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     INFORMATIVE VIDEOS: 
    
Facing Circumcision  Eight Physicians Tell Their Stories
     Restoration in Focus  
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     They Cut Babies, Don't They?  
One Man's Struggle Against Circumcision
     Whose Body, Whose Rights?   Award-winning documentary seen on PBS!

THE BOOK THAT EXPOSES IT ALL: 
    
Circumcision Exposed
Rethinking a Medical and
Cultural Tradition

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Male Genital Mutilation (Circumcision)
A Feminist Study of a Muted Gender Issue

Seham Abd el Salam ©
Cairo, June 1999
B.Sc in Medicine, Graduate Diploma in Medicine, Graduate Diploma in Art Criticism,
MA Anthropology

Post masters Fellowship Research - Supervisor: Professor Cynthia Nelson
American University in Cairo, School of Humanities,
Sociology, Anthropology, Psychology and Egyptology Department

English Version translated by: Azza Ali (Ph. D) and Seham Abd el Salam

Back to Table of Contents


Conclusion

I) Circumcision: a general overview

Male circumcision has various socio-cultural significances and it had been practiced by different human communities before the appearance of monotheistic religions (Hastings, 1980; Abu Sahlieh, 1999). It is a tradition based on Animist rites. However, many Muslim and Jewish clergy consider circumcision as a rite of their religions as well. At the level of social interpretation, infant male Jewish circumcision could be an alternative for human sacrifice of the first born son; while Arab, African, and Australian adolescent male circumcision could be a rite of passage from childhood to manhood.

...male circumcision is mentioned in neither Qur'an nor Gospels.

Unlike the Bible, male circumcision is mentioned in neither Qur'an nor Gospels. The obligatory requirement of male circumcision by Judaism could be explained by the fact that Judaism represents a closed tribal community with primary social organization that depends on mechanical solidarity. In such social organization similarity is mandatory, and any deviation from similarity is severely punished (Durkheim, 1893). This explains the Biblical threat to cut the soul of any uncircumcised male from his people On the other hand, Christianity and Islam represent more open social organizations, which are nearer to the Durkheiman model of organic solidarity, where differences are more tolerated. Moreover, the Deity in Islam and Christianity takes a more sublime image that does not require human blood sacrifice.

In modern times, some Jewish doctors could introduce male circumcision to the modern medical practice in Victorian England on the assumption that it can prevent masturbation. The practice spread from there to the medical institutions in other English-speaking countries and colonies (Wallerstein, 1980, Hodges 1995). Hence, male circumcision became part of the modern Egyptian medical study and practice. Moreover, modern medical sciences and some medieval medical practices coexist in Egypt. Some barbers are officially licensed to perform male circumcision, bloodletting, leeching, and other minor surgeries, which are known historically as Prophetic medicine (Al Tib Al Nabawy). Peter Gran argues that such practices originated initially in Jewish medicine (Gran 1979). Thus, both old traditional, and modern western beliefs cooperated to establish male circumcision as a surgery that is willingly demanded by people and supplied by surgeons.

This gliding movement is the natural mechanism
of sexual pleasure in human males.
Otherwise, sex is performed by a frictional movement,
which is less satisfactory to both partners.

The exact anatomy, histology, and physiological sexual function of the male prepuce were ignored till the 1990s, when they were studied and described by the Canadian doctor John Taylor (Taylor 1996). Unlike the widely prevalent belief among circumcision proponents that the prepuce is just a piece of skin, which is not as significant as the head of the penis, it was proved that it is a highly specialized tissue. It contains sensory receptors of light touch, which are lacking in the head of the penis. It was thought that the only function of the prepuce is its being a protective cover to the head of the penis. But more recent research argue that protection is a mutual function between the prepuce and the head of the penis, where the latter provides shape to the former, and facilitates its gliding movement during coitus (see appendix 3). This gliding movement is the natural mechanism of sexual pleasure in human males. It stimulates the specific sense receptors of the inner layer of the prepuce to generate a pleasurable sensation. Otherwise, sex is performed by a frictional movement, which is less satisfactory to both partners. The situation is made more difficult by the lack of the natural male lubricant, which is normally produced by specific glands in the prepuce (Taylor 1996, Bigelow 1992). There were also some earlier studies on the prepuce (Deibert, 1933; Wright, 1970). Such studies proved that the prepuce is an integral part of the normal male genitalia. Nevertheless, Egyptian medical texts do not mention any of its useful functions. Given the above-mentioned information, circumcision is a deliberate amputation of a healthy part of another non-consenting person’s body. It is an amputation that is performed on helpless children according to cultural pressures (Zoske 1998). According to Denniston (1997), mutilation is any injury that results in removal or alteration of the appearance or function of a body part. Thus, male circumcision, which has similar cultural, social, and biological bases as female circumcision, could be considered genital mutilation.

II) Circumcision: for whose interest?

...they circumcised them because they were afraid to obey reason
and challenge a conservative tradition.

Respondents who are parents of male children did not think that they gain any personal benefit by circumcising their sons. They suffered because of their children’s sufferings. However, they circumcised them because they were afraid to obey reason and challenge a conservative tradition. Acting like this, these intellectual respondents who used to lecture against FGM on "rational basis" behaved exactly like grassroots people who circumcise their daughters. Analysis of the respondents’ experience with their own and sons’ circumcision revealed that it is not in the child’s best interest. They reported memories of bleeding, stress, pain, urinary tract infection, and behavioral changes after male circumcision. Even the only respondent who could trespass the shock of his circumcision because he got a lot of psychological support and social compensation during and after his ritual circumcision ceremony said that other boys who were circumcised along with him were really shocked in spite of the supporting ceremony. Some of his peers resisted, tried to escape, and expressed verbal and non-verbal protest against circumcision. 

Male and female circumcision do not serve men, women, or children
as social categories. It rather serves the persistence of
patriarchal gender power balance...

So, male and female circumcision do not serve men, women, or children as social categories. It rather serves the persistence of patriarchal gender power balance that presupposes a peculiar symbolic formation of the body to establish a clear gender differentiation. Accordingly, circumcision removes the delicate, protective, and sensitive (all feminine characteristics) part from the male genitalia; and the strong, hard, active (all masculine characteristics) part from the female genitalia. Because circumcision results into useless unnecessary pain and harm for the individual, it is not a health procedure. It is a practice with symbolic and political nature. Its hygienic justifications are nothing but a tool to put such social body politics into action.

In addition to its role in gender power politics, circumcision establishes hierarchical power relationships at different levels of social organization. It encourages conformity to old traditions for no other reason apart from their antiquity, discourages taking any initiative towards change, and requires repression of any sympathy with individual sufferings if such sympathy challenges a tradition. Thus, continuation of circumcision establishes a model of behavior characterized by absolute submission to the orders of seniors and an inclination to keep the status quo. This model is publicly known as "abd el ma’mour", i.e. the slave of the major. This model conflicts with some key social roles of the intellectuals. Intellectuals have to use updated knowledge for ongoing revision and development of theories and practice in order to develop a better future for their communities. The intellectual respondents whom I interviewed stated that they act against FGM because modern medical and social sciences told them that it hinders women’s development, and consequently social development. This attitude is correct. However, to be consistent, the same approach should be adopted in all social issues. Nevertheless, intellectuals are not a homogeneous entity, neither are they separate from all other social groups. 

The same approach is needed to break the silence
around male circumcision. 

So, as part of the community, intellectuals are aware of the predominant social biases. I think that they need wide discussion of their own biases before they can really assimilate new knowledge instead of their older beliefs. This process took place in the issue of FGM in Egypt. The barrier of silence was broken by persistent social interaction about the issue. Men and women were encouraged to exchange experiences and points of views on FGM. Researchers contributed in the process by their field studies and situation analyses. The same approach is needed to break the silence around male circumcision. Men need to be encouraged to express their experiences, biases and feelings, with all due respect to whatever they express. The data given by men need to be analyzed, so that they can be provided by different interpretations for their biases. When this happens, it will enhance the adoption of a consistent intellectual and humane attitude towards MGM, exactly as it happened with FGM. Moreover, it will enhance the settlement of a comprehensive vision for gender issues. Social construction of femininity and masculinity is the focus of gender politics. Moving towards more egalitarian gender power politics will improve the social conditions of men and women. This will be impossible with addressing social construction of femininity alone.

III) Medical doctors and male circumcision

Physicians consider the sexual and excretory organs as dirty body parts. Such medical bias plays a role in the continuation of MGM. Society considers medical doctors as knowledgeable people who give health care. Moreover, getting doctors’ services requires a sort of financial ability. Wealth and education are positive social attributes. Thus, community members who seek medical doctors’ services and obey their instructions (or rather their biases) are considered well-to-do and educated persons. On the other hand, retention of the prepuce is considered as a mark of ignorance, negligence, and poverty; because medical doctors disdain it. Nevertheless, other body parts, like the mouth, are known to be dirty according to objective bacteriological criteria. Even one of my medical professors used to tell us that the mouth is dirtier than the anus. However, no doctor will rush to cut parts of the mouth or extract teeth as a "preventive" measure. In these two examples (the mouth and the male genitalia) medical doctors behave according to their social biases not to their scientific knowledge. Analysis of the body parts that are either excised by doctors for "prevention" of diseases, or are thought by some of them as "useless" (like Dr. Afkar’s beliefs towards the toes) reveal a relationship between the doctors’ and the traditional cultural biases towards the same body parts. For example, a social researcher in North Africa found bias against the uvula (the projecting tissue between the tonsils), and that barbers used to excise it from children’s throats as a traditional ritual surgery (Prual 1994). The modern medical analogue to this practice is "preventive tonsillectomy" that prevailed in medical practice for a long time, till studies proved the relevance of the tonsils as part of the immune system. Dr. Afkar’s thoughts about the toes could be a theoretical analogue to the tradition of foot binding which was practiced in China on girl children. The practice ended when the Chinese people broke the silence around it. There is even a study that found a link between Chinese foot binding and African infibulation (Mackie 1996).

The fact that medical doctors still perform male circumcision indicates the need for more elaborate social studies about the relationship between the traditional cultural biases and the professional medical practices. In the chapter that describes the respondents’ experience with male circumcision, we find many indicators that signify that medical doctors handle circumcision as a traditional ritual wounding rather than as a scientific surgery. Contemporary society assumes that doctors should provide people with healing and preventive services that are based on the most updated medical science. In this respect, taking science as a reference serves the community’s best interests. That is why doctors should not take traditions as their point of reference when they conflict with physical integrity and psychological welfare. Hence, they should stop performing circumcision. When circumcision is tested according to the criteria of modern science, we find that it is a surgery in search of a justification. For the last one and half centuries, medical doctors changed their justification for male and female circumcision from treatment to prevention. Similarly, they always changed its indication to fit the most feared disease of the time. So, they first recommended circumcision to treat and prevent masturbation, then venereal diseases, then cancer, to end with AIDS.

Prevention and treatment of masturbation was the first justification to be invalidated by research. Accordingly, medical doctors stopped performing FGM. Although venereal diseases, cancer, and AIDS were equally invalidated by medical research as justifications for male circumcision, doctors continued to perform MGM, and justify it by the need to conform to the dominant social traditions.

Medical practice in the third millennium should follow
more updated scientific and ethical models.

It is time for the medical profession to trespass the last centuries’ models of handling the human body, which are described by Foucault in his book The Birth of the Clinic (Foucault 1975). Medical practice in the third millennium should follow more updated scientific and ethical models. I think that breaking the barrier of silence around MGM will raise a wide debate among medical doctors about this issue, exactly as it happened with FGM. Such a debate would attract the most enlightened and scientific minded doctors to the new model, which would encourage them to stick to the first principle of the medical ethics "first, do no harm." Surgery should be the last resort in any medical plan for treatment of sick persons, and it should never be performed on healthy persons. Ethically and scientifically speaking, there is nothing called "preventive surgery." Doctors will change their attitude towards MGM when they start to recognize that it is not appropriate to repeat the ideas of a minority of Victorian doctors, who ignored that circumcision removes the most sensitive part of the penis, and interferes with the natural mechanism of sexual satisfaction (see appendix 3). The Victorian doctors’ ideas pre-dated the British occupation of Egypt. Now, with Egypt’s liberation, is it not high time for the minds of Egyptian doctors to be liberated too?

Revision of the medical institution’s attitude should include medical education as well as medical practice; because it is important to disseminate the most updated information to medical students and young doctors, as well as to the public. Moreover, criticism of the traditional cultural biases, bearing in mind the modern information should be encouraged, with the health interests of the children in focus. This criticism should take place through ongoing medical education. With the great evolution of scientific discoveries in our time, education is no more a close-ended process "khatm el ilm." Doctors should not consider what they studied to fulfill the requirements of their degrees as a perpetual given. All of the medical tools, whether they are pills or scalpels, are double-edged weapons. Various users use weapons differently. Criminals use weapons to serve their personal interests; executors use weapons to serve legal sentences; and medical doctors use weapons to heal people’s sicknesses. Thus, it is doctors’ duty to use their tools according to the most updated medical knowledge, not to their own cultural biases.

The medical institution is also responsible for translation of medical knowledge and making it available to the public. Scientific writings are not similar to artistic ones. For example, novels, paintings, or symphonies will always have the same significance to the audience. This is not the case with theories of science, because unlike products of art, they develop and change with time. That is why scientific writings should not be translated once and for all. The latest edition of any medical text should be consulted before publishing a new edition of its translated version. Without this necessary precaution, re-printing of old medical theories will turn into a tool for deceiving the public instead of enlightening and upgrading their awareness.

IV) Feminist intellectuals and MGM

Feminism...is for building new and fairer social politics
for both genders, especially children.

After she knew the new information about anatomy and physiology of the male prepuce, Dr. Salma stated that she felt like bursting into tears, and that such information should not be concealed from men, who have every right to know it. This is a consistent feminist attitude. Women suffered for a long time from patriarchal social obstacles that hindered their acquisition of knowledge, which may help them to improve their status (Smith 1987). Women will not gain more benefits or empowerment by playing the same unfair role with the assumption that men are the primary beneficiaries from the new information about their bodies’ anatomy and physiology. Feminism is not for women only. It is for building new and fairer social politics for both genders, especially children. Now, with the defeat of the false hygienic justifications for male circumcision, its ugly and unfair face is revealed: a blood and flesh sacrifice presented to the patriarchal society.

Women will also benefit from defending male children’s rights. 

The results of the study show that women intellectuals are currently more ready than men intellectuals to launch the issue of MGM. They are more ready to accept change and stop circumcising their own sons, or advising others against male circumcision. Women will also benefit from defending male children’s rights. When women acknowledge that gender issues include men’s rights as well, more open-minded men will support women’s rights.

(W)omen are recommended to take the initiative to encourage men
to break the barrier of silence about MGM, to support them,
and be understandable when some of them show resistance or denial.

Of course, that does not mean that women should dominate the advocacy against MGM. It rather means that women are recommended to take the initiative to encourage men to break the barrier of silence about MGM, to support them, and be understandable when some of them show resistance or denial. Bringing an end to the silence that surrounded such a taboo issue for thousands of years needs patience and persistent efforts to move MGM from the arena of political and ideological conflict to that of the right of bodily integrity for all as a basic human right.

Women’s defense of men’s right to bodily integrity and their work against MGM will not have a negative impact on their struggle against FGM. On the contrary, work against MGM will defeat the argument that is used by some doctors that they can perform a sort of FGM analogous to male circumcision, on the assumption that the later is a simple "beautification" and non-harmful procedure.

When women revise their attitude from the issues of other weak social categories they will win a lot. First, they will win the direct personal benefit of protecting their own children from a useless, hazardous, and maybe fatal injury. Second, they will get a general benefit, because their new attitude will prove that the women’s rights movement is useful to women, men, and the society as a whole.

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