Category Archives: Complications of circumcision

So what happens when a baby dies after circumcision?

In my time as an intactivist, I have seen this scenario play out a few times. A parent, relative or friend of a relative posts in facebook asking for prayers for a baby who became severely ill after a circumcision. One of them kept bleeding and had seizures. Another one developed a UTI and a fever after a second procedure to try to fix an already botched circumcision.

Then the baby dies.

The intactivist community at large starts expressing sadness and grief, but they also start sharing the story, hoping that some parents will realize that there is a real danger of death when you send a baby to circumcision.

And then the family comes back… asking for silence. They claim that it was not the circumcision what caused the death. They claim that they are being attacked for their decisions and their beliefs.

What should the community do in those cases?

Accepting that their child died as a consequence of their circumcision means accepting that their child died because of a decision they took. It’s easier to go into denial. In fact, the circumcisers have an interest in keeping the family quiet, so they will likely distort the facts to make it seem as if circumcision was the only chance for the child to survive a pre-existent condition.

In the case of the baby that bled in 2013, the parents later said that bleeding gave them the only chance to fight a bleeding disorder; never mind that their baby didn’t make it.

In fact, in an amazing display of arrogance and irresponsibility, doctor Nisha Jain, M.D., chief of the Clinical Review Branch in FDA’s Office of Blood Research and Review, wrote Patients [of hemophilia] can be diagnosed as infants during circumcision”

In the case of a baby that stopped breathing shortly after a circumcision in Israel in June 2013, the Rabbis claimed a pre-existent condition and said that the circumcision had been performed “flawlessly”.

That same week, a teenage girl died in Egypt after circumcision (FGM) by a medical doctor. A health inspector report said the cause of the death was due to “a sharp drop in blood pressure resulting from shock trauma”. The doctor who performed the female genital mutilation was found guilty, but it is said he is not in jail.

But shock trauma is never considered in the case of baby boys dying after circumcision.

It is likely that hospitals offer some kind of incentive to families of babies dead after circumcisions. Families in turn will keep quiet about what happened. For example, when Jacob Sweet became severely disabled after having an infection and seizures after circumcision, and the hospital “lost” the records, the family offered a reward to anyone coming back with the records. The legal proceedings lasted for years, and the family was finally compensated. The family, that up to that point had even attended genital integrity events, suddenly became silent. When Jacob died, at the age of 26, his circumcision was not even mentioned in the obituary and related news.

But, who benefits from this silence?

The families don’t want to have their story plastered on the news and all over the internet. They want to settle and move on. The doctors don’t want the bad publicity. So, is it a surprise that the AAP didn’t find studies of mortality, only case reports, and thus didn’t provide any numbers on mortality on their policy statement on circumcision of 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)
- American Academy of Pediatrics
Technical Report on Circumcision 2012

In Canada, a baby, the son of an Iranian couple, died in 2013 after a circumcision that the parents didn’t even want in the first place, but were convinced by a doctor to have it done for medical benefits. The story remained silent for two years, until the family succeeded in seeing the doctors named. So you can see that there is an interest in keeping silence over these cases.

But, who speaks for the child? Who speaks for the one whose voice was never heard?

Genital integrity activists claim that circumcising a minor is a violation of human rights. Many medical communities refuse to accept this and frame circumcision as a parental right. But when a baby dies after his circumcision, can we claim that his rights were violated?

The World Health Organization (WHO) frames female genital mutilation as a violation of human rights, with this paragraph:

FGM is recognized internationally as a violation of the human rights of girls and women. It reflects deep-rooted inequality between the sexes, and constitutes an extreme form of discrimination against women. It is nearly always carried out on minors and is a violation of the rights of children. The practice also violates a person’s rights to health, security and physical integrity, the right to be free from torture and cruel, inhuman or degrading treatment, and the right to life when the procedure results in death.

We disagree that it “reflects deep-rooted inequality between the sexes” as those societies that practice FGM also practice traditional forms of male circumcision, often resulting in death and mutilation. However, in this moment, we are more interested in the last part of the paragraph:

The practice also violates a person’s rights to [...] life when the procedure results in death

Circumcision apologists claim that every medical procedure has risks. Genital integrity activists remind them that circumcision is not essential to the well-being of the child, and as such is considered an “elective” procedure – and yet the subject is not given the chance to “elect” (or refuse).

So what happens when circumcision results in death?

Who speaks for the baby whose right to life was violated?

How can we stay silent, and wait in silence for the next victim? What good is that?

Sorry families of those babies who died after circumcision. We grieve with you. We feel your pain. But staying silent is the worst form of disrespect for your lost one, and we will speak, if anything with the hope that one family won’t have to go through what you just went.

A South African baby loses part of his penis during circumcision – but what went wrong?

As reported by Sunday Times News (South Africa) on November 29th, a Jewish religious court decided that a Johannesburg mohel will not be allowed to perform circumcision again, as a consequence of a botched circumcision performed last year. During that circumcision, the penis of the baby was partially amputated.

The article states that “[n]o details were revealed of why this circumcision went wrong. The Sunday Times was unable to establish how the baby is doing now and whether there have been surgical attempts to rectify the partial amputation of his penis.”

The article then quotes one Rabbi Warren Goldstein saying that circumcision “has a longer track record of proven safety than any other surgical procedure” and that “Jewish circumcisions have been done in South Africa for more than 175 years and this case is the first time that an injury of this severity has been reported“.

The name of the (ex)mohel was not disclosed. Which is not a surprise, considering that even cases where babies die after a circumcision are usually kept secret, as we found happened in Canada recently.

Well, let me tell you what Goldstein won’t tell and the reporter won’t research. Jewish circumcisions typically use a Jewish shield (barzel) or a Mogen clamp. Neither of those two devices protects the penis. The devices are supposed to clamp on the foreskin leaving the glans on one side, but improper installation, device malfunction or anatomical variation can cause part or all the glans to be trapped by the device, allowing the scalpel to cut through it without the operator even realizing it. The mogen clamp has an increased risk of injury or amputation of the glans, even with experienced physicians.

I have no way of verifying that no cases have been reported in South Africa, but I can quickly reference one in Pittsburgh, where Rabbi Mordechai Rosemberg amputated the penis of a baby in 2013. The penis was re-implanted using microsurgery and… leeches, but there is no way to know yet if the baby will even have normal sexual function.

In 2004, another Rabbi, Daniel J. Krimsky, also amputated part of the penis of a baby during a bris in Florida. The resulting lawsuit ordered Mogen instruments to pay a settlement of 10.8 million dollars, but the company was already in default after another millionaire lawsuit, over similar injuries occurred in 2007.

In 2004, Dr. Haiba Sonyika amputated most of the glans of a baby circumcised with the Mogen clamp (in a Medical environment). Reattachment was not fully successful.

All these cases could have been prevented, since in 2000, the FDA warned about the potential for injury from Mogen and Gomco clamps – but no changes were made to the devices and the warning was later archived. Ten years later Mogen Instruments would be out of business due to the lawsuits mentioned above.

Another Floridian mohel posted a blog in 2010 warning others not to use the Mogen clamp.

In spite of all this, researcher Rebeca Plank conducted a trial of Plastibell vs. Mogen clamp in Botswana in 2010, concluding that the Mogen clamp could be safer in regions where immediate emergent medical attention is not available. We wonder what she would recommend in cases of penile amputation, without immediate emergent medical attention. BTW, when stating the safety of circumcision in Botswana, Plank neglected to mention that one “participant” baby died within 24 hours of being circumcised. No autopsy was performed and the death was simply not mentioned at all in the final report. Good to know that Dr. Plank holds her research to such high standards.

The Good Samaritan Hospital in Cincinnati also performed a trial, this one of Mogen vs Gomco clamp, between 2012 and 2014. When intactivists protested, a spokesperson for the hospital released a statement calling the clamps “two medically accepted circumcision processes” – neglecting to mention the FDA warning and incidents related to the Mogen clamp.

The Good Samaritan researchers concluded that “Mogen clamp is associated with less neonatal pain physiologically by significantly lower percentage change in salivary cortisol, lower heart rate, and mean arterial blood pressure. There was no difference in CRIES scores. Mogen clamp circumcision duration is significantly shorter than Gomco clamp. Both methods demonstrate satisfactory maternal and pediatrician short-term follow-up.” I’ll let the readers find for themselves what the metrics are in the CRIES pain score, so that you know what the babies were consciously subjected to by the researchers.

Other clinical trials took place in 1999 (USA) and 2013 (Zambia) favoring the Mogen clamp.

Additionally, the Mogen clamp is the favored device of Dr. Neil Pollock in Canada, and the many disciples he enlists. Pollock also exported it to Haiti and is currently looking for the support of Charlize Theron and Sean Penn to provide similar training in South Africa.

And with this we have gone full circle, starting with a Jewish botched circumcision in Johannesburg, South Africa, and finishing with a Canadian doctor who wants to export to South Africa the very same technique that caused said botched circumcision.

While the Mogen clamp appears to cause less pain through a faster procedure, the risk of glans or penis amputation may not be realized in 100 or 200 procedures, but will eventually occur. As it happened to this baby, in Johannesburg, in 2013. Even when performed by experienced doctors or mohelin.

Sean Penn, Charlize Theron, save your money. There are better ways to actually help people.

 

 

The secrecy of circumcision mortality

As intactivists protested during the AAP convention 2015 in Washington DC, and less than two months after the Canadian Pediatric Society (CPS) updated their circumcision policy with a mediocre paper that provides no criteria, while apparently discouraging routine circumcision and promoting it at the same time, we learned of a sad development in Ontario. We learned that a 22-day-old baby called Ryan Heydari bled to death following a circumcision in 2013.

Ryan Heydari

Ryan Heydari

Now, why did it take so long for this story to become public? Details about the complaints against the two physicians made to the College of Physicians and Surgeons, including their identities, would have been kept secret had Ryan’s parents not sought a review by an appeals panel.

“We are so shocked that we will not have an answer to bring us some peace for our broken hearts, to prevent other cruel deaths like Ryan’s and to ensure that doctors take proper care of their patients,” mother Homa Ahmadi told the National Post.

We learned that the parents originally did not want the surgery but were convinced of it by their family physician, who referred them. Dr. Sheldon Wise performed the surgery, and when contacted later over concern that the baby was bleeding too much, advised them to take Ryan to Toronto’s North York General Hospital.

Ryan was eventually transferred to Sick Kids hospital, but died there seven days later. Pathologists said he succumbed to “hypovolemic shock” caused by bleeding from the circumcision, which emptied his body of 35 to 40 per cent of its blood.

Dr. Jordan Carr, the North York General hospital pediatrician who saw Ryan after he started bleeding, was cautioned in writing for “his failure to recognize the seriousness of the patient’s condition and to treat compensated shock.” Carr was also ordered to write a 2- to 4-page report on the possible complications of circumcision and on how to recognize and treat compensated shock.

Wise told the complaints committee he routinely performs circumcisions, and the committee expressed no concerns about his technique or equipment, according to the HPARB decision. But it did feel that he should be obtaining and documenting informed consent before doing the operation.

Ryan’s parents said in a statement: “Our family doctor convinced us though of the health benefits of this procedure, but we had no idea that the loss of Ryan’s life was one of the risks”

Details about the death of this baby are absent from both doctors’ profiles in the College of Physicians and Surgeons’ online registry, as the complaints against the doctors were made before the college changed its policies as to what information it releases to the public.

This same month, less than two weeks ago we learned of another circumcision death, one that was also not disclosed by the media when it happened. We only learned of it incidentally.

Chance Walsh

Chance Walsh

We had been following the news of the missing 9-week old infant in Florida, Chance Walsh, who was found buried in a shallow grave. Details were released of his death, after being beaten by the father, and how he was left to decompose on his crib for several days until the mother complained of the smell, at which point the body was wrapped in plastic bags and moved to the closed, and then taken 13 miles from home and buried on a shallow grave.

But news stories released also that this was not the first baby lost by this couple. On March of 2014 the mother, Bury, gave birth to Duane Jacob Walsh. Duane was found dead 22 days later, and the cause of his dead was ruled to be a kidney infection that resulted from a botched circumcision.

His dead would have remained silent, if it wasn’t because the couple had this other baby, Chance, who died after being severely beaten by the father, a baby that the mother “despised whenever she would look at him because he wasn’t Duane.”

How many more deaths are kept in silence?

The AAP, on their Technical Report on Circumcision of 2012 wrote:

“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 [...*] and death.213″

An official estimate of mortality by the American Academy of Family Practitioners (AAFP), often cited by other medical organizations, is 1 in 500,000 circumcisions. Thomas Wiswell and Brian Morris, both avid circumcision promoters, introduced a number 20 times smaller. It really doesn’t matter. Deaths happen, and when they happen, they are often ignored. There are no official lists. Parents don’t have access to this information. The AAP Task Force on circumcision can call them case reports, but truth is nobody is trying to keep real numbers, and without real numbers, parents are being deceived. Like Ryan’s parents were.

“we had no idea that the loss of Ryan’s life was one of the risks”

Circumcision promoters often accuse intactivists of exploiting these deaths to further our agenda. But what is our agenda? To try to prevent these tragedies? To promote that all children deserve to grow with intact genitalia? And what is their agenda? To keep making money out of an unnecessary surgery? To continue providing biomedical supplies (amputated foreskins) to the biomedical industry?

Which agenda benefits babies?

Is it fair to these babies to let their names be forgotten, to allow their tragedies to be ignored, and their stories to be repeated over and over?

Let me finish this post by saying:

Rest in peace, Ryan Heydari

Rest in peace, Duane and Chance Walsh

National Post: Ontario newborn bleeds to death after family doctor persuades parents to get him circumcised

The Star: Secrecy questioned about baby’s death after circumcision

Morning Ledger: Body of 9-Week-Old Infant Allegedly Found Dead; Parents Under Custody

Yahoo: Body of 9-Week-Old Was Allegedly Left to Decompose in His Crib Until His Mom Complained About the Smell

 

Richard Dawkins tweets Marilyn Milos’ video.

Richard  Dawkins tweeted:

11008517_823637881053422_7197394066429671049_n “What this woman says about circumcision has the ring of sense. If she’s right, I find it very depressing.”

What he is referring to is the video of Marilyn Milos about the sexual harm of circumcision, recorded by James Loewen.

https://www.youtube.com/watch?v=BgoTRMKrJo4

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.

bb

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.

 

#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

FDA: Infant Circumcision… to detect hemophilia?

Contraindications to newborn circumcision
include significantly premature
infants, those with blood dyscrasias,
individuals who have a family history of
bleeding disorders[...]” -
AAP – Technical Report on Circumcision, 2012

A recent FDA article about treatments for hemophilia, quotes doctor Nisha Jain, M.D., chief of the Clinical Review Branch in FDA’s Office of Blood Research and Review, saying:

“Patients can be diagnosed as infants during circumcision”

Dr Nisha Jain, M.D

Dr Nisha Jain, M.D

The problem with this though is that these patients may die as a consequence of the bleeding caused by their circumcision. These deaths often go unreported. Babies are not tested for hemophilia prior to circumcision.

In March of 2013, baby Brayden Tayler Frazier was transferred to UC Davis Medical Center, Sacramento, CA, because he wouldn’t stop bleeding after his circumcision. He later went to seizures and finally died, 2 days later. His death was not reported on the media, and it was only because of activists scanning social media for circumcision-related topics, that the intactivist community learned of and followed this tragedy.

After the death, doctors and family were in denial that circumcision had anything to do with his passing. He had been sick, they argued. His initial sticks and pricks didn’t heal as quickly as normal, and yet in the face of this telltale sign, the circumcision was performed. It would be hard to deny that the massive bleeding that followed led to the catastrophic outcome.

Baby Brayden was treated with coagulants, platelets, plasma, everything to try, unsuccessfully, to save his life.

Another known victim was Ryan White (1971-1990). Again, his circumcision caused massive bleeding and so he was detected to be hemophiliac. In his case, it wasn’t the bleeding though what killed him, but the medication used to treat it;  weekly transfusions of Factor VIII,  a blood product created from pooled plasma of non-hemophiliacs, infected him with the HIV virus. He died from AIDS related complications.

That Dr. Jain thinks it’s fine to detect hemophilia on infants during circumcision is a disrespect to babies like Brayden and others who died from loss of blood and other related clotting disorders and conditions after their unnecessary and unethical circumcision.

Finally, only in the United States will doctors enable parents to risk their children’s health in the name of a social surgery. See this paper by Kuthan Kavakli et al, arguing that “Hemophilic boys (60%) and their parents (82%) have an inferiority complex because the boys are unable to be circumcised” – notice how the dissatisfaction of parents was higher (82%) than that of the boys (60%). Kavakli concludes that “circumcision is an important social problem of hemophilic patients that needs to be solved.

A social problem indeed, and rational minds wonder why not solve it with education. Maybe that is too much to ask.

 

 

NEW CIRCUMCISION “STUDY”: Complication Risks May Increase With Age – Does Medical Necessity?

“Circumcision fails to meet the commonly
accepted criteria for the justification of preventive
medical procedures in children. The cardinal
question should be not whether circumcision can
prevent disease, but how can disease best be
prevented.”
Frisch et al, Cultural Bias in the AAP’s 2012
Technical Report and Policy Statement on
Male Circumcision

Another day, another article. This time, it’s about a study by Charbel El Bcheraoui  published in JAMA Pediatrics, funded by the US Centers for Disease Control and Prevention (CDC). The study claims that “Male circumcision had a low incidence of AEs (adverse events – a euphemism for complications) overall, especially if the procedure was performed during the first year of life, but rose 10-fold to 20-fold when performed after infancy.

The question that El Bcheraoui circumvents is, however, are those circumcisions necessary? Without medical or clinical necessity, are those circumcisions ethical?

Without those considerations, this is nothing more than a sales pitch. “Circumcision! Buy now, or tomorrow it will be 20 times riskier,” El Bcheraoui seems to urge.

But, what are the chances a child will need to be circumcised later on in his lifetime?

What are the reasons a man would have to be circumcised at a later age? Do they increase with time? (Answer: No, they don’t. The majority of men who are left intact, stay that way.)

El Bcheraoui concludes that “Given the current debate about whether MC should be delayed from infancy to adulthood for autonomy reasons, our results are timely and can help physicians counsel parents about circumcising their sons” but this is nothing more than self-interested hogwash. The argument of bodily autonomy is mentioned but not expanded on. In effect, what the author is saying, without daring to say it, is that bodily autonomy can be violated in order to decrease the risk of complications; a risk the author already considers to be low.

If we were to extrapolate the reasoning behind this conclusion, it would be possible to argue that removing the breast buds from baby girls is easier, less traumatic and has less complications than waiting for breast cancer to develop and then perform mastectomies, where breast cancer is the second leading cause of cancer death in women.

The authors did not declare any conflict of interest. But of course it is not surprising that El Bcheroui is affiliated with the Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention. Let’s just quickly remember that in 2009 the CDC was considering promoting universal circumcision to prevent the spread of HIV in the United States, despite pre-existing evidence (from the CDC nonetheless) that the high rates of circumcision in the United States had no effect over transmission of HIV.

It seems nowadays no circumcision article or “study” is complete without the obligatory “benefits outweigh the risks” soundbite from the 2012 AAP policy statement on circumcision. Of course, what is never mentioned is that this is only part of the statement, which is rarely ever quoted in its entirety:

“The American Academy of Pediatrics found the health benefits of newborn male circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision” - http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/Newborn-Male-Circumcision.aspx

Circumcision advocates love to quote the AAP, but they could not recommend circumcision in their last statement because, in their own words “the benefits were not great enough.” How is it lay parents are expected to analyze the same “benefits” which couldn’t convince an entire body of medical professionals, and somehow come to a more reasonable conclusion? Why are doctors expected to act on it, and why is the public purse expected to pay?

The AAP said in their last statement that “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)” and catastrophic injuries were excluded from the report because they were reported only as case reports, not as statistics. The statement also indicates 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.”

In the opening statements of this study, El Bcheraoui estimates that 1.4 million circumcisions are performed in medical settings annually in the United States. This appears to contradict a previous statement by none other than El Bcheraoui himself, claiming a rate of 32.5% in 2009. Perhaps he expects the 2012 AAP Policy Statement to result in the resurgence of circumcision rates.

The study reviewed the medical history of approximately 1.4 million males circumcised between 2001 and 2010, and found that approximately 4,000 infants had suffered complications, leading them to calculate a rate of complications (adverse events) of less than 0.5%

This would mean, using the data they present, that every year, between 5,600 (0.4%) to 7,000 (0.5%) infant males will suffer complications from circumcision; circumcisions that will in all likelihood be medically unnecessary.

This would not include those complications that can be minor or undetected by the parents (skin tags, skin bridges, uneven scarring) or those that will not be detected until much later (pain caused by tight erections, lack of sensitivity).

The researchers note that some complications might not have been picked up because they were reviewing claims data on problems that typically occurred within the first month following the circumcisions.

This would likely exclude meatal stenosis. High prevalence of meatal stenosis has been found in circumcised males (see here and here), possibly as consequence of ischemia (poor blood supply) to the meatus or permanent irritation of the meatus caused by friction with the diaper and resulting in scarring.

A recent ecological analysis by Ann Z. Bauer and David Kriebel found a correlation (but not causation – further studies are needed) between early exposure to paracetamol and other analgesics, and autism spectrum disorders (ASD). This took into consideration that most newborn circumcisions before 1995 used no pain relief at all, but with growing awareness of the pain of circumcision and increasing use of paracetamol, a sudden rise on the rates of male ASD occurred.  According to this analysis a change of 10% in the population circumcision rate was associated with an increase in autism/ASD prevalence of 2.01/1000 persons (95% CI: 1.68 to 2.34) ”

These findings of course would not have been included in El Bcheraoui’s paper, as this would be out of existing billing codes and administrative claims within the first month from the procedure.

So, let’s just think for a moment, if these circumcisions are not necessary, if these circumcisions are “elective,” then what is the tolerance for errors and complications? El Bcheraoui claims that a 0.5% complication rate is low. But how low is it when it means 5,600 to 7,000 babies who will suffer complications annually? And what kind of complications are we talking about?

These low rates fail to explain the increasing rates of circumcision revisions as well.

How many cases like the one of David Reimer can we afford to have before it is ethically wrong, morally wrong? How many more like Jacob Sweet?

How many MRSA infections?

How many partial or full ablations of childrens’ penises, like that baby in Memphis and that other baby in Pittsburgh last year?

How many infections with Herpes?

How many deaths?

Catastrophic complications, rare or not, mean destroyed lives. Not numbers. And to destroy lives of innocent babies in the name of “religious, ethical and cultural beliefs” is simply not right. Because there is no medical indication for surgery in healthy, non-consenting minors, any complications above zero is ethically unconscionable.

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Circumcision Goes Wrong: 1-yr-Old Loses Manhood to Cutting

Posted: http://frontpageafricaonline.com/index.php/news/963-circumcision-goes-wrong-1-yr-old-loses-manhood-to-cutting

1 year old boy loses his penis in a circumcision performed on January 5th by a doctor in Liberia. Phillip Zinnah, Sr. 25, father of the boy explained that he took his son to the TB Annex to one Dr. Nimley for circumcision, but it all went wrong when the doctor completely cut off the boy’s penis, leaving him in severe pain. The doctor is not responding for the damages, and the institution, TB Annex, says they don’t perform circumcisions and this would have been done in secret by the doctor.

Meanwhile, a child’s life has been irreversibly damaged in a way to seems to echo the baby hurt by a rabbi from Pittsburgh and a Memphis baby hurt at Christ Community Health Centers last year. A Saudi baby also had his penis partially cut off last November.

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What Brian Morris, in conjunction with Richard Wamai (research on HIV), Aaron Tobian (Johns Hopkins University), Ronald Gray (Johns Hopkins University and director of one of the 3 African trials on HIV and circumcision), Robert Bailey (responsible for another one of the 3 African trials), Daniel Halperin (author of several papers on HIV and circumcision),  Thomas Wiswell (author of the often cited study on circumcision and UTIs) and others, wrote on their propaganda paper from 2012, “A ‘snip’ in time“:

Infant circumcision is safe, simple, convenient and cost-effective. The available evidence strongly supports infancy as the optimal time for circumcision.“ 

Of course, for those illustrious individuals, this child’s horrible experience is simply an “adverse event“. According to a 2012 paper by Robert Bailey cited by the World Health Organization:

“In developed countries, adverse events following neonatal circumcision are well documented and their incidence is very low, from 0.2 to 0.6%.5 Before the RCTs, outcomes in Africa for male circumcision among adults were poorly documented. In a review,6 adverse event rates following African male circumcisions ranged from 0 to 24%. The RCTs, which provided services in a clinical trial setting, reported the following adverse event rates: 3.8% in Orange Farm, South Africa; 1.5% in Kisumu, Kenya; and 3.6% in Rakai, Uganda.1,7,8 Most recently, at the former Orange Farm RCT site, 1.8% of medical male circumcisions offered in one high-volume facility resulted in an adverse event”

Let’s stop treating children as statistics. Let’s respect children. Children of all genders deserve to grow with intact genitals.

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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