April 3, 2013
The AAP gets letters
The American Academy of Pediatrics' journal, Pediatrics, has published three eletters opposing its Circumcision Task Force's reply to the 38 senior European critics of its 2012 policy statement. But it has published them in two different places.
This one is at "published letters"
Smoke and Mirrors
Christopher L. Guest, Co-Founder
Children's Health and Human Rights Partnership
Children's Health and Human Rights Partnership
In response to concerns raised by Frisch et al, the task force seems reluctant to concede any meaningful sensory function to the human prepuce whatsoever. It is astonishing that members of the task force are able to appreciate that the prepuce is richly innervated and contains Meissner's corpuscles, but they are "unable to speculate about the effect that circumcision might have on sexual function or pleasure." Surely the task force recognizes the obstinate relationship that exists between structure and function. Structure predicts function. Function is constrained by structure.
Histologic studies indicate that the prepuce is richly innervated and contains specialized corpuscular neuroreceptors. During erection, the prepuce retracts and everts to expose the erogenous internal mucosa to external stimulation. Does this not seem like a structure whose function is, at least in some way, related to sexual pleasure? Is it reasonable to speculate that the prepuce is more likely related to sexual pleasure than say, the Achilles tendon?
If members of the task force are unwilling to consider the effect that circumcision might have on sexual pleasure, parents should ask themselves the following question: "Do I think removing richly innervated tissue from my child's genitals is more likely to INCREASE sexual pleasure or do I think removing richly innervated tissue from my child's genitals is more likely to DECREASE sexual pleasure?" It seems rather disingenuous for members of the task force not to speculate about the sensory function of the prepuce but at the same time sanction its amputation. The response to concerns raised by Frisch et al is deliberately evasive - smoke and mirrors!
Conflict of Interest:
None declared
This is published at "early"
A goldfish knows nothing about water
Hugh P. Young, Independent researcher
A goldfish knows nothing about water. The American Academy of Pediatrics Task Force on Circumcision is unaware of the peculiar circumcising culture in which it is immersed. For example, characters in American TV sitcoms may exhibit a casual vindictiveness toward the foreskin, or the man with one, that would cause widespread outrage if it involved race.1 American medical texts portray "normal" penises as circumcised, and may define the foreskin as "the part removed by circumcision".2
This unawareness permeates the Task Force's 2012 circumcision policy.3 Dr Frisch and 37 eminent European pediatricians, speaking for 22 pediatric associations, and for 17 countries from Iceland to Lithuania, have accurately pointed it out. The Task Force's reply amounts to "Tu quoque" ("You're another").
Those countries have "a clear bias against circumcision" the same way they have "a clear bias against parentally-elective infant toe amputation". They have no Task Forces on Leaving Boys' Genitals Alone.
The reply, like the policy itself, discounts the only study that actually attempted to measure the sensitivity of the foreskin itself, by ignoring its main, uncontested, finding: "male circumcision ablates the most sensitive part of the penis."4
The Task Force admits the role of the innervation of the foreskin in experiencing pain, but not pleasure. Frisch et al. do not need to "speculate" about it: they almost certainly have foreskins, or partners who have them. Human lips also "have nerve fibers". Whose first thought about those would be how to minimise the pain of lip-removal? Who needs proof that the nerves of the lips are intimately involved in the pleasure of kissing? To deny that a richly innervated structure, near the head of the penis, with a unique rolling action, is involved in sexual pleasure, is perverse. Impairing that pleasure was one of the purposes of circumcision, explicit for 1900 years until "medical" circumcision became customary and a generation had grown up that had never experienced sex unimpaired5
The Task Force now admits that the basic right to physical integrity is an important one, but it ignored that important basic right in its 2012 policy.
It contrasts the harm of being circumcised (without any measure of the worst of that harm, such as major complications and death) with a new, undocumented and unmeasured "harm of not being circumcised", but such harm could equally apply to failure to amputate any other less-than-vital body parts, such as the earlobes.
The Task Force offers no rebuttal to Frisch et al.'s substantive case, based on the AAP's own policy, that the diseases circumcision reduces (if the studies the Task Force cites are to be relied on) are so rare, or of such late onset, or so readily prevented or treated, that circumcising infants to prevent them is a bad option compared to letting the child grow up to decide the fate of his own genitals.
Its original claim that "the benefits outweigh the risks" was made with no actual weighing. It is now nowhere to be seen, and goes undefended.
References
1. Young, H. "That Thing": portrayal of the foreskin and circumcision in popular media, in "Human Rights Under Assault: The Atrocity of Circumcision" (Springer 2008), and online at the Intactivism Pages
2. Roberts, A. The Complete Human Body, DK Publishing (2010): Guyton, AC, Hall, JE. Textbook of Medical Physiology Saunders (2000): McCracken, TO ed. New Atlas of Human Anatomy MetroBooks (2001)
3. American Academy of Pediatrics Task Force on Circumcision. Male circumcision. Pediatrics. 2012;130(3).
4. Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007;99(4):864-869
5. Philo of Alexandria, Of the special laws, Book I (ii), in Works of Philo, trans. F. H. Colson, Loeb Classical Library, 1937, Vol. VII, p. 105
Conflict of Interest:
I edit the Intactivism Pages ("Circumstitions")
[A video version of this letter is on YouTube.]
This letter is published at both of the above sites:
Function follows form
Dennis C. Harrison, Independent researcher
The response of the AAP Task Force on Circumcision to the commentary by Frisch et al is marred by a lack of attention to detail and a disregard for elementary principles of biology. The Task Force asserts that "all of the commentary authors hail from Europe," when the affiliation of one of the authors, Noni MacDonald, MD, is listed as "Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada." A bit later the Task Force refers to the stance of "The Canadian Medical Society," a non-existent organization.
The authors dismiss four histological studies of the prepuce on the grounds that these studies "were not designed to correlate anatomic findings with physiologic or functional roles." It is true that the function of the prepuce has not been fully elucidated, but the link between form and function is an axiom of biology. It is reasonable to suppose that specialized sensory tissue at the business end of the penis serves a specific reproductive function. In the words of Sir James Spence, "nature is a possessive mistress, and whatever mistakes she makes about the structure of the less essential organs such as the brain and stomach, in which she is not much interested, you can be sure that she knows best about the genital organs..."[1]
1. Spence On Circumcision. Pediatrics 1965;35(2):220.
Conflict of Interest:
None declared
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