Circumcision complications

Drs say complications are rare. NewsMedia says complications are rare. Families say complications are rare. Consent forms say complications are rare. Medical books and websites say complications are rare.
However, rare complications are pretty scary to the parents and children they affect.
Rare is not rare enough when it is your child.
Infant/child Circumcision is unnecessary surgery on a healthy child. The foreskin is not an issue, disease or defect.

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Soggy mamas 2.0

https://m.facebook.com/SoggyMamas2?id=559007567474275&refsrc=http%3A%2F%2Fwww.google.com%2F&_rdr

My heart is aching for those children. Click on the link and read the screen shots. Many babies are bleeding heavily and getting infections from circumcisions. Mothers are saying how their babies are screaming in pain.
Look at the screen shots. Your heart will break too.

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Medical Journal on infant circumcision complications

Danish medical journal

Abstract Introduction: As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated our results from a paediatric surgical department. Material and methods: Patient file data from children who had undergone ritual circumcision in the 1996-2003- period were retrieved. Complications recorded until December 2011 were noted. Results: Circumcision in 315 boys aged from 3 weeks to 16 years (median five years) were evaluated. A total of 16 boys (5.1%) had significant complications, including three incomplete circumcisions requiring re-surgery, two requiring re-surgery six months and five years postoperatively due to fibrotic phimosis and two requiring meatotomy due to meatal stenosis two and three year postoperatively. Acute complications included two superficial skin infections one week postoperatively and five cases with prolonged stay or re-admissions for bleeding the first or second postoperative day, whereof two underwent operative treatment. Finally, two had anaesthesiological complications leading to a need for overnight surveillance, but no further treatment. Discussion: Parents should be counselled and be required to provide informed consent that any health benefits of childhood circumcision do not outweigh the reported complication rate and that therefore they should weigh the health benefits against the risks in light of their religious, cultural and personal preferences. As ritual circumcision is legal, a strong focus on high surgical/anaesthesiological standards is needed to avoid complications. Funding: not relevant. Trial registration: not relevant.

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Excerpt from: Land of Yu-phonia

I did not write this. I love this piece. Click the link below the excerpt to read the entire piece.

Land of Yu-Phonia
by Rosemary Romberg (Wiener)
illustrations by Linda Tagliaferro

I once went to visit a far off land. As soon as I arrived there I noticed that the people all looked just like us except for one thing. Hardly any of them had ears. On the sides of almost all of the people’s heads were small holes surrounded by small scars where ears should be. I imagined that this was probably an unusual breed of people who were born that way.

I had been visiting for a few days when I came upon a group of children. All of them were earless, just like nearly all the inhabitants of Yu-Phonia. Some of these children stared at me with fascinated curiosity. I soon realized why. I have ears. Soon a woman came along and scolded the children. “It’s not nice to stare at people! Now, go away and leave her alone!”

……..

Click below link to read the rest

http://peacefulbeginningsrosemary.wordpress.com/circ-information/land-of-yu-phonia/

Your son is fine….. But these boys weren’t

http://ripe-tomato.org/2013/02/16/cock-ups-happen/

Complications during male circumcision are rare, being estimated to occur in 1 of every 500 procedures. These complications, which can be severe, include poor cosmetic outcome, bleeding, infection, injury to the penis and the removal of too much or too little skin.

Using “rare” for a 1 in 500 risk, when earlier the benefit of “avoiding the need for circumcision later in life” (about 1 in 2,000) is mentioned without qualification, is biased. The figure also applies to the best series. Less well organised services report rates up to 20%, e.g. Nigeria, click here. Since the manual is for use in developing countries the possibility of higher complication rates should be mentioned. Finally, Complications, which can be severe, include poor cosmetic outcome… is clearly designed to play down severity.

But more importantly, catastrophic complications are omitted altogether. Fully informed consent means telling people everything, however rare, which might alter the decision of a reasonable patient/parent. In gynaecology we mention the 1 in 10,000 risk of temporary colostomy after laparoscopic surgery for example. Unless we have a double standard for Africa, the complications below, which all appear elsewhere in the guide, should be mentioned. Italic text and pictures are all taken from the guide.

None of these complications are common, but they all occur. If infant circumcision programmes get rolled out widely in developing countries, it is inconceivable that everyone will read all 140 pages of the WHO manual In the real world sterilisation goes wrong, mismatched Yellen clamps get packed together, and diathermy and wrong sized Plastibells get used. Even if they don’t, infants wriggle. Parents should be told.

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pics in link at top

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Different article

http://helpingmenblog.blogspot.co.uk/2013/03/majority-of-britons-support-ban-on-male.html?m=1

in Britain (UK)

Complications are common, two boys a week are admitted to the Emergency Department in Birmingham Children’s Hospital and one boy a month comes close to death as a result of male circumcision.

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Another baby hemorrhaging… Lucky to be alive and yet supposedly the risks are worth it? How is almost dying worth it? How is almost dying because of a medically unnecessary surgery being performed on a healthy infant worth it?

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A few of the many reasons I do not believe in circumcising children: Circumcision complications

Circumcision complications.
Just a few excerpts if MANY from a board that I am on.

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These are only a few…. I retrieved more but haven’t edited out the screen names yet….
These mothers love their sons. Of this there is NO doubt…. There is also no doubt that their sons have gone through needless pain or trauma or problems because of a needless, potentially harmful socially supported surgery.

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The the board where these were originally listed there are 18 pages worth of complications. Figure about 9 questions/complications per page =162 complaints minus around 30 for repeat postings that’s still over 100 complaints just on this board/forum.
These complaints range from simple adhesions, to bleeding and hemorrhage, to probable loss of penile function or at least severe penile problems upon maturation.

This is what we Americans are doing to our boys! We love our children. These mother’s love their children. They didn’t know about the possibility of these complications because they were not informed.
Prior to the circumcision surgery a parent must sign a consent form saying they were INFORMED! The consent form says what the possible complications are…. I guess they just didn’t read it or the dr didn’t explain it or the consent form minimized the risks…. (Probably all 3)

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http://www.palmbeachobgyn.com/Circumcision%20consent%20form.doc

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A medical circumcision textbook
Scroll through: you will see the normal processes of the circumcision surgery
And continue scrolling and it will list and show pictures of the possible complications for each circumcision surgical tools.
http://whqlibdoc.who.int/publications/2010/9789241500753_eng.pdf

Here is a graph from the text

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A scholarly article of infant circumcision and informed consent
http://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=1166&context=facpubs

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http://www.virginia.edu/uvaprint/HSC/pdf/040162.pdf

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The disillusionment…….

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Circumcision- practice and complications

Circumcision videos if you can’t watch them don’t subject your sons to them. If you can etch them and still have it done then I feel sorry for you and sympathy for your poor sons.

I know you love your sons. There is no reason for circumcising children. Let the adult choose circumcision if it is for cultural, religious or medical reasons.

Plastibell circumcision video

http://youtu.be/5MLtxCwdMv0

Listen with volume. The dr calmly explains the procedure while the baby screams in agony and in neglect.


Another plastibell circumcision. However, this dr was very liberal with the emla cream and used it pre-surgery and during the surgery in addition to numbing shots.

http://www.youtube.com/watch?v=ra5t0OsmWf0&sns=em

Just because this baby wasn’t screaming doesn’t mean it wasn’t in pain later and doesn’t mean he may not have complications later. Also emla cream is not recommended for infants or genital tissue.

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Holy fhtbhthh
You can’t hear anything but you can see the baby struggling. This circumcision was done with an electrocautery device. (Foreskin cut off using a burning device)

electrocautery /elec·tro·cau·tery/ (-kaw´ter-e) an apparatus for surgical dissection and hemostasis, using heat generated by a high-voltage, high-frequency alternating current passed through an electrode.

I’m traumatized just watching this. Poor baby.

http://www.youtube.com/watch?v=HMZeVULHKug&sns=em

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Gomco clamp

http://www.youtube.com/watch?v=fb39r6CvhqU&sns=em

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Mogen

http://youtu.be/KybDD3nepxA
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Female circumcision
http://youtu.be/yQHNoxZnraM

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Circumcision complications
http://newborns.stanford.edu/CircComplications.html#infection

http://www.cirp.org/library/complications/

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Below: yes, this is an extreme complication. Yes, thus can be construed as a scare tactic. However, if this was your child wouldn’t you wish some one had scared you into sparing your child this hideous catastrophe

http://www.acwf.net/male-circumcision-procedure/

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Maggots in circumcision wound
http://www.hindawi.com/crim/surgery/2012/483431/

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http://www.urology-textbook.com/circumcision.html

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Complications from infant circumcision on the now mature man
http://www.circumstitions.com/Botched1.html

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History if circumcision for the non-Jewish, non-Muslim peoples of the USA.
http://www.historyofcircumcision.net/index.php?option=com_content&task=category&sectionid=8&id=73

Surprise! American Christians didn’t circumcise!

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Adding this April 14, 2013

Another baby hemorrhaging… Lucky to be alive and yet supposedly the risks are worth it? How is almost dying worth it? How is almost dying because of a medically unnecessary surgery being performed on a healthy infant worth it?

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Circumcision- time to cut it out

http://newhumanist.org.uk/2856/circumcision-time-to-cut-it-out

These tragic examples are more than unfortunate, isolated episodes. For every extreme case that gets reported in the media and debated in the courts, hundreds of nasty little incidents sink without a trace. For certain hospitals in Britain, the practice of patching up circumcision botch jobs is said to be appallingly routine. Largely, these interventions go unrecorded. The infant is simply stitched up and sent home. The perpetrator is not reported. Censure is not issued. Cultural sensitivity trumps child protection. One wonders if, say, the parents of a newborn suffering from skin lesions following a clumsily administered home tattoo would get off the hook so lightly.

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ncbi.nlm.nih.gov: Routine circumcision: the opposing view

The link below is from a site i usually post as non-biased but leaning towards pro-circ. I only put the conclusions but the circumcision complication rates were interesting to note. Click the link below to read the full article.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2422979/

Routine circumcision: the opposing view

Andrew E MacNeily, MD, FRCSC, FAAP

….

Conclusion
Newborn circumcision remains an area of controversy. Social, cultural, aesthetic and religious pressures form the most common reasons for non-therapeutic circumcision. Although penile cancer and UTIs are reduced compared with uncircumcised males, the incidence of such illness is so low that circumcision cannot be justified as prophylaxis. The role of the foreskin in HIV transmission in developed countries is unclear, and safe sexual practice remains the cornerstone of prevention. There remains a lack of knowledge regarding what constitutes the normal foreskin both among parents and among primary care providers. This lack of knowledge results in a burden of costs to our health care system in the form of unnecessary urological referrals, expansion of wait times and circumcisions. Routine circumcision of all infants is not justified from a health or cost-benefit perspective.
Go to:
Footnotes

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below is a link to pictures of a circumcision…. Look at it and realize this torture is happening to a child
http://assets4.pinimg.com/upload/295971006731352403_q5BmioSt.jpg

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Mogen clamp

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Adding 4/14/2013

Another baby hemorrhaging… Lucky to be alive and yet supposedly the risks are worth it? How is almost dying worth it? How is almost dying because of a medically unnecessary surgery being performed on a healthy infant worth it?

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Moralogous: Why not circumcise

A really good blog
http://www.moralogous.com/why-not-circumcise/

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What would newborns say

http://m.theepochtimes.com/n2/health/male-circumcision-what-would-newborns-say-299128.html

Pics from south Florida intactivist unite on Facebook
James Loewen 2012- outside the AAP conference in New Orleans

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below is a link to pictures of a circumcision…. Look at it and realize this torture is happening to a child
http://assets4.pinimg.com/upload/295971006731352403_q5BmioSt.jpg

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Another baby hemorrhaging… Lucky to be alive and yet supposedly the risks are worth it? How is almost dying worth it? How is almost dying because of a medically unnecessary surgery being performed on a healthy infant worth it?

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First do no harm: Huffington post

Ahhhh, I just posted this on my Facebook. Almost everyone I know on fb cuts or is cut. I’m sure to get a backlash from this….. Ekkkk

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http://www.huffingtonpost.com/mobileweb/georganne-chapin/circumcision-task-force-report_b_1919711.html

By georganne chapin

Not only does the Task Force report blatantly ignore the ethical obligation of physicians to respect their patients’ autonomy and do no harm, it repeatedly calls for doctors to be paid by private insurance or Medicaid for removing healthy, functioning tissue from an infant baby boy who cannot consent to this permanent alteration to his body.
Specifically, the report says:
“Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns.”
The Task Force says that it’s the parents’ responsibility to decide whether their particular newborn might benefit from being circumcised, though no guidance is given on how parents should make this decision.

Nonetheless, for 2012 alone, the toll of American baby boys tied down and surgically altered will number 1 million (no baby “consents” to circumcision, as a fleeting glance at an infant circumcision on video or in the flesh will make clear). This is a human rights violation on a massive scale.
In justifying the perpetuation of infant circumcision, the AAP Task Force cites studies conducted among sexually-active adults in parts of sub-Saharan Africa with very high HIV prevalence. These studies looked at the role circumcision might play in retarding transmission of the HIV virus. They claim to have found a reduction in transmission from females to males, though not from men to women. Circumcision has not been conclusively found to reduce transmission of HIV in men who have sex with men, which together with intravenous needle-sharing, account for most cases of HIV in the United States.
Whether or not circumcision actually plays a role in reducing HIV transmission among some adults in sub-Saharan Africa has no relevance to baby boys in the United States. Babies are not sexually active and are therefore at no risk of sexually-transmitted HIV or any other venereal disease. In my opinion, these African studies are being used as after-the-fact justification for a custom that is increasingly being rejected by those who see it as violating children’s rights to bodily autonomy and their own future freedom of religion.

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Pubmed circumcision complications, severe complications and more

as you may have noticed I do a lot of cut and paste from other sources. Maybe I’m not original or maybe I’m lazy, but I figure if someone can get the point across better and more articulately than me, I might as well let them say it. I do a lot of copy/paste so that I can tag and label it so that maybe just maybe it will pop up easier in the Internet search engines…. And in case you were wondering I am totally against circumcising babies and children without immediate medical need. I have no problem with an adult choosing genital modification surgeries

http://www.ncbi.nlm.nih.gov/m/pubmed/11150473/

CONCLUSIONS: Genitourinary trauma in the newborn is rare but often necessitates significant surgical intervention. Circumcision often is the causative event. There has been only 1 prior report of a perineal injury similar to case 7, with a fatal outcome.

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Infant pain measured during circumcision

http://lib.bioinfo.pl/paper:9925869

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Some statistics of complications for on study group…
http://www.biomedcentral.com/1471-2490/6/21/

Results
Our circumcision rate was 87%. Neonatal circumcision had been performed in 270 (83.9%) of the children. Two hundred and fifty nine (80.7%) were performed in hospitals. The operation was done by nurses in 180 (55.9%), doctors in 113 (35.1%) and by the traditional circumcisionist in 29 (9%) of the children. Complications of circumcision occurred in 65 [20.2%] of the children. Of those who sustained these complications, 35 (53.8%) had redundant foreskin, 16 (24.6%) sustained excessive loss of foreskin, 11 (16.9%) had skin bridges, 2 (3.1%) sustained amputation of the glans penis and 1 (1.5%) had a buried penis. One of the two children who had amputation of the glans also had severe hemorrhage and was transfused. Even though the complications tended to be more likely with nurses than with doctors or traditional circumcisionists, this did not reach statistical significance (p = 0.051).

Conclusion
We have a very high rate of complications of circumcision of 20.2%. We suggest that training workshops should be organized to adequately retrain all practitioners of circumcision on the safe methods available.

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The scientific world journal
http://www.tswj.com/2011/373829/

ABSTRACT

In the United States, circumcision is a commonly performed procedure. It is a relatively safe procedure with a low overall complication rate. Most complications are minor and can be managed easily. Though uncommon, complications of circumcision do represent a significant percentage of cases seen by pediatric urologists. Often they require surgical correction that results in a significant cost to the health care system. Severe complications are quite rare, but death has been reported as a result in some cases. A thorough and complete preoperative evaluation, focusing on bleeding history and birth history, is imperative. Proper selection of patients based on age and anatomic considerations as well as proper sterile surgical technique are critical to prevent future circumcision-related adverse events.

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The rate of adverse events varies widely across reports, depending on the definition chosen for a postoperative complication. In a large meta-analysis of prospective and retrospective series, Weiss et al. reported a frequency of adverse events of and for serious adverse events [14]. This can represent a significant cost in terms of utilization resources and healthcare dollars. During a five-year period at the Massachusetts General Hospital, 7.4% of all visits to a pediatric urologist were for circumcision complications. This translated to an average total cost per patient for redo procedures of $1,617 and an estimated annual cost of $137,122 to the institution [15].

For ease of discussion, adverse events following circumcision can be categorized as either early or late complications. Early complications such as: bleeding, pain, inadequate skin removal, and surgical site infection tend to be minor and quite treatable. However, postcircumcision bleeding in patients with coagulation disorders can be significant and sometimes even fatal. Other serious early complications include chordee, iatrogenic hypospadias, glanular necrosis, and glanular amputation. The latter, of course, requires prompt surgical intervention. Late complications include epidermal inclusion cysts, suture sinus tracts, chordee, inadequate skin removal resulting in redundant foreskin, penile adhesions, phimosis, buried penis, urethrocutaneous fistulae, meatitis, and meatal stenosis. These are commonly treated in an outpatient setting. Most of the aforementioned conditions are avoidable giving attention to detail and proper technique. Mayer et al. found that some subtle anatomic variations are significantly associated with late circumcision complications, including penoscrotal webbing, suprapubic fat pads, and prematurity [16].

4.1. Death

Fortunately, death from neonatal circumcision is fortunately an extremely rare occurrence. King reported a period when 500,000 consecutive circumcisions were performed in New York city without a single fatality [17]. However, a case of a misplaced Plastibell ring which caused complete meatal obstruction resulted in acute venous stasis and subsequent death from sepsis reported by the Ontario Pediatric Death Review Committee in 2007. In this situation, prompt recognition of the obstruction is critical and primary management should be immediate removal of the Plastibell ring and catheter placement [18]. There are other reports in the international literature that describe mortalities from tetanus as a result of circumcisions performed under nonsterile conditions. Bennett et al. reported that topical antibiotics could decrease this risk of neonatal tetanus 4-fold [19].

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Necrosis of the glans can occur as a result of cautery injury during a Gomco circumcision or from distal migration of an incorrectly sized Plastibell ring [9, 20]. Management of glans necrosis depends on its severity

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I know the examiner is a dubious source…..

http://www.examiner.com/article/circumcision-s-complications-what-could-go-wrong

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http://www.sch.edu.au/health/factsheets/joint/?circumj.htm

Some research in North America has shown that boys, who were circumcised as small babies, have less chance of developing urinary tract infections in the first year of life than those who are uncircumcised (there is no difference in older boys). However, the numbers of uncircumcised boys who will get urinary infections is small. If 1000 well boys are circumcised, 8 infections will be prevented, but 20 will have a complication related to the circumcision. So the risks of circumcision surgery outweigh the benefits. In those boys with an underlying urinary tract problem, circumcision has been shown to reduce the risk of recurrent urinary tract infections, particularly if still in nappies.

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Even with the most skilled and careful hands there are small incidence of risks from both the operation and the general anaesthesia. There is a risk of bleeding and infection following the operation. The risk of death or serious disability due to general anaesthesia is 1:80 000. Very rarely the penis may be permanently damaged. After circumcision, irritation of the exposed penis tip can cause narrowing of the urine opening (meatal stenosis) that may require further surgery. About 5% of children who have been circumcised require further surgery to correct problems it causes.

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http://www.jpurol.com/article/S1477-5131(06)00053-2/abstract
http://www.jpurol.com/article/S1477-5131(06)00053-2/abstract

The most commonly observed complication was preputio-glandular fusion, seen in 25 cases (52%). The other complications were: meatal stenosis in 11 (23%), urethral fistula in five (10.4%), partial glandular amputation in four (8%) and opening distal urethra in three (6%). Adhesion freeing and revision were performed in all cases of preputio-glandular fusion, patients with meatal stenosis underwent meatotomy, urethral fistulae were repaired by simple closure, partial glans amputations were patched with buccal mucosa, and patients with complete open distal urethra were repaired by Mathieu (one patient) and tubularized incised plate urethroplasty techniques.

Conclusion
Circumcision may be associated with many serious complications. To prevent these complications, the operation should be performed by educated and experienced personnel.

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http://www.aafp.org/online/en/home/clinical/clinicalrecs/children/circumcision.html

Obtaining informed consent for medical procedures is an important practice. In emergent cases when a parent or legal guardian is not available to give consent, a procedure will often be performed if it is judged to be life-sustaining and in the best interest of the patient. When a person having a procedure is unable to give consent and a guardian is present, the guardian’s consent is acceptable. This occurs for routine medical procedures of clear benefit to children such as immunizations. A physician performing a procedure for other than medical reasons on a nonconsenting patient raises ethical concerns.

While routine circumcision is widely practiced, the small medical benefits of circumcision lead many to consider routine circumcision to be a cosmetic procedure. This leads to questions regarding medical ethics and whether and how to present to a parent a balanced discussion of the relative benefits and harms of the procedure. Key to the ethical discussion is respect of the parent’s religious, ethnic, or other cultural beliefs for which circumcision is practiced.

ECONOMIC ANALYSIS
One cost-effectiveness analysis estimated that the lifetime cost difference for men who were circumcised was $25, with a benefit of 10 additional days of life. (30) Another analysis estimated that routine circumcision cost $102 per person, resulting in 14 hours of extended life. (31) These findings suggest that cost factors should be removed from the decision of circumcision. (4)

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http://www.springerlink.com/content/9w834626551u8087/

Results
A total of 8,967 children were operated during the study period, of which 424 (4.7%) were for complications resulting from previous neonatal circumcision. Penile adhesions, skin bridges, meatal stenosis, redundant foreskin (incomplete circumcision with uncircumcised appearance), recurrent phimosis, buried penis and penile rotation were the most frequent complications. At the outpatient clinic of the Section of Pediatric Urology, 127 boys with concerns following newborn circumcision were evaluated, representing 7.4% of the total volume of cases seen in this clinic.
Conclusions
Our results indicate the need to undertake a collaborative study to define the incidence of complications following newborn circumcisions, which should be performed by practitioners with adequate training in the technique of their choice and its post-operative care.

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http://www.avvo.com/legal-guides/ugc/botched-circumcision—what-to-do-when-your-sons-circumcision-goes-wrong

Medical malpractice attorney:

6
Why Was I Not Warned About the Risks?
It is an unfortunate fact that doctors often do not fully discuss the risks and disadvantages of circumcision with parents or their patients before obtaining consent for the operation. Too often circumcision is viewed as a minor surgery. [Of course, the definition of minor surgery is that which is done on another, while major surgery is that which is done on oneself!] The fact is that in most states the parents of a baby boy or the man about to undergo a circumcision are entitled to be fully informed about the risks and disadvantages. If such is not done, circumcision is performed, and a reasonable person would not have consented if told about the risks and disadvantages, then a suit may be brought for “lack of informed consent.”

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below is a link to pictures of a circumcision…. Look at it and realize this torture is happening to a child
http://assets4.pinimg.com/upload/295971006731352403_q5BmioSt.jpg

Copy: circumcision the painful dilemma

book: http://circumcisionthepainfuldilemma.wordpress.com/

Whatever the reasons, I have learned that the concept of circumcision has held a far greater “stranglehold” on the American public than I had ever realized. Medical arrogance, refusal to listen to lay people (no matter how thorough or valid our research may be), and media distortion of scare stories have left the general public confused over the matter. Some people, desperate to find any kind of rationalization for circumcision as the old medical myths have been debunked, have grabbed at whatever possibility of new “reasons” crop up to put in their place. But the biggest heartbreak is that I have had a few people who were otherwise close to me who have been given (and in some instances requested) my information, and then, upon giving birth to boys have chosen to circumcise anyway. I have, of course grieved for the babies involved and for the parents’ seeming lack of compassion for their children. But these instances have also felt like a personal slap in the face to all of my intensive research and energies.

——-

However, despite Ryan’s heartrending experience, I did not start my research being anti-circumcision. I was even undecided over whether or not I would choose circumcision again should I ever have another son. I fully intended to write a book that was NEUTRAL on the subject. I had planned that this book would present the pros and cons of both choices, guiding parents to either direction as best suits their lifestyles.

—-

Three significant concerns surround the issue of infant circumcision:

First, the operation is painful to the newborn infant. Feelings of tenderness and protection surround most of our attitudes about tiny babies. Why then have we considered it okay to strap the baby down and proceed to pinch and smash his foreskin, tear it away from his glans, and then clamp and cut it off? Usually this is done without anesthesia. Circumcision was often deliberately intended to be a means of torture of slaves and in primitive initiation rites. Today, if an older child or adult is to undergo circumcision, anesthesia is used. Why do we believe that infants either feel no pain or that their feelings are unimportant?

Secondly, is the foreskin a useless piece of tissue-an “anomaly” in need of surgical correction? Is the human male body made wrong the way it normally comes into the world? Or does the foreskin serve a purpose? Can we improve on the body by cutting part of it off?

Thirdly, do we have the right, in the absence of true medical need, to alter another person’s body without his permission? Does a person have the right to keep all parts of his body? Isn’t each person’s foreskin rightfully his? If so, aren’t parents who consent to circumcision and doctors who perform the operation taking something away from that child?

——
below is a link to pictures of a circumcision…. Look at it and realize this torture is happening to a child
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TWN: dangers of plastibell circumcision

http://www.thewholenetwork.org/14/post/2012/08/the-dangers-of-plastibell-circumcisions-graphic.html

***WARNING: this article contains very graphic material that is not intended to be viewed by children. Some adults may be offended by it, as well. Viewer discretion is advised.***

please go to the link. Pictures of plastibell complications are in the link provided above

All circumcisions involve cutting, tearing and blood (even Plastibell methods). From birth, the foreskin is fused to the head of the penis (like a fingernail is fused to a finger). Before any circumcision begins, the foreskin must be ripped away from the glans. With a Plastibell circumcision, typically the foreskin is slit down the top to allow the insertion of the Plastibell. When in place, a string is tightly tied to necrotize the foreskin. After everything is secured, the excess skin is removed with scalpel or scissors.
………look at the pictures here
As you can see, the Plastibell procedure is not painless. It’s not safer than other circumcision methods. It’s not without its own unique set of risks and complications. All methods of circumcision have risks. All methods of circumcision remove a normal, healthy part of the male genitalia. ,

this video is of a plastibell circumcision. it is surprisingly bloodless, abnormally so, (wondering if this is a live baby or a corpse for medical study)-http://www.youtube.com/watch?v=_vo_eIGHr-I&feature=youtube_gdata_player

For a video of a live child click the link below:

http://www.thewholenetwork.org/14/post/2012/08/the-dangers-of-plastibell-circumcisions-graphic.html

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Copy/paste: Gloria Lemay: Pediatric Response by Petrina Fadel

this is a copy/paste. Even though I pasted the entire article please click on the link provided to leave feedback with the original poster. Show support for this well thought out arguement

http://www.glorialemay.com/blog/?p=780

Part 1 : Dear AAP Board Members and AAP Task Force on Circumcision:

I am writing to you to request that you withdraw or rescind the newest
2012 AAP Circumcision Policy Statement. Below I have critiqued for you some of the serious problems with this new statement.

The Abstract states on page 585 that “health benefits are not great enough to recommend routine circumcision for all male newborns”, but this is not repeated even once in the long text on pages 758-785.
Other long columns favoring circumcision are repeated over and over again, on pages 761-762, 770, 775-776, and 778. The 1999 AAP Statement was 8 pages long (pages 686-693), but this diatribe against living with a foreskin goes on for 28 pages. There is almost the feeling that AAP physicians hope that if they repeat something over and over again, eventually it might become true.

The AAP concludes on page 778 that “the health benefits of newborn male circumcision outweigh the risks”, and yet on page 772 the AAP admits that “the true incidence of complications after newborn circumcision is unknown”. If one doesn’t know how often complications occur, then one can’t make the judgment that the benefits outweigh the risks! The AAP lacks the evidence it needs to make such a claim.

The 1999 Statement studied 40 years’ worth of research, and the 2012 studied only selective research since 1999. Only 1031 of 1388 studies were accepted to look at. Balance might have been found in the 357 studies that were omitted, but the AAP was not seeking balance. The AAP statement goes on ad nauseum about alleged “benefits”, to the point of fear-mongering that something will go wrong if an infant isn’t circumcised. It’s a high pressure sales pitch to try to get the American public to buy the circumcisions that AAP and ACOG doctors are selling. This is in direct contrast to Europe, where circumcision is uncommon and the health of European children equals or surpasses that of American children.

No studies on ethics were included in this statement, and it is clear that the rights of the child and how a grown man might feel about HIS foreskin being stripped from him were never given any consideration at all by the AAP. These are major issues, and even more important than many of the other minor issues the AAP discusses. Material was provided to the AAP to study this aspect of circumcision, but it was ignored. With one bioethicist on the panel, you would have thought that the AAP might at least have given the ethics of circumcision a cursory examination, considering that they were provided with many sources showing the emotional distress many men feel. Ethics and mental health, however, nowhere enter the picture for the AAP. Respect for the bodily integrity of another person were not included, and medical ethics were thrown out the window as infants were thrown under the bus.

Financing studies weren’t included in the studies, but the AAP did its best to push financing repeatedly for third-party reimbursement of non-therapeutic circumcision, at the expense of taxpayers during a time of budget crises. Those with private insurance would see premiums and medical costs rise. The cost for circumcision on page 777 ranges from
$216 to $601 per circumcision in the U.S. In 2010, the in-hospital U.S. circumcision rate was 54.7%. Thus, 45.3% of newborn males left
the hospital genitally intact. If the AAP were to convince parents of
these 45.3% to circumcise (as they are attempting to do in this 2012 statement), then there would be 45.3% of roughly 2.1 million baby boys that could be an additional income source for physicians. (Remember, don’t consider the ethics!) This would be an additional 951,300 male infants to profit from. At prices the AAP quotes, this could mean an additional $205,480,800 to $571,731,300 for doctors who circumcise.
This is no small sum, and as Thomas Wiswell, M.D. stated on June 22,
1987 in the Boston Globe, “I have some good friends who are obstetricians outside the military, and they look at a foreskin and almost see a $125 price tag on it. Each one is that much money. Heck, if you do 10 a week, that’s over $1,000 a week, and they don’t take
that much time. “(Lehman 1987) Money like that would certainly help
doctors make their mortgage payments and their car payments, pay for vacations, etc. – a “benefit” that the AAP failed to mention. Under Literature Search Overview, it is understandable why AAP physicians might consider it important to investigate “What are the trends in financing and payment for elective circumcision?”

No studies on the anatomy and functions of the foreskin were included.
This is surprising, since it would seem like common sense to consider what the functions of any healthy body part are before amputating it.
Probably since the male AAP Task Force members are all circumcised, this idea was difficult for them to grasp. Only one study on the sexual impact of circumcision was included, and this from Africa.
Other studies were ignored or discounted. “The effect of male circumcision on the sexual enjoyment of the female partner”, which appeared in BJU INTERNATIONAL, Volume 83, Supplement 1, Pages 79-84, January 1, 1999, is not mentioned. Nor is the newest Danish study that was publicized on November 14, 2011 – “Male circumcision leads to a bad sex life” – “Circumcised men have more difficulties reaching orgasm, and their female partners experience more vaginal pains and an inferior sex life, a new study shows.” See:
http://sciencenordic.com/male-circumcision-leads-bad-sex-life The AAP had time to include this study, but it was ignored. Others sent material to the AAP about CIRCUMserum, Senslip, foreskin restoration that men are undergoing to undo some of the damages of circumcision and how this improves the sexual experience for both men and women. It didn’t fit the AAP’s pro-circumcision agenda, so it was ignored. The Policy Statement is totally lacking in ethics, anatomy, and foreskin functions. Instead, the Task Force is more concerned with how to train more doctors to circumcise, and how to do so with different devices and various forms of anesthesia.

The physical and sexual harms from circumcision are minimized or dismissed outright. Deaths from circumcision and botched circumcisions are considered “case studies”, and the children horribly damaged from circumcision don’t merit the AAP’s consideration, even though the AAP’s alleged mission is that it is “Dedicated to the Health of All Children”. When cribs are faulty or car seats aren’t safe, the AAP becomes concerned and warns the public. When physicians botch circumcisions and are at fault, children don’t matter. After one botched circumcision lawsuit and a large settlement, the company that manufactured the Mogen clamp went out of business. The AAP report should have advised physicians to NOT use the Mogen clamp because of the botched circumcisions that have resulted with this device. If still in use, no doubt there will be future tragedies with the Mogen clamp, but parents will only be able to sue the doctor and hospital and not the manufacturer.

There was so much reliance on studies from Africa in this statement, that it seemed like the AAP should change its name to the African Academy of Pediatrics. In contrast to the AAP, the American Association of Family Physicians (AAFP) has stated: “…the association between having a sexually transmitted disease (STD) – excluding human immunodeficiency virus (HIV) and being circumcised are inconclusive…
most of the studies [of the effect of circumcision on HIV] …have been conducted in developing countries, particularly those in Africa.
Because of the challenges with maintaining good hygiene and access to condoms, these results are probably not generalizable to the U.S.
population”. But generalize the AAP did! In addition, the AAP listed page after page of STDs that allegedly circumcision would prevent, and wrote conflicting statements about syphilis. A recent study in Puerto Rico found that circumcised men have HIGHER rates of STDs and HIV. The 60% reduced risk of HIV following circumcision is the relative risk reduction, not the absolute risk reduction. There’s a huge difference.
Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive”, so the absolute decrease in HIV infection was only 1.31%, which is not statistically significant.”
(Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J Law Med 2011; 19:316-34.)

Infants are not at risk of STDs or HIV through sexual contact, so this speculation about their future risk is foolhardy. Infants can also be at risk for many other diseases, but surgical amputation of healthy body parts is a foolhardy approach for prevention and treatment of disease. If an infant is at risk of an STD, then it is probably safe to say that an adult is perpetrating a crime against the child and needs to be arrested and charged.

Judaism and Islam are mentioned as religions that practice religious circumcisions. Once again, the statement ignores Christianity, which teaches that circumcision is unnecessary. Christianity is the largest religion in the U.S., but its teachings don’t even get a mention by the AAP, which is rather insulting! With an over-representation of members on the Task Force who have a religious bias favoring circumcision, this is not surprising.

The AAP promotes parents choosing medically unnecessary circumcision for their male children, completely contradicting what it said in PEDIATRICS, Volume 95 Number 2, Pages 314-317, February 1995. It said then, “Thus “proxy consent” poses serious problems for pediatric health care providers. Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. . . the pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent.”

Parents deserve factual information about circumcision, but they won’t find it in the new AAP Statement. In fact, the AAP wrongly advises parents of intact baby boys to retract the foreskin and wash it with soap and water. (page 763) Soap can alter the good bacteria under the foreskin, potentially causing infections that should then be treated with liquid acidophilus to restore the good bacteria. Water is sufficient for cleansing. Circumcised doctors with circumcised sons probably don’t know this.

On page 764, the AAP speculates that the foreskin contains a high density of Langerhans cells, “which facilitates HIV infection of host cells.” Actually, the exact opposite is true. “Langerin is a natural barrier to HIV-1 transmission by Langerhans cells” (Nature Medicine- 4 March 2007). This study states, “Langerhans cells (LCs) specifically express Langerin . . . LCs reside in the epidermis of the skin and in most mucosal epithelia, such as the ectocervix, vagina and foreskin.”

UTIs can be prevented through breastfeeding, which the AAP allegedly supports. This is nowhere mentioned under “Male Circumcision and UTIs”
on page 767. HPV can be prevented with a vaccine for both boys and girls, but it is not mentioned on that same page. A recent study reporting on the large number of re-circumcisions done following infant
circumcisions is also not even mentioned. On page 770, EMLA is
mentioned as a possible anesthetic, but EMLA is not supposed to be used on infants. The fact remains that unnecessary surgery performed with anesthesia is still unnecessary surgery.

There is so much wrong with this new statement that it should immediately be withdrawn before it is presented on Monday. The AAP should either start all over again (with new, unbiased Task Force members), or renew its 1999 statement which attempted to at least give a more balanced view of circumcision. The 1999 circumcision statement certainly had its flaws by ignoring ethics and the anatomy and functions of the foreskin, but it wasn’t as atrocious as this new statement is.

If the AAP wants to be regarded as a credible organization, it will look to the judgment of other foreign medical associations who recognize that circumcision is medically unnecessary and has serious ethical problems underlying its practice. American parents should look to these foreign medical associations for good advice, since the AAP is not providing it in its new statement.

Sincerely,
Petrina Fadel, Director
Catholics Against Circumcision

Part 2 : Sent to the AAP Board of Directors and the AAP Task Force Members on Aug 24, 2012 :

After rereading the AAP’s new Circumcision Statement, several more problems have emerged with this statement. This statement needs to be rescinded and withdrawn immediately! Others are becoming aware of this matter as well.

Under “Ethical Issues” (pages 758-759), two of the references for this opinion come from Dr. Douglas Diekema (AAP’s bioethicist), who signed his name to this statement. The rights of the child are totally ignored in this section, from an organization that claims to be concerned with the welfare of children but in this case isn’t. This is Diekema’s own personal opinion that the Task Force has bought into, based on what he wrote before. References are also taken from M.
Benatar and D. Benatar (both Jewish circumcision supporters), as well as from AR Fleishman (whom I suspect has a religious bias favoring circumcision). Under “Ethical Issues” (page 759), there’s an interesting choice of words by the AAP. “In cases, such as the decision to perform a circumcision in the newborn period, … and where the procedure is not essential to the child’s immediate well-being …” , the AAP admits here that circumcision “is not essential”. It even calls circumcision “elective” in several other places, but it then proceeds to do a massive sales pitch for this unnecessary surgery.

Under Ethics, Reference #14 comes from the British Medical Association- “The law and ethics of male circumcision: guidance for doctors: J. Med Ethics 2004. The BMA did not print a favorable piece on circumcision, but the AAP cherry-picked something from it on page 760. Medical associations in other countries, like the British Medical Association, do not promote circumcision as the AAP has so foolishly chosen to do.

On page 760, the AAP states, “The Task Force’s evidence review was supplemented by an independent, AAP-contracted physician and doctoral-level epidemiologist who was also part of the entire evidence review process.” Who was this? The AAP should reveal the name of this physician.

Several times in the report, the AAP states (page 762), “For parents to receive nonbiased information about male circumcision in time to inform their decisions…clinicians need to provide this information at least before conception, and/or early in the pregnancy, probably as a
curriculum item in childbirth classes.” There is absolutely no way
doctors can do this before conception, and “Inform their decisions” is code for brainwashing parents as early as possible. This is mind control at its worst, supported by the AAP!

The AAP on page 763 uses the term “Uncircumcised” under “Care of the Circumcised Versus Uncircumcised Penis”, and later the term “non-circumcised” when saying, “The non-circumcised penis should be washed with soap and water.” The correct terminology is intact penis, or normal or natural penis. We don’t say “uncircumcised” female or “non-circumcised” female.

The APP on page 764 states, “Mathematical modeling by the CDC shows that, taking an average efficacy of 60% from the African trials, [Note:
This is the relative risk, not absolute risk, which is 1.31%.) and assuming that protective effect of circumcision applies only to heterosexually acquired HIV” …” The AAP states here that they are assuming, which means to “suppose to be the case, without proof.”
There’s a saying that if you “assume” anything, it makes an ass out of u and me. Assumptions are not evidence, and since when should the AAP be relying upon or making assumptions? “Sexual Satisfaction and Sensitivity” (page 769) never once mentions or considers how circumcision impacts the sexual experience for females. The AAP gets it totally wrong about males, while then totally ignoring females! A Danish study by Morten Frisch (whom the AAP uses as a reference in
#118) revealed late last year that circumcised men have more difficulties reaching orgasm, and their female partners experience more vaginal pains and an inferior sex life.

“Analgesia and Anesthesia for a Circumcision After the Newborn Period”
(page 771) states, “Additional concerns associated with surgical circumcision in older infants include time lost by parents and patients from work and/or school.” The AAP is promoting newborn circumcision so parents don’t have to miss work? Parents miss work all the time when their kids get sick as toddlers or later on as young children. Now, all of a sudden, the AAP is concerned about parents missing work, but not concerned about the rights of the child.

Under “Complications and Adverse Events” (page 772), the AAP twice mentions how circumcision risks are lower in hospitals with trained personnel than those performed by untrained practitioners in developing countries. U.S. parents don’t live in a developing country, and this doesn’t even belong in an AAP statement!

“The true incidence of complications after newborn circumcision is unknown …” (page 772) “Two large US hospital-based studies with good evidence estimate the risk of significant acute circumcision complications … ” “(T)here are no adequate studies of late complications in boys undergoing circumcision in the post-newborn
period; this area requires more study.” (page 773) “There are not
adequate analytic studies of late complications in boys undergoing circumcision in the post-newborn period.” (page 774) Under “Stratification of Risks” the AAP says, “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.” After admitting that the true incidence of complications is unknown (i.e. the risks), the AAP then has the audacity to state that “the health benefits of newborn male circumcision outweigh the risks”. (page 756). Under “Task Force Recommendations” (page 775), the AAP says, “Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks …” The AAP doesn’t know the incidence of risks, so how do they expect physicians to know that?

The AAP sings its own praises under “Medical Versus Traditional Providers”. “Physicians in a hospital setting generally have fewer complications than traditional providers in the community setting.”
Was this the AAP saying that doctors are safer than mohels? I don’t think they’ll like that!

In 2009, ten years after the AAP did not recommend circumcision (and still doesn’t apparently, doesn’t on its words on page 585, but which one would never know after wading through this rubbish), their own survey of AAP members found that “18% responded recommending to all or most of their patients’ parents that circumcision be performed.” (page
776) I don’t find that surprising that AAP doctors would recommend a surgery that means more money for them. On pages 777-778 the AAP wants to know about the effectiveness of their new 2012 statement to mislead parents. “The Task Force recommends additional studies to better understand … The impact of the AAP Male Circumcision policy on newborn male circumcision practices in the United States and elsewhere.” In other words, how effective are we in deceiving American parents and people in other countries?

The AAP wants to work with the ACOG, AAFP, American Society of Anesthesiologists, and American College of Nurse Midwives to develop a plan about which groups are best suited to perform newborn male circumcisions. (page 777) In other words, how is the AAP going to divvy up the money it so eagerly wants?

The AAP targets blacks and Hispanics in the U.S. for unnecessary circumcisions. “African-American and Hispanic males in the United States are disproportionately affected by HIV and other STIs, and thus would derive the greatest benefit from circumcision.” (page 777) But then, under Areas for Future Research, the AAP says, “The Task Force recommends additional studies to better understand … The impact of male circumcision on transmission of HIV and other STDS in the United States because key studies to date have been performed in African populations with HIV burdens that are epidemiologically different from HIV in the United States.” The AAP just spent several pages before this promoting newborn circumcision to allegedly prevent STDs and HIV based on African studies, but now it’s admitting that more studies are needed because the results could be different in the U.S. Was this put in to help with the solicitation for more funding for pro-circumcision researchers at Johns Hopkins and elsewhere, to keep them going? Maybe these researchers are tired of Africa and want to come home?

The AAP did actually say ONE good thing, but only ONE good thing in this whole statement. On page 760 the AAP says, “The Task Force advises against the practice of mouth-to-penis contact during circumcision, which is part of some religious practices, because it poses serious infectious risk to the child.” If I were to guess, I’d say that perhaps Dr. Susan Blank put that in. While working for the New York City Health Department, Dr. Blank has done nothing to ban metzitah b’peh, so as not to offend the Orthodox Jews who practice it.
Babies have died of herpes from metzitzah b’peh under her watch.

This atrocious AAP Statement needs to be rescinded immediately. I suggest that the AAP use good judgment and do precisely that.

Sincerely,
Petrina Fadel, Director
Catholics Against Circumcision

Circumcision complications

The site below is not an anti-circ site. Circumcision is not a surgery without complications…. Serious complications may be rare but if it is your child suffering it is a decision you can never take back.
Infants do not need circumcision! In almost all cases there is no medical need. In the case of medical need, doctors usually wait until the baby/child is older so that the “work area” is bigger and more developed.
Circumcision complications can kill or cause life long pain and problems.

Click the link to see the pictures of the complications.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253617/

The rate of adverse events varies widely across reports, depending on the definition chosen for a postoperative complication. In a large meta-analysis of prospective and retrospective series, Weiss et al. reported a frequency of adverse events of and for serious adverse events [14]. This can represent a significant cost in terms of utilization resources and healthcare dollars. During a five-year period at the Massachusetts General Hospital, 7.4% of all visits to a pediatric urologist were for circumcision complications. This translated to an average total cost per patient for redo procedures of $1,617 and an estimated annual cost of $137,122 to the institution [15].
For ease of discussion, adverse events following circumcision can be categorized as either early or late complications. Early complications such as: bleeding, pain, inadequate skin removal, and surgical site infection tend to be minor and quite treatable. However, postcircumcision bleeding in patients with coagulation disorders can be significant and sometimes even fatal. Other serious early complications include chordee, iatrogenic hypospadias, glanular necrosis, and glanular amputation. The latter, of course, requires prompt surgical intervention. Late complications include epidermal inclusion cysts, suture sinus tracts, chordee, inadequate skin removal resulting in redundant foreskin, penile adhesions, phimosis, buried penis, urethrocutaneous fistulae, meatitis, and meatal stenosis. These are commonly treated in an outpatient setting. Most of the aforementioned conditions are avoidable giving attention to detail and proper technique. Mayer et al. found that some subtle anatomic variations are significantly associated with late circumcision complications, including penoscrotal webbing, suprapubic fat pads, and prematurity [16].
4.1. Death
Fortunately, death from neonatal circumcision is fortunately an extremely rare occurrence. King reported a period when 500,000 consecutive circumcisions were performed in New York city without a single fatality [17]. However, a case of a misplaced Plastibell ring which caused complete meatal obstruction resulted in acute venous stasis and subsequent death from sepsis reported by the Ontario Pediatric Death Review Committee in 2007. In this situation, prompt recognition of the obstruction is critical and primary management should be immediate removal of the Plastibell ring and catheter placement [18]. There are other reports in the international literature that describe mortalities from tetanus as a result of circumcisions performed under nonsterile conditions. Bennett et al. reported that topical antibiotics could decrease this risk of neonatal tetanus 4-fold [19].
4.2. Bleeding
Bleeding is the most common complication of circumcision, with an incidence of 1% in a large retrospective review [20]. Bleeding may occur along the skin edges between sutures or from a discrete blood vessel, most commonly at the frenulum. Meticulous attention to hemostasis during an open procedure and adequate time for skin edge compression during newborn circumcisions should prevent the majority of cases although dislodging of a clot or cautery eschar can occur. The majority of postcircumcision bleeding can be controlled with application of direct pressure or careful application of silver nitrate. Rarely is wound exploration and suturing necessary. A hematologic workup is warranted only in patients who persistently bleed, or bleed significantly. In a retrospective review of the Mayo Clinic Pediatric Hemophilia database, 48 patients with a range of coagulopathies were circumcised. 21 patients had known coagulation disorders, while the remaining 27 patients were diagnosed after prolonged bleeding from their circumcision. There were 11 bleeding complications, three of which were severe and required transfusion of RBC’s for severe anemia despite preoperative factor replacement [21]. In those patients with hemophilia who must undergo circumcision, preoperative and perioperative factor replacement is a definite requirement. Fibrin glue has also been shown to decrease the amount of recombinant factor replacement needed (and the cost of treatment, as well) without significantly altering bleeding complications [22].
4.3. Infection
Due to the superb dual blood supply of the penis, wound infection occurs infrequently. In a series of 5,521 circumcisions comparing the Plastibell technique to the Gomco clamp, Gee and Ansell reported only 23 (0.4%) infections. Of those, the Plastibell group had significantly more infections, 19 versus four (P <; 0.005) [20]. All responded to a combination of topical treatment and oral antibiotic therapy. Causative organisms are usually skin flora, but due to the uniquely dirty environment of the diaper, colonic flora has also been reported. Most infections can be prevented with proper patient preparation, glove wearing and good local wound care including cleaning the penis, and application of antibiotic ointment with diaper changes [2].
Severe infections following Plastibell circumcision, including necrotizing fasciitis, have been reported as well. Several authors describe presenting signs and symptoms as erythema, induration, pain out of proportion to physical findings, coupled with tachycardia, leucocytosis, or bandemia. As in adults, this is usually a polymicrobial infection. Empiric broad spectrum antibiotics to cover Gram-negative, Gram-positive, and anaerobic organisms are essential. A suggested regimen is an aminoglycoside, nafcillin, or vancomycin and clindamycin. Prompt surgical evaluation and aggressive debridement of necrotic tissue is required [23].
4.4. Loss of Skin/Wound Dehiscence
Wound dehiscence and degloving injuries of the shaft are possible following using any of the techniques described above for neonatal circumcision. De-gloving injuries result from excess skin being drawn up into the clamp and then amputated. While, less likely, improper determination of the amount of skin to remove during free-hand circumcision may occur. Often these injuries are treated with local wound care and allowed to heal by secondary intention. There are reports of autografting the excised skin with good cosmetic result [24].
4.5. Trapped/Concealed Penis
Similarly, a concealed penis can result from overzealous removal of shaft skin coupled with a prominent suprapubic fat pad resulting in healing within the fat pad. Another consequence of this configuration is a secondary phimosis from the progressive closure of the skin over the glans penis. This can be avoided by firmly compressing the fat pad to the abdominal wall to best determine how much skin should be removed [16]. In addition, the suprapubic fat should be compressed regularly after the procedure to allow the penis to be protrude. Corrective surgery may be necessary if there is absence or significant laxity of the penoscrotal angle or penoscrotal webbing that precludes adequate protrusion of the penis.
4.6. Redundant Foreskin/Circumcision Revision (Figure 6)
Inadequate circumcision, or excess foreskin, is a fairly common indication for referral to a pediatric urologist. In a retrospective review of 476 late circumcision complications treated at Massachusetts General Hospital, 40% were for inadequate circumcision and another 5% were for phimosis requiring revision. The criteria for treatment are purely subjective and mainly cosmetic excepting those with phimosis, of course [15]. Repair is scheduled electively under general anesthesia and is best accomplished using the “free-hand” skin sleeve technique removing the redundant skin.

Figure 6

Examples of redundant skin following circumcision (a,b,c).
4.7. Preputial Adhesions/Skin Bridges (Figure 7)
Preputial adhesions often result from either inadequate lysis of natural adhesions prior to circumcision or from distal migration of the skin from a prominent suprapubic fat pad. Williams et al. report that 63% of patients presenting for circumcision revision were found to have prominent suprapubic fat pads [25]. The majority of adhesions should lyse spontaneously as the penis grows, suprapubic fat recedes, and erections become more frequent and firmer. Otherwise, lysis of preputial adhesions can be performed in the office by gently pushing away the adhesions from the glans after administering a topical anesthetic cream such as EMLA. Recurrence of these adhesions can be limited by regular compression of the suprapubic area to make the penis protrude and placement of petroleum jelly or any other such ointment. During healing, the circumferential incision can adhere to the glans and in some cases heal into an epithelialized skin bridge [2]. If thin and transparent, they can be divided in the office. However, extensive adhesions and thick skin bridges require surgical intervention. These can be divided sharply after a period of compression with a hemostat. Skin bridges accounted for nearly 30% of the late complications reported by the Massachusetts General Hospital group [15].

Figure 7

Penile adhesions (a) between the shaft skin and the glans can be manually separated while penile skin bridges (b) cannot be manually separated and need to be excised—skin bridge.
4.8. Meatitis/Meatal Stenosis (Figure 8)
In the absence of the prepuce, the erythema of the meatus commonly occurs after circumcision as a result of irritation. Meatitis is commonly a self-limited problem but can be treated by application of an antibiotic ointment and keeping the area dry. Meatal stenosis has been postulated to be a result of ligation of the frenular artery or from ammoniacal meatitis [2] and account for 26% of the late complications [15]. While the meatus may appear small, it can open adequately during voiding; this explains why most children with meatal stenosis do not present until after toilet training. Surgical treatment is indicated in the presence of symptoms such as deflection of the urine stream, dripping, dysuria, or urgency frequency from inadequate emptying. The treatment is meatotomy or meatoplasty, which can be accomplished under local anesthesia in the office or in the operating room.

Figure 8

Meatal stenosis in a 3 year old circumcised male who presented with a narrow stream.
4.9. Urethrocutaneous Fistula
Urethrocutaneous fistula is a rare complication, but nonetheless has been reported after both Plastibell and Gomco circumcisions [9]. Fistulae may present as an obvious fistulous tract or as a split urine stream. Often this is a result of compression necrosis from a retained Plastibell ring or a direct injury from incorrect placement of the Gomco clamp. Injury to the urethra during any ventral dissection can occur during a “free-hand” circumcision. Delayed flap repair can be done electively after the child's penis has grown enough for good tissue handling.
4.10. Glanular Necrosis/Glanular Amputation
Necrosis of the glans can occur as a result of cautery injury during a Gomco circumcision or from distal migration of an incorrectly sized Plastibell ring [9, 20]. Management of glans necrosis depends on its severity. Mild cases can be managed with local wound care and topical antibiotic ointment and allowing the necrotic skin to slough. Some authors report management of severe cases with suprapubic diversion and delayed urethroplasty [9]. There are rare case reports of complete necrosis of the glans and phallus in which gender reassignment was performed after multiple attempts at staged repair [20]. For this reason, the use of electrocautery is contraindicated in clamp circumcision.
Amputation of the glans occurs extremely rarely, but is a devastating complication of Mogen clamp circumcision. The Mogen clamp or shield seems uniquely susceptible to this particular injury given the surgeon's inability to directly visualize the glans prior to incising the foreskin. Sherman et al. report seven glanular reconstructions after traumatic amputations. The authors reported that minimal debridement and recovery of the amputated tissue were critical to the repair. Simple primary reanastomosis of glanular tissue was possible in 6 of 7 patients, the last patient required urethral reconstruction [26]. The patient's own tissue can remain viable up to 8 hours and used successfully for repair if adequately preserved by wrapping the tissue in moist saline gauze placed in a plastic bag and transported on ice [26].
4.11. Hypospadias
Isolated cases of iatrogenic hypospadias have been reported after the surgeon performed a ventral rather than a dorsal slit prior to initiation of circumcision [27]. It is important that the proper plane be entered for the initial lysis of adhesions so that the meatus is not inadvertently entered and then damaged.
While not technically a complication, failure to recognize a hypospadias prior to circumcision may be problematic if there is insufficient skin for subsequent repair. While most cases of hypospadias are associated with a dorsally hooded prepuce, the megameatus with intact prepuce variant will have a configuration as described in its name. Thorough physical examination is imperative prior to circumcision regardless of the method employed.

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Taken from an online forum…. Cropped to protect speaker and privacy.

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Mja phimosis: This link used to work….

https://www.mja.com.au/journal/2003/178/4/treating-phimosis

The link above used to be a valid link. It showed a picture of a normal intact infant penis and an abnormal intact infant penis with true phimosis.
Basically, they showed slightly pulling back… Normally a non-retractable I can’t foreskin when pulled back slightly will pucker like lips and have a healthy pink look.
For true phimosis, when the foreskin is slightly pulled back the lips of the foreskin flatten out and look strained and white-ish and does not pucker like puckered lips.

(these are my own words above as the link above is now only for member use and I am not a member. I am only writing what I remember. I am not a dr or a scientist just someone who has been reading for 5 yrs on the intact boy because I am a mother.)

I found a link that works. It’s for a site in Canada
http://www.cfp.ca/content/53/3/445.full

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phony phimosis diagnosis: http://www.drmomma.org/2010/01/phony-phimosis-diagnosis.html?m=1

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http://www.isrn.com/journals/urology/2012/707329/

“Phimosis is nonretraction of prepuce. It is normally seen in younger children due to adhesions between prepuce and glans penis. It is termed pathologic when nonretractability is associated with local or urinary complaints attributed to the phimotic prepuce. Physicians still have the trouble to distinguish between these two types of phimosis. This ignorance leads to undue parental anxiety and wrong referrals to urologists. Circumcision was the mainstay of treatment for pathologic phimosis. With advent of newer effective and safe medical and conservative surgical techniques, circumcision is gradually getting outmoded. Parents and doctors should a be made aware of the noninvasive options for pathologic phimosis for better outcomes with minimal or no side-effects. Also differentiating features between physiologic and pathologic phimosis should be part of medical curriculum to minimise erroneous referrals for surgery.”

……..

“11.2. Conventional Male Circumcision

In this case, the phimotic foreskin is totally excised. Circumcision is one of the oldest elective operations known in humans. It started as a religious/ritual sacrifice [90]. But gradually it became a routine neonatal procedure in USA and in some countries of Euro pein view of its reported hygiene and cancer-preventing benefits [91]. It cures phimosis and prevents recurrence [92]. It also prevents further episodes of balanoposthitis and lowers incidence of urinary tract infections [26, 93–95]. But it is besot with its own innumerable short, and long-term problems. Pain, difficult recovery, bleeding, infection, psychological trauma, and high cost are seen with circumcision [96, 97]. The literature is full of reports of morbidity and even deaths with circumcision. Besides, circumcision could lead to keloid formation. Possibility of decline in sexual pleasure for both circumcised males as well as their female partners due to loss of erogenous tissue has been reported [96, 98–105]. With advent of newer plastic surgical procedures for phimosis, this traditional surgery is gradually getting outdated. Circumcision is to be avoided in children with genital anomalies where the foreskin may be needed for later corrective surgery for the anomaly.”

Copy/paste: Opinion: Lawmakers clueless about circumcision research Posted on 01 May 2012.

completely copy-pasted the below article : http://www.healthpolicysolutions.org/2012/05/01/opinion-lawmakers-clueless-about-circumcision-research/

“Categorized | Legislation, News, Opinion, Public Health Issues
Opinion: Lawmakers clueless about circumcision research
Posted on 01 May 2012.

By Jere DeBacker
“A remedy for masturbation which is almost always successful in small boys is circumcision. The operation should be performed by a surgeon without administering an anesthetic, as the pain attending the operation will have a salutary effect upon the mind, especially if it is connected with the idea of punishment.”
John Harvey Kellogg, in his book “Treatment for Self-abuse and Its Effects” 1888

This is child abuse by today’s standard, but it was embraced as the norm in the late 19th century. This is the root of circumcision in this country today.
Each year, as people learned that the latest claim didn’t work, a new disease was introduced that circumcision would cure. Dr. Paul M. Fleiss states, “In fact, no procedure in the history of medicine has been claimed to cure and prevent more diseases than circumcision.”
There is still confusion and much ignorance on this subject. Just last week, Sen. Brandon Shaffer, D-Longmont, was e-mailing constituents saying, “Reliable studies prove that male circumcision reduces instances of infectious disease, some congenital obstructive urinary tract anomalies, neurogenic bladder, spina bifida and urinary tract infections. ”
Shaffer continued to dispense this fiction despite having been challenged previously by Dr. Mat Masem, who stated, “There are rare therapeutic indications for male circumcision, which generally relate to pathologic conditions of the foreskin. However, a number of the conditions you mentioned as being positively affected by circumcision have absolutely nothing to do with the foreskin. Spina bifida is an anomaly of the spine; congenital obstructive urinary tract anomalies are related to urethral strictures or other abnormalities of the urinary tract; and neurogenic bladder is a neurological condition. ”
Sen. Irene Aguilar, D-Denver, was on the Senate floor last Thursday telling her colleagues that there is a link between reduced cervical cancer and circumcision. Excuse me? The American Cancer Society states: “Research suggesting a pattern in the circumcision status of partners of women with cervical cancer is methodologically flawed, outdated and has not been taken seriously in the medical community for decades.” It concludes by saying: “Perpetuating the mistaken belief that circumcision prevents cancer is inappropriate.”
Dr. Aguilar must have missed the memo.
Sen. Joyce Foster, D-Denver, the instigator of this bill, is repeating her mantra that “This is not about religion.” For her, it is about religion. No one is trying to change her faith, but the State of Colorado cannot and must not be paying to justivy her religious rituals, either.
All the senators who have been pushing this bill so hard will fail to tell you that although America has the highest number of sexually active cut men in the world, we also have the highest rates of STDs and HIV in the developed world as well. Circumcision has proven over and over again that it does not cure or prevent disease. Education, behavior, condoms and vaccines prevent disease.
Rep. Lois Court, D-Denver, the House sponsor of this bill, thinks that circumcision is some kind of special gift that bestows mainstream American-hood on poor boys and that we just can’t deny this important medical “choice” to poor families just because of money. Well, her old mid-1900s paradigm worked for her in the 1950s, 1960s, 1970s and she hasn’t needed or wanted to change it since then. Ironically, mainstream America is changing it for her and fast going the other direction. Young, educated, more affluent and technologically savvy parents are saying NO to circumcision in record numbers.
In the last century, the truth about circumcision was very hard to find. Americans, including experts in medical schools had forgotten everything about the foreskin, its functions, the long-term complications of neonatal surgery and the reasons circumcision started in the first place.
In today’s world, in five minutes anyone with a smart phone can look up the history of circumcision, and the functions of the perfectly evolved, multi-purpose foreskin. They can see the horrendous complications and the long-term implications of circumcision and they say NO and they take their whole baby home, without any problems, just like the other 70-80 percent of the world’s people.
Please consider abandoning the old paradigm, if you are still embracing it. Read a book, go to a website, watch a video or documentary, talk with a doctor who has done her last circumcisio, or talk with a victim of circumcision complications. Be a leader.
Make sure that Colorado is not endorsing circumcision for poor people who don’t always have the time, energy or resources to discover what their more affluent brothers are learning quickly and enthusiastically. The young men of the next generation will thank you.
Jere DeBacker is a Realtor and a player piano technician, who has been associated with NOCIRC for over 30 years.
Opinions communicated in Solutions represent the view of individual authors, and may not reflect the position of the University of Colorado Denver or the University of Colorado system.”