Statement on Behalf of Jews Against Circumcision in Observance of the Worldwide Day of Genital Autonomy, 2020

by David Balashinsky

Grüß dich, and greetings from Binghamton, New York. 

My name is David Balashinsky and I'm proud to be speaking to you today on behalf of Jews Against Circumcision in observance of the Worldwide Day of Genital Autonomy, 2020. 

I'd like to begin by clarifying what we're for and what we're against, since the name "Jews Against Circumcision" is actually a misnomer.  It would be more accurate to call ourselves "Jews Against Forced Circumcision."   While it's fair to say that we don't approve of any medically-unnecessary genital surgery, we recognize that the same principle that gives people the right not to have their genitals cut or surgically altered without their consent also gives them the right to choose elective genital surgery for any reason they might have, provided they're adults and capable of exercising informed consent. 

There could be any number of reasons why people might willingly undergo cosmetic genital surgery.  One of them is undoubtedly nothing more than internalized self-hatred, because the natural anatomy of human genitalia - whether female, male or intersex - is so often stigmatized.  In the case of women, at least in the United States, this phenomenon, known as labiaplasty, actually seems to be increasing.  Another reason closely related to this is the pressure to conform to cultural norms.  Again, in the United States, several of the rationalizations for male genital cutting that are most frequently given fall into this category.  "So he won't be made fun of in the locker room," we are often told.  A man who has escaped forced circumcision at birth could still succumb to pressure like this in adulthood.  It's even possible that, after serious and mature reflection, an adult might want to undergo circumcision as an expression of his deeply-felt religious convictions.  What matters in all of these cases, though, is that in a society that respects fundamental, universal human rights, the decision to have part a person's genitals removed is a decision that belongs to that individual himself and no one else.   It's his body - his choice.

What matters equally is that performing any medical treatment when there is nothing to treat is considered malpractice and unethical.  And when the "treatment" is a surgery that permanently removes a functional part of a person's body, the harm is immeasurably greater because it is irreversible.  Amputating a perfectly healthy body part is a harm in and of itself.  It is not a "cure" but an assault.  And when infants and children are deprived of their right to refuse the permanent removal of a part of their genitals, that is when genital cutting, by any name you want to call it, is a human-rights violation.

 
So it is not genital surgery that Jews Against Circumcision is against but forced genital surgery.  It is not circumcision that we're against but forced circumcision. We're against it because, as Jews, we believe that every human being has a right to grow up with his genitals whole, intact, un-scarred and unharmed.  What we're against is the genital cutting that is imposed on those unable to exercise informed consent and unable to defend themselves from it: infants and children.  We oppose any and all medically-unnecessary genital surgery for all children, whether female, intersex or male.  We believe that the right of bodily self-ownership - which necessarily includes the right of genital autonomy - is a universal and fundamental human right that transcends every conceivable group identification.  The right not to have part of one's genitals cut off without consent is a right that belongs to every infant and every child, regardless of sex, race, ethnicity and nationality, and no matter what religion that child is born into: whether Judaism, Christianity, Islam or any other religion.   As Jews, we believe that the right of bodily self-ownership is the most basic and important human right there is. 

What's more, we're not just supporters of the right of genital autonomy but believe that we have a moral obligation to defend that right on behalf of those who can't defend it themselves.  As we see it, the moral obligation to actively oppose genital cutting is intrinsic to our self-concept of who we are as Jews. This obligation comes from the principle of tikkun olam, which is typically translated as "repairing the world." Although tikkun olam is originally a religious concept, it is also deeply ingrained in secular Jewish thought, philosophy, ethics and culture. It is a moral imperative that impels followers of Judaism and secular Jews, alike, to strive to leave the world better than we found it.  That is why the brit milah is increasingly being replaced by the brit shalom among religious Jews.  It is why so many secular Jews are actively working to end all forced genital cutting.  Jews Against Circumcision is against all forced genital cutting not in spite of our being Jewish but because we are Jewish. 

As many of you know, the Worldwide Day of Genital Autonomy commemorates the 2012 Cologne court ruling that recognized that forced circumcision constitutes a grievous bodily harm to the child who is subjected to it.  The notion that Genital Autonomy is a universal right is reflected in the fact that this commemoration is observed all over the world by those who value human rights and human dignity above all else.  It reflects the powerful idea that every child - no matter where that child is born, no matter who that child's parents are, no matter who or what that child's parents worship or pray to, no matter what tribe, ethno-linguistic group, clan, ethnicity, race, people, religion or nationality that child is born into - that child is first and foremost a human being: a member of the human race.  The fundamental rights that we recognize as human rights aren't adjuncts to being human but intrinsic to being human.  They aren't severable and they aren't conditional.  They don't belong to some but not to others.  They don't belong to infants and children of one sex but not to infants and children of another or indeterminate sex.  They belong to every infant, every child, every human being the world over.

Unfortunately, as history all too often demonstrates, the existence of a right is no guarantee that that right will be respected. At this moment, hundreds of millions of girls and women and a billion boys and men around the world are living with the scars and the damage of forced genital cutting. Who knows how many intersex individuals around the world are living with the trauma of having had binary sexual-assignment-surgery imposed on them without any need for it and without their wanting it.  That is why the Worldwide Day of Genital Autonomy exists.  Not to encourage parents, religious leaders, medical professionals and legislatures to grant the right of genital autonomy to every child - for how can one grant to children a right they're born with?  Rather, it's to demand respect for the right of genital autonomy that, by virtue of being human, every child already has. 

Here, again, in the worldwide campaign for genital autonomy, we see the same impulse as that of tikkun olam - "repairing the world."  This impulse, of course, isn't unique to Jews.  It motivates people of all cultures and religions and, of course, free-thinkers who recognize that freedom, dignity and self-determination are universal values and who feel themselves called to fight for universal human rights.  The right of bodily self-ownership and genital autonomy lies at the very heart of the ongoing struggle for basic human rights the world over.

The worldwide effort to secure the right of genital autonomy for every male, female and intersex individual, no matter how old or how young, is what the Worldwide Day of Genital Autonomy is all about.  That is why Jews Against Circumcision is proud to join our brothers, sisters and non-binary siblings of all faiths, all ethnicities and all nationalities in participating in this international event.  And that is why we encourage you, on this day - and every day - to defend that most basic and essential human right: the right of Genital Autonomy. 

Thank you.

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David Balashinsky is originally from New York City and now lives near the Finger Lakes region of New York. He writes about bodily autonomy and human rights, gender, culture and politics.
 

On Medically Unnecessary Genital Surgery and Human Rights: ACLU NorCal and the San Francisco Ballot Initiative to Protect Bodily Autonomy

by David Balashinsky

Nine years ago, supporters of a proposed, citizen-initiated city ordinance presented more than 12,000 signatures to the Department of Elections in San Francisco.  The ballot initiative that they hoped to place before the voters sought to accomplish one thing and one thing only: a ban on the forced circumcision of male minors when not medically necessary.  Shortly thereafter, attorneys from the ACLU of Northern California filed an amicus curiae brief with the Superior Court of California in San Francisco "urging the court to issue a writ of mandate restraining San Francisco's Director of Elections from placing [an] initiative criminalizing circumcision on San Francisco's November 8, 2011 ballot." 

To be clear, the proposed ballot initiative did not aim at "criminalizing circumcision."  It specifically did not include a prohibition against penile circumcision when medically necessary.  As the language of the ballot initiative stated, an exception to the (proposed) ban would exist in those cases in which circumcision is deemed "necessary to the physical health of the person on whom it is performed because of a clear, compelling, and immediate medical need with no less-destructive alternative treatment available."  

Nor did the petitioners seek a blanket prohibition of circumcision.  Penile circumcision practiced for religious reasons and cultural reasons (such as social conformity and socially-constructed "ideals" concerning the appearance of the human penis) all would continue to be perfectly legal.  Under the provisions of the ballot initiative, there would be nothing to prevent an adult male from choosing circumcision for himself for any reason he might have.  And that, of course, is as it should be: it's his body and it should be his choice.  The initiative simply sought to insure that any individual who undergoes circumcision has an opportunity to exercise informed consent and, more importantly, that he has an opportunity to make a personal choice about whether or not to have a major portion of erotogenic tissue permanently removed from his penis.  The most appropriate and effective way to accomplish this goal is to restrict the availability of this surgery to adults.  While 18 may seem an arbitrary age, the idea behind it is that, until an individual is mature enough to fully grasp the ramifications of his choice, society has an obligation to prevent him from making the wrong one.  This is particularly important in the case of an irreversible genital surgery.  

The other objective of the age restriction was to protect minors from undue influence or coercion by adults.  Whether we are speaking of girls, boys or intersex children, and whether we are speaking of female genital cutting (FGC), male genital cutting (MGC) or the binary, either-or sexual-assignment surgery to which intersex children frequently are subjected (IGC), medically unnecessary genital surgery (as opposed to gender-affirming treatment and surgery, which I am emphatically not including in this discussion) is something that no infant and few children ever ask for and to which no infant and few children ever meaningfully consent.  Rather, medically unnecessary genital surgery is something that adults impose on their children's bodies.  Given that minors can obtain cosmetic surgery with parental consent, there probably is no way to ascertain that a minor's choice to undergo genital surgery is, in fact, his choice.  The most effective way to safeguard the fundamental rights of the child, therefore, is by taking medically unnecessary genital surgery off the (operating) table altogether.  

For these reasons, then, the language of the proposed ballot initiative established 18 as the minimum age at which an individual could undergo medically unnecessary (non-therapeutic) circumcision.  To repeat, the rationales behind this were to insure that an individual's choice to undergo circumcision is, in fact, his choice and that his choice be an informed one.  

To this long-time supporter of the ACLU, the objectives and reasoning behind this ballot initiative seem not just equitable but incontrovertibly equitable.  It is self-evident that subjecting an infant or child to a surgery that is medically unnecessary, irreversible, and that removes an integral part of his penis without his consent violates his fundamental human rights.  It violates his right to bodily integrity (the right to keep one's body whole, unaltered and unscarred) and his right of bodily autonomy (the exclusive right of an individual to make decisions about his own body).  That is why it is baffling that ACLU NorCal not only did not support this ballot initiative but went out of its way to oppose it.  ACLU NorCal, after all, is an an affiliate of the national ACLU - an organization that, in the words on ACLU NorCal's website, "was founded . . . to defend and preserve the individual rights and liberties guaranteed to every person in this country by the Constitution and laws of the United  States."  In its own Mission Statement, ACLU NorCal describes itself as "an enduring guardian of justice, fairness, equality and freedom. . . ."

These principles -  justice, fairness, equality and freedom - are not adjuncts to ACLU NorCal's mission but lie at its very heart.  They guide the organization in every battle that it wages and in every cause that it champions.  Their centrality to ACLU NorCal's mission should have been reason enough for it to support this ballot initiative, to say nothing of not standing in its way.  This is what makes ACLU NorCal's position in this case so stunning.  It is not only diametrically opposite its own professed principles but diametrically opposite the positions that the ACLU has taken in virtually every other case in which it has defended bodily autonomy and fundamental human rights. 

On abortion rights, for example, ACLU NorCal proclaims, "The ACLU fights for Californians' bodily autonomy. . . ."  An action-alert email that I received from the ACLU in 2018 (as I  said, I am a long-time supporter) began with the words, "The right to make decisions about our own bodies and lives is in jeopardy."  Yet the ballot initiative that ACLU NorCal fought against in 2011 merely sought to codify this very right - the right of individuals to make decisions about their own bodies.  It would simply have guaranteed that right to minors with penises whose fundamental right not to be subjected to medically unnecessary genital surgery is, to this day, routinely violated.

When the issue was same-sex marriage, the ACLU went to court to compel Kim Davis, the county clerk from Rowan County, Kentucky, to issue marriage licenses to same-sex couples which, "because of her personal, religious opposition to marriage for same-sex couples,"  she had refused to do.  Despite its long history as a stalwart defender of the first amendment, the ACLU recognized in this case that the freedom to practice one's religion ends where other persons' rights begin.  In other words, each person's fundamental right to act in accordance with her beliefs is circumscribed by every other person's even greater and even more fundamental right not to be harmed.  Contra- vening this important principle, and notwithstanding the fact that any medically unnecessary removal of a body part without consent is a harm in and of itself, the freedom to harm others as an expression of one's own religious belief is precisely what ACLU NorCal defended when it opposed the San Francisco ballot initiative.  As then managing attorney of ACLU Northern California Jory Steele explained in a press release after the citizen initiative was struck from the ballot, "This initiative would have undermined the right to religious liberty that we cherish in a pluralistic society."

It seems paradoxical that an ACLU NorCal attorney should invoke "religious liberty," the rallying cry of right-wing religious extremists.  After all, "religious liberty" has been claimed not just in defense of a "right" to deny same-sex couples their right to marry but as a justification for denying women access to reproductive health care and abortion, for denying equal accommodations and services to LGBTQ persons, and even for denying basic medical care to transgender persons.  Yet in each of these other cases, the ACLU recognized - as ACLU NorCal itself posted on its Facebook page (on November 6, 2019) - that "Freedom of religion is a fundamental right, but it cannot be used to harm others."  Unless, apparently, those others are persons with penises who are under the age of 18.

Perhaps nowhere is ACLU NorCal's inconsistency more glaring than in the double standard that it applies to MGC, on the one hand, and to IGC on the other.  To fully grasp the magnitude of this particular contradiction, consider the words of Elizabeth Gill, Senior Staff Attorney, which appear on ACLU NorCal's website under the heading "We Must Stop Forcing Conformity on Intersex Bodies":

A core aspect of human autonomy and dignity is to be able to make decisions about our own bodies. But each year, doctors around the country continue to perform medically unnecessary, harmful surgeries on intersex infants and children, just to “normalize” their bodies.  What this means is that doctors are forcing infants and young children to undergo medically unnecessary genital surgery simply to force their natural bodies to conform to traditional societal—and binary—views of “male” and “female” bod[i]es.

These irreversible surgeries are increasingly considered a violation of human rights and can lead to a lifetime of trauma, physical pain, loss of genital sensitivity, incontinence, scarring, sterilization, or incorrect gender assignment.  Yet they are often justified solely by the adult fear of the child being stigmatized by a perceived nonconforming body.

Instead of forcing conformity, we should celebrate our differences. October 26th marks Intersex Awareness Day. On this day—and every other day of the year—the ACLU stands with intersex people and allies throughout the country and world to protect and advance the fundamental human rights and civil liberties of intersex people.

Virtually everything that Gill asserts about forced sexual-assignment surgery is equally true of forced penile circumcision.  (Try re-reading Gill's comments while mentally substituting "intersex" with "male.")  It is medically unnecessary and it is performed primarily for reasons of social conformity ("so he will look like his father") and "normalization" ("so he won't be made fun of in the locker room").  Just as forced sexual-assignment surgery is "increasingly considered a violation of human rights," so, too, is forced, non-therapeutic penile circumcision.  Just as forced sexual-assignment surgery can entail numerous complications and adverse sequelae, including loss of sensation, so, too, does forced, non-therapeutic penile circumcision.  (The many problems associated with neonatal circumcision are discussed here.)  It can even result in "incorrect gender assignment." 

I also happen to agree with everything in Gill's statement as it pertains to the rights of intersex individuals.  I just wonder why it hasn't yet occurred to Gill and to ACLU NorCal to advocate for "human autonomy and dignity" for all humans, including those born with penises.  If they did, I could imagine their issuing a position statement that might go something like this:

On this day - and every other day of the year - ACLU NorCal stands with girls, boys, women, men and intersex people throughout the country and throughout the world to protect and advance the fundamental human rights and civil liberties of all human beings.

 

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About me: I am originally from New York City and now live near the Finger Lakes region of New York. I write about bodily autonomy and human rights, gender, culture and politics.  I currently serve 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.
 

 

On Bodily Self-Ownership: An Open Letter to Cheryl Axelrod, M.D., F.A.C.O.G.

by David Balashinsky

Dear Dr. Axelrod,

You may recall that I wrote you a little over two years ago after I received an email from you and NARAL Pro-Choice America.  I was on NARAL's mailing list because I support abortion rights and have donated to this organization in the past.  When I wrote you, NARAL had recently embarked on a campaign of encouraging women who had had abortions to "come out" and tell their stories.  The point of the campaign was to humanize the reality of abortion, since terminating a pregnancy is among the most significant and personal decisions a woman can make about her health, her body and her life.  If politicians - most of whom are men - have succeeded in passing laws that regulate women's bodies, one of the reasons for their success is that abortion typically is represented as something abstract.  Conversely, abortion is also frequently misrepresented in the most lurid terms, as is happening now * with "late-term abortion" bans and "fetal heartbeat" laws.  In either case, putting a human face to the reality of abortion was one way, as Kate Thomas (digital director of NARAL) wrote in the email, to "de-stigmatize what is a very common medical procedure."  As an OB/GYN and as a woman who had made the difficult choice to terminate a pregnancy, you were in a position of particular moral authority to speak out in support of a woman's right to choose. You did this by sharing your personal story.   I hope you will recall that, when I wrote you, it was partly to express my admiration not just for your courage in sharing it but for your doing so on behalf of such an important cause.

On the other hand, if you prefer not to recall my letter to you in 2017, perhaps it is because my other reason for writing it was to call your attention to what I felt was a glaring double standard with respect to your idea of bodily autonomy.  This is because, in your appeal on behalf of NARAL and in support of abortion rights, you wrote, "It's our body and our decision."  You wrote these words even as in your professional practice  -  perhaps that very day - you were depriving male neonates (and the men that they will become) of the right of bodily autonomy (and of much more, besides) by subjecting them to non-therapeutic penile circumcision, or male genital cutting (MGC).  Frankly, I was stunned by the contradiction between your claim of bodily autonomy for women like yourself and your denial of that same right to men like me.

Before going any further, I should explain why I am under the impression that you perform non-therapeutic circumcisions.

To begin with, when I visited your clinic's website in 2017, under your name was a list of "services performed" and one of these was circumcision.  I use the quotation marks around "services performed" because an individual who has had a major portion of erotogenic tissue cut away from his penis without his consent and in the absence of a medical indication is unlikely to regard himself as having been the recipient of a "service."

Now, to be fair, your website did not specify whether the circumcisions you perform are medically indicated or performed for non-therapeutic reasons, the chief one of which is that MGC has become a deeply entrenched cultural practice in the United States.  However, the reality is that, currently, in the United States, the overwhelming majority of neonatal penile circumcisions are performed without a diagnosis, hence, without a rational or sufficient medical justification for performing them.  (And, of course, 100% of them are performed without consent.)  Given that circumcision is, in fact, medically indicated for between 0.8% and 1.6% of pre-pubescent boys while the incidence of MGG is currently in the neighborhood of 50%, that makes it much more likely than not that most of the penile circumcisions that you have performed (like most circumcisions performed by most medical practitioners) were non-therapeutic.

There are other circumstances that tended to confirm my impression.  First, the fact that the initials "F.A.C.O.G." follow your name.  This means that you are a fellow of The American College of Obstetricians and Gynecologists.  This is an organization that has endorsed the American Academy of Pediatrics' 2012 Technical Report on nonconsensual penile circumcision which, in its own words, "emphasizes the primacy of parental decision-making."  To put that in plain English, the AAP believes that a parent's right to order the removal of normal, healthy erotogenic tissue from a child's penis for religious reasons, for cultural reasons, for cosmetic reasons, for any reason or for no reason outweighs that child's right to live his life with his genitals whole and intact. ACOG happily and profitably endorses this view.  It is not an unreasonable inference on my part, therefore, that, because you are a member of ACOG (like the majority of physicians in your clinic), you support ACOG's pro-male-genital-cutting policy. 

Added to all this is the fact that, at some point after I reached out to you in 2017, the wording on your website was changed.  It now no longer states that you offer "circumcision" but, rather, "surgical procedures."  It is hard to avoid the suspicion that this is a euphemism, the use of which represents your clinic's tacit acknowledgement that routine, non-therapeutic circumcision is a discredited practice that has been rejected by professional medical organizations around the world and that is increasingly being condemned as the human rights violation that it is.  For example, in 2016, the Danish Medical Association issued a statement declaring non-therapeutic circumcision "ethically unacceptable."  Lise Moller, the chairwoman of the DMA, was quoted as follows: "To be circumcised should be an informed, personal choice.  It is most consistent with the individual's right to self-determination that parents not be allowed to make this decision but that it is left up to the individual when he has come of age."

There are two important ways that all this ties together.  By "all this," I mean the right to obtain a timely, safe and legal abortion (on which we both agree), the right not to be subjected to genital cutting (on which apparently we do not agree), and the power of personal narrative.

To take up this last thread first, I want to emphasize that I was not only moved by your abortion story but gratified to see such powerful, first-person advocacy on behalf of the right of women to own and control their own bodies - a right I have long supported.  (I was out in the streets demonstrating in support of a woman's right to choose probably while you were still in elementary school - possibly before you were born.)  Above and beyond all this, your story inspired me.  It brought home to me the power of personal narrative.  Law, social policy, culture itself can be unyielding.  Progress in all of these domains can be glacially slow.  Sometimes, the best way to reach hearts and minds and to effect change is by speaking one's truth not to the ether but directly to one's fellow human beings.

Here  is my truth and I am speaking it to you: Involuntary circumcision deprived me of the right of bodily autonomy.  It deprived me of the right of bodily integrity and the right to experience the full range of my innate human sexuality.  I cannot imagine that I would ever willingly have chosen to have such an important part of my penis cut off but, even if I would have made that choice, the fact that this "choice" was made "for" me, without my consent, means that I was denied my right to choose.

This brings me to the other major thread of this letter: the principle of bodily autonomy or, as I prefer to express it, bodily self-ownership.  In the case of your own abortion, you explain that the fetus you were carrying had developed severe abnormalities and would not have survived past delivery.  This factored crucially in your  decision to terminate the pregnancy.  Equally crucial to the abortion-rights debate is the fact that legislation being passed now by anti-choice legislators would ban abortions during the second trimester, which, as you point out, "often involve medical complications."  Although I acknowledge that abortion is a valid and sometimes necessary medical procedure, my support of abortion rights transcends any specific medical justifications for abortion.  I believe that girls and women have a right to choose abortion because I believe that they own their own bodies.  It's that simple.  The right to obtain an abortion does not need to be justified on the basis of severe developmental abnormalities of the fetus or on the basis of medical necessity for the girl or woman.  It is sufficient that, because it is her body, it is a pregnant person's right to terminate her pregnancy.  It does not follow from this that every abortion is ethical, nor that every reason for abortion is morally valid (such as in the case of sex-selection abortion, which I find morally abhorrent).  Yet the right to terminate a pregnancy is as fundamental to basic human rights as any other right that is predicated on the principle of bodily self-ownership. 

That principle - bodily self-ownership - applies no less to males and to male bodies and to intersex bodies than it does to females and to female bodies.  It applies no less to bodies with penises than it does to bodies with uteruses.  And it applies no less to the practice of nonconsensual penile circumcision, which is incompatible with it, than it does to abortion rights, which are supported by it.  As you, yourself, wrote in NARAL's email:  "It's our body and our decision."

One of the goals of personal narrative - coming-out stories, like yours - is to foster constructive and civil dialogue.  I see this personal narrative - this open letter to you - as a way for me to extend a hand in order to help you across what I believe to be the cultural chasm that divides us.  On your side of the chasm, nonconsensual penile circumcision is a normalized, entrenched cultural practice that has been gilded with counterfeit legitimacy through decades of medicalization.  On my side, nonconsensual penile circumcision is a human rights violation.  This is why:  Because it is medically unnecessary.  Because it causes needless pain and trauma.  Because it is a theft from an individual of a body part that he has a fundamental right to keep.  Because it removes densely innervated erogenous tissue, the loss of which necessarily impairs sexual function, sensation, intimacy and  satisfaction.  Above all, because it deprives people with penises of their right to choose.

If you believe, as your clinic's website led me to assume you do, that nonconsensual penile circumcision is a legitimate and ethical practice, you and I remain light years apart on this issue.  If, on the other hand, you believe, as I'm sure you do, that bodily self-ownership is a fundamental human right, you are one small step away from recognizing that the right to obtain an abortion and the right not to be subjected to genital cutting stand on the same moral foundation.  

*Update: Since this open letter was published, the Supreme Court has overturned Roe v. Wade.  See my post on the significance of the Dobbs decision here.

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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 and as Director of Outreach for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), he serves on the board of directors and advisors for Doctors Opposing Circumcision and serves on the leadership team for Bruchim.
 

On Stigmatizing the Male Prepuce and Male Body Image: An Open Letter to Cara Natterson, M.D.

by David Balashinsky

Several weeks ago, I attempted to engage Cara Natterson, M.D. in an online conversation about the two topics named in the title of this open letter.  The impetus for this was her recent Times essay, "The Beauty Myth for Boys."  Although Natterson's essay reflects what I believe to be an overdue corrective to popular notions about young men's body image, I also believe that what she says and what she does represent an irreconcilable conflict between two fundamentally opposing principles.  That is because she argues on behalf of male body positivity on paper but performs non-therapeutic neonatal circumcisions (male genital cutting, or MGC) in practice.  I was stunned by this contradiction (not to say hypocrisy).  And yet, because of what she wrote in her essay, I was encouraged to hope that this is someone whose thinking I might be able to influence on the topic of genital autonomy.  As far as MGC is concerned, if there is a problem with Natterson's essay, it is that it starts down the right path but stops before reaching the right destination.  If one genuinely cares about how males view their own bodies, can this lead to any conclusion other than that it is wrong to surgically alter their genitals without their consent?  The premise of Natterson's concern for male body image is that what males think about their bodies matters.  The premise of the practice of forced circumcision is that what males think about their bodies doesn't matter. How, I wondered, does someone simultaneously entertain such mutually exclusive ideas?  It seemed to me that, like most people possessed of the pro-genital-cutting mindset, Natterson wasn't evil: she simply hadn't thought this through.  That is why it seemed that she would be an ideal person with whom to share an exchange of ideas in a forum intended to fulfill the promise of the internet - constructive dialogue - as opposed to what has proved unfortunately to be the internet's ugly reality: invective and "echo-chamber" affirmation of entrenched positions.  I reached out to Dr. Natterson, therefore, with these goals in mind. Unfortunately, despite several attempts to elicit her participation, my letter has gone unanswered.  In order to rescue it from the dead-letter bin, where it would likely remain forever, I am posting it here (with one or two very minor alterations), on my blog.

Dear Dr. Natterson,

Your recent essay in the New York Times, "The Beauty Myth for Boys,"  both struck a chord and hit a nerve with me.

First, insofar as social pressures regarding their bodies are concerned, while there may be some similarities between the experiences of girls and boys and women and men in our society, young men certainly are not subjected to the relentless sexualization and objectification of their bodies that young women are.  Nor is the male experience even remotely comparable to the female experience of constant bombardment with demeaning and sexist imagery.  But, leaving that aside, and allowing that the problem you cite is real, the disparate attention paid to these twin sets of pressures is at least in part due to a vibrant feminist movement that has struggled hard to combat the undeniably greater pressures placed on girls and women in this regard (hence, Naomi Wolf's book), and it is reasonable that that is where feminism should focus its efforts.

Yet it has also long been recognized that patriarchal culture harms both sexes, albeit differently. The ways that males (of all ages) are expected to look and, especially, to comport themselves in our society is as much a construct as the ways that females are.  For both sexes, these expectations are intrinsic to the construction of gender.  Key attributes of masculine gender are stoicism, strength, fearlessness and taciturnity.  When society's expectations conflict with a boy's authentic nature (whatever it may happen to be) and when the inevitable emotional and social difficulties result, he is supposed to "man up," "stop whining and just deal with it."  Our society still discourages males from acknowledging, let alone exhibiting, weakness and pain, whether the pain be physical or psychological.  It seems to me, therefore, that before we can address the body-image problems of boys, we need to address the problem of gender and how it warps human nature to the detriment of both sexes.  To your point, then, about the importance of encouraging boys to communicate their feelings, boys (and men) must first be permitted to express their feelings without being ridiculed, having their masculinity, heterosexuality or even their sanity questioned, or having their sexual orientation or gender identification (or non-identification) attacked.

From everything I have written up to this point, you might suppose at least some concord between us on the question of boys' and young men's body-image problems.  And yet, it is because we are likely on opposite sides of a related philosophical divide that I am reaching out to you in the spirit of constructive dialogue. You see, it is my belief that, to the extent that boys do have body-image problems, one of the ways that our society contributes to them is through the practice of non-therapeutic circumcision, or male genital cutting (MGC).  You, on the other hand, have publicly acknowledged performing neonatal circumcisions.  While I do not believe that you ever intended or desired to cause deliberate harm to the boys and future men whose genitals you irreparably altered without their consent, I do think that you need to hear from at least one man whose perception of his own circumcision (performed long before you started doing these surgeries) is that he was harmed by circumcision.  You make much in your Times essay about valuing the male perspective and getting adolescents to open up about how they feel about their bodies.  While I am no longer an adolescent, I am still connected to the adolescent that I was by an unbroken chain of days lived within this male body.  And expressing myself both as a male and as a victim of MGC, I would like you to understand that what was done to my body without my consent was a violation of my fundamental human rights.  Involuntary circumcision deprived me of the right to bodily autonomy, the right of bodily integrity, and the right to experience the full range of my innate human sexuality.

It also occurred to me, when reading your essay, that there was not just a conflict between our views on body image (let alone bodily autonomy) but an inherent contradiction between your own professed views on the importance of boys having a healthy body image and your practice as someone who performs involuntary circumcisions.  While your support for male body-positivity and your validation of the male experience come through loud and clear, involuntary circumcision is a complete negation of those very principles.

It is universally acknowledged that neonatal male circumcision is not medically necessary. MGC is, in fact, performed primarily for cultural and "aesthetic" reasons.  Social conformity - "so he will look like his father" and "so he won't be made fun of in the locker room" - are among the most common rationalizations offered by parents for having their sons circumcised.  More broadly, because we live in a culture in which MGC has been normalized, many if not a majority of Americans conceptualize a surgically-reduced penis as "normal."  Thus, they tend to regard a healthy, intact penis as abnormal, ergo, deformed.  It remains common, therefore, for intact boys and men to be mocked for the natural anatomical structure of their genitals (hence the concern about locker rooms).  Isn't this the very sort of harmful social pressure exerted on male psyches about male bodies that you criticize in your essay?  Think what a toll this social pressure takes on the body image and self-esteem of intact boys. 

The problem, however, for such boys and young men is not that their penises are intact but that their prepuces have been pathologized by our society.  Thus, it is the very act of MGC and the normalization of this practice that have created a culture in which the male prepuce has been stigmatized.  As a result, every boy - whether circumcised or intact - grows up with the perception that he was born with a congenital "deformity" of his penis that either was "corrected" through circumcision or, if it wasn't, ought to have been.  And every time a physician performs a medically unnecessary circumcision, she or he contributes to this body-shaming culture.

While I congratulate you, therefore, on your Times essay and welcome your effort to bring to the attention of the public the body-image problems faced by boys and adolescents,  I would respectfully suggest that a serious and comprehensive discussion of this phenomenon must also take account of the practice of MGC and its harmful effects on male body image and self-esteem.

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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 and as Director of Outreach for the Genital Autonomy Legal Defense & Education Fund, (GALDEF), he serves on the board of directors and advisors for Doctors Opposing Circumcision and serves on the leadership team for Bruchim.
 

On the Gendering of Defecation

by David Balashinsky

I could easily have trod the path of the Men's Rights Movement.  From a very early age, I did not feel it a privilege to be male but the opposite.  Even before puberty, as I became more and more conscious of the way that the world treated me on the basis of my sex, I became convinced that girls and women had it much better than boys and men.  My developing awareness of issues related to sex, gender and sexism coincided with the renaissance of the women's movement back in the late 1960s, or what was then known as the "women's liberation movement" and what is now known as second-wave feminism.  Because of my early exposure to feminism, much of my own perception that I had been relegated to a status inferior to that of females arose in direct response to the feminist critiques of society that were then gaining popularity but had not yet become firmly established in the popular consciousness.  In many of the specific ways that feminists contended females were disadvantaged relative to males, I perceived a reality that suggested the very opposite.  Examples seemed to abound.

One of the most salient was the contention that advertising routinely denigrated women with sexist stereotyping and imagery that reinforced traditional gender roles. In advertisements on television (and, of course, in other media), women were invariably represented as housewives whose main role in life was to clean the house, do the laundry, do the grocery shopping, do the cooking and take care of their children and their husbands. It is self-evident that such representations of women functioned to reinforce their traditional consignment to the domestic sphere while serving to limit women's opportunities for personal and professional fulfillment (and the attainment of social and financial independence). But these advertisements were often just as denigrating to men and just as reinforcing of the traditional male role as breadwinner. Insofar as anything related to the home or childcare was concerned, the husbands in these advertisements typically were portrayed as incompetent, lazy and clueless if well-meaning dolts. By invoking and promoting the trope of the useless husband, these advertisements tended to relegate men to the same level of dependency on the woman as her children. Thus, these advertisements not only demeaned men but infantalized them. Viewing these representations of men through youthful male eyes, I did not perceive them as confirming my status as superior to women, nor did I find them "empowering." I was offended by them.

Another example would be the criticism that women were treated in the popular culture as what was then known as "sex objects." Beauty and sexual desirability, especially in advertising, were strictly represented as female attributes. Viewed through innocent male eyes, however, the sexual objectification of women and of women's bodies seemed to me to represent society's dictum that to be beautiful and sexually desirable was a privilege reserved for women only. I didn't pity women for that; I envied them for it. A common retort by men back then to the criticism that women were treated as sex objects was something along the lines of "What's so bad about that? I'd love to be treated like a sex object!" I do not ever recall wanting to be female, as though I identified, as a matter of gender, as female. But I have often wanted to be female when I imagine what it must be like to be viewed as a sex object. The standard objection - not just from feminists and often reinforced in popular culture - to the sexual "objectification" of women's bodies is that it is demeaning to desire someone only for her body but noble to desire someone only on account of her mind. Yet if the mind and the body are both aspects of the self, I wondered, why is it complimentary to be appreciated for one's mind but not equally complimentary to be desired for one's body? I would have loved to be lusted after by women in my youth in the way that I lusted after women.

Whether the sexual objectification of women's bodies is a conscious act, an unconscious, sexist, patriarchal social construct, or merely something that heterosexual males are hardwired to do because to do so is a trait that has been selected for by our evolutionary history, the sexual objectification of women's bodies is the classic double-edged sword. It is as impossible to make the case that this does not make being female a liability as it is to make the case that it does not simultaneously confer on females certain benefits that males simply do not enjoy. I have yet to meet a woman who has not been propositioned and pursued sexually to a degree that men even in their wildest fantasies never experience. I can only imagine how much sex I might have had in my youth had I been born female (or gay, for that matter) or, at the very least, how much greater my self-esteem might have been had I perceived myself as being sexually desirable which, being male, I was not socialized to do. When I was young, the notion that the male body could be viewed as something sexually desirable to the opposite sex was a concept that was still decades away. I confess that one of the reasons I enjoyed the company of gay men when I was young (most of my friends were gay) is that I found it reassuring to know that I was at least attractive to someone. And yet, I am also thankful that I can walk down a street without getting grabbed, ogled, told to "smile, Honey," have someone say "Nice tits" to me, follow me, stalk me, harass me, or make me seriously concerned that I might get raped. Nor have I, in fact, been raped (although I was sexually abused when I was in summer camp).


The point of these examples is to illustrate the principle that a sexist cultural belief or norm that is regarded, axiomatically, as damaging to girls' and women's self-esteem is often, in fact, also damaging to boys' and men's.  Perhaps this was never more true than in the case of a phenomenon that is discussed in an essay that appeared in the Times this past fall, entitled, "Women Poop. Sometimes At Work. Get Over It." In this essay, the authors Jessica Bennett and Amanda McCall argue that

Poop shame is real - and it disproportionately affects women, who suffer from higher rates of irritable bowel syndrome and inflammatory bowel disease.  In other words, the patriarchy has seeped into women's intestinal tracts.  Let's call it the pootriarchy.

Girls aren't born with poo shame - it's something they're taught.

It is not at all clear to me how Bennett and McCall arrive at the conclusion that "poop shame . . . disproportionately affects women." It seems to me that a study intended either to confirm or disprove this hypothesis ought to contrast or compare the prevalence of "poop shame" among women with its prevalence among men. Yet one of the sources that the authors cite is a Canadian study on bowel health and bathroom anxiety that surveyed exclusively women (1,000 of them). And when attempting to conduct their own survey about "fecal habits at work," the authors pre-selected their pool of potential respondents by soliciting the participation of "mostly women." Men are simply assumed, evidently, not to experience feelings of shame about their bodily functions, so why ask? As it happens, one of the three people who did respond to the authors' survey was a man who, it turns out, expressed precisely the same sort of shame about defecating at work as women and described resorting to precisely the same sort of elaborate subterfuges as women do in order to avoid detection when he did.

That all people, to one degree or another and irrespective of sex, experience feelings of embarrassment about their bodies and their bodily functions should surprise no one. Feelings of bodily shame and self-loathing are deeply embedded in most of us. These feelings certainly pertain to our sexuality but they are particularly acute with respect to the functions of excretion and, especially, defecation. (Personally, I attribute this to the incompatibility of intelligence with corporeality. As homo sapiens sapiens, we simply cannot reconcile the transcendent superiority of our minds with the fact that our bodies belong to the kingdom Animalia.) Moreover, these feelings of shame about excretion and defecation are intricately bound up with our concepts of sex and gender. As Nicholas Haslam (a psychologist and author of "Psychology in the Bathroom") notes in Bennett and McCall's article, "The bathroom is saturated with gender in fascinating ways." Why, to question a sacrosanct convention, should bathrooms even be segregated according to sex? Surely it is at least, in part, to maintain the illusion that neither sex actually performs bathroom functions by concealing what men do there from women and by concealing what women do there from men.
 
Yet this collective illusion that we like to maintain about ourselves is not equally applied nor enforced. It is almost certainly true that men are permitted, much more than women are, to acknowledge without shame the need to defecate. And that women do experience their own particular shame about defecating must be related to one of our culture's most cherished myths about female physiology, namely, that women do not defecate at all, ever.

This fantasy of idealized femininity was drilled into me by own father who routinely insisted that women did not do such things (for how could they be such perfect, sublime creatures if they did?). Despite the fact that I grew up with a twin sister with whom I regularly shared bathroom time when we were children, and so knew otherwise, this fantasy that women do not defecate nonetheless shaped my concept of women. Yet it also shaped my concept of myself. Even though, intellectually, I understood this myth about women to be a fiction, on a deep, emotional level I interpreted this as evidence not just of female "purity" but of female superiority. This left an indelible mark upon my male psyche and male self-esteem. After all, if women do not defecate, the corollary of this is that only men do. The concepts, then, of female and male that were instilled in me - not just by my father but by society - were that women are essentially spiritual, sublime creatures unpolluted by base biological functions in contrast to men, who are essentially bestial creatures whose bodies perform the most disgusting function imaginable - a function that no female's body ever would. As a result, from my earliest childhood, I felt that my body was disgusting because it was male. And I always felt inferior to women, in the sense of being less human, as a result.

This notion - that males are less human and much closer to barnyard animals, either because they defecate or because, like animals, they are assumed not to experience shame about it when they do, in contrast to females who are much closer to angels or goddesses, either because they do not defecate or because, if they do, they at least have the refinement to be ashamed about it - was reinforced at the elementary school that I attended. In this public school (P.S. 193), the toilet stalls in the girls' bathrooms had doors for privacy whereas the stalls in the boys' bathrooms did not. I still remember the intense feelings of shock, outrage and envy as well as experiencing a profound sense of being diminished as a male when I discovered this. The point was driven home to me in no uncertain terms that privacy and dignity were privileges that I did not merit because I was male. Being so much farther down the phylogenetic tree than girls, what right did boys have to expect privacy when defecating?

The standard feminist interpretation of this double standard in bathroom accommodations is that, in patriarchal societies, girls' modesty must be protected and their idealized purity preserved at all costs. Boys, being stronger, more worldly, less preoccupied with frivolity and propriety, have no need of such things as privacy when defecating. This all makes perfect sense to a social scientist or ivory-tower-ensconced academic. Yet I do not think that this is how most of the boys in my elementary school perceived this double standard. It certainly isn't how I perceived it.

Of course the notion that women don't defecate is sexist and downright Victorian in that it places women on a pedestal.  Of course it reinforces the notion that women's bodies must be "pure" and unpolluted by base biological functions.  As Haslam (again, quoted in Bennett and McCall's essay) puts it,

At one level, it's an association of women with purity. . . .  At another it's a double standard applied to hygiene and civility, where the weight falls disproportionately on women to be clean, odorless and groomed.

It's easy to see how such a double standard adversely affects women. It is dehumanizing, in its own peculiar way, not to be regarded as an actual human being, since defecation is an essential physiological part of being human. But if the myth that females do not defecate is harmful to girls and women, how is its corollary - that only males do defecate - any less harmful to boys and men? As I see it, the gendered mythology about defecation is a paradigm of the principle that sexist gender roles harm both sexes. Sexist myths and gender constructs are surely toxic in different ways and to different degrees but they are, notwithstanding, opposite sides of the same coin. Social critics are right to condemn gender roles, sexist myths and idealized standards that harm girls and women but they err when they fail, as many so often do, to take account of the ways that these things also harm boys and men. Bennett and McCall's Times essay is a case in point.

About me: I am originally from New York City and now live near the Lakes region of New York. I'm a licensed physical therapist and I write about bodily autonomy and human rights, gender, culture, and politics. I currently serve 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.