South Florida based doctor Christopher Hollowell posted a video of a circumcision of a 1 year old child. During the narration, Hollowell first appears satisfied about the lower rates of circumcision (and even misrepresents it) but as the video progresses, he becomes strongly biased for circumcision.
He claims that as a urologist, he sees all the cases where uncircumcised boys have problems. He claims, for example, that the 1 year old child he is circumcising has phimosis and balanitis.
This is problematic already. Most babies are born with congenital phimosis (also known as physiological phimosis), which is a normal condition: the foreskin is not ready to retract. It takes years, for this phimosis to be overcome, with the average age being 10 and a large variance. Being non-retractable at 15-17 is still normal.
Balanitis is often claimed as a reason for non-neonatal circumcisions. However, balanitis simply means inflammation of the penis. Quite often, it’s just an ammoniacal dermatitis resulting from bacteria in the feces staying in the diaper for too long, and can be resolved with medicine and patience, without need for surgery.
The doctor claims the child has severe penile adhesions. What he is doing is patologizing a normal condition. As we have often explained in this blog, the foreskin and the glans start as a single structure, and at some point a layer starts desquamating, creating the subpreputial space. This layer is called the balanopreputial sinechiae or balanopreputial lamina, and it dissolves slowly through several years. But our doctors tend to call it adhesions. The AAP erroneously claims that these adhesions should be resolved by the 4th month of life.
At 1 year of age, these “adhesions” are in fact normal. The foreskin and the glans are still in the process of separating, and there is no need to rush them.
Dr. Hollowell then pulls the foreskin back and claims that the penis of this child has a “cobra head effect” because pulling it down causes the glans to curve downwards, pulled by the frenulum. Based on this observation, he proceeds to excise the frenulum.
Personally, I consider the removal of the frenulum of a child a criminal act. And it is also unnecessary.
It is unnecessary because at 1 year of age, the penis of this boy has not reached its adult size, so any present consideration will completely change during puberty, once production of testosterone increases and the body starts reaching its adult size. So even if the frenulum is short now, it still has plenty of time to grow. Not only that, but even if at 18 the frenulum was still short (frenulum breve), there are non-invasive ways of correcting it. There is no need to fully remove it.
I believe that removing it is a criminal act because the frenulum carries an artery and a high concentration of nerves. The frenulum itself is said to be one of the most pleasurable parts of the penis -by those who were lucky enough to retain their full frenulum, or did not suffer total damage of it. So, to remove it before the person has attained an age of maturity seems to me a purposely damaging action which has long term effects over the sexual experience of that child.
The loss of irrigation due to cutting the frenular artery can potentially have long term effects. Some suggest that ischemia (lack of blood) is behind the common occurrence of meatal stenosis in circumcised boys. Loss of blood flow could also affect the surface of the glans, as hypothesized by Ken McGrath. Finally, loss of blood flow could be related to erectile dysfunction later in life.
Dr. Hollowell repeats several times that the foreskin is very vascular tissue, yet he doesn’t seem affected by the idea of removing it.
He says that he likes to think of circumcision as plastic surgery of the penis and that he likes to think that every man likes to have a beautiful looking penis. But, isn’t it problematic to perform plastic surgery on the genitals of a child, to think of the genitals of a child in terms of “beautiful looking” as a result of plastic surgery – particularly when performed without consent of the person?
During the procedure he marks the line where he is going to cut. It can be observed that the line is traced around the center of the penis. Now, if we consider that the foreskin is a double layered area, then the total area of tissue being removed accounts for approximately two thirds of the covering of the penis. If it was single layered, it would be one half, but since the foreskin is double layered, it counts two times, thus the total tissue removed is 2/3rds or 66% of the covering of the penis.
Hollowell says that when asked why do the procedure at one year and not at birth, his response is that he couldn’t do it before and had to try conservative measures because of the age. He then goes on an explanation about aging and bleeding that has more to do with Jewish myths than with actual science. “The foreskin we’ve learned over centuries that if you cut the foreskin before the 10th day of life you will have very little bleeding of the foreskin, so many cultures will just do it as a ceremony without any problems, however after that time, if you decide to cut the foreskin it will bleed significantly and in young boys, a little bit of bleeding can be devastating“. He says this without acknowledging that the only cultures that circumcise babies are the Jewish and the American culture, not “many cultures“, and the reasons he gives have more to do with bible myths than with any solid science. In fact, babies circumcised on the 8th day according to the Jewish tradition, may still die from exsanguination, as we have previously showed in this blog.
As he explains this, Hollowell keeps cauterizing the penis to stop any bleeding. Has anyone studied the harm caused by cauterizing all those blood vessels? If American doctors were using more recent circumcision technology, they would be able to circumcise children and adults without cauterizing the inside of the penis as if it was a piece of grilled steak.
Now, the real reason why Hollowell performs these circumcisions at 1 year of age has everything to do with insurance and little to do with medical reasons. See, for a few years, Medicaid didn’t cover neonatal circumcisions in Florida. So instead of paying the $200 to $800 out of pocket, many families waited one year at least, and then procured a referral for circumcision. Because there has to be a diagnosis code for insurance to cover it, doctors would diagnose phimosis, knowing very well that they are providing a fraudulent diagnosis because those children are perfectly normal. But at that point, because of the age, the procedure (at least in the U.S.) requires general anesthesia and becomes a more involved surgical procedure (mostly because the American doctors are not using the most recently invented devices for non-neonatal circumcision, which would greatly reduce the cost and risks of the procedure), so now the procedure is up to 20 times more expensive.
This medical fraud is what led one doctor Saleem Islam to claim that the cost of circumcisions in Florida “skyrocketed” after Medicaid stopped covering neonatal circumcisions. Doctor Islam in his paper candidly recognized that parents came asking for circumcision for their children, but didn’t mention that those circumcisions would be fraudulent because they were not based on real medical necessity – so they shouldn’t even be covered at all.
So this is the reason Hollowell is circumcising a 1 year old child over a diagnostic of phimosis and balanitis: because the parents did not want to pay the low cost of a neonatal circumcision out of pocket and preferred to seek a referral after the age of one, for a more complicated and risky procedure under general anesthesia and at a higher cost to the tax payers.
Closer to the end of the video (while suturing the penis) Hollowell goes into his litany of things that can happen to uncircumcised boys: they can have adhesions, they can have balanitis, they can develop penile cancer later, they can have urinary tract infections, they have more risks of getting STDs… all the myths we’ve heard over and over.
And then he compares circumcision to a vaccine. “And I tell you if you could have a vaccine that gave the same results we would jump at it every time, so it is quite interesting to see where our new thought process is on what we would do to offer this to young boys again on a routine basis”
The lies they say:
- The child has phimosis
- The child has balanitis
- The adhesions are abnormal
- The frenulum causes the penis to bend downward
- Circumcision protects against STDs, penile cancer, etc.
- Circumcision is a surgical vaccine
- He won’t know the difference
The crimes they make:
- Fraudulent use of insurance
- Cutting one of the most pleasurable areas of the penis – the frenulum
- American doctors don’t use the most recent technology for non-neonatal circumcisions – thus increasing the risks, complications and cost of the procedure.
- Subjecting a 1 year old child to general anesthesia for a non-medical surgery (plastic surgery of the penis – give the child a beautiful penis).
Shame on you Dr. Christopher Hollowell.