Tuesday, May 2, 2023

GALDEF Statement in Support of the 2023 WWDOGA

by David Balashinsky

May 7th, 2023 is the eleventh anniversary of the ruling by the Regional Court of Cologne recognizing that nonconsensual, non-therapeutic penile circumcision constitutes an illegal act of bodily harm.  That ruling has been commemorated every May 7th since as the Worldwide Day of Genital Autonomy.

The Worldwide Day of Genital Autonomy, or WWDOGA, calls for the State Parties to the United Nations Convention on the Rights of the Child to honor their commitment to "take all effective and appropriate measures with a view to abolishing traditional practices prejudicial to the health of children."  WWDOGA also calls for legislative initiatives to protect all children, regardless of sex, against non-therapeutic genital surgeries.  It calls for the protection of children with atypical sex characteristics from genital surgeries when not medically indicated; it calls for an immediate end to the campaign of mass circumcision of African boys; and it calls for a program of publicly-funded research and education on the consequences of genital cutting for children in all its various social contexts.  These objectives are so basic to any rational definition of fundamental human rights that WWDOGA has now grown into an annual observance that is supported by over 90 organizations around the world. 

One of these is the Genital Autonomy Legal Defense and Education Fund (GALDEF) which is proud to support of the eleventh annual Worldwide Day of Genital Autonomy.

GALDEF's Mission is "to promote impact litigation by providing the resources needed for our clients to win legal cases involving medically unnecessary genital cutting."  Our Vision is "to create a world where the rights of children to bodily integrity and future autonomy over their genitals and their sexuality are respected and legally protected."  

Although our strategies may differ, the ultimate goals of WWDOGA and GALDEF are the same.  Both organizations are working to create a world in which the right of every individual to ownership of their own genitals is recognized and respected.  Like WWDOGA, GALDEF believes that this right is absolute, fundamental and belongs to every human being regardless of sex or any other individual- or group identification.  For us at GALDEF, that means helping those who have been deprived of this right seek redress through the judicial process.  But our mission is much broader, much deeper and much more ambitious than fighting for this cause on an individual, case-by-case basis.  We believe that strategic and targeted legal actions can result in precedent-setting and high-profile judgments that will reverberate throughout the legal landscape, across the country and beyond.  This will have the effect of discouraging others from violating or assisting others in violating the right to genital autonomy of every child everywhere.

It is not a coincidence that both WWDOGA and GALDEF have the phrase "genital autonomy" in their names.  The principle of genital autonomy is the moral foundation of both organizations; the universal safeguarding of this right, the cause to which both organizations are committed. 

Nor is it a coincidence that a judicial remedy for forced genital cutting lies at the heart of both organizations.  For as long as there have been law codes, charters and constitutions, courts have been the place of last resort where those who have been aggrieved can seek justice.  Courts have been the place where statutes that violate human rights have been struck down and where previously unrecognized rights have been recognized.  Throughout the history of jurisprudence, courts have been one of the most important tools that civilized societies have to insure justice and equality for every citizen within their jurisdiction.  On May 7th, 2012, it was one regional court in Cologne, Germany that issued the ruling that we now commemorate every May 7th as the Worldwide Day of Genital Autonomy.

The essential holding of the Cologne ruling is that "a [medically unnecessary] circumcision, 'even when done properly by a doctor with the permission of the parents, should be considered [a] bodily harm if it is carried out on a boy unable to give his own consent.'"

The essential fact of the Cologne ruling is that it was symbolic: it had little or no practical effect because the German Bundestag shortly thereafter passed legislation explicitly permitting non-therapeutic penile circumcision - legislation that, of course, superseded the ruling. 
The essential significance of the ruling, however, is that it represented the first time that a legally-instituted body officially recognized that people with penises actually have a right to decide for themselves what part of their penises they may keep and what part gets cut off.  It was the first time that a court recognized that non-therapeutic penile circumcision is a harm in and of itself and that, when imposed on a child without his consent, his right not to be physically harmed is violated.  Thus, while this may have been one legal decision by one regional court with little or no practical effect, for the genital autonomy movement it was the legal shot heard round the world.
The deeper significance, then, of the Cologne ruling is that it transcended the personal interests of the child whose medically unnecessary penile circumcision led prosecutors to bring charges against the physician who had committed it.  The Cologne ruling was a vindication of the rights not only of that child but of every child born with a penis.  And, although the Cologne ruling pertained strictly to penile circumcision, the Worldwide Day of Genital Autonomy, to its credit, regards the right to genital autonomy as universal, meaning that it is a right that belongs to every human being irrespective of sex, gender, nationality, religion and irrespective of the particular shape or structure of an individual's genitals.
The concept of universal human rights is important not only because it means that the rights apply to everyone equally but because the concept itself provides a moral framework in which each of us can extrapolate from our own unique situations to those of others from whom we differ.  That is why WWDOGA seeks to bring together advocates from every genital autonomy movement: not just those of us working to end male genital cutting but those working to end female genital cutting and intersex genital cutting, too.  Likewise, we at GALDEF believe in the universality of the cause of genital autonomy and we also recognize the strategic importance of making common cause with other genital autonomy movements.  This is reflected in our Values Statement in which GALDEF expresses its "solidarity with female and interesex victims of genital cutting. . . ."  
Sooner or later the world will recognize what the regional court in Cologne recognized eleven years ago.  Either there is a fundamental right to genital autonomy that applies to everyone regardless of sex or there isn't.  And, if there is, sooner or later that right must be recognized by unbiased courts in the constitutions and statutes that already exist or it must be enshrined in constitutional amendments or codified in new legislation.  Whatever course this campaign takes and however long it takes, GALDEF will be fighting for the right of every child to grow up with their genitals uncut, unharmed and intact. 



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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He is a licensed physical therapist and writes about bodily autonomy and human rights, gender, culture, and politics. 
He currently serves on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.

Wednesday, April 26, 2023

Some Thoughts on "They" as a Singular Pronoun and Other Linguistic Pet Peeves

by David Balashinsky
I had the good fortune to be off from work yesterday and so had the opportunity to listen to Here and Now which, where I live, airs on WSKG radio at 12:00 noon.  Yesterday's show featured an interview with sociolinguist and author Valerie Fridland who was there to discuss her new book, Like, Literally, Dude: Arguing for the Good in Bad English.  

I was not aware of the fact that so many people become so exercised about their linguistic pet peeves or what they believe to be misuses of the English language as to become impelled to write indignant emails about them to radio shows.  However, this phenomenon formed the backdrop not only of yesterday's interview but also (at least to some extent) of Fridland's book which on her site is described as "A lively linguistic exploration of the speech habits we love to hate - and why our 'like's and 'literally's actually make us better communicators."  
For my part, I do not object to "like" nearly as much as I object to "you know" but that phrase did not come up during the interview.  (I do not know whether Fridland addresses "you know" in her book and, if she does, whether she is as forgiving of it as she is of "like," "literally," "um" and ""uh.")  However, I found myself experiencing my own outrage at certain usages that did come up during the broadcast.  Not coincidentally, these happen to be several of my own favorite pet peeves so, like any indignant language lover who fires off an angry email, I am sharing them now - except, of course, that I get to vent spleen here on my blog. 

First is the use of the singular "they." I loathe the use of "they" as a singular pronoun not because I oppose the existence of a gender-neutral pronoun but simply because "they" is already taken (as a plural) and its use as both a singular and a plural is often confusing and grates on the ears like fingernails on a chalkboard.  There really should be a better alternative and I hope someone can come up with one.  In the interview, Fridland claims that "hundreds" of alternative, gender-neutral singular pronouns have been tried but that none has caught on in the way that "they" has.  Fridland attributes this to the fact that the use of "they" as a singular pronoun is "an organic development."  Not having read her book, I do not know how Fridland defines this term but it's probably safe to assume that by "organic development" she means a change in language that is unconscious and "natural."  I understand that English is always changing but I also know that people misuse words all the time and how we speak is inevitably influenced by what we hear and learn from others.  For this reason, common misuses of words tend to spread and become even more common until at last, through the alchemy of semantic change, a frequently misused word becomes a legitimate way of expressing the idea that it was formerly improperly used to convey.  
Is that a good thing or a bad thing?  Well, after contacting Fridland directly and receiving not one but two very gracious and hugely enlightening responses, I believe it is fair to say that, at least from Fridland's perspective, it is neither.  A sociolinguist views the evolution of language much as a biologist views evolutionary changes in a species over time: these changes are neither "good" nor "bad" but merely adaptive.  As Fridland pointed out in her first email, the pronoun "you," exactly like "they," is used in both a singular and plural sense and this does not seem to bother anybody - at least not now.  I hadn't considered this and, honestly, this got me 98 per cent of the way there. 
And yet it is hard for me to let go of the idea that not every change is for the better.  Isn't it possible that, while language may be characterized by "organic development," like everything else it also tends to degrade from sheer entropy?  Over time, a building will begin to sag and its foundations give way until the building collapses.  At room temperature, food will decay and what once might have been dinner is now slimy and putrid.  That might be great for bacteria but it's not so great for the larger, more complex organism who was hoping to make a meal out of that rotting food.  This illustrates the principle that, that depending upon one's point of view, change can be either "organic development" or simply organic decay. 
But this is where the view of the sociolinguist can actually be liberating.  As Fridland explained to me in her second email,
Over the long haul, language evolves in ways that meet the needs of speakers, but not always in ways that meet the social desires of those who have come to feel tied to the conventions of use at any one point in time on the long continuum of a language's history.  This is the crux of why people are so vehement in their views about language - it is a resource both intensely personal (communicating our own views and experiences) and, at the same time, communal (based on a set of conventions and usages that arise via collective agreement).  When people start messing with what we feel is established as normative use - especially when those speakers belong to groups less valued or well thought of socially, economically and politically (be it due to age, gender, ethnicity or region) - it irks us that they are changing the conventions we have helped to establish.  Toss in the fact that these norms have been taught to us every year in grammar class and so are validated in that way that these new forms are not and you get fierce opposition.  I think what is key is to realize that many of the forms that one or two centuries ago really angered people are now the things we all say without the dissolution of our ability to communicate having resulted.  One great example is that we now are not only using 'you' for both singular and plural but also using it as a subject pronoun (as in "You went home") when 'you' historically was only used for objects, and 'ye' was used exclusively for subjects.  In the 16th century, 'you' and 'ye' seem to have started to fall together, likely because in fast speech they sound similar and because in certain sentences it was a bit hard to tell which one should be used.  For instance, "ye know that man" becomes 'Know ye that man" where the subject 'ye' now is in a position that 'you' typically occupies, i.e., following the verb. Thus 'you' started to get used in that case instead, creeping into 'ye' territory one grammatical inch at a time.  The result?  Now all we say is 'you' and 'ye' is nowhere to be seen.  Has language been destroyed because of this change we didn't even know had happened?  Not really.  But when someone today does something similar such as saying "him and I are going to the party," we get upset with this grammatical infraction - one which we actually commit every time we use 'you' as a subject.  We might socially disfavor it, but that is . . . [no] worse . . . than what we did with 'you' and 'ye.'
That got me the rest of the way there - at least, intellectually.  And yet I still have a visceral antipathy for the singular "they."
There is another dimension to the question of whether "they" ought to be accepted as both a singular and a plural pronoun.  In realms such as language, where education, skill, artistry and rules figure prominently (and aren't these precisely what give language its charm, beyond its strictly utilitarian function?), changes over time can be either conscious and inorganic or unconscious and organic.  An example of a conscious, inorganic change in language - and one, for the better, in my opinion - would be the now ubiquitous title "Ms." as an alternative to "Miss or "Mrs."  There was nothing at all natural or "organic" about the way "Ms." was incorporated into everyday usage.  Its adoption and popularization were the result of very conscious and deliberate campaigns which arose in response to the inherent sexism of the use of either "Miss" or "Mrs."  
A further development along these lines would be to abandon "Ms." and "Mr." altogether in favor of a gender-neutral title such as "Mx.," which is now the leading choice among those expressing a preference.  To me, however, "Mx." seems inelegant and awkward in the same way that "Latinx" does.   On the other hand, "Ms." undoubtedly seemed unnatural and awkward when it was introduced, also.  And while there is a certain logic and even validity to "Mx.," the same, apparently, cannot be said of "Latinx." 

"They," as a singular pronoun, falls somewhere in between the organic development that Fridland talks about and the inorganic change in language that is consciously advocated as a way to rectify inequity, as in the case of "Ms."  I do not dispute that "they" has a long history of use as a singular pronoun but the organic development by which it came to be used was not a result of gender consciousness or of a rejection of heteronormativity and sexual-binary normativity.  People have misused "they" when they meant to say "he" or "she" for decades.  It is only recently that advocates for a more inclusive language have argued for the use of "they" specifically as a gender-neutral singular pronoun.  That is certainly a much more valid reason for its use than sheer carelessness or ignorance.  
That said, and aside from my longstanding objection to the use of "they" as a singular pronoun on strictly grammatical and aesthetic grounds, my argument has been that, if we are going to use "they" as a singular pronoun, we should at least follow the rule of grammar that a pronoun and a verb must agree in number.  In other words, we should be consistent, especially if there is any hope of the singular "they" acquiring any grammatical legitimacy.  Thus, for example, one ought to say "they is," not "they are."  Here are several additional examples of the correct way to use "they" as a singular pronoun in a sentence: "They is the president and CEO of that organization," or, "They writes for The Guardian and is a frequent contributor to other publications," or, "They is going to be delivering a lecture on semiotics which you won't want to miss because they is the leading expert on this topic."  Admittedly, using the correct verb forms, as in these examples, grates on one's ears, but no more so than the singular "they" does.  And if we are being asked to get used to "they" as a singular pronoun, don't we have a right to expect the champions of the singular "they" to get used to conjugations such as "they is"?
On the other hand, though, there is the powerfully convincing example that Fridland cites in which "you" is used as either a singular pronoun or a plural pronoun but always with a verb form as though it were a plural.  We never say "you is."  Yes, maintaining agreement in number between the singular "they" and the accompanying verb would serve the purpose of making it clear that one is speaking about one person and not more than one and so avoid the confusion that may occur with the use of the singular "they," as in this example: "The committee members and the chair could not come to an agreement about the budget because they were afraid that the funds would not be allocated properly."  In that sentence, does "they" refer to the committee members, to the chair of the committee, or to all of them?  Now try this: "The committee members and the chair could not come to an agreement about the budget because they was afraid that the funds would not be allocated properly."  Awkward, yes, but at least we understand that it is the chair of the committee and not the committee members who has reservations about approving the budget.   
Of course, all this awkwardness and confusion could be avoided by using a different, gender-neutral pronoun altogether.  However, if we are to use the singular "they," using it in a way that preserves agreement in number between the pronoun and the verb would, over time, as our ears become accustomed to it, have the added virtue of conferring more legitimacy on the use of "they" as a singular, specifically gender-neutral pronoun because it would make it unambiguous that the speaker used "they" deliberately as an affirmation of the non-binary gender of the person being spoken about rather than that the speaker used "they" simply out of carelessness.
To be clear, I am not objecting here to a person's choice of pronouns but to the inappropriate use of the verbs that accompany them.  As I have written elsewhere, I respect the right of everyone to identify herself, himself, or themself in any way that she or he or they chooses to.  Indeed, I do not regard it as "woke" so much as common courtesy to respect the wishes of each person to be addressed and identified as she, he or they wishes.  (And I say this not only as someone who bristles when people presume to call me "Dave" rather than by my real name - David - but as someone who legally changed his last name as an act of public repudiation of what I had long regarded as the ethnic self-abnegation of my forebears.)
So much for "they."  Secondly, I was flabbergasted to hear Professor Fridland use the expression "flash forward" (at 4:40 in the interview). No! No! No! It is "fast forward" - not "flash forward." This expression is used metaphorically - as Fridland used it - but comes, unless I am completely mistaken about this, from tape cassette players which included a "Play" button, a "Stop" button, a "Rewind" button and - you guessed it - a "Fast Forward" button.  If one wanted to quickly advance the tape, one would press "Fast Forward," hence the use of this phrase to mean rapidly advancing and skipping over the contents of something in order to get to the desired location much later on or farther along in the sequence.  "Fast forward" is therefore now used synonymously with phrases such as "skipping ahead to the present time. . .," or "bringing us up to the present moment. . . ."   "Flash forward" seems to be a corruption of "fast forward" and it also seems to be used exclusively by young people - at least, I have only ever heard young people use it.  This tends to confirm what I suspect is the cause of the change from "fast forward" to "flash forward," namely, the fact that most young people nowadays have never even seen, let alone operated, a tape cassette player.  They are, however, familiar with flash drives.  It is my hypothesis, therefore, that their familiarity with this more contemporary recording technology is the source of the corruption of "fast forward" into the increasingly prevalent "flash forward."  I also have to infer from her use of "flash forward" that Fridland falls into the category of post-boomer.
The broader point of Fridland's comments and, I assume, of her recent book, is that, because language is always changing and because this change reflects a natural process - the organic development of language cited above - one should respect neologisms and new constructions and be less dogmatic about English.  Fair enough.  But this raises another point which is my third pet peeve. Namely, if language is always changing, including its grammatical rules, the meaning of words, etc., then why even bother teaching grammar in the first place?   Why teach English as a subject to native English speakers?  When I was in elementary school, we all laboriously diagrammed sentences and learned what words to use, how to use them and how not to use them.  Was that all a gigantic waste of time?  It seems as though what Fridland is arguing is that every usage is valid.  Anything goes.  This would be consistent with what one of my English professors back in college stated, namely, that dictionaries are descriptive, rather than prescriptive.  As it happens, though, this is emphatically not what Fridland is arguing.  As she explained to me,
Language is self-sustaining and a remarkable and highly rule governed system - just not by the rules we tend to think of when we talk about 'language rules' typically.  People often mistake linguists to be saying there are no rules, but this is far from true.  Language can't operate without cognitive and articulatory rules that are deeply tied to how we understand and produce language. . . .  Natural inherent linguistic rules . . . allow language to keep thriving and changing without losing meaning or utility. . . .
These "inherent linguistic rules" differ, then, from "the social rules that have just become what we like to do [but do not reflect] what we need to do as language speakers."
So perhaps it's not unreasonable to say that, at least to some extent, the rules of grammar that we all struggle with are constructs (and, therefore, artificially rigid) in a way that the "cognitive and articulatory rules" to which Fridland refers are not.  If I understand her correctly, what Fridland is saying is that the formal rules of grammar - as taught - differ from the inherent logical rules of language itself.  I can accept that.  But if that is true, then I still maintain that no professor or grade-school teacher should ever again wield the red pen when grading a student's paper and criticize or "correct" her grammar, spelling, punctuation or (alleged) misuse of a word.
One last point - you'll notice that I used the pronoun "her" rather than "their" just now to refer to an individual of unspecified sex or gender.  As much as I loathe the use of "them," "they" and "their" in the singular, I also appreciate that the universal "he" or "him" when used to refer to an unidentified individual reflects the patriarchal and sexist roots of our society and actually perpetuates patriarchy and sexism by reinforcing the concept that maleness is the standard or the default in relation to which everything else is a subsidiary variation.  Accordingly, for decades now I have (with rare exceptions) used "her" or "she" instead of "him" or "he."  It's true that feminine pronouns are not inclusive and therefore "privilege" females, however, I figure that white males have enjoyed the benefits of affirmative action in language as in most other things for at least 5,000 years so it's probably time to give someone else a chance.

Revised, and with grateful acknowledgement to Professor Valerie M. Fridland, Ph.D., on 30 April 2023

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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He is a licensed physical therapist and writes about bodily autonomy and human rights, gender, culture, and politics. 
He currently serves on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.

Monday, March 6, 2023

You Say "Tetra-"; I Say "Quadri-". . . Let's Call the Whole Thing Off

by David Balashinsky

As a physical therapist, one of my responsibilities - to my patients and to the profession - is to keep learning.  Whether it's to learn about new developments in the field or treatment techniques with which I might not be familiar, I am obligated to take continuing education courses.  (I am also legally required to do so, just as most licensed healthcare professionals are, as a condition for renewal of my license every three years.)  These are generally lectures online or in person that can last from as little as a couple hours to several days and that cover myriad topics related to physical therapy.  

Physical therapy, incidentally, is a great field, not least because it is so rewarding for the therapist and beneficial to the patient but because it addresses so many different types of diagnoses and encompasses so many different types of treatment techniques.  Physical therapists treat patients with strokes, cancer, fractures, joint replacements, pelvic-floor dysfunction, neuropathies, vestibular problems, amputations and many other conditions, as well.  They treat the young and the old, female, intersex, male, gay, straight, transgender, cisgender and everything in between and beyond.  The number and type of continuing "ed" courses available, therefore, is as vast and diverse as the diagnoses and patient populations it is our privilege to serve.

One of the most serious types of injuries that physical therapists treat are spinal cord injuries.  Most people are fortunate enough not to have to cope with the day-to-day challenges of living with a spinal cord injury (SCI) or even to think about what that might be like.  The statistics, by themselves, do not adequately convey a sense of the gravity of this condition.  For that, I encourage you to listen to first-person accounts of people living with SCI.  But, for what it's worth, there are roughly 300,000 people with SCIs living in the United States.  Interestingly, the sex identification of about 78% of all new reported cases of SCI (since 2015) is male.  Motor vehicle accidents are the leading cause of SCI followed by falls, but other "common" causes are acts of violence (primarily gunshot injuries) and injuries resulting from sports and recreational activities.  

The type and severity of SCIs are categorized according to a system of classification established by the American Spinal Injury Association (ASIA).  This system, which is known as the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is used throughout the United States and abroad and is considered "the gold standard" for SCI classification.  (The ISNCSCI includes the ASIA Impairment Scale [AIS] but, although the AIS classification of SCI is derived from and, therefore, constitutes just one part - a major part but, still, only one part - of the battery of sensory and motor testing that comprise the ISNCSCI, in the jargon of healthcare "the ASIA" has come to be used to refer broadly to the ISNCSCI itself.)

I was introduced to the ISNCSCI and the AIS in physical therapy school but it was only an introduction.  In a class on inpatient rehabilitation, we watched a video that demonstrated how to perform the elements of "the ASIA," one of which is to insert a gloved index finger into an anus in order to check for sensation to deep anal pressure and voluntary contraction of the external anal sphincter.  (The thing I remember most about this is one of my classmates asking if he could please watch that part of the video again.)  Like much if not most of what one learns in a physical therapy program, this was just an introduction to material that one cannot possibly hope to master without additional training and, above all, experience - preferably under the guidance of more experienced therapists.  Although I have worked with SCI patients over the years, the inpatient rehabilitation facility (IRF) where I work does not typically receive patients during the acute phase of their (newly diagnosed) spinal cord injuries.  Largely for this reason, I have not had occasion to use the ISNCSCI and have never acquired what I felt was a sufficient grasp of how to administer it and how to interpret its results.  This is why I chose, a couple weeks ago, to enroll in a series of continuing ed courses devoted to SCI and to "the ASIA."

It was while taking these courses that I was reminded that there has been an effort underway by the leading authorities on SCI to replace the term "quadriplegia" - which is how most of us, at least here in the United States, know it - with "tetraplegia."  These words mean the exact same thing and are defined as

impairment or loss of motor and/or sensory function in the cervical segments of the spinal cord due to damage of neural elements within the spinal canal.  Tetraplegia results in impairment of function in the arms as well as typically in the trunk, legs, and pelvic organs. . . .

For a long time, I have been dimly aware of the fact that there is an official policy of preference for "tetraplegia" over "quadriplegia."  Revisiting these topics, I discovered that the ISNCSCI explicitly says so.  What I have not known is why.  Seeing "tetraplegia" used again and again in these courses rekindled my interest in understanding the reason for this change in nomenclature.  I was finally able to find an explanation for it on the website of the online organization, facingdisability.com:

We get asked about this subject a lot, “What’s the difference between quadriplegia and tetraplegia?” 

Surprisingly, there isn’t any difference in meaning. Both words apply to paralysis of all four limbs.  And both terms are used interchangeably these days.

The difference is in the derivation of the words.   The word “Quadri” means four in Latin; the word “Plegia” means paralysis in Greek.  So the roots of the word “quadriplegia” which means paralysis in all four limbs, come from both Latin and Greek. It combines two different languages.

The Greek word for four is “Tetra.”  Combine that with “plegia” and you have a word with Greek roots for both halves.  The British have always used the term “Tetraplegia” for four-limb paralysis, so they are not combining Latin and Greek words.

Such distinctions are important to the English, but Americans don’t seem to mind. Although there was a movement in the 1990’s to try to adopt “tetraplegia” in America, it never really caught on outside of the medical literature.

That’s why most Americans still continue to refer to “quad rugby,” for example, and why the word “quadriplegia” remains in common use.

Incidentally, since “para” is the Greek word for two, and “plegia” is Greek for paralysis the word “paraplegia” all comes from the same language of origin—Greek.

As much as I revere (and generally comport myself with due deference to) experts and expertise, I am also, by nature, highly skeptical of (and even hostile to) neologisms.  This holds as much for those that fall from the spires of ivory towers as it does for those that arise from the propagation bed of vernacular.  Learning the reason, therefore (and at long last), for the use of "tetra-" versus "quadri-"elicited from me an especially large eye-roll.  Could the clash of civilizations that threatened to result from the pairing of the Latin "quadri-" with the Greek "-plegia" possibly matter less?  Are the Barbarians - with their battle axes and their "quadri-" - not just at the gate but inside, and in need of expulsion?  (Except, of course, that the Barbarians, in this case, are not the Greeks but the Romans themselves.  And, in any case, the civilizations of antiquity frequently learned and borrowed from one another.)  

I am a language purist as much as anyone but I am also an American: after this initial reaction, my patriotism took hold of me.  I take pride in the fact that every person in this country is or is the descendant of immigrants, including Native Americans who were themselves "immigrants" in the Americas (long before they were "the Americas") many thousands of years before the Vikings and the Europeans were, and that, perhaps more than any other nation on Earth, the United States is woven from the myriad cultures, ethnicities, races and nationalities that make up the ornate tapestry of the American body politic.  I admit it: I am one of those who believe that diversity is a positive good.  When I was young, the concept of "the melting pot" was instilled in us as part of our civics instruction in elementary school.  After Alex Haley (and many others) and the recognition that what "melting pot" really meant was Anglo-conformity, that metaphor was replaced by one which was much more apt.  This one - "a gorgeous mosaic" - was popularized by David Dinkens, although apparently it was coined by Mario Cuomo, who referred to my home town, New York City, and to the United States as "a magnificent mosaic."  This concept - the mingling of people and cultures as coequals in which their individual identities are retained and honored yet, at the same time, are subsumed within a single whole for the greater good - I believe is epitomized by the word "quadriplegia."  It is a word that marries two languages and two cultures; it is like Cleopatra and Mark Antony.  Opposition to the use of "quadriplegia" on the basis of its impurity seems as contrary to my view of people and America and is almost as offensive to my values as are anti-miscegenation laws.

Then, there is the problem that well-meaning efforts to change terminology often just fall flat for other reasons.  The prefix "tetra" is undeniably beautiful in and of itself.  It elicits associations with such naturally elegant structures as tetrahedrons and such beautiful creatures as "tetras" (short for tetragonopterus).  Contrast "tetraplegia," however, with another recent effort to change the medical nomenclature from "stroke" (or cerebral vascular accident - CVA) to "brain attack."  Yes, that really happened.  A number of years ago, there was a similar effort to begin using "brain attack" to describe a stroke on the principle that the etiology (at least in the case of an ischemic stroke, which is caused by the obstruction of blood flow through an artery) is the same as that which results in a heart attack.  (In contrast, a hemorrhagic stroke results from the rupture of a blood vessel so it's unclear to me whether "brain attack" advocates intended that this should refer to both ischemic and hemorrhagic strokes or merely to those that had in common with heart attacks a mechanism involving an arterial blockage.)  Like "tetraplegia," "brain attack" never caught on, possibly because it sounds less like a medical diagnosis than like the title of a trashy 1950s science fiction movie.  Still, this example should stand as a warning to all who would attempt to change diagnostic terms from those that are near and dear to our hearts to those that are alien.

Of course, most of the medical terminology that has come down to us comes from both Greek and Latin.  Moreover, there are plenty of words in common use that combine Greek and Latin elements.  Words such as "appendicitis," dehydration," and "mononuclear."  "Mononucleosis" is created from first a Greek element (monos), then a Latin element (nucleus), and then another Greek element (osis).  I don't see anyone rushing to purify these terms by converting them to either all-Greek-based or all-Latin-based elements.

For me, what matters most - what should matter most - is what people living with SCI themselves prefer.  I sought the answer to that by joining several SCI support groups on Facebook, identifying myself as a physical therapist and posting a query as to whether anyone had a preference for either "quadriplegia" or "tetraplegia" and, if so, why.  Although I did not get a large response (so my informal survey has no scientific validity whatsoever), the consensus seemed to be that we should leave well enough alone and stick with "quadriplegia."  I did receive one particularly thoughtful and illuminating reply from someone who, though she had not herself sustained a spinal cord injury, was a close family member of someone who had.  As it happens, she also identified herself as a Latin teacher and a classicist and she therefore began her response by acknowledging her familiarity "with the problematic Greek-and-Latin combining phenomenon in English words," adding that "it bothers some language fans more than others."  (I replied that I could hardly imagine anyone being better suited to answer my question.)  This respondent ultimately expressed a preference for "tetraplegia," explaining that "I favor 'tetraplegic' because it is unfamiliar-sounding and the first feeling I have on hearing it is curiosity, not fear."

What is notable about that response is that it validates this person's own feelings and lived experience relative to SCI, rather than falling back on deference to authority.  That puts her sentiments in line with those who express a preference for "quadriplegia."  Both are equally valid and it is my intention, going forward, to respect that preference, whichever it may be.  None of what I have learned recently has undermined my belief that the right of patients and of all individuals to choose their own identifiers, names and designations (and, yes, even their own pronouns) should always be respected.

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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He is a licensed physical therapist and writes about bodily autonomy and human rights, gender, culture, and politics. 
He currently serves on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.

Monday, February 6, 2023


by David Balashinsky 

February 6, 2023 is the twelfth anniversary of the International Day of Zero Tolerance for Female Genital Mutilation.  This annual observance was established by the United Nations General Assembly as an occasion "to raise awareness, renew commitments and reiterate that female genital mutilation is an unacceptable harmful practice and a violation of women and girls' basic human rights."

The Genital Autonomy Legal Defense and Education Fund (GALDEF) supports the United Nations' goal of ending female genital cutting (FGC) worldwide.  We agree that FGC is an inherently harmful practice that violates the fundamental right to bodily integrity of those who are subjected to it.  As our Values Statement makes clear, GALDEF stands in full "solidarity with female and intersex victims of genital cutting. . . ."  Likewise, the United Nations' goal of eradicating FGC is consistent with GALDEF's Vision: "To create a world where the rights of children to bodily integrity and future autonomy over their genitals and their sexuality are respected."

In light of our Values and Vision, GALDEF believes that it is incumbent upon us to join the many voices around the globe on February 6 calling for an end to FGC and we are proud to do so.  At the same time, we believe that it is equally incumbent upon us to point out - and equally incumbent upon the international community to recognize - the ongoing disparity between the widespread condemnation of genital cutting of girls (or people with vulvas) and the continued tolerance of genital cutting of boys (or people with penises) and intersex children.  

We believe it is necessary to call attention to this disparity in part because of the harmful effects it is having on efforts to end FGC, itself.  As the universal right (irrespective of sex) to genital autonomy has gained popularity, the position that genital cutting of girls should be prohibited under all circumstances while genital cutting of boys should continue to be permitted has become untenable.  In recognition of this changing cultural landscape, defenders of male genital cutting (MGC) are therefore increasingly arguing that certain "benign" forms of FGC should be permitted.  At the same time, the widespread medicalization of MGC in the United States has provided a convenient model for proponents of FGC.  The result is that, more and more, FGC is being performed by medical professionals, undermining efforts to eliminate this practice.  In both of these ways, then, the continued tolerance for MGC will only undermine efforts to end FGC.

Apart from these practical, strategic concerns, however, is the matter of basic fairness and equitable treatment.  Paradoxically, the United Nations' official theme for this year's observance of the International Day of Zero Tolerance for Female Genital Mutilation is "Partnership with Men and Boys to Transform Social and Gender Norms to End Female Genital Mutilation." Yet, while it is estimated that about 250 million girls and women worldwide have been subjected to genital cutting, it is also estimated that about one billion boys and men worldwide have been subjected to genital cutting.  It is unknown how many intersex individuals worldwide have been subjected to intersex genital cutting (IGC).

We do not believe that a moral distinction can be made between the medically unnecessary genital cutting of children based upon nothing more than a child's sex or the appearance of that child's genitals.  GALDEF believes that all children, regardless of sex, have a fundamental and inherent right not to have their genitals cut, scarred or surgically modified in any way without their consent and when not urgently and medically indicated.  By the same token, we do not believe that the goal of ending FGC is "trivialized" or efforts to end it undermined in any way by making common cause with the movements to end MGC and IGC but, rather, will only be strengthened by doing so.  A moral principle is always more powerful when applied universally.  If the United Nations is to succeed in situating its campaign of zero tolerance for FGM on a solid moral foundation and if it is to succeed in its goal of ending FGM, it will have to revise its policy of tolerance for male genital cutting and adopt a position of universal respect for genital autonomy, regardless of sex.

It is in this spirit of universal respect for genital autonomy and in observance of the International Day of Zero Tolerance for Female Genital Mutilation, February 6, 2023, that GALDEF reiterates its support of the right of genital autonomy for girls and for all children and calls upon all people of good will who value human rights to do the same.

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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He is a licensed physical therapist and writes about bodily autonomy and human rights, gender, culture, and politics. 
He currently serves on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.


Tuesday, January 3, 2023

One Cat's Short Life and Thoughts for 2023

by David Balashinsky

On New Year's Day, 2023, my wife received a call from the office manager of the animal hospital where she works as a veterinarian.  The day before, after hours, someone had dropped off a sick stray or feral kitten.  The kitten had been placed in a cloth carrier and left outside by one of the entrances.  (Note to people who dump animals, including Good Samaritans: leaving a sick animal in a carrier overnight in the dead of winter without food or water is a terrible idea.)  Although the hospital was closed for the holiday weekend, by chance, the office manager had gone in to attend to some outstanding clerical work.  That is the only reason the kitten was still alive when she found him.  By then it was obvious that the kitten needed either urgent veterinary care to save his life or euthanasia to spare him needless suffering.  After placing him in a cage with food and water and covering him with towels, the office manager called my wife.  When the call came, we were both hunkered down, so we thought, for the rest of the day.

If you have dogs and cats living with you, as we do, one of the fringe benefits of being married to a veterinarian is free house-calls.  On the other hand, being married to a vet has imposed obligations on me that I never imagined I would have to assume.  For example, I always  accompany my wife whenever she goes to the animal hospital on an emergency call in the middle of the night.  I do this not only for her safety and to provide moral support but because there are no overnight staff at the hospital.  Accordingly, there are times when I have to assume the role of veterinary assistant, also.  Once, many years ago, my wife had to go in at about 2:00 in the morning in order to euthanize a hopelessly ill, elderly dog.  I had to assist her while she ran the IV and injected the drug.  My wife dealt with this almost as if it were nothing.  For an experienced vet, this was standard protocol: the dog was beyond hope so euthanizing him was the only humane course of action.  I, however, had never even witnessed a euthanasia, let alone having assisted in one.  My job was to restrain the dog and apply pressure to one of the veins in his right foreleg while my wife inserted the needle (although he was so docile that it was more like embracing him than restraining him).  He was about forty pounds, had grey shaggy fur and large brown eyes.  I will never forget the searing emotional conflict between the pity that I felt for this dog and the guilt that I felt for my role in ending his life.  And I will never forget how trusting, innocent and unknowing of his fate he seemed in his final moments.  When it was done, I sobbed and sobbed and sobbed.

I wonder if the public fully appreciates the toll being a veterinarian can take on someone.  What emotional fortitude must it take to end an animal's life, even though euthanasia is almost always the ethical choice (and my wife has a strict policy against performing "convenience" euthanasias).  What degree of commitment and self-sacrifice are required to get up at 2:00 in the morning or simply to drop everything on a crappy New Year's day in order to attend to an animal in need.  I am reluctant to cheapen these reflections with any mention of money but I also think, in fairness to veterinarians everywhere (and to my wife), that it should not go unacknowledged that, in cases like this, there is no compensation because there is no bill.  (Who would it be sent to?)  The ministrations with which my wife rang in the new year were performed strictly for the sake of the kitten's welfare.

Here is a picture of him:

These are the most likely and obvious conditions from which, according to my wife, this kitten was suffering.  He had an upper respiratory tract infection (the mucus dripping from his nose is visible in the picture above).  He had pneumonia.  He had fleabite anemia (fleas do not just cause itching and irritation to the skin but feed on their host's blood).  He had hypothermia.  He was malnourished and emaciated (he weighed under two pounds yet, based upon his likely age, which my wife was able to gauge by his teeth, he should have weighed five or six).  He had diarrhea and his gut had likely been colonized by intestinal parasites.

Here are some pictures of my wife attending to him:

My wife quickly got to work providing the emergency treatments that would be needed to save the kitten's life.  All I could do, besides petting him and trying my best to comfort him when my wife wasn't working on him, was look on in awe.  I felt privileged, although it came at an enormous cost for the kitten, to be a witness to the drama unfolding before me.  I was reminded of the enormous admiration I have for my wife's skill and dedication.  I allowed myself to hope that she could save the kitten's life and it occurred to me that watching her do it was probably among the best possible ways I could spend New Year's Day.  This entire holiday season, after all, is my favorite time of year because I regard it as a time of renewal, rebirth, and new beginnings.  I am always on the lookout for the deeper meaning in things and this kitten's struggle to survive and my wife's valiant efforts to save him seemed the ideal source for a homily about what the holiday season really means.  I had already begun mentally composing it - the kitten's new lease on life would serve as a metaphor for the new year while my wife, by virtue of her diligence, generosity, and steadiness under trying circumstances, would serve as a paragon of how we ought to approach the new year, and life in general -  when the kitten commenced his death throes and suddenly, quickly and quietly expired.

Nature is heartless.  Life itself sometimes seems sadistically cruel.  What I had hoped would serve as an uplifting story with which to inaugurate 2023 became, instead, like so many other stories, one that ended in defeat and in death.  I was ready to forget the whole miserable episode. 

But maybe the more important meaning in this is that, although success is never guaranteed, we still have to try.  What if the Good Samaritan, misguided as she or he was, had not even bothered to try to rescue the kitten?  Its fate would have been sealed.  What if my wife had not intervened with emergency measures to try to save his life?  It would have ended just the same but without the modicum of comfort that we were able to provide the kitten during its final hours.  If 2023 doesn't look all that promising, that only means that we need to muster more resoluteness, more courage and more commitment to ending suffering, saving lives, expanding rights and making the world a better place, even though, sometimes, we will fail.  Because, sometimes, we succeed.  That's the thought I intend to carry with me into 2023.

Tuesday, November 1, 2022

Dear Rachel E. Gross: Welcome to Our World

by David Balashinsky

The New York Times recently published an article by Rachel E. Gross, "Half the World Has a Clitoris. Why Don't Doctors Study It?"  As stated in its subheading, the premise of Gross's article is that the clitoris is "'completely ignored by pretty much everyone,' . . .  and that omission can be devastating to women's sexual health."  One of the leading experts in the field of sexual medicine whom Gross interviews uses the metaphor of "a small town in the Midwest" to describe the prevailing attitude among physicians about the vulva.  Paraphrasing him, Gross writes, "Doctors tend to pass through it, barely looking up, on their way to their destination, the cervix and the uterus."  But if the vulva "is an underappreciated city," Gross continues, "the clitoris is a local roadside bar: little known, seldom considered, probably best avoided."

On its face, there is nothing wrong with Gross's argument that the clitoris has been given short shrift by the medical profession.  No one even marginally familiar with the history of anatomy and the medical profession's historical treatment of women1 can be surprised by that.  The problem with Gross's article is its underlying assumption that medical knowledge of the clitoris stands in marked contrast to medical knowledge of the penis.  More particularly, that physicians' general knowledge of the clitoris is as meager as it is simply because it is proportional to their concern for the sexual pleasure and satisfaction of people with vulvas.  This lack of concern, Gross contends, not only contrasts with physicians' concern for the sexual pleasure and satisfaction of people with penises but ultimately is the chief reason for this difference in knowledge.  As Gross explains (citing Dr. Rachel Rubin, a urologist and sexual health specialist), the "clitoris is intimately bound up in female pleasure and orgasm.  And, until very recently, those themes have not been high on medicine's priority list, nor considered appropriate areas of medical pursuit." 

Reinforcing her argument that, when the medical profession does turn its attention toward women's reproductive health, its orientation is one of disease-prevention or cure (or facilitating or preventing pregnancy) as opposed to women's sexual pleasure, Gross quotes Dr. Frances Grimstad, a gynecologist at Boston Children's Hospital: "We don't do a great job . . . talking about sex from a pleasure-based perspective.  We talk about it from a prevention standpoint. . . .  We don't talk about sexual pleasure."

Although the focus of her article is on the clitoris itself, Gross emphasizes the contrast between medicine's putative preoccupation with male sexual pleasure and its indifference to female sexual pleasure:

Even in fields like urology, where male sexual pleasure and orgasm are considered integral, women's sexual health "is seen as hysteria, Pandora's box, all psychosocial, not real medicine, said Dr. Rubin. . . .   Sexual health and quality of life is not something we focus on for women."  (In contrast, Viagra is one of the most lucrative pharmacological drugs in recent decades, bringing in tens of billions of dollars to Pfizer since being introduced in 1998.)

It's significant that Gross mentions Viagra here, particularly in support of her thesis that male sexual pleasure and orgasm are of so much greater concern to physicians than women's sexual pleasure and orgasm are.  To be clear, Viagra has nothing whatever to do with "male sexual pleasure" and it is not male sexual pleasure but urinary function that is "integral" to urology.  Strictly speaking, Viagra doesn't even have anything to do with male orgasm since an erection is not necessary to have one.  Yet, in making this reference to a drug that is used exclusively to treat erectile dysfunction and no other sexual dysfunction that afflicts people with penises, Gross conflates penile erection with sexual pleasure.  In other words, she reduces male sexuality to performance: erection (and, presumably, ejaculation).  This construct reflects and perpetuates traditional patriarchal concepts of masculinity and masculine sexual prowess in which penetration and insemination are viewed as paramount while penile sensation is regarded as irrelevant and even detrimental2 to male sexual performance.

This is entirely consistent with the most glaring and overarching flaw of Gross's article.  Namely, that despite the fact that the medical profession has been every bit as indifferent - and, in fact, hostile - to the erotosensory experience of people with penises as it has to the erotosensory experience of people with vulvas, Gross goes out of her way to draw a false contrast between the two.  I am not referring to the amount of attention given overall to penises as opposed to the amount given to vulvas in the medical literature, nor am I suggesting that people with penises do not have parity with people with vulvas in medical practice.  Far from it.  And I am certainly not demanding inclusion of penises in an article about clitorises.  (No, it doesn't always have to be about men.)  Yet, virtually everything Gross has written here concerning physicians' lack of regard for the clitoris is equally true, and more so, of their lack of regard for the penile prepuce, or foreskin.  In paragraph after paragraph throughout Gross's piece, one could simply replace the word "clitoris" with the phrase "penile foreskin" and practically wind up with a perfectly accurate and cogent article explaining the widespread dearth of medical knowledge of the male prepuce and the hugely deleterious consequences this ignorance has had on the sexuality, the sensory pleasure, the sexual satisfaction, the bodily integrity and the bodily autonomy of people with penises in the United States.

This is not a trivial comparison, that between the (penile) foreskin and the clitoris.  The penile prepuce comprises up to 50% of the penile skin system.  It is a complex, fully vascularized and densely innervated erotogenic structure that contains more specialized light-touch sensory nerve fibers per unit of area than is found anywhere else on the penis, including the glans.  It also plays a critical biomechanical role during intercourse, increasing pleasure for both partners while preventing or minimizing dyspareunia for the female.  The penile prepuce also serves other functions, including protecting the glans penis, exactly as the female prepuce provides protection for the glans clitoris.  In short, the penile prepuce is an integral part of male genitalia.  It is no more an adjunct to male genitalia than the clitoris or any other structure is to female genitalia.  In fact, the evidence supports the proposition that the penile prepuce is as important to the sexual pleasure and fulfillment of people with penises as the clitoris is to the sexual pleasure and fulfillment of people with vulvasThe penile prepuce is indispensable, therefore, to providing the full range of erotic sensation, pleasure and fulfillment of which the person who has one is capable. 

Notwithstanding the erotosensory similarities between the penile prepuce and the clitoris, Gross treats it as axiomatic that male sexual pleasure and fulfillment are prioritized by physicians whereas female sexual pleasure and fulfillment are not and that this disparate treatment is directly related to the fact that physicians' knowledge of penile structure is as comprehensive as their knowledge of clitoral structure is lacking.  In support of this proposition, Gross documents "a tradition of neglect" of the clitoris.  In particular, one of the factors primarily responsible for physician ignorance about the clitoris is simply that information about this body part generally is not included in medical school curricula.  "Asked what she learned in medical school about the clitoris," Gross reports, "Dr. Rubin replied, 'Nothing that sticks to my memory.  If it got any mention, it would be a side note at best.'" 

Yet, this is no less true of what medical students typically are taught about the penile prepuce.  I put this same question (but substituting "clitoris" with "penile prepuce") to George Denniston, MD, MPH, the founder and President of Doctors Opposing Circumcision.  In an emailed response, Dr. Denniston told me that, when he was in medical school, "to the best of my knowledge, nothing was ever discussed about the clitoris or the male prepuce."  

This is one physician's experience but it is by no means exceptional.  I contacted Adrienne Carmack, MD, a board-certified urologist and author of Reclaiming My Birth Rights and The Good Mommy's Guide to Her Little Boy's Penis.  (Dr. Carmack also serves on the board of directors of Doctors Opposing Circumcision.)  I asked her the following questions: 

DB: What did you learn in medical school about the male prepuce?

AC: Nothing.

DB: Was it discussed at all?

AC: No.

DB: Were its functions, its sensory capacity and its biomechanical role in intercourse taught to medical students or to interns during rotations?

AC: No.

I also spoke with Leif Thompson, MD, a family medicine specialist practicing in Fairbanks, Alaska.  Dr. Thompson, likewise, reported having been taught nothing about the penile prepuce in medical school.  In a follow-up email to our conversation, Dr. Thompson shared the following:

In 1996 I took human anatomy as the standard coursework for medical school training in the MD program at Oregon Health Sciences University.  When it came to the section on the pelvic organs I was surprised that the male foreskin was not even mentioned once.  Not in the lecture and not in any of the reading material that was prepared for us.

As a medical student I found this odd for two reasons.  First, the foreskin is the site of the most common surgery in the United States.  At that time, I was guessing that 80% of boys were circumcised, and if you include girls in this population, this surgery was being performed on 40% of the entire US population.  Yet this part of the penis was not even mentioned.

The second reason I found this odd was, because unlike the male anatomy, the clitoral foreskin was indeed mentioned several times!  A much smaller structure, not the site of any routine surgery, and its function, the protection of the clitoris, was mentioned.

Gross goes on to explain that, historically, the clitoris has been omitted not merely from medical school lectures but from medical school anatomy books.  As a case in point, she cites the experience of Dr. Helen O'Connell when she was in medical school (in Australia): "In the 1985 edition of the medical textbook Last's Anatomy that she studied, a cross-section of the female pelvis omitted the clitoris entirely. . . ." 

This, too, is no different from the treatment accorded the penile foreskin in medical school textbooks.  A 2004 study entitled "An Analysis of the Accuracy of the Presentation of the Human Penis in Anatomical Source Materials" by Gary L. Harryman, MA (published in Flesh and Blood, edited by Denniston et al. [Kluwer Academic / Plenum Publishers, New York, 2004]; a link to this study can be found here) reviewed 90 different sources that included representations of the penis, including "definitions, photos, illustrations and drawings."  The study was based on sources "available to medical students and medical professionals in five Los Angeles, California campus bookstores and two biomedical libraries" and included "medical text books, life-sized medical models, medical study aids, medical charts, medical dictionaries, medical encyclopedias, medical catalogues and (medical) general interest books."  This is what the study found:

In the 90 sources, we found . . . 365 images of the penis.  Of these 365 images, [only] 33%, showed anatomically correct depictions of the foreskin, while . . . 67%, showed penises from which the foreskin had been amputated.  Of those . . . images [i.e., those in which the prepuce had been removed], only one includes an explanation of why the foreskin was absent.

The study further found that 

Out of . . . 272 primary images of the penis [i.e., those that "present the penis as the direct subject of study or discussion"], only . . . 29% were anatomically correct in their depiction of the foreskin. . . . 71%, were anatomically incorrect (i.e., foreskin absent). . . .  Out of . . . 93 secondary images of the penis, . . . 54% were anatomically incorrect in their depiction of the foreskin.

The study concluded that, more often than not,

the penis is misrepresented in the medical literature used in medical schools.  The penis is routinely defined and depicted in a partially amputated condition, as if this were a natural state, without explanation or caveat.  This study concludes that students are being misinformed about fundamental anatomy.

Similar to Dr. O'Connell's experience with the omission of the clitoris from Last's Anatomy, Dr. Thompson recounted to me his own experience with the practice of medical school text book publishers omitting or minimizing the penile prepuce:

It is understandable why the anatomy professor did not mention the [penile] foreskin.  The anatomy texts that I had access to represented the penis either without a foreskin, or a foreskin that was greatly diminished from its true characteristics.  Some texts showed a partially absent foreskin cut away or retracted to show the deeper structures and the glans of the penis, again, greatly diminished in size.  Basically, the depictions communicated that the foreskin (if it is present at all) is the skin that is in the way of the more important aspect of the penis.

Gross cites the medical school experience of Dr. O'Connell as evidence that, when it comes to educating physicians, female sexual physiology and function receive much less attention than male sexual physiology and function do.  Referring to Last's omission of the clitoris, Gross points out that, in contrast,

[d]escriptions of the penis went on for pages.  To [O'Connell], this widespread medical disregard helped explain why her urology peers worked to preserve nerves in the penis during prostate surgeries but not during pelvic surgeries on women.

What it does not explain - and what Gross and O'Connell both seem to fail to recognize, let alone acknowledge - is that, in men who have been subjected to circumcision, the only nerves left to preserve during prostate- or any other surgery are those that haven't already been removed by circumcision.  The nerves that surgeons endeavor to spare during prostate surgery primarily are involved not in penile sensation but in producing penile erections and maintaining urinary function.3

This, again, points to widely-held and, I would argue, deeply-ingrained patriarchal attitudes - attitudes that Gross seems to reinforce - about male and female sexuality and, especially, about male and female genitalia.  The penis is regarded as active - hence, masculine - whereas the vulva is regarded as passive and, therefore, feminine.  (That, indeed, is why the erect penis is traditionally regarded as a symbol of male power.)  In this view, the penetrative and inseminating role of the penis, possible only when it is fully erect, is prioritized to the exclusion of its sensory capacity.  To this day, this view predominates not only within the medical field but throughout popular culture.  In "Genital Cutting and Western Discourses on Sexuality," the anthropologist, Kirsten Bell, describes this attitude among her students in a course on gender that she was teaching that included the topic of female and male genital cutting:

Over the course of our discussions on this topic, one thing became clear: students did not think that carving up male genitalia had any damaging effects on male sexuality as long as the penis remained largely intact.  My students reasoned that as long as the man retained the ability to ejaculate, his sexuality was unimpaired.  They were so ready to assert that female sexuality has been totally annihilated by genital surgery of any kind and so reluctant to proclaim that anything short of full frontal castration will affect a man's sexuality in the same way, it seemed clear that something very interesting was being revealed.  Importantly, their insistence seemed to have less to do with [male and female genital-cutting] practices themselves and more to do with underlying assumptions about the nature of female and male sexuality. . . .

These assumptions, Bell goes on to explain, are reflected in the attitude (Bell, here, is citing Lenore Tiefer) that "sexual prowess is central to masculinity."

In "Circumcision, Sexual Experience and Harm," (where Bell's passage above is originally cited) Brian D. Earp and Robert Darby point out that this attitude seems to be shared by the medical profession itself:

Reading through the medical literature, one is liable to form the impression that the mere capacity to maintain an erection, ejaculate, impregnate one's female partner, or experience some degree of pleasurable sensation during sex, exhaust the scientific imagination on male sexuality.  In other words, if these or other similar basic capacities are retained, many commentators are prepared to conclude that circumcision has negligible, if any, adverse effects on male "sexual function." . . .
. . . 
A common assumption in this discourse, according to Marie Fox and Michael Thomson, is that "male sexual pleasure is not an issue provided the penis is adequate for penetration, thus privileging one popular understanding of male sexual function and pleasure."  And yet, "the sensitivity protected by the foreskin, the erogenous nature of the foreskin itself, and sexual practices relying on an intact penis - such as docking - are all erased in these characterizations."

If, on balance, the esteem in which the penile prepuce and the clitoris are held - and the erotosensory pleasure that each provides - is not quite so different after all, the parallels in medical practice do not end there.  In the opening paragraphs of her article, Gross provides a lurid description of a vulvar biopsy. 

If there was one thing Gillian knew, it was that she did not want a hole punch anywhere near her genitals. . . .

To Gillian . . . taking a chunk out of her most sensitive body part sounded a bit extreme.

For the biopsy, she was placed in stirrups and given a spinal epidural to numb the area.  Afterward, to stem the bleeding, the doctor put one hand over the other and pressed hard against her vulva. . . . Even through the anesthesia, she could feel the pressure against her pubic bone.  She screamed.

Anyone who shudders at the thought of a what a "hole punch" can do to a vulva should think long and hard about what a Circumcision Clamp, a Plastibell, forceps and surgical scissors do to the most sensitive part of an infant's penis.  And anyone who is made squeamish by Gross's description of Gillian's biopsy should watch a video of an infant being subjected to a circumcision.  (One is available in the excellent presentation given by Ryan R. McAllister, "Child Circumcision: An Elephant in the Hospital."  The clip of the actual circumcision begins at 10:24 but I encourage you to watch McAllister's entire lecture.)

One of the problems in gynecological healthcare to which Gross calls attention (citing a 2018 study in Sexual Medicine) is that "most providers 'neither know how to examine nor feel comfortable examining the clitoris.'"  But this, too, is comparable to the problem that intact boys are faced with.  Intact America reported that same year (2018) that, by the age of 7, up to 40% of intact boys had had their foreskins forcibly retracted by medical professionals who should have known better but, because of widespread medical ignorance about the normal physiology and development of the male prepuce, did not.

A related but opposite sort of problem affects people with vulvas and people with penises.  Gross reports that the 2018 Sexual Medicine study

found that a failure to examine the vulva and clitoris led doctors to regularly overlook sexual health conditions.  Among women visiting Dr. [Irwin] Goldstein's clinic, nearly 1 in 4 had clitoral adhesions, which occur when the hood of the clitoris sticks to the glans and can lead to irritation, pain and decreased sexual pleasure.

The condition of clitoral adhesions is remarkably similar to phimosis, which is when a post-pubescent person "is . . . or becomes unable to retract his foreskin. . . ."   (The hood of the clitoris, of course, is the female version of the male foreskin.  The clitoral hood and the male prepuce develop from the same embryonic tissue and both are designated anatomically as "prepuces.")  But whereas physician ignorance has led to underdiagnosis of clitoral adhesions, physician ignorance has also led to overdiagnosis and misdiagnosis of phimosis in children with penises.  At birth and throughout early childhood, the penile prepuce is tightly fused to the glans until it separates naturally at various ages all the way up through adolescence.  Ignorance by medical practitioners about the normal physiological development of the penile prepuce not only leads to the misidentification of a non-pathological condition as a pathological one but results in unnecessary "corrective" circumcisions in children who had escaped this fate during infancy.  (It is also worth mentioning here that, despite the relatively high incidence of clitoral adhesions, we never hear of medical professionals advocating the prophylactic amputation of girls' clitoral hoods during infancy in order to prevent the possible development of this condition later in life, just as we never hear organizations like the American Academy of Pediatrics or the American College of Obstetricians and Gynecologists assert that the "benefits" of surgical removal of the clitoral hood in infancy or early childhood "outweigh the risks.")

Gross describes efforts to rectify the unacceptable state of affairs that she outlines in her article.  One of these efforts aims to address the paucity of medical knowledge about the anatomical structure of the clitoris:

Dr. O'Connell set out to investigate the full anatomy of the clitoris using microdissection and magnetic resonance imaging.  In 2005, she published a comprehensive study showing that the outer nub of the clitoris . . . was just the tip of the iceberg. . . .  The full organ extended far beneath the surface, comprising two teardrop-shaped bulbs, two arms and a shaft.

Yet an equally groundbreaking study of the penile prepuce was not undertaken until 1996, less than ten years before O'Connell's study and decades after amputation of the prepuce by medical practitioners had become a routine part of childbirth in the United States.  This is reported in Jessica Wapner's 2015 article, "The Troubled History of the Foreskin," which is available in the online magazine, Mosaic

[A] pathologist named John Taylor . . . published the first description of the cells that make up the foreskin.  An uncircumcised [sic] Englishman, Taylor was initially motivated by the prospect of his Canada-born children being circumcised.  That's what led him to examine the foreskins of 22 uncircumcised [sic] corpses.  He wanted to know whether the tissue had any functional value - if foreskin cells are specialised [sic] and serve some particular purpose, Taylor reasoned, that should be weighed when considering circumcision.

Specialised [sic] cells were exactly what Taylor found.  Measuring about 6.5 centimetres [sic] long when fully grown, the foreskin is a mucosal membrane that contains copious amounts of Meissner's corpuscles, touch-sensitive cells that are also present in our lips and fingertips.  "We only find this sort of tissue in areas where it has to perform specialised [sic] function, Taylor told an interviewer. . . .  The mucosal inner surface is kept wet by a natural lubricant, and the tip contains elastic fibres [sic] that allow it to stretch without becoming slack.  "This is sexual tissue, and there's no way you can avoid the issue."

One of Taylor's most noteworthy discoveries was the "ridged band", [sic] an accordian-like strip of flesh about 10 to 15 millimetres [sic] long that is as sensitive as the fingertips.  During an erection, the band is turned inside out. . . .  In later work, Taylor and a colleague described the band as far more sensitive than the glans [the "head" of the penis], the part of the penis left exposed after circumcision.  "The only portion of the body with less fine-touch discrimination than the glans penis is the heel of the foot," they wrote.  The penis still works without a foreskin, of course.  But the foreskin is erogenous tissue. . . .

That bears repeating.  It is the foreskin, not the glans penis, that is the primary sensory structure of the penis.  This is information that has been available to medical science and to medical practitioners for a quarter century.  And it is information that has been confirmed by subsequent studies.  And yet this information remains generally ignored by medical school text book publishers and generally unknown (to give them the benefit of the doubt) by physicians.

Another effort to raise the level of physician knowledge of the clitoris that Gross writes about is that undertaken by Jessica Pin who "began a social media campaign to get OB-GYN textbooks and training standards updated to cover this anatomy."  Once again, and for precisely the same reasons, it has proved necessary for a similar project to be initiated in order to raise the level of physician knowledge of the penile prepuce.  This project has been undertaken by Your Whole Baby, an organization whose mission is "to provide gentle education to parents-to-be and healthcare providers about the functions and care of the foreskin. . . . "  As Your Whole Baby explains on its website,

In the United States, many students in healthcare-related fields receive inadequate education on the structure and functions of the prepuce (foreskin), as well as proper care of the intact penis.  As a result, medical professionals may perpetuate long-held myths surrounding the natural penis and contribute to the resistance toward leaving babies' penises intact. . . .

Your Whole Baby has begun reaching out to authors and publishers in an effort to improve the quality of medical textbooks. . . .

On the matter of harm, another distressing but necessary development that Gross writes about is that "Increasingly, women are speaking out about injuries they sustained to this area during routine procedures."  This reflects the increasing and overdue valuation that our society is now giving to personal narratives - undoubtedly, greatly assisted by the MeToo movement.

But men are speaking out also.  The Global Survey of Circumcision Harm, completed in 2012, received responses from more than 1,000 men, 100% of whom reported perceiving themselves as having been harmed in some way by the circumcisions to which they had been subjected.  The website where the results of this survey can be found includes video testimonials by men who were harmed by circumcision.  

Another site, Men Do Complain

exists to dispel the myth that men do not mind being circumcised . . . .

Men circumcised as children (and therefore without consent) often complain about their condition. . . .  Men who complain about having had their foreskins amputated without their informed consent are consistently treated as having something wrong with them rather than being treated as having had something wrong done to them [MDC's emphasis].

Earp and Darby find that 

many men who were circumcised as infants do insist that they have been sexually harmed as a result of the procedure and strongly resent what was done to them without their consent. . . .   [O]ften this absence of consent is as serious a cause of psychosexual distress as any overtly "physical" effects of the procedure.

 The same authors report that 

a 2015 YouGov poll concluded that 10% of circumcised American men wish that they had not been circumcised. . . .  [A] more recent demographically diverse survey . . . found that 13.6% wished that they had not been circumcised, with nearly a quarter of that sub-group reporting that they would "seriously consider" changing their circumcision status if it were possible. . . . [notes omitted].

Estimates of the percentage of males living in the United States who have been subjected to circumcision range from 71.2% to as high as 80.5%.  Given that there are currently 101 million males 18 and over living in the United States, and taking the lower of both of these sets of figures - that is, being conservative - ten million people with penises in this country object to what was done to their penises when they were infants.

These first-person accounts and surveys, of course, represent perceptions of harm.  "Objective" statistics are harder to come by.  Tim Hammond, a longtime human-rights activist and lead author of a recently-completed study ("Foreskin Restorers: Insights into Motivations, Successes, Challenges and Experiences with Medical and Mental Health Professionals" [2022]; Hammond T., Sardi L.; Jellison W., et al., publication of which is pending in the International Journal of Impotence Research) shared with me what is currently known and understood about the additional harms associated with non-therapeutic circumcision, which he summarized as follows:

Despite an impressive list of known immediate and short-term complications, the American Academy of Pediatrics has twice acknowledged that the precise risk and full extent of complications are likely not known.  This is because complications are ill-defined, obstetric circumcisers rarely do patient follow-up, many complications become evident only as the penis matures, and there is no comprehensive record-keeping of complications.  Some authors have reported a complication rate as low as 0.06 percent [but] at the other extreme, rates of up to 55 percent have been quoted. . . .  This reflects the differing and varying diagnostic criteria employed; a realistic figure is 2-10 percent.  A systematic review concluded that neonatal male circumcision complications are indeed common.  An analysis of medicalized circumcisions found a complication rate of 4%. . . .  Even if serious complications are statistically rare, with over 1.2 million newborn circumcisions performed annually in the U.S., a 0.06% to 4% complication rate means that 7,200 to 48,000 males per year . . . may suffer serious physical and/or sexual complications that likely also cause psychological distress or grief [internal references omitted].

Gillian, whose vulvar biopsy resulted in her losing the ability to reach orgasm, is quoted in Gross's article in words that powerfully convey her anguish about what she has suffered: "The devastation from this is something you can never repair.  Ever."  Yet, as tragic as Gillian's situation is, it also points up a crucial difference between the iatrogenic injuries suffered by the women interviewed in Gross's article and non-therapeutic penile circumcision.  This is that, in Gillian's case, as in all the others that Gross describes, the harm done to these women's erotogenic tissue and the resulting damage done to their capacity to experience sexual pleasure was unintended.  In contrast, in the case of penile circumcision, obliteration of all the erotogenic tissue of which the foreskin is comprised is the whole point.  That is why penile circumcision was promoted and employed as a "prophylaxis" against masturbation during the nineteenth century.  It is why John Harvey Kellogg is as infamous for his views on masturbation (and his enthusiasm for circumcision) as he is famous for the invention of Corn Flakes:

A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis.  The operation should be performed by a surgeon without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases.  The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed.  If any attempt is made to watch the child, he should be so carefully surrounded by vigilance that he cannot possibly transgress without detection.  If he is only partially watched, he soon learns to elude observation, and the effect is only to make him cunning in his vice.

It is why Moses Maimonodes, 700 hundred years before Kellogg, wrote,

With regard to circumcision, one of the reasons for it it is, in my opinion, the wish to bring about a decrease in sexual intercourse and a weakening of the organ in question, so that this activity be diminished and the organ be in as quiet a state as possible.  It has been thought that circumcision perfects what is defective congenitally....  How can natural things be defective so that they need to be perfected from outside, all the more because we know how useful the foreskin is for that member?  In fact this commandment has not been prescribed with a view to perfecting what is defective congenitally, but to perfecting what is defective morally.  The bodily pain caused to that member is the real purpose of circumcision.  None of the activities necessary for the preservation of the individual is harmed thereby, nor is procreation rendered impossible, but violent concupiscence and lust that goes beyond what is needed are diminished.  The fact that circumcision weakens the faculty of sexual excitement and sometimes perhaps diminishes the pleasure is indubitable.  For if at birth this member has been made to bleed and has had its covering taken away from it, it must indubitably be weakened. . . . [This is excerpted from Marked in Your Flesh - Circumcision from Ancient Judea to Modern America by Leonard B. Glick, {Oxford University Press; 2005}; p.65.]

To be sure, although the ostensible purpose of medicalized neonatal circumcision may, since the nineteenth century, have "evolved" from a deliberate reduction in the erotosensory capacity of the penis into something else, the anatomical structure of the penis and its prepuce have not, so the end result of penile circumcision remains the same.

Another important way in which the "documented injuries to the clitoris" sustained by the women in Gross's article differ crucially from neonatal penile circumcision is that they were the unintended consequences of surgeries or procedures that had been deemed necessary either to correct pathological conditions or to diagnose them.  In contrast, in the overwhelming majority of neonatal circumcisions, there is no pathological condition to correct - just a natural, healthy, functional prepuce.

One possible point of comparison between the iatrogenic injuries to which Gross refers and penile circumcision is in the matter of informed consent.  Gross points out that the risk of sustaining the particular type of injury suffered by one of the women profiled in her article was not mentioned in the consent form.  

But, however widespread the problem may or may not be of women being insufficiently informed about the risks to their sexual sensation posed by various surgeries, it's hard to imagine that it could be worse than the problem of parents being insufficiently informed when they are asked (and often pressured) to consent to their child's penile circumcision.

The preliminary findings of a study ("A systematic quality assessment of neonatal circumcision consent forms issued by major hospitals in Masschusetts and New York") by the organization Intaction that is currently under way were shared with me by its chief researcher and author, Mathew Goodwin.  Goodwin's investigation of

the quality of over 20 neonatal circumcision consent forms at major hospitals in Massachusetts and New York State revealed a disturbingly large variance in the risks presented to parents.  The lowest quality forms used a generic template that broadly applies to any procedure, states no specific risks of circumcision, and relies entirely on oral communication to secure parental permission.  Upon further examination of the fine print in these forms, we found that parents were asked to consent to questionable terms, such as full authorization to the hospital to use the severed skin and tissue [not just] for research . . . but for commercial purposes.  Disclosure of the hospital's financial incentives for collecting and selling infant foreskin was strategically absent.

Goodwin found that the most serious deficiency of these forms was their failure to disclose "any of the known long-term harms and consequences to the individual" of penile circumcision.   The forms also omitted any reference to the ethical consideration of the child's right to bodily autonomy and, instead, "promote[d] unsubstantiated health benefits [in order] to secure permission . . . from parents" and payment by third-party payers.

It should go without saying that the consent forms that parents are given prior to circumcision of their child routinely omit the most significant "risk" of circumcision: the irreversible loss of the most erotogenically sensitive part of the penis.  The consent forms also routinely fail to quantify this risk, which is, in fact, 100%.  

More basically, as Peter Adler has observed in "Is Circumcision a Fraud?," "Legal scholars have argued that parents do not have the legal authority to consent to the surgical amputation of normal, healthy tissue from their infant children. . . ."

Perhaps more relevant than any other factor is that no neonate ever consents to his own circumcision.  And while infancy is transitory, circumcision is permanent.  The person subjected to penile circumcision as a neonate or toddler has no way of undoing or reversing the harm that was done to his genitals and he is left without any meaningful legal mechanism of compensating him for the deprivation of his bodily autonomy.

This is in no way to minimize the tragedies suffered by Gillian or the other women profiled in Gross's article.  It is merely to point out that, for every Gillian, there is a Gary Shteyngart, for every Jessica, there is a Goodluck Caubergs and, for every Julie, there is a David Reimer.

What I have attempted to show here is that two of Gross's major premises are wrong.  To review, these premises are, first, that physicians' knowledge of penile anatomy is as comprehensive as their knowledge of vulvar anatomy is lacking; and, second, that male sexual pleasure and fulfillment are prioritized by physicians whereas female sexual pleasure and fulfillment are not.

In fact, far from being knowledgeable about the anatomy of the penis, physicians are every bit as clueless about a vitally important portion of it (the prepuce) as they are about a vitally important portion of the vulva (the clitoris).  And, far from being concerned with male sexual pleasure, physicians are concerned almost exclusively with male sexual performance

This distinction - between male sexual pleasure and male sexual performance - is important not because it falsifies another one of the premises of Gross's article but because it confirms it.  This other, deeper and implicit premise is that the disparate treatment given by the medical profession to penises and vulvas has its roots - like so much else - in patriarchy and sexism.  Although Gross does not explicitly make this argument, I do not think any reasonable person can deny that traditional patriarchal concepts and attitudes about vulvas, penises, women and men have had a profound and lasting influence on Western medical practice.  If this is one of Gross's working assumptions - and I believe that it is - I think she's spot on, but in more ways than even she may realize.

There is no doubt that the medical profession and the pharmaceutical industry in the United States pay a great deal more attention to penises than they do to vulvas.  The problem is that, most of the time, it's the wrong kind of attention.  (And with friends like these, who needs enemies?)

Superficially, the disparate treatment by the medical establishment of adults with penises and adults with vulvas might appear to support Gross's thesis that physicians have little concern for women's sexual pleasure in contrast to their abiding concern for men's.  But when one steps back and takes in the broad perspective that includes the medical establishment's treatment of people with penises from birth onward, it is difficult to come to any conclusion other than that medicine's actual concern with the penis is limited exclusively to its ability to become erect, and physicians' actual concern with male sexual fulfillment is limited to the ability of a person with a penis to achieve an orgasm brought on by the act of penetration.  The sensory experience of intercourse itself (as opposed to the sensory experience of having an orgasm, for which one does not need a partner) does not even appear to be on physicians' radar.  Nor is it, I suspect, on Gross's, which is why she seems to reflexively substitute penile virility or function for penile sensation (much as Kirsten Bell's students did) when she contrasts medicine's interest in preserving or maximizing the sexual fulfillment of people with penises with its lack of interest in preserving or maximizing the sexual fulfillment of people with vulvas.  This is also why I suggested just now that, insofar as patriarchy's effects on penile integrity are concerned, Gross misses the larger picture and is, therefore, only half right.  The medical profession's contempt for the clitoris and and its contempt for the penile prepuce do not stand in contrast to one another but are, in fact, of a piece.  They are opposite sides of the same patriarchal coin.  To understand how, it is necessary to contextualize neonatal circumcision historically and socially.

The patriarchal roots of circumcision - as we know it today - in the Judaism of the sixth-century BCE4 are well established.  Explaining in 2001 (in "The Kindest Un-Cut: Feminism, Judaism and My Son's Foreskin") how he and his wife came to decide not to subject their son to circumcision, the sociologist Michael Kimmel writes that,

. . . what was ultimately decisive for us was the larger symbolic meaning of circumcision, and particularly the gendered politics of the ritual.  After all, it is certainly not circumcision that makes a man Jewish. . . .  
No, circumcision means something else: the reproduction of patriarchy.  Abraham cements his relationship to God by a symbolic genital mutilation of his son.  It is on the body of his son that Abraham writes his own beliefs.  In a religion marked by the ritual exclusion of women, such a marking not only enables Isaac to be included within the community of men - he can be part of a minyan, can pray in the temple, can study Torah - but he can also lay claim to all the privileges to which being a Jewish male now entitles him.  Monotheistic religions invariably worship male Gods, and exhibit patriarchal political arrangements between the sexes. . . .
Circumcision . . . is the single moment of the reproduction of patriarchy.  It's when patriarchy happens, the single crystalline moment when the rule of the fathers is reproduced, the moment when male privilege and entitlement is passed from one generation to the next, when the power of the fathers is exacted upon the sons, a power which the sons will someday then enact on the bodies of their own sons.  To circumcise our own son, then, would be, unwittingly or not, to accept as legitimate 4000 years not of Jewish tradition, but of patriarchal domination of women.

Another detailed analysis of the inextricability of penile circumcision from traditional patriarchal power can be found in Miriam Pollack's monumental essay, Circumcision: Identity, Gender and Power.  Pollack explains the crucial role that penile circumcision plays in what she describes as

. . . the twin patriarchal fears: the fear of woman and the fear of pleasure.  Circumcision is both the vehicle and the product, the menace and the antidote, which simultaneously assuages and perpetuates those ancient terrors.  This is the achievement and true function of circumcision.  Circumcision achieves this by violently breaching the maternal-infant bond shortly after birth; by amputating and marking the baby's sexual organ before he knows what he has lost; by disempowering, "taming," the mother at the height of her instinctual need to protect her infant; by bonding the baby to the community of men past, present and future and to a male-imagined G-d [sic]; by restructuring the family and the society in terms of male dominance; and by psycho-sexually wounding the manhood still asleep in the unsuspecting baby boy.  In all of these ways - socially, politically, religiously, ethnically, sexually, tribally, and interpersonally - the cutting of our baby boys' sexual organs is the fulcrum around which patriarchy exerts its power.  Circumcision is a rite of male domination - domination and the entitlement of domination over other men, women, and children both institutionally and personally.  It is the essence of patriarchy.

Gloria Steinem, who, I think it's fair to say, knows a thing or two about patriarchy, had this to say about  circumcision:

These patriarchal controls limit men's sexuality, too, but to a much, much lesser degree.  That's why men are asked symbolically to submit the sexual part of themselves and their sons to patriarchal authority, which seems to be the origin of male circumcision . . .   Speaking for myself, I stand with many brothers in eliminating that practice, too.

Steinem was speaking figuratively, of course.  The individuals who are subjected to circumcision are not "men" and they certainly aren't "asked."  That aside, Kimmel, Pollack and Steinem all recognize that penile circumcision, when imposed upon the body of an unconsenting child, is not just an artifact of patriarchy but is intrinsic to it and perpetuates it.

In our own time, a point I have argued previously, penile circumcision persists as a deeply ingrained cultural practice in which masculinity is inscribed on the bodies of children with penises.  As I wrote several years ago,

The language that parents often use to describe their sons' reaction to the circumcision surgery is . . . highly revealing of the way in which they - whether consciously or unconsciously - are apt to regard the masculinizing ordeal of genital cutting through which their infant sons must pass.  It is not uncommon to hear parents who have subjected their infant sons to circumcision speak in glowing terms about "how tough" their "little guy" was throughout the ordeal.  It is also no coincidence that parents will often refer to their infant in this context as a "little guy" or a "little man."
. . .

Beyond literally "toughening up" the glans penis (thereby making it more "masculine"), there can be little doubt that, again, whether consciously or unconsciously, the primary purpose of male genital cutting is the "toughening up" of the boy himself.  That deeply entrenched notions of gender and masculinity are intrinsic to this custom are, if anything, demonstrated all the more by the ridicule and scorn - the gender policing - to which men who publicly express their resentment about having had part of their genitals removed without their consent frequently are subjected.

Gross cannot be faulted for any supposition she may have that patriarchy adversely affects women's sexual health.  But I do think it appropriate to question her implication that patriarchy, of which neonatal circumcision is an integral part, does not also adversely affect men's sexual health - and not just as much as it does women's but, in fact, much, much more.  After all, say what you will about their neglect of the clitoris, when presented with one in a clinical setting, physicians do not, as a matter of course, cut it off. 

Gross ends, if not on an optimistic note, at least on a positive one.  Paraphrasing Dr. Rubin, she concludes,

There must be a concerted movement, one that transcends medicine's traditionally siloed specialties, to understand and map this anatomy.  And for that to happen, other fields need to recognize female sexual pleasure as essential and worth preserving.

I would go further than that.  Medical professionals, whatever "silo" they may occupy, ought to respect the sexual anatomy of everyone equally.  They should not impose their own preconceived concepts of gender on the bodies of patients and especially not on the bodies of neonates, whatever sex that neonate might be or even might just appear to be at birth.  Medical professionals should accord no less respect to the boundaries and integrity of prepuces than they should to clitorises.  They should not abandon their ethical obligations when parents ask them to remove normal, healthy erotogenic tissue from their children's bodies.  Medical professionals should be guided by a respect for the whole bodies, including the totality of their genital anatomy, of people with vulvas, people with penises, and intersex people, equally.  Above all, they should recognize not only that the sexual pleasure of every human being is essential and worth preserving but that the full sexual anatomy of every human being - prepuce and all - is, likewise, essential and worth preserving.


1. In "Genital Cutting and Western Discourses on Sexuality," the anthropologist, Kirsten Bell,  provides a short history of the Western conception of the clitoris - its "rise and fall and rise," again - that is considerably more nuanced than Gross's article might lead one to suppose.  Citing the work of Thomas Laqueur, Bell notes that 

during the Renaissance, the clitoris was routinely described as the organ 'which makes women lustful and take delight in copulation.' . . .
. . .
In 18th-century Europe, a radical reconstitution of female sexuality took place. . . . [and] the idea that woman was inherently passionate was sacrificed in the effort to assert a fundamental, underlying difference in female biology.

2. Bell (see footnote 1, above) also cites examples in her paper of circumcision proponents who readily acknowledge that circumcision decreases penile sensitivity yet view this as one of its "benefits," enabling the man to "'last' longer."  Bell observes that

although these commentaries are mostly from men circumcised at a later age, I believe that they articulate constructions of of male sexuality that are entrenched and pervasive.  Importantly, these anecdotes speak to the role that sexual competence plays in constructions of contemporary masculinity, as many men clearly believe that any loss of sensitivity that accompanies circumcision is compensated by their enhanced sexual performance [notes omitted].

3. It should also be borne in mind that the author of Last's Anatomy, Chummy S. Sinnatamby, was an anatomist from the United Kingdom and that Last's publisher, back in the 80s, was also based in the U.K. (which is, presumably, why it was available to O'Connell in Australia).  I do not know how many of those pages of descriptions of the penis in Last's Anatomy included accurate descriptions of the prepuce but it would not be surprising if they did, given that the incidence of neonatal circumcision had already begun to decline significantly in the U.K. by the1980s, in contrast to the United States where, to this day, over 50% of neonates who are born with penises are subjected to penile circumcision. 

4. Glick, Marked in Your Flesh, cited above; p. 15.


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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He is a licensed physical therapist and writes about bodily autonomy and human rights, gender, culture, and politics. 
He currently serves on the board of directors for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and the leadership team for Bruchim.