Tag Archives: social media

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.

bb

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/