Circumcision's complications: what could go wrong?

Circumcision's complications: what could go wrong?

By Ryan McAllister

The web is peppered with articles about circumcision. But for parents there is a vital area of information about circumcision that often goes unaddressed: What could go wrong?
Circumcision is a surgical procedure, and as such it does have complications. However, no medical organization tracks complication rates or severity, so it's hard to find a good estimate of either. When making medical decisions on behalf of their children, parents deserve and need complete information about any procedure and its hazards.
Digging deep reveals surprising facts. Complications range in severity from the "mild:" excessive bleeding, infection (including antibiotic resistant Staphylococcus), to the severe: surgically caused genital deformity, accidental amputation, and even death. And complication rates are higher in children circumcised shortly after birth than in older children (and presumably adults also), possibly because surgery on such a small child is more intricate.
Addressing complications
Tissue removed in a circumcision cannot truly be replaced or re-grown. However, there are so many complications from infant circumcision that there is a flourishing sub-specialty of pediatric urologists who treat children with severe circumcision-induced complications.
Dr. David Gibbons is one such pediatric urologist serving the Washington, DC area. He has seen so many bad results from circumcision in his practice that he wishes the procedure would fall out of favor. Here is a post of his reproduced in entirety to preserve completeness of his point of view.

Neonatal circmcision [sic] is totally unnecessary, and there is no current role for preventative or prophylactic neonatal circumcision.
Unfortunately, 70-80% of neonatal circumcisions are performed by obstetricians, who can neither manage their complications (2-5% incidence) nor obtain proper informed consent (defined as outlining risks and benefits of a procedure, as well as alternatives-including nothing) for neonatal circumcision. Currently, the American College of OB-GYN (ACOG) have no paramenters [sic] for training (learning and performing neonatal circumcision, managing complications) of residents, who then go out and continue this practice.
In my practice, as a pediatric urologist, I manage the complications of neonatal circumcision. For example, in a two year period, I was referred >275 newborns and toddlers with complications of neonatal circumcision. None of these were 'revisions' because of appearance, which I do not do. 45% required corrective surgery (minor as well as major, especially for amputative injury), whereupon some could be treated locally without surgery.
Complications of this unnecessary procedure are often not reported, but of 300 pediatric urologists in this country who have practices similar to mine...well, one can do the math, to understand the scope of this problem...let alone, to understand the adverse cost-benefit aspect of complications (>$750,000) in this unfortunate group of infants and young children.
Fortunately, neonatal circumcision is on the decline as parents become educated...but the complications still continue.
Until the time that the USA falls in step with the rest of the planet who does not submit newborns to neonatal circumcision, ACOG should assure that the training of obstetricians to perform this procedure is adequate, particularly in avoiding and managing complications of a procedure that is unnecessary, and that obstetricians learn to obtain proper informed consent from parents who have no idea of the problems that can ensue.

Conclusion
The United States is the only country where doctors routinely perform neo-natal circumcision. The risks for any surgery, including circumcision, are highest for newborns. Generally, parents do not receive true informed consent about circumcision through their doctors because there is a systematic failure to collect that information and make it available to doctors. Circumcision is an optional procedure; it puts the child at risk for serious complications that can be avoided entirely by not circumcising.

Risk of Adult Circumcision

Risk of Adult Circumcision
by Daniel Barrett

Noted authority on phimosis, Chris Moore is determined to save adult
foreskins. How did his odd passion get started? He almost made the biggest
mistake of his life - getting circumcised. Since he made some startling
medical discoveries, he has worked hard to educate men about what they would
be losing and stop unnecessary adult circumcision.

There has been a steady decline in male newborn circumcision in North
America since 1971 when the American Academy of Pediatrics (AAP) reported
that there are no valid medical reasons for infant circumcision. In 1999,
the AAP issued yet another statement discouraging the routine practice of
newborn circumcision. Shortly thereafter, the American Medical Association
also declared that there is no proven medical benefit for infant
circumcision. The Canadian Pediatric Society calls circumcision an obsolete
procedure.

As a direct result of these announcements, in 2006 the rate of infant
circumcision in the United States was claimed to be less than half at 48.3%.
In Canada, currently 48% of adult males have been circumcised although the
incidence of newborn circumcision there in 2005 was less than 10%.

More than 80% of the worlds men are not circumcised. Circumcision is rare in
Asia, South America, Central America, and most of Europe. Doctors there are
well versed in the care of intact men; not so in the United States. Doctors
here quickly recommend circumcision for even minor problems.

North American men are left to turn elsewhere to find effective alternatives
to avoid circumcision when diagnosed with common problems such as phimosis.
This condition occurs when the foreskin is too tight to be pulled back
completely. This can lead to conditions ranging from mild discomfort to
persistent infections and painful intercourse.

If not treated, a too tight foreskin can lead to a more serious condition
called paraphimosis which occurs when the tight foreskin is retracted and
gets stuck behind the head of the penis. Circulation can be cut off and lead
to gangrene or even auto-amputation if not treated quickly.

The first thing these uneducated doctors recommend for every problem
involving the foreskin is circumcision. This is 100% unnecessary and
extemely undesirable. It is estimated that nine out of ten men being
circumcised do not need the surgery! Aside from the pain, physical and
emotional trauma, cost and down time, what is the big deal with cutting off
the foreskin?

Chris Moore was one of these men with a foreskin that was too tight and was
about to go under the knife. Moore is also a medical researcher. When he
started researching about his own problem, he discovered that there are
thousands of men who are desperately attempting to regain, re-grow and even
surgically replace their lost foreskins. Moore had to find out why they so
desperately wanted back what he was about to give up. What he discovered
shocked him.

It has been reported that 100% of circumcised men suffer from reduced
sensitivity and sexual response. Additionally, it has been estimated that
the uncircumcised male has 10 times the sexual pleasure and satisfaction
than a circumcised male. Does this sound like an old wives tale to you? It
did to Moore so he turned to science for the facts.

Moore found out the foreskin is not just a piece of unnecessary skin as is
commonly assumed. It is in fact a highly sensitized part of the male body
and amputating it also removes many critical components of the male anatomy.
Without the foreskin, 80% of the penis' erogenous zones are gone which are
critical for achieving the fullness and intensity of sexual pleasure and
response.

The frenulum is a very sensitive nerve-laden area that attaches the foreskin
to the underside of the head of the penis. For uncircumcised men, this is
the male "G-Spot" and it is highly pleasurable during sexual activity.
Depending on the surgical method, the frenulum is usually completely
destroyed by circumcision.

The foreskin covers the head of the penis and protects it from abrasion,
dryness, calluses and infection just like the eyelid protects the eye. The
head of the penis is meant to be a protected internal organ. The drying and
callusing causes a loss of sexual feeling, pleasure and fulfillment.

The inner foreskin creates plasma cells which distribute antibodies and
antiviral proteins. This is believed to be one reason why whole men are at a
lower risk of getting Chlamydia, HIV (AIDS) and other sexually transmitted
diseases.

Once Moore learned about the importance of the foreskin, he was not about to
let someone amputate his. He still had to solve his tight foreskin problem
though. Moore dug into all the research he could find and consulted many
foreign doctors familliar with intact males. He tested methods for easily
curing phimosis at home with no cost. Moore then set out to help other men
with phimosis.

In a subsequent clinical trial 509 out of 512 cases (99%) of Phimosis were
cured at home with simple painless foreskin stretching exercises. Moore
decided to spread the word to other sufferers of a tight foreskin. He
created a website designed to help educate men about the importance of
rejecting circumcision and how easy it is to treat the problem in the
privacy of your own home.

With this new resource available, Moore hopes that many more men who are
fortunate enough to be left with their foreskins, will reject circumcision
before making a life altering mistake.

Circumcision - Medical Myths

Circumcision - Medical Myths

Circumcision: the first cut is the deepest

Circumcision: the first cut is the deepest

Tuesday 29 September 2009
Circumcision: the first cut is the deepest
A proposal to remove the foreskin of every infant boy in America on health grounds is pointless, illiberal and harmful.
Ethan Epstein

Opposition to female circumcision has become something of an article of faith for international development organisations. While there are still great and unresolved debates among policymakers and intellectuals about the importance of promoting democracy, bestowing foreign aid and mandating international standards of criminal law, everyone seems to agree that female circumcision is abhorrent and needs to be stopped.

The consensus, for once, is right: female circumcision reduces – if not eliminates – sexual pleasure, provides no apparent health benefits, and violates individual autonomy. At its core, female circumcision is a degrading and brutally unfair practice.

All of this is true of male circumcision – the removal of penis foreskin – as well. Yet, as the New York Times recently reported, the Centers for Disease Control (CDC), an arm of the United States federal government, is now considering a plan to ‘promote [the] routine circumcision’ of infant boys in the US with the aim of reducing the spread of HIV (1). This proposal is as degrading as it is illiberal.

The scientific evidence that the CDC is relying on in considering the new recommendation is laughably weak. Consider, first, the people who were the object of the study: the population group surveyed was from sub-Saharan Africa, where sexual mores and cultural conditions are utterly different from those of the US.

The study found that adult circumcision led to a modest reduction in the transmission of HIV. However, the cited research found a reduction only in the incidence of HIV transmission as a result of sex between men and women. This is an extremely rare form of transmission in the US. Most damningly, even advocates of circumcision as a means of HIV reduction concede that circumcised men still need to use condoms to protect themselves. But this simply raises the question: why remove the foreskin in the first place, then? At best, therefore, the health benefits of circumcision are marginal.

Moreover, another recent study determined that circumcision does absolutely nothing to reduce the spread of HIV amongst men who have sex with other men – the group most likely to come into contact with the virus, at least in the US (2). Self-evidently, circumcision will do nothing to combat the spread of the disease among intravenous drug users, another group beset with HIV problems. And despite the claims of medical fearmongers regarding the supposed AIDS ‘epidemic’ in the US, fewer than 500,000 Americans are living with the disease in a country of over 300million people (3). To recommend universal circumcision is a wild overreaction to this problem.

While science gives us little reason to pursue this policy, it does tell us something important about circumcision: it greatly reduces sexual pleasure. To take just one academically determined example of what is quite self-evidently true, Gregory Boyle of the University of Australia has observed that the ‘inner layer of the foreskin comprises thousands of erogenous nerve endings’. He further determined that circumcised men enjoy ‘significantly less penile sensation as compared with genitally intact men’ (4). This makes plain sense: after all, the foreskin is an erogenous zone, and removal of said zone is bound have a deleterious result on sensation. To deny men a life of sexual pleasure because of highly dubious claims of ‘health benefits’ is ethically unjustifiable. To add insult to (ahem) injury, other studies have concluded that not only does circumcision deny males pleasure, it actually causes them pain as well (5).

More troubling, the plan to mandate circumcision betrays an insidious disregard for individual autonomy. Indeed, even if circumcision could be shown significantly to reduce the spread of HIV, the practice of circumcising infants would remain an affront to human dignity. It denies men autonomy over their own bodies. No right-thinking person would ever endorse the involuntary circumcision of adult males – indeed, even the most vehement supporters of the practice shy away from this. Why should the case of an infant male be any different? The detriments to his life he is likely to receive as a result of the procedure will only affect him when he is an adult.

Is there really any ethical difference between circumcising a baby against his will and circumcising an adult against his will? What kind of ethical framework is it that allows parents the right to deny their children future sexual pleasure?

Lamentably, many American elites have ridiculed and maligned opponents of compulsory cutting. Substituting mockery for argumentation, Hanna Rosin, writing in the influential Atlantic Monthly, referred dismissively to the circumcision ‘controversy’ (note the use of scare quotes) and accused opponents of being ‘hysterical’ (6). Emily Bazelon, a senior editor at the highly respected web magazine, Slate, characterised critics as ‘crazy’ and ‘on the rabid side’ (7). It is difficult to imagine two liberal women being quite so glib about opponents of female circumcision.

Of course, the impulse to regulate personal behaviour in the name of health and safety has been ascendant in Western society for some time now. But that impulse, as we have seen time and again, can go too far. If we were really to pursue such an outlook to its logical conclusion, we would demand a ban on homosexual sex, since this would result in a far larger reduction in HIV transmission than circumcision. This, most people would agree, would be ridiculous, but if any regulation is permissible in the name of health and safety, then why not simply mandate this?

The safety impulse is the same one that has brought us public smoking bans, seatbelt laws, and fees on shoppers’ use of plastic bags. And now, left unchecked, that safety impulse is set to hit American men where it really hurts.

Ethan Epstein is a business writer living in Portland, Oregon.

Male Circumcision 'Risky' say Doctors

Male Circumcision 'Risky' say Doctors
Sunday 6th September 2009

With another inquest about to begin, leading medics are calling for a wider awareness of the risks of circumcision, and for the protection of boys' safety and their personal autonomy.

16-day-old Amitai Moshe died in 2007 following a painful ritual circumcision in North London and his inquest will begin at Hornsey Coroner's Court on Monday 7th September. A previous inquest in Windsor this year found that baby Celian Noumbiwe had bled to death within hours of his circumcision.

Many parents who consider circumcision necessary for ritual reasons believe that the operation is harmless in early infancy, and that it will bring benefit to the child. This position is not supported by experts, who also point to the psycho-sexual effects of genital reduction surgery which is botched or bitterly regretted.

Gordon Muir, Consultant Urological Surgeon at King's College Hospital
commented: "There is no evidence that circumcising children has lower risk than carrying out the same procedure in adults and no medical benefit can be shown for baby boys in the UK having this procedure unless there are significant abnormalities of the foreskin." He added, "While the risk of major tragedies such as this is very low, I see many men who have suffered years of trauma and anxiety due to badly performed circumcisions they never needed for medical reasons, or consented to".

Dr John Warren, founder of men's health charity NORM-UK said:
"Circumcision related deaths in the West are rare but not as rare as the public think.... as well as the two deaths investigated in England this year and another in 2006, two baby boys bled to death in Italy in Summer 2008, and one in Ireland in 2003. We believe there are other cases which have passed under the radar due to the political sensitivity of the issue."

He added, "New Labour seem to wish to turn a blind eye to the issue of male ritual genital cutting, both its immediate risks and its intrinsic sexual harms. After baby Moshe died in 2007 we asked to have a list of other deaths and received a response that there were none on record.
This is plainly untrue as there are several cases which have been reported in the press including Boma Oruitemeka and Raju Meha in the 1990s. The government have also persisted with the line that male and female genital cutting cannot be compared, despite the fact that in some communities the female cut targets only her foreskin and this tradition has been banned. Apparently her hood is sacrosanct but his is fair game!"

Based on a census analysis, it appears that around 19,000 male children are at risk of forced circumcision each year in the UK. NORM-UK made a series of freedom of information requests to hospitals in England to find out the number of serious complications resulting from circumcision operations. This revealed that serious complications are being treated in hospitals across England, in boys from babies to teenagers, and child protection reports have been filed in some cases.

Some hospitals have proved reluctant to release the data, and Great Ormond Street is one of these. After some pressing, the hospital revealed that over the last five years it has treated, on average, almost two boys each week for complications of circumcision in the community. Yet no child protection reports are on record since 2005, despite the fact that in one case NORM-UK has heard of, a child of six had his injuries photographed by the police while at the hospital.

The Mental Health Charity MIND comments on its website that circumcision has been shown to be `overwhelmingly painful and traumatic' and points to a research paper by prominent Jewish circumcision campaigner and Psychologist Ron Goldman which details the evidence of post traumatic stress disorder following circumcision.

Child protection experts now also recognise male circumcision as a potential source of significant harm to a child and the official London Child Protection procedures state that "if a professional in any agency becomes aware, through something a child discloses or other means, that the child has been or may be harmed by circumcision, a referral must be made to [the Local Authority] children's social care."

Circumcision is a Painful, Costly and Unnecessary Procedure

sign the petition to the cdc against routine circumcision to prevent aids

http://www.thepetitionsite.com/takeaction/760537185

Keep America's baby boys intact

Keep America's baby boys intact
By Jennifer Margulis
Guest opinion
August 26, 2009

On Tuesday the Centers for Disease Control and Prevention held a meeting in
Atlanta as part of a four-day conference on HIV prevention to discuss how to
urge non-circumcising communities in American to circumcise. At the same
time, the American Academy of Pediatrics, which has long remained neutral on
the subject, is currently revising its guidelines in favor of circumcision.
Growing up Jewish in America, I never questioned circumcision. But now,
after having children and seeing how grown men in my life continue to suffer
psychologically because of a procedure done to them as infants, I've come to
believe that circumcision is not only unnecessary, it's a painful and
traumatizing procedure that should not be done in infancy, if at all.

Deciding whether to circumcise is a decision that every American parent of a
boy faces, though the majority simply choose to follow the doctor or
hospital's recommendation.

According to an Aug. 24 article in the New York Times, approximately 79
percent of all adult American males are circumcised. According to Intact
America, a nonprofit organization trying to stop routine circumcision in
America, circumcision is the most common surgery performed in America and it
happens to more than 1 million newborns a year, more than 3,000 times a day,
or once every 26 seconds.

Before my brother Zach's wife gave birth to their third child, I started
receiving frantic emails from a 28-year-old male relative whom I'll call J.
"Do you know if they are planning to circumcise?" J. wrote me. "Could you
find out about it? Could you tell them not to? Could you talk to them?" As
the due date approached, the messages become increasingly desperate, as if
J. felt that circumcision were a matter of life and death. At the same time,
J. was ashamed for being so worried. He asked not to tell anyone that he was
inquiring; he said he felt embarrassed and couldn't talk to my brother
directly. He begged me not to mention to his mother, especially, how worried
he felt about Zach's baby.

J. himself is circumcised. Circumcision is part of my family's cultural
heritage. All of my relatives, including my father, my uncles and my
grandfathers, have been circumcised. In the Bible, God actually commands
Abraham to circumcise his male descendants. Practicing Jews hold what is
usually a festive ceremony, called a bris, on the eighth day of a boy's life
during which his foreskin is removed either by a doctor or a mohel, a rabbi
trained in circumcision. Even in countries where circumcision is not the a
norm, the majority of Jews choose to circumcise.

Yet it is not for traditional reasons that health officials want to see an
upswing in American circumcisions. Recent health studies in Africa suggest
that circumcised heterosexual men are less likely to get an HIV infection
than their non-circumcised counterparts. Circumcision proponents also argue
that urinary tract infections are less likely among circumcised men, and
that it is necessary for cleanliness. They discount the pain involved in the
procedure and argue that it creates no lasting damage.

Those in favor of circumcision for medical reasons are wrong. First of all,
the procedure is painful, even with the administration of anesthesia. Anyone
who has ever witnessed a circumcision (you can watch one on the internet if
you don't believe me) and heard the high-pitched scream of a newborn having
the tip of his penis cut off knows that this surgery causes terrible pain.
For the week that the cut is healing, a baby is peeing and defecating on a
raw, open wound. Circumcision is also dangerous. Just this past March a jury
in Atlanta awarded $1.8 million in damages to a boy's parents after a
seriously botched circumcision.

It's also a procedure that causes lasting regret in some grown men. J. feels
so badly about being circumcised that he is on a campaign to stop all of us
having children from circumcising. Other men I know wish their parents gave
them the option to choose instead of forcing them to undergo a painful
procedure as one of their earliest life experiences. If there really is a
correlation between circumcision and HIV prevention, then we should let
adult men choose to have the procedure done once they are sexually active.

My brother's baby turned out to be a girl. But my own son is not circumcised
and if the baby I am carrying now, due in October, is a boy he will not be
either. Forced circumcision of newborns is wrong. Let's not impose trauma on
newborns and instead give adult men the right to choose.

Jennifer Margulis is a professional writer and the co-author of "The Baby
Bonding Book For Dads." Read more about her at

http://www.jennifermarguli s.net