Andrew Sullivan, gay political pundit and blogger at The Daily Beast, lobbed some rather nasty insinuations my way last Wednesday. He was flabbergasted that any fellow gay man could possibly think that infant male circumcision is justifiable. The whole thing is madness, wrote Sullivan, disgusted with the very thought of it. Now before I respond, heres some of the context behind this spat.
Two years ago, here at my Bering in Mind column at Scientific American, I reviewed some of the science and bioethical issues associated with the always-incendiary topic of infant male circumcision. In that earlier piece, titled Is Male Circumcision a Humanitarian Act? I highlighted some research from the past decade elucidating the now established fact that rates of HIV acquisition are significantly lower among circumcised heterosexual males, namely because they lack the high concentration of target receptor cells for the virus found on the inner mucosal surface of the prepuce. This anti-HIV effect is dramatic; it is at least on the magnitude of a 60 percent reduction in this demographic. Most of this research was conducted with African populations, but not exclusively so, nor has every study been equally incontrovertible.
About a week ago, I was asked by Discover magazine to revisit this topic in light of the controversial revised position statement of the American Academy of Pediatrics, which had just been published in the journal Pediatrics a few days earlier. The AAP task force, comprised of an accomplished team of pediatric bioethicists, epidemiologists, urologists and anaesthesiologists, along with consultants from the Centers for Disease Control and Prevention, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists, analyzed hundreds of peer-reviewed scientific studies published between 1995 and 2010, including the HIV findings that Id gone over in my original Scientific American piece. The consensus regarding this cascade of new datasetsall of which, they claimed, they went over methodically with a fine-toothed combmoves the AAP away from its historically noncommittal view and towards a clear stance that the benefits of infant male circumcision now unambiguously outweigh its minimal risks when performed under sterile conditions by properly trained physicians.
The AAP has not strayed from their message that the decision is to be made by parents only. Yet the Academys endorsement of infant male circumcision as a minimally invasive prophylactic medical procedure offering potentially major health benefits makes it alignedand unapologetically sowith a growing body of other formidable organizations, including the World Health Organization and UNAIDS.
In my editorial at Discover, I concurred with the AAPs scientifically updated view. Sullivan read my piece and, in a post he chose to label with the deliberately rabble-rousing title, Attacking Sexual Pleasure at Birth, he cited dubious survey data suggesting negligible sexual problems in circumcised adult males, then wrote this:
Jesse Bering thinks parents should follow the American Academy of Pediatrics's recommendation on male genital mutilation. Yes, I have seen someone slowly succumb to AIDS and it wasn't because they were uncircumcized. It was because we had no treatments for it. The 60 percent number is from female-to-male transmission in Africa - with very very limited application in the US. It's rare to read a gay man who still echoes the HIV-phobia of the 1980s - but Bering's irrational panic is pretty glaring. And the notion that in order to prevent infection via a body part, you just remove that body part after birth is equally bizarre. Can you imagine forcible prophylactic mastectomies to prevent breast cancer? This whole thing is madness. Mutilation of any part of an infant's body should only be for vital immediate health dangers, not nebulous future threats, which the person could choose for himself later, if he so wanted. It's only the foreskin and the clitoris that can be treated this way - and rational people defend the barbaric. And by the way, why doesn't Bering demand his unmutilated partner to remove his own foreskin to lower the chance of HIV infection? Because this kind of barbarism could only be done to infants and be defensible.
Theres so much propaganda stuffed into Sullivans commentary that Im not entirely sure where to begin. I should point out, before going any further, that my first choice in addressing this would have been to reconcile our differences privately. Having just finished a series of fun interviews for his Dish blog at the Daily Beast, I thought that Sullivan would at least respond to my friendly email about his rather personal post. Even a well, lets just agree to disagree quick exchange would have gone far. But I heard only steely silence. My participation in the Ask Jesse Bering Anything video series was by his invitation, so if he feels so strongly about infant male circumcision, Id have thought hed have been aware of what I wrote on this subject two years ago (its been up at Scientific American all this time, after all). My Discover piece doesnt waver from that earlier position; its merely a reiteration of my personal opinion that, knowing what we do now, and with a rationale no longer linked to indefensible, archaic religious customs, infant male circumcision isto methe more humane choice for parents facing this hard decision. Anyway, what I write below is the result of Sullivans revealing muteness. Its not the way that Id have preferred this go.
With that in mind, what on earth does my being gayour being gayhave to do with anything at all? It certainly doesnt affect my ability to critically evaluate cumulative, peer-reviewed studies conducted by leading specialists in their fields. Or would Sullivan prefer I do as he does, which is to skim cherry-picked abstracts through his confirmation-biased lens, something that, contrary to unfounded accusations levelled against them, the AAP did not do? Or perhaps like Sullivan, I should swallow whole the angry, emotionally flooded baby-harming message that litters intactivist websites, blog comments and Twitter feeds, all while brazenly turning a deaf ear to the measured andmore importantlyknowledgeable advice of world-renowned bioethicists serving at their own peril (given the vitriol of those like him regarding this subject) on expert panels working for the public good, and which are governed by the admirable, if impossible, goal of balancing ethics and objectivity?
Does Sullivan believe that, because Im gay, I shouldnt be concerned whatsoever about HIV/AIDS in heterosexual males, but rather only in gay males like us? That this is their problem and not our problem? Thats quite a limited style of humanitarianism, if so. He also apparently hasnt read some of the latest research indicating that male circumcision may reduce the likelihood of HIV acquisition in insertive-only gay males (tops) similar to straight males engaging in penile-vaginal sex. Or is Sullivan saying that because there are effective treatments for HIV now, any fear of HIV in the gay male community today must therefore be panicky and irrational? My own fears are entirely irrelevant to the arguments that I made, but in fact Sullivan is right that, while it may no longer be the 1980s, Im still scared shitless by HIV. Ive written about my relationship with AIDS before, and my paranoia is something, admittedly, Ill probably never escape entirely. But I'm also a Type I diabetic on a writers salary, already paying a small fortune (one that exceeds my mortgage payments) for private health insurance just to keep myself alive with insulin and other basic medical supplies. Both of my parents had heritable forms of cancer at young ages, and that places me at heightened risk of other life-threatening illnesses. Adding HIV into the mlange of my worries is, indeed, scary as hell to me. Sullivan ought to do a little navel-gazing before traipsing any further into his furyhe is exceedingly fortunate to survive as an HIV-positive Brit in the US with employee-provided healthcare.
The circumcision debate is not my cause clbre. I'm just a science writer who was asked to weigh in on the AAP decision in an editorial. Yet I confess, this whole issue really is starting to perturb. The righteous indignation of those who casually employ such mutilation rhetoric should be turned right back against them by those of us who are, in fact, circumcised males and do not appreciate being called mutilated or made to feel as if we are inferior or less desirable as sexual partners simply because we lack a foreskin. Likewise, women (or men) in healthy, positive sexual relationships with circumcised men should really be speaking up more loudly on behalf of their partners.
Sure, there are circumcised men out there who wish they still had their foreskin. There are people who have issues with everything when it comes to bodily issues. There are also plenty of men who have suffered from god-awful infections and only wish today that their parents had them circumcised as infants. The vast, vast majority of circumcised men who had the procedure done in infancy feel neither violated nor mutilated. To say that its the least of our worries is a monumental understatement. We have zero complaints about our sexual function, we are by no means jealous of men with foreskin (and smegma), and we feel absolutely no shame about our circumcised penises, in spite of the fact that the intactivists (an aggressively vocal minority that is, incidentally, overwhelmingly comprised of women and non-circumcised men who have no insight whatsoever into what its like to be a man who had his foreskin removed during a developmental stage that guarantees he has no memory of it) have made it their mission in life to convince us that we should be.
Not everyone sees infant male circumcision as an important issue for our collective conscience to be grappling with. Nor do most conceptualize it as genital mutilation, least of all those of us who have actually been circumcised as infants and should arguably be the ones deciding whether what was done to us deserves to be classified as a human rights violation. Even if you insist on casting it in this light, parents today who opt for circumcision are saving their sons from having to decide as adult males, with adult male genitalia (and thus with much more elaborated, intricate veinal and nerve systems in their reproductive organs), whether or not to undergo a qualitatively more complicated and expensive medical procedure as a consenting adult.
Sullivan trots out the standard intactivist party line, which is to compare infant male circumcision with the removal of some critical body part as a pre-emptive measure. Can you imagine forcible prophylactic mastectomies to prevent breast cancer? he writes, astounded by my and the AAPs stupidity. Notice how intactivists like to sneak in loaded words like forcible to trump up the false horror. Nobody is forcing parents to circumcise their infant sons. I've stressed repeatedly that I am not pro-circumcision but pro-parent choice," and the AAP has emphasized the same. Sullivan would have you believe that male circumcision is now occurring by government decree. We can play runaround mind games all day long about parents being okay with the removal of some body parts in our culture and not others. Perhaps Im just not tapped in, but Ive certainly not seen any activist communities take on the cause of prophylactic wisdom tooth removal in adolescents, or better yet, the non-health related extraction of fully functional teeth to make way for braces and create an aesthetically pleasing smile. Like foreskin, permanent teeth are permanently removed. And guess what, also like foreskin, while the risk of complications is present for any invasive procedure, their judicious removal doesn't really make much, if any, difference for the individual's quality of life either.
But heres why Sullivans little thought experiment really had steam coming out of my ears. When I was in elementary school, my mother had a double mastectomyone breast contained a malignant tumor that had already metastasized to her lymph nodes and the other breast harbored a precancerous growth that may or may not have done the same, and so she followed the surgeons advice to have that one removed a few months later as a preventative measure, which was not an easy decision. She endured years of chemotherapy, and I have clear memories of clumps of her hair falling out in my hands while she vomited her guts out over the toilet. This was followed by the brand new trauma of deciding to undergo breast reconstruction surgeryshe was still a young woman, after allwith areolas formed by skin grafts from her inner thighs. (She died of a different cancer several years later.) For Sullivan to so breezily liken my complete non-issue of being circumcised as an infant to my mothers devastating experiences in her mid-thirties with prophylatic mastectomy is the height of an emotionally addled arrogance masquerading as obvious logic.
Furthermore, infant male circumcision is not, as Sullivan would have you believe, the moral equivalent of female clitoridectomy. That analogy would only apply if, say, circumcision meant the removal of the actual glans penis (the head) and if it were done not in the best health interest of the child, but instead to eliminate his capacity for any future sexual pleasure. So to compare removal of the male foreskin with that hideous practice of clipping off the clitoris is, at best, a show of remarkable naivet regarding human reproductive anatomy. At worst, it is patent dishonesty by a rhetorician that is designed to exploit the emotions of more ignorant others. Ill let you decide which of the two Sullivan is guilty of in juxtaposing foreskin with clitoris.
Even minor diminution of sexual pleasure is far from being an obvious result of male circumcision. Until some clever cognitive scientist comes up with a way to operationally define the subjective degree of mind-blowing sensitivity often claimed to be experienced by uncircumcised intactivist men, above and beyond that felt routinely by lifelong circumcised males, I remain thoroughly unimpressed by this particular argument. In fact, the limited data that do exist on this subject dispute such a claim. A thermal imagining study conducted in 2007 revealed no difference between the sensitivity of circumcised and uncircumcised erect penises in males between the ages of 18 and 45. In fact, this alleged difference in pleasure-qualia also fails to find much anatomical support. In a systematic critique of anti-circumcision arguments currently in press at the Journal of Law and Medicine, Richard Wamai and colleagues write that, Of all glabrous (hairless) regions of the body, the foreskin has the lowest number and least sophisticated Meissners corpuscles (touch receptors). More important, though, is the fact that sexual sensations are mediated by genital corpuscles, not Meissners corpuscles, and these are absent from the foreskin.
I dont need someone else to tell me what I should be outraged by, Sullivan, thank you very much. Its certainly not going to be in response to already stressed-out parents acting sensibly as their childs health advocate and appealing to the ethical directives of professionals, rather than online blowhards who think that repeatedly referring to an act with an amygdala-fuelled term like mutilation makes it so. If you want your child to be at an increased risk of urinary tract infections, herpes, genital ulcers, HPV and HIV, thats entirely your choice, and feel free to celebrate with other science-denialists sharing similarly misplaced passions. But spare me your righteous indignation over those parents today that fail to see their benevolent, educated decision to circumsize their infant sons as an attack on their sexual pleasure at birth.
Delivering upon new parents such a guilt trip is simply loathsome.