Group Backs Ritual ‘Nick’ as Female Circumcision Option

[Bostonian]

http://www.nytimes.com/2010/05/07/health/policy/07cuts.html

Group Backs Ritual "Nick" as Female Circumcision Option

By PAM BELLUCK

Published: May 6, 2010

New York Times

 

In a controversial change to a longstanding policy concerning the

practice of female circumcision in some African and Asian cultures,

the American Academy of Pediatrics is suggesting that American doctors

be given permission to perform a ceremonial pinprick or “nick†on

girls from these cultures if it would keep their families from sending

them overseas for the full circumcision.

 

The academy’s committee on bioethics, in a policy statement last week,

said some pediatricians had suggested that current federal law, which

“makes criminal any nonmedical procedure performed on the genitals†of

a girl in the United States, has had the unintended consequence of

driving some families to take their daughters to other countries to

undergo mutilation.

 

“It might be more effective if federal and state laws enabled

pediatricians to reach out to families by offering a ritual nick as a

possible compromise to avoid greater harm,†the group said.

 

But some opponents of female genital mutilation, or F.G.M., denounced

the statement.

 

“I am sure the academy had only good intentions, but what their

recommendation has done is only create confusion about whether F.G.M.

is acceptable in any form, and it is the wrong step forward on how

best to protect young women and girls,†said Representative Joseph

Crowley, Democrat of New York, who recently introduced a bill to

toughen federal law by making it a crime to take a girl overseas to be

circumcised. “F.G.M. serves no medical purpose, and it is rightfully

banned in the U.S.â€

 

<rest of story at link>

 

This is a shocking story. I don't want the indefensible to be normalized in the U.S. Immigrants who are bent on female genital mutilation should not come to the U.S., and if they practice it here (or abuse American children while abroad), they should be prosecuted as other child abusers would be.

[Carrie12345]

As much as I WANT to be outraged, I find myself unable to be. I think it's discriminatory to completely discount the cultural aspect when "we" (generally speaking) continue to defend the cultural aspect of male circumcision, which is much more extreme than what the Journal of the AAP discusses.

 

If you read the actual text of the paper (http://pediatrics.aappublications.org/cgi/reprint/peds.2010-0187v1), the "nick" itself isn't listed in the recommendations, but is mentioned in the body of the paper.

[Renee in NC]

As much as I WANT to be outraged, I find myself unable to be. I think it's discriminatory to completely discount the cultural aspect when "we" (generally speaking) continue to defend the cultural aspect of male circumcision, which is much more extreme than what the Journal of the AAP discusses.

 

If you read the actual text of the paper (http://pediatrics.aappublications.org/cgi/reprint/peds.2010-0187v1), the "nick" itself isn't listed in the recommendations, but is mentioned in the body of the paper.

 

:iagree:

[Spy Car]

Given the reality of Female Genital Mutilation (which includes the removal of the clitoris as a means of inalterably denying a female sexual pleasure for their life-time) this "nick", while troublesome, does seem a reasonable way to protect a girl from a very much greater harm.

 

Is it perfect? No. But we live in an imperfect world and this is a "compromise" I'd support until this terrible practice vanishes from the earth. We need to work on that too.

 

Bill

[stripe]

Is it perfect? No. But we live in an imperfect world and this is a "compromise" I'd support until this terrible practice vanishes from the earth. We need to work on that too.

 

Bill

It's pretty sad, in fact, that quite some time ago, the very idea of such a nick for those bent on such procedures was promoted by the Prophet Muhammad in order to prevent "full" circumcisions, with the ultimate goal of getting rid of the whole thing, but unfortunately it hasn't exactly succeeded. One can only hope that it does, in fact, die out soon.

[ThatCyndiGirl]

As much as I WANT to be outraged, I find myself unable to be. I think it's discriminatory to completely discount the cultural aspect when "we" (generally speaking) continue to defend the cultural aspect of male circumcision, which is much more extreme than what the Journal of the AAP discusses.

 

If you read the actual text of the paper (http://pediatrics.aappublications.org/cgi/reprint/peds.2010-0187v1), the "nick" itself isn't listed in the recommendations, but is mentioned in the body of the paper.

 

 

:iagree:

 

Males deserve genital integrity just as much as girls do!

[Spy Car]

:iagree:

 

Males deserve genital integrity just as much as girls do!

 

Let's not go down that road. Female genital mutilation and male circumcision are not comparable. How about we stay on topic?

 

Bill

[mcconnellboys]

If this could catch on and prevent full clitoral mutilation, and be done under antiseptic conditions to boot, then I think it would be a good thing.

[Carrie12345]

Let's not go down that road. Female genital mutilation and male circumcision are not comparable. How about we stay on topic?

 

Bill

 

It IS on topic when you consider the actual contents of the AAP article and how it compares to their position on other routine newborn procedures that are based on cultural expectations vs. medical knowledge.

[Smithie]

"I don't want the indefensible to be normalized in the U.S."

 

It already is. Given the choice between "nicking" a daughter of mine and circumcising a son of mine - it would be no choice at all. I don't intend to do either, but I don't see any legal basis for disallowing a tiny ritual cut on a girl's genitals, given the staunch legal support for the hideous ritual cutting that is such an entrenched problem among my own people.

[HRAAB]

While I hope that in some future time FGM is never done and seen as the atrocious act that it is, this seems like a better alternative.

[Spy Car]

It IS on topic when you consider the actual contents of the AAP article and how it compares to their position on other routine newborn procedures that are based on cultural expectations vs. medical knowledge.

 

To my mind the topic has been rather beaten-to-death in other threads (see "search function"). To compare FGM to a procedure where reasonable people can differ as to risk and reward, is to engage in "pot-stirring" from my point of view.

 

The thread is about a "nick" as a way of preventing FGM, dragging in attitudes about male circumcision takes the discussion way off course IMO.

 

I'm under no illusions about the way things go on this forum sometimes, but...

 

Bill

Edited May 8, 2010 by Spy Car

[Carrie12345]

To my mind the topic has been rather beaten-to-death in other threads (see "search function"). To compare FGM to a procedure where reasonable people can differ as to risk and reward, is to engage in "pot-stirring" from my point of view.

 

The thread is about a "nick" as a way of preventing FGM, dragging in attitudes about male circumcision takes the discussion way off course IMO.

 

I'm under no illusions about the way things go on this forum sometimes, but...

 

Bill

 

Everyone is going to look at it with a different bias, I suppose.

 

Personally, I don't see how it (it being the actual contents of the paper) can be discussed without addressing ethics and cultural "norms" with an expectation of consistency, regardless of one's personal opinions.

 

I've never seen anyone (irl or on any board I frequent, though obviously there are those out there) who support "typical" FGM. And this paper doesn't support "typical" FGM. It contemplates what might be "acceptable" here, in our country. Yes, I think that should be weighed against what other "acceptable" cultural rituals we "allow".

[kokotg]

Let's not go down that road. Female genital mutilation and male circumcision are not comparable. How about we stay on topic?

 

Bill

 

It's only off topic if one accepts your premise that the two are not comparable. Given that both male and female circumcision inarguably involve cutting someone's genitals without his or her consent, I don't think it's at all unreasonable to argue that there are comparisons to be made.

[elizabeth]

I think it is a violation of the Hippocratic oath to participate. I would actively file a complaint to have the license suspended of any MD who participated. Unless you have seen the results of this monstrous abuse you cannot truly appreciate the horror of life for these women. Our next door neighbor is a British woman who has a young Ethopian woman as the housekeeper. She speaks out on this issue and has shared photographic evidence with MD's and the local domestic violence board. I did not sleep for days but am glad to have learned the full truth about this practice. The abuse and degradation of these women starts with the mutiliation and continues until the day they die.

Edited May 8, 2010 by elizabeth
typo

[Whereneverever]

I think it is a violation of the Hippocratic oath to participate. I would actively file a complaint to have the license suspended of any MD who participated. Unless you have seen the results of this monstrous abuse you cannot truly appreciate the horror of life for these women. Our next door neighbor is a British woman who has a young Ethopian woman as the housekeeper. She speaks out on this issue and has shared photographic evidence with MD's and the local domestic violence board. I did not sleep for days but am glad to have learned the full truth about this practice. The abuse and degradation of these women starts with the mutiliation and continues until the day they die.

 

I agree.

[HRAAB]

It's only off topic if one accepts your premise that the two are not comparable. Given that both male and female circumcision inarguably involve cutting someone's genitals without his or her consent, I don't think it's at all unreasonable to argue that there are comparisons to be made.

 

But isn't the end result different? Female circumcision is performed to prevent sexual pleasure. That is not the purpose of male circumcision. I don't have any boys, and if we had had boys, they would NOT have been circumcised. By the way, it's my dh that is adamantly opposed to circumcision. Still, I cannot see how you can compare the two procedures. It's just not apples to apples in my eyes.

[Carrie12345]

But isn't the end result different? Female circumcision is performed to prevent sexual pleasure. That is not the purpose of male circumcision. I don't have any boys, and if we had had boys, they would NOT have been circumcised. By the way, it's my dh that is adamantly opposed to circumcision. Still, I cannot see how you can compare the two procedures. It's just not apples to apples in my eyes.

 

It's not a comparison of "typical" FGM to "typical" male circumcision. (For me,) it's a comparison of a "nick" vs. the removal of a body part. To (legally) support one and not the other is nonsensical to me.

[kokotg]

But isn't the end result different? Female circumcision is performed to prevent sexual pleasure. That is not the purpose of male circumcision. I don't have any boys, and if we had had boys, they would NOT have been circumcised. By the way, it's my dh that is adamantly opposed to circumcision. Still, I cannot see how you can compare the two procedures. It's just not apples to apples in my eyes.

 

There's a difference between saying they're exactly the same and saying one can make comparisons. For me personally, the fact that they both involve cutting a person's genitals without consent is a pretty important similarity.

[kokotg]

It's not a comparison of "typical" FGM to "typical" male circumcision. (For me,) it's a comparison of a "nick" vs. the removal of a body part. To (legally) support one and not the other is nonsensical to me.

 

:iagree:

 

And this too.

[Spy Car]

I think it is a violation of the Hippocratic oath to participate.

 

Is it a violation of the Hippocratic oath to take a "blood-draw"?

 

 

 

Unless you have seen the results of this monstrous abuse you cannot truly appreciate the horror of life for these women.

 

Correct. That's why it is an open question of bio-medical ethics to ask if this savagery can be prevented with a ceremonial prick under the trained care of a physician, whither participation by a physician is in the best interests of a patient who might otherwise be subjected to serious harm.

 

 

Our next door neighbor is a British woman who has a young Ethopian woman as the housekeeper. She speaks out on this issue and has shared photographic evidence with MD's and the local domestic violence board. I did not sleep for days but am glad to have learned the full truth about this practice. The abuse and degradation of these women starts with the mutiliation and continues until the day they die.

 

I have a close friend who was mutilated as a girl. It is a horrifying practice.

 

Bill

[kalanamak]

Given the reality of Female Genital Mutilation (which includes the removal of the clitoris as a means of inalterably denying a female sexual pleasure for their life-time) this "nick", while troublesome, does seem a reasonable way to protect a girl from a very much greater harm.

 

 

 

Let's face it. The practice of medicine is an imprecise battle between science, belief, and the inevitability of sickness and death. Would I "nick" a child in clean conditions over a trip back home and a butcher? Yes. Most patients who are inflexible in their goals make it very clear from the get-go they are inflexible. Once I get more than 5 minutes of calm billy-goat from someone I have only once or twice seen that patient change their mind (unless pain intervenes, as in "I'll just pass my gall stone, thank you" and a week later they are in the ER with a change of heart.) At that point, the physicians job is to do damage control.

[kalanamak]

I

 

I have a close friend who was mutilated as a girl. It is a horrifying practice.

 

Bill

 

And wouldn't it be nice is such a "gesture" watered down the belief enough that it was dropped all together. After all, a few women who aren't rampant nymphos despite not being "completely done" might convince people the whole she-bang (no pun intended) is unnecessary.

[Mejane]

In my perfect world, no one would be cut. In the real not-so-perfect world, nicking is a better alternative.

[Carol in Cal.]

The road to hell is paved with good intentions.

 

The 'nick' would leave scar tissue in an area where it would disturb later s*xual pleasure. It would have the support of law locally. People would do it as the 'local custom'.

 

Far, far better to continue to fight against the entire practice.

[Quickbeam]

I've never seen anyone (irl or on any board I frequent, though obviously there are those out there) who support "typical" FGM. And this paper doesn't support "typical" FGM. It contemplates what might be "acceptable" here, in our country. Yes, I think that should be weighed against what other "acceptable" cultural rituals we "allow".

 

I agree. Anyone who recoils in horror at FGM should know that male circumcision is the same; it just happens to be our cultural practice.

 

But isn't the end result different? Female circumcision is performed to prevent sexual pleasure. That is not the purpose of male circumcision.

 

Male circumcision does affect sexual pleasure/function, as it deprives the person of the most sensitive skin on the penis. Whatever the purpose of circumcision on either gender, it should be against the law to amputate parts of genitalia without consent of the person who's getting cut.

[Parrothead]

The road to hell is paved with good intentions.

 

The 'nick' would leave scar tissue in an area where it would disturb later s*xual pleasure. It would have the support of law locally. People would do it as the 'local custom'.

 

Far, far better to continue to fight against the entire practice.

:iagree:

With all the things the human race has eliminated or virtually eliminated, I think this hideous practice can be a thing of the past with education and cultural changes.

[Carol in Cal.]

I agree. Anyone who recoils in horror at FGM should know that male circumcision is the same; it just happens to be our cultural practice.

 

 

 

However, they are not the same. No reasonable reading of the details of the two could lead to the conclusion that they are comparable. Castration would be much more like FGM. Unanaesthesized, ritually performed castration, actually.

[elizabeth]

Well it seems that basic biology and embryonic development is not commonly known here. To that end and to frame the discussion around science I offer this handy chart that shows how inappropriate it is to compare female genital mutilation to circumcision. Actually when homologous structures are compared one can readily see that in order for circumcision to be equal to female mutilation one would literally have to sever the penis. The structure that is removed at circumcision is in no way structurally, biologically or in any way akin to the removal of the clitoral structure.

http://en.wikibooks.org/wiki/Human_Physiology/The_female_reproductive_system#Similarities_between_male_and_female_reproductive_systems Look in any basic embryology textbook for the same information. You might "feel ," that it is the same thing but biology says it is not.

[kokotg]

Well it seems that basic biology and embryonic development is not commonly known here. To that end and to frame the discussion around science I offer this handy chart that shows how inappropriate it is to compare female genital mutilation to circumcision. Actually when homologous structures are compared one can readily see that in order for circumcision to be equal to female mutilation one would literally have to sever the penis. The structure that is removed at circumcision is in no way structurally, biologically or in any way akin to the removal of the clitoral structure.

http://en.wikibooks.org/wiki/Human_Physiology/The_female_reproductive_system#Similarities_between_male_and_female_reproductive_systems Look in any basic embryology textbook for the same information. You might "feel ," that it is the same thing but biology says it is not.

 

But this thread isn't about "standard" FGM (which I'm fairly certain the AAP has no intention of condoning); it's about a "nick" to female genitals. I really can't see how to have a discussion about whether that is acceptable while ignoring the elephant in the room that our society widely accepts a much more invasive procedure on baby boys.

[Renee in NC]

But this thread isn't about "standard" FGM (which I'm fairly certain the AAP has no intention of condoning); it's about a "nick" to female genitals. I really can't see how to have a discussion about whether that is acceptable while ignoring the elephant in the room that our society widely accepts a much more invasive procedure on baby boys.

 

Exactly. Of course female genital mutilation and circumcision are not the same thing. However, it does seem to me that the position of the AAP does mimic circumcision.

[elizabeth]

For those who think a ceremonial nick would suffice the ritualistic aspect of this and protect young women, I say you grossly underestimate the level of savagery towards women that those who subscribe to this belief actually are willing to perpetuate. It is in my mind a violation of the very heart of the profession. It is not acceptable to do this nor commemorate said ritual in any way. It is interpreted as sanctionand/or toleration for the whole concept. I have a great idea for the docs who think that this is the lesser of two evils,you" take a nick" at a female you get one in return. OK? Oh not such a good idea now is it???

Edited May 8, 2010 by elizabeth
typo

[Quickbeam]

This issue goes deep, and we do well to ask ourselves (again or for the first time) what we think about our purpose, or telos. Not trying to be too dramatic, but clearly cutting genitals has a significance with roots way older than our postmodern age.

 

I was reading a tabloid (gasp!) where Sandra Bullock talked about circumcising her new son, and I thought "Why in the world would she go to that trouble when she was trying to keep him a secret?" Is she Jewish? I think we all would do well to rethink our own circ. rituals as we try to protect others from theirs (FGM).

 

As for equivocating the two surgeries, you are amputating a part of the penis when you circ., and it's an important part. Even with sterile instruments and good aftercare (which FGM victims do not often receive), there can be complications.

[Spy Car]

So what will the children be wearing for Halloween?

 

Bill (suddenly hankering for bean-dip)

[Quickbeam]

Bill, if you don't want to talk about it (and need some bean dip) why come onto the thread? I am not trying to bust your chops, but I am curious. What's it to you if people want to discuss this topic?

[Firefly]

The road to hell is paved with good intentions.

 

The 'nick' would leave scar tissue in an area where it would disturb later s*xual pleasure. It would have the support of law locally. People would do it as the 'local custom'.

 

Far, far better to continue to fight against the entire practice.

 

For those who think a ceremonial nick would suffice the ritualistic aspect of this and protect young women, I say you grossly underestimate the level of savagery towards women that those who subscribe to this belief actually are willing to perpetuate. It is in my mind a violation of the very heart of the profession. It is not acceptable to do this nor commemorate said ritual in any way. It is interpreted as sanctionand/or toleration for the whole concept. I have a great idea for the docs who think that this is the lesser of two evils,you" take a nick" at a female you get one in return. OK? Oh not such a good idea now is it???

 

 

Exactly! 100% agree with the above posters.

[Spy Car]

Bill, if you don't want to talk about it (and need some bean dip) why come onto the thread? I am not trying to bust your chops, but I am curious. What's it to you if people want to discuss this topic?

 

The topic is the bio-medical ethics of doctors involving themselves in a "ceremonial" blood-pricking as a way of fulfilling a cultural ritual and thereby preventing an act of Female Genital Mutilation. It is an interesting ethical question.

 

But some people insist on bringing in issues that are not germane to the discussion, and the debate about male circumcision has been done to death. The suggestion that FGM and male circumcision are the "same" is obnoxious in the extreme and flat-out wrong, but that is not the discussion at hand, as much as you and some others might attempt to interject your views on the latter into this discussion.

 

Bill

[Mejane]

I would be interested to know what the girls who would be nicked as opposed to permanently mutilated would say. I think it's easy for those of us who will never have to go through this to sit around saying that they should opt out and continue to "fight the good fight." Unfortunately, while that fight is still raging, many more girls will be ritually mutilated.

[junepep]

For those who think a ceremonial nick would suffice the ritualistic aspect of this and protect young women, I say you grossly underestimate the level of savagery towards women that those who subscribe to this belief actually are willing to perpetuate. It is in my mind a violation of the very heart of the profession. It is not acceptable to do this nor commemorate said ritual in any way. It is interpreted as sanctionand/or toleration for the whole concept. I have a great idea for the docs who think that this is the lesser of two evils,you" take a nick" at a female you get one in return. OK? Oh not such a good idea now is it???

 

:iagree:

It really won't stop them and any condoning of the procedure will normalize it. This was a mistake by the AAP.

[Quickbeam]

We disagree as to what is germane, Bill. Your position isn't any more self-evident than mine.

 

Both male and female circ. are rituals. Neither is medically necessary and both are amputations. Some of us believe the AAP should take a stance against any ritual, non-medical cutting of a child's genitals.

[Veritaserum]

We disagree as to what is germane, Bill. Your position isn't any more self-evident than mine.

 

Both male and female circ. are rituals. Neither is medically necessary and both are amputations. Some of us believe the AAP should take a stance against any ritual, non-medical cutting of a child's genitals.

 

:iagree: In my experience, those of us who grew up without the cultural expectation of male or female genital modification tend to look upon both with great alarm.... I have mixed feelings about the new AAP guidelines. On one hand, if this does prevent even more invasive cutting, then it may be viewed as a good thing. On the other hand, it rather disturbs me to see any medically unnecessary genital cutting of babies (of either sex) as something to be protected or condoned.

[Sputterduck]

If it's good enough for our boys, it's good enough for our girls, right?

 

I'm happy to live in this country. They don't cut any parts of their babies' genitals.

Edited May 8, 2010 by Sputterduck

[mcconnellboys]

That's why it is an open question of bio-medical ethics to ask if this savagery can be prevented with a ceremonial prick under the trained care of a physician, whither participation by a physician is in the best interests of a patient who might otherwise be subjected to serious harm.

 

 

 

I agree. If modern medicine could help change minds, change cultural mores, and change primitive practices, it could change lives for the better all over the world.

[mcconnellboys]

Weeelllllll....... sometimes it's the same. Sometimes, at least in days gone by, the docs missed or slipped (or the baby moved suddenly) and then the male child ended up with a mutilation that was on a par with FGM. However, it was never the intended consequence, as with FGM.......

 

(And since we're not talking about male circumcision, I won't go into the many, many reasons that's it's really not the same as FGM at all, save for those accidents.....)

[NoPlaceLikeHome]

Let's not go down that road. Female genital mutilation and male circumcision are not comparable. How about we stay on topic?

 

Bill

 

:iagree: 100% even though I think uncircumcised for males or circumcised is fine. FGM OTOH is barbaric IMHO since it is the equivalent of removing a male's whole penis which is unthinkable:(

[NoPlaceLikeHome]

I agree. If modern medicine could help change minds, change cultural mores, and change primitive practices, it could change lives for the better all over the world.

 

I tend to agree although I truly wish it would not have to come to this, but if it prevents this barbarism them I would be in favor. I would still worry about accidents though as can happen rarely with boys:(

[Greta]

I agree. Anyone who recoils in horror at FGM should know that male circumcision is the same; it just happens to be our cultural practice.

 

It. Is. NOT! The. Same.

 

It's hard for me to imagine that anyone would make this claim if they understood what FMG really is. I hesitate, however, to post a description here, as it is truly graphic and horrifying. I encourage you to look it up.

 

Male circumcision does affect sexual pleasure/function, as it deprives the person of the most sensitive skin on the penis. Whatever the purpose of circumcision on either gender,

 

There is no "circumcision on either gender". FMG is NOT circumcision. It does a whole lot more than merely "affect" sexual pleasure, it often eradicates it. Common consequences include obstruction of the passage of urine and/or menstrual fluid, cysts, increased risk of c-sections, and increased risk of death to the baby during childbirth. Circumcision does NOT cause the same kind of permanent and far-reaching damage.

 

it should be against the law to amputate parts of genitalia without consent of the person who's getting cut.

 

On that, at least, we can agree.

[elizabeth]

:iagree: 100% even though I think uncircumcised for males or circumcised is fine. FGM OTOH is barbaric IMHO since it is the equivalent of removing a male's whole penis which is unthinkable:(

 

Yep they are homologous structures. Pesky biology and such. I refuse to spend one second of my energy worrying about whether men have the perfect ability to enjoy their" manhood" if they are circ'd. Seriously I could not care less. They have way too many advantages and far too few scruples ,let them fend for themselves. They have done a great job of doing so for many , many years. Feminist? You bet. Mean? Darn right. Happily married ? Absolutely, to an observant Jew who thinks the fact that this is even an issue for debate is beyond silly.

[Impish]

Wolf, many years before meeting me, was considering proposing to his gf at the time. She was from Ethiopia, and had been 'circumcised'.

 

It was her insistence that any daughter she had would also be circumcised that caused Wolf to end the relationship. She had no qualms about telling him she would sneak the child out of the country if need be.

 

This was a woman who had been mutilated, willing to visit it upon a child...You would think that she would be one of the biggest opponents, yet was one of the staunchest supporters.

 

Some things are just so ingrained...I don't know if the availability of a 'nick' would actually make any difference at all.

[Greta]

As for equivocating the two surgeries, you are amputating a part of the penis when you circ., and it's an important part.

 

But female genital mutilation is more akin to removing the *entire* penis, not just some of the skin on it.

 

Even with sterile instruments and good aftercare (which FGM victims do not often receive), there can be complications.

 

Yes, but even when an FGM victim receives "good aftercare" if there is any such thing for such a horrifying procedure, the "complications" are a guarantee, not a mere statistical possibility. Your insistence on equating the two is very disturbing.