Category Archives: Culture

The court of public opinion speaks against the circumcision of 4 and 1/2 year old in Florida

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While the Joe DiMaggio Children’s Hospital keeps tight silence over the reported scheduled circumcision, activists and public from all over the world rush to the facebook page of the hospital to express their distaste for what a German commenter called a “middle-age procedure”.

Posts to the hospital, reviews, comments on the reviews, comments on the posts of the facebook page of the hospital. Allegedly the hospital started deleting comments yesterday (Tuesday) but gave up given the high numbers.

New Times Broward-Palm Beach, Palm Beach Post and ABC 25 WPBF were among the first news outlets to pick up the information, along with several bloggers and discussion forums.

What can you do? (1) Post on the hospital’s Facebook page, demanding that they refuse to circumcise a healthy child whose mother is vehemently opposed to the surgery, and telling them that if they do, there will be both public relations and legal consequences; (2) call the hospital 954-265-5933, and (similarly) tell the risk-management department that there will be both legal and reputational consequences if they circumcise the Hironimus (Nebus) boy; (3) call the physician’s office (954) 265-0072 and warn him that the mother of the child is vehemently opposed to the circumcision, and that to conduct medically unnecessary surgery under these circumstances is both unethical and legally risky. SPREAD THE WORD, PLEASE!!

The hospital wrote one post trying to “appease” the commenters. It had been shared 236 times and had over 1800 comments:

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While posts to the page can be easily deleted, that didn’t stop people from posting to the page anyway.

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Thousands of reviews clearly indicated the rejection:
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New Times Broward-Palm Beach: In Hironimus Case, Circumcision Scheduled for 4-Year-old; Protest Planned at Hospital,

Palm Beach Post: Protests planned at hospital where Boynton boy may be circumcised

ABC 25 WPBF: Circumcision scheduled for 4-year-old boy

Anonymous information about Nebus vs Hironimus, Joe DiMaggio Children’s Hospital, Dr. Gary A. Birken MD

The Chase’s Guardians page received this anonymous message:

“To the page administrators,

This is a throwaway account. I cannot give you any further information about me. This is NOT my real name. But I work at JDCH and due to my position and job I have gotten to see a lot of what has been going on surrounding Chase’s situation. I want to share what I know because I am so strongly against anyone so much as touching Chase with a ten foot pole. This is what I know – rumor or otherwise – and whether you share it with your followers or not is up to you.

-Chase’s father has not actually met with Dr Birken. From what I understand from his scheduling nurses, they are being ushered in without needing to establish a new patient relationship. Thursday will be their first meeting.

-Dr Birken will cut Chase no matter what Chase says or does in office. I have worked with Dr Birken in his office before and he is a very no nonsense doctor who will do whatever he has to in order to get done what he feels should be done. He has pressured patients and parents into unnecessary or excessive procedures in the past and I have no doubt he will have Chase forcibly restrained and put under anesthesia without regard to Chase’s medical history. Birken is NOT one of the more well loved doctors in our hospital system and that he has agreed to do this does not surprise me. You WILL NOT stop this by trying to reach out to Birken’s office – but you WILL make a big difference through the hospital itself. If you can convince them that their general image will be tarnished or that they may face lawsuits they may bar Birken from taking Chase as a patient.

-Hospital administration is threatening staff that chooses to participate in any sort of walk out, protest, or refusal to come in/work with the patient. Nobody in Birken’s office is allowed to call off sick on Thursday. They have said that they will place anyone who participates in any acknowledgement of Chase’s procedure on leave or will outright fire them for insubordination and violation of HIPPA (because by refusing to come in, protesting, or refusing to work with Birken or Chase they are acknowledging that he is a patient who will be in that day – it is a VERY fine line but the hospital believes they are within their rights).

-There is talk of secretly rescheduling the procedure to TOMORROW (Wednesday, June 10) or even to Friday. It’s said that one of the administrators is even considering having Birken be called to “emergency surgery” later today so that Chase can be circumcised, but I do not think this will happen.

-Regardless of when the procedure occurs the hospital will likely hire additional security detail and may also ask the police to be present all day on Thursday. This may mean additional risk for protesters, so those who do choose to protest should bring cameras and be prepared to be as open and obvious about being peaceful as possible.

-Currently the hospital is directing all questions about the case to the director of corporate communications, Kerting Baldwin – and that’s only because if it’s going to one person then all phone calls and emails can be systematically ignored if they are not “important”. I have been told that comments on the Facebook page will likely start being deleted soon (within 24 hours) and that they may shut down commenting entirely.

-Despite discussing taking precautions, hospital administration does NOT think that there will be much to worry about on Thursday. They are PREPARING for the worst but I have personally heard one of the upper level admins say that they would be shocked if there were “more than one or two of those crazy, smelly hippie moms with misspelled signs whose kids are homeschooled and unvaccinated”. That comment will probably stick with me forever. It was wrong on so many levels.”

Nebus vs Hironimus – circumcision scheduled

According to Intact America and intactivist Brother K, there is a report “that Dr. Gary A. Birken, MD, 1150 N 35th Ave, Hollywood, FL phone: (954) 265-0072, has diagnosed Chase with a foreskin problem and that the circumcision is scheduled for June 11 at a Florida hospital.”

Dr. Gary Birken also writes fiction, with his name, and as Mason Lucas MD. As Mason Lucas MD he published “Error in Diagnosis”. Using his name he published “Error in Judgement”

Dr. Gary Birken will commit a terrible error in judgment if he proceeds to circumcise Chase based on a fraudulent diagnosis.

Physicians examining C.R.N.H. or performing surgery on him should be warned that they are being observed by thousands of activists, several intactivist organizations, the national and international media and the international community, and any fraudulent referral or procedure over “phimosis” will no doubt lead to reports of misconduct and ethics complaints.

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Phony phimosis – medical fraud

Physicians examining C.R.N.H. should be warned that they are being observed by thousands of activists, several intactivist organizations, the national and international media and the international community, and any fraudulent referral over “phimosis” will no doubt lead to reports of misconduct and ethics complaints.

In 2013, Dr. Saleem Islam published a study called: “Allocation of Healthcare Dollars: Analysis of Nonneonatal Circumcisions in Florida“, indicating that the cost of circumcisions in the state of Florida had “skyrocketed” since Medicaid stopped covering neonatal circumcisions.

Islam explained: “Parents often explained that they were unable to pay for the procedure after the child was born. We hypothesized that neonatal circumcisions were deferred among families in lower socioeconomic classes because public funding was not available. Circumcisions would then be done when the child was older, a costlier procedure requiring general anesthesia in an outpatient surgical facility.”

After the age of 1, circumcision is a more complex procedure and up to 20 times more expensive, now requiring general anesthesia. The risks also grow by 20 times, according to the CDC’s Charbel El Bcheraou.

Islam wrote: “Our data show the cost of nonneonatal circumcisions in Florida has more than doubled over the 5 years studied, the apparent result of defunding nonneonatal circumcisions. Our experience suggests that parents continue to want the procedure done in early childhood because of the availability of public financing. If public funding were available for the procedure in the neonatal period, they would have had the procedure done then.

But here’s where things go wrong. Neonatal circumcision was defunded because it was an elective, non-essential procedure. In order to obtain a referral and funding for a non-neonatal circumcision, the physician needs to provide a diagnosis – and this diagnosis is usually phimosis or congenital non-retractable foreskin. But the diagnosis of phimosis at that age is usually wrong because the foreskin at that age is not supposed to be retractable.

There is debate over what really constitutes phimosis. Some experts suggest that real phimosis is characterized by lesions caused by BXO – balanitis xerotica obliterans, not just the inability to retract the foreskin.

Øster showed that at age 10, less than 50% of the boys become capable of retracting their foreskins, but between 16 to 17 years close approximately 95% can retract. Thus, diagnosing non-retractable foreskin of a child as “phimotic” and referring to circumcision interrupts the normal development cycle of the foreskin and results in loss of normal healthy genital tissue.

The World Health Organization has made this travesty simpler  by codifying a normal condition as a disease: ICD-10-CM code N47-0 corresponds to “Adherent prepuce of newborn” – and it is a diagnosis that applies to males only. Other related diagnosis continue the N47 series, including phimosis, paraphimosis, deficient prepuce, etc.

Physicians consciously commit fraud when they refer a child for circumcision over a diagnosis of “phimosis”. By playing into the “wants” of the parents, the “tradition”, the cultural or religious arguments, or parental preferences, physicians ignore their duty to their patient and become cultural or religious brokers, referring a non-consenting patient to genital surgery without any real medical indication. This clearly shows that circumcision of children in the United States is nothing but a medical ritual, a harmful traditional practice affecting the health of the boy child – to paraphrase an expression used by the World Health Organization.

As we denounced two years ago, some medical institutions even today, check intact (uncircumcised) boys for retraction during their well checkups, and “offer the option of circumcision” – in what may be perceived by the parents as a recommendation.

Nebus vs Hironimus

This information is particularly relevant to the case of Nebus vs Hironimus, which we have covered in detail this last year. In 2014, Nebus argued that his son, C.R.N.H., suffered phimosis and it was causing him to urinate on his legs. A medical expert testified that C.R.N.H. did not have phimosis and had no medical need for circumcision – a testimony that was cherrypicked by Judge Gillen to suggest that the “benefits” of circumcision were enough to justify enforcing the parental agreement, ignoring the increased risks and fears and the child’s opinion.

Now that Hironimus has been forced to sign a “consent” form (under the threat of indefinite incarceration) and Nebus has been granted wide power to schedule the procedure, in or out of state, and without warning Hironimus in advance or afterwards, the next step is clear: Nebus will seek a referral for circumcision arguing “phimosis” – so that Medicaid or any applicable health plan will pay for the procedure.

Physicians examining C.R.N.H. should be warned that they are being observed by thousands of activists, several intactivist organizations, the national and international media and the international community, and any fraudulent referral over “phimosis” will no doubt lead to reports of misconduct and ethics complaints.

Tyranny and patriarchy in America – let’s break those mothers who wish to protect their children from unnecessary genital surgery!

You may have heard that thing of home of the free, land of the brave?

I don’t know what country they were talking about. Certainly not the United States of America.

Let’s follow the recent developments in the Heather Hironimus / Dennis Nebus case:

After lawyer Thomas Hunker filed to dismiss the federal case last Wednesday (the child’s last legal possibility to preserve his genital integrity), a date for Heather to appear before the judge was set, for today, May 22th of 2015 at 10:30 AM.

Heather had been in jail one week and one day without seeing a judge.

Judge Jeffrey Dana Guillen has played doctor through the legal proceedings, touting the benefits of the procedure, dismissing the risks, dismissing Heather's fears and Chase's wishes, and ignoring the expert testimony that the circumcision is not medically necessary and the doctor himself wouldn't circumcise a son at that age.

Judge Jeffrey Dana Gillen.

Heather was transferred from the Paul Rein detention facility in Ft. Lauderdale, to a Palm Beach jail around midnight. One has to ask, why around midnight, especially when she was to appear in court in the morning? Sleep deprivation? Psychological torture?

Judge Jeffrey Dana Gillen told Heather that she would be held indefinitively unless she signed the consent form for circumcision – “the clearest instruction in the world“.

Heather initially declined and lawyers left. But then she changed her mind, and crying and hadcuffed signed the consent form.

May Cain, new attorney for Dennis Nebus

May Cain, new attorney for Dennis Nebus

Nebus’ new attorney , May Cain, requested full custody for Nebus, suspension of the parenting agreement rule that each parent notify the other. She wants Nebus to be able to enroll the child in voluntary pre kinder without consulting with Heather and to have him circumcised anywhere in United States without notifying Heather before or after.

Attorney May Cain said extraordinary measures are necessary because “intactivists continue to make death and kidnapping threats on social media”, and the judge agreed.

Judge Gillen chastised Attorney Thomas Hunker for being in touch with “fringe circumcision” groups and extremists – alluding the email Hunker directed to the intactivist community on Monday announcing the dismissal of the federal case. Hunker apologized for being in touch with “those people” and swore that he has had no contact with intactivists since then.

(“Those people”, including the over 11,000 followers of the Chase’s Guardians Facebook page, collected thousands of dollars to pay the bills from Thomas Hunker.)

According to the Sun Sentinel, while the contempt charges have now been dropped, Heather still faces a criminal charge of interferring with custody, from her time keeping the boy from his father in an apparent violation of a custody-sharing agreement. The charge is a third-degree felony punishable by up to five years in state prison for a conviction and will appear before a criminal court judge next Tuesday

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From Shyann Malone, anchor/reporter in South Florida

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Marc Freeman, criminal courts reporter for Sun Sentinel

So there you have it, this is what happens when you threaten the patriarchy to try to protect a child’s right to physical integrity in the United States. That infectious cultural disease that is forced genital cutting will attack you with all its might to make an example of you. It will ruin you.

If a foreskin is such a “negligible thing” in this culture, how come there is such a forceful strength used to dispose of it?

It’s ironic that courts in Israel, where over 90% of the boys are circumcised for religious reasons, had the common sense to protect the right of one child to remain intact when the mother did not agree to the circumcision, but in the United States, where circumcision is not even a religious issue, they will destroy you and they will label everyone who helps you as “fringe groups” and “extremists”… until they break you… until you provide…

FORCED CONSENT.

This is not the face of someone about to sign real consent

This is not the face of someone about to sign real consent

This is not how you sign your consent

This is not how you sign your consent

This is not what you do when you really consent

This is not what you do when you really consent

This is not the face of a person who consented

This is not the face of a person who consented

These photos belong to the Sun Sentinel

These photos belong to the Sun Sentinel

 

Forced consent isn't consent. It's rape.
CBS: Circumcision Battle: Heather Hironiums signs consent form

IBT: Florida Circumcision Case Update: Mom Heather Hironimus Signs Consent Form Allowing Son’s Surgery

WPBF 25 News: Mom jailed in son’s circumcision case emotional when she signs consent form

Sun Sentinel: Mom signs consent for son’s circumcision to get out of jail — but now faces new criminal charge

Joseph4GI: And the Florida Circumcision Court Battle Draws to a Close

Florida circumcision case – update

Breaking news. Or, heart-breaking news.

After Monday’s first audience in front of a Federal Court, Attorney Thomas Hunker, attorney for Heather Hironimus, filed a Withdrawal of Motion and Notice of Voluntary Dismissal of the federal case.

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Another boy’s right to physical integrity and genital autonomy has gone down the drain. Father is now free to collect his trophy.

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cut these veins
Remember: the medical witness clearly said that the child does not have phimosis and the surgery is unnecessary. The mother expressed her fear of the risks, particularly the risk of death because of the anesthesia. Judge Jeffrey Dana Gillen did not see merit enough in that risk, or the risk of psychological harm, to protect a vulnerable child from an unnecessary genital amputation, performed only to appease the father.

United States of America, the country where men do not own their genitals. Land of the wounded, home of the mutilators.

Mary Jane Minkin, MD, FACOG, stigmatizes men and pathologizes a normal body part

In an interview in 2Dun’s Spread, Dr. Mary Jane Minkin, MD, FACOG, clinical professor of obstetrics and gynecology at Yale School of Medicine and staff member at Obstetrics Gynecology & Menopause Physicians, violates the ethical principle of justice by stigmatizing 70% of the males in the world, those who are not circumcised, and by pathologizing a normal body part, the foreskin, in what only can be interpreted as blatant cultural prejudice.

This starts with the media circus around the CDC proposed guidelines, of which we spoke on our previous post. The Background document by the CDC also warned (page 40):

“Furthermore, recommendations to increase rates of male circumcision in the U.S. to reduce male acquisition of heterosexually acquired HIV infection may result in stigmatization of uncircumcised men or groups of men who are not routinely circumcised should they choose to not undergo circumcision.” ~ CDC

And Dr. Minkin gives us a clear example of what that meant.

Asked by 2Dun whether “doing the deed with an uncircumcised man puts you at a higher risk for contracting an STI?“, Dr. Minkin replies: ”To be exact, yes, if uncircumcised men are more likely to get infected with [an STD], then they’d be more likely to transmit“.

Dr. Mary Jane Minkin, M.D., FACOG, stigmatizes normal men

Dr. Mary Jane Minkin, M.D., FACOG, stigmatizes normal men

Dr. Minkin tells us two lies in this statement, first, that the mere presence of foreskin makes a man more likely to get infected, and second that the mere presence of foreskin makes a man more likely to transmit an infection.

But some readers will say, “the science is sound”. What the readers are forgetting, what the AAP and the CDC often would like people to forget, is that adult individuals can make lifestyle choices. Humans have a capability to make rational decisions, we are not bound by uncontrollable instincts, we can make decisions about whether to have sex or not, whether to engage in safe sex or not, whether to have multiple sex partners or follow a more monogamous lifestyle, and all those decisions are not reflected in the presence or absence of a normal part of the body.

A high risk male has a larger chance of contracting STIs than a low risk individual, regardless of their circumcision status. The risk attitude has far more priority on the chance of contracting sexually transmitted diseases than submission to circumcision.

If the presence of foreskin immediately implied a higher prevalence of HIV and STIs, how can we explain that most countries in Latin America and Europe, where circumcision is uncommon, have a lower prevalence of HIV than U.S., where circumcision rates are prevalent?

Dr. Minkin’s second implication, that uncircumcised males would be more likely to transmit an STI, is again fallacious and stigmatizing. Infected males will transmit infection no matter what, as the virus pollutes the sperm. The presence or absence of foreskin does not alter the composition and presence or absence of virus in sperm.

Dr. Minkin then re-states her lie: “The data is certainly suggestive that circumcised males are at less risk of acquiring—and then transmitting—certain STDs” and then says the only fully true statement:”but not to the point of saying it’s okay to not use a condom.”

All sexually active adolescent and adult males should continue to use other proven HIV and STI risk-reduction strategies such as reducing the number of partners, and correct and consistent use of male latex condoms, and HIV preexposure or postexposure prophylaxis among others. ” – Recommendation #2 in the proposed CDC guidelines

It is sad and corrupt when doctors and university professors, particularly in such a prestigious university, abuse their positions to pass cultural prejudice and false beliefs as science, stigmatizing in the process the vast majority of males in the world and demonizing a normal part of the body. It is simply shameful.

We recommend that Dr. Minkin takes the time to read the full Background document and review those good old ethical principles.

P.D., would it be a surprise that Dr. Minkin is originally from New Jersey, an area with high prevalence of circumcision? And why is a doctor who is “interested in all aspects of women’s health, she has a special interest in menopause” speaking about men’s health? Does she teach her students based on her beliefs on circumcision – or in real science?

Dr. Minkin, you had a chance to educate the public on the importance of safe sex and risk management, but you wasted it to promote a social surgery. We are so disappointed.

CDC, circumcision and misleading headlines

For anyone following the issue of genital cutting of minors in the United States, yesterday brought a plethora of new and misleading headlines:

The Verge: Benefits of circumcision outweigh the risks, US CDC says

NPR: CDC Considers Counseling Males Of All Ages On Circumcision

webmed: CDC Endorses Circumcision for Health Reasons – WebMD

Salon:  CDC: Circumcision is a very good idea – Salon.com

The Raw Story: CDC to parents: Consider circumcising your sons, because

UPI:  CDC recommends circumcision procedure, says benefits

NYTimes (blog):  Circumcision Guidelines Target Teenagers – NYTimes.com

But are these guidelines really such endorsement?

Or is it that the media is hungry to present benefits and call for a universal endorsement, something that really hasn’t happened?

It is our opinion that these headlines are nothing but a feeble attempt to manipulate the public opinion, under the assumption that everybody is too lazy to go to the source materials.

Anyone wishing to produce objective reporting on the CDC guidelines should start by fully reading and understanding the 8 pages draft document and the 60 pages technical report. It is unlikely that any of the reporters lending their names to the apparently carefully scripted articles, read any of the documents.

But we did, so let’s share our interpretation.

The CDC guidelines refer to counseling. Counseling does not mean immediate and universal endorsement. Counseling means aiding a person through a decision-making process, and that is what the guidelines attempt to do, to counsel patients or parents through a decision-making process.

In this decision making process, the CDC considered 3 main categories of individuals based on the age range: neonates and children, adolescents, and adults.

The CDC also considered the sexual orientation and lifestyle choices as factors to be weighted during this decision making process. And for those willing to go deep enough (as deep as page 39 of the technical report), the CDC also gave consideration to the fact that parents deciding for a newborn raise concerns about autonomy, including the argument that “a man with a foreskin can elect to be circumcised but if circumcised as a newborn, cannot easily reverse the decision“. The PHEC  (Public Health Ethics Committee) subcommittee is, however, of the opinion that “both a decision to circumcise and a decision to not circumcise are legitimate decisions“.  This is one opinion that genital integrity promoters and people for the rights of the child would oppose though.

For those saying that the CDC is fully recommending circumcision, they probably need to read in detail where the technical report indicates that “There are advantages and disadvantages to performing male circumcision at various stages of life” and one of the listed disadvantages of neonatal circumcision is that “the newborn has no ability to participate in the decision“.

The guidelines recognize that in the case of adolescents, both the adolescent and his parents should be involved in the decision-making process.

Let’s make one thing clear. One of the main reasons for the CDC’s discussion of circumcision has to do with the African trials on circumcision and HIV, considered to be evidence that circumcision could help reduce the risk of heterosexual transmission of HIV from infected females to males. The role of the CDC is not to discuss each one of those studies and their validity, strengths and flaws, but to make their recommendations based on currently accepted medical practices and standards. So of course an important premise of these guidelines is the so-mentioned potential benefit of reducing the risk of heterosexual transmission of HIV from infected females to males. As such, it is not within our current scope to discuss the African trials, something that has been already done by others in detail, but to discuss how the CDC interpreted those trials in reference to the U.S. conditions.

When discussing adult circumcision, the CDC recognizes both the documented benefits and limitations of circumcision as part of the prevention of HIV, that is:

  • that circumcision does not replace the need for condoms and safe sex,
  • that circumcision does not reduce the risk of male to female transmission
  • that circumcision does not reduce the risk or male to male transmission,
  • that circumcision does not reduce the risk of transmission through anal or oral sex, or for intravenous drug users.

In other words, that circumcision would only curb the transmission of HIV from females to males during vaginal penetration.

So, with those premises, the guidelines recommend a discussion of the person’s HIV risk behavior, HIV status, sexual preferences and gender of the sexual partner, in order to provide proper guidance depending on individual circumstances.

The PHEC subcommittee concluded that the disadvantages associated with delaying male circumcision would be ethically compensated to some extent by the respect for the integrity and autonomy of the individual.

And what are those “disadvantages”? A slightly increased risk of UTIs during the first year of life (risk of UTIs is low and they are generally easily treatable) and the possibility of the adolescent having a sexual debut prior to counseling and assessment of risks, which could potentially expose the adolescent to the risk of heterosexually transmitted HIV from infected female partners.

The CDC then states that:

The prevalence of HIV infection in the United States is not as high as in sub-Saharan
Africa, and most men do not acquire HIV through penile-vaginal sex. Targeting
recommendations for adult male circumcision to men at elevated risk for heterosexually
acquired HIV infection would be more cost effective than offering routine adult male
circumcision. Men may be targeted according to sexual practices or an elevated
prevalence of HIV within a geographic region or race/ethnicity group.

Also, regarding sexually active individuals:

“All sexually active adolescent and adult males should continue to use other proven HIV and STI risk-reduction strategies such as reducing the number of partners, and correct and consistent use of male latex condoms, and HIV preexposure or postexposure prophylaxis among others.”

So, are these guidelines an immediate and universal recommendation for circumcision? No, as much as biased media and individuals would like it to be, it is not.

The CDC gave slight consideration to sexual effects of circumcision. Again, we need to consider that they are reviewing existing medical standards, practices and publications (and it is noteworthy that proper discussion of the male foreskin is so absent from American health books that even pictorial representations of the foreskin are missing most of the times except in the context of its removal through circumcision). So, the guidelines devote the full length of a single paragraph to the discussion of sexual effects from circumcision:

The foreskin is a highly innervated structure and some authors have expressed concern
that its removal may compromise sexual sensation or function. However, in one survey
of 123 men following medical circumcision in the United States, men reported no change
in sexual activity and improved sexual satisfaction, despite decreased erectile function
and penile sensation. Furthermore, a small survey conducted among 15 men before and
after circumcision found no statistically significant difference in sexual function or sexual
satisfaction. Other studies conducted among men after adult circumcision have found
that relatively few men report that there is a decline in sexual functioning after
circumcision; most report either improvement or no change.”

This paragraph acknowledges the histological studies of John Taylor and Sorrells’ study on fine touch pressure thresholds, but not the European surveys of Bronselaer in Belgium and Frisch in Denmark (both of which showed sexual difficulties among circumcised males), preferring instead to refer to Krieger‘s Kenyan study (which does not show the same difficulties). This begs the question of why African studies are more relevant to the sexual function and satisfaction of American citizens than European studies, but we will leave such discussion for the readers to make their own conclusions.

Finally, missing from the guidelines is any discussion of the role and functioning of the foreskin, something that could be accomplished by simple observational studies of the sexual behavior of uncircumcised males. But one could argue that the role of the CDC is to counsel on control and prevention of diseases, and not on sexuality.

I can’t avoid, however, citing this quote from the late Dr. Paul Fleiss, from his 2002 book:

“Accurate information about the foreskin itself is almost always missing from discussions about circumcision. How can parents make a rational decision about circumcision when they are told nothing about the part that will be cut off?” Fleiss. What your doctor may not tell you about circumcision

Our conclusion is that the CDC draft is far from being the universal recommendation for circumcision that biased media, organizations and individuals may wish for, it is actually more balanced on its ethical aspects than the AAP’s Policy Statement, however it is not unbiased as it still gives more relevance to African studies than European, in spite of the American circumstances being more comparable to those of Europe than to Sub Saharan Africa. The media however latches to key phrases like “benefits from circumcision” ignoring the harms and collateral effects and autonomy concerns, thus distorting the message and manipulating the public opinion.

Janet R. Weber – teaching nurses how to harm babies

Sometimes the ignorance of some statements makes your head hurt. When a respected teacher makes mistakes which will result in harm to innocent babies for generations, you can only shake your head in disbelief.

But that is what just happened.

intactivists on facebook shared a graphic about Dr. Janet R. Weber, RN, MSN, EdD, author of the “Nurse’s Handbook of Health Assessment, 8th Edition, 2013″, where she is quoted explaining that “An unretractable foreskin in a child older than 3 months suggests phimosis. Paraphimosis is indicated when the foreskin is tightened around the glans penis in a retracted position.”

We verified the quote by going to Amazon, observing that the inside of the book can be previewed, and running a search for “unretractable” which brought up page 613.

janet_r_weber_2

janet_r_weberWhile the data on normal age of retraction has changed over the years, it is in general accepted that less than 10% of the boys are capable of retracting their foreskins before the age of 1. In fact, it is accepted that the age of retraction greatly varies from child to child, with a high percentage of boys not becoming retractable until puberty, and some until late adolescence.

Used with artist's permission.

Used with artist’s permission. Source:  http://circumcisiondecisionmaker.com/foreskin-facts/development/

It is also accepted that trying to retract the foreskin of a baby can result in pain, bleeding, infections and scarring. The foreskin and the glans start as a single structure during the fetal development and separate slowly, as the epithelium keeping them attached desquamates. Forceful retraction hurts this epithelium and can result in iatrogenic damage.

So what is Janet Weber teaching her students? That a normal condition (unretractable foreskin during infancy) indicates an abnormality and is an indication for surgery. In lack of further information, students can construe this information to mean that they need to attempt retraction in order to assess the genitalia of infants, harming their normal genitals in the process.

And this from a professor of nursing who holds a Master. My head hurts.

janet_r_weber_3

Her book will pass in history as further evidence of the American ignorance of the normal development of the male genitalia, and will hopefully serve as evidence of malpractice.

Follow up

On August 29th, Brother K posted on his facebook that after another activist contacted Mrs. Weber, she replied: ”Thank you so very much for your concern and this will be changed in the next printing. Janet Weber ”.

CircWatch will keep an eye on future printings of the book.

What the AAP says:

“Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teen years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until the foreskin fully separates, do not try to pull it back. Forcing the foreskin to retract before it is ready can cause severe pain, bleeding, and tears in the skin.”

http://patiented.aap.org/content2.aspx?aid=5211&lan=en

Additional resources

Normal Development of the Foreskin

Development of retractile foreskin