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Is male circumcision as harmful as female circumcision? I have had multiple discussions about this, but someone said that certain types of FGM are equally or less invasive than MGM

Hi! No, no it is not.

Male circumcision

So, the big question about male circumcisions is if it's ethical or not. A while ago, I would have said, no definitely not, since it's a violation of bodily autonomy. However, someone has since pointed out to me that we do a lot of things to infants (and children) that are technically violations of bodily autonomy.

We consider this morally acceptable because we are providing some intervention that they (the children) are not capable of either requesting or refusing on the basis of it's benefits outweighing the harms. The best example of this, in my opinion, is vaccines. We give children a lot of vaccines because we know that they have (and do) substantially lower the chance of the child getting sick and/or dying from a preventable disease. In this case, the minor violation of bodily autonomy (vaccination of a child) is permitted because waiting until they are able to give their consent would introduce a substantially larger risk of harm.

How does this relate to male circumcision? Given this framework, we could accept male circumcision if (1) there are benefits to the procedure, (2) the benefits outweigh any risk of harm, (3) waiting until the child is able to consent to the procedure is not feasible (i.e., some significant portion of the benefits would be lost).

There is some mixed evidence for these three claims. Evidence in favor includes:

There are a number of reviews [1-3] by the same team that provide support for all three points. In particular this review [3] directly reviews the evidence of "arguments opposing male circumcision", debunking each one in detail. However, the fact that they are all by the same team is less encouraging. The evidence here is substantial, but there's a potential for bias.

That being said, the American Academy of Pediatric [4] also concludes that the "health benefits of newborn male circumcision outweigh the risks".

This Cochrane Review (essentially the highest quality evidence) [5] found male circumcision substantially reduces acquisition risk of HIV by heterosexual men and that incidence of adverse events is very low.

And this review and meta-analysis [6] found the same reduction for HPV.

Evidence against:

This review [7] suggests the benefits of male circumcision may not apply in North American countries

This article [8] claims the same for developed countries in general

This commentary [9] claims the same, suggesting that "from the perspective of the individual boy, there is no medical justification for performing a circumcision prior to an age that he can ... choose to give or withhold informed consent himself"

That being said these papers have also been challenged by advocates for male circumcision [10] and even opponents [9, 11] recognize that the rates of complications are very low, and the rates of serious complications even lower. In addition to that, complication rate was greater for older children [11], which provides support for the third point I highlighted above (i.e., waiting until they are older may introduce more harms than benefits).

And all of that being said, if the procedure is done, it should absolutely be done with some form of pain relief. Thankfully, it appears that the vast majority are performed in this fashion [11].

In the end, there is strong evidence supporting male circumcision for infants in developing countries. There are research gaps concerning if these benefits apply to developed countries (i.e., little work has examined this population specifically), which indicates a need for such research. That being said, with the extremely low complication rate and moderate evidence of benefits, there also isn't a strong argument against the procedure.

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Female Genital Mutilation

Comparing this to female genital mutilation (FGM) will highlight just how egregious such equivalencies are.

First, a brief detour into biology. Men and women have various embryological precursors that develop into either male or female sex organs. These are called biological homologues, and they are roughly (although not perfectly) comparable. For example, an embryo has the gonad which, during sex differentiation, develops into the ovary in women and the testicle in men [12].

This framework allows us to make some rough comparisons between male circumcision and FGM. For example, it's likely that the "less invasive" form of FGM you were referred to is type 1A [13]. In this type, only the clitoral hood is removed. Both the clitoral hood and the foreskin develop from the prepuce, as they are homologous structures. Notably, even here, male circumcision and FGM type 1A would still only be homologous if (1) FGM type 1A has a similarly low risk profile as male circumcision and (2) male circumcision actually provides no benefits to the infant.

For the first point, we have little to no data on the complication rate of type 1A FGM, specifically because it is essentially never performed in isolation [14]. This is – almost entirely – a theoretical form of FGM. Despite this, even if it were more common it doesn't necessarily follow that the procedures would have a similar adverse effect profile. In fact, one of the most common arguments against male circumcision involves the numerous nerve endings in the glans (head of the) penis, generally in reference to how the foreskin "protects" the penis head or "preserves sensitization" (neither of which are proven assertions). But while the glans penis and glans clitoris have a similar number of nerve endings in absolute terms, the clitoral head is much smaller and therefore much more densely innervated [15]. As a result, it would be much more likely for the removal of the clitoral hood to result in irritation than the removal of the foreskin.

And for the second point, I've discussed the mixed literature on the topic in developed countries. However, most FGM is performed in developing countries (although certainly not exclusively so) [14], and in this context there is strong evidence of a health benefit to male circumcision and absolutely no health benefit to FGM.

To complete the comparisons between FGM and male circumcision in terms of homologous structures [12, 13]:

Type 1B involves the removal of the clitoris with the prepuce (clitoridectomy). This, anatomically speaking, would be similar to removal of (minimally) the penis head.*

Type 2 involves partial or total removal of the clitoris and the labia minora, with or without excision of the labia majora. This would be roughly comparable to the removal of the penis head, mutilation/cutting/removal of penile raphe (underside of the penis) with or without mutilation/cutting/removal of the scrotum.*

Type 3 is infibulation, or the narrowing of the vaginal orifice with creation of a covering seal by cutting and apposition the labia minora and/or the labia majora, with or without excision of the clitoris. There is no direct comparison for men, as they do not have a vaginal orifice or any similar structure.

Type 4 is all other mutilation/anything that cannot be categorized as above.

*Note: these comparisons aren't perfect due to differences in how the homologous structures are arranged. For example, removal of the penis head would also impact the urethra, whereas removal of the clitoris would not. That being said, these comparisons are far more accurate than between FGM types 1B - 4 and male circumcision.

To further drive home the differences, FGM results in substantial, severe health complications (unlike male circumcision) and has absolutely no known health benefits (possibly unlike male circumcision). These articles [16-21] go into great detail on this; the complications range from: infection, incontinence, infertility, severe and sometimes chronic pain, pregnancy complications, PTSD and post-traumatic symptoms, other psychiatric disorders, greater risk of STDs, and death.

There is no evidence of any benefits.

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Conclusion

Hopefully, it's clear that male circumcision and female genital mutilation are in no way comparable.

The opponents of male circumcision often suggest that any violation of the bodily autonomy of infants is morally wrong, but this fails to consider the nuanced situation inherent to infant-hood and early childhood. They are physically and mentally unable of consenting to or refusing any medical procedure, which is why we have a – generally recognized – moral caveat to this principle that allows caregivers to act in the best interests of the child, particularly when waiting for the child to grow older before allowing any intervention would increase the risk of harm. (Childhood vaccinations and, really, any other medical procedure done on children, are other examples of this.)

It's possible that future research may indicate that male circumcision is not associated with benefits in developed countries. (This would remove male circumcision from the category of procedures described above.) Even then, however, it would not be comparable to FGM due to the vastly different complication rates.

I hope this helps you!

References under the cut:

Morris, B. J., & Krieger, J. N. (2013). Does male circumcision affect sexual function, sensitivity, or satisfaction?—a systematic review. The journal of sexual medicine, 10(11), 2644-2657.

Morris, B. J., Kennedy, S. E., Wodak, A. D., Mindel, A., Golovsky, D., Schrieber, L., ... & Ziegler, J. B. (2017). Early infant male circumcision: systematic review, risk-benefit analysis, and progress in policy. World journal of clinical pediatrics, 6(1), 89.

Morris, B. J., Moreton, S., & Krieger, J. N. (2019). Critical evaluation of arguments opposing male circumcision: A systematic review. Journal of Evidence‐based Medicine, 12(4), 263-290.

Task Force on Circumcision, Blank, S., Brady, M., Buerk, E., Carlo, W., Diekema, D., ... & Wegner, S. (2012). Male circumcision. Pediatrics, 130(3), e756-e785.

Siegfried, N., Muller, M., Deeks, J. J., & Volmink, J. (2009). Male circumcision for prevention of heterosexual acquisition of HIV in men. Cochrane database of systematic reviews, (2).

Shapiro, S. B., Laurie, C., El-Zein, M., & Franco, E. L. (2023). Association between male circumcision and human papillomavirus infection in males and females: a systematic review, meta-analysis, and meta-regression. Clinical Microbiology and Infection, 29(8), 968-978.

Bossio, J. A., Pukall, C. F., & Steele, S. (2014). A review of the current state of the male circumcision literature. The Journal of Sexual Medicine, 11(12), 2847-2864.

Frisch, M., & Earp, B. D. (2018). Circumcision of male infants and children as a public health measure in developed countries: a critical assessment of recent evidence. Global public health, 13(5), 626-641.

Deacon, M., & Muir, G. (2023). What is the medical evidence on non-therapeutic child circumcision?. International journal of impotence research, 35(3), 256-263.

Moreton, S., Cox, G., Sheldon, M., Bailis, S. A., Klausner, J. D., & Morris, B. J. (2023). Comments by opponents on the British Medical Association’s guidance on non-therapeutic male circumcision of children seem one-sided and may undermine public health. World Journal of Clinical Pediatrics, 12(5), 244.

Shabanzadeh, D. M., Clausen, S., Maigaard, K., & Fode, M. (2021). Male circumcision complications–a systematic review, meta-analysis and meta-regression. Urology, 152, 25-34.

26: The Reproductive System . (n.d.). In Anatomy and Physiology (Boundless) . LibreTexts. https://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Anatomy_and_Physiology_(Boundless)/26%3A_The_Reproductive_System

Abdulcadir, J., Catania, L., Hindin, M. J., Say, L., Petignat, P., & Abdulcadir, O. (2016). Female genital mutilation: a visual reference and learning tool for health care professionals. Obstetrics & Gynecology, 128(5), 958-963.

WHO, U. O. (2008). Eliminating female genital mutilation: An interagency statement. World Health Organization.

Shih, C., Cold, C. J., & Yang, C. C. (2013). Cutaneous corpuscular receptors of the human glans clitoris: descriptive characteristics and comparison with the glans penis. The Journal of Sexual Medicine, 10(7), 1783-1789.

Utz-Billing, I., & Kentenich, H. (2008). Female genital mutilation: an injury, physical and mental harm. Journal of Psychosomatic Obstetrics & Gynecology, 29(4), 225-229.

Klein, E., Helzner, E., Shayowitz, M., Kohlhoff, S., & Smith-Norowitz, T. A. (2018). Female genital mutilation: health consequences and complications—a short literature review. Obstetrics and gynecology international, 2018(1), 7365715.

Iavazzo, C., Sardi, T. A., & Gkegkes, I. D. (2013). Female genital mutilation and infections: a systematic review of the clinical evidence. Archives of gynecology and obstetrics, 287, 1137-1149.

Berg, R. C., & Underland, V. (2018). Immediate Health Consequences of Female Genital Mutilation/Cutting (FGM/C).

Sarayloo, K., Roudsari, R. L., & Elhadi, A. (2019). Health consequences of the female genital mutilation: a systematic review. Galen medical journal, 8, e1336.

Reisel, D., & Creighton, S. M. (2015). Long term health consequences of Female Genital Mutilation (FGM). Maturitas, 80(1), 48-51.

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☆ 14/06/24

i think ive found a new found interest in someone today,, i bought falafel with my friends it was super yummy~ the squirrel stopped and looked at me and then posed when i pulled out my phone lol

☆ 23/06/24

my nephews left :( sad about it :(( no joke all i had was falafel today i swear i ate the entire box, today was very slow

i find it so surreal on how even the most forgetful things hold so much memories, to one person a pen might just be a necessity and to another it might just be the meaning of love in itself