Category Archives: Medical Community

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

The sick compulsion to circumcise

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

American Academy of Pediatrics
Technical Report on Circumcision, 2012

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

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

brian goode wave tv - Copy

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

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

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

mother reason

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

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

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

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

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

mother2Activists who called were cursed out.

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

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

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

kosair

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

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

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

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

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

 

 

 

The secrecy of circumcision mortality

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

Ryan Heydari

Ryan Heydari

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

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

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

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

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

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

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

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

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

Chance Walsh

Chance Walsh

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

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

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

How many more deaths are kept in silence?

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

“The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this literature review). These rare complications include glans or penile amputation, 198–206 [...*] and death.213″

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

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

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

Which agenda benefits babies?

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

Let me finish this post by saying:

Rest in peace, Ryan Heydari

Rest in peace, Duane and Chance Walsh

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

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

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

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

 

Has Google been hijacked by the pro-circumcision lobby?

A few days ago it had been mentioned that searching for “intactivist” on Google was displaying, before any results, a suggested 2012 text from an odious article by pro-circumcision and misandryst author Charlotte Allen.

Bad as that is, today something far worse and way more dangerous has been reported. Searching for “care of uncircumcised newborn” displays a snippet from a webmed article explaining how to retract the foreskin to clean “under” it. It is problematic, because it is missing a sentence from the beginning of the paragraph, that limits this advice to “[w]hen the foreskin is easy to retract”, and also omits the most important, initial warning: “Do not force the foreskin back over the tip of the penis. At first, a baby’s foreskin can’t be pulled back (retracted) over the head of the penis. After the first few years of life (though it may take somewhat longer), the foreskin will gradually retract more easily“.

12122910_573713709443202_4359581206496907196_n

Naive parents may take the snippet as advice without reading the full article, resulting in pain, bleeding, possible infection and possible scarring which may require surgical care in the future.

Even then, the webmed article isn’t that great. It states that “[b]y the time a boy is 5 years old, his foreskin is usually fully retractable“, and also that “[a] boy as young as 3 can be taught to clean under his foreskin“. Both statements are wrong. It’s long been known that there is wide variation to the age of retraction, with close to 50% of the boys becoming retractable by age 10, and approximately 95% being retractable by age 17. Trying to retract the foreskin of a 3 year old boy or a 5 year old boy (when less than 30% of the boys are capable of retracting) is likely to create trauma and injuries to the child.

McGregor et al (2007, Can Fam Phys) wrote: “if one is patient and does not rush Mother Nature, most foreskins will become retractile by adulthood“. Likewise, Wright (1994, Med J. Aust) wrote “nature will not permit the assignment of a strict timetable to this process.”

Denniston and Hill (2010, Can Fam Phys) explain: “Gairdner’s bar graph [1949!] shows a steep increase in retractility from birth to age 3 years. This does not occur in nature; it is possible that these values were obtained by the use of the probe. In any event, they have been disproved by later research. In actuality, development of retractility tends to be much slower. [...]  Gairdner’s values for the development of foreskin retractility stood alone and unchallenged for decades, during which they were quoted by the authors of numerous textbooks. Unfortunately, thousands of physicians the world over have been trained with these false values.”

In fact, the advice from the webmed article seems to be using the retraction values of Gairdner (1949) and the erroneous advice of Allan F. Guttmacher (1941) who came with the idea that a baby’s foreskin needed to be retracted and cleaned daily. Both pieces of really dangerous advice.

We call on Google to become more responsible with the snippets presented when they can lead to harming babies.

For a far better article on care of the uncircumcised newborn, read this page of the Paediatric Society of New Zealand

Update: I searched some more keywords on Google. The word “uncircumcised” also brings a biased article, this one from Cosmopolitan: “Although circumcision rates are declining in America, foreskin is still a hotly debated issue“. No Cosmo, foreskin is a part of the body. Circumcision is a debated issue.

And afterwards, a downward arrow offers more related topics: the definition of cicumcision and the definition of mohel.

In the United States, the foreskin is the only part of the body that when named, is followed by the description of the procedure to remove it. Sad and ridiculous.

uncirc

Little sproutings and circumcision – more of the same

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

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

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

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

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

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

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

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

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

According to the American Academy of Pediatrics, AAP, on their 2012 technical report on circumcision (page 17 of 32): “The true incidence of complications after  newborn  circumcision  is  unknown, in part due to differing definitions of “complication”and differing standards for determining the timing of when a complication has occurred

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

A situation of injustice. Which is your side?

A situation of injustice. Which is your side?

 

Intermountain moms, nurse Dani and Doctor R. bring their lies to circumcision

Oh the circumcisers are desperate and they have the lies to prove it. It’s been a while since I last woke up to two terrible YouTube videos full of half truths and obvious lies about circumcision.

So, let’s see. Intermountain Moms’ nurse Dani “tries to” answer this question: “Will a doctor numb a baby boy if he gets circumcised?”

Nurse Dani says “circumcision is usually done before a baby goes home from the hospital or two weeks later“… What about the other possibility, like, not doing it at all? Not mentioned, which reinforces the sense of normality that all boys are circumcised.

And the good thing about doing it when a baby is very very new”, says nurse Dani, “is that they kinda are in a natural sleep state, this is almost a natural anesthetic

Yes folks, that’s what she says. She must have missed that Oxford University study published in April and widely reported in the media, where “researchers at Oxford University have watched infants as young as a day old as their brains process a light prodding of their feet. The results confirm that yes, babies do indeed feel pain, and that they process it similarly to adults.

The Time article reports that: “Until as recently as the 1980s, researchers assumed newborns did not have fully developed pain receptors, and believed that any responses babies had to pokes or pricks were merely muscular reactions.“, but clearly nurse Dani still believes it. In fact, as early as 1997, most of the neonatal circumcisions (some 95% or so) were performed without any anesthestic. The American Academy of Pediatrics on its last policy statement on circumcision states that “adequate analgesia should be provided whenever newborn circumcision is performed“.

Nurse Dani continues: “in addition to that, we give babies a binky that has sugar water on it, and let them suck on it, and that is very soothing to them“. The AAP indicates: “Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.”

She then completes her statement: “and yes, they are also numbed

So what was that all about? Why the “natural sleep state”? Why the “soothing binky with sugar water“? To make parents feel better?

Nurse Dani says “if you don’t want to watch, then that’s okay“. What’s that all about? As a parent, if anyone is going to do ANYTHING to my baby, it will be in front of me. And if it’s too horrible for me to watch, it’s probably too horrible for my baby to endure. And if on top of it all, it is unnecessary, then you better believe I’ll keep my baby safe.

No nurse Dani, I won’t recommend you to my friends or family. You are just too willing to hurt babies.

From there we go to Doctor R. who brings Dr. Geoffrey Nuss, an urologist with Urology Associates of Texas and a surgeon specialized in reconstruction of the urinary tract, to speak about circumcision.

Doctor R. spends some time making puns and jokes about circumcision.

Doctor Nuss describes the foreskin saying: “there is a redundant portion of skin that covers the glans“. How was it defined that the foreskin is “redundant“? Who ever made that call?

Asked what functions the foreskin has, doctor Nuss goes on: “mainly protecting the glans from the  outside environment but really we don’t… we don’t have… it doesn’t have a major function today“. You can see him choking on his words.

Perhaps he needs to be reminded that “The amount of tissue loss estimated in the present study is more than most parents envisage from pre-operative counselling. Circumcision also ablates junctional mucosa that appears to be an important component of the overall sensory mechanism of the human penis.” Taylor JR, Lockwood AP, Taylor AJ. The prepuce: specialized mucosa of the penis and its loss to circumcision. Br J Urol 1996;77:291-295.

Why remove it, that’s a good question. Many people will remove it for religious reasons” (except that it’s not the person getting it removed the person who practices the religion, which means it is an intromission on a person’s physical integrity, an assault), he goes on: “health related reasons: the American Academy of Pediatrics recommends circumcision to prevent … ” STOP.

The AAP recommends? Let’s see what the AAP ACTUALLY says: “Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns.”

And to prevent AIDS, AIDS, or HIV infection“. Unfortunately referring to the African studies in this non-specific way is irresponsible and does way more harm that good. Need we remind our readers that thousands of circumcised Americans have died of AIDS related complications?

But that’s in very young boys, less than six months. Adult circumcision is much different“.

Here we have that other common myth. It’s easier when they are young. “Buy now and you will get!”. See, if the American medical community wished, they could do away with this myth by certifying for use in the United States the devices that were invented for adult circumcisions in Africa. The PrePex, the Shang Ring, the AccuCirc. With these devices the cost of an adult circumcision can decrease from thousands (due to required location and general anesthesia) to a few hundred, like infant circumcision is now. But of course that’s not a good business for the American medical community, as many adults won’t submit since they would know that their foreskin is pleasurable, and the hospitals would lose their role as suppliers of human tissue to the biomedical industry.

Asked if the foreskin makes a different for sex, dr. Nuss answers “I tell men, what you have is what you should have“. He says “changing your foreskin or altering in any way will not provide any benefit” (so what happened with those health benefits he was touting for young boys?) “ and in fact some men will complain that it’s different and they don’t like it. So I don’t recommend circumcision for enhancing sexual performance or sensation

He says he doesn’t recommend that men get circumcised for aesthetic reasons, and he says that when men go to him for circumcision it is due to phimosis.

He says: “Unless kids are [at least] 6 months they don’t have the sensation developed to have a painful experience.”  We just discussed this point at the beginning of the article. Apparently the medical community was too busy in April to read the news.

Asked what is the current trend, he says:  “to circumcise most men still in America however there are many people who are advocating against it.”

Let’s think about this one point. If he knows that adult men who get circumcised often do not like it afterwards, what makes it okay for parents to decide (or for doctors to coerce parents into “deciding”) to alter a baby into a state which, if he had reach as an adult, he would not have liked it?

Asked about complications he says: “Potential complications would be shortening of the foreskin and just an altered cosmetic appearance as an adult. As a kid, you obviously will not know what the difference was as you grow up with it.

Can we send these guys back to the 19th century, where they truly belong?

 

INTERNATIONAL NURSES GROUP CONDEMNS MEDICALLY-UNNECESSARY CIRCUMCISION OF FOUR-YEAR OLD BOY, URGES NURSES TO CONSCIENTIOUSLY OBJECT

11 JUNE 2015

For immediate release: http://childrightsnurses.org/index.php/news/international-nurses-group-urges-nurses-to-conscientiously-object/

Nurses for the Rights of the Child supports the genital autonomy rights of Chase Hironimus, a healthy 4.5 year old boy from Florida, USA. Chase’s human rights are in jeopardy following a bitter family court dispute surrounding a parenting agreement which was drawn up after Chase was born. This parenting agreement included the option for a medically unnecessary circumcision desired by the father. The circumcision was not performed during Chase’s infancy. Later, his mother Heather researched circumcision and became aware that it was not medically recommended and that it had risks generally and specifically with regard to her son, who had reacted adversely to anesthetic in the past and who develops keloids. Heather was imprisoned until she agreed to sign a circumcision consent form, which she did while bound in handcuffs and crying. Nurses for the Rights of the Child condemns the actions of Judge Jeffrey Gillen on this matter and notes that this forced consent was done under duress, which is unacceptable and contrary to the principles of informed consent.

We call on nurses who may be asked to assist with the proposed circumcision of Chase to demonstrate moral courage by taking conscientious objector status.

The Association of Women’s Health Obstetric and Neonatal Nursing (AWHONN) supports nurses’ rights to conscientious objection and recommends that every institution have a written policy protecting these rights and making reasonable accommodations for nurses with such objections. It also says that taking a conscientious objector position “…should not jeopardize a nurse’s employment, nor should nurses be subjected to harassment due to such a refusal.”

The Code of Ethics for Registered Nurses in Canada states: “Ethical (or moral) courage is exercised when a nurse stands firm on a point of moral principle or a particular decision about something in the face of overwhelming fear or threat to himself or herself. [… T]he nurse should discuss with supervisors, [or] employers […] what types of care she or he finds contrary to his or her own beliefs and values (e.g., caring for individuals having an abortion, male circumcision, blood transfusion, organ transplantation) and request that his or her objections be accommodated, unless it is an emergency situation”.

According to the American Academy of Pediatrics, “Performing an action that violates one’s conscience undermines one’s sense of integrity and self-respect and produces guilt, remorse, or shame. Integrity is valuable, and harms associated with the loss of self-respect should be avoided.”

If you are a nurse in moral distress about assisting with Chase’s proposed circumcision or any non-therapeutic circumcision, please contact Nurses for the Rights of the Child via www.ChildRightsNurses.org. We can assist you with resources and support regarding conscientious objection and refer you to legal support if needed.

You are not alone.

____________________________________________________

Nurses for the Rights of the Child is a non-profit organization dedicated to protecting the rights of infants and children to bodily integrity.  As health professionals, we specifically seek to protect non-consenting infants and children from surgical alteration of their healthy genitals.

Nurses for the Rights of the Child was founded in June of 1995 by a group of nurses who had become R.N. Conscientious Objectors to infant circumcision at St. Vincent Hospital in Santa Fe, New Mexico.

 

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

Hironimus2
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

How medical staff pushes unnecessary circumcisions

The AAP on its “technical report” on circumcision writes:

“Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.”

While the purpose of this sentence is to indicate that some people may choose to circumcise for religious and cultural reasons, it also means that parents should be entitled to make a negative decision in the light of their own experience (cultural, religious, medical, preference or otherwise). Which is why it is disturbing when hospitals and medical staff blatantly ignore negative decisions and reiterate their request over and over, in what amounts to solicitation of an elective surgical procedure.

The following review was posted on Lexingon Medical Center’s facebook page on March 18th of 2015. (Name, profile picture and other details blurred for privacy).

b_r_edited

According to the American Medical Association, AMA:

Physicians should not provide, prescribe, or seek compensation for medical services that they know are unnecessary

This compulsion to circumcise has sometimes resulted in “wrongful” circumcisions – circumcisions that were not consented by the parents, and which should amount to bodily harm.

One such “wrongful circumcision” occurred in 2010 in Miami. Another one in Indiana, 2003, had a jury find no harm to the boy, after a lawyer argued that “an award of (…) in damages to the boy would “open the courthouse door to every kid who’s been circumcised.””.

Imagine if it was any part other than the foreskin. You know your son does not need to have a finger amputated. You leave your child for a moment in the care of medical staff, and when they return the baby to you, the finger has been amputated. How do you react to that?

For people who are from non-circumcising cultures, or who oppose circumcision, it doesn’t matter if, as the Miami hospital said back then, “the procedure itself was performed following appropriate surgical guidelines“. What matters is that it was done or offered at all, that there was the intention or the fact of removing part of a child’s penis. It matters that the child now has a wound and is missing part of his normal anatomy.

A mother we recently talked with, was enraged that her ethical opposition to circumcision became reflected on her son’s medical history after she questioned a facility to find out if they performed circumcisions. See scan from the medical history:

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The person who wrote this on the history would like to think that the CDC and the AAP “recommend” circumcision. These two organizations in fact argue for the benefits, but do not “recommend” the procedure as a routine, leaving the decision to the parents. A decision that activists argue does not belong to the parents because there is no medical urgency, most potential “benefits” can be obtained by less invasive ways without surgery, and the marks and scarring of circumcision last a lifetime regardless of the preference and feelings of the person who should really be concerned about it, the child, when he obtains the age and maturity to provide his own informed consent.

At circumcision protests, there is usually a blame game. Pediatricians argue that most circumcisions are performed by OB/Gyns, yet it was the AAP (pediatricians) who came with the 2012 policy statement on circumcision. OB/Gyns argue that they do it because the parents request it. But what we hear from parents is different. We see a picture where the medical establishment is interested in continuing to push the procedure. Whether this is done by the establishment per se, or by the staff as a result of their own personal bias, is not always clear. We will soon show some of the problems with circumcision consent forms. In the meantime, here’s an intactivist meme that clearly reflects this problem:

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When having your normal body is seen as problem: Medical facilities providing improper advice

The American medical community’s ignorance of the normal care of intact male minors’ genitals is evident, but few times we run into written evidence of how doctors fail to follow even American medical standards, providing instead misinformation that is likely to harm children.

Before showing the specifics, let me explain:

During fetal development, the glans and the foreskin of the penis start as a single structure, and later on start to separate by the dequamation of a membrane, called sometimes the balanopreputial synechia. Typically, at birth this membrane has not separated completely and the opening of the foreskin is tight, a condition that is called physiological phimosis, and which requires no treatment.

Note: the term “balanopreputial synechia” appears to be uncommon outside the intactivist community, but the membrane described by those words has been studied and known for a long time, described in 1933 as ”a layer of stratified squamous epithelium”, also referenced by MediLexicon as “glandoprepucial lamella“.

After a relatively long time, this membrane dissolves completely and the opening of the foreskin becomes more flexible, allowing for retraction of the foreskin in order to expose the glans, the head of the penis. This may happen at any time, it could be as early as a few months, or as late as 17 or 18 years of age.

Used with artist's permission.

Used with artist’s permission.

Source:  http://circumcisiondecisionmaker.com/foreskin-facts/development/

Read: Øster J. Further fate of the foreskin: incidence of preputial adhesions, phimosis, and smegma among Danish Schoolboys. Arch Dis Child 1968;43:200-3.

Typically physiological phimosis should be superated at least after puberty, as a sign of sexual maturity. Not being able to retract the foreskin before the sexual debut can sometimes make sex difficult.

See Leonard MP. Pathologic and physiologic phimosis: Approach to the phimotic foreskin. Canadian Family Physician 2007;53(3):445-448.

When a sexually mature individual cannot retract the foreskin, or the opening of the foreskin becomes scarred and does not allow the glans to come through, we are now talking of a pathological phimosis. This is not very common but not extremely rare either. Depending on the cause, pathological phimosis may be resolved through non invasive procedures (such as stretching, exercises, steroid creams, etc), or some surgical paths can be taken  such as preputioplasty, dorsal slit, synechiotomy, or circumcision (as an informed and consenting adult).
See: Orsola A, Caffaratti J, Garat JM. Conservative treatment of phimosis in children using a topical steroid. Urology. 2000;56:307–310.  [PubMed]
Nevertheless, some adults are not bothered by their phimosis and may choose not to do anything about it, even if that means keeping the glans covered during sexual relations.

Most medical organizations, including the AAP, agree that:

  • Having a non-retractable foreskin during infancy is normal
  • Trying to retract the non-retractable foreskin of a child (forceful retraction) causes pain, and may cause bleeding, scarring, infections, damage to the foreskin, and may even result in a iatrogenic phimosis (phimosis caused by intentional injury).

The myth that parents of uncircumcised (intact) children needed to retract the foreskin and wash the inside every day, was started in 1941 by Allan F. Guttmacher, who also promoted mass circumcision (Should the baby be  circumcised? Parents Magazine 1941 Sept;16(9):26,76-8]). Unfortunately this myth still persists, even in many members of the medical community, even when standards, policy statements and medical school books advice against it.

So think about this:

You have a 10 months old baby with a stomach problem. You take your baby to the ER. Upon examination, the doctors notice that your baby is not circumcised. The foreskin becomes their prime suspect. They check your baby for infections and find none. However, retraction is difficult and painful (as it should be at that age). They diagnose your baby with viral gastroenteritis AND PHIMOSIS, even though your reason for consultation had nothing to do with the penis.

And then they proceed to give you a care sheet, where their main concern is to tell you to RETRACT THE FORESKIN WITH EVERY DIAPER CHANGE and clean area with a q-tip, even before telling you about the actual care for the real problem (which was to provide motrin for fever and discomfort as needed, no dosage indicated).

Now, if you are an inexpert parent, you may go home to do just what they told you to do. And what you will find out is that retracting the foreskin is not easy and it causes pain every time, but they recommended it so that’s what you do. And if you keep doing it, you may notice some bleeding at times (ah, it’s the phimosis, you will say), and it may become progressively more difficult (due to scarring of the wounds caused by retraction), or the child will cry more every time (because he learns that diaper change means pain), and soon you may give up and just ask for a referral to circumcision, kicking yourself for ever trying to keep your baby uncircumcised.

We’ve seen it happen before. I’ve heard a mother share: “I tried to retract but no matter what I did it wouldn’t retract far enough“. When she learned the truth she felt abused and violated by the health providers, but it was too late for her child.

Today, we have a scan of a care sheet providing such misguided advice. Fortunately for this baby, the mother was educated enough to dismiss the recommendation.

Providing wrong information which results in harm to a baby should be denounced as malpractice.  If we can confirm the name and location of the facility that provided this care sheet, we will update this post to let you know.

Phimosis? Forced retraction?