Julien was 8 days old when he was circumcised, as recommended by Jewish tradition. If he has no memory of it, the Franco-Israeli forty-something continues to bear the traces of a ritual that “ruined” his life. “The Mohel [NDLR : le nom donné aux circonciseurs juifs] performed the operation in my grandparents’ house. He then cut my foreskin too much, so much so that he locked himself in a room to operate on it again”, he testifies. As the years passed, neither he nor his parents noted complications related to this gesture. But in adolescence, the young man will become aware of his difference. “My penis was very unsightly, and the scar was more marked in me than in other men. Above all, my glans dried up quickly, which caused me severe pain during sexual intercourse”, he explains. Also a victim of “infections” and “recurrent herpes”, Julien one day took advantage of a operation on his urethral conduit to ask the doctors to improve the aesthetic aspect of his penis: “This has made it possible to alleviate the problem a little. But I still have pain, and I remain psychologically destroyed.”
“Complications, there are all the time”
In France, 14% of men are circumcised according to a survey carried out in 2008, mainly for religious reasons. The practice, as a medical act, is performed only in the event of phimosis – an abnormal narrowing of the foreskin -, in hospital and under general anesthesia. So-called ritual circumcisions are performed differently depending on the religion. Among the Jews, the mohalim (the plural of mohel), who are not necessarily rabbis or doctors, realize it most of the time at 8 days. At this age, no hospital accepts to perform this gesture for medical reasons. The act therefore takes place in the synagogue or in private homes, without anesthesia. Among Muslims, there is no immutable rule, but the most widespread practice is that children are circumcised later, between 3 and 8 years old. In general, general practitioners take care of it, or conciliatory surgeons, who agree to make circumcision pass for a medical act, allowing in addition reimbursement by social security.
“But the professionals agree less and less to do it, so that the parents turn to unqualified circumcisers”, observes Florent Guérin, pediatric surgeon at the Kremlin-Bicêtre hospital (Val-de-Marne). In his service, one to two complications related to ritual circumcisions, mainly on babies, are observed each month, ranging from hemorrhage to amputation of the glans or necrosis of the penis, for the most serious cases. Silvia Scarvaglieri, a surgeon at the Armand-Trousseau hospital in Paris, believes that this type of problem happens “at least once a week”. Operations carried out by general practitioners, who are not specialists in this procedure, are also concerned. “I remember three ritual circumcisions done by a doctor, which required skin grafts and reconstruction of a foreskin. Complications, there are all the time, because there is no training to circumcise and the practice is not supervised”, analyzes Patrick Carlioz, pediatric surgeon, member of the National Academy of Surgery.
If medical circumcision must be performed by a urological surgeon in hospitals, ritual circumcision can indeed be performed by anyone, doctor or not. “The practice is so old that the Council of State considered it ‘admitted’ in a report in 2004, although it is devoid of any textual basis”, explains Alexandre Charpy, doctor of law and author of a legal article on the subject. And to add: “According to article 16-3 of the Civil Code, ‘the integrity of the human body may only be harmed in the event of medical necessity for the person’. This is not the case with ritual circumcision”. This tolerance of the judge, coupled with the taboo that sexuality constitutes for some and the weight of tradition, pushes the victims to remain most often silent. “90% of patients whose I took care of not filing a complaint”, says Patrick Carlioz. The situation is all the more complex as “certain complications only appear in the long term, whether they are sexual disorders or psychological trauma”, recalls Christian Castagnola , former vice-president of the French Association of Urology.
In October 2020, the Ritual Circumcision Center (CCR) in Bordeaux, opened three years earlier, was pinned down by a dozen mainly Muslim families, for hematomas, persistent bleeding or healing problems, of which their children aged 1 to 3 years. One should even perform “reconstructive surgery as a teenager”. “Instead of having the circumcision performed by an imam or a rabbi, my clients preferred to perform it in a medical center. They had the impression of remaining in their traditions, while being safe”, relates Me Pierre Landete, lawyer of three plaintiffs. On its website, the CCR indeed promises “a revolutionary technique” and “almost painless”, the “Magen clip”, invoiced 500 euros. “The idea is to squeeze the foreskin very tightly with pliers before cutting it. But the argument of low pain is misleading, because it is one of the areas of the penis with the most nerve endings”, comments Patrick Carlioz.
At the head of the center and of these operations, Doctor David Assuied, “mohel from father to son”, defends his practice: “I was trained in the United States and in Israel, and I performed more than 3000 circumcisions .With the local anesthesia that I perform, the children do not suffer.” Pending the conclusions of the criminal investigation, the practitioner can no longer operate and the Bordeaux center has closed. But the structure has since continued to rent houses for ritual circumcisions, performed by other mohalim.
The “metzitsa” at the heart of the discord
To avoid this type of abuse, the Israelite Central Consistory of France – the institution responsible for organizing Jewish worship throughout the territory – created in 2014 the French Association of Mohalim. “With rabbis, lawyers and urologists, we have established a guide to good practices for performing ritual circumcision. This has made it possible to standardize the techniques of the mohalim, who are trained abroad”, explains Moché Lewin, adviser special from the Chief Rabbi of France. If the 15 circumcisers approved by the association are not all doctors and perform the operation without anesthesia, Moché Lewin assures us: “Since the creation of the association, we had to withdraw the approval only once from a mohel We are currently studying another case for which the circumcision would have gone wrong, but all our mohalim are very rigorous.”
One practice in particular remains much debated: that of metsitsa, a Hebrew term that designates the sucking of blood from the baby’s penis through the mouth of the mohel, once the circumcision is complete. “The association banned this method, used in particular among ultra-Orthodox Jews, because it was dangerous for the child. Our mohalim therefore use a pipette”, specifies Moché Lewin. In the United States, several newborn victims of metzitsa have indeed caught neonatal herpes, a rare infection which caused the death of two of them in 2011. In France, Sarah* , a former extern in pediatric intensive care in a Parisian hospital, remembers a similar case. “A baby had undergone this ritual, and developed sepsis which had necrosed his brain,” she says.
L’Express has found a dozen mohalim who continue to practice the metzitza on the territory. Among them, Aharon Altabé, who explains having carried out more than “1500 circumcisions of infants and adults”. On his site, the latter writes that “it brings nothing to seek to do circumcision in a doctor’s office”, and that “it is dangerous to do it in a hospital environment”. Regarding the metzitza, Aharon Altabé supports the safety of the method, “based on a teaching of the Sages”: “If the metzitza was so dangerous, how to explain the low rate of infected children?”, He asks. “You know very well that beyond the metzitza, what interests our enemies is the very practice of circumcision, under cover of the right of children to physical integrity”, can we read in another passage. Contacted, Aharon Altabé did not wish to answer our questions.
*Name has been changed.