Do not consider the contents of this blog as professional medical advice.

28 January 2012: My Revulsion at HR 2400

There is a current bill in Congressional Committee, one that both shocks and frightens me.  It is as follows:

HR 2400 IH
1st Session
H. R. 2400
To prevent States from prohibiting male circumcision.
June 24, 2011
Mr. SHERMAN (for himself, Mr. ELLISON, Mr. WAXMAN, Mr. NADLER, Mr. BERMAN, Mr. ENGEL, Mr. LEVIN, Mr. CARSON of Indiana, Mr. ISRAEL, and Mr. ACKERMAN) introduced the following bill; which was referred to the Committee on Energy and Commerce

To prevent States from prohibiting male circumcision.
Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,
This Act may be cited as the ‘Religious and Parental Rights Defense Act of 2011’.
Congress finds the following:
(1) Male circumcision carries significant medical benefits, including lower risk of sexually-transmitted diseases, certain kinds of infection, and overall improved hygiene.
(2) Male circumcision is an important part of many world religions, including Judaism and Islam, and observers have safely embraced its practice for generations.
No State or political subdivision of a State may adopt or continue in force a law, regulation, or order that prohibits or regulates the circumcision of males who have not attained the age of 18 years and whose parent or guardian has consented to the circumcision, unless such law, regulation, or order--
(1) applies to all such circumcisions performed in the State; and
(2) is limited to ensuring that all such circumcisions are performed in a hygienic manner.
There are constitutional problems with this bill right off of the bat.  The first red flag that this bill raises is with the 10th Amendment, which is as follows:
Amendment X
The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.
This amendment guarantees that Congress cannot interfere with state rights or powers, and that federal government cannot supersede this power unless under certain conditions enumerated by the Constitution.  States should maintain the right to ban practices that they find questionable or dangerous.

Another problem with this bill stems from another federal law, the Female Genital Mutilation law as passed in the US in 1997 in conjunction with Amendment XIV guaranteeing equal protection under the law.

The texts are as follows:



Sec. 116. Female genital mutilation

(a) Except as provided in subsection (b), whoever knowingly circumcises, excises, or infibulates the whole or any part of the labia majora or labia minora or clitoris of another person who has not attained the age of 18 years shall be fined under this title or imprisoned not more than 5 years, or both.

(b) A surgical operation is not a violation of this section if the operation is--

(1) necessary to the health of the person on whom it is performed, and is performed by a person licensed in the place of its performance as a medical practitioner; or

(2) performed on a person in labor or who has just given birth and is performed for medical purposes connected with that labor or birth by

[[Page 33]]

a person licensed in the place it is performed as a medical practitioner, midwife, or person in training to become such a practitioner or midwife.

(c) In applying subsection (b)(1), no account shall be taken of the effect on the person on whom the operation is to be performed of any belief on the part of that person, or any other person, that the operation is required as a matter of custom or ritual.

(Added Pub. L. 104-208, div. C, title VI, Sec. 645(b)(1), Sept. 30, 1996, 110 Stat. 3009-709.)

Effective Date

Section 645(c) of div. C of Pub. L. 104-208 provided that: ``The amendments made by subsection (b) [enacting this section] shall take effect on the date that is 180 days after the date of the enactment of this Act [Sept. 30, 1996].''

Congressional Findings

Section 645(a) of div. C of Pub. L. 104-208 provided that: ``The Congress finds that--

``(1) the practice of female genital mutilation is carried out by members of certain cultural and religious groups within the United States;

``(2) the practice of female genital mutilation often results in the occurrence of physical and psychological health effects that harm the women involved;

``(3) such mutilation infringes upon the guarantees of rights secured by Federal and State law, both statutory and constitutional;

``(4) the unique circumstances surrounding the practice of female genital mutilation place it beyond the ability of any single State or local jurisdiction to control;

``(5) the practice of female genital mutilation can be prohibited without abridging the exercise of any rights guaranteed under the first amendment to the Constitution or under any other law; and

``(6) Congress has the affirmative power under section 8 of article I, the necessary and proper clause, section 5 of the fourteenth Amendment, as well as under the treaty clause, to the Constitution to enact such legislation.'' 
Amendment XIV, Section 1.

All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.
I especially highlight sections 1, and 3 through 6 because I feel that they are particularly applicable in this case for the prohibition of religious genital cutting of minors of both genders.

Now, bear in mind that this legislation is stating that genital cutting of females has religious significance, and the prohibition of religious genital cutting does insert government into matters of religion.  Is this a violation of the First Amendment, guaranteeing the right to practice religion?  

Before that question is answered, first consider the role of the law in our everyday lives.  The law a social code of ethics and rules that at its core functional level protects people from other people or sometimes themselves.  The federal outlawing of religious female genital mutilation does "brush shoulders" with the First Amendment, but this legislation seeks to protect unconsenting minors from harm and does not infringe upon the religious rights of the individual.  Essentially, this legislation prohibiting the involuntary genital cutting of female minors, including for religious reasons, does draw a proverbial "line in the sand" on the First Amendment.  In this sense, we all still experience our own personal freedoms of religion, but our freedom to practice our religious rituals ends where another person's body begins, and we are not to cause harm in its name.  This sounds reasonable, does it not?  It seems to say to us "Practice your religion however you please, but don't do body mods to baby girl's genitalia."  Piece of cake.

Now, this being said, Amendment XIV guarantees in its own words "equal protection of the laws."  The fact that there is a federal law protecting female minors from unnecessary genital cutting but not one for males is in violation of this principle, and in the case of religious male circumcisions, the aforementioned and previously established "line in the sand" on the First Amendment is crossed.  The very title of this bill, "Religious and Parental Rights Defense Act," is against this principle of protecting the child rights.

I now draw your attention to Amendment X, the one protecting citizen unenumerated rights:

"The enumeration in the Constitution of certain rights shall not be construed to deny or disparage others retained by the people."  

Congressional passage of HR 2400 would abridge the rights of minor males to not have knives taken to their genitals without medical necesity.

This bill's constitutional problems aside, I draw your attention to the ethical problems with this bill.  The first and foremost thing is that Congress would essentially endorse religious genital cutting, which is of course, not ethical.

Another problem comes from the phrase: "Male circumcision is an important part of many world religions, including Judaism and Islam, and observers have safely embraced its practice for generations."  The fallacy comes from assuming that this procedure is safe, because, frankly, it isn't.

I draw your attention to this following study's abstract:
THYMOS: Journal of Boyhood Studies, Vol. 4, No. 1, Spring 2010, 78-90
- Dan Bollinger
Abstract: Baby boys can and do succumb as a result of having their foreskin removed. Circumcision-related mortality rates are not known with certainty; this study estimates the scale of this problem. This study finds that approximately 117 neonatal circumcision-related deaths (9.01/100,000) occur annually in the United States, about 1.3% of male neonatal deaths from all causes. Because infant circumcision is elective, all of these deaths are avoidable. This study also identifies reasons why accurate data on these deaths are not available, some of the obstacles to preventing these deaths, and some solutions to overcome them.
Clearly, there is a present form of danger in circumcision.  Calling this safe would be a false claim, and it would allow Congress to endorse or accept such deaths as an acceptable loss.  I don't feel comfortable with our government condoning an unnecessary practice that causes death.

Apart from death, other life-altering problems can arise from male genital cutting, like skin bridges, uneven scarring, keloid formations, hypertrophic scarring, adhesions, partial amputation of any part of the shaft, denudation of the penis, iatrogenic hypospadias, meatal stenosis, and complete amputation of the penis, to name just a few physical complications.

Look at my story.  Look at the story of Dr. Shane Peterson.  Have you ever heard of David Reimer?  Clearly, this procedure has its share of risks.

Infections at the wound site also are common.  Gangrene, staph, and MRSA have all been documented as occurring at a circumcision wound.

Another fallacy arises from the phrase "Male circumcision carries significant medical benefits, including lower risk of sexually-transmitted diseases, certain kinds of infection, and overall improved hygiene."  First of all, there is a surgical open wound on the genitals during the healing phase of circumcision that is regularly exposed to feces and urine.  I fail to see this as hygienic.

Under this reasoning, we are better off without fingernails, ears, or arms, because our fingernails can get dirty, our ears get waxy, and our arms have stinky armpits.  Enough is enough.  We have soap.  We have water.  Hygiene should not be a problem.

Similarly, we have condoms.  We have sex education.  How can Congress somehow state that circumcision holds down rates of STDs and other infections when there is such a high rate of circumcision, and yet, a high rate of STDs and other infections present in our own back yard?  This is incongruous to say the least.

Furthermore, the AAP recognizes that there is not significant concrete evidence to outright support routine infant circumcision.  I thus find the Congressional endorsement to be, at the very least, unsettling.  Our politicians want to condone religious genital cutting.

21 January 2012: Am I an Intactivist?

I received an angry message in my anonymous comment box from a reader asking, among other things, if I was some sort of intactivist.

In all truth, I am not entirely sure.

I'm sure this would have come up sooner or later, so I'll just take some time to explain, now.

When I see the word intactivist, I see a portmanteau between the word "intact," and "activist."  In the literal sense, I am neither intact, nor am I an activist.

I support the right for children to not have knives needlessly taken to their genitalia, period.  Having been through what I have, how could I not?  However, this being said, the "activist" portion of "intactivist" implies being physically or otherwise observably active to fight for bodily integrity rights, which I have not done, physically.  I have written no letters, called no congressperson, marched, nor held up a sign.  In my physical life, I am not like this.

If anything, I am covert.

For example, one evening someone was joking around about circumcision with a chainsaw, to which I casually (and superficially) in jest replied "Oh, yes.  Because circumcision isn't traumatically frightening and painful enough as it is," to which he replied "babies don't remember it."  I then said something in my continued, feigned joviality like "Neither do people who get roofied, because not remembering makes everything OK" with light sarcasm in my voice. 

My conversation partner grew quiet.  He then said mumbled something like "it's cleaner."

My the final words on this topic, uttered conversationally lightly, came out of my mouth when I said "Say of it what you will, but in the end you are taking a knife to a baby's genitals, and that is never going to be OK in my book."

I am not an intactivist in that I am overt in the physical world about it, but rather deliberately and pensively covert with my sentiments and statements.  Every statement I make in this sense is measured, carefully planned, another progression in an invisible game of perspective-altering chess.  The moment I might say aloud a statistic, I risk marking myself to them as somebody "obsessed."  If I keep it in jest, keep it light, and focus on the ethical facts, I can plant many, many seeds of doubt in others' minds about circumcision.  It isn't hard.  If anything, I prime and open up this sort of person for the real intactivists to spread the truth.

If I am an intactivist, I am undercover, working in the margins and behind the lines.  My support is there.  It is small, it is not measurable, but I am doing what I can to at least call people to think outside of their own box on this issue.

In my own way, I guess I am sort of an intactivist.  Or at the very least I can say that I am against the genital cutting of unconsenting minors, and am doing subtle things to spread this feeling.

15 January 2012: Associative Trypanophobia and a Scar Update

There is an unusual aspect of my life that strikes me as odd, and it is my unusual simultaneously high and low tolerance to pain.

I have had my fair share of falls, tumbles, scrapes, cuts, a few gashes, and other accidents growing up, but none of that really seemed to phase me that much in terms of how painful they were.  For example, I once had someone playfully take a hard swing at me with a large icicle (don't ever do this, seriously), which didn't break, and thudded as it smacked me in the thigh.  This wasn't that bad, in terms of pain.

In spite of being able to take all of this, I have a terrible anxiety when there are needles involved.  I have as long as I have been able to remember been resentful of needles being inserted into my body, and literally started shaking the few times it has been necessary.  The pain of needles isn't really that bad, or sharp for that matter, but the psychological anticipation of the pain coming is what causes me to worry and shake.

For example, in a practice lab for class we once used disposable lancets to test our own blood glucose levels, but I could not bring myself to administer the sharp, sterile device to draw blood from my finger.  I had to hand someone else my lancet, and looked away.  I told my partner to pick a finger random, but not to tell me which one.  When my partner asked if I wanted him to countdown, I said no.  I felt that counting would have made it worse.  Someone sitting next to me was kind enough to distract me with an anecdote, but I still was shaking and jumped when I felt the sharp pain on my finger.

This shaking anxiety has always been in my life in response to anticipated physical pain.

I remember reading somewhere once a study about negative changes in infant and toddler pain thresholds or vaccination discomforts as correlated with circumcision status, and I can't help but wonder.  This fear and anxiety for anticipated pain has been around as long as I can remember.  My earliest memory of vaccination was an anxious one, even before the needle, and at the time I didn't know and couldn't remember why.  This was the first shot I would ever remember.  Why was I so frightened with no previous concrete negative memory before?

This might all seem speculative, because, well, for me it is.  Whether or not it is speculative, I think this is significant.

All speculation aside, I will conclusively state that taking two shots directly into my penis on the day of surgery certainly did nothing to improve my already present anxiety for needles.

In other news, there has been some mild improvement in the scars.

The fibroid fissure is now not a local, hard, raised, clearly defined lump under my skin anymore.  Now it is only a tough gristly area where I am guessing the collagen scar matrix is breaking down.

The fleshy crater is still a crater, and has surfaced over with gray, shiny scar tissue.  It appears to be filling in very, very slowly from the bottom.  I'll keep my fingers crossed that it continues.

11 January 2011: Reader Q&A I

Courtesy of the comment box, I received some questions from an anonymous reader that I felt prudent to publish (with permission) and relevant to this blog.

A reader writes:
"When you had painful erections, where specifically was the pain - on either side of the skin bridge?  Was it a sharp pain like "oh my god my dick is about to tear open!" or a dull ache?"
The pain varied.  It was sharper during erections and dull after the refractory period afterwards, but this dull ache regularly faded after a while.  The dull ache was like the kind one feels from a bruise.

If I had to describe the sensation during erection, I would say that the pain at the beginning and ending of the bridge was sharp where the skin pulled on my scar and corona, and in the middle it felt completely different.  When skin gets pulled too tight, the sensation is different for everyone, but in this case, the sensation throughout the bridge was much like “snakebite,” that thing that kids used to do to each others' forearms in playgrounds.
Afterwards, the entire area would ache, dully.
"Did the pain interfere with masturbation and sex?"
This pain did interfere with the normal functioning of my penis, and I was basically incapable of sex or masturbation, let alone a simple erection without pain when it started to come on around age 16.  It started gradually and increased as the skin bridge got tighter as my penis grew and the skin bridge did not.
 "If masturbation and sex were impossible after age 16, how did you release your semen?"
Nocturnally.  I would wake up with an aching semi-erection from time to time, and find myself a mess.
"Has your circumcision damage prevented you from having sexual contact at all?"
This is a complex question, but a good one.

In the literal sense, yes, because pleasurable sexual stimulation wasn't really possible during my five year hiatus with erection pain.

On another level, the mental/emotional/social level, I am not immediately sure how to express my answer. I stated in my first entry that I always was conscious of something being wrong or different down there, and in the grand scheme of things, I wonder how this really has changed how I grew up, or how I perceived sex growing up.

For example, around the early teen years, my peers became very interested in sex. My interest in sex and females grew, but I did not embrace that same confidence that they employed, and never came to. Now that I think back on this, I wonder if the weight of having an abnormal "outside-of-either-box" (it didn't look either like either a like an intact one or a "typical" cut one) penis did not on some fundamental level subtly undermine my confidence with the opposite sex if not my confidence in general, at least as I grew increasingly conscious of my problem. Locker room teasing began in phys-ed, and it all went downhill from there.

It certainly has impacted how I approach the topic of relationships and women.  I want to someday start a family, surround myself with people that I care about and care about me in return, but oddly enough, I have practically no drive nor interest for sex.  Under the sex-as-baseball analogy, I am still on that bench, and have crossed nary a single base.  Not back then.  Not today.

This disinterest in sex is the part that is the hardest for me.  This is the part that I feel set me apart from everyone else back then, and still does today.  I found it difficult to contemplate something that would only lead me to literal physical pain, and possibly embarrassment of my body.  I had thus written myself off of the sexual roster back then, assuming that I would never be able to function down there without pain.  Such a terrible self admittance back then is not so easily overcome today, years later, without some personal lingering effects for me, I will say.
"What does your erection feel like now, now that the skin bridge is gone?"
The pain I described earlier is gone, but there are new, unpleasant (but not entirely painful) sensations during my erections. The lack of mobile skin makes my erections uncomfortably tight, drawing up a fair bit of hairy skin onto my shaft from my pubic area and scrotum. The scars being pulled taut produces a sensation much like pin-prickles after regaining sensation in a numb limb.

See one of my earlier entries for more details on that.

1 January 2012: A New Baby at a Family Gathering

As many other families do, my family gets together during the winter holidays.  We gathered together as is custom, but with a twist this year: my cousin had recently had a new son.  This particular child was born a few months ago prematurely via an emergency Cesarean section due to an unusual condition affecting my cousin, the mother.  He was under intensive care for a period of time lasting around two months.

Something strange was said aloud.  The mother of this child, rather non-nonchalantly I might add, mentioned after saying that her child never really picked up on breast feeding that she hadn't heard her child scream like he did during routine vaccinations since his screaming immediately after his circumcision.  This new mother, this pediatric nurse even, had consented to have her child put through the conscious pain of circumcision, and even was able to laugh (uneasily) about the situation.  This child, who had struggled to even survive and cling to life for more than a month, was subjected to an unnecessary and painful surgery, and his mother found his frightened and pained screaming a topic fit for idle chat.

I had never felt such a strange, disgusted mixture of emotion in my entire life.

I watched this woman coddle and coo, sing sweet little nothings, smother with love and kisses, and speak endearingly to her firstborn child, whose genitals she paid some stranger to partially amputate with no anesthesia.

It all felt so incongruous--the reality of this child's unconsentually modified body, his pain, blood, the loving and singing mother crooning and mewling over her child--I had never felt such a lump of discomfort in my throat as I did gazing warily at the scene before me.  It felt sick.  It felt wrong.  The phrase "lovingly mutilated" reverberated in the back of my mind.

When it came to be my turn to hold this nine pound, four ounce child in my lap, I gazed down upon his sleeping, furtively furrowed brow, and wondered if he would someday came to same stinging realization that I had--that what was done to his body was not ethically sound and very painful.

I felt so strange to be with them, like an alien among them, to probably be the only one thinking such things.  I feel changed, altered, different from them, in both a surgical and ethical-awareness sense.  How exactly is it that our culture has reached this point of looking away?

I wonder if this would have even phased me before.

The mother spoke of how her fellow nurses said they were against it, but she went ahead with it anyway because she thought it was "the right thing" to do.  I doubt I could have done much more than that group beyond telling my personal tale, if I had tried to persuade her.

Alas, by the time I had reached the morbid epiphanies that I have, it was too late for me to voice them to save him.  He was circumcised very shortly before I began to even write this blog.

Even so, I don't know if I have the courage to admit my greatest source of pain and shame to another person, let alone family.  I can write these things here, behind the formidable electronic wall of anonymity, but out and about in social contexts, my secret is safely hidden but from a select few, for fear of judgment and out of shame.

Am I a coward?  I feel like one.