Wednesday, June 13, 2012

Only Clean What is Seen: Reversing The Epidemic of Forcible Retraction

Source http://preventdisease.com/news/10/102610_only_clean_what_is_seen.shtml


Sadly, premature, forcible foreskin retraction (PFFR) is a much more painful, serious, and potentially permanent injury than most parents imagine. It is also epidemic in Anglo-American medicine and, as the number of intact boys grows, the situation is worsening.

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Parents were also advised to retract their boy's foreskin and scrub out any 'dangerous' secretions regularly, or have the boy circumcised so these could not possibly accumulate. Throughout the 20th century in all English-speaking countries, forced retraction for genital cleaning became standard medical practice. Millions of living, intact Anglo men, it is safe to say, were forcibly—and painfully—retracted as children.

An Australian medical historian recently published the following observation about the invented and erroneous myth of the need for rigorous infant male hygiene. He notes the irony that females only narrowly escaped similar treatment:

To appreciate the scale of the error, consider its equivalent in women: it would be as if doctors had decided that the intact hymen in infant girls was a congenital defect known as 'imperforate hymen' arising from 'arrested development' and hence needed to be artificially broken in order to allow the interior of the vagina to be washed out regularly to ensure hygiene.

—Dr. Robert Darby, A Surgical Temptation, The Demonization of the Foreskin and the Rise of Circumcision in Britain.

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Care of the foreskin

Proper infant hygiene, for both girls and boys, is actually astonishingly simple:

'Only Clean What Is Seen.'

This means the boy (or girl) needs only warm water, gently applied to the outer, visible, portions of his or her genitalia. No soap is needed. No intrusive or interior cleaning of the genitalia of either gender is ever needed or desirable. Aggressive interior hygiene is destructive of developing tissue and natural flora, and is harmful as well as painful.

At birth the penis is anatomically immature. The foreskin is connected to the glans by a natural membrane, the balano-preputial lamina (translation: 'glans-foreskin layer'). This membrane is apparently nature's method of protecting the highly nerve-supplied and erogenous foreskin of the developing penis from irritation by faeces, the ammonia in urine, and invading pathogens. Although very different in structure, it can reasonably be thought of as the male's hymen, protecting the sexual organs during the years when they are not needed for sexual purposes. This membrane may take as long as 18 years or more to disappear naturally, allowing retraction.

Numerous studies have shown that the mean age for natural foreskin retraction without pain or trauma is around 10 years.  Some men never see their glans until they are in their 20s. Any age is normal; there is no need to see the glans prematurely. Indeed, pre-adolescent boys, like pre-adolescent girls, need no internal cleaning whatsoever, and to suggest toddlers need to be retracted at each bath, or should be taught to do so themselves, is antique, 19th-century, medical superstition.


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So what happens to little boys with forecibly retracted foreskin? 

″ Premature forcible foreskin retraction is uniquely painful because the foreskin is among the most densely nerve-supplied structures of the male body. Research shows that pain alone holds later psychological consequences.

″ Likely the child now has an 'iatrogenic' (physician-induced) infection, caused by unnecessary tampering. Invariably forcible retractions are performed without surgical gloves or proper antisepsis, and the open wound becomes an immediate portal for disease.

″ Any infection may worsen, leading to urethral ulceration, and, perhaps to urinary stenosis (blockage). Indeed, septic genital tampering is the likely cause of many avoidable urinary tract infections, themselves then used to justify post-neonatal circumcision.

″ The raw, bleeding surfaces, formerly separated by a natural membrane, might now grow together, causing unnatural adhesions or skin bridges that may, or may not, eventually dissolve.

″ Any infection may leave scar tissue, which renders the foreskin inelastic, complicating adult hygiene and normal sexual functioning.

″ This inelasticity may create pathologic phimosis, an unnatural tightness of the foreskin opening, which might not fade with time and, ironically, may require medical intervention.

″ The child with an inelastic foreskin may suffer periodic paraphimosis emergencies, or trapping of the foreskin behind the glans' corona when retracted. His glans may become strangled, trapping blood and causing swelling, which then must be released by hand.

″ The child may now endure painful nocturnal erections because of his compromised foreskin (four or five involuntary nightly erections are normal at all ages for both genders). This may interfere with necessary REM sleep and might even create sexual dysfunction in adulthood.

″ The child may become understandably reluctant to have any adult touch his genitals or bathe him.

Forcible retraction and circumcision


You might already have sensed the connection between the historical marketing of circumcision and forcible foreskin retraction. Teaching youthful and trusting parents that an intact boy needs thoroughgoing internal hygiene at each bath helped to market circumcision, as it implied amputation might free the parents of this burden, unpleasant for them; painful for their son. Better—goes the argument—the immediate acute pain of circumcision than the periodic pain inflicted by parents over the years. And when the forcible retraction by parents did cause infection, or scar tissue, or adhesions, phimosis, or other problems, it was easy to blame the parents for inadequate hygiene or failing to choose circumcision, the 'sensible' option, to begin with.

Indeed, there is much anecdotal evidence that forcible retraction in the 20th century became a sort of retribution for non-compliant Anglo parents who declined circumcision for their newborn. The two, circumcision and forced retraction, have always been closely allied, and both create work for medical professionals, while leaving the intact boy alone to develop normally holds no economic benefit whatsoever. The false 'either-or' choice presented to parents for over 140 years has always been retraction and cleaning—or circumcision. The easy and more ethical European or Asian solution—leaving the child's genitals entirely alone—has only rarely been recommended in Anglo medical practice.

Post-neonatal circumcision

A tendency to misidentify the normal connective foreskin membrane of toddlers and young boys as an abnormal 'adhesion' also leads to unnecessary post-neonatal circumcisions. Millions of older toddlers in the US, UK, Canada, Australia, and New Zealand have endured painful, unnecessary, and psychologically challenging post-neonatal circumcision, with or without anaesthesia, based on this ignorance.

Misdiagnosis of the child's normal connective membrane is also the origin of the circumcision marketing mantra that 'he'll only need it later'. It is the direct source of many a family's story of their Uncle Bruce's painful circumcision at age six, of which he is only too happy to remind everyone. The implication is that circumcision is best done at birth, when, in truth, normal genitalia do not need fixing at any age, and never did.

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