Monthly Archives: November 2014

Unspoken complications of circumcision

AAP: “Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. [...]Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; [...] Male circumcision does not appear to adversely affect penile sexual function/ sensitivity or sexual satisfaction. It is imperative that those providing circumcision  are adequately trained and that both sterile techniques and  effective pain management are used. Significant acute complications are rare. [...] Parents are entitled to factually correct, nonbiased information about circumcision

AAP: “The true incidence of complications after newborn circumcision is unknown,
in part due to differing definitions  of “complication” and differing standards for determining the timing of when a complication has occurred [...] Significant acute complications are rare, occurring in approximately 1 in 500 newborn male circumcisions.
Acute complications are usually minor and most commonly involve bleeding, infection, or an imperfect amount of tissue removed.[...] Late complications of newborn circumcision
include excessive residual skin (incomplete circumcision), excessive
skin removal … ”

AAP: “Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the  severity of complications. [...] Financial costs of care, emotional tolls, or the need for future corrective surgery (with the attendant anesthetic risks, family stress, and expense) are unknown.”

Activists monitoring social networks often encounter individual cases of complications that usually go unreported, and where evidently medical staff have done as much possible to make parents feel good regardless of the negative outcome. The previous statements mention “excessive skin removal”. While this may not sound very important because, well, “it’s just skin”, truth is penile skin has an important role in sexual life and development. And while parents are not thinking about the future sexual life of their child (except in their desire to conform to a social norm by circumcising), this excessive loss of skin results in dramatic harm to the individuals sexual life.

The skin of the penis is supposed to move during sex. In fact, it is supposed to glide over the glans, something that is almost always destroyed by circumcision. But the skin also has to be able to accommodate a normal erection. In other words, when the erectile tissue inside the penis swells with blood to make the penis enlarge and become stiff, there needs to be enough skin to accommodate its length.

When there is not enough skin, many things can happen. The penis can bend unnaturally when erect. The skin can chafe and even bleed during sex due to friction. The penis may pull surrounding skin (from the scrotum and pubic area) to make for the lack of normal penile skin, resulting in pubic hair climbing up the shaft, and potentially penetrating the individual’s sexual partner, causing bruising and tears inside. Insufficient skin can also cause part of the penis to push inward during erection (because there is nowhere else for the erectile tissue to go) causing pain during erection.

Many men who experience these complications may not seek help because they assume it’s normal, it’s what an erection feels like or looks like.

In fact, the loss of tissue due to circumcision is the reason why American supermarkets and pharmacies devote shelf space to artificial lubricants, so that men who lost too much tissue can masturbate or have sex.

In a bodybuilding forum we found one such case reported by a non-activist individual asking for advice from his peers.

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What motivates this post today is a photo found by activists today on Facebook. In that photo, a relative of a newborn reports that the baby finally left the hospital. Bleeding after circumcision was stopped, but infection is still a concern. Too much skin was removed and they are going to let it heal and follow up in two weeks, and they may use skin grafts later on.

baby1baby2

This is one of those complications that barely registers with people, one that the media doesn’t care about, one of those stories that will go unreported and unnoticed. It’s just skin. Until one day, 20 or 30 years later, baby is now an adult, and finds himself wondering why he can’t masturbate or have sex without lube. Why his skin chafes and gets sore if he tries to. Why he ends in pain if he does.

Or his girlfriend, wife, etc., wonders why she ends up with pain and burning inside her vagina after intercourse.

Oh, but it was just some extra skin, wasn’t it?

Oh, but the benefits outweigh the risks, don’t they?

I’m disgusted by the comments I see. Nobody should have to refer to a baby as a “trooper” or a “fighter” just because they allowed a doctor to harm the baby.

Notice the relative’s comment: “wish it was over for him or better yet it never happened“. Well, sad to say, but it wouldn’t have happened if it wasn’t for the circumcision. This injury was 100% preventable.

Another person says “somebody needs to answer a question about removing too much skin“. Well, they did. The AAP statement mentions the risk. Most consent forms mention the risk. They just don’t tell you how bad it really is when it happens. So parents assume that removing too much tissue is just a cosmetic problem. Not that it will involve bleeding, risk of infection (weren’t they trying to prevent infections anyway?), pain, additional surgeries… And what they don’t know yet, long term pain. During sex.

Notice the person who says one of her children had the same problem and the nurses told her that it was a “French cut” and “girls loved it“. The moment when the baby’s genitalia becomes sexualized to appease adults. This again proves that American circumcision is mostly a social fetish disguised as medicine, and that doctors and nurses will say anything to make parents feel good.

In fact, Googling “French cut circumcision” reveals that it something different. What is considered a European or French style circumcision is a low and loose circumcision, not one where excessive tissue was removed.

I’ve known many cases of men harmed in this way. Some became activists. Some have been restoring their foreskins for many years to reduce the pain.

I know a mother who had her first 3 children circumcised. She used to think the right circumcision was the one they did on her first born, the one that had a tight circumcision. Until he turned 4-5 and started expressing pain when he has erections. She is now an activist against circumcision, of course, and regrets the harm that came to her child.

Seeing this photo on Facebook today I can only think: Poor hurt baby. My heart breaks for you and all the other babies and the adults they become who were and will be harmed by this mindless unnecessary, risky and damaging surgery.

Is this harm always accidental?

A number of circumcision fetishists tend to favor “high and tight” circumcisions and often fixate on the removal of the frenulum – something which is necessarily sexual harm, given the sexual sensitivity and pleasure caused by an intact frenulum. And American doctors never mention what happens to the frenulum during circumcision – in fact the word “frenulum” is not even present on the AAP Technical Report on circumcision from 2012!

In this video, the makers of a circumcision device explain how to use their device for a tight circumcision with frenulum cauterization. In other words, to cause as much harm as possible!

One can only wonder… Why?

But they won’t answer.

 

Dr. Charles E. Flack – the expert witness in the case of Chase

Important: the fundraiser page moved to http://www.savingchase.org

The hearings for the case of Nibus vs. Hironimus took place between March of 2014 to May of 2014. During these hearings, Pediatric Urologist Charles Flack “testified by telephone upon agreement of the parties’ lawyers even though no notary was present with him to verify the Court’s administration of the oath“.

Dr Charles E. Flack

Dr Charles E. Flack
Office Location
10301 Hagen Ranch Rd
Suite C130
Boynton Beach, FL 33437
Contact
Phone: (561) 736-7313
Fax: (561) 736-2309

According to inside sources, Dr. Flack could be the pediatric urologist of choice by the father to perform the circumcision. If that is the case, it must be noted that there would be a conflict of interests as Dr. Flack would stand to profit from a ruling in favor of the father (and from performing an unnecessary surgery on a minor).

According to the order of May 9th, “while Dr. Flack did opine that the procedure was not medically necessary, significantly, he advised the Court and the parties that penile cancer occurs only in uncircumcised males and uncircumcised males have a higher risk of HIV infection than circumcised males. He further testified that the procedure last only 17 minutes and patients experience little post-operative discomfort and few recovery problems. Finally, he testified that performing the procedure on boys up to 10 years of age is medically acceptable, the concern being that with older boys who have reached puberty, an erection could cause tears in the sutures.

Court order from May 2014

Court order from May 2014

Well, let’s see if Dr. Flack’s assertions are supported by current standards of medicine (whether we agree with them or not).

Penile Cancer

Dr Flack: “penile cancer occurs only in uncircumcised male

AAP: “A history of phimosis alone confers a significantly elevated risk of invasive cancer (OR: 11.4). In fact, in men with an intact prepuce and no phimosis, there is a decreased risk of invasive penile cancer (OR: 0.5). When excluding phimosis, the risk disappears [...] The clinical value of the modest risk reduction from circumcision for a rare cancer is difficult to measure against the potential for complications from the procedure.” (AAP Technical Report on Circumcision from August 27th of 2012)

So, penile cancer is a rare disease and it occurs mostly on old men. It is usually associated with HPV and with phimosis during adulthood. HPV infection can occur in any sexually active individual. Adult phimosis can often be treated without circumcision. Penile cancer DOES, in fact, occur on circumcised men.

It would make more sense from a social health point of view to remove the breast buds of girls to reduce the risk of breast cancer, than removing the foreskin as a way to prevent penile cancer.

HIV

Dr Flack: “uncircumcised males have a higher risk of HIV infection

AAP: “40% to 60% for male circumcision in reducing the risk of HIV acquisition among heterosexual males in areas with high HIV prevalence due to heterosexual transmission (ie, Africa). [...] more than 619 000 people in the United States have died of AIDS since the epidemic began.38 In the United States, HIV/AIDS predominantly affects men who have sex with men (MSM), who account for almost two-thirds (61%) of all new infections. Heterosexual exposure accounts for 27% of new HIV infections, and injection drug use accounts for 9% of new HIV cases. In other parts of the world (eg, Africa), heterosexual transmission is far more common.”(AAP Technical Report on Circumcision from August 27th of 2012)

Notice that the text of the ruling does not mention that this “protective effect” is limited to “heterosexual males in areas with high HIV prevalence due to heterosexual transmission”. Given the high rates of circumcision in the United States and the prevalence of the American epidemic of HIV on MSM (men who have sex with men), most of those people who died from AIDS would have been circumcised males.

In 2009, Dr. Ronald Gray, one of the main researchers of circumcision and HIV in Africa and author of some of the studies that found this “consistent” protective effect, said:

“If you were to ask me, should the U.S. be promoting circumcision, my answer would be, ‘no,’ What I do think ought to be the policy is that parents should be informed about the potential protective effects” NYTimes

Studies have failed to find such “protective effect” in the United States due to the different characteristics of the epidemic. Reuters

Complications

Dr. Flack: “patients experience little post-operative discomfort and few recovery problems

AAP: “The true incidence of complications after newborn circumcision is unknown, in part due to differing definitions of “complication” and differing standards for determining the timing of when a complication has occurred (ie, early or late). Adding to the confusion is the comingling of “early” complications, such as bleeding or infection, with “late” complications such as adhesions and meatal stenosis.” (AAP Technical Report on Circumcision from August 27th of 2012)

CDC’s Charbel El Bcheraoui:  the risk of experiencing complications was 20 times higher for boys ages 1 to 9 years. (May 2013)

For an idea of what the complications can be and the different age ranges, see this list at Circleaks and this other list for 2013, at Circwatch.

James R. Robertson, Ed.D., studied the effects of circumcision during childhood. He concluded: “In summary, the 19 letters from men circumcised between ages three and six reveal emotional results in conformity with predicted psychoanalytic consequences for circumcision performed during the phallic stage. These 19 men characteristically feel mutilated, diminished and incomplete. They are preoccupied, if not fixated, with their lost foreskins. They show anger at having been denied the right to choose. When they have attempted to discuss their feelings, they tend to have been met with ridicule, rejection and amusement.” (1989)

Erections

Dr. Flack: “performing the procedure on boys up to 10 years of age is medically acceptable, the concern being that with older boys who have reached puberty, an erection could cause tears in the sutures

NewKidsCenter.com: “Erection is common among infants and toddlers. (…) Often early erections come for no reason at all (…) Erection could also mean that the boy’s bladder is full and he ‘needs to pee’.”

AAP: An old guideline for parents on care of the uncircumcised penis used to say: “The foreskin may retract spontaneously with erections which occur normally from birth on and even occur in fetal life.” This information is no longer available in the current AAP page on care for the uncircumcised penis.

So, evidently, erections can occur at any age and do not make a difference as to whether a male can be circumcised or not. Over a million baby boys are circumcised in the U.S. every year in spite of erections being also present in neonates.

This is not a valid reason to perform the operation before the patient has the age to consent, but perhaps the reason for this artificial age is the legal precedent of Boldt vs. Boldt, in Oregon, which started when a divorced father decided to convert to Judaism and have his (9 year old) son convert and get circumcised, which the child refused. While the process took several years, the court ruled that a parent could not compel a child to get circumcised against his will.

Conclusion

All the points quoted by the Court from Dr. Flack’s testimony are either partially false, or irrelevant. The only fully true statement is that “the procedure was not medically necessary“.

Dr. Flack may have a conflict of interest in his testimony if he is the doctor that the father is depending on to perform the circumcision, and as the person that stands directly to gain financially from a favorable outcome for the boy’s father, he has incentive to withhold information that could dissuade the judge from ruling in the father’s favor. He may even be inclined to misrepresent, even present false information. In essence, his testimony in court may have been no more than a shameless self-advert.

Were Dr. Flack to perform a circumcision on Chase, not only would he have given a misleading, partially false testimony in Court, but he would also be profiting from the results of his testimony and from causing bodily and emotional harm to a child.

#SavingChase – follow up on Judge keep your hands off my penis

Judge Jeffrey Gillen

Judge Jeffrey Gillen

Chase

Chase

In May we shared that a Florida judge had ruled that a mother must submit her 3 and 1/2 year old son to circumcision as required by the father, in spite of the mother’s fear of the risk of death related to general anesthesia, and in spite of admitting that the procedure is not medically necessary.

Back then the mother filed an appeal. Last Thursday, November 6th, the Court of Appeals denied her motion. Chase, now 4 years old, is now running out of time, but the mother continues fighting and the case might have to go all the way to the Supreme Court to protect the physical integrity of her son and his right to bodily integrity and genital autonomy.

You can help in any of these places

Fundraiser:
http://www.youcaring.com/other/saving-chase/259991

Photo and video campaign:
https://www.facebook.com/events/357342571110808/358327774345621

Petition:
http://tinyurl.com/l53w9rp

Youtube:
https://www.youtube.com/channel/UCqZFAkBXp5PdpVQ1Rp7cC7A

Facebook Page:
https://www.facebook.com/ChasesGuardians

Twitter:
https://twitter.com/savingchase4