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Safer as an adult

February 26, 2013

Watch these clips – your baby can’t

Even the most enthusiastic proponents of circumcision admit that doing it on newborn babies is ethically problematic. Here’s the WHO infant circumcision manual; An infant cannot consent to the procedure. […] there is a risk that when the child is older he will be unhappy he was circumcised as an infant.

This leaves relative safety as the only plausible medical reason for mass circumcision of newborn boys. But if we are to believe the claims of the inventor of the Prepex device, the adult procedure is likely to be safer.

The new device is essentially an adult version of the Plastibell for infants. Both consist of a circumferentially grooved plastic ring, which is inserted under the foreskin and a ligature tied along the groove to cut off the blood supply to the distal foreskin.  In infants the ring is attached to a plastic handle which is snapped off after the ligature is tightened.  The adult device has no plastic handle, and the manufacturers also provide a second larger ring with preloaded ligature to make that part of the operation easier. In infants the distal foreskin is usually cut off during the initial procedure, leaving the ring to fall off later. In adults the ischaemic foreskin is left attached, and removed with the ring after a week.

Click here for a video of the Plastibell procedure on a newborn, and here for one of the Prepex device used on an adult.

It seems almost certain that complications will be lower in adults.

1. In infants the foreskin is naturally adherent to the glans so it needs to be forcibly stripped off to allow insertion of the plastibell. Sometimes a longitudinal incision needs to be made in the foreskin.  This means anaesthetics with all their attendant risks.  In adults anaesthesia is not necessary.

2. In infants the main source of serious complications, which can include loss of the whole glans, urinary retention and even ruptured bladder, (click here if you have a strong stomach) arise from a too tight Plastibell ring trapping the distal penis.  If the parents don’t realise what is happening, it can be too late when the child is finally bought in.  Adults will notice something wrong, and get the ligature snipped and the ring removed before catastrophic damage results.

3. Anyone watching the two procedures will appreciate that the scope for accidentally cutting the glans, or removing more skin than intended, is much greater in infants.  No doubt there will be complications with the Prepex device, which is why various trials are going on in Africa, but they must be fewer than with infants and the Plastibell.

If you believe there are reasons to choose circumcision, there are none that say you should choose it for your son before he can make his own mind up. Let’s hope we’ve heard the last of mass infant circumcision campaigns.

Jim Thornton

10 Comments leave one →
  1. February 26, 2013 4:03 pm

    Thank you for posting this important information. No child ever needs to be cut in the genitals, that is a sick social custom, a severe from of child abuse and medical fraud that must be eradicated from a just society.

  2. Keith Rutter permalink
    February 26, 2013 8:59 pm

    An adult is given anaesthetic for surgery, unlike a baby. The adult can also decide what result he wants, it is pure guesswork what happens after the infant procedure. But the most important consideration in favour of leaving baby boys intact, is the fact that very few men elect to have their foreskin altered.

  3. Richard Russell permalink
    February 26, 2013 10:28 pm

    Depending on which study you accept, 117 to 230 infant boys die from circumcision every year in the US. To my knowledge there is no record of an adult ever dying from a medical circumcision in the US. (This is not to be taken as an endorsement of circumcision at any age. The craving for it in some men is due to their living in a circumcising culture that continuously imposes on them the belief that they need it. In non-circumcising cultures [80% of Earth’s males] it is almost unheard of for a man to desire to be circumcised for “personal reasons.”)

  4. Petite Poulet permalink
    July 29, 2013 6:23 pm

    One of the myths propagated by circumcision enthusiasts (see Brian Morris’s ‘A Snip in Time’) is that infant circumcision has few complications than adult circumcision. There is no evidence to support this and several studies have indicated the opposite is true. If circumcision is safer and easier with fewer complications in adults, there is no reason to do it on infants and the ethical quandary about informed consent is avoided.

    • August 1, 2013 3:21 pm

      This is indeed the knockout practical argument. The problem is getting unbiased data on safety. I suspect the modern RCTs provide the best data. note to self.:must chase is.


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