Category Archives: Culture

Fundamentals of anatomy? What’s up with Dr. Frederic Martini?

To think that the American medical community is biased for circumcision is an understatement. The most information that American medical texts provide about the foreskin is that it is removed by circumcision. That would be like describing the female breasts as the part removed by mastectomy, with no regard to function, form, and benefits of having it.

Fundamentals of Anatomy & Physiology

Fundamentals of Anatomy & Physiology

Today we received a couple of images from a book called “Fundamentals of Anatomy and Physiology“, by Dr. Frederic Martini, Dr. Judi Nath and Ed Bartholomew. On their text, the prepuce is described as a “fold of skin” with glands that “secrete a waxy material known as smegma” which “can be an excellent nutrient source for bacteria“. Because of that, “mild inflammation and infections in this area are common, especially if the area is not washed thoroughly and frequently“, but thank God for the solution, because “one way to avoid such problems is circumcision, the surgical removal of the prepuce“.

Then we are told that “in Western societies (especially the United States) this procedure is generally performed shortly after birth” and then we are told that circumcision reduces the risks of UTIs, HIV infection and penile cancer. Finally we are told that the practice remains controversial because of the risks of “bleeding, infections, and other complications“.

14225598_10154521174798385_5457800265120875240_n

Nothing else is said about the foreskin. Not a thought of describing the outer skin, the inner mucosa, the frenulum, the frenular band, the frenular delta, the dartos fascia, the meissners corpuscles, the balanopreputial synechiae, the normal development of retraction, the immunological functions of the foreskin, the gliding motion… you know, the real anatomy and physiology of the foreskin!

So, let’s see. First, they focus their description on the fact that the foreskin secretes smegma. Big deal. Secreting smegma is normal, men and women do it. Smegma can accumulate inside the foreskin of children, and that is normal. Irritations can occur, but irritations can occur on any part of the body; foreskin irritation is often the result of overzealous cleaning or leaving soap residue, or using antibacterial or scented soap, not just from having some smegma.

Removing the foreskin to eliminate smegma is really absurd. Your body will still shed cells, they just won’t accumulate, they will stick to your underwear instead. But even if this was such an important factor, it should be a personal decision, not a parental one.

We are told that Western societies, especially the United States, practice infant circumcision. In fact, it would ONLY be the United States, which hardly accounts for the totality of “Western societies“. Most of the world does not circumcise, not Europe, not Latin America, not non-Muslim Asia. In general, circumcision is limited to the United States, Israel, Philippines, South Korea, Muslim societies and some African tribes. But perhaps mentioning this wouldn’t really make such a good case as the fictitious “Western societies” described by these doctors.

Discussing the topics of UTIs, HIV and penile cancer would take pages and has been done already, here and in other places. Penile cancer, scary as it sounds, is rare, and is mostly associated with HPV infection and maybe with phimosis during adulthood, but it’s not an argument in favor of infant circumcision.

According to a letter to the AAP sent by 38 physicians heads of medical organizations from the actual “Western societies”, “only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves“.

Finally the practice of circumcision is not controversial because of the risk of pain, infection and complications. Yes, those things are problematic, but the practice is controversial because it overrides informed consent and restricts body ownership, by performing an irreversible non-medically necessary genital alteration on a person who is not yet competent to provide informed consent – but who will one day be competent. But of course, they won’t acknowledge the central human rights issue of the controversy, why would they?

So, for a book that sells new for $231 and which is used to educate medical students, we feel that this piece misleading information is a disservice to generations of medical professionals.

 

AAP 1984 – or how circumcision causes amnesia

As told by Steven Svoboda of Attorneys for the Rights of the Child, on October of 2013 there was a debate at the Medical University of South Carolina in Charleston, South Carolina, during which, Dr. Michael Brady MD, one of the 8 members of the American Academy of Pediatrics’ task force on circumcision responsible for the Policy Statement and Technical Report of 2012, declared: “I don’t think anybody knows the functions of the foreskin,” and then reiterated, “Nobody knows the functions of the foreskin.”

That is strange, because just 29 years earlier the American Academy of Pediatrics had a pamphlet discussing the “Care of the uncircumcised penis”, which included a brief discussion of some of the functions of the foreskin, and a drawing clearly showing the anatomy of the intact penis.

The first edition of this 1984 pamphlet had the word “uncircumcised” spelled incorrectly: “uncircumcized”. There was a second batch printed with this misspelling corrected, but then, when a new batch was printed in 1990, the paragraph about functions of the foreskin and the anatomical drawing suddenly went missing.

Ronald Goldman, Ph.D., of the Circumcision Resource Center, started inquiring about this curious omission on January of 1996. He contacted the AAP eight times about this change. After having been passed by four  AAP officials, he finally obtained this response in September of 1996:

The reviewers felt it was not necessary to reinstate the paragraph because the revision of the brochure included a complete reorganization of the information contained in previous editions.”

According to Dr. Goldman, a comparison of new and previous editions did not show “complete reorganization of the information” and there was no reason why the removed information would have stopped being relevant to parents.

In fact, the AAP still has a page on the “Care for an uncircumcised penis” on their website. It is not a bad page, although there are some things that could be a lot better, and the functions of the foreskin are still missing.

Perhaps if they had listened to Dr. Goldman in 1996, Dr. Brady would have been able to describe some functions of the foreskin when asked about them, during the 2013 debate.

So… what was that controversial paragraph?

The Function of the Foreskin: The glans at birth is delicate and easily irritated by urine and feces. The foreskin shields the glans; with circumcision this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, meatitis (inflammation of the meatus), and meatal stenosis (a narrowing of the urinary opening). Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life.

This is the anatomical drawing, prepared by Edward Wallerstein (author of the 1980 book “Circumcision: An American Health Fallacy“), which was included in the pamphlet:

wallerstein

It is important to note that no anatomical drawings are included in the 2012 AAP Policy Statement and Technical Report on circumcision. The word “Frenulum” (or “frenum”) does not even appear in either document.

This is a scan of the 1984 pamphlet, as shared by Dr. Goldman (click to enlarge).

AAP1

AAP2

Given these obvious omissions, it seems hypocritical from the AAP to claim, as they do, that “It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

Our conclusion is that perhaps circumcision causes amnesia. Selective amnesia. That, or they have a vested interest in maintaining high rates of circumcision for financial gain, but that would be dishonest, wouldn’t it?

Dr. Goldman’s discussion of the pamphlet: http://circumcision.org/pamphlet.htm

CIRP page mentioning this pamphlet: http://www.cirp.org/library/normal/aap/

CIRCUMSTITIONS discussion of this pamphlet: http://www.circumstitions.com/AAP-care.html

Attorneys for the Rights of the Child telling of the 2013 debate: http://www.arclaw.org/our-work/presentations/charleston-debate-marks-turning-point-movement-recognize-circumcision-human-r

AAP Current page: Care for an uncircumcised penis. https://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Care-for-an-Uncircumcised-Penis.aspx

 

 

Jennifer Bossio confirmed: foreskin most sensitive part of penis

Yet she was too biased to admit it!

Bossio, Jennifer, “EXAMINING SEXUAL CORRELATES OF NEONATAL CIRCUMCISION IN ADULT MEN” is a PhD thesis which attempts to “provide a multidimensional perspective of the sexual correlates of circumcision with implications for public policy and individual stakeholders (e.g., medical professionals, parents, men).”

Jennifer Bossio validated Sorrells study and didn't recognize it

Jennifer Bossio validated Sorrells study and didn’t recognize it.

Chapter 3 is dedicated to study penile sensitivity in men who were circumcised as babies, vs. men who were not circumcised (intact). This is evidently a response to the 2007 study “Fine-touch pressure thresholds in the adult penis” by Sorrells et al.

Bossio writes (pg. 69): “we did not obtain sufficient evidence to support the notion that the foreskin of adult intact men is the most sensitive region of the penis to all forms of stimuli; however, the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested, and it was significantly more sensitive to warmth than the glans penis.” She also writes: “our results—and those of Payne et al. (2007)—differ from those of Sorrells and colleagues (2007) who found that the glans penis in circumcised men was less sensitive to touch than in intact men.”

In her conclusions, Bossio writes that “we directly assessed the assumption that circumcision leads to a reduction in penile sensitivity by testing tactile detection, thermal sensation, and pain thresholds at multiple sites on the penis” and offers one conclusion that “this study provides no evidence that neonatal circumcision decreases penile sensitivity, no evidence that the exposed glans penis in circumcised men becomes less sensitive over time, and insufficient evidence to suggest that the foreskin is the most sensitive part of the penis.” and then suggests that “if differences in sexual functioning or sexual dysfunction are related to circumcision status, these differences are not likely the result of changes in penile sensitivity resulting from neonatal circumcision

Finally, she concludes that “findings from this study can be used to inform individual stakeholders, public policy makers, medical health care professionals, and parents regarding the minimal long-term implications of neonatal circumcision on penile sensitivity.”

We have issues with the inclusion and exclusion criteria. Excluding participants over 40 years of age creates a bias. Many individuals restoring their foreskins typically started after their 40s. They also excluded individuals with history of sexual dysfunction.

Reading her paper we found contradictions to her assertions that “this study provides no evidence that neonatal circumcision decreases penile sensitivity [...] and insufficient evidence to suggest that the foreskin is the most sensitive part of the penis“.

We also suggest that Bossio missed a vital point by neglecting to study men who have undergone non-surgical foreskin restoration.

First, the assertion that the foreskin is the most sensitive part of the penis comes directly from the Sorrells study, and it is one assertion that is often misunderstood. Sorrells simply evaluated “fine-touch pressure thresholds” – nothing more, nothing less. So when Sorrells concluded that “circumcision ablates the most sensitive parts of the penis” it should be read that “circumcision ablates the most sensitive parts of the penis [to fine-touch]“. Sorrells did not make any attempt to measure pleasure or satisfaction. Only fine touch, and his findings are consistent with those of Bossio as she said it herself, that “the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested“.

So, if the foreskin is significantly more sensitive to touch, it follows that the circumcised penis, in which the foreskin has been removed, is less sensitive to touch – particularly to fine touch. Which again, contradicts her conclusion that her study “provides no evidence that neonatal circumcision decreases penile sensitivity“.

Now, we partially agree with her assertion that “if differences in sexual functioning or sexual dysfunction are related to circumcision status, these differences are not likely the result of changes in penile sensitivity resulting from neonatal circumcision“, basically because the studies are missing one important point. Static stimulation is not the main method of stimulation during sexual activity. People don’t just lie down being stimulated by touch, warmth, pain, etc. Individuals move during sex. Stimulation is dynamic.

A visual comparison between a typical intact man masturbating, and a circumcised man masturbating, yields important differences – and  this has even been observed by circumcision promoters such as Guy Cox – in a paper published with the pen name of James Badger. While Badger describes it as a difference in preference, the reality is that it is a difference in what is possible to do with the available tissue.

Most intact men masturbate by grasping the mobile penile skin and sliding it up and down the shaft. In most cases this results in the glans being repeatedly covered and uncovered, with the rim of the foreskin stimulating the glans; typically the hand does not touch the glans. In the case of males with particularly long foreskins, the glans may never be uncovered at all, and the hand stimulates the glans only indirectly, through the foreskin.

In circumcised males, the typical technique consists in moving the penile skin what little length it can be moved during erection, or when no mobile skin is available at all, the hand rubs the penile skin, in which case external lubrication (hand lotion or adult lubricant) is needed to avoid chaffing the skin. In many cases direct contact with the glans is avoided unless using lubricant.

What this indicates is that there is a mechanic component of stimulation by using the foreskin as an agent, a mobile part, which interacts with the glans. Obviously, removing the foreskin makes this action impossible, thus altering the mechanism of stimulation for the circumcised male.

We can also consider that during heterosexual penetration, the glans touches the opening of the vagina and goes through its vestibule, but once inside it is not in contact with anything else. The vagina instead is grasping the penile skin, and facilitating its gliding motion during the repeated penetrative motion. For the circumcised male, the vagina simply rubs directly against the penile skin – because there is no movement of the skin, which tends to dry the lubrication of the vagina.

So there is a change that goes deeper than simple passive sensitivity. Circumcision alters the mechanics of the penis and causes stimulation to be different, both for the male and the female.

Bossio’s paper simply moves between two contradictory positions: 1) that the foreskin is more sensitive to touch, and 2) that the circumcised penis is as sensitive as the intact penis – which is simply not possible if a) the foreskin is more sensitive to touch and b) has been removed by circumcision.

It seems to me that given the importance of Sorrells’ study as a starting point to Bossio, she missed the mark. Neither Bossio nor her reviewers understood the meaning of “sensitivity” as used by Sorrells.

Perhaps the real importance of Bossio’s paper was to superficially contradict Sorrells, as an attempt to undermine a common argument used by promoters of genital integrity, and by calling the long-term implications of neonatal circumcision on penile sensitivity “minimal” she gained enough approval from a culturally biased academic community to obtain her PhD.

Misuse of Bossio’s paper:

Annette Fenner published in Nature Reviews Urology a highlight of Bossio’s published study (on The Journal of Urology), which is related to her thesis, with the superficial headline “Circumcision does not affect sensitivity“, and the first sentence, predictably enough, reads “Neonatal circumcision has minimal effects on penile sensitivity“. Fenner misrepresents Bossio’s paper by indicating that “No differences in tactile or pain thresholds, or sensitivity to warmth and heat pain, were observed between circumcised and intact men“. This clearly contradicts Bossio’s assertion that “the foreskin was significantly more sensitive to touch as compared to all the other genital sites tested“.

She then offers an allegedly quoted conclusion that Bossio’s data “do not support the idea that foreskin removal is detrimental to penile sensitivity.” – a quote that is really an inaccurate paraphrase, and we repeat, is deeply flawed based on the non-existent definition of sensitivity.

Fenner then offers her own conclusion, the one that everybody was hoping for, the direct contradiction to Sorrells: “removing the foreskin does not, in fact, remove the most sensitive part of the penis.”

We have already shown above how deeply flawed is this, given that the same assertion is contradicted by Bossio herself.

But that’s what Bossio’s thesis was written for: to allow culturally biased academics to contradict Sorrells’ study by quoting a paper that didn’t understand what Sorrells was writing about, and which is so poor that it contradicts itself without raising the eyebrows of any mindless reviewer.

Misleading headlines

We wrote this review back in January, but we didn’t publish it, silently waiting. Last week, however, the media picked up Jennifer Bossio’s paper, and predictably, as we have often indicated, used misleading headlines to make this look as far more conclusive than it really is. Many of the articles we reviewed, clumsily include Bossio’s contradiction without pointing it out.

Some examples of these disappointing articles:

Science Daily: Neonatal circumcision does not reduce penile sensitivity in men, study finds (New research challenges widely accepted beliefs)

UPI: Study: Circumcision does not reduce penis sensitivity. This article even says “In men with foreskin, it was more sensitive to tactile stimulation than other parts of their penises, however when foreskin sensitivity was compared to other sites intact men had no greater sensitivity than the circumcised men” – the first part obviously contradicts the premise of the headline: if the foreskin is more sensitive to tactile stimulation, removing it has to reduce the penile sensitivity (to tactile stimulation). The second part of the statement simply makes no sense and seems to be a derailing tool.

Tech Times: Getting circumcised does not shrink male organ sensitivity.

Medical Express: Circumcision does not reduce penile sensitivity, research finds.  In this article, Bossio is quoted saying “We found that while the foreskin was more sensitive to fine touch, it was not more sensitive to the other stimuli we used, and those stimuli are likely more important in sexual pleasure“. However, that sentence alone already contradicts the headline – and the whole premise of Bossio’s publication. In fact, the underlined sentence alone shows that Bossio validated Sorrells’ study, the very study that she appears to be trying to contradict.

Queens University: NEWS RELEASE – New research finds circumcision does not reduce penile sensitivity. This must be the originating point of all these press releases, as Bossio’s study was the core of her PhD thesis at Queens University. This article, just like the one from Medical Express, quotes Bossio saying “We found that while the foreskin was more sensitive to fine touch, it was not more sensitive to the other stimuli we used, and those stimuli are likely more important in sexual pleasure” – which we are getting tired of repeating, contradicts the headline and the very premise of her study.

Daily Mail: Circumcision does NOT reduce sensitivity of the penis, experts say.  Unfortunately Bossio’s sad excuse of a study made its waves all the way to England. This article is preceded by 3 bullet points, one of which states: “Findings also suggest the foreskin is not the most sensitive part of the penis“. In this article, Bossio herself is quoted saying that her study “provides preliminary evidence to suggest that the foreskin is not the most sensitive part of the penis“. This version of the article avoids saying that “the foreskin was more sensitive to fine touch“, as the Queens University press release and the article on Medical Express did. Perhaps the contradiction would have been too obvious.

Healio, Medical Daily, True Viral News, Australian Networks, The Independent, I Fucking Love Science, GCO News, Renal and Urology News, Today’s Parent and many others also mindlessly reported on this absurd study.

So congratulations Jennifer Bossio. Your nonsense fooled a lot of people. Who knows how many men will be harmed because of your sad thesis.

UPDATE: Additional problems with Bossio’s paper

  • Some readers pointed out that Jennifer Bossio’s measuring point was the outside of the foreskin (see diagram). The foreskin is not a single structure. It has an outer layer of regular penile skin, and an inner layer of mucosa. There is also a transitional area which was pointed by Sorrells as the single most sensitive area to soft touch, and there is the frenulum, joining the ridged band and the inner foreskin to the glans and the meatus. Sorrells measured sensitivity at 8 different points of the foreskin. Bossio did not take measurements on the points indicated by Sorrells as the most sensitive ones to fine-touch sensation, which are the ridged band and the frenulum. Nevertheless, she found that the outer foreskin was significantly more sensitive to touch than the rest of the penis, which is consistent with Sorrells, even if her conclusions fail to indicate that.
    This was the site used by Bossio:
    bossio1
    These are the testing sites used by Sorrellssorrells_sites
  • According to the Queens University press release, Bossio “extended the research methods in her study to include warmth detection and heat pain because these stimuli are more likely to activate the nerve fibres associated with sexual pleasure“.For one, Sorrells did not make any claims regarding fine-touch sensitivity and pleasure.Second, “extending” the method makes the results difficult to compare. For example, Bossio writes “with respect to warmth detection, the foreskin was more sensitive than the glans penis, but not the midline shaft or an area proximal to the midline shaft. Using a different stimulus modality (warmth sensation, as opposed to fine-touch punctate pressure), we partially replicated the findings reported by Sorrells et al. (2007), in that the foreskin was more sensitive than the glans penis, but—unlike Sorrells—not two sites located on the penile shaft.” This makes no sense, because since Sorrells did not take measures of warmth sensitivity, there is no way to compare the data collected to Bossio in this aspect to anything in Sorrells study. It is not correct to say that this data “partially replicates” Sorrells given that they are referring to different types of stimulus.

    Sorrells declared that the foreskin was the most sensitive part (to soft-touch and to soft-touch only). Different parts of the body specialize in different kinds of sensitivity, according to our body’s needs. For example, our eyes are probably the most sensitive part to light. Our ears are probably the most sensitive part to sound. We wouldn’t try to assess sensitivity to sound in our eyes, or sensitivity to light in our ears. If the foreskin is sensitive to soft-touch, it is likely because we need that area to be sensitive to soft-touch, and removing it is going to affect the reasons why we need that sensitivity.

    Think about it this way. Removing one person’s eyes does not make the person deaf. But that is not a reason to justify removing the person’s eyes without necessity, particularly if we don’t know if the person needs to be sensitive to light.

  • Regardless of whether the foreskin is the most sensitive part, or just as sensitive as the rest of the penile skin, or if it was not sensitive at all, removing it would still violate the bodily autonomy and genital integrity of the person. Bossio writes on BJU that her “results are relevant to policy makers, parents of male children and the general public.” This statement misses the point that the most important stakeholder is the person holding the foreskin: the male child, the future male adult, and that no matter to what extent sensitivity is affected, removing the foreskin of the child deprives the child from the freedom to choose and the right to provide informed consent – thus violating his bodily autonomy and genital integrity.

    To be fair, on her thesis, Bossio writes that “Individual stakeholders are also expected to benefit from this research program, such as medical professionals, parents of male infants, and men themselves.” For some reason, “men themselves” were omitted from the conclusion in BJU.

  • Hugh Young pointed out that the graphics on Bossio’s thesis (i.e. figure 3.2) are collapsed across circumcision status. This conceals any existing difference between circumcised and uncircumcised.Figure 3.2 basically shows that the foreskin is more sensitive than the other testing points for tactile, warmth and heat pain (this last one only by a small difference), and that the glans is more sensitive to pain. The collapsed bars fail to show any difference. Young explains: “This makes the inclusion of the bar for the foreskin absurdly different from the others, because the foreskins of the cut men are non-existent. If their measurements were shown, their bars would be infinitely tall, indicating that no amount of pressure, heat etc, would evoke a response.” Sorrells study includes figures that are not collapsed by circumcision status. Two adjacent bars show the results for circumcised and uncircumcised. In the case of the circumcised males, the bar for non-existent measuring sites is simply omitted. If Jennifer Bossio wanted her study to be comparable to Sorrells, she should have considered presenting graphics that were comparable to those by Sorrells.Bossio’s figure 3.2
    bossio_fig

    Sorrells’ figure 3

    sorrells-fig

Bibliography

Bossio, J.A.EXAMINING SEXUAL CORRELATES OF NEONATAL CIRCUMCISION IN ADULT MEN. Thesis (Ph.D, Psychology) — Queen’s University, 2015-09-18 00:15:45.183

http://qspace.library.queensu.ca/handle/1974/13627

 

Bossio, J.A. et al. Examining penile sensitivity in neonatally circumcised and intact men using quantitative sensory testing. J. Urol. http://dx.doi.org/10.1016/j.juro.2015.12.080 (2015)

 

Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int 2007;99:864-9.

http://www.cirp.org/library/anatomy/sorrells_2007/

Badger J. A Survey about Masturbation and Circumcision. 2000

http://www.circlist.com/surveys/badger-06.html

 

Fenner, Annette  - Male circumcision: Circumcision does not affect sensitivity – Nat Rev Urol

PY  - 2016/01/20/online

VL  - advance online publication

http://www.nature.com/nrurol/journal/vaop/ncurrent/full/nrurol.2016.3.html

Subtle language to perpetuate the fraud – by Touro Infirmary

I believe we all, regardless of whether we oppose circumcision of children, or promote it, can agree that circumcision is not a necessary procedure.

In fact, the third paragraph of the American Academy of Pediatrics’ 2012 Policy Statement on Circumcision starts: “Although health benefits are not great enough to recommend routine circumcision for all male newborns“. Then it goes on to boast the “benefits” and endorse insurance coverage of the procedure.

Nevertheless, the important point is, the procedure is considered elective. Intactivists and the medical community disagree over who has the right to “elect” the procedure, but there is no medical view that considers the procedure necessary.

Which is why it is important to see how subtle language is used to convince parents otherwise.

Touro Infirmary

Touro Infirmary, Louisiana

We were alerted to Touro Infirmary’s verbiage and had  the chance to verify it on their website. Touro, founded in 1852, claims to be New Orleans’ only community based, not-for-profit, faith-based hospital, and their “about us” page claims they have always  taken a progressive path.

But are they progressive when it comes to male newborns’ genitalia?

The “before delivery” page reads:

You may have already signed the “Consent for Circumcision” for your male child when you signed your other consents at 36 weeks. If not, this consent will also need to be signed shortly before the circumcision procedure is done.”

Notice the language: this consent will need to be signed before the procedure is done. There is no question of whether you are the parents have decided. The language presents circumcision of the male child as something inevitable, and the consent form as something that just needs to be signed so we can move forward and be done with this.

The “after delivery” page then starts with this question and answer:

“I have heard that after the birth of my baby, the baby will remain in my room, with me, rather than go to the nursery. Is this true?”
“Touro offers “rooming-in/mother-baby care” before and during the newborn’s initial bath and examination by the nurse and pediatrician. Of course, circumcisions and other necessary procedures are done in the nursery, not in the mother’s room.”

Notice the wording: “circumcision and other necessary procedures” which seems to imply  that circumcision is one of those necessary procedures. In fact, it seems it is so important that it is the first one mentioned!

The only place where they hint that circumcision is not necessary or otherwise mandatory is on their example of a birth plan, which includes this line:

“If your baby is a boy, do you want to have him circumcised?”

The website makes no attempt to educate parents on why they would want or not, to have their male child circumcised. But by using careful language,  they present circumcision as a necessity, as something that is simply done. And by doing this, they attempt to ensure the perpetuation of male infant circumcision in the United States.

Touro, shame on you.

 

Which doctors claim that legalizing some forms of FGM will help some girls?

The most recent discussion in genital integrity forums is the publication of a paper (and related news articles) by two U.S. based gynecologysts, Kavita Arora and Allan Jacobs, of an article called “female genital alteration: a compromise solution” in the Journal of Medical Ethics. In this paper, authors Kavita Arora and Allan Jacobs reframe the discussion of female genital mutilation (FGM) as a matter of “alteration“, because they consider that the term mutilation is culturally insensitive and discriminatory towards women. They argue that mild forms of “FGA” do not constitute a human rights violation, and thus promote that some of those forms could be offered and tolerated as a “compromise” to protect children from more extensive forms of “FGA“, allowing parents to uphold cultural and religious practices “without sacrificing the health and well-being of female children“.

This is obviously a scandalous proposal, and one that is not entirely new. In May of 2010 the American Academy of Pediatrics had already suggested a similar path with their maligned “policy statement on ritual genital cutting of female minors“, a paper that was criticized by the World Health Organization as an obstacle to their efforts to eradicate FGM, and was also criticized by pro-genital integrity and children’s rights organizations such as Intact America, fearful that the American medical community may slowly reinstate the practice of FGM among Americans, a practice that persisted for at least the first half of the 20th century, before slowly falling in obsolescence. The AAP’s policy statement was retired one month later.

Both papers, the AAP policy statement and now Arora and Jacobs’ article, however, acknowledge something that most FGM activists deny: that there are parallels between FGM and the circumcision of male children. The AAP declared that some forms of FGM are far less invasive than male circumcision as practiced in the “West” (sic). Arora and Jacobs refer to the difference in the treatment of male circumcision and “FGA” as “disparate“, and recognize that a possible solution would be to proscribe both practices. They acknowledge that both practices have been criticized as a violation of human rights. However, they have already argued in a previous paper that infant circumcision is not a violation of human rights.

And here is where this new paper is a logical consequence of their previous article.

Published in 2015 in the American Journal of Bioethics, the  article, entitled “Ritual Male Infant Circumcision and Human Rights“, is a very flawed rationalization meant to deny that male infant circumcision can constitute a violation of human rights. It has been one of my objectives for several months, to write a response to this paper, but many circumstances have slowed my efforts. I will, however, summarize a few points here, so that we can better understand their mental process.

Their paper on ritual male infant circumcision pretends to appear multicultural, by using language that appeals more to an European audience.  For example, referring to infant circumcision as “ritual” is common in European circles, since it is not considered a medical practice in those places – I imagine that many American doctors would feel relatively insulted by the suggestion that they are practicing a ritual, which is what Arora and Jacobs  are doing. Through the paper, they often reinforce the fact that Muslims practice circumcision, to give the appearance of diversity. However, Robert Darby pointed that by framing their paper around infant circumcision, they are in fact excluding most “ritual” circumcision practices, such as those from African tribes, Philippines, and Muslim groups, since they occur mostly after infancy. It’s worth noting that in some languages, “infancy” refers to childhood in general, but its current use in English refers only to the pre-verbal period, so mostly the first year of life. Arora and Jacobs responded, in fact reaffirming that their paper refers to infancy only -without expressing disapproval or approval to circumcision beyond infancy, which they consider subject to a separate but related discussion, and state that Islamic circumcisions in the United States are often performed during infancy. Which leads to the basic conclusion, that their paper was not written to protect circumcision as it is performed in Africa, The Philippines or in Muslim countries, only circumcision as it is performed by Jews and Americans.

The fact that Muslims in the United States tend to circumcise during infancy is not a result of Islam, but a result of the American culture which makes infant circumcision easily available and almost normative at birth. The same argument can be made for Jewish people who allow their male babies to be circumcised by doctors before leaving the hospital; orthodox Rabbis consider circumcision performed on the second or third day of life, by gentile doctors, to be inadequate and invalid. Jewish circumcision requires a proper ceremony performed on the eighth day of life, by a trained Jewish mohel, with methods that are not the most sanitary, nor place particular interest in preventing pain for the baby. American Jews who have their babies circumcised in hospitals on the second day, do so not because they are Jews, but because they are Americans, and a similar argument could be made for American Muslims.

So once removing the embellishment and appearance of diversity, the paper is a discussion concerning American and Jewish circumcision only. Arora and Jacobs repeat a number of fallacious, obsolete and even irresponsible arguments – which we will address in a future post:

* That early circumcision is safer when performed in infancy

* That circumcision has little or no effect on male sexuality

* That circumcision causes little harm to the infant

* That the more severe complications of circumcision are of little relevance because of their low incidence – in other words, that killing or severely maiming infants is acceptable as long as it is in a very low rate.

Their paper goes into a discussion of whether genital integrity is in fact a human right, and whether the principle of open future as suggested by Darby is applicable or not. Both discussions are fallacious, and I promise I will refute them in detail later.

Finally, they propose a three step test to determine if a parental decision constitutes a violation of human rights. Predictably enough, they find that under their test, male infant circumcision is not a violation of basic human rights. The irony that they had defined the test in such a way that a favorable result would be obtained, seems to be lost on Jacobs and Arora.

But here’s the catch: under the same test, mild forms of “FGA” would also have to be considered valid parental decisions and not violations of human rights. This new paper on female genital “alteration” is just the logical consequence of such a finding.

Personally, I believe that it is sad that educated adults and physicians, whose minds should be focused on healing, spend all the time and energy they spent into rationalizing and justifying hurting babies as a valid parental decision, as long as the harm is relatively low and any catastrophic incident has a relatively low incidence. To me, the purpose this paper serves seems to be masturbatory fodder for circumcision-crazed psychopaths, and not the work of professional and empathetic physicians, thus earning them a proper space in the bookshelf, next to the works of J. H. Kellogg, Remondino, John Money, Brian Morris, the Benatar brothers and Doug Diekema.

Kavita Arora

Kavita Arora

Kavita Shah Arora is an Assistant Professor of Reproductive Biology and Bioethics at Case Western Reserve University, as well as a practicing general obstetrician/gynecologist at MetroHealth Medical Center. She received her BS with a minor in Philosophy from the Pennsylvania State University. In 2009, she graduated with both an MD from Jefferson Medical College and a Master’s Degree in Bioethics from the University of Pennsylvania. She completed her residency in Obstetrics and Gynecology at McGaw Medical Center of Northwestern University in 2013. She has served on the national ethics committees of both the American Medical Association and the American College of Obstetricians and Gynecologists.

Dr. Arora is primarily based at MetroHealth Medical Center as a practicing general ob/gyn and also serves as the Department’s Director of Quality. She is an active member of the hospital’s ethics committee. Her research interests include reproductive ethics, reproductive technology, perinatal decision making, conscience, HIV care in pregnancy, and feminist Bioethics. She is also interested in medical education, especially with the intersection of ethics education.

An existent video of Kavita Arora appears to present an idealistic, happy, young adult with passion to provide a nice birthing experience to female patients. When was this passionate healer derailed into defending the indefensible -harming babies, male and female alike? How does she get away with publishing a paper that is beyond the scope of her practice which is not in surgery, urology or pediatric care, but the care of women and their reproductive systems?

Dr. Allan Jacobs

Dr. Allan Jacobs

Allan Jacobs is Professor of Obstetrics, Gynecology, and Reproductive Medicine at Stony Brook University School of Medicine. He received his B.A. (psychology) at Cornell University, his M.D. from the University of Southern California, and his J.D. from St. John’s University. He completed his residency at Parkland memorial Hospital and his fellowship at Mount Sinai Hospital. A board certified gynecologic oncologist, he serves as Chairman of the Department of Obstetrics and Gynecology at Flushing Hospital Medical Center. He has published articles in the field of reproductive ethics in journals such as the Hastings Center Reports. He has also published in the area of health law, a current research interest. He teaches biomedical ethics and health law to medical students and residents.

As for Allan Jacobs, his religious affiliation seems to account for his bias in favor of circumcision. Note that he too, is a gynecologist, for whom the concern for the genitals of healthy male children should be zero.

To our knowledge, none of the American doctors that used to perform clitorectomies and other forms of FGM on all-American female minors, ever paid for their crimes. Not even more recent ones, those that removed the phalluses (clitorises or penises) and gonads of intersex babies, as did Dr. Dix Poppas at Cornell University or Dr. Ian Aaronson at the Medical University of South Carolina, -and then proceeded to rationalize those procedures by calling those babies “disordered” (DSD) in the 2006 “consensus“, have paid their time for performing procedures that should be proscribed by the FGM law of 1997.

 To our knowledge, a single case stands in the United States. Dr. Hatem Elhagaly, Muslim, was fired from the Mayo Clinic  for promoting a practice that is illegal in America but, in his words, “honors Islam.” Mayo Clinic however has experience with surgical treatment of ambiguous genitalia, procedures matching the definition of FGM.

 In publishing this paper arguing for mild forms of “FGA“, Jacobs and Arora have followed the logical steps established by their previous paper, but they have also put themselves at odds with the Western rejection of FGM.

Their only positive point is breaking again that “taboo” that makes most American doctors afraid to suggest any comparison between male infant circumcision and female genital mutilation. But the conclusion that those practices are not violation of human rights seems to detract from the humanity and dignity of the authors.

 We believe doctors should dedicate their efforts to serve their patients as healers, not as cultural or religious brokers defending the “parental right” to harm the child (the patient) as part of a ritual.

We hope to see Arora and Jacobs publicly retract their two papers, or follow the steps of Dr. Elhagaly.

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 sick compulsion to circumcise

“Elective circumcision should be
performed only if the infant’s condition
is stable and healthy.”

American Academy of Pediatrics
Technical Report on Circumcision, 2012

A baby was circumcised on November 10, 2015 at Kosairs Children’s Hospital in Louisville, Kentucky. Ordinarily, this wouldn’t be newsworthy; it is estimated that more than 3,000 male babies are circumcised daily in the United States. However, this was one particular baby. As the parents described on a GoFundMe page, he “was born August [**], 2015 at [**]  at 34 weeks 3 days gestation. He weighed 4lbs 4oz and was 15 inches long. Shortly after birth, he started having breathing problems and was intubated and put on ventilation. The doctors at Owensboro Health noticed he had a very small ribcage, after doing xrays, they decided to fly him to Kosairs Children’s Hospital. He was seen by many geneticists and doctors, and they noticed he was showing signs of something called Klippel Feil Sequence. He has a cleft palate, small ribs, and a short neck along with some renal issues (enlarged kidneys).

While at Kosairs, his spine was found to be detached from his skull (internal decapitation), making his condition even more critical. The baby was intubated and wearing a brace to keep his head from moving.

brian goode wave tv - Copy

And then, they decided to perform a circumcision at the same time as a major surgery on November 10.

The Intactivist community jumped to recommend that the baby be spared from the circumcision; after all, this was a baby with extreme health problems who has been fighting for his life for months now. But all the attempts to contact the parents were met with disdain, with the mother at some point commenting:

Well, uncirced penises look like a turtle hiding in it’s[sic] shell. I don’t prefer them, sexually. And [father's name omitted] gets much pleasure out of sex with his circumcised penis.

mother reason

The Facebook page for the child’s battle posted that they had blocked over 300 people that day. 300 people who were concerned that this baby had suffered too much and didn’t need to be put through a circumcision in his current condition. It’s said that some activists contacted CPS out of concern of what the consequences of the surgery could be to the baby.

Then the Facebook page for the child’s battle informed that the baby “is out of surgery and recovering now. All surgeries went well, just hope that the Nissen is the correct size“.

A few hours later, the page deleted all photos and videos and was marked under construction. Pictures and videos started going back up with watermarks, and about an hour later, the page and the parents’ Facebook profiles went offline.

Attempts to find out the condition of the baby by some activists went unanswered – due to privacy laws. But then in a strange twist, the mother’s profile showed up again commenting in different places:

If you are worried about [baby's name], instead of attacking his family on Facebook, contact us. [phone number]

mother2Activists who called were cursed out.

On November 11, Kosair Children’s Hospital posted on their FB page:

In keeping with the American Academy of Pediatrics’ policy statement on circumcision, parents at Kosair Children’s Hospital are advised of the benefits and risks of the procedure, and make the decision to circumcise based upon religious, ethical and cultural beliefs. If parents do choose circumcision for their baby boy and the infant is already scheduled for a surgery, the procedure is done at the same time under anesthesia. In other instances, pain control measures are used to keep the baby comfortable.”

What they failed to mention is that the American Academy of Pediatrics clearly indicates that “Elective circumcision should be performed only if the infant’s condition is stable and healthy.”

kosair

This post was deleted about one hour later, as the intactivist community kept commenting and providing real information.

Evidently, American doctors have a difficult time realizing that they have a responsibility to their infant patient over the “beliefs” of the parents and understanding that there are times when babies are struggling to survive, when they are suffering so much, that they should do the best to spare them from any additional pain.

We wish we didn’t have to tell parents not to perform unnecessary genital alterations on their babies (our agenda), but more than that, we wish doctors were capable of policing themselves and were capable of telling parents that there are times when their babies are not good candidates for the unnecessary surgery, and this is no doubt one of those cases.

I don’t want to use any baby’s or any family’s suffering to “advance an agenda”. Some suffering is preventable, if only the medical community would be accountable and would stop enabling cultural customs at least in the cases where good sense and logic advise against them.

In my heart I wish the best for this baby. I wish that he survived and that he will heal and grow up to be the best person that he can be. That’s all I can do really.

 

 

 

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

 

Little sproutings and circumcision – more of the same

Jeni Taylor, MPH MSN RN is a nurse, public health advocate and new mom from Northern Virginia, who blogs on her website, Little Sproutings, to share her experiences as a mother and discuss relevant baby-health topics to help parents.

On July 25th, 2015, Jeni published an article called “The circumcision decision“. On this article she intended to “research what the current evidence says about whether or not it’s indicated to circumcise in the developed world“. Her article obviously caused some backslash among the intactivist community.

Jennifer Marali Taylor, MPH MSN RN - we cropped the image to respect the privacy of her baby.

Jennifer Marali Taylor, MPH MSN RN – we cropped the image to respect the privacy of her baby.

In response, Jeni added a disclaimer: “I want to clarify that I am not an expert on the subject of circumcision, and this post is not intended to cover every aspect of such a complex issue. This post is focused strictly on the medical perspective.” Also, responding to a commenter who indicated that Jeni “never once bothered to mention the structure and function of the foreskin“, she responded that she “didn’t discuss the function of the foreskin. That wasn’t what this article was about and that wasn’t what I was set out to do when I wrote this article.”

At the end of the article, Jeni claims that “with regards to expert opinion, the research all points to maintaining this evidence-based practice“. Jeni, however, only reviewed U.S. sources. European medical associations for example hold different points of view in spite of having access to the same evidence.

The problem we have with this kind of article is that many parents will take it as a recommendation, in spite of the disclaimer (“I am not an expert”). And, many people who are not familiar with the topic won’t even ask the question of whether the foreskin has any kind of function or not.

Sure, Jeni said that “wasn’t what this article is about“, but you cannot separate these two elements. When you circumcise a baby, you negate the functions of the foreskin. The baby will never experience those functions. When you do not circumcise the baby, he will grow up to experience those functions. It’s just like the two sides of the coin. You can’t just flip one single side of the coin. Wherever one side goes, the other side follows.

Jeni wrote: “The risks of complications from a circumcision are very low, and most of those that occur are minor“. This statement alone is very incomplete and misleading.

According to the American Academy of Pediatrics, AAP, on their 2012 technical report on circumcision (page 17 of 32): “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

A few sentences later the same report indicates: “Significant acute  complications are rare, occurring in approximately 1 in 500” – But is this really number really “rare”? Take into consideration approximately 1.2 million circumcisions in the United States every year, and you have 2,400 babies suffering significant acute complications every year, over a surgery that they didn’t need.

The Royal Australasian College of Physicians, on their policy statement from 2009, actually says: “Some of the risks of circumcision are low in frequency but high in impact (death, loss of penis); others are higher in frequency but much lower in impact (infection, which can be treated quickly and effectively, with no lasting ill-effects). Low impact risks, when they are readily correctable, do not carry great ethical significance. Evaluation of the significance of high-impact low-frequency risks is ethically contentious and variable between individuals. Some are more risk averse than others“.

But we are talking about babies. How do we know how risk adverse is a baby? Can parents even know?

We know for sure that babies had died as a result of circumcisions, and others have lost their penises (at least two of them in the U.S. in 2013). Babies have been forced to grow without penis, with the most known case being David Reimer (1965-2004) who was raised as a girl after the destruction of his penis, resumed male identity as a teenager, underwent two phalloplasties, and finally committed suicide in 2004. There were also two cases on the same day in a hospital in Atlanta on Aug.22, 1985. A two year old child suffered the same fate in 1984. Then, we have Mike Moore, who lost his penis during circumcision at age 7, circa 1991. And of course, the two babies from 2013, one in Pittsburgh and one in Memphis.

How many babies and children is it tolerable to force to go through life without their penis? Dear reader, how many of your sons would you consider tolerable to endure this complication?

While the American Academy of Pediatrics touts benefits -without being able to fully recommend circumcision-, the Royal Dutch Medical Association indicated in 2010:

“There is no convincing evidence that circumcision is useful or necessary in terms of prevention or hygiene. Partly in the light of the complications which can arise during or after circumcision, circumcision is not justifiable except on medical/therapeutic grounds. Insofar as there are medical benefits, such as a possibly reduced risk of HIV infection, it is reasonable to put off circumcision until the age at which such a risk is relevant and the boy himself can decide about the intervention, or can opt for any available alternatives.

“Contrary to what is often thought, circumcision entails the risk of medical and psychological complications. The most common complications are bleeding, infections, meatus stenosis (narrowing of the urethra) and panic attacks. Partial or complete penis amputations as a result of complications following circumcisions have also been reported, as have psychological problems as a result of the circumcision.

“Non-therapeutic circumcision of male minors is contrary to the rule that minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child, as in the case of vaccinations.

“Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.”

In 2013 the Nordic Association for Clinical Sexology wrote: “Ancient historic account and recent scientific evidence leave little doubt that during sexual activity the foreskin is a functional and highly sensitive, erogenous structure, capable of providing pleasure to its owner and potential partners

Not discussing the functions of the foreskin, dismissing the sexual role of  the foreskin and minimizing the impact of the risks, are three ways in which the American medical community shows its bias in favor of circumcision.

Jeni claims that “Both the AAP and the medical community recommend male circumcisions, for the health and medical benefits”. The AAP never actually recommends circumcision. They favor it, but they do not recommend it, leaving the decision to the parents (which we disagree with since the parents are not the ones who have to live with the consequences, and as we showed before, these consequences can be catastrophic). It would be difficult to limit what Jeni means with “the medical community”. As we have seen in this article, the global medical community at large finds much less value in circumcision than the American medical community.

The AAP says: “Parents are entitled to factually correct, nonbiased information about circumcision“. Skipping the functions and anatomy of the foreskin is providing incomplete and biased information. The AAP themselves are guilty of this omission, and so is Jeni.

A 2013 letter by 38 European and Canadian Physicians, heads of medical associations, says of the AAP: “while striving for objectivity, the conclusions drawn by the 8 task force members reflect what these individual physicians perceived as trustworthy evidence. Seen from the outside, cultural bias reflecting the normality of nontherapeutic male circumcision in the United States seems obvious, and the report’s conclusions are different from those reached by physicians in other parts of the Western world, including Europe, Canada, and Australia.” Furthermore, “To these authors, only 1 of the arguments put forward by the American Academy of Pediatrics has some theoretical relevance in relation to infant male circumcision; namely, the possible protection against urinary tract infections in infant boys, which can easily be treated with antibiotics without tissue loss. The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.

This conclusion contradicts the conclusion in Jeni’s article that we noted earlier, that “the research all points to maintaining this evidence-based practice“.

We wish that Jeni will understand that circumcision and non-therapeutic genital alterations on children of any gender violate the bodily autonomy and physical integrity of children, violates their human rights, and that she as a nurse, as a mother and as a blogger has a responsibility to protect children from unnecessary and harmful procedures.

If you are neutral in situations of injustice, you have chosen the side of the oppressor. If an elephant has its foot on the tail of a mouse and you say that you are neutral, the mouse will not appreciate your neutrality. Desmond Tutu

If you are neutral in situations of injustice, you have chosen the side of the oppressor. If an elephant has its foot on the tail of a mouse and you say that you are neutral, the mouse will not appreciate your neutrality.
Desmond Tutu

 

A situation of injustice. Which is your side?

A situation of injustice. Which is your side?

 

Is it or is it not, Joe DiMaggio?

In an interesting twist of events, the Joe DiMaggio Children’s Hospital tried to deny that the child at the center of the Nebus vs Hironimus dispute, “is or has been” a patient. Shortly afterwards, a copy of a pre-surgical assessment printed on Joe DiMaggio Children’s Hospital at Memorial letterhead, was posted.

Joe DiMaggio Children's Hospital denies that Chase is or has been a patient

Joe DiMaggio Children’s Hospital denies that Chase is or has been a patient

See the screenshot of the pre-surgical assessment, dated 6/4/2015 (first visit) at the bottom of this post.

On it, we can see the typical excuses for circumcision: “father reports frequent urine trapping and ballooning of foreskin. Also has noted mild erythema of distil[sic] foreskin

Ballooning is normal at that age, it’s one of the ways nature has to stretch the balanopreputial lamina to desquamate it. There can be several causes to redness (erythema), from too much soap or improper rinsing, to a mild irritation, to rubbing, to balanitis; all of those causes are usually easily treatable and don’t require circumcision.

The review mentions:

  • “penile pain” – do you cut parts of your body when you have pain, or do you find the cause of the pain?
  • “ballooning of foreskin” – again, not a cause for concern at this age, and
  • “foreskin not retractable”. Per Oster, less than 30% of boys can retract the foreskin at Chase’s age, so again, it’s not a cause for concern.

Down the paper, it reiterates:

  • “Foreskin reduces approximately 30 percent” – foreskin shouldn’t be retractable yet and nobody should be retracting it – indication that doctor was fondling his penis to see whether it would retract or not.
  • “Mild foreskin inflammation” – this is, again, the redness mentioned above; so, if you had inflammation in one ear, would you cut your ear? or treat it? how is this medicine?
  • “Urine noted under foreskin” – the foreskin traps moisture, it’s normal and more in children, every male in the world who has a foreskin maintains a certain moisture between the foreskin and the glans, it’s how mucosas work; to try to make this into a pathological situation is like saying that moisture inside the mouth is indication of improper hygiene, it simply makes no sense!

The paper does not mention the tendency to form hypertrophic scars, which has been noted on a previous surgery, and which could have negative results in a circumcision.

Then, the Assessment and plan continues:

Discussed pros and cons, RCA in detail with father and aunt as relatives to elective circumcision. They have asked that we proceed.

Here we can see that the doctor refers to the circumcision as “elective”. He is not recommending it, he is “discussing pros and cons”. In other words, the procedure is not medically necessary. The child has no condition requiring the procedure. Dr. Birken is clearly washing his hands over the procedure: he didn’t recommend it, the father elected it.

It’s clear from the form that the circumcision is not necessary, and the doctor wants it to be evident so he can dodge any blame later. That’s why he is calling it elective and reiterating that the father gave the go ahead.

The problem is also, if the father elected it (because it is not medically necessary), then Medicaid should not cover the procedure at all. But of course we know that this is where medical fraud is committed daily in this country. Should Medicaid cover this procedure, do not doubt there will be clear investigations.

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