Category Archives: Social Media

Babygaga’s harmful advice on care of the foreskin – Hall of Shame

babygagaBabygaga is known for frequently posting pro-circumcision advice and improper care of the intact foreskin. The problem is, such information does not come without victims. Well meaning mothers may follow such improper advice and injure their babies.

For example, on July 18th, Babygaga published an article called “16 things nobody tells you about newborns“. On numeral 9 (“Be careful with the penis”), the faceless Bridget Galbreath claims “If he isn’t circumcised, you will have to roll the foreskin back completely to make sure that you thoroughly clean the penis with every diaper change.

Even the not-so-luminaries of the American Academy of Pediatrics have it better, when they write on their “Care for an uncircumcised penis” page:

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

Trying to “roll back” the foreskin of a baby is painful and dangerous. Babygaga is recommending this against the advice of the American Academy of Pediatrics and pretty much against anyone who understands normal intact anatomy of the male newborn.

Numerous intactivists have reached out to Babygaga asking to correct this article. We will keep an eye on the article hoping for correction.

In the meantime, Babygaga inaugurates our Hall of Shame.

hall-of-shame

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.

 

 

 

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“.

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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?

 

Unspoken complications of circumcision

AAP: “Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. [...]Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; [...] Male circumcision does not appear to adversely affect penile sexual function/ sensitivity or sexual satisfaction. It is imperative that those providing circumcision  are adequately trained and that both sterile techniques and  effective pain management are used. Significant acute complications are rare. [...] Parents are entitled to factually correct, nonbiased information about circumcision

AAP: “The true incidence of complications after newborn circumcision is unknown,
in part due to differing definitions  of “complication” and differing standards for determining the timing of when a complication has occurred [...] Significant acute complications are rare, occurring in approximately 1 in 500 newborn male circumcisions.
Acute complications are usually minor and most commonly involve bleeding, infection, or an imperfect amount of tissue removed.[...] Late complications of newborn circumcision
include excessive residual skin (incomplete circumcision), excessive
skin removal … ”

AAP: “Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the  severity of complications. [...] Financial costs of care, emotional tolls, or the need for future corrective surgery (with the attendant anesthetic risks, family stress, and expense) are unknown.”

Activists monitoring social networks often encounter individual cases of complications that usually go unreported, and where evidently medical staff have done as much possible to make parents feel good regardless of the negative outcome. The previous statements mention “excessive skin removal”. While this may not sound very important because, well, “it’s just skin”, truth is penile skin has an important role in sexual life and development. And while parents are not thinking about the future sexual life of their child (except in their desire to conform to a social norm by circumcising), this excessive loss of skin results in dramatic harm to the individuals sexual life.

The skin of the penis is supposed to move during sex. In fact, it is supposed to glide over the glans, something that is almost always destroyed by circumcision. But the skin also has to be able to accommodate a normal erection. In other words, when the erectile tissue inside the penis swells with blood to make the penis enlarge and become stiff, there needs to be enough skin to accommodate its length.

When there is not enough skin, many things can happen. The penis can bend unnaturally when erect. The skin can chafe and even bleed during sex due to friction. The penis may pull surrounding skin (from the scrotum and pubic area) to make for the lack of normal penile skin, resulting in pubic hair climbing up the shaft, and potentially penetrating the individual’s sexual partner, causing bruising and tears inside. Insufficient skin can also cause part of the penis to push inward during erection (because there is nowhere else for the erectile tissue to go) causing pain during erection.

Many men who experience these complications may not seek help because they assume it’s normal, it’s what an erection feels like or looks like.

In fact, the loss of tissue due to circumcision is the reason why American supermarkets and pharmacies devote shelf space to artificial lubricants, so that men who lost too much tissue can masturbate or have sex.

In a bodybuilding forum we found one such case reported by a non-activist individual asking for advice from his peers.

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What motivates this post today is a photo found by activists today on Facebook. In that photo, a relative of a newborn reports that the baby finally left the hospital. Bleeding after circumcision was stopped, but infection is still a concern. Too much skin was removed and they are going to let it heal and follow up in two weeks, and they may use skin grafts later on.

baby1baby2

This is one of those complications that barely registers with people, one that the media doesn’t care about, one of those stories that will go unreported and unnoticed. It’s just skin. Until one day, 20 or 30 years later, baby is now an adult, and finds himself wondering why he can’t masturbate or have sex without lube. Why his skin chafes and gets sore if he tries to. Why he ends in pain if he does.

Or his girlfriend, wife, etc., wonders why she ends up with pain and burning inside her vagina after intercourse.

Oh, but it was just some extra skin, wasn’t it?

Oh, but the benefits outweigh the risks, don’t they?

I’m disgusted by the comments I see. Nobody should have to refer to a baby as a “trooper” or a “fighter” just because they allowed a doctor to harm the baby.

Notice the relative’s comment: “wish it was over for him or better yet it never happened“. Well, sad to say, but it wouldn’t have happened if it wasn’t for the circumcision. This injury was 100% preventable.

Another person says “somebody needs to answer a question about removing too much skin“. Well, they did. The AAP statement mentions the risk. Most consent forms mention the risk. They just don’t tell you how bad it really is when it happens. So parents assume that removing too much tissue is just a cosmetic problem. Not that it will involve bleeding, risk of infection (weren’t they trying to prevent infections anyway?), pain, additional surgeries… And what they don’t know yet, long term pain. During sex.

Notice the person who says one of her children had the same problem and the nurses told her that it was a “French cut” and “girls loved it“. The moment when the baby’s genitalia becomes sexualized to appease adults. This again proves that American circumcision is mostly a social fetish disguised as medicine, and that doctors and nurses will say anything to make parents feel good.

In fact, Googling “French cut circumcision” reveals that it something different. What is considered a European or French style circumcision is a low and loose circumcision, not one where excessive tissue was removed.

I’ve known many cases of men harmed in this way. Some became activists. Some have been restoring their foreskins for many years to reduce the pain.

I know a mother who had her first 3 children circumcised. She used to think the right circumcision was the one they did on her first born, the one that had a tight circumcision. Until he turned 4-5 and started expressing pain when he has erections. She is now an activist against circumcision, of course, and regrets the harm that came to her child.

Seeing this photo on Facebook today I can only think: Poor hurt baby. My heart breaks for you and all the other babies and the adults they become who were and will be harmed by this mindless unnecessary, risky and damaging surgery.

Is this harm always accidental?

A number of circumcision fetishists tend to favor “high and tight” circumcisions and often fixate on the removal of the frenulum – something which is necessarily sexual harm, given the sexual sensitivity and pleasure caused by an intact frenulum. And American doctors never mention what happens to the frenulum during circumcision – in fact the word “frenulum” is not even present on the AAP Technical Report on circumcision from 2012!

In this video, the makers of a circumcision device explain how to use their device for a tight circumcision with frenulum cauterization. In other words, to cause as much harm as possible!

One can only wonder… Why?

But they won’t answer.

 

Midwest Urology Center

Midwest Urology Center is the practice of Dr. Roger Schoenfeld, DO, in Joplin, Missouri. His website was/is http://www.midwesturology.com but more recently a different url is taking precedence: http://www.mwurologycenter.com

Dr. Schoenfeld’s website was one of the few websites by U.S. doctors that was critical of circumcision, at least until January of 2014. As of May of 2014, a redesigned website removed most of the most technical content, including the two former pages on circumcision.

Dr. Roger Schoenfeld, D.O.

Dr. Roger Schoenfeld, D.O.

The information on circumcision was presented in two pages, one for pediatric circumcision and one simply circumcision. The page on pediatric circumcision was not as complete, but the other page on circumcision contained information that was more critic of circumcision, including a lot of intact-friendly information about the functions of the foreskin and the existing cultural bias.

Because we believe this information to be relevant, and in lack of a response from Dr. Schoenfeld about the reasons for not reinstating this information, and because this information is available in the WayBack Machine, we are re-posting it.

The page on pediatric circumcision, retrieved from http://web.archive.org/web/20131011000306/http://midwesturologycenter.com/kidcircumcision.htm while not as critical, in included for completeness.

Pediatric Circumcision

Circumcision for Children:

Alternative Names: excision of penile foreskin; foreskin removal; removal of foreskin

Surgical removal of the foreskin of the penis.

Circumcision of a newborn boy is usually done before he leaves the hospital. A numbing medication (local anesthesia such as Xylocaine) is injected into the penis to reduce pain. Ring-type clamps are placed around the foreskin, tightened like a tourniquet to reduce bleeding, and the foreskin is removed below the clamp. The clamp may be metal or plastic (Plastibell). The Plastibell will fall off in 5 to 8 days, after the surgical site has healed.
Circumcision of older and adolescent boys is usually done while the child is completely asleep and pain-free (using general anesthesia). The foreskin is removed and stitched onto the remaining skin of the penis. Stitches that will dissolve (absorbable sutures) are used and will be absorbed within 7 to 10 days.

The common indication for circumcision is:

  • cultural or religious desire for circumcision.

Other indications (rare):

  • treatment for inability to pull back the foreskin completely
  • infection of the penis (balanitis)

Risks

Risks for anesthesia are:

  • reactions to medications
  • breathing problems (general anesthesia)

Risks for any surgery are:

  • bleeding
  • infection

Additional risks include:

  • injury to the penis

 

The page on Male Conditions / Genitalia / Circumcision, retrieved from: http://web.archive.org/web/20131010231240/http://midwesturologycenter.com/circumcision.htm

Circumcision

Circumcision is the surgical removal of the sleeve of skin and mucosal tissue that normally covers the glans (head) of the penis. This double layer, sometimes called the prepuce, is more commonly known as the foreskin.

Parents are encouraged to read as much as possible about circumcision. They should make themselves aware of the complexities of the circumcision procedure itself. Speak to your doctor about the step-by-step procedure. If possible, ask to observe a circumcision at your hospital, so that you will know fully what is involved.

Pictures and video of a circumcision are available on the Circumcision Information and Resource Pages (CIRP) website.

What is the foreskin there for?

The foreskin serves three functions: protective, sensory, and sexual.

In most cases, the foreskin is still fused to the glans at birth and will separate over a variable period of time over the first few years. During the diaper period, the foreskin protects against abrasion from diapers and feces. Throughout life, the foreskin keeps the glans soft and moist and protects it from trauma and injury.

Parts of the foreskin, such as the mucosa (inner foreskin) and frenulum, are particularly sensitive and contribute to sexual pleasure. Specialized nerve endings enhance sexual pleasure and control [19].

The inner foreskin (mucosa) is the skin directly against the glans. Like the lining of the mouth, this tissue is thinner and of a different texture and color than the remainder of the skin covering the penis (shaft skin). The frenulum is a particularly sensitive narrow membrane that runs down the ventral groove of the glans and attaches to the inner foreskin. The frenar band is the interface between the inner foreskin (mucosa) and the shaft skin. It often “puckers” past the tip of the glans. The band contains whorled smooth muscle fibers, giving it pronounced elastic properties that allow the foreskin to be retracted. The frenar band has a tactile sensitivity equivalent to that of the lips.
The foreskin provides ample loose skin for the penis to occupy when erect. It is a movable skin sheath for the penis during intercourse, reducing chafing and the need for artificial lubricants, and allowing the glans and foreskin to naturally stimulate each other. Warren and Bigelow described some of the physiological functions of the foreskin in sexual activity.

What are some reasons that circumcision is performed?

Circumcision is primarily performed for cultural or religious reasons.

Because a large number of men in English-speaking Western countries are circumcised, many think of the foreskin as an unnecessary part of the penis. Many circumcisions are performed because a circumcised father often does not want to feel that he is different from his son.

It is often said that a circumcised penis is cleaner, or easier to keep clean, than an intact penis. Smegma (a natural substance composed of dead skin cells, normal flora, and secretions containing the natural antibacterial agent lysozyme) is more likely to accumulate when the foreskin is present.

Medical grounds for circumcision that are most commonly cited are: Reduced risk of urinary tract infections (UTI); reduced risk of penile cancer; reduced risk of cervical cancer in partners of intact males; reduced risk of sexually transmitted disease (STD).

There is contradictory evidence in the research literature as to whether circumcision reduces UTI [16,17], but this seems to be the strongest of all medical claims in favour of circumcision, because UTI can have serious consequences. These infections can, however, in most cases be treated by antibiotics. The frequency of UTI in US male infants is approximately 1%, but is higher for females. There is evidence that babies who are breastfed have a lower incidence of UTI.

Penile cancer is an extremely rare form of cancer. It occurs mostly in older men, and most doctors will not recommend infant circumcision as a preventative measure. Penile cancer can occur in both circumcised and intact men: The Maden study (an ongoing study of penile cancer at Fred Hutchinson Cancer Research Center in Seattle) observed that 37% of penile cancer cases occurred in circumcised men.

The theory that wives of men with intact foreskins are more prone to cervical cancer has been disproven. The theory that the presence of a foreskin may cause an increased risk of sexually transmitted diseases was disproved by a new study. The question of HIV warrants further study. Although there is an apparent geographical correlation between male non-circumcision and HIV infection on the African continent, this is not true globally, and the pattern seen in Africa could easily be due to other factors.

The only known effective means of preventing HIV infection are fidelity, condom use and abstinence.

Hygiene

The foreskin is easy to care for and the intact penis is easy to keep clean. The foreskin usually does not fully retract for several years and should never be forced. When the foreskin is fully retractable, boys should be taught the importance of washing underneath the foreskin every day.

Gently rinsing the genital area while bathing is sufficient. Harsh soap and excessive washing can irritate the penis, which can lead to inflammation of the glans (balanitis).

Smegma is a white waxy substance that can appear under the foreskin. It consists of natural secretions and shed skin cells. In the past it was feared that smegma might be carcinogenic, but this has been disproven. Good general hygiene and common sense are key to preventing infection and disease.

If my son isn’t circumcised, won’t it have to be done later?

Abnormalities or diseases of the foreskin can be treated conservatively, if and when they occur, on a case-by-case basis.

Probably the most common abnormality of the penis is “phimosis”, or tight foreskin. (This is not the same as the natural attachment of the foreskin to the glans in very young children, which is completely normal.) The foreskin can normally be retracted by adolescence.

If retraction is not possible, a number of newer treatments are available which do not involve circumcision: Steroid creams, stretching, and preputioplasty. Some of these treatments have only been published recently, and not all doctors are aware of them.

If your son has a serious problem with his foreskin, such as a severe infection (balanitis xerotica obliterans) or gangrene, perhaps related to diabetes, removal of the affected area may be a medically advisable option.

If my son isn’t circumcised, won’t he be teased?

Children can be cruel, and will find things to pick on another child about, whether it be his chubbiness, glasses, or freckles. Some parents think that their son should be circumcised so that he will “match” his father, brothers, or friends. As parents, we can help our children to feel good about their bodies and to respect individual differences.

Parents often express a fear that their son will “feel different in the locker room” if he is intact. There is good evidence that proper education is the answer. Boys who are taught from an early age that they are normal, whole and healthy will have a lesser chance of suffering embarrassment in the locker room, especially if some of the other boys are also intact.

Nonreligious infant circumcision is not an issue in European, Asian or South American countries. In Canada the average rate of infant circumcision for boys is roughly 25%, with large regional variations. The rate in the United States has dropped to less than 60%, and will drop below 50% in a few years if present trends continue. This is already true in the Western US (35% in 1993).

What are some reasons not to have my son circumcised?

Your son’s foreskin is a healthy, natural part of his body. It is possible, though very unlikely, that it will cause serious problems during his life. When he becomes an adult, he may prefer not to be circumcised. Leaving your baby’s foreskin alone preserves his right to a whole and intact body.

Circumcision will be painful for the baby (see below).

The medical evidence in favor of routine circumcision of healthy babies is not persuasive. If your son has a problem with his foreskin, such as a severe infection (balanitis xerotica obliterans) or gangrene, perhaps related to diabetes, your doctor may recommend partial or complete circumcision or removal of the affected area. Phimosis (nonretractable foreskin, if it persists much longer than normal) can usually be treated by gentle stretching and/or steroid creams. The vast majority of boys will never have any foreskin problems that necessitate surgery.

Is circumcision painful?

The often repeated statement that babies can’t feel pain is not true. It is documented in the medical literature that babies are as sensitive to pain as anyone else, and perhaps more so.

Most circumcisions are performed without anaesthetic, because there are risks involved with using anaesthetics on babies. Sometimes local injections are used, but this does not eliminate pain. Most babies will show signs of pain during the procedure and in the week or ten days following circumcision. Recent studies have shown that the pain is remembered long beyond the time of the procedure itself.

While pain may help parents decide against circumcision, parents should look at the long term effects of their decision first, not only during infanthood, but all the way to adulthood. Your decision will affect your son for the duration of his life.

Does infant circumcision have risks?

Circumcision is surgery, and like all surgery it has risks. These include:

  • Excessive bleeding
  • Injury to the glans
  • Infection (raw wound is exposed to feces and urine in diaper)
  • Complications from anaesthesia, if used
  • Surgical error, including removal of too much skin
  • In rare cases, complications can be life-threatening.
  • Up to 20% of circumcised males will suffer from one or more of the following complications, to some degree:

Meatal stenosis (narrowing of the urethral opening due to infection and subsequent scarring, that occurs almost exclusively in circumcised boys) extensive scarring of the penile shaft skin tags and skin bridges bleeding of the circumcision scar curvature of the penis
tight, painful erections psychological and psychosexual problems
The surface of the glans becomes dry if not protected by the foreskin. It is believed that dryness and abrasion may cause progressive loss of sensation in the glans, especially in later life. Circumcised men on the whole do enjoy sex and are able to orgasm.

What if we want to have our son circumcised?

Circumcision does not need to be done right away. There is no need to feel pressured by your doctor. Take your time.

If you intend to ask your doctor to have your son circumcised, ensure that the procedure is carried out by an experienced surgeon. Sometimes circumcision is considered “minor surgery” and inexperienced residents are given the task of performing it. This leads to a higher rate of serious errors and complications.

You may desire that your son will retain some inner foreskin, and especially the frenulum, to preserve as much sexual sensitivity and function as possible. Another method is the dorsal slit. This method does not involve the removal of tissue, but allows the glans to be exposed.

Your doctor can help you decide how much skin will be removed and how much of the glans should remain covered if desired. However, in most cases, once your signature is on the consent form, the physician has absolute license to execute the circumcision as he/she sees fit. You must ensure that your intentions are in writing before the operation occurs.

To lessen the pain, speak to your doctor about the use of an anaesthetic for your baby.

When and why was routine neonatal circumcision introduced in English-speaking Western countries?

Doctors in the English-speaking countries started circumcising babies in the mid-1800s to prevent masturbation, which some doctors claimed caused many diseases, including epilepsy, tuberculosis and insanity. Of course, these arguments are not accepted today.

Where can I get more information?

The organization NOCIRC can provide help and advice, as well as free telephone referral of physicians in your area who are trained in the proper care of the intact penis. Telephone (415) 488-9883, or write to: NOCIRC, P.O.Box 2512, San Anselmo CA 94979-2512, USA. A list of local NOCIRC centers in the USA can be found at the NOCIRC Website: http://www.nocirc.org/