Circumcision and the Medicalization of Sex

Conforming to the norms of gender has long been the motivation for harmful medical interventions on young people

I was among several protestors outside the Washington DC convention center in October 2023 for the American Academy of Pediatrics annual conference. The intactivists were there to protest the old policy encouraging circumcision, and the sex realists were there to protest the recent renewal of the policy encouraging interventions in the sexual development of “gender diverse” young people.

I proudly participated in both protests. For thirty years, my work has been driven by protecting children from harmful genital cutting, confronting the pseudoscience used to perpetuate it, and promoting the superior sexual function that can be expected from uncut genitals. While an intactivist’s job is preventing the sexual damage that results from circumcision, I believe that exposing any sexual harm done to minors is morally required of me.

The American Academy of Pediatrics (AAP) was sued that month for its alleged role in damaging the sexual development of a girl suffering from numerous mental health conditions. When she decided to stop treatment, she discovered irreversible damage and vaginal atrophy, excess facial and body hair, compromised bone structure, and an autoimmune disease. The girl’s mother originally refused to consent, but the defendants pressured her into accepting treatments by allegedly suggesting that her child would commit suicide if she did not. The AAP is accused of knowingly crafting a policy for “gender-affirming” interventions that lacked sufficient medical evidence and contained misleading research citations to support its recommendations. The policy fails to mention that gender dysphoria desists in the vast majority of children without intervention. It misrepresents the scope of the studies it cites in support and ignores the contrary evidence given within them.

The American Academy of Pediatrics is the world’s leader in promoting interventions in sexual development, including for youth whom it describes as having “interests and hobbies that may align with the other gender.” It claims that children with gender dysphoria can begin socially transitioning at any age. The AAP is also the world’s leader in promoting routine medical circumcision. In 2012, the AAP policy said that “the health benefits of newborn circumcision outweigh the risks.” In 2018, the AAP recommended puberty blockers and cross-sex hormones as “care for youth who identify as transgender and gender diverse.” Dissenting voices within the organization were suppressed.

Policy statements issued by the AAP are not based on a consensus of its board-certified pediatricians. Instead, the organization defers to a small number who volunteer to be on a committee to craft a policy. A handful of like-minded doctors driven by unscientific motives pushed through the circumcision policy without a systematic review of the evidence. Ideologues and activists can take hold of pediatric medicine to recommend treatments in the absence of scientific basis and long-term outcome data.

Blaming the foreskin

For its advocates, circumcision is not genital mutilation, but only the eradication of a risky anomaly found in every newborn boy. The foreskin has been falsely associated with disease ever since nineteenth-century physicians witnessed little boys rubbing their foreskin to masturbate. Victorian-era physicians equated sex with sin dangerous not just to one’s soul, but to one’s physical health as well. The foreskin was to blame for aiding and abetting this danger, and masturbation became a medical concern. Anxiety about the foreskin’s role as an accomplice to the sin of sexual pleasure later framed it as the cause of numerous diseases. By 1920, cutting the foreskin from the penises of newborn boys became a standard medical procedure in all English-speaking countries. Over the years, physicians continued to claim that circumcision could somehow prevent many diseases.

A set of hypothetical, potential benefits continues to supply excuses to keep circumcising newborns and keep it paid for by insurance. However, cross-cultural comparisons worldwide make it plain that peer pressure and cultural bias are at the root of this American medical custom. Parental anxiety about their son’s penis not looking like other males is really all that is needed for them to demand this gender-conforming surgery. Sadly, boys and men with an intact penis are shamed in cultures that still view the foreskin as dangerous. A teen boy with an intact penis may feel disgust for his foreskin as a result of negative comments by his circumcised peers. “Foreskin dysphoria” may set in, prompting him to get circumcised to conform to his peers or the expectations of his sexual partners.

Thus, circumcision remains a medical custom in the United States due to “conformance anxiety” and the widespread myths used to hide it. As the only routine surgery performed on children without a diagnosis, circumcision lacks medical justification but continues to relieve anxiety about the hazards of male sexuality as embodied in the intact penis itself.

While sex has always been a source of impurity and sin for regulation by clergy, its connection with disease and psychological distress made it a frequent subject of unscientific theories and reckless interventions by medical and psychiatric pioneers. Anxiety about “deviant” sexual expression inspired many medical interventions to ensure conformity to acceptable social norms. Masturbation, nymphomania, birth control, homosexuality, transsexualism, and impotence have all been targets for reckless medical interventions. Each time, a manifestation of sex found disturbing was targeted with a new treatment by ambitious medical pioneers promising to relieve individual suffering and collective anxiety.

Masturbation as the cause of insanity and circumcision as its cure are only two of the many absurdities about human sexuality and its risks told throughout the history of medicine. Civilization’s chronic anxiety around sex finds new expression as feelings or behaviors are problematized, a novel theory becomes an obsession, and experimental treatments suddenly become essential. Conforming to a certain norm of behavior or appearance has always been the stated goal of these psychosexual interventions.

Blaming the body

The history of medical circumcision provides us with a useful template for understanding our current epidemic of “gender-affirming” interventions. While the origins of these two medical controversies are separated by over 100 years, routine circumcision established a precedent for altering a minor’s sexual anatomy in the interests of conformity. Twenty-five years ago, the experimental use of puberty blockers was begun with the hope of improving conformity to the opposite sex by starting transexual interventions earlier in life. Drugs and surgery were soon the standard of care to save a nonconforming teen from suffering incorrect puberty as the “wrong” sex.

Doctors and mental health professionals created a new patient group by insisting that hormones and surgery are necessary to relieve the emotional suffering of young people. The blame for this suffering is located in their sex, now cleverly queered as “gender” because “transexual children” would be an unpalatable label. While the claim is “gender-affirming” care and the presenting symptom is “gender dysphoria,” the target for medical intervention is always sexual anatomy. The goal of these interventions is passing as the opposite sex.

This, then, is the medicalization of sex. Sex has once again been identified as the source of suffering and death. Medicine has once again responded to the resulting anxiety by intervening in normal sexual anatomy. Healthy puberty is rejected as the standard of normalcy, and the maturation of a child’s body is now a threat requiring intervention. Childhood claims of being born in the wrong body are embraced by an eager, profit-driven pediatric medical establishment using the guise of suicide prevention. Gender conformity is pursued medically in the belief that it will fix psychological problems. The risks of gender dysphoria justify its only cure—“gender-affirming” changes to anatomy that seek to mimic the opposite sex.

Gender dysphoria is an anxiety disorder that blames one’s sexed body as the source of distress, much as an anorexic blames her body fat. Sex stereotypes experienced by a child within their small psychosocial bubble serve as a measure of their gender incongruence. Nonconformity may cause them great anguish. An idealized, antithetical sex conforms perfectly in their imagination. They believe that if they cannot match the social expectations of their gender, they can change their gender to match social expectations. However, their sexual development poses a threat by preventing social recognition of this ideal.

Thus, the “transgender child” emerged en masse as an idiom of distress. Problematizing their sex gives troubled teenagers a doctor’s note to excuse their torment, as well as a misguided goal for authenticity and a chance at future social acceptance. They surrender their rebellious nature to pursue conformity in dreams of passing socially as the other sex. This is imagined as the key to their mental health and true self.

Once medical interventions were available, children and adolescents were given hope on social media of evading their conformance anxiety rather than having to deal with it. They can now conform to an alternate identity as the binary opposite sex and be welcomed into a shared fantasy endorsed by their social network and funded by their healthcare network. Treatment is not to fix a defect or disease but to force the body to conform, in rough approximation, to an imagined ideal. This alleviates their anxiety, justifies ongoing medical interventions, and postpones confrontations with biological reality.

The conformance anxiety around sex that perpetuates the practice of infant circumcision now plays a significant role in promoting gender conformity using interventions in puberty. Parents and clinicians are complicit in this. As with the foreskin, normal sexual anatomy is problematized as a risk. Conforming organs are deemed necessary to ensure one’s mental health, whether it be a penis that matches others or a brand new one. Activists insist on acceptance of an anatomical norm, whether it be a circumcised penis or a woman with a penis.

The American Academy of Pediatrics succeeded in pathologizing gender nonconformity by indulging childhood wishes of escape from the limits of one’s sex—limits that are most often based on narrow stereotypes. The use of anatomical alterations for mental health is only possible because a shared delusion, spread by high-status teens on social media, was validated by healthcare professionals. Interventions eagerly provided by physicians were key to the spread of rapid-onset gender dysphoria.

Physicians manufacture parental consent by making hypothetical claims of potential health benefits and threats of dire outcomes if action is not taken. Parents consent to circumcision and medicalized sex because they are led to believe by deluded professionals and activists that these interventions are done for their child’s own good. Morbidity is highlighted to instill the fear of inaction in parents, whether it is sexually transmitted diseases or suicide attempts.

Waking up as the other sex or as a homosexual would hardly justify suicide. However, suicide prevention now includes interventions that make young people appear to be straight rather than gay. Gay teens can transition to escape their own homophobia and that of their families. “Transing the gay away” solves their problems with being gay.

Gender diversity never needs a doctor

The medical profession created the transgender identity as it exists today, which can be better described by its original name: transsexualism. Becoming a transsexual is only made possible by eager doctors and surgeons, by medical interventions covered by insurance, and by psychiatrists and psychologists who endorse a child’s delusion because they themselves have been infected by it. They turn a child’s sex into a medical condition because they believe that lifesaving healthcare includes altering sexual anatomy to conform to the opposite sex.

“Healthcare” is the magic word that enables infant circumcision and the medicalization of sex to continue. Circumcision as healthcare hides religious and cultural biases long held in its favor while “gender-affirming” healthcare hides emotional disorders, homophobia, and autogynephilia. By insisting that conforming anatomy is actually in the best interests of young people, the damage done to them is protected from scrutiny. This, after all, is medicine, and only a hateful bigot would dare to stand in its way.

The transgender social contagion fostered by credulous physicians and therapists has now infected hundreds of thousands of teens. However, systematic reviews of evidence conducted by public health authorities in England, Sweden, Finland, and Denmark concluded that the risk/benefit ratio of medicalized sex ranges from unknown to unfavorable. Researchers and clinicians have exaggerated their findings and failed to study long-term outcomes. Most dissatisfied patients are lost to follow-up.

Intactivists know well the underlying religious, cultural, and financial motives behind the misleading research cited by the American Academy of Pediatrics to support the practice of circumcision—the granddaddy of medicalized sex. We are well aware of the lack of informed consent, ethical review, and tracking of complications that allow doctors and hospitals to perpetuate the illusion that circumcision is healthcare. We know they encourage the practice because most medical insurance plans in the US still cover it. Most of all, we know that diminishing healthy tissue in the genitals always diminishes sexual function.

Puberty blockers and opposite-sex hormones are an unrecognized form of genital mutilation because of their tissue-reducing effects. Interventions in sexual development devalue the complex functions provided by our genitals and the full range of sensations they provide. The physiology that provides sensation, pleasure, erection, lubrication, orgasm, and ejaculation are diminished. Teenagers with little or no sexual experience are signing up for genital atrophy, painful intercourse, and weaker orgasms. They are turned into lifelong medical patients, beginning with puberty blockers, then opposite-sex hormones, breast surgeries, and regular follow-ups.

Adolescents with a history of autism, trauma, and mental disorders have turned their healthy bodies into lifelong medical problems. Medical interventions serve to avoid and hide the true source of anxiety and depression in these young people. Hormonal and surgical interventions in their normal sexual development cannot fix their emotional distress but can make it last a lifetime by reifying psychological pain into their bodies.

As with circumcision, interventions in puberty became widespread before large, long-term follow-up studies were completed to measure actual outcomes. As with circumcision, when critics demand more proof of safety and efficacy, they are told to provide more proof of harm. The lack of objective research and the lack of sexual experience in young patients means that many years will pass before we know the extent of this harm.

Genital surgeries are becoming more common in teenagers as more surgeons learn to fashion Frankenstein sex anatomies using a remix of normal genitalia that leaves them with inferior function, vigor, and appearance. Diminished sexual sensation and response, urinary complications, chronic infections, and chronic pain are all common. A faux vagina must be dilated daily, provides poor erogenous sensation, and has no natural lubrication. A faux penis will not get natural erections, have a normal orgasm, or ejaculate. A penile prosthetic implant is required for intercourse and results in high complication rates. Reattached nipples on reconstructed chests lose their erogenous sensitivity.

For millennia, genital mutilation was forced upon boys and girls by their tradition-worshipping elders. Tragically, for the first time in history, young people are being sexually mutilated at their own request.

Sex realism

Those who pursue medical interventions cannot escape from gender as the social signifier of one’s sex. In the pursuit of sexual conformity, they unwittingly affirm that gender is binary and the subordinate of sex. Sex cannot be assigned nor chosen by anyone because it is not a feeling nor a set of parts. One’s sex, and likewise—one’s gender—cannot be felt like a headache or an orgasm. Sex is a coordinated set of physiological functions provided by organs working in harmony that evolved to succeed in the reproduction of their host. Biological reality—not Christians, Republicans, or parents—imposes limitations on what can be true and what is possible in the bodies that we are.

No doctor’s prescription can ever be written for becoming a man or woman. Sex is not assigned at birth, but sexist stereotypes often are. Troubled teenagers and their healthcare servants should not be allowed to turn these stereotypes into medical conditions. A person’s sex can never be a disease. Neither a boy’s foreskin nor his whole penis nor his functioning reproductive system is a birth defect.

The practice of circumcision and the medicalization of sex are inherently maladaptive ways of coping with conformance anxiety because they damage sexual function. Vain searches for conformity that cause sterility, genital atrophy, sexual dysfunction, and mutilation in young people is not something any children’s rights advocate should ever support. Advocates for youth must work to ensure that genitals, breasts, endocrine systems, and fertility are intact at adulthood.

We are in the early years of desistors and detransitioners going public with tragic testimonies of permanent damage. The personal disenchantment from medicalizing one’s sex and the futility of physical mimicry for psychological health are gradually shifting the discourse from human rights to human tragedies. In the coming years, attention will intensify on the physical and emotional wreckage that plagues bodies crafted upon pseudoscience. State bans, litigation, and court rulings will follow this wreckage. The American Academy of Pediatrics will have much to answer for as Biology 101 bites them back in the form of systematic reviews, lawsuits, and reputational damage.

The progress made in legislatures and courts against the medicalization of sex exemplifies what intactivists have hoped for decades to happen against the practice of circumcision. Lawsuits and bans against modifying immature bodies will likely hasten the day when performing any genital alteration on minors is prohibited. When that day comes, health—and not conformity—will be medicine’s only goal.

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Featured Image: Protestors at the American Academy of Pediatrics national conference, Washington, DC, Oct 21, 2023, by permission