Monday, April 15, 2013

Dangers of circumcision

Circumcision is often lauded as no big deal.

I have strong, strong feelings about the subject of risks and side affects of circumcision surgery.

When I signed for my sons to be circumcised, a piece of paper was shoved under my nose (once weeks before delivery, when I didn't even know I was having a boy, and once while in heavy labor), and the blank where I was to sign was pointed at.  No one explained the procedure to me, or went over the risks.  No one encouraged me to read the statement. No one told me that it was not necessary (that is, until I decided not to do it).

This makes me so, so angry.  With most other procedures, and medications, we are told about all the possible risks.  A doctor should have taken the time to come in and discuss this with me.  With many other procedures that my children have had, someone has explained what was happening, the pros and cons, the risks, and made sure we were fully informed.  That was not the case for me when we circumcised our sons.

Now, let me be clear. I should have researched it. I should have read every word.  I should have considered every possible risk.  I take responsibility for the fact that I allowed a surgery, with risk, to be performed on my sons without really thinking or studying for myself because I just was going with the perceived cultural "norm", and did not even take time to consider or study the matter for myself.  However, I DO believe that medical personnel, as the ones who are performing the surgery, have an ethical duty and obligation to explain procedures and all the risks involved.  That was not done, and that grieves me.

(If you are unfamiliar with the picture to the right, this is the restraint that newborn babies are placed in while their circumcision surgery is performed, and then strapped down, awake, oftentimes with no anesthesia)

There are many possible side effects and problems that can occur as a result of this surgery.  I know many will say that there are side effects or risks of many things, and that is true.  However, the fact that circumcision is not NECESSARY means that these risks are being taken for no reason, other than a cosmetic one.  Is it really worth it? Had I known the risks that I was placing on my newborn, helpless sons, I would NOT have felt it worth it, for a cosmetic procedure.

The first, and most disturbing risk is death. In the United States, over 100 baby boys die each year from side effects of their circumcision surgery. Hospital reported deaths due to circumcision are 174, for the latest reported year.  The estimated actual number is higher than that. (2)  To put this in perspective, over the span of a decade, around 30 children died in drop side cribs, and those have been BANNED in the United States.  (1) It only takes 1 ounce of blood loss for a baby to begin to hemorrhage. ONE. OUNCE. Anytime a baby is subjected to a surgery, death is a definite risk.  (2)

Healthy Newborn Dies Post Circumcision

I will include at the end here a comprehensive, suggested informed consent form.  First, I'd like to give examples of some less extensive consent forms, and highlight some of the risks.

From a consent form from a Virginia practice:(3)
 "These risks, which can be serious, include bleeding, infection, and damage to nearby tissues, vessels, nerves, or organs. They may result in paralysis, cardiac arrest, brain damage, and/or death. Other risks for this procedure may include:bleeding, infection, possible deformity, or need for further surgery"

From a consent form from Brisbane: (4)
"I understand that circumcision for an infant is not a medical procedure. Except for extreme abnormalities, there is no medical reason for circumcision".

A Florida practice (5):
"Risks Discussed: Potential for bleeding, infection, malformation, need for re-circumcision.... The chance of failure, and the risks of unplanned injuries to organs, nerves or blood vessels, to include inadvertent puncture, laceration, a tearing of other internal organs and consequent hemorrhage and need for additional surgery to repair."

 To outline some of the other side effects in detail, I will quote below from Dr. R.S. Van Howe, M.D.  It is his belief that if circumcision is going to be offered to parents, than a full informed consent form should be offered and explained, in order that parents have full and complete understanding of what they are doing.  This should be the absolute MINIMUM of ethical care in the United States-that we have full informed consent of the procedures we are choosing for ourselves or our children.  The consent form is very long.  I will quote part, and include the link to the remainder.(6)

In closing, This simply should not be happening.  Thankfully, the worldwide circumcision rate is low-80% of men worldwide are intact.  The circumcision rate is falling in the United States as well.  Over 50% of boys born now are left intact.  That is a GOOD THING, and I am so thankful.  But it is still too many. One baby dying, or losing the function of his body, for an unnecessary surgery is too many.

From an Informed Consent for Circumcision form, by R.S. Van Howe, M.D.

"Male circumcision is a surgical procedure where 25%-50% of the skin of the penis is removed.  It is important that you understand the well-established known risks of the surgical procedure as well as the possible, but unproven benefits.

The following risks are iatrogenic (doctor caused) and result directly from neonatal circumcision surgery.  Significant complications from neonatal circumcision surgery range from 2%-10%

1. Hemorrhage (bleeding): Serious hemorrhage occurs in about 2% of infants, resulting in shock and sometimes death. While death is a rare complication of circumcision, it does occur......

2. Infections: Localized or systemic infections include bacteremia, spticemia, meningitis, osteomyelitis, lung abscess, diphtheria, tuberculosis, scalded skin syndrome, gangrene of the penis and scrotum, scrotal abscess, impetigo, necrotizing fascitis of the abdominal wall, tetanus, and necrosis of the perineum.  A realistic infection rate is as high as 10%. Serious infections can cause irreparable and lifelong harm.

3. Urinary Retnetion: ....can cause the infant to retain urine, leading, at times, to acute obstructive uropathy when the bladder distends to the point of rupture

4. Laceration of penile skin....

5. Excessive penile skin loss: ...penile bowing and pain occurs at the time of erection.  Pubic hair can be pulled forward onto the penile shaft, and bleeding during sex can occur from shaft skin tears.  Skin grafts are sometimes required.

6. Beveling deformities of the glans...: Varying amounts of the glans are shaved times the entire glans may be amputated.

7. Hypospadias: ....when the frenular area is drawn too far forward, the crushing bell may injure the urethra at the time the foreskin is removed, resulting in a urethral opening on the underside of the shaft.

8. Epispadias: When one limb of the clamp inadvertently is passed into the urethra and is closed, it may crush the upper portion of the urethra and glans, creating a urethral opening on the dorsum (top) of the glans.

9. Retention of the Plastibell ring: The Plastibell may become buried under the skin causing ulceration...Loss of the glans has been reported.

10. Chordee (permanent bowing of the penis)....

11. Keloid formation: Prominent scars can occur where the skin-mucous membrane has been incised...

12. Lymphedema: Chronic swelling of the glans due to infection or surgical trauma

13. Concealed penis: The circumcised penis becomes hidden in the fat pad of the pubic area, requiring surgery to bring the penis out again.

14. Skin bridges and penile adhesions: A common complication consisting of one or more thick areas of scar tissue. These can be quite painful during erection."

15. Phimosis of remaining foreskin: When only a segment of the foreskin is removed, the remaining tip sometimes becomes tight and non-retractable, requiring a second surgery.

16. Preputial cysts: Cysts caused by infection or mechanical distortion blocking the sebaceous glands.

17.Skin tags: Can occur at the circumcision line, representing an uneven removal of skin. 

18.Loss of part or all of the penis: This can be caused by constricting rings, such as the Plastibell, or by use of an electrocautery device. More frequently, the loss is the result of infection, with the penis becoming increasingly necrotic (dead tissue) until finally the entire organ falls off. The proposed solution in many cases is to raise the child as a girl.

19. Meatitis: Inflammation of the urethral opening from the loss of protective foreskin, which can lead to ulceration and meatal stenosis (narrowing). Many infants and children suffer this after their loss of protective foreskin.

20. Meatal ulceration: Caused by meatitis and/or abrasions from dry diapers and from diapers soiled with urine and feces. Meatal ulceration does not occur in the intact male and occurs in up to 50% of circumcised infants.

21. Meatal stenosis: In advanced meatal ulceration, scar tissue can constrict the urethral opening causing urinary obstruction. Meatal stenosis is usually not apparent for several years, occurring in about one-third of all circumcised infants and not at all in intact males.

22. Progressive loss of glans sensitivity: This is the most common complaint of adult circumcised men, whereby some men report stimulated needed to the point of pain to achieve orgasm. 

23.Sexual dysfunction: Includes impotence and premature ejaculation. 

24. Nonspecific urethritis: This venereal disease is more common in circumcised adults.

25. Gastric rupture: Has been reported associated with prolonged crying during circumcision.

26. Glans necrosis: The head of the penis can lose its blood supply and begin to rot from the scarring that follows circumcision.

27. Tachycardia, heart failure and myocardial injury: Have been reported associated with the procedure.

28. Death: Occurs at a rate of 1 in 5,000.
(end quote)


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