Neonatal Male Circumcision: Harmless Tradition or Child Abuse?

For the purposes of this blog post, I am defining ‘neonatal male circumcision’ as the ‘nonreligious tradition of surgically removing the foreskin from a male newborn baby’s penis as practiced in American hospitals’. Let me just say that I firmly believe that circumcising a male infant is wrong. Period. It’s really an issue of consent for me. The infant cannot consent to having a piece of their penis cut off. I really cannot think of any significant reason why infants should be circumcised. I think it’s just another way for medical practitioners to make a little money and just another tradition that most people follow without truly thinking of the their reasons for doing so. In this post, I am going to list three of the most common arguments for male circumcision that I have heard personally and then I will pick them apart. Enjoy.

Common Arguments for Neonatal Male Circumcision:

• Protection Against Future STIs

In their meta-analysis of multiple research studies, “How Does Male Circumcision Protect Against HIV Infection?,” Robert Szabo and Roger V. Short state that “…circumcised males are two to eight times less likely to become infected with HIV. Futhermore, circumcision also protects against other sexually transmitted infections, such as syphilis and gonorrhea…” (1593). HIV is thought to initially attach to CD4 and CCR5 receptors found in genital and rectal mucosa and much of these receptors are found in the foreskin of the penis. So the assertion that circumcision has the potential to act as protection against STIs is valid. However, there are confounds to this research. Most of the research that focuses on male circumcision and HIV are conducted in Africa with adult men. As Robert S. Van Howe asserts in his article, “A Cost-Utility Analysis of Neonatal Circumcision,” “The HIV pandemic in Africa demonstrates distinct epidemiological differences from the outbreaks in North America or Europe. For example, most infections in Europe and North America are transmitted by nonheteroexual means” (591). Stephen Moses et al agrees, “It has been pointed out that different sexual practices or hygienic behaviors can confound the association between circumcision status and HIV infection…different risks of becoming infected may be due to behavioral factors, not circumcision status” (369). In short, it would be inaccurate to take research conducted in Africa and try to apply it in America. The cultures, traditions and sexual practices differ. For example, in Africa, HIV is mostly transmitted though heterosexual PV intercourse. In contrast, MSM (men who have sex with men) are one of the main high-risk groups in the US. Also many of these studies conducted in Africa are with adult males who are already deeply embedded in a widespread HIV pandemic, not currently seen in the US. One major thing easily overlooked in this research is the role of condom-use. Although, in the studies conducted in Africa, condoms are readily available to the participants, it is admitted that most of the men “never used condoms, and condom use did not seem to influence the rate of transmission of HIV” (Szabo and Short 1592)”. Of course, condom-use did not influence the rate of HIV transmission. They were not being used! According to the CDC (Center for Disease Control and Prevention), “Laboratory studies have demonstrated that latex condoms provide an essentially impermeable barrier to particles the size of HIV... [and] particles the size of STD pathogens”. Condoms protect against HIV and other STIs. Is surgery really necessary? Those who support neonatal circumcision as a preventative mechanism against HIV in America are basically using the argument: ‘Circumcising a male infant will probably protect males from possible future transmission of STIs if your son decides to have unprotected sex’. Neonatal male circumcision costs, on average, between $200 and $400. Condoms are given out freely at any healthcare facility and college. How is it in any way preferable as a parent to spend at least $200 on a painful surgical procedure to protect your son from possible future STIs when the same protection could be given for much cheaper with a condom and a lesson in proper bodily and sexual hygiene? And, for that matter, how can one ever be certain that one act in infancy will really protect adult men against anything in the future? The individual has an entire life’s worth of behaviors to confound any kind of neonatal protection. And let me restate, the baby is being put through a painful procedure that they cannot consent to. If it is not ok to cut off a piece of an adult’s anatomy without their permission, why is doing it to an infant perfectly fine? If an adult male wants to be circumcised to lower his present risk for HIV by undergoing this procedure, than that’s fine. That’s his decision. However, putting a male infant through a painful (and costly) procedure that may or may not protect him for possible future STI transmission is sick in my opinion. Also there is a risk of complications, like accidental (further) mutilation of the genitals, infections and, rarely, death. The risks, at least in my opinion, outweigh the benefits of possible future protection.

• Aesthetics

People seem to be concerned about whether or not a penis is circumcised for aesthetic reasons, i.e. circumcised penises are believed to look better. Let me tell you a secret: All erect penises look the same. Problem solved. Cutting off part of your infant’s genitals just because you think they will be more sexually appealing in the future is disturbing. Please stop thinking the aesthetic appeal of your infant’s genitals.

• “Oh, they won’t feel/remember the pain.”

Really? Although at first glance, their status is questionable, newborns are definitely humans. Therefore, they have nerves and they can feel. In their article, “Circumcision Practice Patterns in the United States,” Howard J. Stang and Leonard W. Snellman reveal, “all too frequently, the physician performing the circumcision denies the infant the benefits of anesthesia because of inaccurate perceptions of the risks of anesthesia or denial that the procedure warrants such amelioration of pain” (3). The idea that infants are denied anesthesia just because it is assumed that they probably won’t feel the pain is troubling. And as for the belief that circumcision is ok because the infants will not remember the pain: So I can hurt anyone I want as long as they forget about it later?

Males should be allowed to make the decision of whether or not to be circumcised on their own when they are adults. At the point of adulthood, they will be able to assess their own risk for STIs and will make the decision of whether or not to be circumcised. In an area facing an HIV pandemic, like Africa, where condoms are simply not being used, than it is easy to see why circumcision could be a viable option for adult men who want to lower their risk while still having unprotected PV sex. However, in the United States, where condom-use is mostly encouraged and there is better access to sexual health education materials, neonatal circumcision is unnecessary. Also it is extremely interesting to compare Western views regarding male and female circumcision, also known as Female Genital Mutilation, (I’ll make a post about this at some point in the near future). Nearly everyone in the US will agree that FSM is wrong. Most people will say it’s a nonconsensual act that causes physical and psychological scarring to innocent young girls. However, these same people will argue that male circumcision is perfectly normal and safe ‘in the right hands’. So what’s the difference? At the end of the day, a child is still getting parts of their genitals chopped off without their consent. Is it just because it has become a tradition in Western society? And are parents being properly informed of the extent of the benefits and risks of circumcision? Doctors should inform them of current research and give them the information needed to make educated decisions. And parents should not take every single thing their doctor says as law. Do some research. Weigh the pros and cons and make an educated decision. An infant should not have to suffer just because of possible future STI transmission and shallow societal aesthetics.

A Quick Thought: The F-Up Agreement

So as I’m sure I’ve mentioned once or twice, I do psychology/sexuality research at an internship in NYC. In my internship, I work with and interview the participants in the studies. The other day, I called in one of my supervisors to do her part in the interview and, during her segment, she brought up something that I just have to share with you.

So the concept that my supervisor (let’s call her Sally) brought up is called, “The F-up Agreement”. This agreement applies to individuals in committed relationships who decide that they do not want to use protection (condoms, dental dams, etc) in their relationship anymore and want to become “fluid-bonded” (i.e. have sex without condoms, dental dams, etc). “The F-up Agreement” has two parts. Part one is the agreement that they won’t use protection in their relationship, but if and/or when they have sex with people outside of the relationship, they will use protection. Part two of the agreement states that if one partner “f’s up” and has sex outside of the relationship without protection, they can ask to use protection in the relationship with their primary partner(s) with no questions asked.

Now, I love this agreement. Sexuality researchers and therapists are realistic. As awesome as it would be for everyone to use protection all the time for the rest of their lives, we all know that’s not going to happen. And realistically, no one in a committed relationship wants to use protection for the rest of their lives. It’s understandable. I just want people to be as healthy and safe as possible and to understand/be aware of the risks. This theory is both realistic and risk-aware. One thing I’ve noticed over and over again in sexuality research is how hard it is for people to talk about safe sex and STIs in relationships, both committed and casual. Lots of assumptions are made, but, in many cases, no actual conversations are had. For instance, I know of one man who contracted HIV, but did not do intravenous drugs and was in one committed relationship for years. How did he get HIV? His partner had contracted HIV and never told him because the partner was afraid that he would leave him. It’s easy to judge the partner, but everyone who has been in sexual relationship knows how difficult and “unsexy” it is to bring up STIs. I think this agreement allows for sexual safety without the 'awkwardness' that everyone is afraid of. Now, I know “The F-up Agreement” involves a lot of trust and maturity. I’m sure the temptation to ask your partner exactly why they suddenly want to use protection would be very strong. However, you have to respect the fact that your partner cares enough about you that they would ask to use protection in the first place. And interrogating your partner would put a strain on the relationship and, if a “f-up” happens again in the future, the partner might not say anything anymore. This agreement is about the greater good of the relationship and the sexual health of everyone involved. It’s about trust and responsibility. And honestly, if you don’t trust someone enough to take care of their own sexual health and, indirectly, yours, then maybe you shouldn’t be in a relationship with them. Just a thought.

Sex Addiction Part 2

I recently had a mini-debate with someone in regards to whether or not the word “addiction” was an appropriate word to describe the phenomenon of “sex addiction”. In this section, I will discuss why I think “addiction” is not a suitable word, the other party’s counterargument and my following counterarguments. Please read "Sex Addiction Part 1” first. It explains what the phenomenon of “sex addiction” is, its relation to medicalization, how it reinforces sexual scripts and gender stereotypes, etc.

So I think a great way to start would be to define the word “addiction”. Now, when most people think of an addiction, they think about withdrawal symptoms and trying to quit and being unable to, but that’s not the whole story. Nick Heather, in his article, “A Conceptual Framework for Explaining Drug Addiction,” describes addiction in three parts: “(1) the level of neuroadaptation, (2) the level of desire for drugs and (3) the level of ‘akrasia’ or failures of resolve” (3). To clarify, an individual becomes addicted to a something when they resolve to stop, but fail many times, when they build up a tolerance and suffer from withdrawal symptoms upon trying to stop, and experience neuroadaption, which is when their brain changes permanently as a result of taking the drug. Common examples of permanent changes to the brain would be a decrease in dopamine production or a decrease in gray matter as a result of using the substance, that causes your body to need the substance in order to maintain a state of 'normal' (for lack of a better word at the moment) that non-substance users experience. My argument is that becoming “addicted” to sex is impossible because one cannot become addicted to behaviors. Behaviors do not cause neuroadaption and there has been no empirical evidence that the desire for lots of sex or having lots of sex causes physical changes in the brain. Two counterarguments I have seen for this were “Well, sex releases dopamine so can’t someone become addicted to that release?” and “I stopped having sex for a while and I suffered from withdrawal symptoms. I felt terrible.” To counter the first argument: Yes, sex results in a release in dopamine, many daily activities do. Dopamine is a neurotransmitter that is essential in learning and in making sure we continue to do things that are beneficial to our survival, like eating and having sex. Dopamine is related to feelings of pleasure and its release serves as a reward to the body for performing essential tasks so the individual will continue to do it in the future. However, the release of dopamine does not automatically result in addiction. The release of dopamine in the brain experienced through daily activities is a normal dosage that the body is naturally used to. However, the amount of dopamine released into the system when taking something like cocaine is well over and beyond the amount the body is used to. Cocaine inhibits the reuptake of dopamine, allowing the neurotransmitter to flood the brain. As a result of this unnatural flood of dopamine, the brain decides that it does not need to produce its own dopamine anymore. Now the brain is changed permanently and the user’s dopamine levels are below the norm without the drug. The individual no longer feels naturally rewarded without the drug. This is why many drug users say they need the drug to feel normal. In regards to the second argument, the difference between the experiences one might have after not having sex for awhile versus not taking a drug is that one can actually potentially die from the latter. In their article, “Myth of Sexual Compulsivity,” Martin P. Levine and Richard R. Trioden  agree with me stating: “First sex is not a form of addiction…Sex is an experience, not a substance. Although sexual experiences may be “mood altering,” abrupt withdrawal from sexual behavior does not lead to forms of physiological distress such as diarrhea, delirium, convulsions or death. Vomiting induced by fear of giving up a learned pattern for dealing with anxiety (such as having sex) is not the same thing as vomiting induced by physiological withdrawal from a physically addicting substance” (357). In light of these facts, the word “addiction” is not appropriate and the phenomenon does not fulfill all the necessary requirements to be referred to as such.

Moving away from the biological to more cultural/social perspectives, I want to discuss the main counterargument of the individual with whom I had the mini-debate with. His argument was that discounting the appropriateness of the disease model of addiction in regards to this phenomenon creates a stigma against those who suffer from it. He also specifically mentioned a moral stigma being directed to these individuals as well. My argument is that the term “sex addiction” and all of the connotations and meanings surrounding it create and reaffirm stigmas and stereotypes rather than erasing them. In “Sex Addiction Part 1,” I discussed how individuals who label themselves as ‘sex addicts’ tend to believe that medicalizing this phenomenon removes all the moral judgment and stigma that they otherwise might suffer as if medicine is somehow immune to social influences and morals. I further argued that this is not the case (see post for more). The diagnosis for “sex addiction” actually creates distinctions between “good” sexual behaviors/fantasies and “bad” sexual behaviors/fantasies. “Good” sexual behaviors/fantasies usually exist within the context of heterosexual sex in a heterosexual marriage or committed relationship. Anything else is usually labeled “bad”. Levine et al continues this train of thought, saying, “In addition, as conceptualized professionally, sexual addiction is currently the only type of ‘addiction’ in which the addict is not expected to give up [their] ‘drug’ of choice as a part of the ‘treatment’. As long as sex is ‘used’ in appropriate contexts (such as marriage, a committed relationship), the addict has been ‘cured’. Note that sexual expression is condoned when it occurs in the social contexts that affirm the traditional sexual order, but medicalized as an “addiction” when it falls outside existing norms” (357). Not only does “sex addiction” stigmatize certain sexual behaviors, but it also reaffirms gender stereotypes (see part 1). Another thing to think about is the connotations behind the word “addiction”. Calling this phenomenon/construction an addiction, even amongst lay people in daily life, is not beneficial to those who suffer from it. The word “addiction” is associated with drugs, especially hard drugs that have no real beneficial qualities, due in part to their addictive aspects. It can be implied from this comparison that sex is also inherently bad. We all know this isn’t the case. Sex is generally good. It’s just that when a person feels like that they HAVE to have sex all the time or find themselves constantly thinking about it and it causes them distress or inhibits other aspects of their life, sex becomes negative to them in that situation. In that specific case, the individual should go see a sex-positive therapist as I stated in Part 1. However, we should be careful of the words we use. Words are important. They hold ideas behind them and the words that become commonly used are extremely powerful and we should take care to use words that do not have serious negative effects on the issues we care so dearly about. The term “sex addiction” may be comforting to some on an individual level, but it strengthens societal anxieties about sex by painting different aspects of sexuality in a negative light.

A quick note (more of a P.S.): So I used to subscribe to the term “sexual compulsion” as a substitute for “sex addiction”. After doing the research for and thinking about this blog post, I realized that I was focusing too much on terminology without looking at the bigger picture. Although the term “sex compulsion” fixes the addiction definition issue, it is just as guilty for painting sex in a negative light. Now, I think that giving this phenomenon a special medical name individualizes it and ignores the social issues. I’d rather it not be named and believe that, in therapy, societal factors should be taken into account along with the person’s individual experiences.

Sex Addiction Part 1

This post is part one in a two-part post regarding sex addiction. This part will focus on the phenomenon of sex addiction, its presentation in men and women and how it influences/is influenced by societal norms. Part two will discuss terminology: whether or not the word “addiction” should be used to describe this phenomenon and discusses other terms that have been put forth by mental health professionals.

Ok so, what is sex addiction? According to Martin P. Levine and Richard R. Troiden, it is the phenomenon in which individuals “feel driven to engage frequently in nonnormative sex, often with destructive consequences for their intimate relationships (e.g. marriages) and occupational roles” (349). Diagnosed sex addicts report a sense of being unable to control their sexual behavior and fantasies and feel distress as a result. In my opinion, the phenomenon of sex addiction is another form of medicalization (See previous blog for an in-depth explanation of medicalization). Medicalization is the process in which various phenomena are perceived in the realm of the individual and as an appropriate area for medical and pharmaceutical intervention. In short, medicalization believes that any problem and solution is solely found within the individual person. I’m not a fan of medicalization because it tends give short-term (individual) solutions to long-term (societal) problems. Medicalization tends to believe that giving an individual a pill will solve all their problems without giving any consideration to the environment (societal and otherwise) the person lives in. According to Janice M. Irvine, in her article, “Reinventing Perversion: Sex Addiction and Cultural Anxieties,” many individuals label themselves as  “sex addicts” because “it has the alleged moral neutrality of disease; they feel relieved…to attribute their sexual problems to the disease of addiction” (433).  They believe the use of medical terms and medical intervention erases stigma and social judgment. However, medicine is not immune to cultural and social influences. For example, the first edition of The Diagnostic and Statistical Manual of Mental Disorders, published in 1952, “defined masturbation, fellatio, cunnilingus, homosexuality and sexual promiscuity as forms of mental illness” (Levine et al, 353). However, now, masturbation, oral sex and homosexuality are no longer seen as disorders. The boundaries of what is considered normal and abnormal changes within time and space. Levine agrees saying, “In any given society, sexual scripts provide the standards determining erotic control and normalcy. What one society regards as being sexually “out of control” or deviant, may or may not be viewed as such in another” (351). Medicine is just as susceptible to the changing whims of a given society as anything else. It is not immune and it is not objective, although it would love to be.

The socially constructed phenomenon of sex addiction is influenced by and strengthens sexual scripts and gender stereotypes as well as reinforces cultural anxieties about sex. Men who are diagnosed with sex addiction are said to “exhibit repetitive and extreme forms of behavior. Often they are prone to violence, or engage in fetishistic behavior” (Irvine, 446). These behaviors include “uncontrollable promiscuity, autoeroticism, transvestism, homosexuality, exhibitionism, voyeurism, fetishism, incest, child molestation and rape” (Levine et al, 349). In contrast, women who are diagnosed with sex addiction are said to engage in “frequent dangerous sexual encounters with strangers” (Levine et al, 350) in which they are either “risking victimization or using sex to feel vicariously powerful” (Irving, 446). Men are described as violent, yet powerful in a frenzied animalistic way as a result of uncontrollable lust. However, women are either helpless victims or as desperately trying to seize the power that only men have (Can anyone say Freud?). Irving declares “the concept of sex addiction is also antithetical to feminism in that it shapes ideas about ‘appropriate’ women’s sexuality into static imperatives” (449).  For something that is supposed to erase stigma, it affirms old ones: of men as animals and women as weak.

The concept of sex addiction also attacks sex as a behavior and as an identity/orientation. Many sex addiction self-help groups condemn “pornography, sex without love, and multiple partners” (Irving, 446). An individual is considered cured from their sex addiction when they are engaging in sexual behavior that is normative and condoned by mainstream society, i.e. heterosexual sex within the confines of heterosexual marriage or a committed relationship. Also individuals who participant in sexual behavior that is not considered normative (people who are polyamorous, not straight, and/or enjoy casual sex) are, by definition, labeled as disordered. It does make me wonder if the guilt and distress diagnosed sex addicts feel is, at least in part, linked to societal condemnation of their sexual behavior. Maybe if society were more accepting of non-normative sexual behaviors and fantasies, there be would be less guilt and distress?

Sex addiction is more than a term and much more than a “disease”. It is a powerful construction used to label people, to sway minds and to control the public. It individualizes societal issues and problems instead of solving them and reinforces gender stereotypes. That all being said, if someone feels that they are experiencing sexual urges that are causing them distress and impairs their daily functioning, then they should go see an open-minded, sex-positive therapist. Whether it results from negative societal views of sex or an individual issue or both can hopefully be determined with therapy.