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Makubuya T, Nyembezi A, Kibii K. Newspaper Coverage of Violence Related to Initiation and Traditional Male Circumcision in South Africa. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2835-2844. [PMID: 37948029 DOI: 10.1007/s10508-023-02718-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 11/12/2023]
Abstract
This study reports evidence of violence related to initiation and traditional male circumcision (ITMC) in South Africa. Our study conducted a search of the newspaper databases Newsbank and News24 from January 1, 2016, to August 31, 2023, and carried out a content analysis of newspaper articles that referenced violence in South African newspapers. Our initial search yielded 1796 articles; after screening for relevance and duplicates, 41 articles published in 16 South African newspapers and one online source were included in the analysis of the data. Most articles (41%) were published in 2016. Five major types of violence were identified at three unique stages of the ITMC process: (1) bullying; (2) mental and emotional abuse; (3) neglect; (4) physical violence; and (5) gender-based violence. At the pre-initiation stage, the articles reported that boys were forced, abducted, and trafficked into the initiation schools. While at the initiation schools, various forms of bullying, beating, fighting, slapping, assaulting, torturing, burning, neglecting, and physical, mental, and emotional abuse were reported. At the post-initiation stage, physical violence and mental abuse were reported. We noted that some articles reported violence prevention efforts during ITMC. Future research should examine readers' reception of newspaper information about violence associated with ITMC and their awareness of prevention measures. Our findings have implications for public health policy, including the Customary Initiation Act, which provides for the protection of life, the prevention of injuries, and the prevention of all forms of abuse that initiates may be subjected to as a result of initiation practices.
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Affiliation(s)
- Timothy Makubuya
- College of Education, University of Missouri-St. Louis, 364 Marillac Hall, 1 University Blvd., St. Louis, MO, 63121, USA.
| | - Anam Nyembezi
- School of Public Health, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Kenneth Kibii
- College of Public Health and Social Justice, St. Louis University, St. Louis, MO, USA
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de Haseth KB, Gehrels AM, Widdershoven G, Bouman MB, van de Grift TC. Ethical considerations regarding penis transplantation surgery in transgender men-an empirical ethics study. Sex Med 2023; 11:qfad041. [PMID: 37720817 PMCID: PMC10501463 DOI: 10.1093/sexmed/qfad041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 09/19/2023] Open
Abstract
Background The ongoing quest to surgically create the (nearly) ideal neophallus in transgender men has led to the continuous development of transgender medicine and the proposed introduction of penis transplantation. However, both technical and ethical issues arise when developing this treatment. Aim We sought to extract ethical considerations among different stakeholder groups regarding penile transplantation surgery in transgender men and to define preliminary clinical recommendations. Methods Three semistructured focus groups, consisting of different stakeholders, were organized to participate in discussions of ethical considerations retrieved from the ethics literature of transplantation and transgender medicine. Analysis of the results was performed according to empirical ethics. Outcomes Study outcomes were the identification of qualitative themes describing ethical considerations pertaining to penile transplantation in transgender men. Results Nineteen people participated in this qualitative study. The main domains that emerged included arguments in favor of and arguments against penile transplantation. Although the participants expressed positive attitudes toward developing this care, with acknowledgement of the current limitations stakeholders of all groups were reluctant to endorse the introduction of penile transplantation for transgender men at this point. Clinical Implications Under the present circumstances, all groups expressed both a wide variety of ethical considerations as well as a tendency to prefer developing alternative treatment options or improving the results of currently available treatments in relation to penile transplantation for transgender men. Strengths and Limitations This study was the first (empirical) study to focus on this topic and included a diversity of stakeholder perspectives. Limitations included the hypothetical nature of the discussion as well as the clinical setting in which the topic has been studied. Conclusion Introducing penile transplantation for transgender men, under the current circumstances, comes with a wide range of ethical considerations, which deal with personal identity, autonomy, medical risks, risk for transgender support and donor willingness, and issues regarding equality. Despite the present hesitancy to use penile transplantation, should the technical side of this treatment option develop, further research in the ethical field of penile transplantation for transgender men is recommended.
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Affiliation(s)
- Kristin B de Haseth
- Department of Plastic, Gender, Reconstructive and Hand Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Anne M Gehrels
- Department of Plastic, Gender, Reconstructive and Hand Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Guy Widdershoven
- Amsterdam Public Health Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Mark-Bram Bouman
- Department of Plastic, Gender, Reconstructive and Hand Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
| | - Tim C van de Grift
- Department of Plastic, Gender, Reconstructive and Hand Surgery, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Institute, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
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Earp BD. Genital Cutting as Gender Oppression: Time to Revisit the WHO Paradigm. FRONTIERS IN HUMAN DYNAMICS 2022. [DOI: 10.3389/fhumd.2022.778592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The World Health Organization (WHO) condemns all medically unnecessary female genital cutting (FGC) that is primarily associated with people of color and the Global South, claiming that such FGC violates the human right to bodily integrity regardless of harm-level, degree of medicalization, or consent. However, the WHO does not condemn medically unnecessary FGC that is primarily associated with Western culture, such as elective labiaplasty or genital piercing, even when performed by non-medical practitioners (e.g., body artists) or on adolescent girls. Nor does it campaign against any form of medically unnecessary intersex genital cutting (IGC) or male genital cutting (MGC), including forms that are non-consensual or comparably harmful to some types of FGC. These and other apparent inconsistencies risk undermining the perceived authority of the WHO to pronounce on human rights. This paper considers whether the WHO could justify its selective condemnation of non-Western-associated FGC by appealing to the distinctive role of such practices in upholding patriarchal gender systems and furthering sex-based discrimination against women and girls. The paper argues that such a justification would not succeed. To the contrary, dismantling patriarchal power structures and reducing sex-based discrimination in FGC-practicing societies requires principled opposition to medically unnecessary, non-consensual genital cutting of all vulnerable persons, including insufficiently autonomous children, irrespective of their sex traits or socially assigned gender. This conclusion is based, in part, on an assessment of the overlapping and often mutually reinforcing roles of different types of child genital cutting—FGC, MGC, and IGC—in reproducing oppressive gender systems. These systems, in turn, tend to subordinate women and girls as well as non-dominant males and sexual and gender minorities. The selective efforts of the WHO to eliminate only non-Western-associated FGC exposes the organization to credible accusations of racism and cultural imperialism and paradoxically undermines its own stated goals: namely, securing the long-term interests and equal rights of women and girls in FGC-practicing societies.
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Benjamin H, Celine A, Mounia SM, Barbara H, Jean Paul M. Ethical stakes of penile transplantation: A literature review. J Plast Reconstr Aesthet Surg 2022; 75:1529-1536. [PMID: 35221229 DOI: 10.1016/j.bjps.2021.11.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 04/19/2021] [Accepted: 11/12/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Vascularized composite allotransplantation has become an alternative reconstruction technique for patients with a severe loss of substance. Today, five human penile transplantations have been reported. The objective of this literature review is to offer an updated overview of the technical and ethical questions surrounding penile transplantation compared with conventional phalloplasty. MATERIAL AND METHODS A systematic review was conducted of the literature from 2000 to 2020. A search of PubMed was performed using the keywords: "penile transplantation," "penis transplantation," and "penile vascularized composite allotransplantation." The criteria for the analysis were the type of study, surgical techniques, and ethical concerns. RESULTS Thirty-six articles were selected. These articles include reviews, case report, editorials, and preclinical studies. The first article was published in 2003, but the number of articles has increased after the second human transplantation in South Africa in 2014. Surgical techniques and the medication management specific to each team were successful in the 5 transplant cases, but several complications were noted. CONCLUSION Two decades of successful penile transplantations have proven the technique to be a viable solution to treat a penile amputation, allowing for a better esthetic and sensitive outcome paired with the possibility of natural urinary and erectile functions. Psychological impact of penile transplantation, selection of patients, complications of immunosuppressive therapies, and surgical technicity are the biggest penile transplantation challenges. Further experimental studies are necessary to produce standardized protocols to safely include penile transplantation in the conventional treatment of a penile amputation.
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Affiliation(s)
- Haye Benjamin
- Department of Plastic, Reconstructive, Aesthetic, and Maxillofacial Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Aboud Celine
- Department of Plastic, Reconstructive, Aesthetic, and Maxillofacial Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - SidAhmed-Mezi Mounia
- Department of Plastic, Reconstructive, Aesthetic, and Maxillofacial Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
| | - Hersant Barbara
- Department of Plastic, Reconstructive, Aesthetic, and Maxillofacial Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France.
| | - Meningaud Jean Paul
- Department of Plastic, Reconstructive, Aesthetic, and Maxillofacial Surgery, Henri Mondor Hospital, 51 avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
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Abstract
PURPOSE OF REVIEW To review the current understanding of the ethical and societal difficulties of penile transplantation. RECENT FINDINGS Penile transplantation, as with other forms of vascularized composite allotransplantation, has increasing acceptance in society but is still not entirely accepted. Guidelines aiming to help guide future penile transplant programs in an ethical and scientific safe manner were created. Controversies regarding the economic impact, patient safety, and the rights of the patients choosing penile transplant remains. SUMMARY Penile transplantation has excellent functional and cosmetic results in the short-term and medium-term. The penis, similar to the face in facial transplantation, carries emotional gravity that relates to visible body parts of another that live forth in a tangible manner contributing to psychological and ethical challenges for both the individual and society more broadly, healthcare administrators, and healthcare workers. In the context of these challenges, controversies emerge related to issues of judgment about what society can and wants to afford. Effects of toxic immunosuppression in a nonlife saving life-enhancing procedure, as well as costs, become arguments that have to be considered in the context of ethical and societal challenges.
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Van der Merwe A. In response to an argument against penile transplantation. JOURNAL OF MEDICAL ETHICS 2020; 46:63-64. [PMID: 30737254 DOI: 10.1136/medethics-2018-104795] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 11/15/2018] [Accepted: 01/10/2019] [Indexed: 06/09/2023]
Abstract
Moodley and Rennie's paper arguing against penile transplantation stated out of context arguments and wrongly quoted statements. The cost of penile transplantation is much less than portrayed. The burden of cases is much less than is communicated. The men on our penis transplantation programme represent the poorest of the poor and are one of the most discriminated against groups of humans on earth. The false hope said to be created by Moodley is indeed not false hope at all as there is a real possibility that most patients on our waiting list may be transplanted. Moodley argues that government has, in the context of penile transplantation, no duty to cure those who lost a penis after ritual circumcision, but only an obligation to prevent this from happening. A 'yuk' reaction, similarly described in facial transplantation, may be present in colleagues arguing against penile transplantation.
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Affiliation(s)
- André Van der Merwe
- Division of Urology, Faculty of Medicine and Healthcare Sciences, Stellenbosch University and Tygerberg Academic Hospital, Cape Town, South Africa
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Rennie S, Moodley K. Delineating the role of penile transplantation when traditional male circumcisions go wrong in South Africa. JOURNAL OF MEDICAL ETHICS 2019; 47:medethics-2019-105414. [PMID: 31030184 DOI: 10.1136/medethics-2019-105414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Stuart Rennie
- Social Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Center for Bioethics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, University of Stellenbosch, Stellenbosch, Western Cape, South Africa
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