The 26^th Congress of the World Association for Sexual Health (WAS) in Antalya, Türkiye (2-5 November) convened under the theme “Bridging the Gaps: Sexual Health, Rights, Justice and Pleasure for All.”  It was attended by more than 200 sexual health experts from around the world. WAS is the premier international organization dedicated to both sexual research and sexual rights advocacy. Significantly, WAS has advisory relationships with both the World Health Organization and the United Nations and is an organization with international influence. GALDEF board members Tim Hammond, Dan MacClymont and Leif Thompson, MD, as well as GALDEF Advisory Council member Dr. Mohamed Fahmy brought a focus on male bodily integrity and genital autonomy to WAS2023. Joining with GALDEF was veteran genital autonomy advocate Steve Scott (Genital Autonomy of Utah). Ethicist Brian Earp addressed the topic of genital autonomy for all children (male, female, intersex and transgender). The event was also an opportunity to reunite with our Finnish colleague Tiina Vilponen of the Sexpo Foundation in Helsinki and to network with potential new colleagues in the campaign for children’s genital autonomy.

The four-day event encompassed scores of simultaneous presentations across five different meeting rooms. According to Dr. Fahmy, this was not ideal, as it did not allow conference goers to attend all of the presentations they may have wanted. He suggested that a more desirable format would be to include more plenary sessions where everyone could avail themselves of important information that should have been shared with everyone in attendance.

Presentations were grouped by topic into 60, 90 and 120-minute blocks. The presentations by Tim, Dr. Fahmy and researcher Alfonso Cepeda-Emiliani were scheduled for a two-hour block on the final morning of the conference, which was shared with a Dutch presenter discussing intersex issues. This gave us each 30 minutes for our presentations. After lunch a roundtable discussion on the topic of genital autonomy was held, chaired by WAS president Dr. Elna Rudolph.

Although conference organizers did not have the resources to film every presenter, we took it upon ourselves to film our presentations, which will appear on GALDEF’s YouTube channel and will be shared with the WAS organization for uploading to their website.

Tim’s presentation was based on his published research article titled “Foreskin Restorers: Insights into Motivations, Successes, Challenges, and Experiences with Medical and Mental Health Professionals.“ His presentation was well received and discussed the results of the survey that he, Dr. Mohamed Fahmy and four other co-authors had published in the International Journal of Impotence Research. Almost 1,800 participants from across 60 nations submitted fully completed surveys during the 2021 online collection period, and included heterosexual, gay, and bisexual men, as well as transgender women who were engaged in foreskin restoration. During Tim’s presentation he encouraged attendees to the use the term “intact” (not uncircumcised), coined the term “male F spot,” and introduced Travis Wisdom’s concept of “circumcisionism” to the audience. He stressed that  “Childhood circumcision customs are not healthcare” and that “Medicalization is not harm reduction; medicalization is harm perpetuation.” He also warned that the world is being led astray by medical associations in the U.S. (e.g., American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Urological Association and the Centers for Disease Control) where a genital cutting culture exists within the framework of a for-profit medical system that is disproportionately influential on the international level with entities like the World Health Organization.

Tim’s presentation was followed by important new research conducted by a Spanish team led by Alfonso Cepeda-Emiliani, who discussed foreskin histology. He is solely dedicated to preparing and analyzing foreskin sections in order to document blood supply, lymph vessels, musculature and innervation of the foreskin. His research affirms the complexity and importance of the foreskin and constitutes indisputable evidence of the anatomical and physiological damage caused by circumcision.

Among many important discoveries, Cepeda-Emiliani demonstrated that the only nerve endings found on the genitals of neonates are Pacinian Corpuscles that sense pressure and free nerve endings that sense pain. Other important nerve endings, like Meissner Corpuscles and Rufini Corpuscles develop as the child matures. Cepeda-Emiliani’s paper, published in 2022, reports that “The penile prepuce has a highly organized, dense, afferent innervation pattern that is manifest early in fetal development.”Afferent neurons, typically associated with specialized sensory receptors, are nerve fibers responsible for bringing sensory information from the outside world into the brain.

Later that same day, in the genital autonomy roundtable, Earp called for universal recognition of the need for a harmonized policy regarding medically unnecessary (i.e., non-therapeutic, non-consensual) genital surgeries on children, regardless of sex or gender. He also reported that pro-male genital mutilation (MGM) forces are keenly aware that current anti-female genital mutilation (FGM) laws in Western liberal democracies are unsustainable due to their unconstitutional lack of equal protection for all children. As a solution to this inequity, those forces are eager to propose legalizing minor forms of FGM that are equal to or less severe than MGM, as this “solution” would preserve MGM traditions. However, Earp expressed his belief that criminalization of both female and male genital cutting is but one tool, and perhaps not always the most effective one, to curb these practices, as it stigmatizes practicing communities, causes resistance and results in re-entrenchment. Later in his presentation Earp interviewed Zainab Nur, a U.K. based anti-FGM campaigner who also opposes MGM customs.

While there is great support within WAS for children’s genital autonomy, which enjoys the support of its president, Dr. Elna Rudolph, such support is not universal. In a conversation between her and Tim Hammond she acknowledged that at the previous WAS conference there was not much mention of MGM as being a problem, and said that this topic was better represented at this year’s conference. She encouraged GALDEF to return to the next conference (2025) and to consider becoming a member so that GALDEF would have an official voice within the organization.

Networking was a valuable highlight of the conference. As one example, an Italian female representative of the European Society of Sexual Medicine was shocked to hear about the high rate of newborn circumcision in the USA. This was a common reaction among many non-U.S. participants. Her male colleague, also from Italy, later joined us in the conversation but took a difference approach. He admitted to Tim that he was circumcised – not saying whether it was by his own choice or imposed on him – but he said he found nothing to complain about. He asserted that circumcision was a parent’s choice. Tim shared with him the evolution of circumcision consent in the U.S. – that when the surgery first began in the U.S. it was solely at the doctor’s discretion and that parental consent for newborn circumcision was only instituted in the 1970s. Tim asserted that the next logical step in that evolution should be to postpone consent for medically unnecessary surgery until the person who must live with the consequences reaches the age of understanding and consent. It almost appeared to Tim that a lightbulb suddenly illuminate over this man’s head.

In all of our interactions we asserted that among circumcised men there is a subpopulation of us – finally acknowledged in the academic literature by Bossio and Pukall in 2017 – who experience various degrees of adverse physical, sexual, emotional, psychological and self-esteem consequences from our unwanted circumcisions and that many of us ultimately overcame false beliefs about the foreskin and circumcision that were instilled in us by society. Many of those with whom we networked agreed that more people within WAS and society in general need to hear the voices of men, so they can listen with their ears, minds and hearts to the lived experiences of circumcision sufferers and foreskin restorers.

In 2024 Tim will follow up his WAS2023 attendance with a presentation for WAS clinicians to educate them about the existence and needs of circumcision sufferers and foreskin restorers. For the 2025 conference we plan to submit an abstract for a roundtable discussion composed of a broad range of individuals from the U.S. and elsewhere, devotedly entirely to the topic of MGM (severity and scope of the problem, lack of consent, foreskin harvesting, solutions for community-based education and support for men, and proposals for regulatory and legal solutions).

GALDEF wishes to thank everyone who contributed to its fall Go Fund Me campaign to raise the funds that made it possible for Tim and Dr. Fahmy to attend this important conference.

Ethicist Brian Earp addresses WAS2023 about the need for harmonized medical policies regarding non-
therapeutic, non-consensual genital cutting applicable to all children equally – female, intersex and
male. Photo credit: Leif Thompson.

Tim Hammond shares findings from his survey of circumcision sufferers and foreskin restorers at
WAS2023. Photo credit: Leif Thompson.

Genital autonomy advocates at WAS2023 (L to R): Alfonso Cepeda-Emiliani (Researcher/Spain), Tim
Hammond (GALDEF/USA), Tiina Vilponen (Sexpo Foundation/Finland), Dr. Mohamed Fahmy (Pediatric
Surgeon/Egypt), Dan MacClymont (GALDEF/USA), Brian Earp (Ethicist/UK), Steve Scott (Genital
Autonomy of Utah/USA), Dr. Leif Thompson (GALDEF, DOC, Bruchim/USA). Photo credit: Leif Thompson.