Circumcision Ban to Appear on San Francisco Municipal Election Ballot

PHOTO: Lloyd Schofield
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Lloyd Schofield has come one step closer to achieving his mission to ban circumcision -- the surgical removal of the penile foreskin -- in the City by the Bay.

San Francisco city officials said Wednesday that Schofield had collected enough signatures -- more than 12,000 -- to put the measure on the city ballot in November 2011.

"The foreskin is there for a reason," said Schofield, who is retired from a career in the hotel industry. "It's not a birth defect. It serves an important function in a man's life, and nobody has a right to perform unnecessary surgery on another human being."

Schofield began researching circumcision several years ago and found a local group of "intactivists," people who believe that infant boys have the right to keep their foreskin intact. Together they created an advocacy group called the Prohibition of Genital Cutting of Male Minors. The ban would make it illegal to "circumcise, excise, cut or mutilate the whole or any part of the foreskin, testicles, or penis of another person who has not attained the age of 18 years."

The group has not only collected thousands of signatures but a fair share of ire from religious groups and the medical community alike.

If San Francisco residents vote for the ban, doctors, mohels and any other person who performs circumcisions would face a misdemeanor charge and have to pay up to a $1,000 fine or serve a maximum of one year in jail.

Circumcision, performed on 8-day-old males, is an important ritual in the Jewish -- and Muslim -- faiths. Marc Stern, associate general counsel for legal advocacy at the American Jewish Committee, said the Jewish community is "clearly appalled" by the proposed ban.

"This is the most direct assault on Jewish religious practice in the United States," said Stern. "It's unprecedented in American Jewish life."

"We would agree with the Jewish religious and legal scholars regarding the practice, and ... to my knowledge, there is no compelling medical reason to ban it," said Ibrahim Ramey, the human civil rights program director at the Muslim American Society Freedom Foundation. "There are religious sensitivities that are involved and the decision to circumcise ought best be left to the parents of the child, and not a political referendum."

Stern said that the Jewish community has held strategy meetings to diminish the proposal.

"We want to erase the message that anyone else can try to take away a central ritual, practiced for centuries without harm, to make sure no one tries to replicate this," Stern said.

But with the thousands of supporting signatures, San Francisco is one step closer to making the proposal a reality.

AAP and Circumcision

According to the Centers for Disease Control and Prevention, the rate of circumcision among baby boys in the United States seems to be declining. The government agency found that the incidence of circumcision dropped from 56 percent in 2006 to 32.5 percent in 2009. But those numbers do not include procedures performed outside of hospitals, including Jewish rituals that are usually performed in the home, or circumcisions that were not reimbursed by insurance.

While male circumcision is usually performed for religious or cultural reasons, the American Academy of Pediatrics said there is some scientific evidence that points to potential medical benefits, but the data are insufficient for the organization to recommend routine circumcision in newborns.

"No medical association promotes circumcision," said Schofield. "If there was sound and repeated scientific evidence, there'd be a medical association promoting it."

But Dr. Douglas Diekema, director of education for the Treuman Katz Center for Pediatric Bioethics at Seattle Children's Hospital, said that the procedure has been shown to reduce the risk of infections.

"Boys who are circumcised have fewer urinary tract infections during infancy," said Diekema. "These are serious infections that require hospitalization."

Some data also suggest that circumcision reduces the risk of contracting HIV, HPV and penile cancer.

"Serious complications related to circumcision are very rare," said Diekema. "The most common complications include minor bleeding after the procedure, which is usually easily stopped with some pressure, and superficial skin infections requiring an antibiotic cream."

Arguments against circumcision include the risk of surgery, penile adhesions, reduced sexual pleasure and "the hidden penis."

"It sounds like a concealed weapon, doesn't it?" Dr. Ari Brown, a pediatrician in Austin, Texas, wrote in her book, "Baby 411." "Chubby baby boys have a fat roll above their genitals. It causes the circumcised penis to get sucked inwards. The penis looks normal as the boys grow up, but it's always concerning to parents."

Most experts do not make a recommendation about circumcision, leaving it up to the parents to decide.

Circumcision: A Family Decision

Dr. F. Sessions Cole, a professor of pediatrics and assistant vice chancellor for children's health at Washington University School of Medicine, said most doctors have a full discussion of the medical benefits, potential complications and long-term impact.

"Most families, in my experience, make their decision based on cultural, religious or social considerations," said Cole.

Circumcision=Female Genital Mutilation? Doctors Say No

But Schofield believes cultural and religious considerations should not matter, just as they don't in arguments against female genital mutilation.

"When you take an infant, hold them down and give insufficient or no anesthesia and you cut off the most sensitive part of their body, there's no question it's exactly the same [as female genital mutilation]," said Schofield.

However, experts say female genital mutilation is in no way similar to circumcision, and it's misleading to equate the two.

"The anatomic female equivalent of the male foreskin is the clitoral hood," said Diekema. "Most forms of female genital cutting involve excision or far more than the clitoral hood, often excising the clitoris with or without portions of the labia.

"The male equivalent of those would be removal of the penis with or without the scrotum," said Diekema. "Female genital cutting and male circumcision are not comparable procedures."

Diekema said that there were some demonstrated health benefits to male circumcision but not for any kind of female cutting.

Intactivists Take It One Day at a Time

Schofield said that he and the "intactivists" have a broad range of support among a variety of demographic groups.

"We're taking it one step at a time," said Schofield. "If it doesn't pass this time, then I'm sure it will be tried again."

Schofield refused to say whether he is circumcised or not.

"I don't want the focus to be on me and have people use it as an excuse not to look at the issue itself," he said.

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