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ASAPT
Alliance for Sexual Abuse and Prevention and Treatment

Child Protection Services   Chancellor of Higher EdNDBME
   
         First Letter to ASAPT, 8/23/98.
ASAPT Response to 8/23/98 Letter.
Second Letter to ASAPT, 9/14/98.

September 14, 1998

1002 N. 8th St.
Bismarck, ND 58501
September 14, 1998
Emailed to:
Susan Cordes-Green, Director
Alliance for Sexual Abuse Prevention and Treatment (ASAPT)
Fargo, ND

Dear Susan and the Alliance for Sexual Abuse Prevention and Treatment:

I am disappointed at your response of 9/10/98 to my letter of 8/23/98 for the following reasons: 

Definition of Sexual Child Abuse:

The definition of “sexual abuse” you, Linda and Gladys are now espousing in the name of the ASAPT seems to be unnecessarily narrow and inconsistent with your previous concerns. Why, I now must wonder, did Gladys ask me in 1992 to address the Alliance on the circumcision issue? Sexual abuse need not be done primarily for sexual gratification. Many women tell me that rape, for example, is primarily a crime of domination, humiliation and control rather than sexual gratification. On the other hand, some women claim the cut penis is more sexually gratifying, so they cut their sons, removing his choice and his female partner’s choice if she prefers an intact man. Only the person cut has the right to decide to amputate a healthy body part.

To say physicians receive no sexual gratification from the operation, is speculation, although it is not speculation that the physicians’ financial gratification continues to have a large role in its continuation. It is not accurate to say “the child is certainly not sexually stimulated by the procedure,” since nurses have told me the swabbing of the genitals in preparation for circumcision usually induces an erection (which may make circumcision easier). The circumcised child first experiences sexual stimulation, and is then subjected to pain. It is this transition from sexual pleasure to the imprinting of pain that is so harmful. Must a baby girl experience sexual stimulation to convince adults her genitals have been sexually harmed? And your comment that the circumciser does not experience a sexual response is another assumption. Perpetrators can be found in every profession. And research has shown sexual perpetrators tend to do to others what was done to them.

Intent:

Intent has little to do with the need to stop a criminal act. The courts will not accept as blameless those who did not intend to kill someone when they went through a stoplight causing a fatal collision. You say physicians should be better informed. I whole-heartily agree, but I can tell you they have had every opportunity to access information. They no longer have an excuse. They are either incompetent or practicing fraudulently. In any case they must be stopped. Those whose job it is to be informed, or to inform others, are now legally culpable.

Just look at the ND Quotes. Who is saying this is a medical issue? Who is willing to say this is something so important to do to the child that circumcision is medically justified? Neither federal Medicaid nor the state health insurance (PERS) pays for this elective amputation. Physicians have a higher level of responsibility, not only because they often do the cutting, but because they are supposed to be professionals who practice within the directives of oversight boards who are charged with the responsibility of protecting citizens from physicians who fail their professional duties when they consistently provide inappropriate care, including a pattern of unnecessary surgery (ND Century Code 43-17.1-07, Sec. 4, and 43-17-31, Sec. 6 and 7). Physicians have a moral and legal responsibility not to amputate healthy parts from a child’s genitals even if parents, for whatever reason, provide assent. And contrary to your suggestion, there is little need for additional research. The necessary research has been published, some of it for many years. What is needed is the will to incorporate the findings into a higher and kinder, world-class standard of care. The United States continues to stand alone in their practice of circumcising most baby boys.

Gender Bias:

FGM (female genital mutilation--note that “mutilation” is our term, not that used by those who cut females “for their own good”) is done with the specific intent to make the female cleaner or purer as well as to control her sexuality, all for the well-being of the child and woman she will grow up to be, or so say the cutters and parents who hire them. No harm is intended by the parents or the circumcisers of their daughters.

Your statement that male circumcision “does not make the penis incapable of sexual response;” is usually true (unfortunately, not always), however the identical statement can be made of female forms of genital cutting; but it is also true that one’s sexual response is greatly diminished according to those who have been circumcised as adults and can make a comparison. Even the most extreme forms of FGM do not prevent intercourse, reproduction or even female orgasm. But we must not forget, sexual response is a mind/brain response much more than a genital response of the penis. It is the injury to the mind that has the most lasting damaging effects, as you and your Task Force colleagues are well aware.

Moses Maimonides, an 11th Century Jewish philosopher, specifically says circumcising males makes them less interested in sex so they will be more interested in God. I have recently hear of a circumciser in Bismarck has said this. Ironically, the workshop sponsored in Bismarck by Medcenter One, advertised in your ASAPT March ‘97 newsletter, “System as Perpetrator?” is all too true when it comes to physically and sexually harming males through circumcision.

You say in the opening paragraph of your article, ASAPT Update, 3/97, “Just When You Think You’ve Heard It All,” discussing Alice Walker’s book, Possessing the Secret of Joy, that you “clearly did not find...a respite from thinking about sexual abuse;” and in your concluding paragraph you say again that Walker’s book, did not grant you “the planned-for break from thinking about sexual abuse...,” so you must have thought that FGM was sexual abuse. But according to your present position on male circumcision, FGM could not be sexual abuse. I assume once you have thought through this issue, you will wonder why you asked the readers of the ASAPT newsletter to spend their time on an issue that ASAPT does not address, since there is absolutely no difference of intent between FGM and MGM (see Lightfoot-Klein’s comparisons appended here). In light of your statements dismissing MGM as physical rather than sexual abuse, I must assume ASAPT should not have been and will not be concerned with FGM and its long-term effects either. It seems to me either a statement to this effect is warranted, or allow male circumcision to be an appropriate topic for the ASAPT.

Finally, when you say that the result, even though not intended “may be physical and/or emotional damage,...” let me point out that “may” should read “does.” Circumcision is amputation of healthy tissue; it is mutilation and does cause physical damage. Even the strongest of proponents of circumcision now say it is barbaric if not done with anesthesia, which is the way most were and still are done. But pain is not the issue. One’s right to a whole body (and mind) is the issue.

Missed Point:

But all the above aside, I not only asked the ASAPT Task Force to write a statement acknowledging infant circumcision as abuse, but also to set up an ad hoc group of individuals who are in positions of legal and moral responsibility for this issue so all the state’s implicated bodies can deal with it simultaneously. (Since your Board hasn't met yet, are you, Linda and Gladys speaking for the Task Force when you say infant male circumcision is not sexual, but physical abuse?)

What is most disturbing about your response is your conclusion that since circumcision is not sexual abuse, that you and the members of the Alliance apparently have no responsibility to do anything to stop the physically abusive practice. Professionals are required by state law to report actual or threatened child abuse, sexual or otherwise, are they not? A federal good-Samaritan bill is now pending which would make it a federal crime to refuse to help victims or report such crimes. So now that you seem to have come to the conclusion that this nonconsensual cutting is physical child abuse, who in your opinion has the legal responsibility to address this?

I disagree with Gladys’ view regarding her responsibilities as Director of Child Protection Services. She does not think it is her place to intervene on behalf of a male child when there is threat of physical and emotional harm due to circumcision. But her job is to protect children, not only from the parents, but others who harm or threaten to harm them, both boys as well as girls. Even in her view, the parents are hiring the circumciser and placing their child in his/her hands. It is quite possible the parents will skip the trip to a third-party circumciser and cut their own child. What happens when the parents hold down a 10-12 year old child and cut off his foreskin? This practice, common in Africa and the Middle East, could happen here and likely already has (just as FGM has--see René Bergstrom in the ND Quotes). The male child is helpless. Who has responsibility to address this? The answer, of course, is that we all do. This is why a group must be assembled by the ASAPT Task Force or Child Protection Services to address this issue as we discussed in your office.

Will you tell Rolf Sletten Director of the ND Board of Medical Examiners to ask the Board to take action to stop the cruel and fraudulent practice? Are you going to ask the State Health Officer to make a statement to the press or urge Cathy Rydell, Director of the ND Medical Association, and those teaching at the ND School of Medicine etc., to inform physicians that (as former State Health Officer, Robert Wentz said) the time has come to stop this cutting?

I am angry at this impasse, but more saddened. Cultures have only with difficulty come to see incest and domestic violence as punishable crimes. It wasn’t that long ago when being killed by a drunk driver was considered a terrible “accident;” now it is vehicular homicide. Many forms of domestic violence have been tolerated until recently. Infant circumcision is another common form of domestic violence in this country which is still not being addressed by our state and private agencies.

Just as victims of rape were accused of “asking for it” by what they wore or where they were at night, just as women were beaten because “she provoked me,” just as children were incest victims without there being any community or even family concern (see appended news article), so we too, who have been physically and sexually harmed through the widespread practice of circumcision, deserve to be taken seriously. Boys and girls, men and women in North Dakota can find compassion in your programs and comfort in not being alone if they are incest victims. This level of support and commitment is not available at this time to those harmed like me. We survivors of circumcision’s genital abuse are not seen as adult survivors, so we must find our support outside the systems designed to provide sexual abuse prevention and treatment. What has to happen before our pain, our suffering, our rage is not dismissed? What must happen so that we are no longer revictimized by others apathy or dismissals?

We tire of being told what was done to us was good for us. We are advised to get our heads straightened out, not to straighten out the sickness in our society. If we say those who cut us have harmed us, and want someone to admit that similar actions are harming others, we are dismissed and discounted and even threatened. Survivors survive, when they do, not by undoing what was done to them, but by trying to prevent the same harm being done to others. Have you any idea how frustrating it is to try to prevent this harm year in and year out and be told you are sick for trying?

I don’t need you to commended me for my efforts, but I do need to see you and others who have the moral and legal responsibility to protect children, all children, address this issue through the ASAPT and other organizations. Why must the Bismarck and Fargo call-in talk shows be leading this effort? Please take the high road and convene a meeting of responsible citizens to address this issue. We must all work to protect the more than 3,000 baby boys who are otherwise likely to be harmed by circumcision in North Dakota this year.

Sincerely

Duane Voskuil, PhD
Unrecognized as a sexual abuse survivor
(by ASAPT) as of this year, 1998.

cc. Gladys Cairns and Linda Rice

  _________________________________________

A2 Minot (N.D.) Daily News, Saturday, September 12,1998
Judge
[says]: Fondling Isn't Sexual Abuse

          CHICAGO (AP)   A judge's ruling that a man's fondling of his two children was not sexual abuse because such behavior is culturally acceptable in his native Sicily has angered Italian-American groups.

          Juvenile Court judge Fe Fernandez ruled in February that the father's alleged actions -- tweaking his 10-year-old daughter's breasts and buttocks and his 8-year-old son's genitals -- were clearly inappropriate and, along with reports of physical violence, contributed to an injurious environment.

          She decided, however, that the fondling was not for "physical gratification" and did not rise to the level of sexual abuse because of the father's Sicilian background.

          Fernandez declined to be interviewed, telling the Chicago Tribune In a story today, "I cannot comment on a pending case."

          The judge ordered the children removed from the home but allowed the father unsupervised overnight visits. An appeals court blocked the judge's ruling pending legal arguments. No date has been set.

          In her ruling, the judge said, "This might be something that the father might be brought up thinking that this is cute -- you pat somebody on the butt or you grab them in the breast area."

          No criminal charges were filed.

 
________________________________________

ASAPT's Response to Our 8/23/98 Letter Below

[9/10/98]

Dear Duane,

Thanks for all the information you have sent us. I will keep a file on the subject for anyone who may be interested in learning more.

Gladys and Linda and I have talked at length about the subject. WE are all concerned about the issue, and believe that parents and physicians should receive better information. Given the choice again, I would not readily agree to have my sons circumcised.

However, our major question is: Is circumcision sexual abuse? I have read and re-read the accepted definitions, and it does not meet the criteria. Sexual abuse most often involves the sexual use of a child by an adult or a minor significantly older than the child. This is done for the sexual gratification of the adult at the expense of the child. Neither physicians nor parents derive any pleasure from circumcision, and the  child is certainly not sexually stimulated by the procedure. 

Sexual abuse may also involve power and control linked to sexual gratification. Although circumcision involves physical restraint, the intent is not to control or punish. The intent, though perhaps misguided, is the child's welfare. Because  the result may be physical and/or emotional damage, we join you in your concern. I hope that attempts to research this issue with sound methodology will increase.

If circumcision is to be considered abuse, the appropriate category is physical abuse, not sexual abuse. For this reason, ASAPT will not be acting on the issue, but will stay informed and will keep info available. 

We do commend you on your efforts, and hope that they will effect a greater awareness and increased thoughtfulness regarding this procedure.

Sincerely,

Susan Cordes Green
ASAPT Director

Also posted  in the North Dakota Quotations.

 

___________________________________________________

First Letter to ASAPT,
the Alliance for Sexual Abuse Prevention and Treatment

 

8/23/98

 

Susan Cordes-Green, Director

Alliance for Sexual Abuse Prevention and Treatment

P O Box 9858

Fargo, ND 58106-9859

 

Dear Ms Cordes-Green and Members of the ASAPT:

 

After our all-too short conversation (8/ 21/98), I was pleased to find in you someone informed and sympathetic to the issues surrounding genital mutilation. However, I was left with the impression that one reason you and the Alliance are not even more aggressive in addressing the sexual abuse of non-medically indicated male prepuce amputations on nonconsenting individuals is that no official body has declared it to be sexual child abuse even though you and others feel it probably is (including Gladys Cairns, Director of Child Protective Services and Chair of ASAPT, who said as much to me in 1993). I ask you: Who is it that we expect to make such a declaration?

 

We certainly cannot be waiting for the perpetrators to do so. And the victims are dismissed when they speak out. Ridicule, social and economic ostracization meet them when they finally do become aware of the abuse.

 

We can’t expect the medical profession to make this declaration: They include most of the perpetrators, or harbor the perpetrators; and many physicians correctly see, anyway, that this is cosmetic surgery and not a medical issue.

 

What about the watchdog agencies of the medical community? Specifically the North Dakota Board of Medical Examiners? This Board is charged with controlling medical fraud and unnecessary surgery according to its mandate in the ND Century Code. But here again, the Board is populated mainly by physicians and even when one or two recognize the inappropriateness or the amputation as did former Chair, Rhonda Ketterling, MD, the political pressure within the closed medical community is too much to overcome, so they fail to act. (See my letter, 3/3/95 to the Board to which I’ve never received a response, even after several addition requests, posted at: http://www.datasync.com/SexuallyMutilatedChild/) [I did received a response subsequently, posted here].

 

Then there are the State Health Officers who over the years have said it is a practice that should stop (Wentz); or begged off by saying the office was concerned only with medical issues (an incorrect assessment or the office), so elective prepuce amputation was not a medical issue (Rice); but they have done nothing further towards informing the public or physicians out of fear of inhibiting their career.

 

Since this surgery is a social custom in the United States (at least for the last couple of generations that have been birthed in hospitals), and a surgery better described as “moral surgery” (e.g., to stop masturbation) than as a medical procedure, and since it is an irreversible body modification having to do with social customs and religio-philosophical principles, perhaps we should be listening to what those say whose job it is to fret out the historical reasons for the operation and the ethical principles it follows or violates. One such, Margaret Somerville, medical ethicist at McGill University, after many years of struggling with this issue, has concluded it is “criminal assault” similar to female genital mutilation, since the Canadian Pediatrics Society among others has declared it a procedure with no medical benefit. I would put whatever prestige my doctorate in philosophy and a lifetime of research and teaching has, towards agreeing with this assessment.

 

Then there are the world’s medical societies. They may not come right out and declare it to be sexual child abuse, but again they are not the moral or legal guardians of society. However, no medical association in the world considers amputation of healthy genital tissue to be a procedure done for medical reasons.

 

So while we wait for someone else to declare forced amputation of healthy genital tissue to be sexual child abuse, the abuse continues because of ignorance, malice, greed or fear. We are informed; we are those to whom historical circumstances has cast this lot, like it or not; We must declare to our corner of the world (that is so out of sync on this issue with most of the rest of the world), that this amputation, for whatever reasons it started and still continues, is no longer acceptable; It is morally reprehensible and illegal even though enforcement agencies so far have refused to prosecute, just as they refused to prosecute race discrimination and other such civil rights issues for many decades.

Permanently altering someone’s body in such a significant way cannot be dismissed (as Dr. Somerville says) as de minimis (legally insignificant). It removes a valuable organ, that provides protection and stimulation. It violates one’s basic human and civil rights to decide for himself whether he wants to live with a whole, intact body. Not only does it violate the laws already on the books to protect those too helpless to protect themselves, it also violates one’s right to equal protection under the 14th Amendment of the US Constitution since the passage of the ND and federal FGM laws. It simply is a very unkind thing to do to another person; or as a Swedish nurse exclaimed when she surprisingly learned what we do this to our sons: “It’s barbaric!” I got the same response when I was in China.

 

So what better organization can there be to declare this act inappropriate and abusive than the Alliance for Sexual Abuse PREVENTION and Treatment? The members of ASAPT are people in many walks of life who know about abuse and are charged with protecting the helpless. The time has come to stop waiting for someone else to step forward. Time has come to take a stand and tell parents that new information on the function of the foreskin and insights into the rights of all individuals, even babies, requires us now to see that the surgical amputation of this healthy genital tissue is sexual child abuse. Further, those physicians who claim to be absolved from complicity in the negative effects of this inappropriate surgery because they claim the “patient” requested it, must be educated and/or legally restrained from performing this amputation, first, because the parent is not the patient, and second, because removal of healthy flesh without a compelling medical reason violates the physician’s own oath to First Do No Harm.

 

I would hope that the Alliance would (1) see to it that the medical community is appraised of the inappropriateness of the operation by helping educate physicians on the important functions of the prepuce and its anatomical development; * (2) get behind legislation to make third party payments for these contraindicated amputations illegal, and (3) support legislation to remove the sexism from the present law that only protects female minors; (4) encourage the appropriate government and professional agencies to disseminate information about the inappropriateness of continuing to perform medically unnecessary penile reduction surgery; (5) encourage educational institutions to talk about the issue in classes on ethics, sociology, health, psychology, etc., and especially in the appropriate classes in the University of North Dakota’s School of Medicine’s departments of pediatrics, obstetrics, gynecology and urology; and finally, (6) put together a taskforce of individuals responsible for recommending the simultaneous end of the abuse statewide so no one agency or individual has to go it alone thereby  minimizing personal and economic hardships and the need for litigation.

 

Unless these measures are taken soon, the issue will become more and more the province of litigation wherein the only winners will be lawyers. Sooner or later the courts will have to see, as they finally did with other civil rights issues, that however sanctioned and comfortable people are with treating children like property, like a dog whose tail can be cropped at will, that our society, which claims to be based on maximum individual freedom, cannot allow someone the freedom to take away another’s freedom to decide for himself whether he wants his penis docked. This amputation violates a person’s freedom to have full sexual function and his freedom to chose which religion he wants to identify with, since some religions do not allow their adherents to worship with a mutilated body.

 

I have spoken before, in 1993, to the Alliance on this issue, and would be glad to do so again. I was excited to find the Alliance open to becoming informed then, and encouraged now to find how much more informed you are than people were five years ago. For those with internet access may I suggest that many excellent sites exist such as <http://www.cirp.org/CIRP>. You might want to read my research on the possible ancient origin of male circumcision in the journal Circumcision a Virtual Journal at: >From Genetic Cosmology to Genital Cosmetics: Origin Theories of the Righting Rites of Male Circumcision or Ancient History

 

Here’s hoping we can stop this way of introducing our trusting babies into the world--

 

Sincerely yours,

 

Duane Voskuil, Ph.D.

Philosopher, Educator and now Violin Maker

 

*Even the forced retraction of immature foreskins is abusive; the American Academy of Pediatrics’ pamphlet on the care of the intact male infant says: “Foreskin retraction should never be forced. While the foreskin is still attached to the glans of the penis, do not try to pull it back, especially in an infant. Forcing the foreskin to retract before it is ready may harm the penis and cause pain, bleeding, and tears in the skin.”


 

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