Category Archives: AAP

Baby dies after circumcision – Social networks

We mentioned a while ago that “Activists monitoring social networks often encounter individual cases of complications that usually go unreported“.

A new tragic case will likely be recorded as death caused by ex-sanguination (loss of blood) or systemic failure, while failing to mention that the blood was lost through an intentional wound on the body (circumcision).

The activist who shared the screenshots below, wrote: “On December 14th, 2014, a mother gave birth to her son via emergency c-section. From what I was told the mother and baby were doing fine after the delivery. On December 17th, 2014, the child was circumcised. I do not know the reasoning for the circumcision but I do know they were first time parents. A few hours later the child was pronounced dead. The parents were told the baby suffered massive blood loss but that an autopsy must be performed before the cause of death would be official“.

Rest in peace sweet baby. The names were blacked out by the activist who shared this, in order to protect the privacy of the family.

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As it always happens, some people gets heated about these senseless tragedies, and some people criticize those who share these kinds of information during times of loss for the families, for what they perceive as bashing the families. But if this information was not shared, how would you know? Would you expect to hear this from the AAP? From the CDC? They won’t tell you.

The AAP in the Technical Report on circumcision, August 27 to 2012, “The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this literature review).” (see page 20 of Technical Report)

It’s not the families’ fault. Yes, they signed a consent form, but quite often they were pressured by doctors, nurses, family, society, they were kept ignorant of the risks, they were told that “the benefits outweigh the risks“, most likely the dads are circumcised, who can think that anything can go wrong during a circumcision?

So sad that lives of babies can be “excluded” for being just “case reports”.

Doug Diekema, Susan Blank, Michael Brady, Ellen Buerk, Waldemar Carlo, Andrew Freeman, Lynne Maxwell, Steven Wegner, this is the truth that you withhold from the American public. Your hands are tainted with babies’ blood. The American public will remember you.

 

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.

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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.

 

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Some Catastrophic Complications of Circumcision Recorded During 2013

This is what the American Academy of Pediatrics (AAP) says about catastrophic complications from circumcision, on the 2012 Policy Statement on Circumcision and Technical Report on Circumcision:

The majority of severe or even catastrophic
injuries are so infrequent as
to be reported as case reports (and
were therefore excluded from this
literature review). These rare complications
include glans or penile amputation,
198–206 transmission of herpes
simplex after mouth-to-penis contact
by a mohel (Jewish ritual circumcisers)
after circumcision,207–209 methicillinresistant
Staphylococcus aureus infection,
210 urethral cutaneous fistula,211
glans ischemia,212 and death.213

January 2, 2013. TURKEY: Boy loses penis in circumcision
http://www.hurriyetdailynews.com/Default.aspx?pageID=238&nid=38346&op=sent

February 14, 2013. BELGIUM: Male circumcision tied to less sexual pleasure
http://www.reuters.com/article/2013/02/14/us-health-male-circumcision-idUSBRE91D1CO20130214

February 19, 2013. BRAZIL: Study: mortality of medical circumcision, one death in 7700
http://www.ncbi.nlm.nih.gov/pubmed/23386015

February 21, 2013. JAKARTA: 3 year old Boy with haemophilia bleeds after circumcision
http://www.thejakartapost.com/news/2013/02/21/toddler-with-hemophilia-bleeds-after-circumcision.html

February 28, 2013. JAKARTA: Mother kills 9 year old son after circumcision shrinks penis
http://www.brisbanetimes.com.au/world/indonesian-mum-kills-son-over-penis-size-20130228-2f94r.html#ixzz2MDuQOUQn

March 5, 2013. Queens Infant Disfigured in 2011 Botched Bris, Lawsuit Charges
http://www.dnainfo.com/new-york/20130305/forest-hills/queens-infant-disfigured-botched-bris-lawsuit-charges

March 8, 2013. Baby bleeds after circumcision, suffers seizures and dies two days later. Hospital and family deny that circumcision was the cause.
http://circumstitionsnews.blogspot.com/2013/03/sacramento-another-circumcision-death.html

March 16, 2013. UNITED STATES: More than $80 million paid out for botched circumcisions since 1985
http://www.arclaw.org/resources/settlements

April 6, 2013. NEW YORK. Two Infants Contract Herpes Following Circumcision and Metzitzah b’Peh.
http://www.medicaldaily.com/articles/14560/20130406/circumcision-male-circumcision-jewish-ultra-orthodox-herpes-hiv.htm#445eUUYH8QRI6GtZ.99

May 29, 2013. CHICAGO: $1.3 million for botched circumcision, baby had the tip of the glans amputated during his circumcision in 2007
http://www.suntimes.com/news/metro/20417085-418/jury-awards-13m-for-newborns-botched-circumcision-attorneys.html

May 29, 2013. MOROCCO. A 3 year old child had part of the glans amputated during a hospital circumcision. This was reported online by the family, with a text in Arabic and a horrific youtube video (which was later deleted). The mother commented in our blog to let us know that a Canadian urologist had already seen the child and recommended long term follow up in case there was stenosis later, which may suggest that they were either able to re-attach or otherwise close the wound without further complications.
http://circwatch.org/boy-3-years-old-suffers-partial-amputation-of-the-glans-during-circumcision-in-morocco/

June 7, 2013. TEL AVIV. Baby Dies in Israeli Hospital following Circumcision. Rabbinate denies any connection with the procedure. Baby stopped breathing minutes after the circumcision.
http://www.jewishpress.com/news/breaking-news/baby-dies-in-israeli-hospital-following-circumcision/2013/06/07/

June 10, 2013. EGYPT: Girl dies during circumcision at clinic
http://english.alarabiya.net/en/News/middle-east/2013/06/10/Egyptian-girl-dies-while-being-circumcised.html

June 17, 2013. SAUDI ARABIA: Doctor who botched 7 circumcisions gets 6 months
http://gulfnews.com/news/region/egypt/egyptian-doctor-convicted-of-botched-surgery-1.1198313

June 20, 2013. SOUTH AFRICA: R2.2M for botched medical circumcision of a child in 2009. He suffered severe burning, infections and a loss of his normal penile tissue after the procedure.
http://www.iol.co.za/news/crime-courts/r2-2m-for-boy-s-botched-circumcision-1.1534852

July 7, 2013. CHINA: man loses penis after botched circumcision
http://www.malaysia-chronicle.com/index.php?option=com_k2&view=item&id=125131:ouch-penis-amputated-after-botched-circumcision&Itemid=4#ixzz2YRJLaCh6

July 8, 2013. 20 more die, nearly 300 in hospital in botched circumcisions in Eastern Cape, South Africa
http://www.news.com.au/world-news/circumcision-ritual-kills-30-tribesmen-in-south-africas-eastern-cape/story-fndir2ev-1226675702537

5 men held for about 30 botched circumcision deaths in Eastern Cape, South Africa
http://www.news24.com/SouthAfrica/News/5-held-for-botched-circumcision-deaths-20130708

UGANDA: Man loses penis in circumcision botch – July 2013
http://www.newvision.co.ug/news/645118-man-loses-penis-in-medical-circumcision.html

JULY

Boys forcefully circumcised in South Africa, several botched procedures
http://www.iol.co.za/news/crime-courts/r3m-claim-for-six-botched-circumcisions-1.1594608#.Umt1WlOhs_c

Surgery on intersex children could be unconstitutional – after sex reassignment of an intersex boy in State custody in S.C. (castration and amputation of penis)
http://www.splcenter.org/get-informed/news/federal-court-says-sex-assignment-surgery-on-child-could-violate-us-constitution-r

AUGUST

Two more babies reported to have contracted Herpes after metzitzah b’peh during Jewish circumcision in NYC. August 2013
http://newsok.com/babies-herpes-linked-to-circumcision-practice/article/3875218

More men seeking legal advice after botched infant circumcisions in Australia.
http://www.perthnow.com.au/news/western-australia/botched-circumcisions-on-the-rise/story-fnhocxo3-1226701536216

4 year old boy dies after hospital circumcision in South Africa. August 2013
http://www.iol.co.za/news/south-africa/gauteng/child-dies-after-circumcision-at-hospital-1.1563203#.Ug6TD6z2L2w

Nearly 80 boys and young men die after traditional circumcisions in South Africa. August 2013
http://www.africanspotlight.com/2013/07/20/when-circumcision-can-mean-death-in-south-africa/

NOVEMBER

UAE baby has penis partially cut off during circumcision. November 2013
http://www.emirates247.com/news/18-day-old-baby-s-organ-partially-cut-off-during-circumcision-2013-11-14-1.528015

UK Doctor accused of botching circumcision quits NHS – in order to perform circumcisions independently
http://www.bbc.co.uk/news/health-24961405

Tennessee baby suffers amputation. August 2013. Reported November of 2013
http://www.myfoxmemphis.com/story/23912521/mother-upset-over-botched-circumcision#axzz2p4dLMw5W

November 28, 2013. A baby died during a medical circumcision in Afghanistan. The parents wanted to avoid the pain of a later circumcision without anesthesia. The anesthesia was improperly applied and the baby died as a consequence. This was only reported on a facebook post which was later deleted by the family.

DECEMBER

Brooklyn Rabbi botched circumcision of baby with hypospadias. December 2009, reported December 2013.
http://www.courthousenews.com/2013/12/05/63485.htm

Canadian Doctor barred from performing circumcisions after more than 80 botched procedures. Botched procedures recorded since 2010. News reported December 2013
http://www.montrealgazette.com/health/Doctor+barred+from+performing+circumcisions+after+dozens+botched+procedures/9323461/story.html

Jewish baby in Pittsburgh has penis cut off during Jewish circumcision. April 2013. Reported December 2013
http://www.dailymail.co.uk/news/article-2530755/Jewish-Rabbi-sued-accidentally-SEVERING-newborn-baby-boys-penis-Bris-Ceremony.html#ixzz2otJjZ9Ht

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Memphis report of a botched circumcision

WMCTV5 and Fox 13 reported on a mother’s anguish over a botched circumcision of her three month old son, in August. The mom, Maggie Rhodes described the surgery as taking 3 hours where the baby was crying all the time, and going back home with the baby still crying where her sister removed the bandage to find her “son’s penis was not there”.

While there are not enough details in the report to know whether this was really an accidental amputation (which I don’t consider likely, as it would have been beyond irresponsible and criminal to give back a child with an amputated penis without warning), or if there is lack of clarity and this is a case of buried penis, a known complication of circumcision. Buried penis is sometimes overcome as the baby grows, but it also needs surgical repair some times.

The report says: “All that was left was a partial penis and his tiny testicles. Rhodes said Ashton urinates through a hole in his penis.”

This, however, is consistent with the appearance of a buried penis. I’m speculating here though, because I don’t want to believe that health professionals can be so stupid, criminal and unethical as to amputate the penis and not say a word to the mother.

Concealed penis encompasses both congenital and acquired conditions whereby the phallus is retracted inward beneath the suprapubic fat pad and partially obscured by preputial skin.14  The congenital etiology of concealed penis is thought to result from (1) poor elasticity of dartos fascia, restricting its ability to move freely through deep layers of tissue, and (2) the lack of anchoring of the penile skin to deep fascia, which in turn limits extension.15  In older or obese children, anatomical factors such as a pronounced suprapubic fat pad or a large pannus may contribute to the aforementioned congenital anomalies to effectively obscure the phallus.  Moreover, an unsuccessful circumcision may also serve to exacerbate this condition by causing penile entrapment or by allowing the concealed penis to recede further beneath surrounding tissue.

Buried / Concealed penis

The AAP Technical Report on Circumcision states:

There is good evidence that circumcision of a premature infant is associated with an increased risk of later-occurring complications (ie, poor cosmesis, increased risk of trapped penis, adhesions). There is also good evidence that circumcision of a newborn who has a prominent suprapubic fat pad or penoscrotal webbing has a higher risk for the same long-term complications.

While the AAP states that the “benefits outweigh the risks“, the report also states that:

Financial costs of care, emotional tolls, or the need for future corrective surgery (with the attendant anesthetic risks, family stress, and expense) are unknown.

And the most damning statement: “The true incidence of complications after newborn circumcision is unknown.

“Like, ‘Momma like, how could this happen to me? How could this happen to me?How could you explain that to your child that you don’t have a penis that they have to reconstruct one or you probably have might not never be able to have kids? That don’t sit well with me at all.” – Maggie Rhodes

Read more: http://www.myfoxmemphis.com/story/23912521/mother-upset-over-botched-circumcision#ixzz2k44fAtcl

Also: http://www.wmctv.com/story/23899878/a-look-ahead-mother-claims-doctor-disfigured-son-after-botched-circumcision

FOX13 News contacted Christ Community Health Centers for a comment. They were told the CEO is aware of their request, but so far has not returned their repeated calls.

Maggie, our heart is with you, with your son and with your family.

Factually correct information? Kaiser Permanente flyer on newborn circumcision

The AAP states that: “Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions.

Yet, how much information are hospitals and doctors willing to give to parents?

Check out this pdf file from Kaiser Permanente: http://www.permanente.net/homepage/kaiser/pdf/3558.pdf

It starts with a very common lie: “Circumcision is the removal of the foreskin that covers the tip of the penis“. Actually the foreskin is the tip of the penis, not an attachment, not a fashion accessory. There is no clear line of separation between the foreskin and the penis, and in fact there is no standard as to how much or exactly what tissues need to be removed. The foreskin does cover something, it covers the glans, as much as the lips of the mouth cover the inside of the mouth.

The listed risks of circumcision mentioned by the flyer are: infection, bleeding, pain, injury to the penis.

How severe are these risks? The flyer says these risks are small and “serious complications are very rare (1 in 500)”. I wouldn’t call a 1 in 500 rate to be very rare, when compared to 1.2 million newborns circumcised every year in the United States. That means 2,400 babies every year would experience serious complications.

What the flyer doesn’t state is: bleeding and infections can become fatal. Injuries to the penis can last a lifetime. And exactly what kind of injuries we are talking of? Mild ones, as adhesions (that will be painful and traumatizing for parents), more complex injuries (such as meatal stenosis, fistulas, damage to the urethra, all of which will require additional surgeries to “repair”), to completely damaging injuries (loss of part or the whole glans, loss of the penis, loss of all the skin of the penis, too much skin removed which may result in pain and abrasions during sex in adult life…)

Then the flyer moves to mention the effect on men’s sexual life, saying it “is not fully known. Some studies have reported equal sensation“, but the untold part, implicit by the word “some“, is that some other studies have indeed shown less sensation and decrease on sexual function. One of such studies, which should be enough for doctors to think it twice – and yet it has never been seriously considered by the AAP, is “Fine-touch pressure thresholds in the adult penis” (Sorrells et al, 2007), which states that “The glans of the circumcised penis is less sensitive to fine touch than the glans of the uncircumcised penis. The transitional region from the external to the internal prepuce is the most sensitive region of the uncircumcised penis and more sensitive than the most sensitive region of the circumcised penis. Circumcision ablates the most sensitive parts of the penis“. A slightly similar study by Payne et al., didn’t find a difference, but they never took measurements on the foreskin! In the words on one of the researchers, “[t]he foreskin’s job is to cover the penis and protect it,” she said. “Its job is not to be a part of the sensitivity.” Talk about researcher’s bias.

Then the flyer moves to the “benefits of circumcision”, and the first one is of course “lowers the risk of cancer of the penis“. But how much is the real risk of cancer of penis? Is it frequent? Does it really decrease? The AAP, in spite of touting this same benefit, has to come clean when showing numbers, by saying: “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, which suggests that the benefit of circumcision is conferred by reducing the risk of phimosis and that the phimosis is responsible for the increased risk.” (page 14 of the Technical Report), and again the untold part is that phimosis can often be treated without any excision of tissue, thus making circumcision unnecessary.

Not only that, but this benefit is not proportional to the complications that it would cause. The report again, states that:

It is difficult to establish how many male circumcisions it would take to prevent a case of penile cancer, and at what cost economically and physically. One study with good evidence estimates that based on having to do 909 circumcisions to prevent 1 penile cancer event, 2 complications would be expected for every penile cancer event avoided.121 However, another study with fair evidence estimates that more than 322 000 newborn circumcisions are required to prevent 1 penile cancer event per year.122 This would translate into 644 complications per cancer event, by using the most favorable rate of complications, including rare but significant complications.123 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. In addition, these findings are likely to decrease with increasing rates of HPV vaccination in the United States.

So, 909 to 322,000 circumcisions to prevent a single occurrence of a cancer that takes place in old age, at the cost of 2 to 644 complications. Doesn’t sound that great of a benefits, does it?

The second benefit is a lower risk of UTIs. Other sources (including the AAP) usually say “during the first year of life”. Normally, what they don’t say is that the risk is already lower in males than in females regardless of circumcision status, and that UTIs in females are treated with medicine. Not only that, but circumcised babies still get UTIs. So, does this justify the removal of erogenous tissue?

The third stated benefit is “May help prevent STDS such as HIV“. Notice the words “May help”. We all know that the United States has a high prevalence of HIV and other STDs, compared not only to Europe, but to Latin America, and yet most men in the United States are circumcised and most men in Europe and Latin America are not. So how has circumcision helped, really?

Fortunately, a paragraph later Kaiser states that these long-term benefits are small. It still does not addresses the fact that circumcision DOES NOT prevent STDs and safe sex practices should be encouraged.

Then they state “the decision to circumcise your baby is a personal choice“. Intact-friendly circles strongly oppose this wording, because the personal choice of parents doesn’t take into consideration the personal preference of the person undergoing the procedure. A circumcised baby becomes a forcefully circumcised man, whether he likes it or not, whether he feels it was beneficial or harmful. And in fact, if genital alteration surgery was a personal choice, female circumcision of babies (i.e. labiaplasty or clitoral unhooding) would also be a personal choice of the parents, but it isn’t. In the United States, any non-therapeutic alteration of the genitals of a female minor (except in pregnancy and labor) is a federal crime regardless of the cultural or religious beliefs. We can argue that in both cases, (and not talking of the extreme cases of FGM such as infibulation, clitoridectomy, but of the mild forms, the one that consenting adults can get done at a plastic surgeon, labiaplasty and clitoral unhooding, or even the “ritual nick”) male and female circumcision of minors both remove erogenous healthy tissue without the patient’s consent. Even the AAP stated in 2010 (in a now retracted policy on “Ritual Genital Cutting of Female Minors“) that “Some forms of FGC are less extensive than the newborn male circumcision commonly performed in the West“. So if this is true, why is every form of FGC a crime while male circumcision is “personal choice” of the parents?

The flyer then states that “some parents talk about whether their son will look like his father or like other boys in the locker room”. Both arguments are non-medical and simply fallacious. The boy won’t ever look like his dad, nor like other boys in the locker room. Every circumcision looks different. Parents and sons don’t often sit around comparing genitals, nor boys do. So this is a bullshit reason to appease the sense of conformity and impose a “social surgery” upon non-consenting individuals by brainwashing those who can sign the proxy consent.

The flyer continues: “The American Academy of Pediatrics does not recommend circumcision as a routine procedure” – this is true, and yet people are severely confused about it, thanks to the so touted “benefits outweigh the risks” mantra that the media so gladly parroted on August 27th of 2012.

In deciding, the flyer says: “You may want to talk with your partner, family, or firends to help you decide. Consider your cultural and/or religious values.” – Are there any other excising surgeries that are done for cultural or religious reasons? Is this medicine or religion? Is it ethical to permanently and irreversibly remove part of a person’s body for cultural or religious reasons without that person’s consent?

The flyer then says: “Making a decision about circumcision is more difficult after delivery, when you may be very tired“. Not only tired, but by then the mother may feel protective of the baby and won’t want to hand him for a surgery that is painful. But let’s not talk about that, right Kaiser?

The “How is circumcision done” portion of the flyer is what triggered me to dissect it.

The first phrase: “Infants must be stable and healthy to be circumcised in the hospital“, unfortunately is contradicted in the real world, where premature babies and babies straight out of the NICU are often circumcised, contradicting general medical practices. In March of 2013 I was aware of a case where a baby in California who had shown to have clotting issues (the pinpricks didn’t heal properly), and yet he was circumcised; the baby died two days later, after suffering major loss of blood and seizures, yet the doctors attributed it to an existing bacteria or condition. The non-healing pinpricks should have been enough to suspect that the baby was not in good conditions to undergo an excision.

The flyer says that a shot of pain medicine or an anesthetic cream is used, in addition to a sucrose pacifier, for pain relief. Anesthetic creams don’t stop the severe pain of cutting a densely innervated part of the body. Shots of anesthetic are painful themselves, but are more effective. Sucrose pacifier at most keeps the baby partially distracted (or trying not to choke!).

The flyer then says that your baby may have some mild pain during and after the surgery, which usually does not last more than a day. This is contradicted and you can find reports in social media of babies in severe pain every time the diaper is changed for a week or so. Parents are often unprepared for the pain that their babies will experience.

The flyer then describes the plastibell method as follows:

* A plastic ring is tied around the end of the penis
* The foreskin is removed
* The plastic ring stays on the end of the penis and prevents bleeding after the surgery.

This is highly imprecise. A more realistic description would be:

* The glans and the penis are forcefully separated with a blunt probe.
* A dorsal incision is cut on the foreskin with scissors for easy insertion of the ring.
* The ring is inserted over the glans and tied with a string to cut off circulation to the foreskin (to necrotize the tissue)
* The foreskin may or may not be cut off with a scalpel at that point. The ring keeps the outer and inner layers of the foreskin joined for healing and keeps circulation from the foreskin so it dries and falls off.

Then they describe Gomco and Mogen methods: “The foreskin is removed from the penis using the Gomco or Mogen devices” [clamps! that's what they are]

The Gomco clamp is a slow procedure that forcefully crushes the foreskin between two metal parts, cutting circulation to the foreskin and allowing cutting it with scalpel. A previous dorsal slit is usually done to facilitate insertion of the metal bell used to protect the glans.

The Mogen clamp crushes the foreskin without protecting the glans and allows quick cutting with a scalpel. While generally faster (and probably less painful), it has an added risk of injury because the glans is not protected and may get between the clamp and be amputated.

There is a section on “care of the uncircumcised penis”.

It says: “After 1 to 2 years of age, you can retract the foreskin partially for cleaning“. This is WRONG and PAINFUL. At that age, the glans and the foreskin are likely to still be attached through the balanopreputial synnechia, and retracting it, even partially, may hurt it, may cause bleeding and scarring and acquired phimosis. In fact, it may make circumcision necessary.

When your child is 5 or 6 years old, teach him to do this himself when he takes a shower“. This may be too soon! The percent of boys capable of retracting the foreskin at 5 years is approximately 40%.

Many times the foreskin cannot be fully retracted until your child is a teenager; this is not a reason to worry.” This is true. Over 90% of the boys become capable of retracting by the time they are 17. Those who can’t retract at that age may need to do stretching exercises.

What they also fail to mention is that using soap inside the foreskin can cause irritations. Generally retracting the foreskin (by the person only, and only when he becomes able to do it), rising the glans with warm water, and replacing the foreskin, is all the care that needs to be taken for proper hygiene. The AAP gets this wrong as well.

The flyer does not have a single word about self determination and how circumcising a minor based on parental consent is ethically troublesome, as it is an invasive intervention that is not essential to the baby’s well being. In general the American medical establishment is strongly intent on denying that newborn circumcision violates the bodily integrity and right of self-determination of the person the baby will become, which is perhaps the most important question that parents should ask themselves before making an irreversible decision.

fig2

Circumcision at 5 years: how your doctor gets to lie and collect a check

One of the supposed benefits of circumcision is the “prevention of phimosis“. It is true that phimosis is a condition of the foreskin which may require circumcision, but circumcising babies to prevent circumcision is what I call “prevention by obliteration”: any part of the body that is removed won’t develop any condition or pathology – but won’t serve any functions to the body anymore.

Phimosis occurs when the foreskin cannot retract behind the glans. This condition will make hygiene and sex more complicated, some times even making penetrative sex impossible. Severe cases of phimosis may require circumcision. Milder cases may respond to steroid creams, stretching exercises and stretching devices.

The big confusion however is that there are two different kinds of phimosis:

  • physiological phimosis, which is normal and generally resolves itself in time; and 
  • pathological phimosis, which requires some treatment.

Let’s look deeper into this. At birth, the foreskin and the glans are usually sealed by the “balanopreputial membrane”. This is absolutely normal – this is physiological phimosis. This membrane prevents the foreskin from retracting. Parents of an uncircumcised child do not need to retract his foreskin to wash the penis, and in fact, retracting the foreskin would be painful and harmful.

As the child grows, this membrane desquamates to allow retraction. This can occur in months – or in many years. We will look more into this shortly.

If after puberty, the child cannot retract the foreskin, then we may have a case of pathological phimosis. This often occurs because a ring of skin on the foreskin will not expand enough to allow the glans to glide through. While some men may go their lives without ever retracting their foreskins, some will simply have issues because of this and won’t be able to have normal sexual lives. Phimosis during adulthood is also a risk factor for penile cancer. So it’s better to try to resolve phimosis after puberty.

One important variable here is the age of retraction. A 1999 study by Cold and Taylor shows a graphic of the age of retraction – referring a 1968 study by Jakob Øster. It shows that at 6 to 7 years, approximately 60% of the boys still present adhesions (in other words, they cannot retract the foreskin yet). At 10-11 years, close to 50% of the boys still present adhesions. At 14-15, approximately only 10% of the boys still present adhesions. As we approach 17 years, only a very small percentage will still present adhesions. That means that, left uncircumcised, most boys will be able to retract their foreskin before they are 17 years old.

Incidence of preputial adhesions in various age groups, after Øster

As you can see, there are a lot of details in understanding what is phimosis and when phimosis becomes a problem. But hospitals and doctors often use the ignorance of parents to their benefit, by turning a natural condition into a pathological one.

I often hear parents who during childhood “had to” circumcise the child that they tried to keep intact, because he “had phimosis”, the son was traumatized, and discouraged they have decided that any future son will be circumcised at birth.

This, however, is the result of a lie.

The other day, as I was reviewing the website of the Cincinnati Children’s Hospital, base of some of the researchers in the trial of Gomco vs. Mogen clamp, I ran into an interesting information.

First, I have to admit that their page on circumcision provides some more information than most other clinics do.  For example, this page dedicates one paragraph to the role of the foreskin. While this paragraph is very incomplete (it does not explain at all the sexual function of the foreskin), at least it says that the foreskin “protects the sensitivity of the glans“.

On their section on benefits they also admit that the risks of UTIs, phimosis, balanitis and penile cancer are all low. Very low. And they don’t even try to talk about prevention of STDs. I’m honestly surprised, this page seems more honest than most other hospitals.

However, I also found a referral guide, and this is their guide for circumcision:

Elective circumcisions (outside the newborn period) are performed around 6 to 12 months of age. Therefore we recommend evaluation at age 6 months. 

Neonates who were circumcised at birth should be seen seven to 10 days later in the primary care physician’s office. At this visit, the infant should be checked for the development of adhesions between the glans and the foreskin. These adhesions should he lysed in the office at that time. Children with adhesions that cannot be lysed in the office, or with a sub-optimal initial circumcision, may be seen at age 6 to 12 months for possible surgical revision.  

Children who are uncircumcised should not have their foreskin retracted until 3 to 4 years of age. If adhesions still exist when the child is 5 years old, offer the option of circumcision or recommend waiting until puberty to see if the adhesions resolve spontaneously.

This is the key part: “If adhesions still exist when the child is 5 years old, offer the option of circumcision or recommend waiting until puberty to see if the adhesions resolve spontaneously.” From the graphic, over 65% of the children at age 5 still present adhesions! That means that 65% of the uncircumcised children are at risk of being referred for circumcision at age 5 unless their parents have enough understanding to know that this is not a pathological condition.

Let’s be clear. Diagnosing phimosis on a child is almost always fraud. Retracting the foreskin of a 5 year old child is unnecessary and potentially dangerous, as it can cause pain, bleeding, wounds inside the foreskin, infections and additional adhesions (as wounds inside the foreskin due to forceful retraction may become scar tissue binding the glans to the foreskin!).

Now you know how they do it.

And since we are going at it now, is the AAP Policy on Circumcision any better?

The 9th page of the Technical Report states that:

Parents of newborn boys should be
instructed in the care of the penis
at the time of discharge from the
newborn hospital stay, regardless of
whether they choose circumcision or
not. The circumcised penis should be
washed gently without any aggressive
pulling back of the skin.24 The noncircumcised
penis should be washed
with soap and water. Most adhesions
present at birth spontaneously resolve
by age 2 to 4 months, and the
foreskin should not be forcibly retracted.
When these adhesions disappear
physiologically (which occurs
at an individual pace), the foreskin
can be easily retracted, and the
whole penis washed with soap and
water.

There are several things wrong with this. The use of soap, particularly antibacterial, scented and stronger soaps, on the foreskin and penis in general, may disrupt the pH of the foreskin and damage the beneficial bacteria, causing irritation and infections. It is actually recommended to use just warm water to rinse the penis.

The parents of the child DO NOT need to retract the foreskin at any age. Only the child himself should retract the foreskin, and that only when he becomes able to do it comfortably.

Now, I’m especially concerned with this: “Most adhesions … spontaneously resolve by age 2 to 4 months“. This is definitively not supported by the graphic by Cold and Taylor. It’s only at 17 years of age that most males will resolve their adhesions. This sentence regarding 2 to 4 months will make many people wrongfully think that the inability to retract a child’s foreskin is a pathological condition that merits immediate surgical intervention.

In one occasion someone argued that this document is written for health professionals, not for the typical parents. It is my opinion that even if it is written for health professionals, it should provide more information as this is the one chance to educate them.

So now you know how your doctor gets to lie to you, injure your son and collect a check.

mogen_and_gomco

Call to Action: Clinical trial of Mogen vs Gomco circumcision clamps at the Good Samaritan Hospital in Cincinnati, Ohio

The TriHealth Good Samaritan Hospital in Cincinnati, Ohio, is currently running a clinical trial to find which is better, whether the mogen clamp or the gomco clamp, to perform newborn male circumcisions.

Bottom-left: Mogen clamp. Top-right: Gomco clamp

The purpose of this study is to compare two commonly used circumcision clamps (Gomco and Mogen) to see which results in less neonatal pain. Neonatal pain will be assessed by change in salivary cortisol level pre and post procedure. Secondary to that they will study which one causes more bleeding, requires more time, which one is followed by most parental satisfaction (what about the satisfaction of the adult that the baby will become?) on a follow up visit, which one causes more need for revisions (including recircumcisions) within 6 weeks, and which one is more likely to cause infections.

Bleeding is measured by weight of blood soaked gauzes after the procedure.

Mogen Clamp
Gomco Clamp

Other outcome measures include neonatal pain score and a standarized score including vital signs and facial expression.

Evolution of the facial expressions of a baby during circumcision

They are starting from the hypothesis that the Mogen technique of circumcision is less painful, faster, and associated with less bleeding for newborns when compared to the Gomco technique after a resident circumcision standard teaching curriculum.

The participants are euphemistically called “volunteers”, and they should be male babies 4 days or less, born healthy from pregnancies without complications.

Now, what could be wrong with this?

Let’s start with the obvious. They are not pretending that the procedure is painless. They know that the procedure hurts, and that’s what they want to compare.

The action of inflicting severe pain on someone is called torture. They are torturing babies. But then of course, every forced circumcision of a minor is torture.

Now, in order to do this they obtain consent from the parents. But parents are often unaware of how much pain a circumcision really causes until they see a video of the procedure. I would have to wonder how much information the parents obtain prior to consenting to the study.

In this video, you can hear the dad freaking out as the baby starts crying. The doctor says the baby is “excited”.

Calling the baby a “volunteer” is such a horrible stretch. With the Gomco clamp I’m very sure they have to use a circumstraint, a board with Velcro straps to hold the baby still while they perform the procedure. Volunteers normally don’t have to be forcefully restrained. In fact, I know of a lawsuit in the 1980s that successfully charged that the baby was falsely imprisoned  due to the use of restraints. Most health professionals are aware that forcefully restraining an adult has legal and ethical implications, but why is it that they don’t seem to have the same consideration to minors?

Baby strapped on a circumstraint
1984 NOCIRC newsletter detailing lawsuit including charges for battery and false imprisonment.

But not only do they know that the procedure is painful, they are also aware that there are risks and complications, and they DO expect to see those risks (infections and bleeding being the most common) and complications (including adhesions although they didn’t mention them, and the need to repairs and recircumcisions). In other words, they are running a medical experiment on human babies, knowing that those babies are going to suffer pain and that some are going to need additional surgeries or may suffer even more severe complications.

Skin bridge (adhesion) on a circumcised penis, a common complication that can cause pain during sex

Now, the real messed part is that they are using the mogen clamp. It sounds innocent enough, the more common methods used on newborns are the plastibell, the gomco clamp and then the mogen clamp (which is favored by Jewish mohelin but not so much by the medical community). So what can be wrong with assessing which one is best?

Well, for one, the mogen clamp is far from having a clean record. The “Manual for early infant male circumcision under local anaesthesia” published by the World Health organization in 2010 details that both the mogen clamp and the gomco clamp have an increased risk for penile laceration and amputation, but extends to say that “penile amputation can occur even under ideal circumstances” with the mogen clamp.

http://apps.who.int/iris/bitstream/10665/44478/1/9789241500753_eng.pdf

Now, has this ever happened? Yes, it happened in Israel in June of 2012 to a Muslim baby. It also happened in Illinois in February of 2007 in a medical circumcision, and also in Florida in 2004 in a Jewish circumcision (the mohel, Daniel Krimsky, tried to conceal the error causing loss of time and damage to the tissue, which failed to reattach). The same year it also happened to a baby circumcised by doctor Haiba Sonyika, who also failed to react timely, resulting in significant injury and iatrogenic hypospadias (in other words, the baby urinates through a new hole misplaced because of surgical mishap) and will require counseling and surgeries along his life. And it also happened in 2003 in L.A.

In 2004, Dan Savage, known columnist, received a letter from a man who suffered exactly this kind of injury:

I am 24 years old and lost my entire glans penis, the head of my dick, in a botched circumcision. Basically I have a shaft but there’s no head at the end. Unfortunately, I was left with my balls so I still have a sex drive, but it’s nearly impossible for me to climax. When I was much younger, around 14 to 16, I could sometimes masturbate to a climax, but after a couple of years I stopped being able to do this. Some of the women I’ve been with never saw the condition of my penis, and failed to notice when I didn’t come. Others have seen my condition before intercourse and refused to have sex with me, while still others found out afterwards, after I wasn’t able to come, and then never wanted to have sex with me again. Of course I never dare to ask anyone to suck me, although this might provide the necessary extra stimulation and actually help me climax.

So my problem, Dan, is twofold: I can’t come and I can’t get anyone to stick around and help me try to come. Can you suggest any special techniques for someone in my condition? Any help would be appreciated. I’m very miserable, frustrated, and lonely.

Mutilated and Comeless

Partial glans amputation, a complication of the Mogen clamp – photo from circumcisionharm.org

Glans laceration caused by clamp – photo from circumcisionharm.org

http://www.circleaks.org/index.php?title=Documented_Severe_Complications_of_Circumcision

In fact, these cases have been so common and so catastrophic that Mogen Circumcision Instruments Company went out of business in 2010 after paying several millionaire lawsuits. The clamps however were not recalled.

http://www.circleaks.org/index.php?title=Mogen

http://www.jacksonwhitelaw.com/az-personal-injury/2012/03/21/the-controversy-behind-the-mogen-clamp/

Not only were the clamps not recalled, but they are still in use, being favored by the often mentioned Dr. Neil Pollock in Canada (also a mohel), and recently received favorable reviews in a 2012 paper about the safety of over 1,200 infant male circumcisions in Kenya (in which there was one adverse event involving partial amputation of the glans)

Young, MR, Bailey RC, Odoyo-June E. Irwin TE, Obiero W, et al (2012). Safety of over twelve hundred infant male circumcisions using the Mogen clamp in Kenya. PLoS ONE 7(10): e47395, doi: 10.1371/journal.pone.0047395
http://www.readcube.com/articles/10.1371/journal.pone.0047395

In a 2013 study by Rebecca Plank in Botswana, the mogen clamp and the plastibell were compared. The adverse events with the mogen clamp were considered to be more frequent but “minor” (removal of too little skin and development of skin bridges and adhesions). Bleeding was more frequent with the mogen clamp as well.

Plank RM et al. A randomized trial of Mogen clamp versus Plastibell for neonatal circumcision in Botswana. J Acquir Immune Defic Syndr, online edition, DOI: 10.1097/QAI.0b013e318285d449, 2013.
http://www.aidsmap.com/Neonatal-male-circumcision-feasible-in-resource-limited-settings-Mogen-clamp-may-have-advantages/page/2566263/

Data from Attorneys for the Rights of the Child, ARCLaw, show over 80 million dollars paid on settlements over botched circumcisions since 1985. Beyond the economic value (when compared to a billion dollars a year industry), those numbers represent children whose lives were impacted for ever due to an elective surgery.

So, what the big picture tells us is that what these researchers at TriHealth Good Samaritan Hospital in Cincinnati, Ohio, are doing, is an experiment on human, American babies, which knowingly causes pain, without any existing condition or disease removes normal healthy and functional erogenous tissue from non-consenting “volunteers” (with no regard for the future preference of the adults they will become), subjects healthy individuals to amputative surgery, and risks causing iatrogenic harm to those babies, practicing a XIX century “elective” surgery (which again, they did not elect) with obsolete and dangerous equipment.

Mechanical function of the foreskin during sexual activity – a pleasure denied to circumcised men
Comparison of an intact penis with its frenulum, and a circumcised penis missing the frenulum and with keratinized glans

Personally, it bothers me that the 3 listed researchers are females. I wonder if I’m the only one who sees something wrong in 3 female researchers looking for the best way to slice and skin babies penises. In a way they are doing to babies almost the same thing that Lorena Bobbitt did to her husband, except that they are doing it protected under medical license and with the subterfuge of research.

I’m reminded of a 1959 American researcher, W. G. Rathmann MD, who invented a clamp for female circumcision, as a cure for frigidity. At least he wasn’t targeting infants.

Rathmann Clamp for female circumcision
Rathmann clamp in action – clamping the clitoral hood, the female equivalent of the male foreskin

Promoters of female circumcision were in the wrong side of history, and so are promoters and researchers of infant male circumcision. The fact that it is an unnecessary operation, that it has risks and causes pain, that it provokes sexual changes, and that it is performed on a healthy normal baby who does not have a disease or condition, should be reason enough to stop right now.

Perhaps it is time they run a clinical trial to compare the pain and risk of complications between circumcised babies and “uncircumcised” babies (intact babies). I dare you AAP.

[I]t can no longer confidently assume that circumcising a healthy boy will be viewed by him later as beneficial. Increasingly, circumcised males are learning the functions of intact genitals, documenting the harm from circumcision and pursuing genital wholeness. They will undoubtedly increase their pressure on circumcising societies to affirm male genital integrity and to prevent involuntary nontherapeutic circumcision.“ 

Hammond, T. (1999), A preliminary poll of men circumcised in infancy or childhood. BJU International, 83: 85–92. doi: 10.1046/j.1464-410x.1999.0830s1085.x
http://www.noharmm.org/bju.htm

Information on the trial:

http://apps.who.int/trialsearch/trial.aspx?TrialID=NCT01726036

http://clinicaltrials.gov/show/NCT01726036

Principal Investigator: Mounira Habli, MD
http://www.cincinnatichildrens.org/bio/h/mounira-habli/        
mounira_habli@trihealth.com

Contact: Michaela Eschenbacher, MPH
http://www.linkedin.com/in/michaelaeschenbacher   
michaela_eschenbacher@trihealth.com  

Contact: Rachel Sinkey, MD
http://www.trihealth.com/discover-trihealth/education/trihealth-obstetrics-and-gynecology-residency/list-of-current-residents/      
rachel_sinkey@trihealth.com

Sponsors and Collaborators
TriHealth Inc.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01726036

A list of ongoing clinical trials on circumcision: http://www.nhs.uk/Conditions/Circumcision/Pages/clinical-trial.aspx

Van and Benjamin Lewis, 1970, Tallahassee Florida

PS, while we are at it, this page: http://www.cincinnatichildrens.org/health/m/male-anatomy/ states that “Other boys are not circumcised and may have skin that covers the tip of the penis. If circumcision is not done the skin must be pulled back for proper cleaning” — The problem with this is that it does not specify any age. The foreskin at birth is sealed to the glans, and it CANNOT be retracted. Retracting the foreskin of a child who has not yet separated can result in pain, bleeding, infection and development of adhesions. In turn, this can result in scar tissue that will become acquired phimosis and MAY require circumcision. See how bad this advice is?

Please let these guys know that they need to be clear. Nobody needs to retract a child’s foreskin. Cleaning inside the foreskin can wait until the child becomes retractable (which may take until puberty – 17 years is not an uncommon age to become retractable) and should only be done by the child himself, not by the parents. It is not advisable to use soap in cleaning inside the foreskin as this can cause irritations and infections. Retract, rinse and replace, that’s all it takes to wash the penis of a male who can already retract.

It is fair to acknowledge that on this other page: http://www.cincinnatichildrens.org/health/u/uncircumcised/ they provide better advice regarding age of retraction. But they still recommend soap, and this is a common reason why many “uncircumcised” males complain of irritation and infection. Soap disrupts the delicate pH and bacterial environment of the foreskin and may cause irritations. Soap, if used, should be mild, unscented, and rinsed completely. Better yet, just use warm water.