Category Archives: Harm of circumcision

So what happens when a baby dies after circumcision?

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

Then the baby dies.

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

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

What should the community do in those cases?

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

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

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

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

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

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

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

But, who benefits from this silence?

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

The majority of severe or even catastrophic
injuries are so infrequent as
to be reported as case reports (and
were therefore excluded from this
literature review)
- American Academy of Pediatrics
Technical Report on Circumcision 2012

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

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

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

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

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

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

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

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

So what happens when circumcision results in death?

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

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

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

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Some Catastrophic Complications of Circumcision Recorded During 2013

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

JULY

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

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

AUGUST

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

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

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

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

NOVEMBER

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

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

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

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

DECEMBER

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

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

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

94999c0a1599190a4b64ac94c143128f

Pa. Rabbi facing lawsuit for botched circumcision

A couple filed a lawsuit against Pittsburgh rabbi Mordechai Rosenberg, alleging that he caused a “catastrophic and life-changing injury” to an 8-day-old infant during a circumcision ceremony on April 28 of this year (2013).

Mordechai Rosenberg

The baby had to be taken to a nearby hospital for emergency reconstructive surgery and leech therapy.

Leeches help a body accept reattached parts by promoting blood flow and tissue regeneration, so it is somewhat fair to assume that there was a partial or total amputation of the glans, an injury common to the Mogen clamp, the one commonly used by religious practitioners.

In 2000, the FDA warned about the potential for injuries from Mogen clamps. In 2010 the manufacturer went out of business due to millionaire lawsuits based on catastrophic injuries caused by the clamp. Yet the clamp is still commonly used (currently being part of a trial at the Good Samaritan Hospital in Ohio!).

Glans amputation with a mogen clamp

Rosenberg’s webpage says he’s a certified mohel, or ritual circumciser, who’s done the operations since 1990.

Mohels are not certified by a government agency because circumcision is considered a religious ceremony and not a medical procedure.

If circumcision is a medical procedure, then religious practitioners are performing unlicensed medicine and should be charged with a crime. If this is not a medical procedure, then how can we explain the use of scalpels on the body of a baby and the loss of tissue. And if this is not a medical procedure but just a religious ritual, then we need to consider this ritual abuse of a minor.

Laws against ritual abuse of minors often leave provisions for “activities, practices, and procedures otherwise allowed by law” (http://leg.mt.gov/bills/mca/45/5/45-5-627.htm) – a loophole no doubt enacted to allow cutting male babies’ genitals, while cutting female babies’ genitals is specifically prohibited and “In applying subsection (b)(1), no account shall be taken of the effect on the person on whom the operation is to be performed of any belief on the part of that person, or any other person, that the operation is required as a matter of custom or ritual.” (http://mgmbill.org/usfgmlaw.htm)

Read more: http://triblive.com/news/adminpage/5277845-74/child-mohel-circumcision#axzz2neRB9Skf

And  http://www.kansascity.com/2013/12/18/4700791/pa-rabbi-facing-circumcision-lawsuit.html

In November we found out about a similar injury suffered by a Memphis baby in the context of a medical circumcision, and days later we heard about an 18 day old baby in UAE who had his penis partially severed.

Memphis baby who suffered amputation of his penis during a circumcision in August, reported in November 2013
Saudi baby who had his penis partially cut off during circumcision, November 2013

Circumcision promoters such as Brian Morris boast how safe the procedure is. Yet here, in a matter of 2 months we learn of 3 babies who suffered this life changing injury – and all without medical necessity.

Regarding this risk, the AAP says in the technical report on circumcision:

The majority of severe or even catastrophic
injuries are so infrequent as
to be reported as case reports (and
were therefore excluded from this
literature review). These rare complications
include glans or penile amputation
[...]

Isn’t it time somebody started collecting these case reports? Or do we not care about these babies, Dr. Diekema?

23899878_BG5

Memphis report of a botched circumcision

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

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

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

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

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

Buried / Concealed penis

The AAP Technical Report on Circumcision states:

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

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

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

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

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

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

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

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

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

Does Male Circumcision Affect Sexual Function, Sensitivity, or Satisfaction?- No Morris, it doesn’t work that way

So, a new day and the news already report a new study. “Sydney researchers find that contrary to perception circumcision actually increases sexual satisfaction“. That Sydney researchers would seem to have nothing else to do but to research circumcision seems strange, until you find the same old name: Same old Professor Brian Morris, author of circinfo.net the most rabid fanatic pro-circumcision site on the web, and who is not a sexologist or a urologist, but a molecular biologist. Oh, also founder of the Circumcision Foundation of Australia and author of the book “In favour of circumcision“. Do we need to point any more bias?

But enough with Morris, let’s cut to the meat and potatoes and take a look at the abstract. The article is being published on the Journal of Sexual Medicine (how he gets publishers is something we can’t really understand).

And what is this “new” research, one would ask? Well, it’s nothing but a recycle of the same old papers. In his own words, “A systematic review of published articles retrieved using keyword searches of the PubMed, EMBASE, and Cochrane databases was performed.

From this, 2,675 publications are identified (several of them authored by Morris himself, no doubt), and they are “rated” on their quality level, to conclude that “The highest-quality studies suggest that medical male circumcision has no adverse effect on sexual function, sensitivity, sexual sensation, or satisfaction.“. The problem is, what is the criteria for this rating? Which were the “low quality” studies and what did they reveal?

But, at this point we are not even really discussing the meat and potatoes of the subject, are we? Because, how can we evaluate sexual function, sensitivity, sensation and satisfaction, if we don’t start by defining what those are and how to measure them? Guess what, Morris didn’t.

For being a biologist, Morris willingly overlooks the question of what is sexual function, and skips the topic by going to statistics. Do you see anything wrong there?

Histological studies such as those by John R. Taylor (published in the British Journal of Urology) are evidently ignored, and most likely Sorrells’ “Fine-touch pressure thresholds in the adult penis” (also published in BJU) is most likely rated with low quality, given that Morris (and his friend Jake Waskett, a computer programmer) took it upon himself to criticize that paper by distorting, eliminating and reprocessing the data, as pointed out by Hugh Young. In fact in the Daily Telegraph’s article, Morris is quoted saying “There are no legitimate studies which have found a lack of sensitivity”. Sorry Morris, just because you don’t like the findings of Sorrells et al. doesn’t mean that it’s not legitimate. You can’t remove 20,000 soft-touch receptors from an organ and claim that there is no difference in sensitivity.

Circumcision promoters prefer to ignore Sorrells study while paying attention to Payne et al’s “Sensation and sexual arousal in circumcised and uncircumcised men” which was based on a similar methodology with a fatal flaw: Payne didn’t take sensitivity measures for the foreskin, only for the glans, thus ignoring the main difference between the circumcised and the uncircumcised penis in what can only be called “researcher’s bias” or “researcher’s prejudice”.

Anyway, the question of what constitutes sexual function is not even asked by Morris. Of course that would have to get him to explain about frenulum, ridged band, gliding function (described by Lakshman in the Indian Journal of Surgery in 1980), etc, things that he really doesn’t care to talk about… because he doesn’t have them.

So let’s be clear here.

If sexual function means simply being able to sustain an erection and ejaculate, then, in most cases there would be no difference… except perhaps at an older age (40, 50…) as keratinization of the glans progresses.

But if sexual function means that the penis works as it was intended to work:

  • The foreskin glides over the glans and allows the ridged band and the ridge of the corona to stimulate each other,
  • Pre-ejaculate collects in the subpreputial space for additional lubrication instead of falling down on a useless liquid thread,
  • The intact frenulum and ridged band perceive a lot of sensation and produce tingling sensations and help control the orgasmic threshold,
Then there is no doubt that removing the foreskin changes the function.
Some of the “high quality” studies would have been, no doubt, those by Kigozi et al, in Uganda (including circumcision promoter Ronald Gray) where the men that volunteered for circumcision as part of the “randomized trial” for HIV prevention, were followed up at 6, 12 and 24 months. Participants reported on “sexual satisfaction and function”. Of course at 24 months, keratinization wouldn’t have been enough to represent a good difference (some men circumcised during the neonatal stage report the effects of keratinization when they are past their 40 or 50 years – but I’m sure Morris would dismiss them as case-studies in the best case, or as being brainwashed by anticircumcision literature on the internet at worse).

But given that this is nothing but a “systematic review” of existing literature, then comes the question of what’s the relevance of this paper. Why did Morris even bothered looking for all these articles and writing a new paper based on no new research whatsoever?

Circumcision promoters have suffered some backslash in the recent years. In 2011 the International Journal of Epidemiology published Morten Frisch’s “Male circumcision and sexual function in men and women: a survey-based, cross-sectional study in Denmark” which concluded that “Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment.” In spite of the expected anonymity of reviewers, Morris outed himself as one of the reviewers, as the one reviewer opposing the publication of Frisch’s study, when he asked the members of his mailing list to write letters to the editor protesting the publication of the article. Quite unethical on his part.

In 2013 BJU published Bronselaer’s “Male circumcision decreases penile sensitivity as measured in a large cohort“, a study in Belgium, which concluded that “This study confirms the importance of the foreskin for penile sensitivity, overall sexual satisfaction, and penile functioning. Furthermore, this study shows that a higher percentage of circumcised men experience discomfort or pain and unusual sensations as compared with the uncircumcised population. Before circumcision without medical indication, adult men, and parents considering circumcision of their sons, should be informed of the importance of the foreskin in male sexuality“. Strangely for a study that suggest negative consequences of male circumcision, Reuters covered the study so it reached several global news outlets. In some of the media, particularly in American news sites, a critique by circumcision promoter Aaron Tobian (Johns Hopkins University college of Ronald Gray) was included in an attempt to “balance” the information (or reduce the impact of the study, we could say).

And this would be the reason why circumcision promoters needed some “new” publication to “find” that circumcision “does not affect -or actually increases- sexual satisfaction”, even if it means just recycling all the old articles, even the old and utterly debunked excuse of a “study” by Masters and Johnson from 1966 (here explained and refuted by Hugh Young).

So this is the issue. Awareness of the consequences of male circumcision has been growing. It was already reported in 1997-1999 by Tim Hammond. The past two years have seen two European articles denouncing the reported loss of sensitivity and sexual consequences of circumcision for European males and their partners. 2012 also saw the results of the Global Survey of Circumcision Harm. There is also growing awareness of the possibility of Non-Surgical Foreskin Restoration for men who feel harmed by their circumcision and wish to recover some of the function of their lost foreskin.

So obviously, circumcision promoters are not happy, especially when African men are not rushing to get circumcised as they expected them to. Aaron Tobian prepared the path for the AAP’s new Policy Statement on Circumcision by publishing his “findings” (actually a computer simulation applying premises from African data to the United States) that healthcare cost would increase if circumcision rates continue decreasing. Of course even if this was true, this unethical paper is only putting a price tag on a valuable part of the male genitalia, and most of the public could see through it. More was needed, so Professor Morris did what he knows how to do: review old information to produce new publications, while denying everything that doesn’t fit his model of the world.

Well, Professor Morris, it doesn’t work that way. You can’t deny the changes in function by simply refusing to discuss function. Good try though.

One thing we appreciate of Morris “study”, and it would be pointing us to his coauthor, Krieger JN. Professor John Krieger from the University of Washington. We’ll definitively be learning more about Krieger’s work, such as his previous 2008 study on “Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya“, which no doubt is one of the studies reviewed in this new publication, it’s not like Morris has been known for self-referencing his own publications, what’s the cost of sharing that trick with his coauthor?

One final thought is, why is it that European males report sexual difficulties related to their circumcision while African males don’t? And why is it that the perception of African males would be more relevant to English speaking countries than the perception of European males?

But let’s listen to Brian Morris for a moment, let his words give you an idea of his character. He would be quite amusing if he didn’t think he was being serious.

patrick_izimba

Safe Male Medical Circumcision in Uganda results in penile amputation

Circumcision, like every other surgery, carries some risks. The problem is when promoters argue for a surgery without medical indication and minimizing every risk in order to entice the patients to undergo the procedure.

As we know, the West is currently promoting VMMC (voluntary male medical circumcision, safe male medical circumcision) in some countries of Africa as part of the package for HIV prevention. A lot of emphasis has been set on reducing the costs of the procedure by looking for new methods (such as the PREPEX, the TaraKlamp, the Shang Ring) and trying to perform the procedure without the need for a surgeon, with minimally trained personnel.

Of course this is going to lead to complications, such as what happened to Patrick Izimba in Uganda, reported on July 16th of 2013. Patrick Izimba was enticed by one of the signs offering safe male medical circumcision, and what followed is every man’s nightmare. His penis suffered gangrene and was transferred to a specialist. Plastic surgery will be used to reconstruct his penis, but he won’t be able to have sex.

When you promote mass circumcision, these events are bound to happen. Yet, this the the message that circumcision promoters are sending to Africa:

Check out the explicit manifesto on their page: “Importance of establishing circumcision as a social norm is stressed“. It’s not about health, it’s not about preventing a disease, it’s about creating a social norm.

Let’s quickly visit the WHO’s manual for male circumcision with anesthesia, and on page 16 let’s check the listed risks:

Risks
As for any surgical procedure, there are risks associated with
circumcision. While the benefits of circumcision may be wide-ranging
and long-term, any problems generally occur during or soon after the
procedure. They include:

•pain;
•bleeding;
•haematoma (formation of a blood clot under the skin);
•infection at the site of the circumcision;
•increased sensitivity of the glans penis for the first few months
after the procedure;
•irritation of the glans;
•meatitis (inflammation of the opening of the urethra);
•injury to the penis; 
•adverse reaction to the anaesthetic used during the circumcision.

These complications are rare when circumcision is performed by well
trained, adequately equipped, experienced health care personnel, and
are usually easily and rapidly resolved. Data from controlled trials
show that fewer than 1 in 50 procedures result in complications.

Did I miss loss of the penis? Or is the loss of the penis darkly lumped into “injury to the penis”? When considering the reality of a man who just lost his sexual organ, does it make sense that these complications are rare and easily and rapidly resolved?

The news article about Patrick Izimba mentions anesthesia as possible cause of the gangrene. The WHO’s manual on male circumcision with anesthesia indicates:

“Lidocaine with epinephrine must not be used because there is a risk of constriction of the blood vessels to the whole penis, which can cause gangrene and loss of the penis”. 

Is this what happened? Was he told that gangrene and loss of the penis were possible risks of the procedure? If not, his consent was not informed consent.

Page 148 of the manual also states indicates:

Worsening wound infection with signs of gangrene. A rare risk
of genital surgery is infection with multiple bacteria, causing
progressive skin loss. In this situation, the blood supply is cut off,
and the skin becomes necrotic and turns completely black. This
condition is known as Fournier’s gangrene (synergistic gangrene
or necrotizing fasciitis) and is more common in men who have
diabetes. Any man with signs of spreading infection or black
gangrenous skin should be urgently transferred to a referral
centre. At the referral centre, it is usually necessary to give a
general anaesthetic and remove all the dead skin

And while we are in page 148 of the manual, let us wonder if men are advised about the possible late sexual complications, or are they reassured that their sexual function won’t be impacted? Page 148-149 describes late complications such as:

In the long term, the client may complain of:

• decreased sensitivity of the glans;

• oversensitivity of the glans;

• unsightly circumcision wounds, ragged scars or other cosmetic
concerns;

• persistent adhesions at the corona and inclusion cysts. These
problems can be avoided if the foreskin is fully retracted during the
operation and all adhesions carefully divided;

• discomfort during erection from the scrotal being skin pulled up the
shaft of the penis and a tight scrotal sac. This can result from
removal of too much skin during the circumcision. These problems
can be avoided by careful preoperative marking of the incision
lines.

• torsion (misalignment) of the skin of the penile shaft. This can be
avoided by taking care during the operation to align the midline
raphe with the frenulum.

Is this the new social norm? Males with unsensitive glans, unsightly scars and uncomfortable erections when the scrotum is pulled up by the penis because it doesn’t have enough skin to accommodate a normal erection? Is this the American gift to Africa? Are we transferring the American wound?

Appendix 6.2 of the WHO’s Manual shows a sample consent form for a minor. The consent form does not list the risks and complications of circumcision. It merely states that the parents were counseled on the existing risks. Without a written record, how are they to ensure that providers won’t be lying about the complications and exaggerating the benefits, when their expressed intention is to establish circumcision as a social norm?

Background

Gangrene and loss of penis is a frequent complication of traditional African circumcisions, due to the risk of infections and terrible conditions in which the procedure is usually carried. However, loss of the penis also occurs in sterile conditions. It happened in 2012 to a man in China, 2 weeks before his wedding.  In 2008 a man in Kentucky had his penis removed without consent during a circumcision because the doctor found a cancerous tumor; the man sued on grounds that he should have been waken up and given information prior to the amputation, and yet the court sided with the doctor as the consent form enables the doctor to perform any other procedure deemed necessary. And of course there is the well known case of David Reimer, who lost his penis while being circumcised as a baby, was raised as a girl until his teenage years, was reverted (breast reduction, penile reconstruction…), and committed suicide at 39 years.

Circumcision for HIV prevention remains nothing but speculation about a protective effect, with no proven causal reason. The African studies have been challenged by scientists and general public, but for some reason the UNAIDS and the WHO continue to promote circumcision as part of the HIV prevention package without stopping to think critically, sponsored by PEPFAR and the Bill & Melinda Gates Foundation.

Factually correct information? Kaiser Permanente flyer on newborn circumcision

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

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

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

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

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

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

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

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

Then the flyer moves to the “benefits of circumcision”, and the first one is of course “lowers the risk of cancer of the penis“. But how much is the real risk of cancer of penis? Is it frequent? Does it really decrease? The AAP, in spite of touting this same benefit, has to come clean when showing numbers, by saying: “In fact, in men with an intact prepuce and no phimosis, there is a decreased risk of invasive penile cancer (OR: 0.5). When excluding phimosis, the risk disappears, which suggests that the benefit of circumcision is conferred by reducing the risk of phimosis and that the phimosis is responsible for the increased risk.” (page 14 of the Technical Report), and again the untold part is that phimosis can often be treated without any excision of tissue, thus making circumcision unnecessary.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The flyer then describes the plastibell method as follows:

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

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

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

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

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

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

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

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

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

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

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

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

Boy (3 years old?) suffers partial amputation of the glans during circumcision in Morocco

A boy loses 20% of his glans during a circumcision. The boy cries in horrible pain.

This video may have been posted by the parents, who wrote:

l’assassin est docteur BOUHDI FOUAD Bd Fida à casablanca et le complice Docteur FAYSSAL LAZRAK de clinique ATFAL Oasis à casa: le premier a causé la coupure pendant la circonciosion et a mis des sutures en fermant carrément le canal d’urtine et le 2ème a refusé de délivrer le compte rendu avant et après opération qu’il a effectué sur mon enfant pour sauver le fonctionnement d’urine

(the murderer is Dr. Fouad BOUHDI Bd Fida in Casablanca and the accomplice Doctor FAYSSAL LAZRAK clinical Atfal Oasis casa: the first caused the break for the circumcision and put sutures closing outright the urinary channel and a second refused to issue a report before and after the operation he performed on my child to allow urination)

The video was posted May 18th, 2013.

From the description, the procedure was performed at Clinique Atfal, in Casablanca, Morocco. http://www.blanee.com/etablissements/clinique-atfal-Casablanca

Partial and total amputation of the glans is one of the “low incidence high severity” complications of circumcision, one which leaves life long complications. EVERY CIRCUMCISION exposes the child to this risk, even if with a low incidence.

Not only is the boy traumatized, but he may have problems with urination and sex for the rest of his life.

My heart breaks for this boy.

More information (Arabic): http://hespress.com/societe/79020.html

More documented severe complications of circumcision: http://circleaks.org/index.php?title=Documented_Severe_Complications_of_Circumcision

mogen_and_gomco

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

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

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

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

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

Mogen Clamp
Gomco Clamp

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

Evolution of the facial expressions of a baby during circumcision

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

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

Now, what could be wrong with this?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mutilated and Comeless

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

Glans laceration caused by clamp – photo from circumcisionharm.org

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Information on the trial:

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

http://clinicaltrials.gov/show/NCT01726036

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

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

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

Sponsors and Collaborators
TriHealth Inc.

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

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

Van and Benjamin Lewis, 1970, Tallahassee Florida

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

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

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