, 29 tweets, 16 min read Read on Twitter
I just want to follow up on this shocking conflict of interest case at @WHO, where the inventor of a newborn circumcision device, after applying for a patent, is invited to co-write the @WHO "manual" for performing newborn circumcision, touting his own device for mass use.
Again, the whole @WHO push for mass circumcision in Africa was based on studies of sexually active adults, circumcised (nominally) with their consent. There is no controlled evidence that newborn circumcision lowers risk of HIV in Africa or anywhere else; & newborns can't consent
Suggesting newborn circumcision has no negative effects on sexual outcomes, the device inventor & his @WHO co-authors exclusively cite studies of *adult* circ w/ limited follow-up, including one by Krieger, who ALSO has a patent out for a circ device: threadreaderapp.com/thread/1079164…
In any case, the "null" findings from those adult studies were based on poorly designed self-response questionnaires with vague wording, no attempt to control for socially desirable responding, and other flaws as documented below, from: academic.oup.com/ije/article/41…
But never mind. The point I want to make is that @WHO is talking out of both sides of its mouth. In its policy on "FGM," it claims *any* medically unnecessary cutting of female genitalia, including non-tissue-removing pricking, nicking, or piercing, is a *human rights violation.*
It doesn't matter if the cutting is done w pain control, if parents believe it's religious, or if it's done in a sterile way (the @WHO *opposes* medicalization for girls). *Any* cutting of female minors is claimed to violate their right to physical integrity & rights of the child
Now ask yourself, if studies of consensual *adult* female genital cutting (FGC) suggested a partial reduction in risk of diseases better prevented non-surgically, would @WHO simply extrapolate those findings to non-consenting girls & say their rights are no longer violated?
Would it cite studies of sexual outcomes following consensual *adult* FGC & suggest these directly apply to non-consensual FGC on infant girls? Would it hire the inventor of a FGC device, from a FGC culture, to write a manual for how to perform FGC on infant girls w/ that device?
Presumably not. And yet @WHO - the very same @WHO claiming that the tiniest "nick" of a girl's genitals violates her fundamental human rights - has published a 132-page INSTRUCTION MANUAL for how to perform medically unnecessary genital cutting on non-consenting boys. Let's see:
The first step is to restrain the boy by strapping him into a device that immobilizes his struggling limbs (or you can just pin them down yourself, see Figure 6.1). All subsequent photos from @WHO manual here apps.who.int/iris/bitstream…
Once he's properly restrained, you need to figure out where the corona of his glans is. To do this, you "palpate" (that is, manipulate with your fingers) his penis until it becomes erect -- see Figure 6.5 of @WHO manual here -- so you can better distinguish the tiny structures.
Now, the foreskin is adhered to the head of the penis at birth, in something like the way your fingernail is adhered to your finger. So if you want to get the foreskin off, you have to dilate the opening & then shove a blunt probe between the foreskin & glans to tear them apart.
The next step depends on which clamp you plan to use. If you use the Mogen clamp, you can apply it at this point (Figure 8.6). Then you take a razor or scalpel and just slice across the surface, hopefully avoiding the glans. You then "liberate" the glans as depicted in Figure 8.7
Alternatively, you might use the Gomco clamp -- the one most commonly used in American hospitals -- which is a bit gruesome and requires the use of a safety pin. "For optimal results, the safety pin should be pierced through the full thickness of the foreskin." See Figure 8.14.
Now, I thought "piercing" was a form of FGM Type IV on the @WHO typology. It doesn't matter what part of the vulva you pierce, or whether you do it with pain control; as long as it's medically unnecessary, it's defined as "mutilation" by the @WHO and is a human rights violation.
Not so for boys. Piercing is just one part of the procedure, after the tearing apart of foreskin & glans. With Gomco clamp, you then crush foreskin, cutting off its blood supply. But sometimes you need more room to work with, in which case you can slit the foreskin with scissors:
Of course, all of this tearing, crushing, slitting, and piercing carries risks. You might "deglove" the penis as depicted in Figure 10.1 of the @WHO instruction manual. Additional deglovings depicted in Figures 10.2 and 10.3.
Adhesions are also sometimes a problem. As is "trapped penis." See these pictures here.
There's also a fairly high risk of meatal stenosis (pathological narrowing of the urethral opening); skin bridges might also form, with unsightly scarring on the penis that will affect the boy for the rest of his life.
Now, it is often argued that these risks are not all that common. But as surgeon Hutson argues in @JME_BMJ "The most fundamental principle of surgery is no operation should be done if there's no disease [else] no complication whatsoever can be tolerated." jme.bmj.com/content/30/3/2…
The @WHO needs to get its house in order, fast, or it will lose all credibility on this issue. How does it expect to convince groups that practice BOTH female & male genital cutting together (this is virtually all groups that practice FGC) that FGC is *human rights violation* ...
no matter how slight, no matter what the reason, no matter what part of the vulva is affected, no matter what the risk profile, no matter what social or religious benefits might follow, so long as it's medically unnecessary, if it simultaneously *encourages* such cutting of boys?
And not only encourages, but actually publishes and distributes a 132-page, step-by-step instruction manual for how to cut boys' genitals without their consent, in ways that are MORE invasive than some forms of WHO-defined FGM? And when the authors of that manual have clear COIs?
It is time @WHO stopped pretending to be a neutral 'scientific' authority on this issue. Circumcision promotors within @WHO are small coterie of die-hard devotees from practicing cultures whose close collaborations & power-positioning are well documented: cesp-2016.vjf.inserm.fr/wp-content/upl…
And the opponents of FGC are not neutral either: the funding for @WHO anti-FGC policy comes from Western political funders who have stated mission to "eradicate" all forms of non-Western FGC, based on grossly homogenizing assumptions about such FGC rooted in sloppy scholarship.
Hodzic has done brilliant work showing how data on FGC are "massaged" by @WHO officials to get the results expected by anti-FGC funders researchgate.net/publication/26…
And I have a piece showing systematic contradictions, failures of reasoning, selective use of evidence, etc., in the @WHO policy on "FGM" that should make it hard for anyone to take that organization seriously as a source of evidence on non-Western FGC. kiej.georgetown.edu/editors-pick-j…
See also this coverage in the @nytimes from some years back: tierneylab.blogs.nytimes.com/2008/01/28/cul… ... My hope is that scholars who work on these issues will say enough is enough, and it is time for a new policy that respects all children's right to genital integrity, regardless of race or sex
Missing some Tweet in this thread?
You can try to force a refresh.

Like this thread? Get email updates or save it to PDF!

Subscribe to Brian D. Earp
Profile picture

Get real-time email alerts when new unrolls are available from this author!

This content may be removed anytime!

Twitter may remove this content at anytime, convert it as a PDF, save and print for later use!

Try unrolling a thread yourself!

how to unroll video

1) Follow Thread Reader App on Twitter so you can easily mention us!

2) Go to a Twitter thread (series of Tweets by the same owner) and mention us with a keyword "unroll" @threadreaderapp unroll

You can practice here first or read more on our help page!

Follow Us on Twitter!

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just three indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3.00/month or $30.00/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!