San Francisco May Vote on Banning Male Circumcision

April 27, 2011— -- Lloyd Schofield is a man on a mission to ban circumcision from his community.

"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."

And this November, San Francisco voters may have the opportunity to vote on whether they feel the practice – often associated with religious protocol – should be banned in the city and county of San Francisco.

He and his fellow organizers have created an initiative known as the "Prohibition of Genital Cutting of Male Minors." The proposal 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 collected more than 12,000 local signatures to put the proposal on the city ballot in November 2011. They have also collected a fair share of ire from religious groups and medical experts alike.

Doctors, mohels and any other person who performs the procedure would face up to a $1,000 fine or a year of jail time.

Circumcision, where the foreskin of the penis is surgically removed, has been a hot topic for some time. Schofield began researching the procedure several years ago and found a local group of "intactivists," or people who believe that infant boys have the right to keep their foreskin intact.

Circumcision is an important ritual in the Jewish faith, where it is performed on 8-day-old males. Marc Stern, associate general counsel for legal advocacy with the American Jewish Committee, said the Jewish community is "clearly appalled" by the proposal.

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

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," continued Stern.

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 declined from 56 percent in 2006 to 32.5 percent in 2009. But those numbers did 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 the procedure is usually performed for religious or cultural reasons, the American Academy of Pediatrics states that, while there is some scientific evidence that demonstrates potential medical benefits of male circumcision, the data are not sufficient 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 several infections.

"Circumcision has been shown to reduce the risk of several infections," said Diekema. "Boys who are circumcised have fewer urinary tract infections during infancy. These are serious infections that require hospitalization."

Some data also show that the procedure 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 that 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, Tex., 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 and leave it up to the parents to decide.

Circumcision: A Family Decision

Dr. F. Sessions Cole, 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=FGM? Doctors Say No

But Schofield said cultural and religious considerations should not matter, just as they don't in 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] when you look at it that way," 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 added that there are scientifically 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 are a grassroots advocacy group, and they have a broad range of support, among a variety of demographics.

"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 explained.