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Nursing Times/London, p. 12-13, February 19, 1997
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Male circumcision is coming under increased criticism from people both within and outside health care. Rodney Porter looks at the issues and talks to nurses campaigning against the operation.
By popular demand, Bradford Royal Infirmary has just extended its religious circumcision service to neighbouring communities in Yorkshire. The hospital, part of Bradford Hospitals NHS Trust, started carrying out the operations last year. Five nurses have been trained to perform them and parents pay £65.
|The trust's assistant chief nurse, Pat Inglis, says that the trust was
asked to provide a safe and sensitive service in response to local need. She declined,
however, to comment on the ethical implications of the operation.
In January, the Department of Health asked Bradford Community Health's Race and Health Unit to audit male religious circumcision services in order to develop national guidelines. The practice, however, has been coming under increasing criticism, both from nurses and from some members of those religious communities, which advocate it. It is mainly done for religious reasons.
According to NHS-funded Health Information Service, the only medical indication is when the foreskin is tight, causing ballooning or recurring infection.
Circumcision pressure groups originated in the USA. One of the key figures and founder of the National Organization of Circumcision Information Resource Centers is Marilyn Milos, a registered nurse based in San Anselmo, California.
most important reason that babies should not be circumcised
is that it violates their right to their own bodies."
Ms. Milos claims that when the campaign started in 1984, 90% of infants were being circumcised. Within 10 years that figure had fallen to 59%. She wants to see an end to circumcising infants because, she says, it carries inherent risks, including haemorrhage, infection and surgical problems, as well as psychological damage.
"The most important reason that babies should not be circumcised is that it violates their right to their own bodies," says Milos. She adds that this is supported by the Universal Declaration of Human Rights and the UN Convention on the Rights of the Child.
"I was fired in 1985 for telling parents the truth about circumcision, for telling them what I wished someone had told me," she says. She battled successfully for nurses at another hospital to be allowed to refuse to take part. "The problem for anyone challenging a traditional cultural practice, even from within the community, is that at first the idea id rejected because it challenges the status quo," she adds.
Support has come from around the world and the National Organization of Circumcision Information Resource Centers now has offices in England and Northern Ireland, as well as Canada, France, Australia, Italy, Switzerland, Tahiti and South Africa.
Betty Katz-Sperlich is a Jewish woman living in New Mexico, USA. A registered nurse, she is co-founder of Nurses for the Rights of the Child. She refused to circumcise her son, now aged 13. Ms. Sperlich used to assist in male circumcisions. "I would dread the doctor announcing a circumcision. I used to hide if I knew it was coming."
"I've been called
anti-Semitic by non-Jewish people. But as a Jew, how could I not
speak up against Jewish circumcision? I would be letting Jewish babies down."
She says she was driven to help set up NRC by "the torture and violence" of what she was doing. Founded in 1995, it now has 25 members, three of whom are Jewish. "I've been called anti-Semitic by non-Jewish people. We are touching a deep nerve," she says. "But as a Jew, how could I not speak up against Jewish circumcision? I would be letting Jewish babies down."
Jenny Goodman, from north London, also refused to circumcise her son. She is a doctor and a psychotherapist as well as a Jewish feminist. "I know at least a dozen non-circumcised boys whose parents are identified as Jews," she says. She adamantly opposes circumcision, claiming that it is physically and psychologically damaging to the child and violates human rights: "It also violates the most important of medical ethics, above all do no harm."
Opposition to male circumcision in the UK had its first big breakthrough 18 months ago with the controversial Channel 4 documentary It's a Boy!, by Jewish director Victor Schonfeld. It slammed the practice of Jewish circumcision as unnecessary and barbaric, with potentially horrific consequences. Mr. Schonfeld claims that public consensus against it in the UK is growing.
In 1994 the RCN published its condemnation of female circumcision, Female Genital Mutilation: The Unspoken Issue. Female circumcision was made illegal in 1985 in the UK and from March 1997 will be outlawed in America. Now the RCN's Men's Health Forum is working with the Royal College of Surgeons and the Royal Society of Paediatrics and Child Health to set up guidelines for male circumcision. Forum secretary Glen Turp refers nurses who have a problem with cases of circumcision to Clause 8 of the UKCC Code of Conduct, which covers conscientious objection.
Mohammed Mossadaq is project manager of Bradford Community Health's Race and Health Unit. He believes that the operation can be beneficial and cites research carried out in India in 1982-90 that found that male circumcision reduced the risk of cervical and penile cancers. However, according to the American Cancer Society: "Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate."
Mr. Mossadaq says he is aware of the reported dangers of circumcision, but argues that offering the operation through the NHS makes it safer, especially as the procedure would carry on in the community regardless. "Far be it for me to tell people what their religious beliefs should be," Mr. Mossadaq says. "Circumcision is part of spiritual, emotional and psychological health."
On the Receiving End
David West (not his real name) was admitted to hospital to be circumcised on the day before his ninth birthday. The reason given was balanitis, or inflammation. Now in his thirties, he attributes many physical and psychological problems to the operation, which he claims was unnecessary. "I had difficulty peeing. It reached the stage where it was just a dribble and became very painful," he recalls. He was prescribed antibiotics and the problem cleared up. Mr. West remembers a GP saying circumcision would prevent it happening again, especially as his foreskin was non-retractable. "But the foreskin is non-retractable in most young boys," Mr. West says.
"When I woke up, the first thing I saw was that my penis was grossly disfigured. This is how I've felt every morning since," he added. He believes he experienced something akin to post traumatic stress disorder and resent that he was unable to give informed consent. He says he has itchy scar tissue and that his glans is so insensitive that he can only reach orgasm by masturbating. He is also frightened of intimacy because he feels embarrassed by the sight of his circumcised penis.
Twenty five years after the operation Mr. West met John Warren, a general physician in Harlow, Essex, and the founder of the support group NORM UK (National Organization of Restoring Men). Dr. Warren has been advising Mr. West in skin-stretching techniques to restore the foreskin. Dr. Warren says about 6% of male infants are circumcised in the UK, compared to 1% in the rest of Europe.
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