San Francisco considering banning circumcision

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ShadowKatt

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Kashrlyyk said:
EVERY HUMAN BEING HAS THE RIGHT FOR AN UNHARMED BODY
I like that right there. That's all that should need be said.

I was circumcised. I am not religous(For that matter, neither were my parents). I had no birth disfigurement. There was no reason for me to be circumcised at all.

I am firmly against body modification(against my own body, of course). I don't have any peircings, I have no tatoos, but I still have to live with the fact that when I was only a few minutes old someone felt they had the right to go in and cut a part of my body off.

gphjr14 said:
Mutilate
mu·ti·late
?verb (used with object), -lat·ed, -lat·ing.
1.
to injure, disfigure, or make imperfect by removing or irreparably damaging parts: Vandals mutilated the painting.
2.
to deprive (a person or animal) of a limb or other essential part.
Circumcision removes sensory and protective skin from the penis. The penis is still functional. This is acceptable.

What if we started removing the pinky finger from every infants hand? The hand is still functional. What would it take to make that acceptable? How is that any different?
 
Jan 22, 2011
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this is a good thing in my opinion. If I had a choice I would not want 4/5 inches of my skin cut off my... well you get the gist but still. It should be freaking choice for adults not something forced on kids because of beliefs. I think the Penn and Teller bull-shit epiosde did the best on describing this.
 

Woodsey

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Lord Beautiful said:
I do so very much love these threads. It's awesome being reminded by a sizable amount of people that my parents who have been very loving, stern, and supportive throughout my life are actually acid-drooling demon goats who villainously abused me by having a small piece of penis skin that is essentially vestigial and pretty damn gross-looking to boot cut from my cock.

Thanks, guys!
I do hope you're not trying to apply your sole personal experience to an argument that applies to millions (actually, billions I would imagine) of other people.

Whether you're exaggerating to the extreme on that I don't know (can't really be arsed to look through 11 pages of posts to see if someone has said that the people who do it are terrible human beings or not), but the main point is that you shouldn't be able to permanently remove things from other people's bodies when they have no say in the matter, and then have religion used as a 'legitimate' reason.


Jonci said:
I would have to say that there needs to be proof that there is any psycological damage from being circumcised as a baby/child. Personally, I was circumcised just by the decision of my parents. When questioned as a teen whether I had been or not, I didn't know the answer because my penis had always just been my penis. When I did learn what an uncircumcised penis looked like, I'm glad mine was circumcised.

Plus, I've heard more opinions from women that they prefer circumcised over not. Frankly, I don't see why it shouldn't be done. We pull wisdom teeth and cut out tonsils, sometimes before they even become an issue. Foreskin is useless, ugly, and poses, at least, a cleaning issue.
Again, sole personal experience to validate an argument like this isn't... well, valid.

If people want it done when they're older then people can have it done when they're older. I don't possibly see how having the choice is worse than having no choice.

As for the arguments against having it:

- If you wash daily, then there is no cleaning issue
- When you pull back the magic sleeve (that's what happens automatically when you pitch a tent), the visual difference is negligible

For:

- More pleasure and feeling
- Serves as a protective guard
 

Wolfram23

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I saw a documentary on the subject and to be honest I wish I was never circumsized. I think parents who do it to their children should be punished by law, but I think if a person volunteers to have it done then so be it.
 

Dastardly

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Jonluw said:
So you're saying we shouldn't have laws against harming other people, but rather just try to discourage it?
Legalize, for example murder, child abuse or violence in general, but do our best to keep people from doing that?
That's not at all what I'm saying. I was pretty clear in how I worded what I was saying:

1. Circumcision has not been shown to be 100% dangerous and damaging. I'm living proof of that myself. So it's not a fundamentally hazardous or destructive practice.

2. It is currently an established right for parents to decide this for their children, whether for religious or personal reasons.

Child abuse is fundamentally destructive, and it is not an established right of parents. Now, at one point it likely was, because the law hadn't cared to weigh in on the matter. They then found it to be a purely destructive practice, so they outlawed it on those grounds. When child abuse was found not to fulfill both of the criteria I listed above, they went ahead and banned it.

Now, corporal punishment, on the other hand... That has not been shown to be fundamentally destructive. When properly applied, it's very effective at deterring problematic (or even dangerous) behaviors in pre-verbal children (meaning they can't absorb an explanation for why they should stop). It stings, but does not injure. It startles, but does not terrify. (NOTE WELL: I've said when properly applied.)

So to outlaw that particular right of parents would be a humongous problem, because it fulfills both of the criteria listed above. There has not been a single study that has even come close to demonstrating that corporal punishment cannot be effectively used, and while some have suggested that it's not the *best* way, that's not grounds for outlawing it.

I'm hoping that this has cleared up the distinction I'm drawing. It's not the act of circumcision I'm defending, but rather the retention of existing rights when they have not been sufficiently shown to be exclusively and fundamentally harmful.
 

Redem

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Can't help but think all the circusion debate is doing so much out of so little

:D
 

WOPR

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ShakyFt Slasher said:
It should be a right because: 1: It is a religious practice, 2: It can keep it from getting certain diseases, and 3: It makes sex more pleasurable
research shows that it kills up to 40%-50%** of the pleasure for the guy
true it prevents some, but it also makes it easier to get others

and am I the only person that DOESN'T care if it's a religious right..?
that would be like uber-religious types cutting of their kids left arms in fear the would grow up to be left handed because "lefties are the devils servants"

just saying *shrugs*
and I say that if I can be circumsized without my dads consent then I should be able to scalp him without his
after all, I'm just "cutting the skin off from around his head"
*twitches*

EDIT: **no I don't believe I have that backwards, I'm just going by what I read in multiple other threads of this sort, of course I could be wrong, guess we won't know until a full grown adult guy does it, cuts it off, then does it again
 

funguy2121

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Saucycardog said:
http://www.msnbc.msn.com/id/42784426/ns/health-kids_and_parenting/?GT1=43001

What do you guys/gals think of this? Should circumcision be outlawed or should it stay because it is a religious practice?
MSN = grain of salt at best.

I love the comments about how ugly "uncut schlongs" are, as if cut schlongs are simply gorgeous. It's a personal/religious right/rite (aren't I clever? No?), and San Francisco is one of the most tolerant towns on the continent. It ain't goin' away.

I've also heard that one loses some future sensation when they get it cut. So I'm suing my parents :p
 

Trolldor

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Legal for adults, but fucking stay away from children.

At the very least circumcision impairs sex as you're removing the most sensitive bit which also aids in ease of motion, in turn you get a highly calloused dinger that requires quite a bit more effort to issue an effect. Not an uncommon story to hear girls accustomed to circumcision hurting uncut guys because of how vigorous they're being.

At the most you're inflicting on a child genital mutilation, which has absolutely no benefit whatsoever which can - following religious practice - be taken at any time by that individual (including adulthood), thus restricting it to when they're adults does nothing to inhibit their individual right to choose their own religion.

Edit:

And as a quick medical guide to all those out there, how about a guide from doctors?

http://www.doctorsopposingcircumcision.org/DOC/statement03.html
 

WOPR

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funguy2121 said:
I've also heard that one loses some future sensation when they get it cut. So I'm suing my parents :p
That's a BRILLIANT IDEA!

I wonder- could we sue them for "Child Abuse" because I'm pretty sure it hurt like heck when it happened, and it was- ugh I'm losing my train of though, I'm going to go have some food...
 

Jonluw

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Dastardly said:
Jonluw said:
So you're saying we shouldn't have laws against harming other people, but rather just try to discourage it?
Legalize, for example murder, child abuse or violence in general, but do our best to keep people from doing that?
That's not at all what I'm saying. I was pretty clear in how I worded what I was saying:

1. Circumcision has not been shown to be 100% dangerous and damaging. I'm living proof of that myself. So it's not a fundamentally hazardous or destructive practice.

2. It is currently an established right for parents to decide this for their children, whether for religious or personal reasons.

Child abuse is fundamentally destructive, and it is not an established right of parents. Now, at one point it likely was, because the law hadn't cared to weigh in on the matter. They then found it to be a purely destructive practice, so they outlawed it on those grounds. When child abuse was found not to fulfill both of the criteria I listed above, they went ahead and banned it.

Now, corporal punishment, on the other hand... That has not been shown to be fundamentally destructive. When properly applied, it's very effective at deterring problematic (or even dangerous) behaviors in pre-verbal children (meaning they can't absorb an explanation for why they should stop). It stings, but does not injure. It startles, but does not terrify. (NOTE WELL: I've said when properly applied.)

So to outlaw that particular right of parents would be a humongous problem, because it fulfills both of the criteria listed above. There has not been a single study that has even come close to demonstrating that corporal punishment cannot be effectively used, and while some have suggested that it's not the *best* way, that's not grounds for outlawing it.

I'm hoping that this has cleared up the distinction I'm drawing. It's not the act of circumcision I'm defending, but rather the retention of existing rights when they have not been sufficiently shown to be exclusively and fundamentally harmful.
So you're okay with people cutting of any body part of an infant, so long as it isn't essential? i.e. earlobes and toenails are fine?

Personally, I don't believe it is the right of a parent to cut or otherwise hurt their child.

When I was talking about legalizing violence as per your argument, I also meant violent acts performed on adults by adults by the way.
I was wondering if it'd be okay for a person to respond to an insult with a fist to the face.

And banning corporal punishment sure has caused a lot of trouble.
 

Dastardly

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ShadowKatt said:
Circumcision removes sensory and protective skin from the penis. The penis is still functional. This is acceptable.

What if we started removing the pinky finger from every infants hand? The hand is still functional. What would it take to make that acceptable? How is that any different?
The difference is immense.

1. Removal of the pinky greatly reduces manual dexterity. Connective tissue is left unconnected, less surface area is provided for gripping, and in general the child has fewer digits with which to hold things/type/count/etc. It requires a lot of lifelong adjustments for even performing simple tasks. The hand is not fully functional. A circumcised penis is not the least bit less functional than the alternative. At least mine isn't--your mileage may vary.

2. Removal of the pinky is far more intrusive and dangerous a procedure than circumcision. Far, far more. They're not even in the same ballpark. Getting a tooth pulled is more invasive and destructive to the body than circumcision.

I'm not defending circumcision here. I'm just saying that your example is alarmist and sensationalist, at the very best.

There's also this issue of "consent." Kids very often don't get a vote. There are infants who get ears pierced, and I've never known one to die from it. Hell, I've never known one to complain later in life. Kids are born with little mini-tails all the time, and parents have them removed for cosmetic reasons before the kid is old enough to "consent." What about kids born with incomplete additional genitalia (usually a partial penis)? The kid has to suffer through an entire childhood of uncertainty and screwed-up physical gender identity, simply because the parents aren't allowed to make the call to remove the incompletely developed genitals?
 

Do4600

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Worgen said:
ShakyFt Slasher said:
It should be a right because: 1: It is a religious practice, 2: It can keep it from getting certain diseases, and 3: It makes sex more pleasurable
its only really religious for jews, it doesnt keep you from getting any diseases, it was started to make sex less pleasurable (at least thats why christians did it)
Actually, it does reduce the risk for infections, especially urinary tract infections, STD's, HIV and certain types of diseases which can lead to cancer.
 

Elementlmage

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Radoh said:
It should be a decision made by adults if they want it for themselves.
God no, I don't want to remember that! PLEASE, let my parents make the decision for me!

captcha: tsReva original
 

Trolldor

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Do4600 said:
Worgen said:
ShakyFt Slasher said:
It should be a right because: 1: It is a religious practice, 2: It can keep it from getting certain diseases, and 3: It makes sex more pleasurable
its only really religious for jews, it doesnt keep you from getting any diseases, it was started to make sex less pleasurable (at least thats why christians did it)
Actually, it does reduce the risk for infections, especially urinary tract infections, STD's, HIV and certain types of diseases which can lead to cancer.
Oh really?


I beg to differ. [http://www.doctorsopposingcircumcision.org/DOC/statement03.html]

Cancer of the Cervix in Partners

The risk factors for cervical cancer are infection with human papilloma virus (HPV)61 and smoking.62 Risk of infection with HPV is increased by early onset of sexual intercourse and multiple sex partners.63 There is no clear evidence that male circumcision decreases the risk of infection.

Male circumcision cannot be shown to prevent cervical cancer in female partners. The Royal Australasian College of Physicians (RACP) points out that vaccines are being developed to prevent infection with HPV. The RACP found no data to suggest that circumcision would be of additional benefit.47 When HPV vaccine comes into general use, it should nearly end the threat posed by cervical cancer.

Human papillomavirus vaccine to protect against HPV cervical cancer is now a reality and is being given to pre-teen girls.64
Penile Cancer

Abraham L. Wolbarst, the noted early 20th-century circumcision promoter, started the myth that neonatal circumcision absolutely prevented penile cancer, at a time (1932) when the etiology of cancer was not well understood.53 His claims were accepted as fact, and unfortunately, one still finds such statements in the medical literature today. It was not long, however, until doctors started to report cases of cancer in circumcised men that did not fit with Wolbarst?s inflated claims.54 Wolbarst?s report was incorrect. Maden et al. (1993) reported 41 cases of penile cancer in circumcised men.55 Certainly, it was becoming clear that circumcision did not prevent penile cancer.

True risk factors did not emerge until the 1980s. DNA from human papillomavirus (HPV) was identified in penile cancer cells.56 Infection with HPV (which is contracted by sexual intercourse) is an important risk factor. The use of tobacco is another important risk factor.57

Maden et al. (1993) improperly claimed that lack of circumcision was a risk factor,55 but Cold et al. (1997) discovered that Maden had not adjusted his data for age.58 When Maden?s data were properly adjusted for age, there was no difference in the risk for circumcised and non-circumcised men.58

Circumcision is ineffective for the prevention of penile cancer. Bissada et al. (1986) report that penile cancer forms on the circumcision scar.58 The American Academy of Family Physicians (AAFP) says 600 to 900 circumcisions would be necessary to prevent one case of penile cancer.60 The AAP says the risk of penile cancer in a non-circumcised man is ?somewhat? higher than a circumcised man but remains low.22 The AMA says, because the disease is rare and occurs later in life, the use of circumcision as a preventive measure is not justified.4
Urinary Tract Infections

Ginsburg & McCracken (1982), who studied urinary tract infection (UTI) in male infants at Parkland Hospital in Dallas, noted that 95% of the infant male UTI patients were not circumcised.34 They speculated that lack of circumcision may have contributed to the infection in some way. However, Parkland Hospital, a public hospital, did not perform neonatal circumcisions, even if patients demanded it,35 so most of the client population at Parkland must have been noncircumcised?a fact apparently overlooked by Ginsburg & McCracken.

This observation prompted Wiswell et al. to produce retrospective studies regarding UTI in circumcised infant males as compared with uncircumcised males. The studies all have serious methodological flaws, including failure to control for confounding factors, which include maternal infection, perinatal anoxia, high or low birthweight, prematurity of birth, rooming in, method of urine sample collection, type of hygienic care, and breastfeeding. The Fetus and Newborn Committee of the Canadian Paediatric Society (1989) examined data provided by Wiswell et al. and reported that they found Wiswell?s data to be ?not sufficiently compelling to justify a change in their existing policy that circumcision is unnecessary and should not be performed."36 Altshul (1990) pointed out that the studies had only shown association, not cause and effect.37 Thompson (1990) found that ?unequivocable proof that lack of circumcision is a risk factor for increased urinary tract infection is currently unavailable.?38 Chessare (1993) compared the alleged advantage of preventing UTI with the disadvantages of complications and found that, even if Wiswell was correct in his claims, non-circumcision would still produce the highest medical utility.39

Evidence from Israel establishes a compelling association between ritual circumcision on the eighth day and immediate post-circumcision UTI.40-42

Mueller et al. (1997) reported no difference in the incidence of UTI in circumcised and non-circumcised boys with normal urinary tract anatomy.43

To put this matter into perspective, a Swedish study by Mårild et al. (1998), where infant circumcision is not practiced, found that, in the first six years of life, the incidence of UTI in boys was 1.8 percent, but in girls it was 6.6 percent.44 UTI infection in boys was rare after the first year of life. When UTI does occur, it is easily treated medically. McCracken (1989) and Larcombe (1999) report UTI infections respond rapidly to anti-microbial therapy.,45,46

The Task Force on Circumcision of the American Academy of Pediatrics, in their ?evidence-based? statement, reported serious methodological flaws in all existing studies, and declined to recommend circumcision to reduce UTI.22 The Royal Australasian College of Physicians (RACP) says routine non-therapeutic circumcision ?cannot be justified on the basis of preventing a UTI.?47

The consensus of medical opinion is that circumcision is of little, if any, value in reducing UTI. Risk, complications, an disadvantages of circumcision outweigh any reduction in UTI. The notion that neonatal male circumcsion can prevent UTI increasingly is being viewed as a medical myth ? one started by Ginsburg & McCracken?s failure to recognize that the client population at Parkland Hospital in Dallas was mostly noncircumcised.

Medical authorities now recommend breastfeeding, not circumcision, to reduce UTI in infancy.48,49 Moreover, Hansen (2004),50 and Mårild & others (2004)51 report that breastfeeding continues to have a protective effect even after weaning.

Kwak et al. (2004) report that circumcision after anti-reflux surgery to prevent UTI is not effective. 52
Sexually Transmitted Diseases

Abraham Leo Wolbarst, M.D., was an ardent defender and promoter of the practice of circumcision. After Holt (1913) criticized ritual circumcision because of the large number of cases of tuberculosis resulting in death acquired through infection of the open wound,16 Wolbarst (1914) came to the defense of ritual circumcision by extolling the alleged sanitary benefits of circumcision.6 Wolbarst did this by collecting opinions from other medical doctors, which he then published in an article in the Journal of the American Medical Association. He solicited opinions that circumcision prevented the venereal diseases of syphilis and chancroid. He then cited these opinions as evidence of the value of circumcision. Controlled studies were not available in that long-ago day. The United States military services, on the basis of such flimsy evidence, circumcised large numbers of men to prevent sexually transmitted diseases during two world wars.

Modern evidence-based medicine, however, is unable to support Wolbarst?s overblown claims. Cook et al. (1994) were unable to show a definite benefit for circumcision?finding a slight tendency for non-circumcised men to have more syphilis and gonorrhea, but less tendency to have genital warts.17 Donovan et al. (1994) reported no significant difference between non-circumcised and circumcised men.18 Van Howe (1999) found circumcised men may be slightly more likely to have urethritis and uncircumcised males may be more prone to genital ulcer disease (GUD).19 Dickson et al. (2008) found more STD in circumcised men but the difference was not statistically significant.20 The Fetus and Newborn Committee of the Canadian Paediatric Society found that ?circumcision had no significant effect on the incidence of common STDs.?21 The AAP Task Force (1999) reported that ?behavior factors appear to be far more important than circumcision status.?22 The medical evidence does not support the practice of neonatal circumcision to prevent STDs.

de Vincenzi & Mertens (1994) performed a meta-analysis of the then-existing literature, regarding circumcision and HIV infection. They concluded, at that time, there was insufficient evidence to recommend male circumcision to prevent HIV transmission.23 The Council on Scientific Affairs of the AMA (1999) concluded that ?behavioral factors are far more important risk factors for acquisition of HIV and other sexually transmissible diseases than circumcision status, and circumcision cannot be responsibly viewed as ?protecting? against such infections.?4 The Cochrane Library review of the medical evidence (2003) concluded that there is insufficient evidence to recommend circumcision to prevent HIV infection.24 Thomas (2004) found no evidence that circumcision is protective against HIV in a U.S. Navy population.25 Talbott (2007) reports that it is the percentage of female sex workers in the female population, not the incidence of male circumcision, that determines the level of HIV infection.26 Dowsett & Couch (2007) examined the results of three randomized controlled trials (RCTs), but they still found insufficient evidence to recommend circumcision to prevent HIV infection.27 Green et al. (2008) reviewed the evidence regarding circumcision to prevent HIV infection and found ?insufficient data? as well as countervailing data. They concluded:

?The world community must cautiously review and carefully consider the long-term consequences of mass circumcision campaigns, from the risk of increasing deaths and infections to human rights violations. In the rush to save lives, many may instead be lost and human rights trampled in the stampede. Circumcision is not the panacea the world has been waiting for in the battle to stem the HIV crisis.?28

The Lancet published two coordinated randomized controlled trials (RCTs) on February 24, 2007.29,30 One should note that the lead authors of these RCTs are natives of Australia, Canada, or the United States, all of which, now or formerly, are or were circumcising cultures. These men may well have suffered circumcision as infants. Siegfried et al. (2003) comment that such men are likely to carry ?strong beliefs and opinions? in favor of circumcision.24 They may be compelled, therefore, to produce literature to support their culture of origin. (See Chapter Six for discussion of the effect of circumcision upon medical literature.) These authors wrote papers advocating male circumcision to prevent HIV infection prior to undertaking these RCTs. The severe criticism that these papers have received suggests that something other than pure medical science is at work. Researcher bias cannot be ruled out.

The epidemic of HIV infection in the United States is concentrated among men who have sex with men (MSM). Two studies find that male circumcision is ineffective at preventing HIV among MSM.31,32

Moreover, RCTs carried out among adults in Africa are not relevant to children in North America. Even if the African RCTs are accurate, the incidence of infection and the risk of infection in North America are many times less than in Africa. Moreover, children do not engage in sexual intercourse so they are not at risk of HIV infection by sexual transmission. The African RCTs are not applicable to North America.

Condoms are an effective means of preventing sexually transmitted disease, including HIV.33
 

Elementlmage

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Do4600 said:
Worgen said:
ShakyFt Slasher said:
It should be a right because: 1: It is a religious practice, 2: It can keep it from getting certain diseases, and 3: It makes sex more pleasurable
its only really religious for jews, it doesnt keep you from getting any diseases, it was started to make sex less pleasurable (at least thats why christians did it)
Actually, it does reduce the risk for infections, especially urinary tract infections, STD's, HIV and certain types of diseases which can lead to cancer.
NSFW:

Actually, I would postulate that it does indeed make sex more pleasurable. Imagine if you still had your foreskin how hypersensitive you would be? Would having an orgasm after 10 seconds of sex really be that pleasurable? Or, is it the act and not the stimulation that we find so pleasurable?
 

CommanderKirov

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Elcarsh said:
Sethran said:
Also, it's done to children because it's much easier to get it off quickly and without pain at that young an age.
CommanderKirov said:
it's not like a child feels anything.
I...just...there aren't words to describe...

Go watch the episode of Bullshit! Go do it, now!
Okay that's so taken out of context... *looks up his previous post*... Okay I wrote it absolutley wrong.

What I ment was the pain that you feel than is not kept in your memory. You do not remain traumatized in your adult life. While such procedure in the adult life can leave significant memory of post-op pain.
 

Mister Benoit

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I <3 my turtle neck ^_^

Also it's one of the reasons they make ribbed condoms, to make up for the lack of natural ribs made by the uncircumcised skin being pulled back.
 

ShadowKatt

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Dastardly said:
ShadowKatt said:
Circumcision removes sensory and protective skin from the penis. The penis is still functional. This is acceptable.

What if we started removing the pinky finger from every infants hand? The hand is still functional. What would it take to make that acceptable? How is that any different?
The difference is immense.

1. Removal of the pinky greatly reduces manual dexterity. Connective tissue is left unconnected, less surface area is provided for gripping, and in general the child has fewer digits with which to hold things/type/count/etc. It requires a lot of lifelong adjustments for even performing simple tasks. The hand is not fully functional. A circumcised penis is not the least bit less functional than the alternative. At least mine isn't--your mileage may vary.

2. Removal of the pinky is far more intrusive and dangerous a procedure than circumcision. Far, far more. They're not even in the same ballpark. Getting a tooth pulled is more invasive and destructive to the body than circumcision.

I'm not defending circumcision here. I'm just saying that your example is alarmist and sensationalist, at the very best.

There's also this issue of "consent." Kids very often don't get a vote. There are infants who get ears pierced, and I've never known one to die from it. Hell, I've never known one to complain later in life. Kids are born with little mini-tails all the time, and parents have them removed for cosmetic reasons before the kid is old enough to "consent." What about kids born with incomplete additional genitalia (usually a partial penis)? The kid has to suffer through an entire childhood of uncertainty and screwed-up physical gender identity, simply because the parents aren't allowed to make the call to remove the incompletely developed genitals?
It is a bit alarmist and sensationalist, but then what around here isn't(rhetorical). Still I challenge you to find another parallel. And as far as consent goes...I find that to be a very thin line. I know people get their infants and childrens ears peirced(children, read: 5-7). I don't think that's right either but on the totem pole of things done to children, it's pretty low. Peircings will heal. Circumcision/amputation don't. And then their your issue with cisborn children, which while valid, should not even be a point of contention. Many children cisborn or with disfigured genetalia actually DO need surgery to make them useable, at least in the males case. Females could be damaged or not and we have no ways of knowing, so it's purely males on the chopping block here, figureatively and literally. But that is a necessary procedure, not elective.