The Case Against Male Genital Mutilation, with Dr. Jared Ross

0:00I'm Leslie Elliott Boyce and this is the Radical Center, a recording project I began in 2022 as a way to describe and discuss the social and ideological currents that are rapidly altering our culture. In a time when political polarization seems to be the norm, I'm seeking to understand rather than react. I'm grateful to all the thoughtful men and women who share their stories and insights with me in this conversation series. If you would like to contribute to this project financially, there are links in the description. Thank you and thank you all for listening and being part of this exploration. Today I'm speaking with Dr. Jared Ross and we've spoken once before on this channel. I will link to that previous conversation in the video description if anybody wants to check that out because it gives more of your backstory and more context and I think

1:01that that would be a great watch for anybody who wants to follow up on this video. But I'll start with just reading a brief bio so that people will know who you are, Jared. So Dr. Jared El Ross is a board certified physician with over 25 years of experience as a paramedic firefighter and educator. Jared is clinically active in emergency medicine, EMS, addiction medicine and alternative psychiatry. Jared has presented at over 100 national and international conferences and is frequently interviewed for media commentary. Dr. Ross is the founder and president of EMS ECE LLC which provides medical education and consulting services. Jared advocates for individual rights, bodily autonomy and ending anti-semitism and racism inside and outside of medicine. And Jared, we spoke some time ago about your interest in infant circumcision and concerns around circumcision and I'm really fascinated by this topic.

2:04I have sons. This is a topic that I've grappled with in my own parenting but not really. I haven't really seen the broader medical perspective on this that you can share and also the religious perspective. So I think that this is a really big topic that I think because the decision is isolated to just this one moment in a person's life doesn't get talked about as much as it could. I mean, for me, I've got sons that are 12 and 14 so I thought about this at that point and then it would be easy for me to go the rest of my life not really thinking about this but it actually is a really important subject. And so thank you for bringing this here and being willing to have a conversation about it. Thanks so much for having me on. It's a pleasure to be back on your show. It's been what a couple of years and really awesome to be back on. And I think you're right. This is a topic that just doesn't get talked about.

3:06It's something that people are uncomfortable talking about. It's talking about human genitalia which we tend to self-sensor about a little bit. So I know your audience is all very mature and adult but we're going to get into some of the nitty gritty and I think some of this may be uncomfortable for people to hear. It's certainly not easy to talk about even as a trained physician but I think it's really important that we discuss this. The other side of this is the terminology and I think it's really important that we avoid the terminology circumcision. I'll say it once now. But I think what that does is it normalizes the practice. It gives it a name that is acceptable, societally acceptable. So I think we need to be more accurate and more descriptive in what this is.

4:10We talk about female genital mutilation. This is male genital mutilation. This really is mutilation and that can be a very evocative term for people. Happy to use the term cutting or genital cutting as well which is maybe a little bit more neutral but I'll try to stick to those terms as we chat because I think it's important that we don't intentionally or unintentionally try to normalize this practice. Yeah, I think that's a great point and I think another phrase that comes to mind for me is cosmetic surgery. This really is cosmetic and that was one of the things I wanted to talk about and I'm happy to jump to that. This is altering form purely for cosmetic reasons. At the same time, destroying function and so when I talk about this, one of the arguments

5:14that I'll be back is, well, parents shouldn't be allowed to consent to any surgeries for their child. As people don't know, there's clearly surgeries that are necessary for life or for limb or for well-being and what if your kid has an appendicitis. Okay, well, well, then you shouldn't be able to consent to any elective surgery, any plastic surgery for your child. I think where you get into an issue there is that the plastic surgery is there to restore form and or function, like such as repairing a cleft lip or a cleft palate. You know, an ear pinning is one that commonly comes up because that's controversial, that's not functional, but it's form that you're restoring form to a normative form.

6:17I think that's into an ethical gray area. I mean, I think even to think about leaving a child, I mean, we have teams of doctors that go volunteer overseas in developing nations to fix cleft lip and palate because we have such good treatments for these and these kids do so much better, I mean, not just nutritionally, but their ability to speak and just integrate into society is so much improved. It really has a major impact in their quality of life. So this is really cosmetic surgery and it's not just cosmetic surgery that's, it's not restoring form, it's, it's actually altering form and it's doing so at the cost of function and I think that's what's not talked about a lot is the very important function of the

7:18foreskin, but before we get into any of those arguments, you know, before we get into the sexual harms, before we get into the pain that this causes little boys, before we get into the financial conflicts of interest, I think the really big issue here is that this is a crystal clear ethical, ethical violation. It's, as we said, it's cosmetic surgery without consent and we allow parents to consent for their children when they're functioning in their children's best interests under the assumption that they're, they're acting in their children's best interest, but there's clearly no benefits to this, there's clearly harms to this, this is purely cosmetic. And so the fact that that we're doing this is a clear violation of, of autonomy, bodily

8:24autonomy, which is one of the four pillars of medical ethics. And the fact that physicians are participating in this is, is, is very concerning as well and is a clear violation of their ethical duties as well. Well, how do, how do physicians make sense of, of that question of ethics? I mean, is it, I've heard arguments for hygiene and I know that there are lots of different arguments, but setting aside all of the cultural or religious arguments for just a moment, when you're talking about function and health, there are arguments that it is healthier. And I'm, I'm not saying that I agree with them. I'm just putting that out there because I imagine that must be something that a medical professional is considering when they're offering this service or offering this surgery to a family. Yeah, I think unfortunately doctors are, are very, poorly educated on, on this issue, poorly

9:29educated on the, the function of the foreskin. And this has become so deeply ingrained in our US medical system that it is, it's just normative behavior. No one even thinks, thinks twice about it. You know, there are numerous numerous, I mean, I was, I was just looking this up yesterday. There's numerous lawsuits of boys that have been cut by doctors in the hospital against their mother's wishes. Their mother's clearly said, I don't want, I don't want this to happen and, and they just go ahead and do it anyways. It's like an, an assembly line process and you know, there's, there's stories out there from mothers who have chosen to, to keep their sons intact, who have faced pressure from their pediatricians, from their OBGYN doctors.

10:31And I think even more harmful than that is the labor and delivery nurses. So a lot of the nurses come in and repeatedly push for this. And so there's a lot of, of really, I guess, heartwarming stories of mothers pushing back. You know, that's, I can't imagine, and I know you have, you said you have two boys. I can't imagine what it's like to be in the hospital after giving labor, you know, after, after being in labor and giving birth and, I mean, all the surge of adrenaline and hormones and sleep deprivation and epidural and maybe medications and the rush of emotions, but, you're in such a, a discombobulated state to, to have someone who's an authority figure coming to you multiple times, trying to get you to, to sign this, sign this paper to, to

11:36consent to this procedure, it's just completely medically unnecessary, right? And, and can be done at any time, right? Any, any man, boy or man can, can choose to go have his or skin removed at any time in his life. And there's, you know, the argument against this is, oh, it's, it's more painful, it's more complicated. It's like, you know what, I mean, the issue is that we don't acknowledge the pain of, these infants, infants cry, right? Infants don't have the ability to communicate verbally. And so we neglect that pain and there's a lot of research and I'm, I'm not very well versed on it. There's a lot of research looking at, at the pain that, that boys suffer through these procedures. You'll, one of the things that's important to keep in mind is that until puberty really, the foreskin is attached to the glands penis.

12:42So the foreskin will not retract until puberty. And so what you have to do to, to perform, to remove the foreskin is to first lice those adhesions. So you have to go in there and cut between the foreskin and the glands penis to allow the foreskin to retract. And then you put this, you know, barbaric clamp. There's a few different methods for this and there's, you know, these, these babies are being strapped down into, into these, these trays. Their arms are tied down, their legs are tied down, spread, you go on to these trays. And, and this, you know, so you lice these adhesions, you put this clamp on and then you, you cut the foreskin off. And so it's just an awful and barbaric procedure that's just completely medically unnecessary.

13:43But it's so, you know, as you talked about, how do doctors wrap their head around this? And I think the issue is that doctors don't, they're, this is just so ingrained and, and just such a normalized practice, really in the US. I mean, you don't see, um, see rates, um, of this practice in, in Western Europe. At all, Canada has got lower rates than we do here in the US. Um, and, and so why is that? I mean, there's clearly financial conflicts of interest. And I think that's something that often gets neglected. You know, our OB-GYNs and our pediatricians especially, pediatricians are one of the lowest paid medical specialties. And, um, you know, and that's unfortunate, our primary care specialties are critical to preventive care and to health maintenance.

14:43And they do a lot of work for our community. They're not generally proceduralists. They're having long, difficult conversations with patients. They're following up on things, they're making sure that things happen. They're encouraging safe practices at home, they're modifying risk. But, you know, our medical system, our medical billing is based on procedural billing. And so they're not proceduralists and they're, they're not, uh, fairly compensated for their time. And this is a procedure that is, it is very well compensated. And what's, what's fascinating is that most, at least at last I checked, most state Medicaid, that's your health insurance for ancient patients, for poor patients, will cover 100% of your,

15:45of your pregnancy, of your labor and delivery costs. From your prenatal care, your prenatal vitamins, your prenatal visits, all your ultrasounds, admission to the hospital, delivery, newborn nursery, every, and then all the, all the visits there, you know, the one day visit and the three day visit, all of that. But they will not cover male general cutting because they believe that that is, is cosmetic. And unfortunately, we've seen a shift, um, we're started covering, covering this, and it's very unfortunate. But what shocks me is having worked at a lot of inner city hospitals with, with very impoverished patients, um, who don't have money, who haven't, uh, haven't spent a penny. I mean, we're not talking co-pays that, that you and I might see on our private insurance. We're talking, you know, 100% coverage with no co-insurance, no co-pay, who haven't

16:48spent a penny on, on this, this child, on this pregnancy, are happy to shell out hundreds, if not thousands of dollars to, to have this done. And, and so it's, it's profitable and again, I don't, I don't think that physicians are, are in there thinking, oh, a lot, you know, let me, let me do these in today to, but it just becomes ingrained. It becomes part of this process and it is, it's roots are religious, right? As, as a judge who I can speak to the, the, the Jewish roots of it, it's, it's the covenant. It's the sign of a covenant. And nothing is more, you know, can you imagine the, you know, going back to ancient days, right? How am I going to show my allegiance, how am I going to, as, as the, the, the, the head

17:51of the household is as the man or even as, as the mother, how do I, I show my complete and total allegiance to, to my face, to my tribe? You know, my family lineage is, is dependent, you know, even though Judaism is, is matrilineal right, they're, they're still still a huge importance on, on lineage pass through the, through the sons, through the fathers. Um, so I'm going to let the boy who was a rabbi or is, is a rabbi who's, who's training in this procedure, usually not a doctor, take my eight day old boy and cut off part of his penis. I mean, that's, and we're talking, uh, penis that's, that's this big, right? And, and that, that one wrong move and my, my lineage, my family's continuation is, is

18:52at risk. So it was a huge sign of, of trust and, and I, I think there's a lot of Jews that, that see this as an important covenant, a covenant with God, a covenant with Abraham. Um, but there, there's a lot of things that, that we've changed as, as we've enlightened as humans and realize that this is, is not appropriate. And again, if you, as, as an adult male or, or, or a teenage male of, of competent age decide that this is, is what you want to do, uh, far be it from me to, to stop you from that. I think there's some serious questionable ethical issues, um, if a physician's doing that, um, because, you know, as a physician, we, you know, we have the Hippocratic oath. We are obliged to, to do no harm and, um, this, this is cosmetic body modification, um,

20:00you know, I mean, I guess you could make the same argument about elective breast augmentations for women, right, is that, um, you know, I guess the plastic surgeons will say, oh, it's helping their, uh, the steam or, and, and we can sit here all day and, and argue that. But at the end of the day, I don't, I don't think that's, that's the real issue. I think the real issue is, you know, why are we doing this on, on, on in fit boys? And so, you know, I explain why they started in Judaism, um, um, it started in, in the Muslim faith as well. And I, I'm not an expert on that, um, but this has become ingrained in the American medical system as the, the American, um, ideal of what a, of what a penis should look like. Um, and if you look back on the history of the medicalization of this procedure, taking it out of the religious realm, where it was not done by doctor, it was done by, by a rabbi

21:04or, uh, or another specially trained layperson, um, and you look at the medicalization, what this really comes down to you was the, was the Puritans was this was a puritanical practice. And the idea behind it was to, to decrease masturbation of by boys. And there's no evidence whatsoever that it does that, um, and children of both sexes masturbate and that's a normal part of development and a normal part of human exploration. And I think it's important for parents to, you know, make sure that that's done in a healthy and private setting and not, not in a, in a, uh, grotesque or public way. But, but there's no, there's no evidence whatsoever that this in any way, um, alters masturbation

22:05of behaviors. And then I think most concerning is not so much the physicians, but the financial incentives on the secondary market, right, that, that for skin tissue is incredibly valuable and is, is almost always sold. Wow. So it is a commodity and just like the scandal that Planned Parenthood had with fetal tissue being sold, this is, is tissue that is rich in pluripotent stem cells in cells that have, um, a potential to develop many different ways has very long telemiers and the ability to divide and, and increase in size, right, this is in, in fetishio.

23:07So this is human infant tissue. And, um, so this tissue is very valuable and there's a large, um, industry that buys up and processes for skins and, and those are used for some, some very noble purposes. I mean, they're used as skin grafts for, uh, patients who have suffered, um, burns or, or severe infectious processes that need, um, that need skin coverage. Um, but the, the profit motives behind those companies is the, the markups that they make, um, taking these harvesting these four skins, I'll say harvesting because that's really what it is, harvesting these four skins off of boys and processing them and selling them back to the medical system, um, is, is really scandalous. And I think needs to be, needs to be discussed further. Yeah, you've brought up so many important points and, and I think I could, I would love

24:11to have, if you, maybe someday want to do it, a whole conversation about medical ethics and the way that parents feel pressured to intervene with their kids. But this one just staying on topic and not getting too, too far field, um, I was not that long ago with a young mother, I accompanied a young mother to her, to a specialist visit because she was, she had kept her son intact and she was worried that, um, this is somebody very close to me. So it was, I, I was the person she reached out to, but she, her son was having a problem a little bit of fimosis. So there was a swelling and difficulty with urination, ballooning, I, if, if these things need to be explained, I'm sure you can be the one to do it. But, um, most people will probably be familiar with some of that. So it was just a problem that an infant was having with his urinary tract and his penis. So she was taking him to a specialist and she was really worried that she would be pushed

25:11into an intervention that she didn't want to do. She wanted to make sure that surgery was a really last resort. And so that pressure was really real and, and she felt it and it was one of the first things that was suggested and I think it was helpful just having an older mother present who had, you know, was this wasn't my first time interfacing with doctors and also used to work in the medical field. So I, I just, I think it was helpful having somebody there to help her advocate because she was feeling pushed to do a more dramatic intervention and I just wanted to share that in light of what you were saying about parents feeling pressured. And, um, but you've brought up so many interesting points. I think of the Sandra Bullock clip about her skin. This is a really famous one. Probably a lot of people have seen this. I don't know if she was talking with Oprah or somebody like that. And she's saying how beautiful her skin is and, and Sandra Bullocks as well, it's four skins. It's, it's a cream that's made from infant four skins.

26:11She makes a joke about, you know, it's just baby penises and, and it's, it's funny and people laugh, but there's something really macabre underneath of that. There's something, and, and as you're describing the financial part of this, which is something that I had, had not really ever thought about in this particular context, there, this is a procedure that's being, and that's incentivized due to the, the big billing that the big procedure billing that the providers can do in order to get compensation for this little quick procedure and they can get quite a hefty payday from it. And then there, the hospital or somebody is turning around and also making bank on the product of that procedure, which is the, the skin that's been removed. And that seems, it just seems incredibly shady, like you're, you're, you're basically making me pay you to give you part of myself that you're then going to sell anyway and make a lot

27:18of money on that whole thing. It just feels like from a bioethics perspective, it's really concerning. Very concerning. And I haven't let any of these consent forms recently. I'm sure it's buried in the consent form, but, you know, I don't think any mother actually realizes that I don't think it's verbalized, I don't think it's talked about. And again, you're signing this consent form in, in a, really in a state of, of clouded judgment. I don't know that, I don't know that the mother has the capacity to, to sign the consent form at, you know, in a lot of these situations, right? You're very sleep deprived. You've just gone through huge, formal changes, huge emotional changes. And the fact that it is, is this isn't, there's no urgency here. There's absolutely no urgency. You know, if your, if your child came out and has, you know, a condition called bladder

28:21extra fee where their bladder is on the outside of their abdomen or, or has a severe congenital heart defect that, you know, both of these were, you know, excellent at, in detecting impregnated ultrasound. But, you know, for some reason, you, you know, God forbid, have a child that has a, a, you know, medical emergency that's detected at birth. And you have to say, hey, you know, we got to get a consent for this and, and go address this now. I mean, that's, that's one thing. There's, there's an urgency there. There's a threat to life or a threat to, to function. But this is absolutely just, I mean, it doesn't need to be done period. And, and so to, to imply that somehow it needs to be done urgently or this decision needs to be made, it, it really is, is the boy's decision. And, and, and so I, I thank you for, for being there for her. I mean, that's, I don't know that we'll have time to get into it today.

29:26But there's a whole mother side of this of, of mothers taking their intact sons in for medical care, not, not just as infants, but as, as they go through childhood. And this, you know, the, the negative reaction from doctors of why didn't you, you know, cut your, your boys or whether or not they're having complications. There's groups out there that really try to educate doctors on the force of low retraction of the foreskin. As I mentioned, the foreskin is adhered to the glam's penis until puberty. And so it should never be forcibly retracted, you know, when it, the, and then the boy will never do that to, because it's too painful. Retracted is necessary. You know, fun most of this is, is rare and there's plenty of ways to, to treat it. It's not an emergency. And, and humans have been, have been managing with us for, you know, I mean,

30:26if you include homorectus six to seven million years, not a, not an issue here. So we've, you know, really stigmatized, preserving form and function in any issue that we have, then becomes that the mother, often or the father, or even the child I've heard, becomes blamed for, for being this outlier when in fact our medical system has just, and our society as a whole, you know, I'm, I'm sure we can talk about, you know, the, the normalization of the cut male penis through pornography. And you've talked a lot about pornography on your channel and, and how that impacts us. And I don't think, you know, normalizing a certain, I mean, I mean, it's, it's harmful to women as well, right? We see women who choose to undergo cosmetic surgery on their genitals because of, of what they see in pornography and because of what becomes normalized, you know,

31:30the range of normal female genitalia, external female genitalia is, is incredibly broad, incredibly, incredibly broad. But what we've done with this is normalized a certain body modification of, of the male genitals. And, you know, I think we can look at, you know, the African tribes that put the necklaces on the, the women, I don't know if they do for the men and, you know, stretch their neck out or what are they called? The big barbed piercings that people use to stretch their earlobes outhand. You know, this is extreme body modification. And again, if you as an adult want to pursue that, just like getting your arm tattooed, I mean, have at it. That's your, your bodily autonomy. But we really need to see this, this stop with, with children. That's really where I'm concerned. Yeah, again, I think you're just bringing up so many good points.

32:32And I think about it's relevant to sort of go back to my own thought process about this when I was younger. I mean, the first time that I was introduced to the idea of, of circumcision or, or male genital cosmetic modification was when I was really young. My, my brothers came home from the hospital. And I remember my, my mom changing the baby's diaper. And there was a little ring around, you know, just to speak really plainly here, because we're talking about a medical procedure, a ring around. Yeah, yeah. No, I think it's really important. Yeah, under, under the glands, I guess. And I was, I would have been like little like six. And I remember asking, what is that? And it was a, a protection because he had an alley or something. And that was kind of what my mom said. But it, it just looked kind of shockingly painful

33:33to me like this bright red, like it shouldn't look like that. I didn't know what I was even supposed to be expecting things to look like, but it didn't look good. And I, I remember thinking that his, his little penis is going to be in a diaper with urine. And he's going to be, the, the moisture and just the, the chafing, it just seemed like from my very first experience with this, I thought that poor kid, like the poor baby. And that was kind of as far as I got with that then. And then it was much later, I, I had my first daughter, you really young, I was 19. And she was a girl. So this was a, a topic that got raised and dismissed when I was speaking with her, her father. And we were talking about what, you know, all the things parents talk about when they're about to have a baby. And circumcision came up. And, and I've heard this from other women too, because I later worked in a medical clinic that saw a lot of pediatrics and did maternity care as well. So this issue was

34:38when that came up a lot. And I'd hear how people, how people sort of processed the dilemma over this, this cultural issue, this physical thing that's going to happen or not happen. And I remember kind of this deference to the, the father in myself. And I've seen it over and over in women too. Like, well, you know, this isn't my domain as a woman. I don't, I don't have one of these. And, you know, it's, you know, you're the man, you're the dad. Why don't you make the choice. And there's a often a sort of, there's an amnesia, of course, this happened to him before he could remember. And so it's like a, oh, it was no big deal. And I want my son to look like me kind of decision that's often made. Or if the mother gets involved in it, it's sort of, I don't want him to be made fun of. I don't want him to look different than the other boys when he's older. So maybe we should just do this because it's a cultural norm. But those are some of the ways that I've heard people come across that issue. When I had later on, I had my, my sons when I knew I was pregnant with a boy

35:46had a similar discussion with his dad. And as we got into the, the subject, we went from kind of neutral on it. Like, I don't know. What do you, what do you think is this, this seems kind of painful? And I'm not sure it's necessary. But is it, are there good reasons for it? As we discussed it more, I, we both kind of shifted to a more, a more decisive standpoint of absolutely not me because I didn't want my, my son to be hurt. And I felt like this was going to risk attachment with, with us, just bringing such a sharp and severe pain into his first moments in the world. But I was really kind of focused on that immediate issue of the surgery and what that would be like for him. And then his dad was, the more he thought about it and read about it,

36:47he actually became really upset that this had been done to him. I mean, there was a, there was like a reckoning with this was done to me. And what did this take from me? And how did this change me? And, and I think that it's easy to sort of dismiss that because there are so many men in this, you know, what is it right now? Probably the majority of American men. I think have been circumcised. I know the trend is going the other way in the, in the younger generation. But for adult men right now, probably the majority have had a circumcision. And I think it's easy to sort of just dismiss it because you're walking around and you're doing just fine. You're, you're married, you're functioning of children, whatever it is. But it is profoundly changing to the body. And I wonder if you'd be able to speak to some of the ways that it actually changes in the long term. The man's, the boy's experience of his body, the man's experience of his body. Yeah, I think that, you know, I thank you for bringing those up. I think the, the lack of,

37:55of reluctance to think about this, that it is really this generational thing about what was done to me, I should do it to my sons. And, you know, it does often get left to the father right. I mean, that's, that's really generational harm. I mean, we look at that, we should really look at that the same way as we look at, you know, domestic violence of, you know, I was, I was beaten as a child, so I should beat my children. I mean, that, that's not acceptable. That doesn't, doesn't pass a sniff test. But in fact, that is a very common reason that's given is that, that men don't really think twice about this. And then I think it's, you know, fascinating that, that your partner, you know, went through this and said, whoa, what was done to me? Like, what did I, what did I lose is, is there's something that, you know, that, that I need to critically examine here. And, and I think that's where this, you know, where this really needs to be talked about.

38:58And, and as you mentioned, seeing the blood on, on your, on your brother, I mean, this is really a barbaric practice. This does not look anything like what modern day medical procedures or surgeries look like. And I really implore your viewers to, to, you know, go on YouTube and go Google, there's plenty of videos out there. I mean, this looks really awful. You don't have to be a doctor or have any medical experience to look at this and be like, this, this just doesn't, doesn't feel right. And, and so, so talking about feelings, I guess, a good segue going from, from emotional feeling to, to physical feeling, is that they're clearly, clearly physical and, and sexual harms from removing the foreskin. The foreskin is, is not just an, you know, extra piece of tissue. It has a critical function. And so, one of them is, is preventing the characterization or the,

40:09the outer epithelialization of the glands penis. Just like the skin on the outside of my cheek is very different from the buckle mucosa on the inside of my cheek. Part of the, the, the glands penis is, is very much like the inside of my cheek like the buckle mucosa. And in order for it to stay moist and to stay protected. And, and we talked about, you know, chafing before with, with your brother, but in order to prevent chafing, you know, not just as an infant, but throughout life. The foreskin serves an important purpose to protect the most sensitive part of the male anatomy. Right? And I, I love talking about the analogies, the embryology comparing male genital mutilation to female genital mutilation. Because, you know, everyone, you, you talk about female genital mutilation, everyone is equally agrees that this is, you know, a crime against humanity,

41:15that this is a clear ethical violation is, is completely, completely wrong. But no one goes to a level and says, well, what's the, what's the embryological comparison? What's the, you know, you know, the, the, the glands penis is, is the same as the clitoris embryologically. And the foreskin is the same as the, as the hood of the clitoris. And so, yes, there are adult women who choose to have part of all of their literal hood removed for various sexual purposes or cosmetic purposes. But again, those are adult women who have the right to, to do what they want with their body. But, and the WHO actually has classifications for female genital mutilation. And WHO classification, one A is a complete or partial removal of the clitoral hood. That's the same thing that,

42:19that is being done tens of thousands of times in hospitals across our nation on boys every single day without a second thought given to it. In fact, it's very profitable for, for both the doctors and for the hospitals. If you do this same embryological, if you remove the same embryological tissue from a female in this country, that's a felony. That's a minimum of 10 years in prison. And, and so the disconnect here is just, you know, and people will say, oh, you know, most types of female general mutilation are worse or start removing the clitoris, removing the labia or doing something called the infant mutilation, sewing together the vaginal tissue. And I said, agree, those are all terrible. But, but, but it's all terrible. It all needs to, it all needs to stop. And so, just like the clitoral hood provides protection, retain sensitivity,

43:28um, keeps moisture present and, um, and prevents the characterization, prevents the development of an epithelial layer of a skin layer, um, on the, on the glands, the first skin does the same thing. So it has a very important protective function. It has a very important sexual function, which I think we, you know, again, we self-sensor and we don't want to talk about. But the, the foreskin glides over the glands penis. And so during sexual intercourse, that's an important part of the biomechanics of sexual intercourse is that there's, there, there's a gliding action, um, to, to reduce friction. Um, if you remove that tissue, you are, you know, solely dependent on, on lubrication from the female or from, you know, external lubricants, um, for sexual intercourse. This

44:34is, this is how humans evolve. It's not just how humans evolve. I mean, this is how mammals evolve. I mean, your, your dog has a foreskin. Your horse has a foreskin. And no one, no one removes these, right? We, you know, we regularly castrate dogs and cats in this country. And, and I think, you know, humans are animals are not humans. And there's different ethical standards that apply. And, you know, we can talk about this all day. But no one says, you know, while we're removing your dog's testicles, maybe we should, you know, cut the foreskin off as well. It's just, um, it's just mind-boggling. And, and to think, you know, I mean, humans hopefully aren't rolling around in the mud. But you look at, that dogs and other mammals that that are rolling around. This has a really important, um, you know, protective. It has an important sexual function, you know,

45:38preventing chafing and, and this gliding action of sexual intercourse. And then I think what gets severely, severely neglected is, is the nerve endings is that the, the foreskin has a lot of sensitivity. And it has a lot of a specific type of nerve ending called the C delta fiber. So if you run your hand against the, the palm of your other hand versus run it against the back of your hand on the other hand, when you ride against the back of your hand, you kind of have this sensation that kind of makes the hair on your, on the back of your neck stand. And what that is is that's the C delta fibers. And those C delta fibers are, are only present in certain parts of our body. And they're, they're pressure, pressure sensitive nerve fibers. Um, and nerve fibers don't regenerate. So once you cut off those 15,000 nerve endings, those are gone. Um, and so,

46:43so when we talk about the sexual harms, we talk about the protective aspect, we talk about the functional aspect with sexual intercourse. And then we talk about the sensation and sensory aspect. And again, you know, we don't even have to get into the weeds of the sexual issues of the comparison to female general mutilation, the pain, the financial conflicts of interest to, you know, I try not to get into that with people. What I try to say to people is this is just such a crystal clear ethical violation to, to perform purely cosmetic surgery on an infant because he's a man and, and to, and to send people to prison who do the exact same thing to a female. Um, it is just a huge contradiction. And again, when you're an adult, you know, far be it for me to argue with you, you know, I think tattoos are, are very tasteless. Um, but, you know, that doesn't

47:47stop anyone from, from going out there and, and, and getting tattoos. Mm-hmm. Well, I think, you know, you've, you've shared a lot about the form and the physical experience. And I think something I wonder about is the psychological impact of this. Like, you take a, a human being who's just been born and everything that they need is safety, security, comfort, nourishment. And you pin them down and subject them to an incredibly shockingly painful surgery. And I, I don't know how much they use, um, pain killers at this point. I, I know that that's a, that's a question. Sometimes it's been not used. I, I know that there's an issue around chemical introduction to the baby's body. What is better to let him go through this, this pain that he's not ever going to remember, you know, uh, or to give him a dose of chemicals.

48:53Either way, you've done something that is going to alter his body and his experience of, of bonding and attachment in his first moments. But then not only did he go through a physical, a surgery that was, that was immediately painful, but he's also recovering from a surgery in his first days. He's, his young body is experiencing an ongoing pain that he has to recover from. And I wonder how that impacts the attachment between a little boy and his family and how that might impact his, his ongoing ability to trust and attach. I, I, I can imagine that that's not negligible, that there's something in that. But then also when you talk about sexual functioning later in life, once a person is sexually mature, if your body doesn't work the way it's supposed to, and you have this characterizing of, of really sensitive tissue that was meant to feel a certain way and now it feels another way. And this impacts the experience that you have of physical bonding

49:56with your mate, the most important and most intimate act that, that you share in this particular relationship. How does the, the changed form and changed function of your body impact your ability to, to properly bond with your mate through that, through that most intimate act? And I, I don't know if you have studies or answers to these things. If there's been work done on, but I can only imagine that it's not an insignificant thing. Well, I mean, Leslie, you've got so many, so many great points here. I think the, you know, something I didn't even think about as you are, you're, you're taking a baby boy and he's spending his first, his first formative days on this earth recovering from, from a procedure. And you know, yeah, if he had, was born with a congenital heart defect and this was necessary for his, his survival, I still think that would be traumatic, but we would, we would agree that, that, that the alternative was his, his demise. That's just not the

51:02situation here. And to, to, to take your new baby home and for them to be recovering from this unnecessary surgery is, I think is, is really catastrophic. And I mean, I know your, your expertise is in the mental health side. You know, I certainly get into some of those issues, but I think there's a great deal of emotional trauma and a great deal of grieving and loss that, that men and boys who, you know, who come to terms with this, who realize, you know, what did I, who question this, right? Because I think it's not just the medical system, but it's society as a whole has, has kind of agreed that we take this for granted that we don't question it, you know, don't question the dominant mantra. And so, so maybe that is somewhat of a defense mechanism that if we don't get into this, if we don't think about our loss, if we don't acknowledge our, our loss, we can't, we can't

52:07grieve something that we haven't acknowledged. And, and so it's, you know, it's like the first step of 12 step, you've got to, you've got to acknowledge that there's a problem before you can address it. If you don't acknowledge there's a problem, you don't, you don't have to, to address it. I will talk about the anesthesia side. You mentioned that, by and large, this is done with, with two types of anesthesia, usually a topical numbing cream is, is applied to the boys penis, which is, you know, completely and, and, and utterly insufficient. And that's not what's done when adults are, or adolescent boys choose to undergo this procedure. And, and even with these, with some of these creams, they work very, they can work very well for, for certain procedures. We use similar things in the emergency department to, for instance,

53:07sew up head lacerations of a kid cuts their head. We can put this on instead of getting in there with a needle and traumatizing a kid injecting medication that might burn as well. We can put this cream on, and it's open skin as well, so it kind of soaks in better. But you've got to wait a good 30 minutes for that to, to soak in. Again, these are churned out so quickly that even if this, even if these creams were to be effective, or were to be, you know, they need to be on the, on the penis for, for some significant time. And I just don't think that's being done. The other thing is sucrose, sugar water is, is given, they give the, the baby some drops of sugar water to, like, you know, what is this, like a popsicle with the, if the denser distraction? It's just, it's, it is. It really, it's really just, just absolutely inexcusable. And that's, and that's why it's not, you know, when this is done on, on adult males and adolescents,

54:09it's, it's not done like this. And, and, and then the, the proponents will say, well, yeah, it becomes a big deal to have to have, he has to have anesthesia. We should, no, no, we should have, you know, um, that's, that's not a reason to, uh, to do things inappropriately. Yeah, that's, it's, it's so interesting. And I, I know I'm, I'm tempted to go into other areas with this because I, I, for instance, one of the clinics that I worked for, um, the, the doctor who was also the owner of the clinic trained in doing frenotomy or frenectomy, which is the, the tongue tie, uh, release. And I felt like this is my opinion. I felt like it was being overused. I felt like tongue tie was being overdiagnosed because this became a very lucrative thing. Uh, and, and I, um, in my work there, I assisted in this procedure often. And I,

55:11I, it, it really, it really killed me that the, the, the, the pain relief was sugar. It was the sucrose you're talking about. It was a little, little dropper of sugar water in order to kind of make them go, whoa, what is that? And get, get them kind of distracted. So then the doctor could go in and slice this tissue. And oh, just, I, um, that is a whole rabbit hole that I, I'm tempted to explore with you. But in the interest of time, and since it's a little bit off topic, I'll leave it there. And if we want to pick it back up at some point we can. But one thing I wanted to ask you about, and you touched on this earlier, I know, uh, that your Judaism is important to you, very important part of your life and your identity. And, uh, I know this from previous conversations we've had and from what you just mentioned there. And I also know that this must be a very controversial position to take within a, within a religion that has completely normalized and, um, accepted that this is, this is the thing that we do with our sons.

56:18So I wonder what that's like for what, what kind of responses do you get from other Jews, other Jewish doctors? And how does that conversation look within that context? Yeah, thank you for the question. I mean, it's, it's a, it's a tough, a really tough conversation have as someone who's, you know, I'm, you know, very active in my faith and, and very much practicing. And it's, it's a, a very, very challenging, um, topic. And many people, um, in the Jewish community aren't even willing to, um, to indulge it. Um, and I think this ends up being, you know, one of the things I wanted to, wanted to talk about was the, the attempted justifications, um, for male genital cutting. And, and one of the, you know, often given is, is the religious purposes. And then, you know, people who, who fight against it or call the anti-Semitic and, um, but, you know, first of all,

57:18most of this is being done in the hospital. It's being done, you know, in the first few days after birth before the boy goes home with his mother. So, Jewish law says that, that, that a brisk has to be done at eight days of age. In fact, a, a, it is so important that it's done on the eighth day of life, that it is the only Jewish ceremony that is allowed to occur on the Sabbath, on the Holy Day of France, between Friday night and Saturday night. And it's even allowed to occur on the one day of the year of mourning an atonement, the most solemn day of the year on Yon Kippur, um, when, when people are not supposed to bathe where you're supposed to, you know, wear dark colors, you fast for the entire day. It is an entire day of atonement. There's no celebration that day. If, if a boy is born eight days before Yon Kippur, there will be a brisk and there it will happen

58:24on Yon Kippur. Even funerals in the Jewish tradition are delayed. There's a, there's a time limit from when a Jewish person dies until they have to be put in the ground. There's, there's two exceptions to that. One is the Sabbath is that the time during the Sabbath doesn't count and the other is, is Yon Kippur, is that the day of mourning an atonement or atonement relates. It's not so much mourning. Um, but, um, but a brisk doesn't, doesn't get that. It still happens. So anyone that say that, oh, you know, it's, it's an important part of Judaism, you know, uh, uh, BS. That is absolute BS. If you are, if, if, if you are religious and, and you say, and then this, this is an, any issue in, in some of the Orthodox communities, um, you know, you're going to ask will you say, no, I don't want my baby boy cut because I'm taking him to the boil to the, the Jewish

59:27rabbi who's not a doctor usually. There's some, there's some oils out there who are physicians, but, but I'm taking him on the eighth day for this. You know what, that is for religious purposes. I will still argue wholeheartedly that this is, um, a huge, huge ethical issue. Um, and there's, there's great alternatives to it. There's, you know, there's a wonderful book out there called, called, um, Breit Shalom, um, you know, welcoming the boy into the world, um, as, as the covenant. There's a practice called Breit Adon, which is done for men who convert to Judaism, who have already been cut as a child. So if in an Orthodox conversion, if your, if a man wishes to convert to Judaism and he has not been cut, he is required to, to be cut, which I think is, is awful. Um, but he is already cut. What, what do we do as an acceptable alternative? We

1:00:32take a needle and hope what's left of the foreskin for a drop of blood. And that's the covenant of blood. Okay. And so I'm a big advocate of, of, if, if this is important to you and it's important to me and, and, and if I have a son one day and I, I hope to, I have to have multiple sons, um, and multiple children. Um, that, this is what I'll do for my kids. I mean, is it inflicting pain? Yeah, it's a minimal amount of pain. We give children vaccines, quick needle pokes, right? This isn't, this is not barbaric devices. This is taking the, the same Lancet that a person with diabetes uses on their finger four to six times a day and poking the skin and you get a drop of blood and you call it a day. And there, there's no harm being done. There's no sexual harm. Yeah. Is there a moment, momentary pain? Yeah. But you've fulfilled

1:01:33the covenant of blood. This is good enough for orthodox and ultra orthodox conversions for men who have already been cut as a child. Um, and so there's no reason that, that that can't be, that can't be acceptable. And, uh, but, but still surprisingly, I get a lot of pushback, a lot of pushback from, from Jewish physicians as well. I mean, that can be the hardest, um, the hardest group to, to argue with, uh, which would surprise you. You would think that, that maybe as a Jew, you've been, you know, I don't, I don't want to say indoctrinated, but you've taken this, you've learned to take this for granted. But as we talked about earlier, the medical community has learned to take this for granted and become indoctrinated that this is so normalized. And so what you have is that instead of someone who's able to kind of critically think and try to balance their faith

1:02:35and their medical ethics, instead they've been indoctrinated as a Jew and they've been indoctrinated as a physician. And they just are, are so, so dead set on this. And, and this is where those other, and I mean, if you allow me to go into some of the other justifications, please, um, I'd love to, you know, I mean, you know, one of them is the hygiene, right? You were, you mentioned this, that this, uh, this idea that, you know, boys can't, can't keep their foreskin clean. And so we should, you know, cut it off. And I mean, that's just absolutely absurd. I mean, you know, by that logic, we should, you know, maybe we should just pull all teeth out of kids because, you know, they can't brush their teeth. Yeah. I mean, we just, we just don't do, we don't amputate body parts for the, for the, the purpose of hygiene. We, you know, encourage hygiene,

1:03:38we improve hygiene. Um, I mean, so that's just, just absolutely ridiculous. And then we get into the, you know, complication and infection, right? You know, you were talking about faimosis, which is a, which is a problem, which, you know, what, I mean, less than 1% of boys, again, mostly treated non-surgically, um, not a big deal. I mean, so we don't have to think about this. And there's paraphimosis, which is a more serious condition where the, the foreskin retracts, not in boys, usually after people ear and then where the foreskin retracts and traps the glands. And the foreskin can't be unrotracted to cover the glands. And that can, that's a real emergency. I've had to deal with that as an emergency doctor because the, the gland's penis, again, the most sensitive part of the, the male gingelia is losing blood flow. Okay. And so that does become an emergency, you know, it's, and it's very painful, right? We have, we have ways to

1:04:40deal with that. We, you know, we can compression wrap it, you know, actually as a last resort is to cut a slit in the, in the foreskin so that you can bring it back over. But again, if we're to do this, to do things to reduce the risk of, of, in fact, and, and this is not to say that there's, you know, we're not even talking about the complications from infant male genital cutting, you know, the infection issues, the bleeding issues. I mean, you find out that a kid's got hemophilia because they, he won't stop bleeding after, after you've cut this. I mean, so, so you know, we talk about hygiene and infection, you know, urinary tract infections is a big thing, right, men, men who are cut have almost no urinary tract infections until they get into, you know, they're 60s or so when they start having prostate issues and, and you know, to say, oh, well, we should do this so we don't have urinary tract infections. It's like, you know, come on, we have

1:05:43antibiotics. If, if he develops urinary tract infection, we can treat that with antibiotics. It's not a certain that he'll develop it. And, and by that logic, I mean, we know that women who have undergone female genital mutilation have lower rates of urinary tract infections as well. So let's, I mean, you know, let, let's go down that road. And then the last, you know, the last thing they pull up is, of course, the HIV-AIDS stuff because that's, you know, because we don't have a cure for that because that's not easily treatable. And, and they point to three big studies, all of which we're done in South, in sub-Saharan Africa, which again has very different dynamics than than we have in the West, right? You know, hygiene access to clean water that simply access to medical care in the first place, right? So comparing developing nations to developed nations is, it is just

1:06:49off the bat. I mean, and you've got HIV rate, positive rates in sub-Saharan Africa, you know, 20, 25 percent. So you've got a disease prevalence that's completely different than what you have here. But when you dive into those studies, what you see is a lot of confounding factors is the men that are in the groups that get caught, and these are not, these, these are being done by a margin on boys and men not on infants as much there. They get a lot more attention in the study because they're getting a study intervention so that they get more time with the doctors, they get more education, they get more access to condoms, they're actually required to abstain from sexual intercourse after the, the, the cutting after the mutilation because they've just had a surgery they're recovering from. So, so you've got all this, all these things happening issues,

1:07:49and we know there's other ways to, to reduce HIV. I mean, we know, first of all, abstinence works, limiting the number of sexual partners, you know, prep or pre-exposure prophylaxis is, I think, highly controversial. We could certainly talk for an entire hour about, about prep and, and whether that encourages sexual promiscuity and, you know, all kinds of cultural issues around, around sexual promiscuity, but there are, are clearly ways to reduce HIV that are effective. And, and, you know, another way that reducing HIV, we've actually studied HIV transmission, again, in women who have undergone general mutilation. And guess what, they have lower rates of HIV transmission. But, again, no one seemingly calls this out and, and says, well, you know, why are we mutilating boys, but not mutilating girls, if this is, if this is in the interest of

1:08:56reducing HIV and, and AIDS transmission. And one final thing, I'll, I'll say on that, is there, there were some, some specialized cells that occur in multiple parts of the body, including in the foreskin called the Longer Han cells. And we initially thought, there was some initial evidence that showed that those cells were particularly susceptible to HIV transmission. And so, the proposed mechanism was that, you know, that by removing these cells were potentially decreasing entry pathways for the HIV virus. But actually, there's some recent literature that's come out that's shown that, that maybe these cells are actually important in fighting off infection and, and fighting off viral entry and viral replication. So, again, to be doing something based on three, mind to large studies, but large, but, but very hard to extrapolate. And with a lot of

1:10:01confounding data to, to take that practice and bring it, you know, a world away. Again, I, I think it's wrong in both situations. I'm, I'm, please don't misinterpret me. I'm not by any means advocating that this is, is ethically acceptable in sub-Saharan Africa. But to use these three studies as a basis to argue that this is in any way acceptable in the U.S. or, or in a developed nation is, is just atrocious. Yeah, it sounds like there's a lot of complexity in the studies that you described that was not properly addressed. And sort of this, this sort of simple answers, what's been landed on, but so many questions are raised. And I think that you did a really good job of educating on the background of that. Fascinating. And I had never even thought about the HIV element. So that was really an interesting explanation. There's, this is really an important

1:11:09topic. And I'm really glad that you're doing this work and sharing about this, taking the time to educate people and, and speak about this from so many different angles. Do you have any resources that you would recommend for people who want to do more reading or, or understand more about this subject? Absolutely. I mean, there's so many resources out there. You know, I'll just, I'll start naming a few off the top of my head. There's a wonderful organization out of New York called intact America that supports and, and, and promotes not, not cutting boys. And, thankfully, well, we actually do have a growing issue with, with the cutting of, of girls in this country. But that's a, a whole separate discussion, but, but towards, you know, autonomy. So that's intact America. Within the, Jewish community, there's an organization, Blue Heam that kind of

1:12:14supports Jews that, that choose not to, not to cut. It's really the only Jewish organization out there. I, I have mixed feelings about the organization. They don't necessarily advocate against cutting. They're kind of more of a support organization for people who choose not to. So I'd love to see them be more vocal and, and more oppositional and adversarial. There's an organization called No Cirque. And I know that the chapter, they have a, a national organization. And I believe they only have one very active state chapter at a Michigan. But No Cirque mission can is, is, very active as well. There's so much out there. I was actually just invited next month to a conference in downtown Los Angeles. It's the second annual.

1:13:21I believe, I'm, I want to get their name correct. I believe it's called intact in our national. But they're, you know, a new organization that's really working on multiple fronts with this. You know, I grew up in California. California almost outlawed this on infants. We, we had a bill that, that was passed that then governor Arnold Schwarzenegger vetoed. Um, mostly due to pressure from the Jewish and Muslim communities. Um, interesting bad fellow. It was the enemy of your enemy. But this was a, you know, this was, was cries of anti-Semitism. And this was, there was no anti-Semitism at all that went into this, uh, into this bill. And I, I think a lot of times you, that you bring this up with, with Jews is, is that it gets called out as anti-Semitic. And, um, you know, it's,

1:14:27thankfully, I have the, the benefit of being able to speak from the Jewish perspective and say, no, this is it, this is an autonomy issue. And if you think this is that important as a religious issue, you know, just like the anabaptist movement said, you know, baptism is a choice that a, that a person should make and not something that's cast upon him. Again, I'm a Jew. I don't, I don't know that I can speak to baptism, but I can, from a, a completely secular perspective, pouring water on a baby's head, as a physician, I can assure you is, is harmless as long as they don't, you know, they heal that water. So regardless, religious intentions, you're not doing anything that's causing that child harm. And I really, I kind of appreciate the anabaptist's idea that, you know, we're, we're giving, we're, we're teaching you this. This is how you're growing up. But then at the end of the day, you're making this decision. And, you know, people compare that to something like, like, rimspring out with the amish where they're, you know, allowed to leave

1:15:27and go experience the outside world. And I think those comparisons are problematic because there's a lot of emotional and social pressure that, that they have to come back. If they don't come back, they're excommunicated from their family. There's huge financial penalties for this. So I mean, but, but again, I think that it's, it's the same idea that if this is really important to you from a religious perspective, that that's a decision that, that you as a, as a religious person need to make, that that's not a decision that we should be making for, for defenseless infants. Yeah. Well, thank you for sharing those resources. If you want to send me any links, I'd be happy to include them also in the video description. And where can people find you if they are interested in seeing more of your work? Well, thanks so much. I'll be sure to send you those links. I am in the process of, of launching a new website here. So that'll be DrJerryRoss.com

1:16:35DR J-A-R-E-D-R-O-S-S.com. And I'm most active on, on X, or I still call it Twitter, at, at DrJerryRoss, DRJerryRoss. And also a little bit on LinkedIn and, and YouTube again, the same, the same handle there. Awesome. I will make sure to put all of your links in the description as well for people to follow up with you. And we have you scheduled to come join us on the solid ground livestream in the next couple of weeks. So I, if people hear anything in this conversation that they, they want to comment on, or if they have any questions for you, I hope that you guys just leave, leave a comment under the video. And we can get into that and kind of explore some other angles of this and get a little deeper into the topic when we see you then. I'd love to. I'd really love to. And you know, I welcome all the hard questions and, and to really,

1:17:42really talk through that. I'm, I'm really looking forward to the livestream. Yeah, I am too. Thank you so much, Jared. It's been a pleasure speaking with you. And I'm glad we have a follow-up coming up because I'm sure more questions will, I'll, I'll have more thoughts and questions for you as I think about this conversation. Thank you, Asla. Thanks for an amazing conversation and, and bring up some several points that I didn't even think about in this. Yeah, it raised a lot for me as well. Thank you. And we, just for viewers, I know we have had a little bit of a video delay throughout the recording, but I think the audio's been good. So hopefully you've been patient with us for during this time. And I'll try to clean it up as well as I can, but I think the audio's been great. So thanks for your patience with our little glitchy. You know, such as the Wi-Fi life, right? That is unfortunate. All right. Thank you, Jared. Thanks so much, Asla.