"My Body - My Choice": Abortion Rights, Genital Autonomy and the Vaccine Mandate

by David Balashinsky

There is no right more important than the right of bodily self-ownership.  I cannot conceive of a right that is even a close second.  Without a territorial boundary that demarcates one's entire body as belonging exclusively to oneself and prohibiting all others from trespassing on it or restricting one's control over it in any way, liberty means nothing.  Without the right to exercise sole authority over one's body, full personhood is impossible.  (It should go without saying that when I refer to "personhood," I am speaking about persons who actually have been born - not zygotes, embryos or fetuses.)  Bodily self-ownership is the starting point of personal liberty.  Or, as William O. Douglas put it, "The right to be let alone is indeed the beginning of all freedom."

Because I have always had a healthy contempt for authority, I am biased toward personal liberty.  At the same time, I recognize that ours is a quintessentially social species.  Just as individuals have rights, groups of individuals, acting together, also have rights.  That is particularly true when the group in question is a society or a nation.  In that case, group rights are especially compelling when they are legitimately exercised in pursuit of the public good.  I believe that the guiding principle of any rational and just political system, therefore, should be maximizing personal liberty while simultaneously maximizing the public good.  

These two ideals - personal liberty and the public good - exist in equilibrium.  An increase of one often entails a decrease in the other and, yet, both are necessary.  We routinely sacrifice some of our personal liberties for the public good.  The entire concept of laws - which mostly limit what individuals are allowed to do but also sometimes compel us to do things we otherwise might not - is based on this principle.  A law that prevents an individual from driving drunk is one example of laws that limit our personal liberties.  A law against smoking in a restaurant is another.  Likewise, laws against public spitting or urination.  Some laws compel us to do things; military conscription is an example of this.  Other laws are conditional, imposing obligations on us as a condition of being permitted to engage in certain activities.  Obtaining a valid license before practicing medicine or nursing or physical therapy is an example of a conditional regulation.  No one is obliged to work in healthcare but, if one chooses to work in healthcare, one must accept the conditions under which she or he may be permitted to do so.  Completing the required degree program and getting that license is one of these conditions.  Abiding by a code of ethics is another.  Another is getting vaccinated so that one doesn't spread a highly contagious and deadly disease to one's patients and colleagues.

While both concepts - personal liberty and the public good - represent goods in and of themselves, both also have the potential to be misused, or weaponized.  For example, claims on behalf of the public good - typically made by governments - can be and are used to justify abridging individual liberties.  This is often what occurs when repressive governments prohibit public demonstrations or other forms of expression that are critical of the government.  The rationale typically provided is that it is for the public good - usually to maintain "public order" - despite the fact that curtailments of individual rights almost never have anything to do with the public good but, rather, are imposed in order to preserve the power of the ruling party in government.  Lately, there has been a discouraging and frightening increase in this sort of authoritarianism and repression around the world, from Hong Kong to Belarus and beyond.  This is even happening in our own country as more and more Republican-controlled state legislatures enact statutes criminalizing public protests.

But just as the claim of the public good can be used to curtail individuals' civil liberties and justify harm to individuals, the claim of personal liberty can be used to justify or excuse harm to society and harm to other individuals.  Until recently, the gun-rights lobby demonstrated probably the most extreme example of this phenomenon.  Believers in an individual's absolute right to own any and all kinds of weapons are not concerned in the least by the harm to others and to others' rights that necessarily ensues from an unlimited, "personal-liberty" right to own military-grade weapons with high-capacity magazines.  

A more recent example of the misuse of the claim of personal liberty is the refusal by many Americans (mostly Republicans, it turns out) to get any of the Covid-19 vaccines that have been proven safe, effective, are widely available and absolutely free.  As a result, the Covid pandemic rages on in the United States, with deaths now surpassing 700,000.  Had every American, who could have done so, done his civic duty by getting vaccinated, the pandemic likely would be behind us now and life and the economy would have returned to normal.

It may not be surprising to see antisocial behavior on the part of those who condemn virtually anything that benefits society as "Socialism!" (they use the word as a pejorative because, apparently, they regard anything that produces the greatest good for the greatest number of people as an assault on their individual liberties).  What is surprising, however, and disconcerting - and I speak as someone who has worked directly with patients in hospitals for more than 20 years - is the refusal even by some healthcare workers to get vaccinated.  As a result of their intransigence, New York and several others states have recently had to institute a vaccine mandate for healthcare workers.  In response to this mandate, some of these opponents (and others) have appropriated the phrase, My Body - My Choice.  To me, this represents a new low in the history of those whose rights aren't being violated appropriating the discourse of those whose are.  This is either a shrewd if transparent tactic or just plain persecution envy. We see this in the Men's Rights Movement which, although there certainly are kernels of truth in what it has to say about sex discrimination, is based on the manifestly false premise that it is boys and men, not girls and women, who are, in fact, more often victimized and systematically oppressed.  Claiming persecution also has become a favorite tactic of Christian Conservatives and Evangelicals.

Invoking My Body - My Choice in support of anti-science, antisocial, anti-vaccine obstinacy is a misappropriation of the phrase in several important ways but what is particularly objectionable is the insensitivity that it shows toward those for whom the phrase has real meaning.  As is widely recognized, My Body - My Choice has been the battle-cry of the abortion-rights movement for at least the past half century.  There is a reason for this.  It encapsulates the fundamental issues raised by abortion: bodily self-ownership and the exclusive right of the individual, as the owner of that body, to exercise her own choices about it.  Every human being must be free to chart her or his own course in life and to control her or his own destiny.  Above all, every human being has a fundamental right to exercise absolute ownership of her or his body.  For girls and women, that necessarily and unquestionably entails the right to terminate a pregnancy.¹

It also necessarily entails the right to bodily integrity which is why, although its use in this context is not as widely familiar,  My Body - My Choice also has been taken up by the genital-autonomy movement.  It is frequently phrased as His Body - His Choice in recognition of the fact that, whereas genital cutting of girls is illegal and rare in the United States, genital cutting of boys is still legal and widespread.²   For this reason, the genital-autonomy movement here necessarily advocates on behalf of the right of boys not to be subjected to non-therapeutic circumcision.  Despite the unequal legal status of girls and boys insofar as the right to genital integrity is concerned (one of those truths about which men's-rights activists happen to be right), or rather, because of it, I prefer the universality of My Body - My Choice.  Taking sex out of the equation emphasizes that growing up with one's genitals intact and unharmed is a human right.³

The sex-neutral My Body - My Choice also emphasizes that the right to abortion and the right to genital integrity stand on the same ethical and philosophical foundation: the principle that every individual is born with an innate right of bodily self-ownership.  It is the denial of this right, and specifically in these contexts - the profoundly significant and life-altering human-rights violations that are forced childbirth and involuntary circumcision - to which the phrase My Body - My Choice is an appropriate response.  It is not a catchall for every law and regulation to which those who are irrationally jealous of their personal liberty might object.  There simply is no comparison between either compulsory childbirth or forced genital cutting and being expected, as a condition of employment in healthcare, to get vaccinated against a deadly disease in the middle of a pandemic.  

Invoking My Body - My Choice in opposition to something as benign (not to mention positively beneficial) as the Covid vaccine is a misappropriation of this phrase, then, in part because it trivializes it.  In sharp contrast to the Covid-vaccine mandate, whether we are speaking of preventing girls and women from obtaining timely and safe abortions or whether we are speaking of genital cutting, when an individual is deprived of her or his right of bodily self-ownership in either of these two ways, real harm ensues.

A girl or woman who, against her will, is forced by the state (or, under a provision of SB8 in Texas, by any private citizen in the United States who wants to score ten grand) to undergo the ordeal of a pregnancy and childbirth has no remedy available that can undo the harm that will have been done to her.  Her life will be irrevocably changed.  If she keeps the child, doing so will have major ramifications for her education, her employability, her financial stability and economic independence and her ability to choose to have a family when she is ready to.  It will affect every almost aspect of her personal life, her social life and her professional life.  Even if her child is adopted, the girl or woman who bore her will have gone through not just the trauma of forced pregnancy but the additional trauma of giving up a now, fully formed human being who is her offspring.  Conversely, if she is forced to obtain an illegal abortion, she runs a considerable risk of medical complications and serious injury including sepsis, hemorrhage, sterility and death, to say nothing of the potential legal sanctions.  Pregnancy and childbirth, themselves, pose much greater risks to woman's health and life than abortion does, and those risks increase significantly for younger women and girls.  Beyond all this is the affront to personal dignity and autonomy - the negation of one's full personhood - that is an inevitable part of being denied the right to make one's own reproductive decisions and the right to exercise exclusive control over one's own body. 

What is getting vaccinated against Covid-19 in comparison to any of this?  The most common effects of the available vaccines are not dying or getting seriously ill.  More importantly, a vaccinated healthcare worker is much less likely to spread Covid-19 to others.  Needlessly infecting one's fellow healthcare workers (to say nothing of one's patients), besides causing them harm and being, therefore, unethical on its face, also results in a further depletion of already critically understaffed hospitals.

As with forced childbirth, in the case of forced circumcision there is no remedy.  Ablation of the prepuce is irreversible - it can never be undone and its harms are life-altering and life-lasting.  Non-therapeutic male circumcision removes the primary sensory structure of the penis.  As a result, those who are subjected to this surgery in infancy or childhood can never know what intercourse is supposed to feel like.  They are permanently prevented from experiencing the degree of sexual intimacy and bonding - the shared, mutual sensuality - that is only possible when both partners have fully intact genitals.  If this were not enough, as with any surgery, circumcision subjects the victim to a range of risks and complications,  from meatal stenosis to excessive scarring to complete loss of the penis, to sepsis, hemorrhage and even death.  Also, as with any invasive surgery, non-therapeutic circumcision necessarily subjects the victim to pain.  Beyond all this is the affront to personal dignity and autonomy - the negation of one's full personhood - that is an inevitable part of being denied the right to make one's own decisions about one's sexuality and the right to decide for oneself which parts of one's body one is permitted to keep and which parts get cut off.

Again, what is a vaccine mandate, as a condition of employment, in comparison to any of this?

Another crucial distinction between the vaccine mandate and either forced childbirth or involuntary circumcision is that the vaccine mandate has a rational, reasonable and justifiable public-health objective.  In contrast, there is no justifiable public-health objective in denying women the right to abortion or in subjecting male minors to involuntary circumcision.  Not only are the public-health claims in support of neonatal circumcision - namely a reduction in risk for transmission of STIs - not supported by the evidence but what evidence there is now actually points in the opposite direction.

Of course, the most significant difference between forced childbirth or forced circumcision and the vaccine mandate (and this is a difference not of degree but of kind) is that - the label mandate notwithstanding - no healthcare worker is being forced against her or his will to get vaccinated.  The mandate is being instituted simply as a condition of employment.  Healthcare workers who do not want to get vaccinated remain free to choose not to do so.  They simply are being required to forego, as a consequence of exercising that choice, the privilege of working in healthcare.  They may not like that choice, but it is still a choice.  That is fundamentally different from denying someone access to abortion and it is fundamentally different from subjecting someone to genital cutting without consent - both of which deny the victim any choice in what happens to her or his body.

In addition, the choice for healthcare workers that the vaccine mandate actually allows them to make is not between bodily autonomy and a forfeiture of bodily autonomy.  It is between retaining one's job at the cost of a relatively small degree of one's bodily autonomy and retaining one's absolute bodily autonomy at the cost of one's job.  Even that is still a choice.  Giving up one's job - even one's profession, if it comes to it - is no small thing, and I am not minimizing it in the least.  But one's job doesn't even begin to compare in importance to one's body.  We routinely accept conditions of employment, precisely because they are undertaken voluntarily,  that we would never accept if they were imposed on our bodies without our consent.  That is the difference between forced childbirth and genital cutting as opposed to the vaccine mandate as a condition of employment for healthcare workers.  It is the difference between the fundamental right to own one's body and the everyday compromises we all make in order to hold down a job.  And, while everyone may be entitled to a job, not everyone is entitled to a job in healthcare.  That is because working in healthcare is a privilege - not a right.  Bodily autonomy, on the other hand, including the right to abortion and the right to grow up with one's genitals intact, is a right - not a privilege.

Update (25 March 2025): This essay was written in 2021, at the height of the Covid pandemic.  When I wrote it, the U.S. death toll had recently passed the 700,000 mark.  By the beginning of 2023, 755 million people had contracted Covid worldwide and 6.8 million of them had died.  In the United States, as of about a year ago, 111.82 million Americans had contracted Covid and 1,219,487 of them had died.

I also wrote (in footnote no. 1) that the constitutional right to abortion was "hanging by a thread."  That thread was cut less than a year later when the Supreme Court overturned Roe v. Wade in its infamous Dobbs decision.

1. It seems strange that the right to terminate a pregnancy is not explicitly and universally recognized as a fundamental human right and that that right has not been formally codified.  And, yet, even here, in the U.S.A. - a nation that cherishes the ideal of personal liberty - women's and girls' right to own and control their own bodies is under relentless assault, is now widely and significantly curtailed throughout much of the nation and the constitutional right itself, as recognized a half century ago in Roe v. Wade, is hanging by a thread.  (The Senate can remedy this by passing the Women's Health Protection Act.  The House did so last month.)

2. It also seems strange that the right not to have part of one's genitals cut off without consent is not explicitly and universally recognized as a fundamental and universal human right.  And yet, here we are in 2021 and 3,000 times every day in the United States an infant boy is subjected to a traumatic and totally unnecessary genital surgery for no other reason than that the practice has become a self-perpetuating cultural norm.  Worldwide, at least 200 million girls and women have been subjected to female genital cutting (FGC) and more than one billion boys and men have been subjected to male genital cutting (MGC).  It is not known how many intersex individuals are subjected to genital cutting every year. 

3. It is a paradox that abortion restrictions and involuntary circumcision are both so alike and yet so different.  Feminists cite the unequal effects of abortion restrictions - because they apply to (biological) girls and women only - as an example of systemic, sex-based discrimination.  MRAs, for their part, cite the practice of male genital cutting (MGC) - hence the unequal effects of anti-FGM statutes because they protect girls but not boys from genital cutting - as an example of systemic, sex-based discrimination that affects only boys and men.  Both are right and it is perplexing that feminists and MRAs have not generally made common cause with one another on the principle of bodily autonomy.  They should, because, in theory, at least, their shared belief in bodily autonomy ought to make them natural allies.

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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 have been a physical therapist for about 25 years.  When I'm not doing that or working on my house, I write about bodily autonomy and human rights, gender, culture, and politics.
 

 

 

Whose Flag?

by David Balashinsky

A friend recently posted the following meme on Facebook:

 

I usually avoid taking the bait when I see memes like this but this one seemed so belligerent and so obnoxious that I could not let it go without asking, "Who is telling you to apologize for our flag?"  The implication that Americans are being asked to apologize for the United States flag is only one of several falsities artfully woven into this work of propaganda but, because this notion stood out as being even more goading than the others (which is saying something), this seemed like a logical place to start.  Although my friend never directly answered my question, her response did get me thinking about how this meme epitomizes the right wing's misuse of our nation's flag and the subtle and not-so-subtle ways in which it cleverly packages animosity toward the values actually represented by the United States flag within an outward show of devotion to it. 

First, some context:  It is no secret that, especially since the Vietnam War, the right wing has sought to appropriate the U.S. flag as a political symbol of its view of America.  The left, itself, bears some responsibility for this.  I am old enough to remember when the U.S. flag was desecrated, burned and otherwise disrespected in protest of the U.S. war against Vietnam and in protest of any number of other evils perpetrated by the government of the United States.  (Its support of repressive, military dictatorships around the world and, especially, in Latin America throughout much of the latter half of the 20th century comes to mind.) 

There is an undeniable logic to this form of protest.  Since the flag symbolically represents the nation and since policies that are carried out by the government are carried out on behalf of the nation (and in the name of the People of the United States), U.S. government policies, the administration that enacts them, the nation itself and the flag that represents it are all links in a chain.  It stands to reason that, if one wants to condemn a policy that has the U.S. flag figuratively stamped all over it, stamping all over the flag, in turn, seems a valid and appropriate way to do it.

The problem, however, is that this form of protest by the left has played disastrously into the hands of the right, not just allowing it to appropriate the nation's flag as a symbol of right-wing values but enabling it to exploit the flag in an ostentatious display of its own professed patriotism.  This has reinforced the fiction that right-wingers and conservatives are more patriotic than left-wingers and liberals and that right-wing values are intrinsically more patriotic than left-wing values.  That is why the U.S. flag is ubiquitous on the lapel pins, the podiums, the buildings, the lawns, the websites, the pick-up trucks and motorcycles, even the clothing of right-wingers.  And, of course, in right-wing memes on social media.  

But despite the success that the right wing has had in appropriating our nation's flag as a symbol of its values, these are not the values that the flag actually represents.  And, generally, when the right wing waves the flag, it does so not as a statement of patriotism but as a form of "virtue signaling" and for the purposes of propaganda, as in the meme above.  To this patriotic American, this is an even more offensive desecration of the flag than burning it.  An even greater desecration of the flag occurs when it is waved alongside the flag of the pro-slavery and seditionist Confederacy.  And a desecration even greater than this occurred when the flag was used, literally, as a weapon by Trump's insurrectionists in their attempted coup on his behalf on January 6th.  That is why I believe it has been a gigantic mistake on the part of the left to let conservatives and other right-wingers get away with their appropriation of our nation's flag.  It is long past time that the nation's flag be reclaimed - not as a symbol of the left (although I do believe that the ideals articulated in the nation's founding documents are fundamentally liberal, rooted, as they are, in the European Enlightenment) - but as a non-partisan symbol of the nation's shared ideals and of the nation broadly, including everyone within it.

Which brings me to why this meme is so offensive and how it succeeds at being so antagonistic.  By claiming the flag as his through the use of the first person  - "this is my flag" (my emphasis) - what the creator of this meme is really saying is that it is not yours nor mine.  This contradicts both the letter and the spirit of our nation's original and traditional if unofficial motto: e pluribus unum - "from many, one."  Making the nation's symbol exclusive of one's political enemies is a favorite tactic of the right wing, but it is not just a rhetorical device.  White nationalists, the Christian Identity movement and Christian nationalists all, to varying degrees, actually envision the United States (or at least much of its geographical territory) as a White, Christian homeland in which non-White, non-Christian residents are less authentically American (and less authentically human, even) and not truly part of the fabric of the nation's polity.  That's what the alt-right movement is all about and it was precisely to this quandom undercurrent (until Trump legitimized it and brought it fully out into the open) of White nationalism, racism, religious bigotry, antisemitism and xenophobia to which Trump very deliberately appealed in 2015 and throughout his occupancy of the office of President of the United States.  Referring to the flag as "my flag" rather than as "our flag" clearly signals that this meme has little or nothing to do with patriotism and everything to do with White nationalism.  "My flag," as it is used in this meme, is a repudiation of the sentiments of unity and camaraderie with all other Americans - the shared love-of-country that is the lifeblood of the American spirit - and serves no other purpose than to marginalize those Americans who are not in the same demographic group that overwhelmingly comprises the Republican base.

Is it a stretch to tie Trump and Trumpism to this meme?  Not really.  The person who originally shared it on Facebook (at least the version that I saw when it was re-posted by my friend) is Ina Holiday, a Las Vegas "entertainer and singer," and former candidate for the Nevada State Assembly whose Facebook page includes a goodly amount of anti-vaccine, anti-mask and pro-Trump memes and posts.

More to the point, it is also not a stretch to interpret this meme as a reaction against the Black Lives Matter movement.  Thanks to the efforts of Colin Kaepernick (and those who have joined him), our nation has lately been forced to reckon not just with its history of racism but with the systemic manifestation of that racism which persists to this day.  (This is even more true since the murder of George Floyd.)  Not unlike the flag-desecration of those who protested against U.S. policy and warfare in Vietnam in the 1960s, Kaepernick's symbolic gesture of kneeling during the playing of the national anthem is intended to admonish the United States - albeit in a vastly less confrontational and more respectful way than flag-burning - for its racism by strategically directing that admonition toward the national anthem, a symbol of the United States that is probably second only to the flag itself in terms of significance and veneration.  The meme, of course, makes no mention of the BLM movement or of the increasingly widespread consciousness of racism that we are seeing today but, given the current political and social context, it is hard to imagine that anything else could be intended by the reference to "skin color, race [and] religion." 

Just as denying the existence of racism is a form of racism, attempting to invalidate any criticism of systemic racism on the grounds that such criticism is unpatriotic is also a form of racism.  To the extent that the BLM movement and Critical Race Theory (another favorite bogeyman of conservatives) constitute critiques of our nation's systemic and institutionalized racism, this meme seems intended to invalidate them by treating them as an attack on the nation's flag and, therefore, on the nation itself.  

It achieves this partly through the affectation of grievance but also through the use of innuendo.  Both the second and third statements in the meme ("I will not apologize for [the flag]" and "It does NOT [sic] stand for skin color. . . .") employ the same rhetorical technique: an assertion is phrased negatively and in opposition to what the creator of the meme intends us to believe is a previous assertion to which he is merely - but with justified indignation - responding.  Thus, by declaring that he will not apologize for the flag, the audience is led to believe that someone else has demanded that he should.  And by declaring that the flag does not stand for skin color, the audience is led to believe that someone else has claimed that it does.  

One of the purposes of this meme, then, is to inspire those who view it with this same feeling of righteous indignation against the long-overdue reckoning of our nation's history of systemic racism.  In other words, to get them riled up against the movement for racial justice.  Another is to raise the alarm that the meaning of the flag is being deliberately subverted.  The theme that both the flag and its meaning are under siege is visually represented (and rather artfully, too, to give credit where credit is due) by depicting the flag perseveringly and defiantly waving before a landscape that is clearly intended to be seen as a battleground.  The land in the foreground is barren, the trees stripped of much of their foliage while, in the distance, the sky glows red and orange as though from the fires of a recent or ongoing bombardment.  We are meant to understand from all this that it is not just the flag and its meaning that are under assault but the heart and soul of our very nation. 

The idea that our nation and our way of life are under attack is now the predominant theme of White-nationalist, Republican and Trumpist discourse.  Writing for The Atlantic, Ronald Brownstein described the history and the current state of "the ominous tenor of contemporary Republican messaging":

Late in the 2016 presidential campaign . . . Michael Anton, a conservative scholar who later joined the Trump White House, described the race between Donald Trump and Hillary Clinton as the "Flight 93 Election." . . .  Anton insisted that a Democratic victory would change America so irrevocably that conservatives needed to think of themselves as the passengers on United Airlines Flight 93 on September 11 - the ones who chose to bring down the plane to save the U.S. Capitol from al-Qaeda hijackers.  Letting the Democrats win, in other words, would doom the country. . . .

For at least the past decade, GOP candidates and conservative-media personalities have routinely deployed rhetoric similar to the Flight 93 argument.  Only about 40 hours before the [January 6] insurrection, at a campaign rally hosting an enthusiastic, virtually all-white audience in rural Georgia, President Trump insisted that if Democrats won the state's two Senate runoff elections . . . "America as you know it will be over, and it will never - I believe - be able to come back again."

And, of course, on January 6th, while inciting his mob before it assaulted the capitol in order to prevent the certification of Biden's electoral victory, Trump declaimed "We fight like hell.   And if you don't fight like hell, you're not going to have a country anymore."

In his speech accepting the Republican Party's nomination for him to run for president again in 2020, Trump declared "this election will decide whether we will defend the American way of life, or whether we will allow a radical movement to completely dismantle and destroy it."

As CNN reported last January, the day before leaving office, former Secretary of State, Mike Pompeo tweeted, "Wokism, multiculturalism, all the -isms - they're not who America is.  They distort our glorious founding and what this country is all about. . . ."  In the same story, CNN notes that in remarks he delivered the previous July,

Pompeo fanned the flames of division stoked by Trump, warning that "the very core of what it means to be an American, indeed the American way of life itself, is under attack" amid nationwide protests for racial justice and against police brutality.

Also last January, writing in Vox, Zack Beauchamp drew essentially the same conclusions as Brownstein (in the Atlantic) namely, that "The Capitol Hill mob was the logical culmination of years of mainstream Republican politics."

The animating force of modern Republicanism is this: Democratic Party rule is an existential threat to America and is by definition illegitimate. . . .

Whether elite Republicans genuinely believe what they tell their base is beside the point.  The fact is their delegitimizing rhetoric has been the fuel of the conservative movement for many, many years now.

Beauchamp noted that, on the morning of January 6th, Lauren Boebert, a Republican representative from Colorado, "tweeted that the efforts to overturn the 2020 election results amounted to a new American revolution.  'Today is 1776,' she wrote."  Ten years earlier, Sharon Angle (a Republican candidate for the U.S. Senate) had stated in an interview "that she believed that Americans might need to take up arms against the tyranny of Barack Obama and the Democratic congress."

Writing for the New Yorker last spring, Susan B. Glasser pointed out that

In one alarming survey released this week, nearly thirty percent of Republicans endorsed the idea that the country is so far "off track" that "American patriots may have to resort to violence" against their political opponents.

Last month, writing for the Washington Post, Ruth Ben-Ghiat reported that 

In June, an anchor of One America News suggested that execution might be an apt punishment for the "tens of thousands" of "traitors" who, he claimed, stole the election from former president Donald Trump.  A sitting member of congress, Rep. Matt Gaetz (R-Fla.) told Americans in May that they "have an obligation to use" the Second Amendment, which is not about recreation but "the ability to maintain an armed rebellion against the government if that becomes necessary."

. . . 

This Republican culture of violence and threat builds on histories of racial persecution and on policing used as an instrument of terror against non-Whites.  Habituation to such violence, reinforced by the presentation of non-Whites as an existential threat to the future of America (as in the "great replacement theory" that Tucker Carlson has referenced on Fox News) makes it easier for the public to accept violence around political events, like elections, as necessary to "save the country."  Tellingly, the participants in the January coup attempt, which was billed as just this kind of patriotic act, included 57 local and state GOP officials. . . .

The meme that I have been discussing here is a distillation of the Republican worldview of imagined or affected persecution, that America and "the American way of life" are under assault from within (by Democrats, otherwise known as "radical leftists," and the BLM movement), and that part of the epochal struggle for the heart and soul of America, indeed, its very survival, includes a propaganda war currently underway for the meaning of our nation's national symbol, the U.S. flag.  On this front, the meme's creator steadfastly holds the line against those fifth-columnists who demand that he apologize for the flag and who would see his flag debased as it only could be by the suggestion that its broader meaning might actually have something to do with skin color, race and religion.

So, what does the flag, with its red and white stripes and white stars on a blue background represent?  Of course "it does not stand for skin color, race or religion" but, equally, it does not "stand for" freedom (or "FREEDOM"), as the meme's creator claims.  At face value, the flag symbolizes merely what we all learned in elementary school that it does.  The stars in the upper left-hand corner represent the number of states currently in the Union while the thirteen red and white stripes represent the original thirteen colonies that declared independence from Britain on July 4, 1776.  There are deeper meanings associated with the design of the flag, too, including its colors and the symbolism of its particular design.  Most sources credit  Charles Thompson, the secretary of the Continental Congress from 1774 to 1789, who was instrumental in designing the Great Seal of the United States, with the use of red, white and blue (for the Seal) and attribute their symbolic intent, which comes from heraldry and which subsequently became associated with the colors of the flag, itself, to the following quote by Thompson:

White signifies purity and innocence, Red, hardiness & valor, and Blue, the colour of the Chief, signifies vigilance, perseverance & justice.

Ultimately and most importantly, the flag is a national and non-partisan symbol of the nation and of the unity of its states and of its people.

To be clear, no one is being asked to apologize for the flag.  What their fellow Americans are being asked to do by the Black Lives Matter movement and others is to recognize the reality that the enslavement of Black people was the original sin of our nation's founding, written into our very constitution (its liberal ideals, notwithstanding).  Acknowledging our nation's past wrongs, the legacy of those wrongs and the wrongs that persist to this day is not an assault on the flag nor a demand that anyone apologize for the flag.  To suggest otherwise is to denigrate the cause of racial justice by defining it as conflicting with what the flag represents when, in fact, in a very real sense, this is what the flag represents: "We hold these truths to be self-evident, that all men are created equal. . . ."

My own view of the flag, looking beyond its obvious, superficial symbolism, is that it represents the ideals that our nation was founded on.  It represents not only the best that America has been in the past and is now but could be in the future.  It ought to inspire feelings of togetherness and camaraderie, mutual understanding, compassion, reconciliation, resoluteness, justice, courage and, above all unity.  That means having the rectitude, the strength, the wisdom and the will to acknowledge the ways in which our nation has erred and working together to create "a more perfect union," one that truly embodies justice and equality for all.

When I think of our nation's flag, then, and what it means to me, I experience overwhelmingly positive feelings, including pride.  In contrast, when I see the flag used as it is in this meme, I see only an angry, paranoid, scapegoating and militant belligerence.  This meme manages to turn what should be a positive and uplifting symbol into a hate-filled one.  It weaponizes the U.S. flag and, what is worse, weaponizes it against other Americans.  It perverts the transcendent symbolism of the flag - its very spirit - by converting it from unity and love-of-country to hatred of one's political enemies.  And that may be the biggest desecration of all.

An Appeal to Nurses

This is an appeal to nurses everywhere but, especially, here in the United States.  

Like you, I work in healthcare.  I am a licensed physical therapist with over 20 years of experience helping people recover functional mobility following strokes and other debilitating injuries and illnesses.  Although we don't know one another, the fact that you are a nurse tells me that you share the same concern for the well-being of others that motivates most of us who work in healthcare.  It also means that we have a historical connection, since the first physical therapists were nurses.  As a physical therapist,  I'm proud to work in healthcare, I'm proud of my profession, and I'm especially proud to work in a profession that has its roots in nursing because nursing epitomizes what healthcare is all about: helping people get better.

Unfortunately, although healthcare is among the most honorable and rigorously scrutinized of human endeavors, it is not without its share of historical missteps.  Sometimes, these have been well-meaning interventions that simply did not withstand the test of time.  From bloodletting to lobotomy to the use of IV ethanol as a tocolytic agent to the widespread prescription of Thalidomide to routine episiotomies and unnecessary hysterectomies, the history of medicine is replete with treatments and practices that once were considered state of the art but that subsequently have come to be recognized as not only medically unnecessary but, in many cases, even harmful.

Regrettably, the history of medicine also includes episodes that are even less honorable: practices that are impossible to reconcile with contemporary standards of medical ethics and human rights.  The forced sterilizations of thousands of marginalized women (mostly poor women and women of color) is one example.  The notorious "Tuskegee Study of Untreated Syphilis in the Negro Male"  is another.  Still another is medicine's disgraceful history of labeling homosexuality a "psychiatric disorder" and subjecting gay men and women to electroconvulsive therapy, "aversion therapy," even lobotomies in a misguided attempt to "cure" them of their gayness.

Unfortunately, for as long as medical practice has existed, medical malpractice and human-rights violations committed in medicine's name seem to have existed alongside it.  That is why those of us who are medical professionals have a special obligation to speak out when medical practice fails, as it has so many times in the past, to live up to its own ethical standards, beginning with the cardinal principle, primum non nocere: "first, do no harm."

That is why I am reaching out to you today, as one healthcare professional to another.  The history of discredited medical practices - discredited both ethically and by the failure of evidence to support them - is, even now, not completely behind us.  To this day, and about 3,000 times every day (more than one million times every year), children are subjected to a harmful and medically-unnecessary genital surgery in fully accredited hospitals throughout the United States under the guise of medical care.  I am referring to non-therapeutic neonatal penile circumcision and these are the facts about this surgery:

• Every professional medical organization, both here in the United States and abroad, that has looked at this surgery has concluded that it is medically unnecessary.
• Despite being medically unnecessary, non-therapeutic penile circumcision remains one of the most commonly performed surgeries in the United States.
• The medical profession acknowledges that neonatal penile circumcision is unnecessary yet permits this lucrative genital surgery to continue and profits from it anyway.
• Between 100 and 200 circumcisions would need to be performed (the number needed to treat, or NNT) to prevent a single UTI; to make that concrete, up to 200 infants would have to be subjected to a medically unnecessary genital surgery in order to prevent the occurrence of a single UTI (in one infant).
• From 4,000 to just over 7,000 circumcisions would need to be performed to prevent a single case of penile cancer.
• There is not a single claimed "health benefit" of penile circumcision that cannot be achieved through less invasive, less harmful, less costly and less painful methods, such as
• the use of antibiotics to treat UTIs, as is routinely done in the case of females (who develop UTIs ten times as often as males do)
  
• the use of condoms and other safe-sex practices to prevent the transmission of STIs.
• Non-therapeutic neonatal circumcision is always performed without the consent of the person subjected to it.
• Any intact, adult male can undergo circumcision if he wants to and, although very few men actually make this choice (which is not surprising), those who do are not harmed in any way by having waited until they are adults and capable of exercising informed consent.
  
• When performed on infants, circumcision is excruciatingly painful yet often is performed without any anesthetic and always performed without adequate anesthetic.
• Penile circumcision removes a natural, essential, sensitive and functional body part.
• The penile prepuce (or foreskin) is the primary sensory organ of the penis with a greater concentration of specialized light-touch receptors than is found in the glans or in any other part of the penis or, for that matter, in any other part of the body except the fingertips and lips.  All of that sensory function is permanently lost to circumcision.
• Non-therapeutic neonatal circumcision is irreversible.
  
• The overwhelming majority of men who remain intact value their foreskins and do not want to have them surgically removed.
• Consistent with this, many men who were subjected to non-therapeutic neonatal circumcision report that, had they been allowed to make this choice for themselves, they would not have chosen to have this part of their genitals removed.  Beyond objecting to the irreparably diminished capacity for erotic experience that necessarily results from this surgery, they resent having been deprived of their fundamental right to bodily autonomy: the right to make their own decisions about their bodies, including which healthy parts they get to keep and which healthy parts get cut off.
  

 

Perhaps you haven't really thought much about non-therapeutic circumcision before.  The fact is, this genital surgery is performed so routinely that even many healthcare providers seldom think about the reality of what this genital surgery is and what it entails.  That needs to change.  My hope is that, when you consider the facts about non-therapeutic circumcision, you will come to view it differently from the way you may have been accustomed to viewing it up until now - just as we now view other discredited medical practices differently from the way they were viewed by previous generations. 

My own perspective, which I also hope you will come to share if you don't already, is that of a healthcare provider who believes that it is unethical to subject a healthy child - whether female, male or intersex - to a medically-unnecessary and irreversible genital surgery.  At the same time, my perspective - which I hope you do not share - is that of someone who was subjected to this surgery.  Although I don't expect you to comprehend what it's like to have had part of your genitals cut off without your consent if it hasn't happened to you, I do trust that your capacity for empathy - that same human quality that prompted you to become a nurse in the first place - will enable you to respect the perspective of the millions of men like me who object to what was done to our bodies without our consent.  Ultimately, my hope is that you will come to share our outrage, as well.

If you do already, the good news is that we are not alone.  Non-therapeutic neonatal circumcision has been condemned by many of the world's leading human-rights advocates, psychologists, attorneys, bio-ethicists, physicians and professional medical organizations.  Here, in the United States, one of the organizations that is leading the way is Doctors Opposing Circumcision.  Doctors Opposing Circumcision is an organization that was founded more than 25 years ago by George Denniston, MD, MPH in order to help bring about an end to the unconscionable practice of subjecting unconsenting children to medically-unnecessary genital surgery.  DOC is comprised of like-minded physicians and others who share the principles, the ethics and the core values that all of us, as healthcare providers, are obligated to uphold.  These ethical principles include:

• beneficence: the principle that the care and services we provide must benefit the patient
• nonmaleficence: the principle that we must not harm or injure our patients 
• justice: the principle that all patients should be treated equally and fairly
  
• respect for autonomy: the principle that every human being, regardless of age, sex, religion, race, ethnicity or anything else, has a fundamental and absolute right of bodily self-ownership

Non-therapeutic neonatal penile circumcision violates every one of these ethical principles.  

It also violates both the spirit and the letter of most of the specific provisions of the American Nurses Association Code of Ethics for Nurses, especially Provision 3: "The nurse promotes, advocates for, and protects the rights, health, and safety of the patient [my emphasis]."

For all of these reasons, Doctors Opposing Circumcision is working to end what, for too long, has been a cure in search of a disease - a deeply entrenched cultural practice masquerading as medical care. 

I hope you will take a few minutes to listen to Dr. Denniston explain, in his own words, why DOC exists and why this cause is so important.

After listening to Dr. Denniston, I hope you will listen to the firsthand accounts of a group of nurses - medical professionals like yourselves - who decided that they could no longer in good conscience participate in the harmful practice of non-therapeutic neonatal penile circumcision.  In 1995, these conscientious objectors went on to found the organization, Nurses for the Rights of the Child.  As explained on its website, 

Nurses for the Rights of the Child is a non-profit organization dedicated to protecting the rights of infants and children to bodily integrity.  As health professionals, we specifically seek to protect non-consenting infants and children from surgical alteration of their healthy genitals. 

I encourage you to visit the NRC website in order to learn what your fellow nurses are doing to protect children from medically-unnecessary genital surgery.

I also encourage you to read this short column by Adrienne Carmack, MD, a board-certified urologist and one of the board members of Doctors Opposing Circumcision.  For a comprehensive, evidence-based review of non-therapeutic penile circumcision, see Evidence and Ethics on: Circumcision by Rebecca Dekker, PhD, RN and Anna Bertone, MPH.

Finally, I urge you to visit the website of Doctors Opposing Circumcision.  Here you can find useful information and resources, including information on conscientious objection if you are currently involved in obstetrics and neonatal care.  Nurses for the Rights of the Child also provides information on conscientious objection in a brochure that can be downloaded from its website.  Once you have come to the unavoidable conclusion, as many of us in healthcare already have, that to participate in medically-unnecessary and non-consensual genital surgeries is incompatible with the ethical duties of healthcare providers, you will find it difficult, if not impossible, to do so.  Both the DOC and NRC websites have guidance for medical professionals that can help.

And if you have any other questions or would like to discuss this further, please do not hesitate to contact me directly at my email address: balashinsky@yahoo.com.

Thank you,

David Balashinsky, P.T.

 

 

About me: I am originally from New York City and now live near the Finger Lakes region of New York. I have been a physical therapist for over twenty years and began my career at NYU Medical Center in New York.  I now do inpatient rehabilitation in a major central NY hospital system.  I currently serve on the board of directors of the Genital Autonomy Legal Defense & Education Fund, (GALDEF), the board of directors and advisors for Doctors Opposing Circumcision and I also serve on the leadership team for Bruchim, an organization that fosters welcoming spaces for Jews opting out of circumcision.
 

 

OMV!, OB/GYNs, FACOGs & MGC: A Call for Consistency

by David Balashinsky

There are few things more offensive to one's sense of right and wrong than a double standard by which a harm is condemned in one case but a blind eye turned to a comparable (or worse) harm in another.  And there are few instances of such a double standard more flagrant than the outrage currently being directed at Vagisil for its new OMV! product line by several prominent OB/GYNs.

For those unacquainted with OMV! and the controversy surrounding it, OMV! is a "personal care" product manufactured by Vagisil.  The New York Times, The Washington Post and HuffPost have all reported on this within the past few weeks.  The criticism of products that are marketed to women as palliatives for the pathological condition of having a vulva is not new.  What is new is that Vagisil has recently launched a "feminine hygiene" product line - and an advertising campaign to promote it - that specifically targets teenagers.  This is also the cause of the particular outrage about this product.  As Dr. Jen Gunter (as quoted in WAPO) puts it,

Society's always looking for ways to make people with vaginas feel ashamed.  I hate that industry with a passion because it capitalizes on vaginal and vulvar shame.  But to see it marketed to teens?  Not on my watch.

The objections to OMV! all sound similar themes and I agree with every one of them.  "Feminine deodorant" wipes or sprays are unnecessary.  The vagina, as Dr. Gunter is fond of saying, is "like a self-cleaning oven."  (I love that simile, although I also think that anything that reinforces the link in people's minds between women, housework and especially kitchens is probably best avoided.)  They are potentially and likely harmful. They do not so much address a problem as invent one by pathologizing the vagina and the vulva.  In this respect, such products are the quintessential "solution in search of a problem" or (to put it more precisely) "cure in search of a disease."  Worse, by pathologizing female genitalia, these products contribute to a culture of body-shaming that undoubtedly adversely affects women's and young women's self-esteem.  There is even an argument to be made that such products represent an updated version of ancient, patriarchal notions of women as being essentially malignant and corrupting influences upon their male counterparts (think Eve and the apple).  This peculiar, bipartite and contradictory concept regards women as temptresses with bodies ideally suited to that purpose yet, at the same time, regards that part of women's bodies that is most female and most tempting as the mephitic wellspring of so much pollution and evil that have been unleashed upon mankind.  I don't think it's unreasonable to argue that products that exploit the concept of the vulva and the vagina as being inherently foul and malodorous are a contemporary manifestation of a very ancient, patriarchal view of women and of women's bodies, although this argument becomes a little harder (though not impossible) to make when the founders of two prominent companies that traffic in such garbage (Vagisil and Goop) are women.

So, whence my particular ire?  It is this.  In promoting an unnecessary product that shames female bodies and that has the potential to cause and in some cases does cause physical harm to female genitals, Vagisil is not doing anything worse than what the American College of Obstetricians and Gynecologists (ACOG) has done and continues to do in endorsing an unnecessary genital surgery that shames male bodies and that causes physical harm to male genitals.  Yet four of the most vociferous critics of Vagisil's OMV!, including Jen Gunter, MD, Heather Irobunda, MD, Jennifer Lincoln, MD and Staci L. Tanouye, MD, are all Fellows of the American College of Obstetrics and Gynecology.  My question for these FACOGs (which I posed, in vain, to several of them on Twitter and Instagram) is this: Why the double standard?  I agree that vulvas don't need "fixing" in any way at all.  Why won't ACOG agree that neither do penises?

For context, here is some background.  Most neonatal circumcisions are performed by obstetricians (section 4.2, p. 22 in the linked United Nations report).  As for ACOG, it is a professional organization consisting of obstetricians and gynecologists (obstetricians are generally trained in gynecology and gynecologists are generally trained in obstetrics, hence the acronym OB/GYN).  ACOG has officially endorsed the American Academy of Pediatrics' 2012 Technical Report on neonatal male circumcision.  The AAP concedes that "existing scientific evidence is not sufficient to recommend routine circumcision" and that "the procedure is not essential to the child's current well-being. . . . "  Nevertheless (and possibly because neonatal circumcision generates hundreds of millions of dollars in revenue annually) the authors of the AAP's 2012 Technical Report argued that "it is legitimate for . . . parents to take into account their own cultural, religious and ethnic traditions, in addition to medical factors" when opting to subject their sons to circumcision (note that "medical factors" is listed last) and it concluded, therefore, that "the benefits of newborn male circumcision justify access to this procedure for those families who choose it." The Technical Report acknowledged, incidentally (or not so incidentally), that among the reasons often cited by parents in the U.S.A. for making this "choice" are "hygiene and cleanliness of the penis" and "[s]ocial concerns."  Hence, when they referred to the "benefits" of neonatal circumcision, the authors of the AAP Technical Report were not referring to medical benefits so much as to what they believed were benefits as broadly construed to include social benefits.  This distinction was further clarified in a commentary written by Andrew Freedman, MD (one of the members of the Task Force that prepared the AAP's Technical report) that was subsequently published in Pediatrics.  As Dr. Freedman explained,

To understand the recommendations, one has to acknowledge that when parents decide on circumcision, the health issues are only one small piece of the puzzle.  In much of the world, newborn circumcision is not primarily a medical decision.  Most circumcisions are done due to religious and cultural tradition.  In the West, although parents may use the conflicting medical literature to buttress their own beliefs and desires, for the most part parents choose what they want for a wide variety of nonmedical reasons.  There can be no doubt that religion, culture, aesthetic preference, familial identity, and personal experience all factor into their decision.  Few parents when really questioned are doing it solely to lower the risk of urinary tract infections or ulcerative sexually transmitted infections.  Given the role of the phallus in our culture, it is not illegitimate to consider these realms of a person's life in making this nontherapeutic, only partially medical decision.

The upshot of all this is that ACOG has formally adopted a position supporting a parent's right to subject her or his child to circumcision for cultural reasons, for aesthetic reasons, for religious reasons, for reasons of "hygiene" and "cleanliness," for any reason or for no reason.  In the United States, "just because" is a sufficient justification for performing an irreversible and medically-unnecessary genital surgery on an infant male.  ACOG Fellows are, of course, physicians who presumably have taken an oath to abide by a code of ethics.  Among other things, that code prohibits the use of surgery when less invasive, more conservative treatment options are available.  The Code of Professional Ethics of the American College of Obstetricians and Gynecologists also enshrines the principle of autonomy: the right of the individual to make informed choices about her or his own body.  Yet, with its endorsement of the 2012 AAP Technical Report on infant male circumcision, ACOG invites its Fellows to violate these same ethical guidelines.  That is why I have singled out the four FACOGs mentioned above.  While none of them performs non-therapeutic infant circumcisions as far as I am aware (Dr. Lincoln explicitly informed me on Twitter - before she blocked me - that she doesn't), all of them are dues-paying members of ACOG who proudly include FACOG among their post-nominal letters.  That (along with their failure to publicly and energetically repudiate ACOG's endorsement of unnecessary genital surgery) not only makes their implicit support for ACOG's position a reasonable inference but makes criticism of them for it valid.  More to the point, it makes their inconsistency - the double standard of criticizing OMV! while implicitly endorsing forced non-therapeutic circumcision - fair game.

The parallels between "feminine hygiene" products and non-therapeutic circumcision are several and striking, starting from the simple fact that both target genitals: female and male, respectively.  (It goes without saying that, throughout this essay, when I refer to "feminine hygiene" products, I am not referring to menstrual products but only to unnecessary "cleansing" and deodorant products such as OMV!.)  

Beyond this, one of the chief criticisms of OMV! and similar products is that they pathologize the vulva and the vagina.  In order to sell a cure or a treatment, after all, one must first identify a problem that needs to be cured or treated.  That is exactly what the medical profession (and others) did during the 19th century with the male prepuce (or foreskin).  It is well known that male circumcision was introduced and popularized as a "cure" for masturbation (and its inevitable sequela, "masturbatory insanity") as well as for numerous other ailments that were attributed at the time to the presence of the male prepuce.  The process by which the male foreskin became pathologized within the realms of medical practice and the culture at large (in England and in the United States) has been thoroughly documented.  A concise summary was written by Jessica Wapner and published in 2015 in Mosaic.  In The Troubled History of the Foreskin, Wapner writes, 

One day in 1870, a New York orthopaedic surgeon named Lewis Sayre was asked to examine a five-year-old boy suffering from parallysis of both legs. . . .  

After the boy's sore genitals were pointed out by his nanny, Sayre removed the foreskin.  The boy recovered.  Believing he was on to something big, Sayre conducted more procedures.  His reputation was such that when he praised the benefits of circumcision . . . surgeons elsewhere followed suit.  Among other ailments, Sayre discussed patients whose foreskins were tightened and could not retract, a condition known as phimosis.  Sayre declared that the condition caused a general state of nervous irritation, and that circumcision was the cure.

His ideas found a receptive audience.  To Victorian minds, many health issues originated with the sexual organs and masturbation. . . .

The circumcised penis came be seen as more hygienic, and cleanliness was a sign of moral standards.  An 1890 journal identified smegma as "infectious material."  A few years later, a book for mothers . . . described the foreskin as a "mark of Satan."  Another author described parents who did not circumcise their sons at an early age as "almost criminally negligent."

By now, the circumcision torch had passed from Sayre to Peter Charles Remondino, a popular San Diego physician. . . .  Remondino described the foreskin as a "malign influence" that could weaken a man "physically, mentally and morally; to land him, perchance, in jail or even in a lunatic asylum."  Insurance companies, he advised, should classify uncircumcised men as "hazardous risks."

By the turn of the 20th century the Victorian fear of masturbation had waned, but by then circumcision had become a prudent precaution, and one increasingly implemented soon after birth. . . .  By 1940, around 70% of male babies in the United States were circumcised.

. . . By the 1970s . . . more than 90% of U.S. men were circumcised. . . .  The American foreskin had become a thing of the past.

Throughout its modern history, as one rationale after the other for neonatal circumcision has been discredited, one rationale after the other has arisen to take its place.  Thus has neonatal circumcision - like vaginal douches and "feminine hygiene products" - become the quintessential "cure in search of a disease."

What makes the "feminine-hygiene-products" industry so particularly objectionable is that it not only reflects a culture of body-shaming of people with vulvas and vaginas (recall Gunter's comments, above) but that it contributes to and perpetuates that culture.  But, here again, we see an identical phenomenon at work (except by proxy, because the social pressure is exerted on parents) with respect to non-therapeutic circumcision and penile anatomy.  Non-therapeutic circumcision is 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.  "So his future sex partners [who, of course, are always assumed to be women] won't be turned off,'" is another.  More broadly, because we live in a culture in which male genital cutting 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).  No one should pretend that this body-shaming doesn't adversely affect the body-image and self-esteem of intact boys and men.  The problem, however, for such boys and men is not that their penises are intact but that their prepuces have been stigmatized by our society.  It is the very act of routine circumcision - the normalization of circumcised penises - that contributes to and perpetuates this culture in which intact penises are 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" by circumcision or, if it wasn't, ought to have been.  And every time an OB/GYN performs a medically-unnecessary circumcision, she or he perpetuates this body-shaming culture, just as ACOG perpetuates it with its endorsement of non-therapeutic circumcision.

The similarities do not end there.  It goes without saying that special "cleansers" for the vulva (and the vagina) are unnecessary.  And when washing the vulva is appropriate, water and maybe a mild soap are more than sufficient.   But it turns out that soap and water work just as well on intact penises as they do on vulvas.  Yet "improved hygiene" - "cleanliness of the penis"-  is not only frequently offered by parents as a reason to have their child circumcised, this reason is cited specifically in the AAP Technical Report.  To be sure, the AAP and ACOG do not themselves explicitly cite "hygiene" as a justification for circumcision.  But both organizations do endorse the right of parents to impose circumcision on their children even when their reasons for doing so have no basis in rational thought or medical science.  As noted, the AAP's Technical Report - endorsed by ACOG - asserts that it is perfectly "legitimate" for parents to take social, cultural and religious factors into consideration when deciding on whether to subject their male child to circumcision.  But what is the concept of the vulva as something that is intrinsically unclean if not a social and cultural (and, to some extent, a religious) construct?  What is the concept of the male foreskin as intrinsically unclean if not the same sort of social and cultural construct?  By the same token, if a special "feminine wash" is unnecessary as a method for keeping the vulva clean, isn't surgery even more unnecessary, by orders of magnitude, as a method for keeping the penis clean?

Still another criticism of OMV! and similar products is that they are not just potentially but positively harmful to the vulva and the vagina.  As the Times (which interviewed Dr. Tanouye and others for its coverage of this story) reports,

Any product that is scented can potentially damage the skin, Dr. Tanouye said.  And while not everyone may experience a reaction, or react immediately, experts said that certain health issues can emerge after prolonged use.  "Fragrance is the No. 1 cause of allergic contact dermatitis," Dr. Tanouye said, which is a condition in which the skin gets inflamed and becomes itchy, red and rashy after contact with an irritating substance.

HuffPost reports that "people who used these ["feminine hygiene"] products were up to three times more likely to get a vaginal infection."  Of course introducing an irritant to the vulva, let alone into the vagina, is likely to be harmful.  But what amount of willful blindness is required not to recognize that cutting off part of someone's genitals is even more harmful?  There is a cure, after all, for contact dermatitis.  In contrast, there is no cure for circumcision.  It's irreversible.

Lastly, OMV!'s critics cite the "predatory" nature of this and similar products.  They exist and are promoted for one reason: to make money.  And that, I submit, is precisely the motivation behind ACOG's endorsement of the 2012 AAP Technical Report on infant circumcision.  That hundreds of millions of dollars are spent annually on totally unnecessary "feminine hygiene" products is disgraceful.  That companies like Vagisil and Goop profit to the tune of hundreds of millions of dollars annually by selling these products is unconscionable.  How is it any less disgraceful that hundreds of millions of healthcare dollars are misdirected annually into a medically-unnecessary genital surgery?  (This is money that could be spent on early childhood nutrition programs or providing access to the full range of reproductive healthcare services for uninsured or under-insured women, to offer just two examples.)  And how is it any less unconscionable that ACOG's members directly profit from the performance of this medically-unnecessary genital surgery?

Vagisil exists only to make money.  Its shareholders and most of its officers do not swear an oath of beneficence, nor are they obligated (even if we think they should be) to be guided by the precept primum non nocere.  Every member of ACOG, in contrast, does swear such an oath and is under such an obligation.  Subjecting unconsenting children (and the adults that they become) to a medically-unnecessary and irreversible genital surgery violates that oath and that obligation.  Thus, while I salute Doctors Gunter, Irobunda, Lincoln and Tanouye for their criticism of OMV!, I respectfully suggest that they should also put their own house in order.  Even though they, themselves, may not perform non-therapeutic circumcisions, they belong to an organization of OB/GYNs who do.  Vagisal will probably never abandon its business model in order to do the right thing.  Of ACOG, on the other hand, the public has a right to expect much, much more. 

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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.