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SEXUAL MUTILATIONS: A HUMAN TRAGEDY Proceedings of The Fourth International Symposium on Sexual Mutilations August 9-11, 1996, Lausanne, Switzerland Edited by George C. Denniston and Marilyn Fayre Milos Plenum Publishing Corporation 233 Spring St., New York, NY 10013-1578 ISBN 0-306-45589-7 237 pages 1997 $79.95 (U.S. and Canada) $95.40 (elsewhere) Contents Preface Acknowledgments Voices in Support of The Ashley Montagu Resolution to End the Genital Mutilations of Children Worldwide: A Petition to the World Court, the Hague I. The Geography of Male and Female Genital Mutilations (J. DeMeo) 1. Male Genital Mutilations 2. Female Genital Mutilations 3. Summary 4. References (132) II. A Short History of the Institutionalization of Involuntary Sexual Mutilations in the United States (F. Hodges) 1. Modernizations 2.1. Degenerative Theory of Disease and the Reflex Neurosis Theory of Disease 2.1.1. Pathologization of Sexual Behavior 2.1.2. Pathologization of Sexual Anatomy 2.1.3. Pathologization of Sexual Function 2.2. Castration 2.3. Spermectomy, Neurectory, and Other Treatments 3. Circumcision as Therapy 3.1. The American Medical Association 3.2. The Masturbation Hysteria and Circumcision 3.3. More Miracle Cures 3.4. Anti-Sexual Nature and Circumcision 4. Early Twentieth Century 4.1. Abraham L. Wolbarst and The Cancer Scare 4.2. Advances in Foreskin Anatomy and Development 4.3. Invention of the Gomco Clamp 4.4. Popular Perceptions 4.5. Abraham Ravich and Cancer of the Prostate and Cervix 5. World War II 5.1. Sexually Transmitted Diseases and the Scapegoating of Blacks 5.2. Fate of the Foreskin 6. Corporate Institutionalization of Circumcision in the Cold War Era 6.1. New Cancer Scare 6.2. Kaiser, Gomco, and Europe 6.3. Professional Opposition to Mass Circumcision 6.4. Backlash from the Circumcision Industry 6.5. Legal Action for Children's Rights 6.6. The Urinary Tract Infection Scare 6.7. The HIV Scare 6.8. The Future of Involuntary Circumcision 7. Conclusions 8. References (139) III. Jehovah, His Cousin Allah, and Sexual Mutilations (S. A. Aldeeb Abu-Sahlieh) 1. General Remarks on Male and Female Sexual Mutilation 1.1. Male Sexual Mutilation 1.2. Female Sexual Mutilation 1.3. Circumcision of the Hermaphrodite 1.4. Age for Male and Female Circumcision 1.5. Practice of Male and Female Sexual Mutilation 2. Religious Arguments 2.1. The Bible Is the Major Basis for Male Sexual Mutilation 2.2. Christians Abandon the Obligation of Male Sexual Mutilation 2.3. Male Circumcision in Islamic Sources 2.4. Male and Female Circumcision in the Koran 2.5. Male and Female Circumcision in the Sunnah 2.6. The Gospel of Barnabas 2.7. Qualification of Circumcision in Muslim Law 3. Reason Supporting Religion: Advantages and Disadvantages 3.1. Male Circumcision 3.2. Female Circumcision 3.3. Religious Circles Confronted with Reason 4. Legal Prohibition of Male and Female Circumcision 4.1. Prohibition of Male Circumcision 4.2. Prohibition of Female Sexual Mutilation 5. Strategies to Stop Circumcision 5.1. Scientific Information and Religious Arguments 5.2. Humor and Sarcasm 6. Conclusion: Some Fundamental Points 6.1. Circumcision of the Male and Female Is a Question of Principle 6.2. Differences between Male and Female Circumcision 6.3. Medical Benefits 6.4. God's Orders and the Respect of Others' Will 7. References (105) IV. The Skoptzy: The Russian Sect of the Castrated (D. Diers and X. Valla) V. Functional and Erotic Consequences of Sexual Mutilations (G. Zwang) 1. The Complications of Female Sexual Mutilation 1.1. Immediate Complications 1.2. Long-Term Complications 2. The Complications of Circumcision 2.1. Anatomy and Physiology of the Foreskin 2.2. Consequences of Preputial Mutilation 3. Conclusions 4. Bibliography (11) VI. The Human Prepuce (M. M. Lander) 1. Introduction 2. Language 3. Normal Prepuce 3.1. Possession 3.2. Protection 3.3. Puberty 3.4. Play 3.5. Performance 3.6. Pleasure 3.7. Procreation 3.8. Penetration 3.9. Perfume 4. Relationship of the Glans and Prepuce 4.1. Glans Color 4.2. Advice to Parents Regarding Care of the Intact Penis 5. Pathology 5.1. Narrow Preputial Orifice 5.2. Indications for Circumcision 6. Conclusion VII. NORM UK and the Medical Case Against Circumcision: A British Prospective (J. P. Warren) 1. National Organization of Restoring Men of the United Kingdom (NORM UK) 2. Anatomy of the Prepuce 2.1. Development of the Prepuce 2.2. Functions of the Prepuce 3. Clarification of Preputial Conditions 3.1. Phimosis 3.2. Balanitis Xerotica Obliterans 3.3. Paraphimosis 3.4. Balanoposthitis 4. Circumcision 4.1. Complications of Circumcision 4.2. Pain and Circumcision 5. Circumcision Myths 5.1. Penile Cancer 5.2. Carcinoma of the Cervix 5.3. Urinary Tract Infections 5.4. Sexually Transmitted Diseases 6. Medical Ethics 6.1. Human Rights 7. Psychological Considerations 8. Conclusions 9. References (48) VIII. Circumcision: An Iatrogenic Epidemic (G. C. Denniston) 1. Circumcision: An Iatrogenic (Doctor-Caused) Epidemic 2. Medical Ethics 2.1. Urinary Tract Infections (UTI) 2.2. Penile Cancer 3. Complications and Consequences 4. The Role of Doctors 5. Ethical Considerations 6. Human Rights Considerations 7. Solution to the Problem 8. References (19) IX. Why Does Neonatal Circumcision Persist in the United States? (R. S. Van Howe) 1. Rights of Children 2. The Physician's Role 3. Publication Bias in the American Medical Literature 4. Anti-Semitism 5. Established Protocols 6. The Role of Money 7. conclusions 8. References (80) X. Learned Helplessness: A Concept of the Future (M. Odent) 1. Animal Experiments 2. Exploring the Medical Literature 3. Missing the Links 4. The Case of Neonatal Circumcision 5. Conclusions 6. References (9) XI. Long-Term Consequences of Neonatal Circumcision: A Preliminary Poll of Circumcised Males (T. Hammond) 1. Methods 2. Results 2.1. Demographic Data 2.2. Reported Circumcision-Caused Harm 3. Discussion 4. Conclusion References (2) XII. Similarities in Attitudes and Misconceptions about Male and Female Sexual Mutilations (H. Lightfoot-Klein) 1. Methods 2. Results 2.1. Minimization of Damage and Pain 2.2. Beautification 2.3. Medical Indications 2.4. Maintaining Hygiene 2.5. Preventing Future Problems 2.6. Improving Sex 2.7. Universality 2.8. Medicalization 2.9. Denial of Long-Term Harm 3. Discussion 4. Conclusion XIII. Female Genital Mutilation (B. Ras-Work) 1. What Is Female Genital Mutilation? 1.1. Who Performs the Mutilation and How Is It Performed? 1.2. Types of Female Genital Mutilation 2. What Are the consequences of Female Genital Mutilation? 2.1. short-Term 2.2. Long-Term 3. Age 4. The Reasons Advanced for the Persistence of Female Genital Mutilation 4.1. Religious 4.2. Virginity 4.3. Aesthetic Reasons and Social Integration 4.4. Benefit to Circumcisers 5. History of Female Genital Mutilation 6. Geographical Distribution of Female Genital Mutilation 6.1. Excision (Clitoridectomy) 6.2. Circumcision (Sunnah) 6.3. Infibulation 6.4. Gishiri and Angurya Cuts 7. Progressive Efforts Made to Eradicate Female Genital Mutilation 7.1. International and Regional Levels 7.2. National and Regional Instruments 8. Concrete Actions to Stop the Practice 9. Inter-African Committee (IAC) 9.1. Training and Information Campaign (TIC) 9.2. Training of Traditional Birth Attendants 9.3. Alternative Employment Opportunities 9.4. Research 9.5. Production of Education Material 9.6. Inter-African Committee / United Nations High Commissioner for Refugees Joint Project 9.7. Advocacy 10. Proposals 11. References (11) XIV. Epidemiological Surveys on Female Genital Mutilation in Italy (P. Grassivaro Gallo, F. Viviani, M. Livio, R. Corsaro, F. De Cordova, G. Fortunato, S. Beccacini, and S. Salad Hassan) 1. Female Sexual Mutilation in Italy 2. Italian Medical Perspectives 3. Cultural Paradoxes 4. Conflicts Between African Women and Italian Doctors 5. Defibulation 6. Risk Factors for Excision 7. References (7) XV. Female Genital Mutilation in Germany: An Update from (I)NTACT (C. Muller) 1. The founding of (I)NTACT 2. Political Action 3. Female Genital Mutilation in Germany 4. Right of Asylum 5. Conclusions XVI. Redefining the Sacred (M. Pollack) XVII. Challenging Circumcision: A Jewish Perspective (J. Goodman) XVIII. The Wound Reveals the Cure: A Utah Model for Ending the Cycle of Sexual Mutilation (J. Parvati Baker) 1. Revealing the Wound 1.1. Judging the Baby 2. Sexual Wounding in Mormon Society 2.1. Circumcision in Mormon Scripture 2.2. Contradictions in Doctrine and Practice 3. A Model for Change 3.1. Interview Process 3.2. Effecting the Cure 4. Conclusions 5. References (3) XIX. Nurses for the Rights of the Child: An Update (M. Conant and B. Katz Sperlich) 1. Breaking the Cycle of Violence: Accomplices and Witnesses Speak Out 1.1. Nurses for the Rights of the Child 1.2. Saying No to Circumcision 2. References (4) XX. NOCIRC of Australia (G. Williams) 1. NOCIRC of Australia: Statement of Purpose 2. Activities of NOCIRC of Australia 3. Medical Issues 4. Circumcision Statistics and Costs 4.1. Costs of Circumcision 4.2. Rate of Circumcision 5. Human Rights 6. Conclusions 7. References XXI. Circumcision: Are Baby Boys Entitled to the Same Protection as Baby Girls regarding Genital Mutilation? (Z. Baer) 1. Background 2. The Issue -- Circumcision 3. Legal Analysis XXII. Routine Infant Male Circumcision: Examining the Human Rights and Constitutional Issues (J. S. Svoboda) 1. Introduction 1.1. Customary Law and Human Rights Agreements 2. Human Rights Principles Forbid Infant Circumcision 2.1. Reasons for Concern with Infant Male Circumcision 2.2. Circumcision Prohibited by Several Human Rights Documents 2.3. Freedom of Religion Does Not Justify Procedure 2.4. Treaties Prohibiting Torture Apply to Circumcision 3. Cultural Blindness and Circumcision 4. Law Against Female Sexual Mutilation, Which Fail to Outlaw Male Sexual Mutilation, Violate Equal Protection Under Both Human Rights Law and the United States Constitution 4.1. Numerous Laws Forbid Only Female Sexual Mutilation 4.2. Proposed Legislation Also Forbids Only Female Sexual Mutilation 4.3. State Laws Grant Circumcisers Special Exceptions 4.4. Laws against Female Sexual Mutilation Violate Equal Protection Under International Human Rights Laws 4.5. Laws against Female Sexual Mutilation Violate Equal Protection under American Law 4.6. Female-Only Sexual Mutilation Legislation Is Not Justified 5. Conclusion 6. References (53) XXIII. The Ashley Montagu Resolution to End the Genital Mutilation of Children Worldwide: A Petition to the World Court, the Hague (J. W. Prescott) Appendix 1: Declaration of Genital Integrity Appendix 2: Resources Contributors Index Photographs John A. Erickson Three Zones of Penile Skin 1. The area between the groin and the upper line is the skin covering the shaft. The area between the upper line and the lower line is the foreskin's outside fold. Three Zones of Penile Skin 2. The foreskin retracted about half an inch. Three Zones of Penile Skin 3. The foreskin everted. Three Zones of Penile Skin 4. The foreskin everted farther. Almost the entire shaft is now covered with foreskin. Three Zones of Penile Skin 5. The foreskin everted as far as it will comfortably go. The entire penile shaft is now covered with foreskin. Prepuce of adult male Ridged band, displaced behind corona glandis, of everted prepuce Ventral view of frenulum and contiguous ridged band of everted prepuce Eversion of the prepuce 1. Preputial orifice slightly dilated. Mucosal fold of inner prepuce exposed, but still closed Eversion of the prepuce 2. Preputial orifice more widely dilated. Meatus slightly exposed. Eversion of prepuce 3. Preputial orifice dilated, prepuce everted. Ventral view of the pitted and scarred surgically externalized glans penis of a 28-year old American male circumcised at birth (2) Hanny Lightfoot-Klein Genital-rectal area of a 25-year-old married Sudanese woman, showing introitus, urethral opening, and pharaonic circumcision scar Shaun Mather Normal, natural, healthy, intact penises of two hearty Australian boys Tom Reichfelder, M.D. (Courtesy of John Money, PhD) Total amputation of the penis [of a baby] by circumcision Extensive injury and suppuration of newly circumcised penis Destruction of the penis by electrocautery circumcision Skin bridge with inserted probe on circumcised penis Total destruction of the penis of neonatally circumcised American baby from gangrene resulting from infection of circumcision wound Saturday Evening Post Baby strapped onto an immobilizing restraining board in preparation for circumcision Baby enduring the agony of unanesthetized penile mutilation John R. Taylor, M.D. Normal penis of human baby Two intact boys Meissner's corpuscle and myelinated nerve fibers in crest of preputial ridged band
[Thanks to John A. Erickson, qsmd@datasync.com]