|CALLING THE AMERICAN ACADEMY OF PEDIATRICS (AAP)
|by Georganne Chapin|
Just about a year ago, after an article published in the journal Pediatrics called for minimizing painful medical procedures in children, Intact America launched a petition. As of last week, more than 12,000 people had signed that petition, demanding that the AAP tell its member pediatricians to “End the Pain,” and stop circumcising baby boys.
The petition and our demand were further bolstered by an odd piece published in the April 2016 issue of that same journal, Pediatrics, by pediatric urologist Andrew Freedman. If his name sounds familiar to you, perhaps it’s because Freedman, in addition to being a member of the AAP’s Circumcision Task Force that in 2012 published the Academy’s revised policy on the subject of foreskin removal, made headlines by openly talking about circumcising his own son on his parents’ (the boy’s grandparents’) kitchen table.
Freedman’s April 2016 statement sought to “clarify” the meaning of the 2012 Report’s “benefits outweigh the risks” position. According to Freedman, the report wasn’t really talking about the medical benefits of forced foreskin removal from babies who cannot consent, but rather the overall benefits, “given the role of the phallus in our culture….” What’s important, he says, is that parents who choose circumcision for their boys should have “access” to the procedure, in the form of third-party (Medicaid or private insurance) payment (to doctors and hospitals, of course).
Clearly, there’s a lot more we could say here. But for now, we want to thank those of you who signed the petition and tell you that, together with the 12,160 signatures, it’s been forwarded to Dr. Karen Remley, Chief Executive Officer of the AAP. You can see my letter to Dr. Remley below. We will keep you posted on the AAP’s response.
March 2, 2017
Karen Remley, MD, MBA, MPH, FAAP
The American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Dear Dr. Remley:
A year ago, the American Academy of Pediatrics Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine published “Prevention and Management of Procedural Pain in the Neonate: An Update” in the February 2016 issue of Pediatrics. The study prompted the AAP to call for hospitals to minimize the number of painful procedures performed on newborns.
Unfortunately, the AAP did not take the next logical step: acknowledging that the painful and medically unnecessary circumcision of baby boys should cease.
Today, Intact America is submitting to you a petition, signed by more than 11,000 men and women, asking the AAP to take that step and call for your members to stop circumcising baby boys.
For every signature we received, we know there are dozens of other Americans who believe that circumcision needlessly subjects our baby boys to excruciating pain and robs them of a part of their anatomy that is important to their future sexual health.
As the AAP itself acknowledges, routine circumcision is not medically necessary. (Source: “Should the Baby Be Circumcised?,” on the AAP’s HealthyChildren.org website.) Yet, the public perception persists that the AAP recommends the procedure—a perception refuted in a 2016 commentary by Andrew Freedman, MD, pediatric urologist and a member of the Circumcision Task Force that formulated the Academy’s 2012 statement.
“To many, especially in the lay press, [the 2012 AAP statement] was interpreted as moving the needle from a neutral stance… to being pro-circumcision,” Dr. Freedman wrote in, “The Circumcision Debate: Beyond Benefits and Risks,” published in the April 2016 Pediatrics. However, Dr. Freedman explained, the statement’s actual point was that “the procedure’s benefits justify access to this procedure for families who choose it.” (Emphasis added.)
Regarding infant circumcision, parental choice is determined more by culture than health concerns, Dr. Freedman further noted. “Most circumcisions are done due to religious and cultural tradition. In the West, although parents may use the conflicting medical literature to buttress their own beliefs and desires, for the most part, parents choose what they want for a wide variety of nonmedical reasons.”
The AAP should not be complicit in encouraging parents to make a cultural decision under the pretense of science. The AAP must publicly recognize, in an official communication, that an erroneous perception exists and that the AAP does not and has never recommended circumcision as a medical necessity. The AAP also must ask pediatricians to inform parents accordingly. We urge you to take such action.
We also ask that the AAP educate its member pediatricians about the role of the foreskin in (1) protecting the glans, and (2) sexual pleasure—two major benefits not acknowledged in the 2012 assessment of benefits and risks.
In addition, we ask that you correct the mistaken assertion in the 2012 Task Force Report that a boy’s foreskin will usually separate from the glans by 2-4 months of age; while expert opinion on the average age of spontaneous foreskin retraction varies wildly around the world, the AAP’s own HealthyChildren.org says, “Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teen years.” (The Pediatric Society of New Zealand says “by age 18”; the British Association of Urological Surgeons says “by age 10.” A Danish medical survey found the mean age of first foreskin retraction to be 10.4 years.)
We believe that your members should be advised that forcible retraction of a boy’s foreskin is never indicated, because the age of spontaneous retraction is variable and might not occur until late adolescence. It is important that the AAP correct the record, because many American health professionals are unfamiliar with the normal intact male penis, and believe that it is necessary to force separation of the foreskin from the glans —potentially causing boys extreme pain and—potentially—lasting physical damage.
Finally, as our enclosed petition demonstrates, we continue to ask you to tell pediatricians to end the pain, and stop circumcising baby boys.
Both the American Academy of Pediatrics and Intact America share a common goal – protecting the health and wellbeing of children. We can and should work together toward that goal.
Georganne Chapin, MPhil, JD
 Thorvaldsen MA, Meyhoff H. Patologisk eller fysiologisk fimose? [Phimosis: Pathological or physiological?] Ugeskr Læger. 2005;167(17):1858- 62.
|BIG CHANGE IS IN THE AIR|
“Movements are composed of people — people who are living their lives and who look up and say, ‘This is not fair, this is not right.’ They may have been struggling alone, in isolation for some time. But when they come together, and there’s a movement … that’s when you see change….”
As I was preparing to write the introduction to the Intact America December newsletter, I heard these words, spoken by Attorney General Loretta Lynch in an interview on MSNBC. Lynch was reflecting on progress made in civil rights and human rights in the United States — particularly for LGBTQ people and African Americans — over past decades, and on what yet remains to be done. Her words gave me enormous hope.
As 2016 comes to a close, I reflect upon both the progress that Intact America and the intactivist movement have made, and — inevitably — upon the work still left to do to guarantee boys and the men they will become the right to be free from forced genital surgery, The right to keep the whole, intact bodies they are born with.
Another year gone by means we are one year closer to reaching the tipping point — the point at which a critical number of Americans will have come to believe that the foreskin is natural. And valuable. And that nobody but its natural owner has the right to cut a boy’s or man’s or anybody else’s genitals.
Here is more of what AG Lynch said, when asked about the progress toward human rights.
- “History is bigger than just the electoral wheel…. And human rights are bigger than any Administration.”
- “History encompasses all of the change and the progress we’ve made….”
- “[History] is on the side of marginalized people who speak up for themselves, people who feel isolated and left out who speak up for themselves.”
With regard to the passing of legislation guaranteeing equal rights, Lynch emphasized: “… [The] movements came first. And the movements are composed of people — people who are living their lives and who look up and say, “This is not fair, this is not right.” They may have been struggling alone, in isolation for some time. But when they come together, and there’s a movement … that’s when you see change…”
Big change is in the air.
I am so thankful that people have come together to speak out and create this extraordinary movement. And I feel extraordinarily privileged to be a part of it. I wish all of you a happy holiday season, and offer you the gifts of hope, optimism, and confidence in our ability to change the way America thinks about circumcision.
Together, we will win.
by Georganne Chapin and David Grant
Sunday, June 26, Intact America will be rocking an awesome float at NYC Pride. As representatives of a movement that fights for boys’ rights to keep the bodies they were born with, we are proud to join with and be embraced by the LGBTQ community – a community that has fought for decades for the basic human right of ALL people to be who they are.
Circumcision is still a topic that too many Americans turn away from. Intact (or, as some still say, “uncircumcised”) penises are even more frightening. But, thanks to the intactivist movement, THIS IS CHANGING! For years, decades even, people working against the genital cutting of baby boys have been denied participation in baby fairs, children’s rights groups, even organizations that work to end female genital mutilation. But the LGBTQ community has welcomed us, because they understand what it’s like to be stigmatized, what it’s like to have one’s voice silenced or ignored for taking people out of their comfort zones, and what happens when you ask people to question what they’ve been taught (brainwashed?) into thinking is “normal.”
Intactivists have been welcomed in the NYC Pride March since we first asked to be included in 2006. It’s great, because unlike our protests against infant genital cutting, at Pride we can throw a big, informative party for the foreskin, and celebrate the right of every child – male, female or intersex – to keep and enjoy the whole body that nature gave them.
Pride 2015 was the first time that Intact America marched with a float. Decked with “Foreskin Pride” banners, music blasting, we were accompanied by intactivists from all walks of life and of all ages (little kids know right away, unfiltered, that cutting off part of a baby’s penis is NOT ok).
Even before we stepped off, other marchers and spectators came by to talk, to hear our message, and to tell us how happy they were to see somebody taking circumcision OUT OF THE CLOSET!! As we proceeded down Fifth Avenue and into Greenwich Village, we created quite a stir – remarkable, for an event already known to be outrageous. Jaws dropped as people along the parade route saw our #ForeskinPride banners and our “His Body His Rights” and “You Want to Cut Off What?!?” signs, and realized what we were championing. Intactivists who had marched in previous years felt a definite difference – more real curiosity, more openness, more acceptance, more LOVE from the crowd. And besides adding to the celebration, our volunteers gave away lots of fun stuff.
If you’re in or around New York City on Sunday, June 26, join us! We’ll be lining up on East 39th Street, between Park and Madison Avenues at 2 pm. Or give us a shout-out on the parade route. Help us celebrate #ForeskinPride, and everybody’s right to be whole, out, and proud!
Last week, Intact America launched a petition to the American Academy of Pediatrics (AAP). The petition demands that the AAP follow the recommendations from its own research about infant pain, and tell its doctors to END THE PAIN and stop circumcising baby boys. Our goal is 29,000 signatures by February 29. We need your help! Please sign this petition, and share it with your friends. Ask them to sign and share it, too!
The American Academy of Pediatrics (AAP) recently said that babies shouldn’t be subjected to unnecessary pain. But the AAP continues to promote “routine” infant circumcision, a painful, medically unnecessary surgery that removes a normal part of a baby’s penis.
Last month, the AAP published research showing that common medical procedures carried out on newborn babies are very painful, and that the effects of the pain can last many years. The procedures mentioned included heel sticks, insertion of IV needles, and circumcision. The AAP report also found that commonly used pain relievers are neither effective nor safe.
Infant circumcision differs from the other procedures discussed in the report in that it is an invasive surgery that neither tests for nor treats any illness, and permanently removes a natural and valuable part of a boy’s sexual anatomy – the foreskin. The pain from circumcision is intense and continues for days or weeks after the surgery.
Circumcision, originally promoted in the 19th century as a way to prevent masturbation, has become part of American medical culture. Every year, a million baby boys in the United States are subjected to this surgery, although no medical association in the world recommends it.
Some of the falsehoods currently used to support circumcision include hygiene, disease prevention, and aesthetics.
The truth is:
- The intact penis is easily cleaned throughout a boy’s and man’s lifetime.
- Circumcision does NOT prevent sexually transmitted diseases, including HIV. European countries where fewer than ten percent of all men are circumcised have about the same STD rates as the United States, where circumcision is common.
- Any preference expressed by men or women for the circumcised penis is a result of cultural conditioning. Besides, as the U.S. circumcision rate declines, and the number of intact boys and men grow, the intact penis will no longer seem strange or unattractive.
Many Americans also believe that circumcision is “just a snip” – a minor, brief, and painless procedure that babies will not remember. This is FALSE, and the new AAP article on pain proves it.
Because circumcision is NOT medically necessary, and because the pain it causes is unmanageable and harmful over the long term, Intact America demands that the American Academy of Pediatrics tell its doctors to end the pain and stop circumcising baby boys.
Help us reach 29,000 signatures by February 29, 2016.
Please sign our petition TODAY.
The media overlooked an important story late last month that should dramatically change how doctors and hospitals treat newborn babies. On January 25, the American Academy of Pediatrics (AAP) announced a study updating its recommendations on avoiding, minimizing, or treating pain in infants. The AAP statement cites research showing that many “routine” interventions are extremely painful and that there are both short- and long-term consequences of babies’ exposure to painful stimuli.
Now that the AAP is asking health facilities to implement “a pain-prevention program … minimizing the number of painful procedures performed” on newborns, we need to ask again why doctors continue to circumcise nearly a million baby boys a year in the United States. Unlike other painful stimuli the AAP cites, including heel punctures or IV insertion, circumcision is a protracted surgery that does not diagnose or treat any illness, but rather subjects tiny boys to extreme pain for a medically unnecessary procedure.
Until recently, circumcisions have been carried out with no pain relief at all. Instead, practitioners used only physical restraints. Even today, it’s estimated that as many as half of circumcising doctors do not employ analgesia, and that the methods used the rest of the time are only partially effective, if not outright dangerous. (“EMLA,” a topical anesthetic cream widely used in U.S. hospitals, is specifically contraindicated for use “on the genitals of children” in the United Kingdom.
Unfortunately, as the AAP statement acknowledges, it’s nearly impossible to manage pain in infants, given their small size and vulnerability to chemical interventions – even the questionably effective and widely used sugar pacifiers. Implicit throughout the AAP statement is the fact that the safer the analgesic, the less effective it is in eliminating pain.
The next step
Now that the AAP has gone on record to affirm that babies feel and suffer the consequences of pain, and should not be subjected to painful procedures if they can be avoided, the logical next step is for the AAP to call unequivocally for doctors to stop circumcising babies. In its 86-year history, the AAP has never recommended circumcision and has always held that it’s not medically necessary. But, recently, as more and more parents opt out of the procedure for their boys, the trade association’s enthusiasm for circumcision has only increased. In 2012, while admitting that the complications and risks of infant circumcision have never been studied systematically, the AAP took the regrettable position that the operation’s benefits outweigh the risks.
Medical experts from around the world disagree. In response to the AAP’s 2012 statement, a large group of European physicians and ethicists wrote, “Cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report’s conclusions are different from those reached by physicians in other parts of the Western world… [Their claims of] health benefits… are questionable, weak, and likely to have little public health relevance in a Western context.”
Notably, far fewer than 10% of adult men in Europe are circumcised, compared to 75% of the adult male population in the United States.
Now we have a systematic study about the short- and long-term risks of pain inflicted upon infants. This is all we need to know in order for the AAP to stand up and say to its members: “Removing a boy’s foreskin is not medically necessary, it is painful, and the pain may compromise his neurological development for years hence. The AAP recommends that the circumcision of male infants cease.”
In my experience, the more you know about circumcision, the more you oppose it. One important fact is that the foreskin is not “extra skin,” but a natural, necessary part of the male anatomy that protects the head of the penis, provides natural lubrication, and enhances sexual pleasure for men and their partners. In 2011, a study published in the International Journal of Men’s Health found that circumcised men have a 4.5 times greater chance of suffering from erectile dysfunction than intact men.
As an activist, bioethicist, attorney and, most importantly, a mother, I feel a glimmer of hope when I read the AAP’s new policy statement. I see a medical organization increasingly boxed into a corner as it tries to escape the inevitable: infant circumcision is not medically necessary, it is unethical, and it has no place in legitimate medical practice. The organization, which pledges its commitment to “the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults,” thus has no legitimate path other than to tell its physician members to stop circumcising baby boys.
February 13, 2016
Let’s stop arguing about circumcision and begin teaching about it instead.
I floated this idea in “Changing Opinions Over the Changing Table,” a Huffington Post article published Christmas Eve (read the article here), and it seems a lot of people liked this approach. The article received 31 positive comments, 1,800 Facebook likes, 278 shares, and 100 pins on Pinterest.
So, we have to do something to educate relatives, friends, and pediatricians who continue to challenge mothers who want to protect their baby boys by leaving them intact. So, when challenged, I’m asking mothers to turn it into a teachable moment.
To quote the article:
“I know you would like to say, ‘How dare you tell me to butcher my baby! You don’t know anything!’
“But what if you said instead, ‘You know, I was pretty clueless about circumcision in the past, because it’s been the so-called normal thing to do in America. But I decided to get educated, and I’m so happy I did. Do you want to hear what I learned?’
One reader commented, “Thank you Huffington Post for having the guts to keep writing about this issue! Great suggestions, and reminder that at one time most of us ‘intactivists’ took for granted that circumcision was normal and necessary.”
In South Florida, a Mother’s Quest to Protect her Child. In the Nation’s Capital, a Demand for Basic Human Rights
Note: The following essay appeared on the op-ed page of the (Palm Beach, Florida) Sun-Sentinel on March 28, 2015. This version has been edited slightly for timeliness and for the audience of this blog.
The headlines have subsided, but Florida mother Heather Hironimus is in now in her seventh week of hiding to protect her son from his father, who wants to cut off the boy’s foreskin. A Palm Beach County judge has ordered her arrest. As Heather sat in captivity, just recently scores of intactivists gathered in Washington, DC to protest the removal of boys’ normal, healthy foreskins by U.S. physicians. A practice for decades accepted as the regular American thing to do has emerged as a landmark human rights concern.
Widely decried by physicians and ethicists throughout European and Commonwealth countries, circumcision is falling out of favor here as parents learn the facts. Meanwhile, as Denmark and other Scandinavian countries are considering whether to outlaw the surgery on minors altogether, U.S. physician organizations are redoubling their efforts to get the government to pay for it.
Adding to the mix are the ever-more-vehement voices of American men expressing outrage at having been robbed of their normal sexual anatomy – and their freedom of choice – when they were too young to consent.
Incongruously, the judge who ordered Heather’s arrest has said that, once jailed, she will stay there until she signs a consent form for her son’s unnecessary surgery.
The human rights movement against infant and child circumcision relies largely on the principle of informed consent. Arising from revelations of horrific medical experiments inflicted by Nazi doctors on concentration camp prisoners during World War II, this principle requires that before any medical procedure can be administered, the patient must understand its risks and benefits, be told of less invasive alternatives (including doing nothing), and freely agree to it. For children, parents may give “proxy” consent – but only if treatment is medically necessary.
In addition to the fact that “consent” cannot be compelled, “routine” circumcision fails these tests. The foreskin is not a birth defect; it’s a normal body part, and it plays protective and pleasure-enhancing roles. Most of the world’s men are intact, and suffer no ill effects. In fact, despite fear-mongering by a medical establishment that peddles this infant surgery to two million American parents a year, European nations, with circumcision rates near zero, have the same or lower rates of urinary tract infections and sexually transmitted diseases (including HIV) as the United States, where most men have been circumcised.
Heather Hironimus became informed and declined to consent to her son’s surgery, because it’s not needed, it’s painful, and it will put him at risk for bleeding, infection and other complications. Her reasons are backed up by the opinion of a respected urologist who examined the boy and testified that there’s nothing wrong with him.
If Heather’s child were a girl, she would be protected by federal and state law from anybody tampering with her genitals. Heather in Florida and those who come back to Washington to demonstrate every year are asking for the same justice for American boys.
April 5, 2015