Thursday, March 21, 2013

Recent circumcision developments

November 2012, UK: ‘In the past six years, 343 labiaplasties were performed in the UK NHS on girls aged 14 or under. Read more:

September 2012. Medically necessary circumcisions in Brazil kill one in 7700. This, applied to the rate of infant circumcisions in the U.S. would result in 156 deaths per year. Currently, estimates estimates in the intactivist community are of 117 deaths per year (one in approximately 11,000) while the AAFP estimates 1 death in 500,000 (which would still result in at least 2 or 3 deaths per year)

March 2013: Pediatrics published a rebuttal to the AAP's Policy Statement on Circumcision from 38 heads or spokespeople for the paediatric associations of Austria, Britain, Denmark, England, Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Sweden and the Netherlands, and senior paediatricians in Canada, the Czech Republic, France and Poland, accusing the AAP of cultural bias, and finding fault with its methodology, its conclusions, and its ethics. The AAP responded trying to blame the European doctors for being culturally biased against circumcision. This on its own is evidence that circumcision in the United States is done only for cultural reasons (even if it's justified as religion, tradition or prevention). To put things in perspective, no country is being accused of being culturally biased towards amputated/unamputated arms, legs, breasts or any other part of the body, since those amputations are only performed based on medical needs, not on parental preference (or medical pressure to do so).

March 2013: Michigan State University Clinical Professor Robert Van Howe and Berkeley lawyer J Steven Svoboda published an article in the Journal of Medical Ethics which comprehensively takes down the American Academy of Pediatrics' 2012 circumcision policy focusing on the ethical issues. “When physicians decide whether to do a procedure, they must, and normally do, exclude from their medical decisions non-medical factors regarding the parents’ culture. Contrary to what the AAP suggests, doctors are not cultural brokers. Their duty is promoting and protecting the health of their patients, not following practices lacking a solid ethical and medical foundation.”

March 2013: Attorneys for the Rights of the Child disclosed that since 1985, more than 80 million dollars have been paid out in settlements for wrongful and botched circumcisions. Two of the cases totaled $18.3 million against Mogen Circumcision Instruments Ltd, makers of the Mogen clamp (which has the risk of partial or full amputation of the glans). The company has gone out of business, but the Mogen clamps are still widely used, particularly in Canada by Dr. Neil Pollock and doctors who receive training on his "new technique". A recent study by Rebeca Plank concluded that "we consider the Mogen clamp to be a safer choice than the Plastibell for public sector scaleup in HIV-prevention programs" even though they acknowledged the reports of partial amputations of the glans.

March 2013: The Canadian Pediatric Society is expected to reveal a new policy on circumcision, which is likely to be more positive towards circumcision (in line with the AAP - and in opposition to most of the Western world).

Tuesday, March 5, 2013

Queens Infant Disfigured in Botched Bris, Lawsuit Charges

I hate even mentioning this cases, I hate that these things happen, but what people need to realize is that it can happen at any time to any baby. To your baby.

The AAP says that the benefits of circumcision outweigh the risks, and "In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers."

Well, it just came to attention that a traditional religious provider, Rabbi Mordechai Rachminov, sliced part of the glans of a baby in Queens in October of 2011, and then lied about it - causing a delay on emergency attention that increased the permanent damage. The baby had to be operated (under general anesthesia) and "may need even more procedures". The consequences may be life long.

The American Academy of Pediatrics, AAP refers to these cases as "case reports" on page 20 of the Technical Report on Circumcision released on August 27th of 2012; these case reports were excluded from the literature review for their Policy Statement on circumcision, the one where everybody heard that "the benefits outweigh the risks":
Major Complications: 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 transmission of herpes simplex after mouth-to-penis contact by a mohel (Jewish ritual circumcisers) after circumcision,207–209 methicillinresistant Staphylococcus aureus infection, 210 urethral cutaneous fistula,211 glans ischemia,212 and death.213

Image from Saving our Sons

It would be fair to assume that the method of circumcision used was a Mogen clamp or a Mogen Shield, which are the more common methods for Jewish circumcisions. The problem is that neither of them (shield or clamp) actually shield the glans - thus allowing for this kind of injury to occur, as reported by the World Health Organization in the following comparative chart.

Archive image of a Rabbi displaying a Mogen shield

Lawsuits following cases of glans amputation caused Mogen Circumcision Instruments inc to close its doors after going on default, yet the Mogen clamp continues to be used by physicians and mohelin - and promoted by some Canadian doctors as "virtually painless".

Image courtesy of Boys Deserve Better

The story of this baby was reported March 5th, 2013 here:

My heart is with the baby and the family.

May a time come when all babies are safe from forced genital mutilation.

Source: Saving our Sons

Monday, March 4, 2013

Complication, risk or benefit of circumcision: Adhesions - AKA skin bridges

One common complication of circumcision are adhesions. Adhesions occur because the remnant of the foreskin tries to heal and in the process it may become adhered to the glans, becoming a skin bridge. This is not only a cosmetic problem, but it can also cause pain during erections and sex.

The American Academy of Pediatrics on their technical report on circumcision (released August 27th of 2012) state that:

Late complications do occur, most commonly adhesions, skin bridges, and meatal stenosis. There are 2 schools of thought regarding the cause of penile adhesions, which are common after circumcision. One is that fine adhesions represent incomplete lysis of physiologic adhesions at the time of circumcision; the other is that the fine adhesions occur because of raw serosa surfaces. It is unknown how often these late complications require surgical repair; this area requires further study.


In 1 outpatient-based study of 214 boys with poor evidence, the complications seen included adhesions (observed in 55 boys [25.6%]), redundant residual prepuce (44 boys [20.1%]), balanitis (34 boys [15.5%]), skin bridge (9 boys [4.1%]), and meatal stenosis (1 boy [0.5%]).76


There is good evidence that circumcision of a premature infant is associated with an increased risk of later-occurring complications (ie, poor cosmesis, increased risk of trapped penis, adhesions). There is also good evidence that circumcision of a newborn who has a prominent suprapubic fat pad or penoscrotal webbing has a higher risk for the same long-term complications.187 One prospective study with fair evidence examined the natural course of penile adhesions after circumcision and found that adhesions disappeared at some point 6 months postcircumcision without intervention, except for thick adhesions (called “bridging adhesions”). The authors recommended lysis for skin bridges.188

Had you heard about adhesions or skin bridges? Many families find that they have to deal with these and this often means sedation and surgery. Check this link:

And exactly what an adhesion or bridge looks like? Check

And if this is too upsetting to see, maybe babies should not be exposed to this risk!

But again, the AAP stated in August 27th that the benefits of circumcision outweigh the risks. Perhaps adhesions are another benefit - for the doctor who has to perform the additional surgery.

Your opinion about circumcision may harm another person - so get your facts straight

On a recent facebook post, a mom-to-be expressed being nervous about having a boy:
I have heard good and bad (actually horrid) things about getting him circumcised. I am worried that I will make the wrong choice and regret it later on down the road.. I know that this is ultimately up to me and my boyfriend, but to the moms and dads out there that DID circumcise, how did you decide it was right, and how hard was it to see IT happen to your son??
One mommy said that:

My son was circumcised at birth. My husband and I made this choice because we felt it was the best thing for him. We didn't want him to feel different from the rest of his male family members. I'm reading a lot of comments that are talking about the foreskin being cut off, but that was not the case with my son. There was NO cutting whatsoever involved in his circumcision. He never cried because his diaper was hurting him or acted like there was any pain when we cleaned it. For those men out there that are unhappy with a decision their parents made for them as a minor there are steps to have it replaced. Also, the main thing that is on my mind is why would anyone allow circumcision to happen in a hospital of all places if it wasn't safe? Don't you thing CPS would put a stop to this if it was so cruel. Why let potential "uniformed" parents make this decision? My final note to this now probable traumatized women is talk to you doctor, don't just look up answers of the internet. I'm not trying to say that you shouldn't look for answers online, but have your findings verified by your doctor. I wish you the best of luck in finding what is best for you and your family!

 I replied:

She mentions some interesting points.

She said that in her son's case, there was no cutting at all involved. From that, I assume that they used the Plastibell method, which is often marketed as a no-cutting method. But, not only that is a lie (there IS cutting involved, and also there is necrotizing of tissue so that it ends up falling), but the main problem is not whether an scalpel or scissors or a string was used, but the fact that healthy normal tissue was removed.

This blog entry addresses exactly that myth, that there is no cutting involved in Plastibell, and shows a comparative table of risks between the common methods from a World Health Organization publication.

Her second point is that "there are steps to have it replaced" - yes it's called foreskin restoration. However foreskin restoration cannot replace the nerve endings from the original foreskin, meaning that the neurological (or sensory) damage cannot be repaired. The new foreskin is mechanically functional (although it takes years to re-create it, I completed my first year this week), and it's sensitive as the rest of the penis, but not as the original foreskin was. It's kind of like a reconstructed nipple after a mastectomy: it's skin, but not delightfully sensitive skin - nor functional for breastfeeding.

She also says that "why would anyone allow circumcision to happen in a hospital of all places if it wasn't safe?" - That's a good question. In fact, female circumcision of babies in the U.S. was performed up to the 70s in hospitals. It was probably safer than male circumcision is. Why did they do it back then? Why don't they do it now?

Female circumcision is still done in hospitals in places like Indonesia and Malaysia, where the society opposes any attempt at banning it. Do you think that they don't have evidence that it is damaging? Are they "barbaric"?

Circumcision is tolerated here because it's the status quo. It's been done for 150 years. It's a snowball rolling down the hill. It's a cultural, unnecessary practice, to which the American public has devoted a special mystique. As Edward Wellerstein (American Jewish) wrote in 1980: "The "enigma" lies in the United States medical profession's apparent inability to come to grips with the simple fact that there are no demonstrable health benefits of circumcision, and there are risks."

To this her reply was

AGAIN, I will say I'm just stating MY OPINION. People like you are the main reason I don't like to comment on fan pages. It's like a very religious person trying to CRAM THEIR BELIEFS DOWN MY THROAT BECAUSE I DON'T THINK THE SAME WAY. My husband and I made this choice and you throwing every thing you can think of at me to make me look like a bad person or make me feel guilty is not going to work. I'm just trying to answer a question, like you, but if I continue to be villainized I will delete my comments and this women who is looking for what people have to say will only have the extremist to go on.

Was it confrontational to respond to her points? When you make a medical decision that can affect a person's life, shouldn't you have facts to sustain your decision? And even more, when you are giving a recommendation to someone, is it enough to have an opinion? What if your opinion is wrong and a person ends up getting hurt? I don't think I ever judged her, I discussed the points that she stated, but she felt too vulnerable to discuss those points.

Meanwhile, men like me continue wearing devices that pull the skin of our penises towards our knees for several hours every day, almost every day of the week for several years, to re-gain something from what we lost when a doctor raised a scalpel to our private parts. How is this a matter of someone's opinion?

Benefits of circumcision?

On a Facebook page where someone asked about the benefits of circumcision, a man replied:

Let me tell you women about the „benefits“ circumcision has given me.

1) A nasty circumcision scar around the middle of my penile shaft!

2) A hardened, keratinized sand-paperish glans thanks to my lack of a foreskin that rubs the inside vaginal walls of my girlfriend raw ans causes her pain and vaginal soreness as well as microscopic tears.

3) A gradual decrease in penile sensitivity over the years.

4) Painful and uncomfortable sex with my girlfriend. I have to jackhammer her and I still can‘t please her or myself!

5) My male G-spot, the frenulum, has been cut away. Even more pleasure reduction.

6) When I am 40, I‘ll probably need Viagra to get and maintain an erection because circumcision causes erectile dysfunction. Oh it‘s pretty embarrassing if some 80 year old intact man in Europe can still enjoy sex naturally while I need to take blue pills because my culture thought it was a good idea to fuck with my penis!

So tell me about those „wonderful benefits“ of circumcision!. Because I am still waiting for them.

Shame on the people here who are anti-FGM, yet PROMOTE male circumcision, which is MUTILATION. The foreskin has 16+ functions ranging from penile protection to sexual enhancement for both the man and his partner. Amputating the foreskin removes these benefits and leaves NOTHING BEHIND.

Male circumcision has ZERO BENEFITS.
A woman responded:

My husband is circumcised, and it is only recently that I realized the issues we have is due to his circumcision. His glans are hard and sand papery, instead of soft and moist like they are supposed to be. He has to jackhammer to be able to finish, and afterwards I am sore and raw for days because of his dry and sand papery glans and because of the way he has to be rough in order to climax. Men suffer from their circumcisions and so do their partners.

Another woman commented: 

I recently clued my husband in on our sex issues. He has been taking ED drugs since he was 27 which actually make it worse for me. And I have to use a toy every single time, along with massive amounts of lube. There are no long strokes. It's all 'jack rabbit'. 
Hopefully the American Academy of Pediatrics won't take long to realize that adult men are being hurt by what parents are doing to babies, far from what they state when they say that "the benefits outweigh the risks" on their new Policy Statement on Circumcision published on August 27th, 2012.