The AAP: culturally blind or morally bankrupt?

This is tiny amount of tissue removed from a circumcised baby girl in Malaysia. Credit:

By Lillian Dell’Aquila Cannon

Recently, there was an article in the New Times Broward-Palm Beach about circumcision, in which pediatric ethicist Dr. Doug Diekema suggested that the new AAP statement on circumcision would be more favorable towards circumcision.  This has intactivists worried, as one of the major points against circumcision is that no medical organization recommends circumcision.  I don’t think we need to worry, though, considering the flap  over the AAP’s 2010 statement on female circumcision alternatives.

In a policy statement issued April 26, 2010, the AAP proposed physicians could offer a ritual nick to the clitorises of baby girls in order to satisfy the immigrant parents who would otherwise go abroad for a more “complete” circumcision.  In this statement, the AAP revealed its bias:

“The ritual nick suggested by some pediatricians is not medically harmful and is much less extensive than routine newborn male genital cutting.”

“Health educators must also be prepared to explain to parents from outside North America why male genital alteration is routinely practiced here but female genital alteration is routinely condemned.”

There is no instruction on how, exactly, doctors were supposed to explain the discrepancy.  What a pity: I would have liked to see them try.  I am sure that many “uneducated” parents could have given them a quick dose of comeuppance: “Tell me exactly why it is terrible to do to a girl but fine to do to a boy?”

The public response was quick and severe.  Numerous critical letters were published in the Pediatrics journal, and the statement was retired on July 1, 2010.

This is just another example of the cultural blinders we all wear, including well-educated people like physicians: a nick or a pinprick that would not have removed any tissue nor caused any damage is just too terrible to do to a baby girl, but removing all of the foreskin, ridged band, dartos muscle and frenulum from a baby boy is just fine?

When and if the AAP committee’s political wrangling that has been going on for years over a new policy statement on circumcision comes to a head, even if it is more pro-circumcision, it won’t carry much moral weight.  Their lack of adherence to their own policy statement on parental desires and proxy consent exposes their hypocrisy:

“Thus “proxy consent” poses serious problems for pediatric health care providers. Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. Although impasses regarding the interests of minors and the expressed wishes of their parents or guardians are rare, the pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent.”

Source: Informed Consent, Parental Permission, and Assent in Pediatric Practice.  Committee on Bioethics, American Academy of Pediatrics. Pediatrics. 1995 Feb; 95(2):314-317.

Genital cutting is genital cutting, and when people focus on comparing degrees of damage it obscures the underlying, undeniable truth: every human being has a right to his or her whole body, no matter how little another person, including his or her parents, may value that body part.   Circumcision is done to babies here in America because they cannot resist.  Very few men would choose circumcision for themselves; that is why it must be forced on them when they cannot refuse.

What, exactly, makes people in our culture think that female circumcision so much worse than male circumcision?  The common response is that female circumcision is so terrible because it hampers or destroys female sexual response and/or because it hurts or injures the girl because of the unhygienic and barbaric manner in which it was done.  If male circumcision hampered or destroyed male sexual response, or if it caused pain and other injuries besides the injury of having healthy tissue removed, would we then begin to see male circumcision as also obviously morally wrong?  Many people would not – their cultural indoctrination completely blinds them.

What if some female circumcisions were performed hygienically, by a doctor, with a minimum of pain and tissue removed?  Would that make them okay?  Judging by the response to the AAP’s abortive statement, it would not, but that is actually the way female circumcision happens in countries in which it has been medicalized (just as male circumcision is here.)  Here are some Malaysian mothers discussing their infant daughters’ circumcisions:

“yah… i also dont know how to explain how its done although i witnessed both my gals’ procedures myself
both done at different clinics by female Muslim doctors…

dont think it’s like the cutting for boys…. it’s more minimal…. baby can recover by the next day?”


“very nice clinic – they have a surau, play area with slides and comfortable waiting area, good service and they have couple of doctors as well. We only waited about 10-15 minutes and the procedure was a mere 3 minutes and that’s it! She only cried a little bit because she just didn’t like people holding her legs. Once done, she stared at the doc and smile…good girl!”


The more you read these stories, the more obvious it becomes that female and male circumcision are exactly the same thing: a human rights violation.  Both are the non-consensual removal of healthy tissue that can result in sexual dysfunction, infection or death.  Both are culturally-indoctrinated practices.  Both have become medicalized, which have aided their persistence and longevity.

So go ahead, AAP.  Bring on a new statement, be it pro-circumcision or not.  Just be prepared to be raked over the coals for your hypocrisy.  And don’t be offended when I accuse you physicians of wearing cultural blinders, because it’s the only defense you have left.  Without it, you are just unethical, immoral and in constant violation of the Hippocratic Oath to first, do no harm.



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6 Responses to The AAP: culturally blind or morally bankrupt?

  1. James Mac says:

    The AAP has zero credibility when it comes to genital cutting of minors. For decades they have been searching for excuses to justify the profoundly unethical actions of their members who sexually violate and abuse the most vulnerable members of society. 

    Dr. Doug Diekema a pediatric ethicist? What a disgusting joke. 

  2. Mary Lanser says:

    Great article…..and a great job exposing the serious double standard between girls and boys human rights. Thanks!

  3. Lilian says:

    I feel this article to be extremely self-opinionated. I’m a circumcised female. my sexual response is relatively normal. I have not suffer any sexual dysfunction, infection, and I live a healthy life till this day.
    I’ve done it when I already develop awareness(not as an infant). As well as my male cousin, he went through his circumcision procedure in adolescent and claimed a normal ejaculation and a satisfying sexual activity.
    The procedure was quick and harmless, I laid on a board and a certified female doctor open my legs and snipped the protruded tissue between the clitoris. The side effect was only painful urination for a day.
    I found my circumcision beneficial to lessen my vagina odor, and prevent risk of bacterial vaginosis.
    I reccomend you should acknowledge the opinions of people who’ve been through circumcision, before making an assumption.
    Best regards.

    • Hugh7 says:

      Thank you Lilian for your measured reply. It does, however, just prove our point.

      “my sexual response is relatively normal.”
      Compared to what? (We ask circumcised men, like your cousin, exactly the same question.)

      “and claimed a normal ejaculation”
      It is very interesting how circumcised men focus on the ejaculation to the exclusion of everything that leads up to it – exactly what you would expect, given the nature of the tissue that was removed.

      How serious a problem is vaginal odour, and how appropriate is surgery as prophylaxis? Women in non-circumcising countries seem to manage, and don’t flock to have themselves circumcised.

      The “bacterial vaginosis” claim is interesting, but it seems to be unknown where female genital cutting is not customary. Have you a reference?

      The opinions of people who’ve been through circumcision are certainly of interest, but they have to be weighed against their lack of experience of complete genitals.

  4. Frank OHara says:

    Great article! The normal response in America where female genital cutting is virtually unknown is that it is much worse than male genital cutting. According to studies conducted by Hanny Lightfoot Klien, circumcised women experience sexual satisfaction just like women who have not been altered and with the same frequency. Circumcised women are among the most ardent supporters of their daughters being cut just like them as circumcised American men support getting their sons cut.

  5. Pingback: Taking religious circumcision seriously » Moralogous

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