Cock-ups happen
Parental Advisory. Read this first – your baby can’t.
The World Health Organisation Manual for Infant Circumcision’s (WHO MIC) sample information sheet for parents (p110, or click here) is not adequate. Here is the bit on surgical harms:
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.
HIV, and other blood borne infections.
In male circumcision programmes a major concern is the potential transmission of bloodborne […] HIV and hepatitis B virus, to […] patients. The risk of acquiring HIV from an HIV-infected person through a needle-stick injury is estimated at 0.3% […] . The risk of acquiring hepatitis B virus infection, after being stuck with a needle that has been used on a person with hepatitis B infection, ranges from 6% to 37%, […] Most instances of transmission of infection in health-care facilities can be prevented through the application of standard precautions. If “it is a major concern” and only “most […] can be prevented”, it should be mentioned.
Amputation of the penis.
This extremely rare complication can be minimized by using good surgical technique but is unlikely to be eliminated. Unfortunately, even under ideal circumstances and with experienced surgeons [it] continues to occur.
Destruction of the penis by electro cautery.
One should NEVER use an electric current [..] with a metal Gomco clamp. […] The use of electrocautery […] has resulted in total ablation of the penis during male circumcision. To avoid this devastating complication, surgeons must be educated that electrocautery has to be strictly avoided when using a Gomco clamp.
Urinary retention from retained Plastibell rings.
Some of the most serious complications ever seen [retention and bladder rupture] […] have resulted from retained Plastibells. Educating the family to closely monitor the wound and the infant’s urine output is paramount with the use of this device.
Penile necrosis following the Plastibell technique
These two poor fellows aren’t going to be great in the sack.
Degloving – removal of the skin of the shaft.
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.
Jim Thornton
More here, here, here, and here.
Click here for an updated map of circumcision practice globally
Trackbacks
- Male genital mutilation « Ripe-tomato.org
- Newborn Research « Ripe-tomato.org
- Fred at a Wedding « Ripe-tomato.org
- Safer as an adult | Ripe-tomato.org
- Kimeru circumcision | Ripe-tomato.org
- Your son is fine….. But these boys weren’t | Coffee and Kids
- Boston/Botswana circumcision trial – 2 | Ripe-tomato.org
- Cock-ups happen. Parental Advisory: Read this first – your baby can’t | Don't Get Stuck With HIV
- What is Intactivism? | Planting Godly Seeds
- Top 10 of 2013 | Ripe-tomato.org
- Mistakes happen | Ripe-tomato.org
- Another penile amputation | Ripe-tomato.org
- Circumcision video | Ripe-tomato.org
- What is Intactivism? | Chaos and Critters
Ripe-tomato.org 
Thank you for posting this blog. Complications are not rare and occur frequently even in the “modern” health care system of the U.S. All males circumcised will lose the most sensitive part of their penis because the majority of fine touch nerves reside in the foreskin. This ultimately will adversely affect sexual function for the males and their female partners. The WHO has lost all credibility on this one, as has the AAP. Circumcision will prevent nothing except normal sexuality.
I get the impression that sexual pleasure and functionality are not priorities for the American and Australian promoters of prophylactic circumcision, probably because they are themselves circumcised men or the spouses thereof. Another thing: sexual pleasure cannot be quantified, because the nerve impulse traffic between the genitalia and the brain cannot be quantified. This lacuna will be filled within, say, 50 years or so. We will then have hard data verifying that cut men experience masturbation and intercourse in duller ways.
Any unnecessary amputation of a body part has complications. In the case of circumcision, the unnecessary and painful mutilation of a perfectly healthy infant is a major complication. Who on earth cuts up a perfectly healthy newborn without any medical need? Why on earth would you subject anyone to unnecessary procedures especially babies or children?
Sadly, foolish parents and arrogant heartless doctors in America do it. Then there are those being fooled in Africa by scientists claiming they will be protected from disease. What is done to helpless children and coerced adults is truly criminal.
Seing the harm made to these poor babies makes me feel sick. I hurt for them.
Absolutely saddening. This horrible practice needs to stop.
When are parents going to simply wake up and realize that the foreskin is a normal, healthy functioning part of a penis? People consider female circumcision “barbaric”, yet they will gladly allow a doctor to cut off parts of a male infants genitals. If a man said he preferred a woman that was “cut” down there, people would be aghast, yet it’s perfectly acceptable for a woman to say that she prefers a cut man. Where is the logic? Don’t people think? A child’s penis does not belong to it’s parents. It belongs to the child! It’s his penis, so leave it alone!
You write as you do because you are Canadian, and Canadian popular culture never lost sight of the fact that the bald penis is an altered penis. In the USA, the circumcision rate between 1960 and 1980 was at least 90%, and may have been 99% among middle class white families with health insurance. The natural penis can strike an educated adult American as quite weird. And “weird” means “gives rise to the risk of bullying by other boys and the risk of rejection by women he dates.” And so the foreskin must go, to prevent son from becoming a social outcaste.
When an American woman comments on the internet that she has seen both, and is completely comfortable with a dick having all the moving parts, she strikes a blow against the Empire of the Bald Penis.
The reasons “Bullying by other boys and the rejection by women he dates” this is absurd. In the USA, there are no longer “showers” or even the possibility of accidental exposure in the schools. The only possible rejection is by “a women he dates” I say this as nice as possible, 1- you don’t know if he will even date a woman 2- If he does and is rejected by an uneducated irrational woman, does this one or two rejections worth losing all the sexual feeling he could have had over his lifetime? To many people rush to say he will be rejected. However it is those of us that were abused as children that are the ones that have lost something. Not the intact natural males in the “showers” or the women that are ignorant and selfish to require his sexual feeling to be reduced or removed completely yet scream the second she thinks there is one small ounce of anti-female ….
My husband was born in Toronto in 1977 and he (by his own report, not my observation!) is the only circed male in his family because the doctors didn’t get a translator for his parents to be sure they were getting a REAL “yes” out of them (they are Chinese) instead of just a “it’s our culture to say yes to whatever the doctor asks” response. I wish it hadn’t been done to him. Our sons are not circed. I am a natural-born citizen of the United States.
ARGH!
You missed my sarcasm.
“1- you don’t know if he will even date a woman”
ME. Parents almost always assume that a son will grow up to be straight.
“2- If he does and is rejected by an uneducated irrational woman…”
ME. Many educated and otherwise rational Americans have let their boys be circumcised, in the interest of “hygiene” and “a better sex life”.
“…does this one or two rejections worth losing all the sexual feeling he could have had over his lifetime?”
ME. Polite America is in firm denial that circumcision can detract from sexual enjoyment, Because polite America is made up of circumcised men and their spouses. It is very very difficult for a circumcised man to admit that his penis, the penis he saw everyday in the locker room while growing up, or the penis sanctioned by is religious tradition, is an inferior penis.
The AAP has a simple solution to the problem of major complications and death: since it can’t find any statistics for them, IGNORE THEM.
http://tinyurl.com/aapanno p20:
“Major Complications
The majority of severe or even catastrophic injuries are so infrequent as to be reported as case reports (and were therefore excluded from this literature review). These rare complications include glans or penile amputation, transmission of herpes
simplex after mouth-to-penis contact by a mohel (Jewish ritual circumcisers)
after circumcision, methicillinresistant Staphylococcus aureus infection,
urethral cutaneous fistula, glans ischemia, and death.”
A study last year from Brazil found one death in 7700 circumcisions.
http://www.ncbi.nlm.nih.gov/pubmed/23386015
That would translate to 156 deaths per year in the USA.
Hugh, that is a very interesting recent reference. And I suspect that 1 death per 8000 circumcisions is a lot more honest than the USA claim of only one death per 500,000 events. But the AAP – Tobian crowd will say that the Brazilian death rate is much higher than the USA’s, because of unhygienic conditions in Brazilian hospitals, and because of greater carelessness in operative technique.
It is curious that these Brazilian findings broadly bear out Bollinger’s claim of ~100 deaths per year in the USA.
Even one mistake or death is too much. I agree with Midwest MD who said, “Circumcision will prevent nothing except normal sexuality.”
I have been around women and babes since the 1970’s. I have seen 2 incidents with Gomco circs. Plastibell problems would be seen in the office after dismissal, so I have not seen them. However, as an adult of the 60’s and 70’s most males of my generation were circ’ed and reported sexual satisfaction. There are problems with and without circs-to believe other wise is naive. My father was born at home was circed in his 70’s for some reason. Grandson (some Hispanic culture) was not circ’ed at birth. At 18 months he had to undergo circumcision for allergy reasons (sounds strange but as soon as he was circ’ed the allergy was gone). He had to go to the OR and undergo general anesthesia. He had post op bleeding problems. Had to go back to surgery for a re-do. Every case is individualized. It isn’t our job to make this decision for anyone. It is our job to present the information and let the parents decide. I am finding Anglo moms declining circs more and more, especially when their insurance does not pay for “cosmetic” procedures. I would hate to see the return of the barber doing them as is seen in the Middle East. This pendulum swings with each generation. It is Bible based and Old Testament based Christianity/Judism/Muslim will continue. We should not impose our beliefs on them. It is my understanding there is nothing in the Koran to support female circumcision.
1 in 3 US women will need a total hysterectomy before they reach 60 years old, as a result of vaginal erosion caused from sex with the keratinised glans of their circumcised husbands. Look it up. tit4tat. There is a trade off, cutting baby boys prepuces off causes cutting the wombs out of their mothers. Before surgical wombectomies, grandmothers would just die and not be able to warn their daughters and grand daughters, while their circumcised husbands would be freed up to remarry. The curse has doubled back onto the witches.
When someone gets a stye on their eyelid or a boil on their side, we do not count that as a a problem of having an eyelid or a side, let alone consider pre-emptively cutting the parts off. Only the foreskin is treated this way. Your father got 70+ good years use out of his foreskin. Many men would be grateful. Your grandson’s recovery sounds coincidental, depending on the nature of the allergy, and he seems to be yet another victim of “If in doubt, circumcise.”
“…most males of my generation were circ’ed and reported sexual satisfaction.” and they don’t know what they are missing:
“Errol Morris, the filmmaker, was born with strabismus and subsequently lost almost all the vision in one eye, but feels he gets along perfectly well. “I see things in 3-D,” he said. “I move my head when I need to – parallax is enough. I don’t see the world as a plane.” He joked that he considered stereopsis [3D vision] no more than a “gimmick” and found my interest in it “bizarre.”
“I tried to argue with him, to expatiate on the special character and beauty of stereopsis. But one cannot convey to the stereo-blind what stereopsis is like; the subjective quality, the quale, of stereopsis is unique and no less remarkable than that of color. However brilliantly a person with monocular vision may function, he or she is, in this one sense, totally lacking….
“With prismatic spectacles and exercises, Sue Barry recovered stereo vision after a lifetime of using her two eyes separately:
” ‘I went back to my car and happened to glance at the steering wheel. It had “popped out” from the dashboard. I closed one eye, then the other, then looked with both eyes again, and the steering wheel looked different. I decided that the light from the setting sun was playing tricks on me and drove home. But the next day I got up, did the eye exercises., and got into the car to drive to work. When I looked at-the rear-view mirror, it had popped out from the windshield.’
“Her new vision was “absolutely delightful,” Sue wrote. “I had no idea what I had been missing.”
– Oliver Sacks, The Mind’s Eye
Cutting normal, healthy, functional, non-renewing parts off babies’ genitals is not a decision that ever needs to be offered to parents. In much of the developed world it never has been, and in the English-speaking world outside the USA it no longer is – with no outbreaks of any of the ailments it was supposed to be good against. “We should not impose our beliefs on them”? We should not impose our scalpels on children!
I was going to rant, however Hugh Intactive said it best “We should not impose our beliefs on them?” We should NOT inpose our scalpels on children!”
On second thought, I was wondering Dee Dibal, that if I came up with a new religion/belief, that mandated women of your age, to be forcefully cut up, that if you would still belive not imposing your beliefs on me? (which would stop the cutting either way)
You say, “It is my understanding there is nothing in the Koran to support female circumcision.” There is nothing in the Koran to support male circumcision,either.
They say complications of 1 in 500 are “rare”.
Tell that to the poor individual who is the 1 in 500. NOT RARE ENOUGH.
And EVERY circumcision damages the penis and removes 3/4 of the sexual nerves.
This is essentially lying. Professional lying. There is no other way to look at it.
I don’t even want to know how poor my stamina would be if that were really the case that the foreskin has “3/4ths of the sexual nerves,” which I do not believe it is.actually the case.
So if one million boys are circumcised in the United States in 2010, 2,000 of them had serious complications, if we use the 1/500 number given here? 2,000 boys who will live with diminished and damaged penises for the rest of their lives. That is an acceptable number for a procedure that is not necessary and not promoted by any medical association in the world? As an RN and doula, I advocate for my patients and clients and tell parent’s how to care for their intact sons and allow them to have normal and natural sex lives. His body, His choice.
You assuming an obligation to inform the patient of a risk of 1:10,000 risk of temporary colostomy after laparoscopy.
The leading Australian case on medical negligence (malpractice to my learned friends States-side) is Rogers v Whittaker (1992) 175 CLR 479 High Court of Aust where a doctor was held liable for not informing his patient of a 1:14,000 risk of losing sight in her good eye if he operated only on her blind eye as a result of rare “sympathetic opthalmia”. Here it is:
http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/HCA/1992/58.html?stem=0&synonyms=0&query=eye%20near%20surgery
An assumed death rate from circumcisions even as low as 1:7,692 is well within this principle and doctors in the Common Law world should unequivocally inform parents of the risk of death (quite apart from whether they should conscientiously refuse to subject their child patient to that risk without direct consent but I’m digressing…).
Medical Defence Unions (doctors’ insurers) should sit up and take note.
It only mentions the complications DURING infant male circumcision, avoiding the long term physical and psychological complications caused from infant circumcisions that don’t show up until after puberty, such as lack of shaft and foreskin causing painful, crooked erections, ripped glans, scrotum hairs up the shaft, excessively tight scrotum skin, delayed onset PTSD from excessive infant sexual trauma resulting in suicidal depression, excessive nerve damage to the frenular delta nerves, resulting in erectile dysfunction and numbness. Women who get married to circumcised men have an increased chance of being affected with vaginal erosion from their husband’s keratinised glans, leading to total hysterectomy in 1 out of 3 women before they reach 60 years old.
Circumcision is clearly a side effect from religious indoctrination, or casting the Gospell/God spell on the weak minded, superstitious and uneducated. Having a religion means that people have been fooled into believing in and worshipping a false god which leads to brain chemistry dysfunctions. Religious Circumcision/Worship is a form of paranoid delusion caused by the lack of knowledge in; cosmology, plate techtoniques, the existance and effects of microscopic life forms,including infections which may result in audio and visual halucinations from the delirium from untreated UTI’s. and STD’s, halucinogenic plant toxins/drugs, and the brain injuries and PTSD from being sexually traumatised by religion as an infant or small child, such as prepuce excision sacrificings on boys and girls. ~Frederick Rhodes
“such as lack of shaft and foreskin causing painful,” — no
“crooked erections,” — no
“ripped glans,” — what? no.
“scrotum hairs up the shaft” —- bahahahahahaa, definitely doesn’t happen.
“excessively tight scrotum skin,” —- definitely not
“delayed onset PTSD from excessive infant sexual trauma resulting in suicidal depression” —- the first step to not caring that you were circumcised is to not read stupid anti-circumcision websites. And, no, that is not PTSD, it’s being mad that you don’t control everything that happens to you in childhood – tough.
“excessive nerve damage to the frenular delta nerves resulting in erectile dysfunction and numbness.” —- Ok, maybe in some situations.
Your nihilistic denial betrays you.
Thanks for reminder of the obligation to inform the patient of a risk of 1:10,000 risk of temporary colostomy after laparoscopy.
The leading Australian case on medical negligence (malpractice to my learned friends States-side) is Rogers v Whittaker (1992) 175 CLR 479 High Court of Aust where a doctor was held liable for not informing his patient of a 1:14,000 risk of losing sight in her good eye if he operated only on her blind eye as a result of rare “sympathetic opthalmia”. Here it is:
http://www.austlii.edu.au/cgi-bin/sinodisp/au/cases/cth/HCA/1992/58.html?stem=0&synonyms=0&query=eye%20near%20surgery
Brian Morris’ 1:7,692 estimate of circumcision deaths in developed countries is well within the principle and doctors in the Common Law world should unequivocally inform parents of the risk of death (quite apart from whether they should refuse their patient to that risk without direct consent but I’m digressing…)
I don’t remember mine
That’s called amnesia. Traumatic shock affects our hippocampus affecting its development and causes it to black out painful memories . Most of us don’t remember, but sometimes simular traumatic shocks after puberty or as an adult can trigger total recall. When this supressed infant sexual asault/trauma memory resurfaces, it is called delayed onset PTSD and this is when we get diagnosed schizophrenic. Many if not all of the mass murder/suicide terrorists and serial killers are schizophrenic as well as circumcised,
Excellent. I wish I could share it but, unfortunately, the title is unacceptably vulgar in most of the US over a certain age. My mother just refused to read it. I’ll see if I can modify it and try again later. Your facts and photos make a powerful argument.
My sincere apologies to your mother. The expression is quite mild in England, although I agree the context makes it stronger. Do encourage her to read on. If she can influence any parents against unnecessarily circumcising their sons, it will have been worth it.
Interesting. A “cock-up” was originally that feature you see in dry-stone walls built from the C15th in South and SW England; looks like this o0o0o0o0o0o0o if you get my drift. It added extra height to the wall the plebs had to scale to get in and no doubt steal sheep and fish trout etc (when their children were starving).
Tell your learned Mother that it derives from an architectural nomenclature and not from some vernacular genital crudity and she might relax a bit. Good luck to her!
PS don’t forget to warn her about the visual content, and emphasise that it is a medical publication by a Professor of Medecine..
But the professor was ignorant of the etymology, and making a crude genital pun. Ask your mother to forgive him.
Gary
Please tell your mother that this is actually an English phrase meaning error, mistake, screw-up (well maybe not that one) SNAFU etc.
It is not in the least bit rude.
Rather like “bullshit” not being rude whereas the second half of the word on its own is considered rude.
Two nations divided by a common language! (Fags and faggots also have a slightly different usage here).
Jim T
Good pun. Excellent post. Ghastly pictures. Thank dog my father was opposed to the mutilation of babies for dogma and fairy stories. (I found your site referenced on the Quackometer)..
Duh.
Most probably by your posting there!
Sorry – I did not register the name when I linked across.
OR you can clip out a picture of a rooster and sneak it up in front of your mom and “say look at this cock!”
To test the idea that infant circumcision proponents give biased info on risks, perhaps it’s only necessary to look at what insurers think .The Medical Protection Society statement on circumcision cites ‘considerable risks’ to the patient …and that haemorrhage,and infection are ‘common’, as are ‘residual foreskin’ (Weiss et al chose to edit out this issue from their meta-review even though it often entails further surgery under GA). http://www.medicalprotection.org/uk/england-factsheets/mps-policy-on-circumcision.
Laura
I would make a wild guess and suggest that you must be Laura M, the slightly apologetic LM I met on the Quackometer.
You and Andy have done me no favours as I now have something else to feel aggrieved about, along with all the other nonsense, weirdness and mumbo-jumbo.
One small issue has rather puzzled me reading some of the relevant posts on MGM (I learn quickly). I had no idea that mohels did the mouth/genital thing. Is there some peculiar logic (obviously not one of my specialities 🙂 – as you know) or special priviledge which makes this acceptable in the Jewish faith but serious child abuse in the Catholic one? Double standards?/No standards?
(And you will no doubt appreciate the way in which I have self-moderated my somewhat intemperate prose to avoid being blog-moderated – another immense effort of will).
Hey John, I only just saw this. You guessed right. And I feel apologetic all over again when I see your name! Re the mouth suction thing I feel it’s done with the best of intentions – I think in the early days it was believed to help against infection and perhaps it did. [ I have a vague memory of reading that saliva has mild antibacterial properties – and when we have a wound on our hand for example we do tend to suck it so it might be an instinctive thing…?.] As regards a Christian priest who might similarly put his mouth there I don’t think we can reasonably assume he has good intentions so that’s why people make the difference. (Although there are examples of surprising attempts to rationalise paedophilia – look up Chris Brand who was a tutor at Edinburgh Uni for example.) We look at FGM in a similar way, which is why it gets confusing when parents who clearly love their girl take her to a doc to get cut under anaesthetic on the belief that she’ll be cleaner and more beautiful post surgery… It upsets our stereotypes. I think the answer is to look at things more in terms of child realities rather than adult rhetoric.
As a man whose foreskin was cut off by an incompetent doctor back in 1947, I confirm that removing the majority of the nerve endings, and allowing the glans to dry out, definitely does cut down the sexual pleasure. Since I was about 40, I noticed that in intercourse it was taking longer to orgasm, and by 60 it did not happen at all. I have managed to restore a little, which makes it slightly more likely to be able to masturbate.
This is horrifying. People are just worried about what people will think and they need to get a life. I have zero respect for Mothers who do this to their little babies.
Nice bible verse. Gal 5: 12. I just wish that those troublemakers who want to mutilate you by circumcision would mutilate themselves.
Reblogged this on Don't Get Stuck With HIV and commented:
This is a guest blog by Jim Thornton, re-posted from Ripe-Tomato.org
Reblogged this on thepositivevoice.
RIC is criminal assault and child abuse. I owe my clear understanding of this to the School of Humanity – http://www.IntactHumanity.org here is what we say:
Child Abuse Prevention and Treatment Act (CATPA)
• “Child Abuse is a Criminal Offense that involves the physical, emotional, or sexual mistreatment of or Infliction of Non-Accidental injury to a child committed by a parent or another party if responsible for the child’s welfare or not, either purposefully, or due to neglect.“
• “Any recent act or failure to act on the part of a parent or caretaker or any other person, which results in death, serious physical or emotional harm, sexual abuse, or exploitation, or an act or failure to act which presents an imminent risk of serious harm.”
Forced Circumcision is Child Abuse
• Assault – Non-accidental injury, deliberate wound, amputation of a functional part of the reproductive system, bodily harm
• No established benefit – lack of an existing problem
• Forces a religious identity/branding – exploitation
• Mutilation – Disfigures, removes sexual functions, leaves a scar, alters normal aesthetics, harm
• Risk infection, bleeding and even death
• Adults have indicated physical and emotional harm from circumcision
• Doctors are sworn to an oath “first do no harm” – they break their oath
• 14th Amendment of the US Constitution: Gender Discrimination
/ Violation of the Constitutional Right of Equal Protection
• Forced Circumcision is Child Assault and Abuse – A crime tolerated and ignored
The WHO manual is an extraordinary document, promoting early infant circumcision as good timing, while acknowledging that the person circumcised may later object.
The authors go into great detail of the potential complications, and yet the specimen information for consent plays down the complications. Surely it is fraudulent to demonstrate an awareness of compliications and then not advise disclosure for consent?
And of course one of the risks “lack of informed consent.” is a risk for the doctor, not just the patient.
Perhaps most fascinating of all are the photographs. The detailed “before and after” photographs for each of the different methods seem somewhat prurient. They are reminiscent of the interest that circumcision fethishists have for particular outcomes.
And one of the photographers, David Tomlinson, is the inventor of the Accucirc circumcision clamp. Is this an undisclosed interest?