaps an opportune moment for the US to lead the world in pausing for a moment to rethink the female (and male) circumcision controversy in global health policy: the homogenizing as well as hegemonic (and hypocritical) claims of western feminism over this issue; the cultural meanings FC and MC hold for the majority of practitioners and their right to self-determination; and importantly the internal ethnic politics of economically deprived African countries whose leaders often manipulate the female circumcision question, whether promoting or banning it, for political and economic expediency.
In the spirit of true diplomacy, we advise that the use of the term FGM is a slight to the very women you claim to support and speak for. Women in Sierra Leone do not form a homogenous group - most of us come from ethnic groups that practice female and male initiation, a section of the minority Krio who are descended from freed slaves do not. Most women support the continuation of FC and some are against it. We expect the US Ambassador, to show respect for all women of Sierra Leone and not use derogatory language that diminishes the majority of women over a minority. This would never happen in the United States where the public use of racist language can be viewed as an incitement to violence, and can be punishable by federal law. Prior to the civil rights movement, it was commonplace and uncontroversial for whites to refer to blacks by the n-word (and many blacks to refer to themselves as such, as some do today); the moral inferiority of blacks was not really in question. However, there is no doubt that the use of the n-word then (as it still does today) caused resentment and anger among many blacks. Similarly, the term FGM causes resentment and anger among circumcised women, even though the common perception of the day is that we are mutilated and hence morally inferior to so-called intact women.
In our local languages we too have vulgar terms for uncircumcised women, which is the marked category in our cultures. Even when used by circumcised women to refer to other circumcised women in a derogatory way it is an automatic provocation that spurs violence. In your proclamation against FGM you have given, albeit unwittingly, license to a minority group to use insulting language against the majority of women. [So insutling language is OK for the majority to have to use against the minority, but not vice versa?] If Bondo women were to respond by using their own vulgarities to refer to uncircumcised women there would be all out war among women in Sierra Leone eventually and inevitably - unknowingly or unintentionally triggered by the US Embassy. And, all Sierra Leoneans are tired of senseless war. Thus, we ask that the US Embassy and other western diplomats show due restraint and respect to all Sierra Leonean women, even as you, your NGOs and International Organizations advocate against our cultural practice.
To the Inter-African Committee (IAC) that has declared February 6 Zero-Tolerance to FGM Day, we do not know you, you have not made yourselves known to us, we have not elected you, you do not represent us and your organization has no legitimacy in the eyes of the masses of grassroots women across the sub-Sahara African belt. If the world does not know this, it will soon be made evident. Though you insult (and support the imprisonment of) our traditional female leaders as financially benefiting from the modest sums of money and basic goods they receive from families of initiates, you do not tell us the amounts of your own salaries, consultancy fees and per diems in the burgeoning anti-FGM global industry in which some African sisters (and brothers) are now fighting to outdo one another for international recognition. It is your leaders and your members (how many, 10, 20, 50 women?) who will need to start looking for alternate sources of income other than the horrific lies and images you have packaged and sold a world too ready to believe the worst of Africans. We will continue to celebrate and uphold our initiation practices and we will challenge whatever global international process that has given you official status to decide what happens to our bodies over against our knowledge and what name others should call us over against our will.
Finally, to our main judges, mostly otherwise liberal-minded uncircumcised women: please understand that the global feminist movement to eradicate female circumcision in Africa (and anywhere else) masks what is in fact a global movement to standardize and universalize the white European female body as the cultural, psychic and moral ideal. To the extent that many African and other third word women do not practice female circumcision within their own ethnic groups then these women’s bodies conform to the “healthy”, “normal”, “beautiful” and “desirable” European prototype for all women. We ask that you not ignore the blatant racism which underlies the zealousness of western feminists in abolishing FC but not MC, in marking African women’s bodies and sexuality as mutilated, while remaining quiet on other forms of women’s bodily and even similar genital surgeries. Their agenda is not really about our bodies, circumcised or not; it is about justifying theirs and thus resolving the uncomfortable dissonance that the existence and support of female excision by subversive African women poses for western feminist imperialism.
We ask that you consider what is happening to the minds of some of our immigrant daughters in western countries as they watch the sensationalist media spectacles of young circumcised African women who, in order to break into the modeling industry, accept invitations to publicly condemn their bodies as mutilated (as a couple of their infamous, albeit tragic predecessors did previously in bestselling tell-all books) on talk shows, reality TV, as well as magazine spreads where they exhibit their barely clothed bodies for the gaze and wonderment of the western world. We ask how different is the circulation and consumption of these images from that of South African “Hottentot” women paraded around Victorian circles; their photos eliciting feelings of sexual horror in a perturbing voyeurism engaged in by those (both European men and their wives) with the power to gaze as well as to define the “other”.
In that Victorian era, when white European women were defined as sexually repressed they projected their fears (in complicity with their husbands) onto African women who were viewed as sexually licentious and immoral. Today, to the extent that the descendants of these women view themselves as sexually liberated (calling attention to their external clitoris as the phallic symbol of theirs and so all women’s liberation and autonomy) they project their fears of past repression onto circumcised African women, who given their deliberate excision of the external clitoris, are conveniently marked as sexually repressed and passive. As circumcised women are already defined by white women and in comparison with them as mutilated, no one has bothered to ask what it is that circumcision symbolizes to African women. This would require a great leap of faith that Africans, not the least African women, have constructed, defined and continue to reproduce a meaningful social world, worthy of existence and defense, outside of dominant European socio-cultural and religious contexts and hence, moral control.
Thus, though we see that most of you are sincerely convinced of your concern about the health, sexuality and bodies of African women and girls, we suggest you remove first the plank in your own eyes: What are your own fears and concerns about your own bodies and how do these relate to your individual experiences of male oppression or violence in your lives as well as your societies’ historical experiences of patriarchy? What myths have your own cultures evolved about women’s sexuality including the relatively recent (re)discovery of the external clitoris as the supposed ultimate site of women’s pleasure and orgasm? How do you condone the routine circumcision of your sons, if this is the case in your own cultures, and react emotively to the idea of the circumcision of girls? Do you see no issue with the increasing popularity of Beverly Hills 90210 genital cosmetic surgeries among well to-do western women, including clitoral and labia reductions, vaginal rejuvenation or tightening and even restoration of the hymen?
And, to our formidable opponents, the radical few western imperial feminists who arrogantly say that multiculturalism is bad for women (and really mean only Euroamerican culture is good for all women), we suggest that in your self-righteous determination to draw the line at FC you reveal more about your hidden racism and xenophobia than you allow the world and yourselves to see. Whatever the case, my sisters, while we will not interfere with your rights to promulgate your steadfast beliefs in the superiority of western gender norms, cultural and aesthetic practices and pretend as if they are the same for women the world over, we will not allow you to deny us what is truly our own: our African cultural rites and our rights to uphold them. Your global power and financial resources, your attempts to divide and conquer us by handpicking, promoting and rewarding those of us who will do your dirty work on the ground in Africa, in the parliamentary and congressional halls of western countries and in secretive, exclusive UN meetings as well as your manipulation of the global media will never match our communal African feminist spirit of resistance, stretching from one end of the Sahara to the other, from the beginning of human history to this day.
We cannot end without acknowledging the sincere efforts of those circumcised and uncircumcised women, insiders and outsiders, activists, scholars, medical researchers and so on who believe in the equality of individuals and cultures and have tempered their individual beliefs with a commitment to evidence-based interventions and research that do not prejudge or stigmatize individuals, entire groups and cultures. We will continue to work with the growing number of such individuals in advocating for rigorous design, implementation, analysis and dissemination of scientific studies that look at the reproductive and sexual health outcomes of both circumcised and uncircumcised women in a wide range of geographic contexts and SES levels. We will continue to respect the rights of NGOs and other entities to try and convince women to abandon these cultural practices as long as their methods are culturally sensitive and respectful.
We will, however, also insist on the rights of African women to continue their traditions if they so choose and will challenge and protest any unjust laws and policies that unfairly discriminate against them. We will step up to organize and sensitize affected girls and women to the full range of their human rights and not just the ones anti-FGM activists choose to share with them.
Our new movement includes both circumcised and uncircumcised African women, those who are for and some who are against the continuation of FC as a personal and family decision. We believe that it is in such open and honest woman to woman dialogue and collaboration that we can come up with policies and interventions that protect the rights of minorities to dissent and the rights of the majority to rule as well as the dignity of the individual to choose what happens to her (or his) own body. This is not a subversive idea or a radical one, it is the principle of pro-choice and respect for privacy applied to African women; it is the same principle that supports a woman’s right to abortion, though critics view this as the killing (read: worse than mutilating) of an innocent child; it is the same principle that supports the right of a sixteen year old to opt for genital and bodily piercings, though others may see this as mutilating and repulsive; it is the same principle that invokes sympathy for gender confused individuals and supports their right to radical surgery to change their genitalia and gender.
As for those girls too young to give consent, we must accord to their parents the same rights we [should] accord to the parents of boys in neonatal male circumcision and not discriminate on the basis of gender, religion, ethnicity or country of origin [- or age. The Intactivist movement agrees wholeheartedly: girls and boys must all be protected equally from non-consensual modification of their bodies.] We will work with willing stakeholders on all sides to determine appropriate ages of consent in varying socio-cultural contexts depending on how majority is determined for decision-making in other important life-crises or stages of development. None of this will be easy and western feminist opposition seems daunting, but from today we, African feminists, educated and illiterate, professionals and rural rice farmers, Christian, Muslim and followers of traditional religion, take the important step to begin speaking up for ourselves in local, national and international contexts in support of our global rights.
The AWA-FC is announcing a press-conference on March 6th 2009, in the Washington DC Metropolitan area, specific time and location to be announced shortly.
"Being circumcised means never having to wear a condom"
Isaac Ikone, "I am ready for circumcision"
[A detail of an Egyptian tourist papyrus with the caption "If there is a better way to prevent HIV so that I can enjoy sex skin-to-skin, I will do it."]
LODWAR, The Kenyan government launched a campaign to promote male circumcision in 2008, but it has not yet reached most parts of the country. In the northwestern district of Turkana, where the practice is not part of the culture and few have even heard of it, IRIN/PlusNews spoke to Isaac Ikone, 22.
"The government has not yet come here to talk about male circumcision, but I have heard about it from friends. They say it prevents HIV and sexually transmitted diseases. If that's true, I would definitely go for it so I can remain healthy.
"A while ago a friend and I found out we had the same sexually transmitted disease, and when I began to wonder how that happened, he told me he had slept with a girl I had also slept with in town. He is the one who told me that if we were circumcised, we would not have got sick. [Nobody has told him - or the readers of this paper - that this is false.]
"My girlfriend is still in secondary school and when she is not around I try to abstain from sex, but I'm not always successful. I don't like condoms; if there is a better way to prevent HIV so that I can enjoy sex skin-to-skin, I will do it.
[Clearly, the crazy mixed message, "get circumcised but wear condoms", is not getting through.]
"I don't know exactly how circumcision stops these diseases. If the government would give us more information on how it works, and also if the procedure was free, more people would be interested.
"Maybe the old men would not agree - I have heard some of them say that they have had all the sex they are going to have, so they don't see the need for circumcision ... others think it is against our culture.
"I don't feel that way; your body is your own business, you choose what to do with it. Myself, I am ready for circumcision."
[This short feature is published without comment or emphasis. Apparently the UN is unconcerned that false messages are being propagated.]
Think before you snip
MERCEDES SAYAGUES: BODY LANGUAGE
First things first. I like circumcised men. They smell and taste better, and have longer erections. Circumcision is cleaner and protects from some nasty infections. I also like uncircumcised men. Each to his own.
There. Done. Nobody can accuse me of having an anti-circumcision agenda. Let's move on into this unfolding juggernaut, this mounting hype about snipping foreskins to prevent Aids -- in United Nations/NGO jargon-speak, the roll-out and scaling-up of mass male circumcision programmes across Africa.
Last year I attended a colloquium on male circumcision at the perinatal HIV research unit at Johannesburg's Chris Hani Baragwanath Hospital in Soweto. More than a debate, it was a barrage of propaganda. The zeal was missionary and seemed to be led by desperation: if nothing else works, maybe this will.
I will not go into the relative benefits of the relative protection -- at 60% male circumcision still requires safe sex -- but into other disturbing aspects.
Real men are circumcised.
Real men are circumcised and use condoms.
This one is a no-brainer, two messages cancelling each other.
Real men? Interventions that separate and polarise people worry me. Who defines a real man? Whose hegemonic model of masculinity will be endorsed? Is a man who chooses to keep his foreskin less of a man? He could be faithful. He could practise safe sex. He could just like his foreskin. His partner could like it.
Circumcision as a test of manhood. That's dangerous, crafting messages that endorse discrimination and exclusion in a country where speaking some words of isiZulu means the difference between being burnt alive or not. Where a joke about the size of an Indian penis gets three men shot and killed at a bar in Durban.
Remember the hate emails against the uncircumcised Luo, pitted against the circumcised Gikuyu during Kenya's post-election violence a year ago. In South Africa, one hears more hostile, ethnically based remarks about the uncircumcised Zulu and the initiated Xhosa, the ANC boys (uncut) versus the ANC men (cut). The Fikile Mbalula initiation saga played right into this tension. To market a slogan like "real men are circumcised" is to stoke the bonfires of prejudice.
The emphasis on speed A pilot project in Orange Farm is streamlining the procedure, whittling every movement to make it easier, faster, more efficient. Only five minutes of the doctor's time per patient. Wow. Would you choose the doctor who advertises the fastest tooth implant or the fastest hysterectomy? I wouldn't. I like to kid myself that my doctor spends a bit of time because I am paying through the nose for it.
But the poor don't have that choice: rows of narrow beds separated by blue curtains; rows of penises emerging from sterile sheets. The doctor moves quickly down the row spending less than five minutes with each penis. The team does the rest. The slideshow reminded me of a factory assembly line of cattle-dipping.
Counselling takes longer than the operation and a three-day interval allows for rethinking. The French fund this project, and this is the rule in France and in French-funded projects. Forty percent of counselled men in Orange Farm decide not to do it. It would be good to hear their reasons, but the project does not know. In any case the dropouts are a sign of good counselling that gives the pros and cons: the operation does not grant full and permanent protection, they still must have safe sex and no sex during the first six weeks after the operation. And it hurts.
The drain on resources
Meanwhile those health workers are not attending births or trauma victims. To hear this at Chris Hani hospital -- scene of horror stories about patients bleeding unattended for hours in the emergency ward -- was disturbing. Project this to poorer countries. Can African public health systems afford to divert precious human resources? Will the pots of donor money for male circumcision drive health staff to the well-funded snip programmes? Are we robbing Peter to pay Paul?
Circumcising babies is faster, cheaper and presents fewer complications. One way of raising an Aids-free generation might be to offer it routinely to new parents, along with HIV testing. This lands us in another bonfire: is male circumcision a form of genital mutilation. Does it violate a baby's right to his foreskin? Yes or no; people feel very strongly about this.
Mass male circumcision treads on cultural and ethical minefields. Every step must be carefully thought through.
Why Is Up to 1 in 10 Boys Still Being Circumcised?
Some 5 to 10 percent of newborn babies are being circumcised, says a paper published by Inje University Ilsan Paik Hospital in the Journal of Korean Medical Association. Even after the American Academy of Pediatrics said in 1999 that newborns need not have the operation, one out of 10 babies here is having it. The proportion of circumcision for newborn babies is 65.3 percent in the U.S. and 35 percent in Canada, but it hovers below 1 percent in Germany and Japan.
Doctors attribute its popularity to several factors. First, a growing number of newborns need the surgery for medical reasons. If the bladder or the kidney has problems, or adhesion between the foreskin and the glans is serious, a circumcision may be necessary. Second, many doctors believe circumcision is good for men since it can decrease the risk of diseases including penis cancer, urinary tract infection, and AIDS. Third, it makes money for the hospital since medial insurance doesn't cover an operation for phimosis, so it earns W50,000 [~$US35.50] to W200,000 [~$US142] for a relatively simple procedure.
Professor Song Seung-hoon of Kangnam Cha Hospital's urology department said, "It was widely believed 10 years ago that this must-do surgery is better done right after birth when babies cannot feel the pain, but that isn't the case now. The detriments far outweigh the advantages."
Another preventable tragedy
Baby boy bled to death after operation, inquest heard
A nine-week-old baby boy bled to death just hours after his parents had him circumcised, an inquest heard yesterday.
At an inquest in Windsor on Thursday, coroner Peter Bedford criticised the lack of advice given to French couple Carole Youmby and her partner Monthe Bautrel, on how they should cope after the routine operation, carried out on little Celian Noumbiwe by GPs at a surgery in Chatham Street, Reading.
A leaflet given to Mrs Youmbi advised that the child's nappy should not be changed for a minimum of four hours. But when she tore off her baby's nappy she found he had been bleeding heavily.
Re-living the harrowing ordeal, she said: "When we saw it there seemed to be so much for such a little person and we started to panic."
They called the emergency number given to them by the clinic, but it had been cut off.
Less than 12 hours later, the tot went into shock and died after losing a fatal amount of blood.
The couple had decided to wait until the morning to call their GP. They said their son was acting normally and playing in his cot. By morning Celian had deteriorated. He was taken to Wexham Park Hospital where he died in his mother's arms.
The coroner heard how Dr Raj Sharma and Dr Ali Asghar had performed more than 1,000 such procedures at their practice in the past decade. They said they had not felt it necessary to see the patients or their parents before or after the procedure and left it up to senior nurse Zahida Aziz to answer any queries.
Dr Asghar told the inquest: "There were no complications during Celian's surgery or any bleeding and there was nothing to concern us." Dr Sharma admitted the emergency number had been disconnected and said it had been left on the paperwork given to Celian's parents due to an 'administrative error.'
Recording a narrative verdict [in which the circumstances of a death are recorded without attributing the cause to a named individual], Mr Bedford said: "The following factors contributed to a greater or lesser extent to the circumstances of death.
"Firstly, his parents did not meet the doctor who performed this procedure before or after it being carried out. Secondly, the consent form did not include anything about risk of post-operative bleeding.
"Thirdly, an after-care sheet provided to Celian's parents indicated that his nappy be left in place for a minimum of four hours, obscuring any bleeding that occurred."
He also made reference to the fact that the parents were unable to make contact with the surgery after things started to go wrong.
[The primary cause of death was circumcision.]
RWANDA: "The invisible condom" and other male circumcision myths
KIGALI, 11 February 2009 (PlusNews) - Rwanda is in the process of adopting male circumcision as a part of its national HIV prevention strategy, but experts worry that a spike in requests before a planned public awareness campaign has been launched could have negative implications.
Alphonse Ndakengerwa, a surgeon at King Faisal Hospital in the capital, Kigali, said clinics in the city had recently been overwhelmed by requests for the procedure, largely as a result of media reports on research indicating a lower risk of HIV infection in circumcised men.
Three randomised controlled trials in Kenya, South Africa and Uganda produced results showing that circumcision could significantly reduce the risk of sexually transmitted HIV infection in men.
Unlike many other cultures in Africa, Rwandan men and boys are not circumcised as a rite of passage, and although unofficial information has filtered through to the population, few people properly understand the benefits as well as the risks of the procedure.
"For me, I believe that when you make circumcision, it's like an invisible condom," said Ignace Hategekimana, 27, a student in Kigali who was recently circumcised. "It reduces the chance to get infections."
Antoine Rwego, a circumcision expert at Rwanda's Treatment and Research AIDS Centre (TRAC), told IRIN/PlusNews there was a danger that many Rwandan men would see circumcision as a substitute for condoms. "If we don't give the right message we can increase the risk of HIV transmission," he told IRIN/PlusNews.
Rwego was particularly worried by a belief among many young men that the procedure improved a man's sexual prowess and provided total immunity from sexually transmitted infections, and Hategekimana's comments to IRIN/PlusNews justified this concern.
"Before I went to the hospital I spoke with many friends and they told me it was a good thing ... when the foreskin is not there, you feel the sex very well. When you have made the circumcision you can't get wounds when you are having sex," he said.
Dr Stephenson Musime, a surgeon at King Faisal Hospital agreed with Rwego. "Some people feel that you will be more of a man ... very many people believe it will make them stronger and that it increases their sexual energy," he said.
"For someone who is circumcised it provides some protection ... but it doesn't mean that it is 100 percent protection - alone, it can't prevent HIV transmission - it has to be done with other protective mechanisms," Musime pointed out.
''When the foreskin is not there, you feel the sex very well ... you can't get wounds when you are having sex'' Agripine Tunga, 40, who had just given birth to a son at King Faisal Hospital, held a different view: "I believe the association is that they [circumcised men] feel sexy ... I don't want my son to be so sexual."
Studies to investigate these assertions were conducted in 2008 in Kenya and Uganda.
Both studies found that circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm, but experts say there is no evidence that the procedure actually improves sexual performance or prowess.
Urgent need for an effective communication strategy
Health workers say it is important that the public understands how circumcision protects men from sexually transmitted infections, and that they also know the procedure is not a guarantee of protection.
"There are many different reasons that people get circumcised ... medical, cultural, religious ... it has to be accompanied by counselling," Rwego said. "We have to develop the right message for the population."
The Rwandan government is embarking on a Knowledge Attitude and Practice (KAP) survey to ascertain the levels of awareness and information about male circumcision.
"Some people can think that male circumcision is a full protection, like an invisible condom, so with the KAP study we will know what to tell the people and what message to develop," Rwego said. "After that we have to develop guidelines, train staff and buy equipment."
The government began rolling out male circumcision in the army in 2008, as a precursor to widespread adoption of the measure by the rest of the population. Rwanda's national AIDS control council will start the national campaign by offering circumcision to newborn babies.
Reporters stripped by S.Leone circumcision society
By Christo Johnson
FREETOWN, Feb 11 (Reuters) - Four women journalists were abducted and stripped naked in Sierra Leone by members of a secret society that practices female genital cutting, one of the reporters and a press freedom watchdog said on Wednesday.
Female genital cutting is common across much of West Africa. In Sierra Leone, ranked bottom of the U.N. human development index, most women have undergone some form of cutting and are therefore regarded as members of the "Bondo" secret society.
The radio reporters were in the eastern city of Kenema reporting on the tradition, also known as circumcision or genital mutilation, when they were assaulted, one of the journalists said.
"The four of us were suddenly picked up at different areas in the town," Isha Jalloh, a reporter with Eastern Radio, told Reuters by phone.
"We were stripped naked in the bush for them to make sure that we have indeed undergone the various processes of the society, especially if we have gone through circumcision," Jalloh said. All four were members of the Bondo, she said.
Jalloh said she had been injured in her genital area during the examination and was on her way to the capital Freetown, 200 km (125 miles) west of Kenema, for a medical checkup.
Press freedom watchdog Reporters Without Borders said another of the reporters, Manjama Balama-Samba of United Nations radio and the Sierra Leone Broadcasting Service, had been forced to walk naked through the streets of Kenema.
"Such disgraceful behaviour worthy of a bygone age is very damaging to Sierra Leone's image," the organisation said in a statement.
It said the four reporters had conducted interviews in Kenema to mark International Day of Zero Tolerance of Female Genital Mutilation (FGM) on Feb. 6.
Haja Massah Kaisamba, a senior Bondo member, said female genital cutting was a sensitive matter.
"It is their right as journalists to do their job, but at the same time they, as journalists and also members of the society, do know very well how talking publicly about the society is sensitive," Kaisambai told Reuters.
"Whoever may wish for our society, the Bondo, to desist from FGM should come to the bush and address senior members ... then we will all discuss it and come to a conclusion, rather than going to the radio and speaking," Kaisambai said. (Writing by Alistair Thomson; Editing by David Lewis)
Sudanese activists slam government position on female genital cutting
February 7, 2009 (KHARTOUM) — Right[s] activists slammed a decision by the Sudanese cabinet to drop an article banning the practice of female genital cutting in the country. The government took its decision in accordance with an Islamic fatwa on the issue.
The Council of Ministers on February 5 dropped the article (13) of the draft Children’s Act of 2009, which provides for the ban of female genital mutilation as part of other customs and traditions harmful to the health of the child, and after approval of the draft Children’s Act 2009.
The cabinet decided to drop the article (13), which deals with female circumcision, taking into account the advisory opinion of the Islamic Fiqh Academy, which distinguish between harmful circumcision or infibulation (Pharaonic circumcision) and the circumcision of Sunna, a less extensive procedure.
The government decided to allow the Sunna practice allowed by the Figh Academy and prohibit the infibulation with its introduction in the Penal Code which is currently under preparation.
Human Rights Defenders in Sudan called in a statement issued today to support their efforts to stop the legislation for any type of FGM. They said such move is a clear violation of human rights, violence against the girl -child and against Sudan’s international legal commitments and against the Sudanese constitution.
The activists also say that this decision breaches article (32) of the interim constitution which requires to ensure the "equal rights of men and women to the enjoyment of all civil and political rights and all social, cultural and economic rights"
While the government seems adopting a gradual approach to end these harmful practices, the rights activists say the legalization of Sunna practice would open the door for maintaining all the forms of female genital mutilation and also would complicate ongoing efforts to eradicate it.
Religious affiliation is one of the factors determining which type of genital mutilation is to be performed. According to to a report issued by UNICEF in 2000, infibulation is most common among Muslim women (83 percent compared to 27 percent of Christians). Sunna is mainly practiced by Christians (46 percent).
Bravo! How very different from babies born with any variation of the genitals.
Double Dozen Digit Baby Blessing
Doctors in California have been astonished by a baby boy born with 24 perfectly formed and fully functioning fingers and toes.
Kamani Hubbard has six digits on each hand and foot, a condition commonly known as polydactylism.
Doctors at St Luke's Hospital in San Francisco say, because the extra fingers and toes are so well formed, they do not consider it a deformity or disability.
Maternity staff and the radiographer did not detect the baby's extra digits, so it came as quite a surprise to Kamani's father.
Kris Hubbard said "I was in amazement. It took a little while for me to take it all in.
"My son has six fingers, then I saw his toes and I thought 'This is quite unique'."
Polydactylism affects around 1 in 500 babies.
The extra digits are usually small pieces of soft tissue. They occasionally contain bone without joints and are rarely complete, functioning digits.
Famous polydactyls include: actress Gemma Arterton; West Indian cricketer Gary Sobers; Blues guitarist Hound Dog Taylor; and Anne Boleyn, second wife of Henry VIII.
Dr Michael Treece, a paediatrician at St Luke's Hospital, said: "It's merely an interesting and beautiful variation rather than a worrisome thing.
"Imagine what sort of pianist a 12-fingered person would be. Imagine what sort of flamenco guitarist. If [nothing] else, think of their typing skills."
The parents have not decided whether to have the extra fingers and toes removed, but doctors say the baby should keep them.
Real headline: "Circumcision does not affect HPV acquisition"
Circumcised HIV-negative men more likely to clear HPV infection
Circumcised men appear more likely to clear human papillomavirus (HPV) infections, including those with oncogenic (cancer-causing) strains, according to a prospective US cohort study published in the Journal of Infectious Diseases. Men with higher numbers of sexual partners were more likely to be infected with HPV, but also appeared more likely to clear oncogenic infections.
HPV is a sexually transmitted virus that can cause genital and anal warts; prolonged infection with certain (oncogenic) strains can lead to anal, cervical and penile cancer.
The HPV Infection in Men study recruited 18- to 44-year-old men in Tucson, Arizona, with no history of genital warts, penile or anal cancer, and no current sexually transmitted infections (including HIV and hepatitis C). Of 377 men screened between 2003 and 2005, data from at least two study visits was available for 285 (median follow-up, 15.5 months). Most (88%) were circumcised [so only 12% or 34 men were intact], 26% had previous sexually transmitted infections (STIs), and 41% had not used condoms in the past three months.
No data on the sex of the men's sexual partners was provided, and the study only investigated penile, not anal, HPV infection.
No data on the sex of the men's sexual partners was provided, and the study only investigated penile, not anal, HPV infection.Over twelve months, 29.2% of the men acquired a new HPV infection: 19% with oncogenic and 16% with non-oncogenic strains (some men acquired both).
In multivariate analysis (adjusting for all other factors), only the total number of lifetime sexual partners affected the risk of new (incident) HPV infections. [So circumcision did not significantly affect the rate of infection, meaning the number of intact men infected with HPV was about 29% of 34 or TEN. ] Men with more than 16 partners were more likely to become infected with HPV (adjusted hazard ratio [AHR], 2.8; 95% confidence interval [CI], 1.1 – 7.1), oncogenic HPV (AHR, 9.6; 95% CI, 2.4 – 37.8) and non-oncogenic HPV (AHR, 3.6; 95% CI, 1.3 – 9.9) than men with zero to four partners (p < 0.05). (Note that these figures refer to new HPV infections, not the cumulative risk of sustained HPV infection overall.)
The estimated median time to clearance of new infections was roughly six months. (However, as study visits were six months apart, shorter times could not be distinguished.) By multivariate analysis, circumcised men were three times more likely to clear HPV infections (AHR, 3.1; 95% CI, 1.2 – 8.2) and six times more likely to clear oncogenic infections (AHR, 6.5; 95% CI, 2.1 – 19.7). [With only about ten intact men infected, it is preposterous to apply these high-level statistics or to draw any conclusion at all about circumcision.] Men with over 16 lifetime sex partners were five times more likely (AHR, 4.9; 95% CI, 1.2 – 19.8) to clear oncogenic HPV infection than those with zero to four partners, even though these men were also more susceptible to HPV infection.
Other studies have also found a link between the number of sexual partners and, firstly, the risk of infection and, secondly, the likelihood of clearance. Previous researchers have suggested that previous exposures may lead to a greater antibody response to new HPV infections, increasing the chance of clearance. However, it is unclear why previous exposure might also increase the susceptibility to new infection.
Other studies have also found a link between the number of sexual partners and, firstly, the risk of infection and, secondly, the likelihood of clearance. Previous researchers have suggested that previous exposures may lead to a greater antibody response to new HPV infections, increasing the chance of clearance. However, it is unclear why previous exposure might also increase the susceptibility to new infection.The reason that circumcision protects against persistence of infection, rather than protecting against infection itself, is also unclear, although it is also consistent with findings of other studies. [Because they, too, are junk science?]
Study limitations included the relatively small sample [And the much smaller number of intact men] and the uncertainty as to the exact dates of infection and clearance, due to the six-month study visit interval. Nevertheless, the authors concluded that "the key factor associated with acquisition of HPV infection of all types … was lifetime number of sex partners, whereas the most important determinant of clearance of any [penile] HPV infection and of clearance of oncogenic HPV infection was circumcision." [Yes, never mind the facts, at all costs, circumcise.]
KENYA: FGM falsely touted as a panacea for HIV
Can FGM prevent HIV?
KISII, 27 January 2009 (PlusNews) - Priscilla Bosibori, now 17, was 14 when an aunt fetched her from her school in Kisii, western Kenya, on the pretext of taking her to an important family function. Once they had left the school grounds, her aunt said her family had found a way of protecting her from HIV.
Bosibori arrived home to a welcome of songs and dances by female members of her family before being placed in a room with other girls her age.
"Immediately I knew that I was about to be circumcised and I was shocked that even my mother, who had all along resisted my father's attempts to have me cut, was convincing me that this would be the best way to protect myself from getting infected with HIV," she told IRIN/PlusNews.
Proponents of female genital mutilation/cutting (FGM/C) in Kisii, where the practice is widespread, claim that the removal of part of the clitoris reduces a woman's sexual desire and the likelihood that she will have several sexual partners, thus reducing her chances of contracting the virus.
"When you are cut as a woman, you do not become promiscuous and it means you cannot get infected by HIV; even our men want circumcised girls who will not turn out to be prostitutes," said Grace Kemunto, a traditional circumciser.
According to local residents, a campaign by the government and NGOs to end the practice has made people like Kemunto even more aggressive in their efforts to keep FGM/C alive. [This aggresssiveness to perpetuate is a common factor to FGC and MGC.] The practice goes against Ministry of Health policy and also contravenes the Kenya Children's Act of 2001, which outlaws FGM/C of girls under the age of 18.
"I do not know where this idea of female genital mutilation being a remedy to HIV infection originated, but it is a strong belief here," said Jacqueline Mogaka, an anti-FGM/C campaigner in the area. "Young girls are now even voluntarily turning up for the cut because of this belief ... the proponents of this practice will die fighting."
An estimated 97 percent of girls in Kisii undergo circumcision, usually when they are teenagers but sometimes while still prepubescent.
A false premise
Anti-FGM/C campaigners in the region say the argument used by people like Kemunto is extremely harmful, particularly since it assumes that girls and women are in control of their sex lives, which is not true of most women in Kisii.
''When you are cut as a woman, you do not become promiscuous and it means you cannot get infected by HIV ''
According to the Kenya Demographic and Health Survey of 2003, in the rural areas of Nyanza Province, where Kisii is located, an estimated nine percent of girls are married by the age of 15, while 53 percent are married by the age of 19.
Many of these girls and young women marry older men and have little say in the marriage. Women in Nyanza are also much more likely to report physical and sexual violence than those in other parts of Kenya.
The notion that FGM/C reduces sexual desire has been challenged by researchers, who found that girls who undergo the practice do not show any significant difference in sexual desire compared to those who are uncircumcised.
Dorothy Onyancha is convinced that her 12-year-old daughter contracted HIV when she was secretly taken by her father to a traditional circumciser. "The father lied to her that if she is cut she will be free from HIV," she said.
"She is now HIV-positive and I know she got it from the practice because she confided to me that the woman who cut them used one knife to circumcise 15 of them," Onyancha said. "Now I take care of her alone, yet the father does not even care ... he cares more about his pride of having a circumcised daughter." One of the girls later died from excessive bleeding.
FGM/C increases a woman's risk of HIV primarily through the use of a single blade to cut several girls during traditional circumcision. There is also an increased risk of haemorrhage, leading to a greater likelihood of blood transfusions becoming necessary during circumcision, at childbirth, or as a result of vaginal tearing during sexual intercourse, with an even higher risk in areas where a safe blood supply cannot be guaranteed.
"How can one claim to be reducing HIV by practicing female genital mutilation when we know one knife can be used to circumcise up to 10 girls or even more?" asked Dr Erick Abunga, the Kisii District medical officer of health.
Prohibited but still widespread
Kisii District Commissioner Benjamin Njoroge said the practice was difficult to eradicate because families now did it secretly for fear of legal repercussions, and those who dared to talk about it were silenced by the community.
The fight against FGM/C in Kisii had made some progress by using the argument that traditional methods increased the risk of HIV, but lately nurses and midwives had been carrying out circumcisions.
Anti-FGM/C campaigners said this was common, even though it was illegal, and was now holding back the fight against FGM/C because the practice was no longer associated with a fear of HIV.
Nyanza province has the highest level of HIV in the country - 15.3 percent - compared to a national average of 7.4 percent.
The Nation (Thailand)
Clinic staff face penalties for circumcision error
By Duangkamon Sajirawatthanakul
An inquiry into a mistake at a Samut Prakan clinic, which saw a young boy circumcised - instead of being treated for an abscess in his mouth, has determined that people responsible could face up to two years jail and/or a fine of up to Bt40,000, the Public Health Ministry said yesterday.
Dr Somyos Deerasamee, head of the Department of Medical Service, said the team looking into the matter, found that miscommunication had resulted in the boy, aged 12, being mis[-]treated at the Phra Pradaeng clinic.
A fact-finding sub-panel met yesterday with related agencies and agreed that the doctor at the clinic was at fault according to Article 34 (1) of the Medical Facilities Act of 1998, for not properly supervising a professional nurse during a procedure allowed according to his training background. Punishment for this offence was up to two years jail and/or a fine up to Bt40,000.
He said the ministry would submit the case to the Medical Council to consider punishment in relation to the professional code of ethics.
The ministry also reported the case to the Nursing Council to consider punishment for the male nurse who performed the procedure on the boy.
Meanwhile, the clinic would take care of the boy until his wounds healed and he grows up. Consideration would also be given to an appropriate sum of compensation for the victim, he said.
[This story appears to contract the following one. It is not clear which comes first.]
Wrongful circumcision - big joke
Sydney Morning Herald
Nurse let off over mistaken circumcision
Thailand's Medical Council has exonerated a male nurse who mistakenly circumcised a 12-year-old boy instead of removing an abscess from his mouth, news reports said.
Acting Medical Council President Somsak Lohlekha said the unwanted circumcision was the result of a "miscommunication" between doctor and nurse, reported the Bangkok Post.
The boy's mother, Rattanaporn Manaschuen, on Thursday lodged a complaint with the council after her son had his foreskin removed at a clinic in Samut Prakan instead of receiving treatment for a mouth abscess.
After investigating the case, Somsak concluded that the clinic's doctor had ordered an "excision" be performed on the boy but the nurse had understood that a "circumcision" was needed.
Looking on the bright side, Somsak advised the mother of the now circumcised boy that the operation would help him keep his genitalia clean. [Yes, and if they'd mistakenly castrated him, he could look on the bright side that eunuchs live longer than whole men. Life imitates art.]
Like which end of an egg should be cracked ...
IOL (South Africa)
Fight about 'real man' leads to death
A recent initiate was stabbed to death during a fight with a friend over who the "real" man is, Butterworth police said on Friday.
Captain Jackson Manatha said the two, from Mzqantsi Village, graduated from initiation school in January but began arguing because one had had the circumcision procedure conducted by a medical surgeon.
In the heat of the moment, 18-year-old Sivuyile Maji was allegedly stabbed in the chest by the 22-year-old he was arguing with, and he keeled over and died. [It is not clear from this which had the 'real' man's circumcision - nor does it matter; neither is.]
Police arrested the man he had been arguing with and he will appear before a Butterworth Magistrate on Monday to face a murder charge.
The ritual, observed in many cultures globally as a means of receiving cultural knowledge and gaining recognition as an adult in a community [actually only a few cultures, mainly African, at this age and for this purpose], has been dogged with controversy.
Initiates have died of exposure while receiving their instruction at remote bush venues during winter, or due to medical complications caused by unqualified [or qualified] surgeons performing the circumcision.
Many initiates and their parents are opting for the operation to be conducted by a conventional medical practitioner, a choice considered alien by traditionalists.
Renal and Urology News
Unexpected Penectomy Lands Urologist in Court
Ann W. Latner, JD
Squamous cell cancer is discovered during a circumcision. Is that justification for additional emergency surgery?
Physicians and hospitals typically require patients to sign a boilerplate consent form before surgery. These forms usually specify that in the event of an emergency or unforeseen medical issue, the physician has the patient's consent to do whatever is medically necessary under the circumstances.
But can a general consent form protect a surgeon when he performs a penectomy in the course of a circumcision?
Dr. U, 54, was a board-certified urologist with almost 25 years' experience. His practice was doing well, treating both routine and less common complaints.
One of his patients was Mr. B, a 61-year-old white man who had been complaining of inflammation, foreskin soreness and tightness, and drainage from the penis. Dr. U recommended circumcision, and after discussing it with his wife, Mr. B agreed to the procedure.
On the day of the operation, a nurse checked Mr. B's vital signs and gave him a consent form to sign. During the circumcision, Dr. U noticed a suspicious lesion on the penis shank. He sent a specimen to the pathology department for biopsy, and the results confirmed his diagnosis: squamous cell carcinoma. Rather than subject Mr. B to a second surgery under general anesthesia, Dr. U decided to perform an immediate penectomy.
When the patient came out of anesthesia, Dr. U sat down with him and his wife to explain what had happened.
“I'm very sorry to have to tell you this,” he said, “but I discovered a lesion, a skin cancer of the penis. [The quotations in direct spech appear to be conjectural.]...
... The case was settled for an undisclosed amount.
While Mr. B did sign a general consent, these forms are primarily designed to cover “medical necessities” in emergencies:
... Judges always instruct jurors to resist allowing their emotions to interfere with how they apply the law; but any man on this jury would be likely to see himself in Mr. B's place and have a difficult time dispassionately assessing whether penile amputation was the best medical choice. Certainly the fact that neither the patient nor his wife was consulted prior to such a radical procedure would arouse compassion in jurors – both male and female.
One picture ...
A boy refusing to go through circumcision is carried by volunteers during a mass circumcision in Kampung Nakhoda village, north of Kuala Lumpur, December 19, 2008. About 25 boys, aged between 7 and 11 years old, were given a grand welcome to a mass circumcision surgery, including a ceremony similar to the reception of a groom at a wedding, in festivities some consider as a celebration of reaching manhood. [...and others consider as akin to pack rape.]
The Tide Online (Nigeria)
Myths surrounding female genital mutilation
A number of assumptions ranging from religious, sociological, psychosexual to hygienic are generally associated with the performance of female genital mutilation in Nigeria, some plausible, others remote from reality, yet strongly adhered to by the people.
(a) Cultural Identity: First and foremost the practice of FGM is a means of cultural identity. This view usually propounded by men is well articulated by Jomo Kenyatta of Kenya in his essay (1938: 128) when he asserts: “Excision and infibulation unite us tightly, they prove our fecundity (...) Clitoridectomy as indeed ,circumcision among Jews is a bodily mutilation, viewed somehow as the condition sine qua non for receiving a complete religious and moral education” As a rite of passage, therefore, the ceremony initiates girls into the community’s way of life. It bestows on the initiates a sense of responsibility and also of social belonging ‘in the overall social activities of the people. It is a status determinant and a stepping-stone to other social hierarchy. For only the initiate is eligible to claim ,her rights in the community, undergo other rites of passage and climb to the apex of social ladder as the case may be. For these reasons, any woman who is uncircumcised is not only subjected to frequent embarrassing innuendoes from other women reminding her of her precarious status in the community, looked down upon by women younger than herself, but virtually remains a social outcast for life.
In the play, In the Fullness of Time: (Okoh, 1. 2000) Esele and her mother incarnate the predicament of the “uncircumcised woman living in a patriarchal community. In this play, Esele’s mother was pressurised by her mother-in-law to have Esele circumcised. At the heat of the crisis it was discovered that the mother herself who was from a different” [v]illage has never been circumcised. With expediency, the mother was chased out of the community accused of defiling her husband’s bed and bringing shame to the family. As she moved away from the village, accompanied by her two children, the people hooted after them ‘Osu!’ ‘Osu!’ implying “Outcast! Outcast! Go and hide your shame somewhere else. The woman and her children went to take refuge in a missionary compound. Few years latter the mother died mysteriously in her cassava plantation. Who killed her?
(b) Religion: In some communities circumcision is given a religious overtone. For example, among the Ibo in Ezza community (Odey, John, 1986: 19) as well as in Afikpo of Ebonyi State, male and female circumcisions are believed to bring about solidarity between the community and the earth spirit. Hence they are performed at specially designated locations such as at the shrine of the goddess of fertility located in a grove in a neighbouring forest or in the family barn behind the house regarded as the habitat of the goddess of fertility. This is done in the hope that the earth goddess will bless the initiate with many offspring. Islam also underlines the practice of FGM in Sokoto.
(c) Attenuation of Sexual Desires: In almost all the ethnic sub-groups in Nigeria, it is generally believed that FGM serves to reduce sexual desires in women hence it protects women against promiscuity. It is necessary to recall that in these societies, female virginity is an unconditional prerequisite for marriage and bridal virginity test serves as a proof of chastity. Among the Ijaw for example, the test is conducted in the girls’ house. On the appointed day, in a room specially designated for the test is placed a bed or mat on top of which is laid a white cloth. As soon as the test is over, the female members of the suitor’s family are the first to enter the room to check whether there is blood stain on the white cloth, if positive there is jubilation and a date is fixed for the payment of dowry. But if negative the relationship is abrogated there and then. This tradition is also prevalent among the Yoruba as illustrated by Soyinka (1984) in Death and the King’s Horseman. In order to confirm that his young bride was still a virgin, after his first mating with her on the occasion of their wedding, The Elesin Oba comes out of his hut to show to the waiting crowd a blood stained clothe. And the crowd shouted with joy.
Emphasis on female premarital virginity is not restricted to the southern part of Nigeria. In September 2000, Bariya Ibrahim Maguzu, a 13/14 years old girl was found pregnant and charged guilty of pre-marital sex in Zamfara State. Under the provision of Sharia law based on the Koran, a sentence of 180 lashes was passed on Bariya. Due to international intervention, the authorities in the state deferred the punishment until two weeks after the delivery of her baby. Then, in January 2001 Bariya was publicly flogged before the crowd of people. Commenting on the issue, the Deputy Governor of the State said “The disgrace in public is what deters people... She will never be disgraced again.”
Meaning that the public humiliation was desirable in order to prevent young girls from having pre-marital sex.
On the other hand, in all the communities that practice female genital circumcision, the belief that uncircumcised woman has a rampant and voracious craving for promiscuous sex is prevalent (Giorgis, 1991: 17). However, extramarital relationships provoke very severe sanction on women in these communities. But in polygamous community, it is physically impossible for a husband to satisfy all his wives as may be required by nature. So in these communities, FGM serves not only to protect a woman from aggressive men but also against her own sexuality.
(d) Hygiene: Another reason given for the practice is hygiene. In some ethnic groups, uncircumcised women are considered unclean. So young girls are circumcised to prevent them from having bad odour. According to Oduntan and Onaedeko (1984: 96-98), among the Yoruba, it is widely believed that the clitoris is an aggressive organ and that should a baby’s head touch it during delivery, such baby will either die or develop a hydrocephalic head. The women are therefore circumcised during their first pregnancy often with complicating birth, severe hemorrhage and genital infection. This belief is also tenable by the Ijaw of Bayelsa State, the Ogbaru of Delta State and the Esan people of Edo State. These ethnic groups even circumcise woman during child delivery as the case may be.
Moreover, the Yoruba practice excision as a form of contraception (Mclean, 1980: 7) and as a coping measure (Ogunmodede, 19). Believing that the sperm could navigate to the nursing mother’s milk which may have adverse effect on the baby, some women abstain from sexual intercourse as long as they breast feed their baby. So it is believed that they are able to cope with the abstinence because they have been circumcised.
Health: It is also believed that circumcision helps to maintain good health in a woman. And that it cures in women ailment such as melancholia, nymphomania, hysteria, insanity, epilepsy as well as klepwmania (Kouba & Muasher 1985: 104) and (Koso-Thomas 1987: 9) Similarly, according to Usman Mandara (2000: 98), the gishiri cut, an incision on the virginal wall made with a razor blade or penknife “is performed commonly; as a “cure” for a variety of ailments. Including obstructed labour, amenorrhea, infertility pruritus vulvae, and others.” The “zur-zur” cut is an incision on the cervix, intended to remedy obstructed labour. Hymenectomy, locally called “chire angurya” “chire haki” or “chire belun gaba” (excision of abnormal growth) practiced by the Hausa involves the removal of the hymen to facilitate sexual penetration. For the Hausa believe that thickened hymen makes sexual penetration difficult. It is practiced in communities where child marriages are commonplace (Fran Hosken, 1993: 1947).
All these beliefs may be true or false. However one thing is certain, in areas of Nigeria still rooted in patriarchal social set up, the association of circumcision with premarital chastity is so strong that most often the non-excised girls is ridiculed. So, mothers readily arrange to have their daughters circumcised in order to safeguard the latter from the disdain that may be intended towards them by the conservative members of their community. Motivated by love and concern for their daughter’s future, these well meaning women continue to perpetuate the customs, out of a firm belief in the physical and moral benefits of this operation as the sure guarantee of marriage and consequent social and economic security. So, reasons ranging from religious, hygienic and social have been advanced to justify and validate the continuity of the practice of female genital mutilation in Nigeria. In order words, the rite is erroneously shrouded with myth and superstitions that are remote from biological and medical realities.
[All this will be eerily familiar to those involved with the struggle against the male version.]
Another death from circumstition
Clacton and Frinton Gazette
Local based charity needs your help to save
Circumcision makes people do crazy things. Is anyone surprised?
Daily Nation (Kenya)
Man pays heavily for rejecting fine
By PATRICK MUTHURI
Youths on Tuesday attacked a home in Meru, forcibly circumcised a Standard Six boy and destroyed property worth more than Sh100,000.
The more than 100 youths had been angered by the boy for trespassing into the seclusion house of his cousin who underwent the cut three weeks ago.
The boy’s father, from Nkurune village, Imenti North District, allegedly rubbed the group the wrong way after he declined to pay Sh10,000 expenses for the forced cut and a fine of a bull for his son’s “offence”.
The Meru tradition prohibits a woman or an uncircumcised person from entering a seclusion place of a boy who is still healing after circumcision. The healing takes about a month.
However, the father declined to give the cash and the bull and allegedly insulted the youths while daring them to take any action they deemed fit.
It was then that they invaded his homestead, destroyed his two houses and his entire farm of bananas, potatoes, nappier grass, miraa, yams, arrow roots, sugarcane, mangoes, sweet potatoes, onions and exotic trees.
The mob also defecated all over the compound before police arrived. Some are said to have brought the waste in containers.
The man’s family has been forced to flee the home with his wife and his three other children. They have taken refuge at a relative’s home 20 kilometres away at Nthoro village in Miiriga Mieru Division.
The angry youths warned him against returning home with his family until he pays the traditional fine.
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