Two Articles, One About Abortion and One About Women, Gender, Sexuality and Medicine

First, from The New York Times, The New Abor­tion Providers:

[After Roe vs. Wade,] the clin­ics also truly came to stand alone. In 1973, hos­pi­tals made up 80 per­cent of the country’s abor­tion facil­i­ties. By 1981, how­ever, clin­ics out­num­bered hos­pi­tals, and 15 years later, 90 per­cent of the abor­tions in the U.S. were per­formed at clin­ics. The Amer­i­can Med­ical Asso­ci­a­tion did not main­tain stan­dards of care for the pro­ce­dure. Hos­pi­tals didn’t shel­ter them in their wings. Being a pro-choice doc­tor came to mean refer­ring your patients to a clinic rather than doing abor­tions in your own office.

This was never the fem­i­nist plan. “The clin­ics’ founders didn’t intend them to become vir­tu­ally the only set­tings for abor­tion ser­vices in many com­mu­ni­ties,” says Car­ole Joffe, a soci­ol­o­gist and author of a his­tory of the era, “Doc­tors of Con­science,” and a new book, “Dis­patches From the Abor­tion Wars.” When the clin­ics became the only place in town to have an abor­tion, they became an easy mark for extrem­ists. As Joffe told me, “The vio­lence was pos­si­ble because the rela­tion­ship of med­i­cine to abor­tion was already ten­u­ous.” The med­ical pro­fes­sion rein­forced the out­sider sta­tus of the clin­ics by not speak­ing out strongly after the first attacks. As abor­tion moved to the mar­gins of med­ical prac­tice, it also dis­ap­peared from res­i­dency pro­grams that pro­duced new doc­tors. In 1995, the num­ber of OB-GYN res­i­den­cies offer­ing abor­tion train­ing fell to a low of 12 percent.

“Under pres­sure and stigma, more doc­tors shun abor­tion,” wrote David Grimes, a lead­ing researcher and abor­tion provider of 38 years, in a widely cited 1992 med­ical jour­nal arti­cle called “Clin­i­cians Who Pro­vide Abor­tions: The Thin­ning Ranks.” In a 1992 sur­vey of OB-GYNs, 59 per­cent of those age 65 and older said that they per­formed abor­tions, com­pared with 28 per­cent of those age 50 and younger. The National Abor­tion Fed­er­a­tion started warn­ing about “the gray­ing of the abor­tion provider.” In the decade after Roe, the num­ber of sites pro­vid­ing abor­tion across the coun­try almost dou­bled from about 1,500 to more than 2,900, accord­ing to the Gutt­macher Insti­tute. But by 2000 the num­ber shrank back to about 1,800 — a decline of 37 per­cent from 1982.

There’s another side of the story, how­ever — a delib­er­ate and con­certed coun­terof­fen­sive that has gone largely unre­marked. Over the last decade, abortion-rights advo­cates have qui­etly worked to reverse the mar­gin­al­iza­tion encour­aged by activists like Ran­dall Terry. Abortion-rights pro­po­nents are fight­ing back on pre­cisely the same turf that Terry demar­cated: the place of abor­tion within main­stream med­i­cine. This abortion-rights cam­paign, led by physi­cians them­selves, is try­ing to recast doc­tors, chang­ing them from a weak link of abor­tion to a strong one. Its lead­ers have built res­i­dency pro­grams and fel­low­ships at uni­ver­sity hos­pi­tals, with the hope that, even­tu­ally, more and more doc­tors will use their train­ing to bring abor­tion into their prac­tices. The bold idea at the heart of this effort is to inte­grate abor­tion so that it’s a seam­less part of health care for women — embraced rather than shunned.

Sec­ond, from Newsweek​.com, The Anti-Lesbian Drug:

Genetic engi­neers, move over: the lat­est scheme for cre­at­ing chil­dren to a parent’s spec­i­fi­ca­tions requires no DNA tin­ker­ing, but merely giv­ing mom a steroid while she’s preg­nant, and presto — no chance that her daugh­ters will be les­bians or (worse?) ‘uppity.’

Or so one might guess from the storm brew­ing over the pre­na­tal use of that steroid, called dex­am­etha­sone. In Feb­ru­ary, bioethi­cist Alice Dreger of North­west­ern Uni­ver­sity and two col­leagues blew the whis­tle on the con­tro­ver­sial prac­tice of giv­ing preg­nant women dex­am­etha­sone to keep the female fetuses they are car­ry­ing from devel­op­ing ambigu­ous gen­i­talia. (That can hap­pen to girls who have con­gen­i­tal adrenal hyper­pla­sia (CAH), a genetic dis­or­der in which unusu­ally high pre­na­tal expo­sure to mas­culin­iz­ing hor­mones called andro­gens can cause girls to develop a deep voice, facial hair, and masculine-looking gen­i­talia.) The response Dreger got from physi­cians and sci­en­tists who were out­raged over this unap­proved use of dex­am­etha­sone caused her to dig deeper into the sci­en­tific papers of the researcher who has pro­moted it.

Dreger is one of the women who brought the cli­toral surg­eries per­formed by Dr. Dix Pop­pas to light.

Fragments of Evolving Manhood: Do You Like Your Body 4 (More on the Expendability of the Foreskin)

When a good friend of mine who is not Jew­ish found out that her first child was going to be a boy, I asked her if she intended to have him circumcised.

“Yup,” she answered, smiling.

“Do you know how unnec­es­sary and painful the oper­a­tion is?”

Same smile, same answer, “Yup.”

“Then why do it?”

“Because I will not have my son look­ing like a freak! I’ve been with guys who weren’t cir­cum­cised, and they were, well, dis­gust­ing.” She shook her head and wrin­kled her nose at the mem­ory. “They told me sto­ries about what it was like to be dif­fer­ent in the locker room. I just don’t want my son to have to go through that.”

“What if the knife slips?”

Back to the orig­i­nal smile, “It won’t. It almost never does.”

I asked her if she’d ever actu­ally seen a cir­cum­ci­sion. She said no, and so I asked if she planned to be present when her son was cut. Given how strongly she felt, I sug­gested, it seemed to be only right that she should be, if only so she could answer any ques­tions her son might have when he got older. She closed her eyes and raised her palms between us to ward off the image I’d just con­jured, “I, I, I couldn’t. There’s no way I’d be able to let them do it.”

“But then why have it done at all?”

“Look, my son will be cir­cum­cised!” Her tone made it clear the con­ver­sa­tion was over. “He will have a nor­mal penis and a nor­mal sex life, and I will thank you in the future to mind your own business.”

///

I remem­ber how shocked I was – I was a col­lege fresh­man – when my friend Pierre turned around in the locker room after a bas­ket­ball game and dis­played an organ hang­ing between his legs that looked more to me like an elephant’s trunk than a man’s sex­ual appa­ra­tus. I’d never seen an uncir­cum­cised penis before. Well, no, strictly speak­ing, that’s not true. I know now that at least some of the men in the het­ero­sex­ual pornog­ra­phy I’d watched were uncir­cum­cised, but since I only ever saw those penises when they were erect, the skin the women on the screen would occa­sion­ally pull up and down over the glans of those organs appeared to me in my igno­rance to be skin no dif­fer­ent than what I had left over after my cir­cum­ci­sion (which was almost non-existent); I just assumed that, for what­ever rea­son, those men had more of it. So I guess the accu­rate thing to say is that I’d never seen an uncir­cum­cised penis that was not erect, and my first response to see­ing Pierre’s was that it looked fem­i­nine, effem­i­nate. Or maybe emas­cu­lated is a more pre­cise term. Either way, what I felt was a mix­ture of pity and disgust.

I went back to my room and thought hard about my reac­tion. Pierre was a good friend and it trou­bled me that I should be repulsed by his body. It took a while, but I finally real­ized that what made Pierre’s penis seem so alien to me was not merely the cov­er­ing his fore­skin pro­vided; it was that his fore­skin made it impos­si­ble for me to pic­ture Pierre’s penis erect. Not that I thought he didn’t have erec­tions; I knew he had a girl­friend with whom he was hav­ing sex. Rather, I couldn’t imag­ine what Pierre’s erect penis looked like, couldn’t fathom the mech­a­nism by which the fore­skin moved out of the way, mak­ing it pos­si­ble for him to enter a woman’s vagina and expe­ri­ence the plea­sures of sex, includ­ing orgasm and ejac­u­la­tion, that depend upon an exposed glans. It was this inabil­ity to envi­sion Pierre pen­e­trat­ing a woman or ejac­u­lat­ing that made his penis seem to me some­how less than mas­cu­line than mine – because, of course, I assumed that my penis, cut as it was, was the way a penis was sup­posed to be.

Iron­i­cally, in cul­tures that prac­tice cir­cum­ci­sion as an ado­les­cent rite of pas­sage, remov­ing the fore­skin is often equated with remov­ing the last ves­tige of mater­nal, mean­ing fem­i­nine, influ­ence. Not to have it removed, even to flinch while it is being removed — sig­ni­fy­ing fear and the inabil­ity to with­stand pain — is to reveal one­self as cling­ing to the fem­i­nine, unwill­ing to sep­a­rate from one’s mother, and there­fore unwor­thy of man­hood. Since we in the United States cir­cum­cise our boys as infants – and I am talk­ing here about rou­tine med­ical cir­cum­ci­sions, not the Jew­ish rit­ual of brit milah, which needs to be dis­cussed in a dif­fer­ent con­text – ques­tions of fear and the inabil­ity to with­stand pain are irrel­e­vant, but I think that the image of a cov­ered glans as less than mas­cu­line is nonethe­less very present in our cul­tural imag­i­na­tion. Or, to put it more pre­cisely, I think that the rou­tine med­ical cir­cum­ci­sion of infant boys makes their bod­ies con­gru­ent with our culture’s ideal of mas­culin­ity as clean, hard, always ready for action, and always, implic­itly if not explic­itly, on the offensive.

To start, cir­cum­ci­sion quite lit­er­ally turns a boy’s penis inside out, mak­ing what is essen­tially an inter­nal part of his body, the glans, an exter­nal one, and since the exposed glans is what first enters a woman dur­ing vagi­nal inter­course, it is hard not to read the cir­cum­cised penis as a penis always pre­pared, if not com­pletely ready at any given moment in time, to pen­e­trate – rep­re­sent­ing in the flesh the patri­ar­chal het­ero­sex­ual norm that val­ues a man’s “get­ting it in her” over almost every other aspect of sex. More­over, the cleaner and dryer penis that cir­cum­ci­sion cre­ates has nei­ther the odor nor the taste asso­ci­ated with the lubri­cat­ing dis­charges of both its uncir­cum­cised coun­ter­part and women’s gen­i­talia. Just like the ado­les­cent rite-of-passage cir­cum­ci­sions that I men­tioned above, in other words, the rou­tine med­ical cir­cum­ci­sion per­formed on boys here in the US removes from an infant’s penis that which makes it sim­i­lar to a vagina – except that, because we cir­cum­cise our boys when they are infants, a cut penis will feel to those boys as they grow up as if it were the penis with which they were born, pro­vid­ing the illu­sion of a bio­log­i­cal proof that patriarchy’s gen­der dichotomies – embod­ied in the dry, clean and there­fore “civ­i­lized” penis ver­sus the wet, messy and there­fore “sav­age” vagina – are indeed “nat­ural,” inher­ing in male and female bod­ies and not con­structed through the processes of cul­tural production.

Once these boys under­stand that they were cir­cum­cised, of course, the cat – so to speak – ought to be out of the bag, but the idea that a cir­cum­cised penis is the nor­mal, nat­ural and there­fore healthy penis, is given the weight of med­ical author­ity not only through doctor’s pro­mot­ing the procedure’s osten­si­ble health ben­e­fits (which I will dis­cuss in more detail else­where), but also through the med­ical images that shape our under­stand­ing of what our bod­ies ought to look like. In many of those images, at least here in the United States, the fore­skin is either entirely absent or, if it is present, not labeled. Here are two online examples:

  • Shands Health­Care is a pri­vate, not-for-profit orga­ni­za­tion affil­i­ated with the Uni­ver­sity of Florida. The A.D.A.M. Mul­ti­me­dia Health Ency­clo­pe­dia on its web­site includes this image of the male repro­duc­tive sys­tem in which the glans is exposed and in which the fore­skin is not even labeled. (To my eye, it’s ambigu­ous whether the bunched skin at the base of the glans is sup­posed to be the fore­skin or not.)
  • Vis­i­ble Pro­duc­tions, a Colorado-based mul­ti­me­dia com­mu­ni­ca­tions com­pany, which boasts, accord­ing to its web­site, the “world’s most exten­sive library of 3D dig­i­tal mod­els [of the human body]” based on data from the Vis­i­ble Human Project. Do a key­word search on “penis” and you get nine results, none of which show an intact penis. Searches on “fore­skin” and “pre­puce” return no results.

In Five Bod­ies, John O’Neill writes that the “oper­a­tion of polit­i­cal and eco­nomic power does not aim sim­ply to con­trol pas­sive bod­ies or to restrain the body politic, but to pro­duce docile bod­ies” (ital­ics in orig­i­nal), bod­ies which accept the truths of power as self-evident and not in need of exam­i­na­tion, moti­vat­ing the peo­ple inhab­it­ing those bod­ies to gov­ern them­selves in con­gru­ence with those truths. Rou­tine infant male cir­cum­ci­sion is a per­fect exam­ple. By per­form­ing the oper­a­tion on infants whose gen­der iden­ti­ties have not yet formed, med­i­cine recre­ates as phys­i­cally embod­ied med­ical facts a set of male dom­i­nant cul­tural beliefs about mas­culin­ity — always ready for sex, dry, clean, civ­i­lized — and then teaches us that these are the bench­marks against which we need to mea­sure men’s gen­i­tal and sex­ual health. To argue this, how­ever, is not to argue that cir­cum­ci­sion causes male dom­i­nant sex­ual behav­ior in men; nor is it to pre­dict that cul­tures which med­ically cir­cum­cise will be inher­ently more male dom­i­nant than those which don’t. Rather, it is to sug­gest that those cul­tures which do med­ically cir­cum­cise infant boys have cho­sen that pro­ce­dure as one of the ways they give men bod­ies in which patri­ar­chal mas­culin­ity and male dom­i­nant behav­ior feel natural.

Clearly, then, end­ing the rou­tine cir­cum­ci­sion of infant boys will not bring patri­archy to its knees, but pulling at the threads by which the pro­ce­dure is woven into our cul­tural fab­ric as nec­es­sary, or at least desir­able, does reveal some of the more insid­i­ous ways in which patri­archy itself is woven into men’s bod­ies as the nat­ural state of things; and once that weave is revealed as pre­cisely not nat­ural, we can start to imag­ine not just a dif­fer­ent kind of pat­tern, but even a dif­fer­ent way to use the loom on which the fab­ric is woven. Think objec­tively for a moment. Leave aside, if you can, the med­ical jus­ti­fi­ca­tions and ratio­nal­iza­tions, the myth­i­cal con­tent and his­tor­i­cal imper­a­tives we are taught to impose on the prac­tice of med­ical cir­cum­ci­sion, and think sim­ply in terms of actual events. A boy is born. Some­time between his entrance into the world and his first two weeks of life, he is taken away from his mother, strapped down with full phys­i­cal restraint in a room full of strangers, and his fore­skin, a sen­si­tive, func­tional and still devel­op­ing part of his body is pulled away from the head of his penis and ampu­tated – some­times with and some­times with­out anes­the­sia. He has given no con­sent, has no aware­ness of the med­ical and/or cul­tural con­sid­er­a­tions that moti­vate the pro­ce­dure, and he has lit­tle or no recourse, once the surgery has been per­formed, to change what has been done to him. There is no way to pre­dict what effect his cir­cum­ci­sion will have on him, but that is not the ques­tion we ought to be ask­ing our­selves. Rather, we ought to be ask­ing why we as a cul­ture so despise the body with which he was born that we need so rad­i­cally and so painfully to alter it, and then we need to be ask­ing if that is the kind of soci­ety we really want to be.

Works Cited

O’Neill, John. Five Bod­ies: The Human Shape of Mod­ern Soci­ety. Ithaca: Cor­nell Uni­ver­sity Press 1985 (The link takes you to the revised edi­tion.)

A New Covenant

They say it’s a shame we didn’t do it
when we should have, that prob­a­bly you’ll need it
later in life, when it’s more com­pli­cated,
more painful and, worse, you’ll remem­ber it.

They say women won’t want you, that you’ll not
for­give us, ever, espe­cially me, and that
the Jews who’ve died for what it means to be cut
will have died in vain because we left you complete.

And I know I can’t not bur­den you with that.
You have to, have to, res­onate with what
your body would have meant to all that hate,
and you will — but sit­ting here alone tonight,

my ampu­tated life aching anew,
I’m grate­ful for all that’s merely whole in you.