Botched circumcisions. Report on CBS 6, WTVR.

[Crunchy Frog]

http://www.wtvr.com/wtvr-botched-circumcisions-20110517,0,4411553.story

This is a report from Richmond VA. Pediatric urologist Dr. Boyd Winslow reports having done over 1600 corrective surgeries for botched circumcisions in the past 3 years.

I know that there are currently people in the medical community, and even some here on DU who are advocating circumcision as some sort of "vaccination" that will protect people against HIV and other STDs (notwithstanding that this country has the highest circ rate in the developed world and the worst statistics as far as STDs). It seems to me that the complication rates for this sugery are grossly underplayed by much of the medical community in this country. Comparing it to a vaccination, are there any doctors out there who have done 1600 reconstructive surgeries for vaccination complications? I've never heard of anything like that, but maybe there's something I'm not aware of.

I apologize for opening such an inflammatory post, but I did find this report and found it intriguing in light of some of the recent claims being made for health benefits and low risks.

I'll put on my flame retardant suit now.

[pnwmom]

1. The article says that some doctors are still doing them without anesthesia.

That's inexcusable, since they've had the research supporting anesthesia for more than 20 years.

http://aappolicy.aappublications.org/cgi/content/abstract/pediatrics;103/3/686

PEDIATRICS Vol. 103 No. 3 March 1999, pp. 686-693

AMERICAN ACADEMY OF PEDIATRICS:
Circumcision Policy Statement

Task Force on Circumcision
Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.

_____________________________

http://www.auanet.org/content/guidelines-and-quality-care/policy-statements/c/circumcision.cfm

American Urological Association
Circumcision Policy Statement

The American Urological Association, Inc.® (AUA) believes that neonatal circumcision has potential medical benefits and advantages as well as disadvantages and risks. Neonatal circumcision is generally a safe procedure when performed by an experienced operator. There are immediate risks to circumcision such as bleeding, infection and penile injury, as well as complications recognized later that may include buried penis, meatal stenosis, skin bridges, chordee and poor cosmetic appearance. Some of these complications may require surgical correction. Nevertheless, when performed on healthy newborn infants as an elective procedure, the incidence of serious complications is extremely low. The minor complications are reported to be three percent.

Properly performed neonatal circumcision prevents phimosis, paraphimosis and balanoposthitis, and is associated with a decreased incidence of cancer of the penis among U.S. males. In addition, there is a connection between the foreskin and urinary tract infections in the neonate. For the first three to six months of life, the incidence of urinary tract infections is at least ten times higher in uncircumcised than circumcised boys. Evidence associating neonatal circumcision with reduced incidence of sexually transmitted diseases is conflicting. Circumcision may be required in a small number of uncircumcized boys when phimosis, paraphimosis or recurrent balanoposthitis occur and may be requested for ethnic and cultural reasons after the newborn period. Circumcision in these children usually requires general anesthesia.

When circumcision is being discussed with parents and informed consent obtained, medical benefits and risks, and ethnic, cultural, religious and individual preferences should be considered. The risks and disadvantages of circumcision are encountered early whereas the advantages and benefits are prospective.

Three studies from African nations published in 2005 and 2007 provide convincing evidence that circumcision reduces by 50-60% the risk of transmitting the human immunodeficiency virus (HIV) to HIV negative men through sexual contact with HIV positive females. While the results of studies in African nations may not necessarily be extrapolated to men in the United States at risk for HIV infection, the American Urological Association recommends that circumcision should be presented as an option for health benefits. Circumcision should not be offered as the only strategy for HIV risk reduction. Other methods of HIV risk reduction, including safe sexual practices, should be emphasized.

[Crunchy Frog]

3. It's alot more common than many people realize.

I've recently started a group on a VERY popular parenting forum, and it's shocking to read about some of the complications that people have been through with their babies. It's also pretty clear that there are many docs out there who are still not using anesthesia, or are not doing it correctly or adaquately.

The OB that I had for my high risk twin pregnancy did them in his office, and I was around for a few of them (was there alot due to complications). He apparently does administer a shot of lidocaine, but I got the "privilige" of getting to listen to one being done while I was waiting in another exam room, and that baby was screaming in agony (and apparently still was when he was brought back out to the waiting room, according to my mother).

There are doctors who give only a pacifier dipped in sugar water and call it "anesthesia".

There is no excuse, other than a medical culture that has historically devalued and ignored pain in young infants, as well as parents who don't really question.

[pnwmom]

5. For our first son, we had a different OB do the procedure,

because that OB (another one in my doctor's practice) was experienced in using anesthesia -- which was new then. By the time our second son was born, most doctors here seemed to be using anesthesia.

The procedure was done in the hospital and my husband was there both times. He said that the doctor injected several shots of lidocaine and our sons whimpered with the first. He said they didn't cry during the circumcision itself. (And I saw them afterwards and they were calm.)

Every family has to make their own decision about this. We have a relative who is a urologist; he provided us with some data about urinary tract infections that, for us, tipped the scale. (In infants they can lead to kidney infections, which is a very serious thing.)

[FLyellowdog]

2. Just an added bit of info...

I found out only today that the foreskin from circumcisions can be donated to skin banks where the tissue is used to grow skin grafts. I know someone who has had several of these grafts done due to diabetic complications of her feet.

Medical science is wonderful. But I have no opinion about the circumcisions. :hi:

[Crunchy Frog]

4. I personally don't think that it's ethical to use the bodies of newborn infants

as tissue banks. And it's apparently not particularly safe for the babies either. It would seem to me that there must be other ways of obtaining tissue that could be used in grafts.

Incidently, Oprah Winfrey uses and promotes face cream that's made from infant foreskins. I personally think that they should be looking elsewhere for tissues to be used, whether for skin grafts or for cosmetics.

[pnwmom]

6. It's not unsafe if they're doing the procedure anyway.

:shrug:

If they were, the donation wouldn't add any risk at all.

[Crunchy Frog]

7. I would say that the "donation"

(usually done without parental knowledge or consent, and usually more of a "purchase" than a "donation") probably adds a financial incentive to hospitals to encourage the procedure. If that is the case, then it is adding an extra risk, at least indirectly.

[pnwmom]

8. I have trouble believing that doctors would make enough money

on this -- if anything at all -- to influence the advice they give to parents.

[Crunchy Frog]

9. I'm talking hospitals, and not individual doctors.

The fact that some of them sell the foreskins to biotech companies and therefore benefit financially could incline them to push circumcision more aggressively.

Hospitals differ a great deal in how aggressively they promote this surgery. Some won't even ask, or will ask only once. Some people have reported being asked as many as a dozen times, and even having people appear in their room to take the baby for circumcision after they had repeatedly said "no". I just wonder if there could be a correlation. It might be something worth looking into.

[pnwmom]

10. Maybe it is regional.

Here I had to arrange it all with my OB during my pre-natal care. We do have lower rates of it though in the PNW.

[Crunchy Frog]

14. I just found this interesting post from the site that I moderate.

It's from a father of preemie triplet boys.

We had our boys at one hospital, but one was rushed to a second hospital at 36hrs old due to a congenital heart defect. In the 2 and 3 weeks our "healthy boys" stayed at the original hospital, we were both asked repeatedly about circumcision. One neonatologist in particular was a real bully about it. Funny thing, there were only 4 boys in our "pod" of the NICU. Our 2, a Mexican boy and a Scottish/Venezuelan boy. None of us were circ'ing and we were all getting "harassed." I remember one day Jorge's mom whispered to me "Are you getting your boys, you know, altered?" When I told her "No" she looked so relieved. She told me how the one doctor kept asking her about it. When she translated for her husband he was appalled. He did NOT understand why this crazy American doctor wanted to cut off his son's penis! I loved his open, naive, honest reaction to something we take as the "norm" here. When my 3rd son was finally released 54 days later from the Children's Hospital, I realized that not one person ever asked us about having him "snipped." It's crazy how different our experiences were at the two hospitals. They're only a mile from each other, but apparently that's all it takes.

So it's not even always regional, but can differ even between hospitals a few miles separate. I do kind of wonder if the first hospital he described had any added financial incentives, especially since the pressure was coming from a member of the hospital staff and not from their regular doctor.

Myself, I never actually had one single doctor say one word about it. Not my OB, not the neonatalogist, none of the peds that they saw after they were released from the hospital, and not the doc that we finally settled on for them when they were 3 months. At the NICU they were in though, they did have these consent forms that just materialized next to their isolettes, and I did have one random nurse ask about it (even after I thought I'd made it clear we weren't interested).

[uppityperson]

12. The thing about those skin transplants is they grow to fit the mood

sorry

[FLyellowdog]

13. A 3 X 3 inch skin graft from this tissue costs $1800.00.

Insurance is covering the cost.

[Crunchy Frog]

15. $1800.00. And the "donor" of that tissue didn't get nuthin,

in fact he lost quite a bit, and his parents or their insurance company had to pay so that some biotech company could make that kind of profit off it.

I must be the only one here who finds this just a little bit morally questionable. :shrug:

[Rowdyboy]

11. No flames from me...I had one at age 54 for medical reasons....Stupidest

decision I ever made.

Given the option now I would happily tolerate the medical condition the circumcision "fixed".

[Manifestor_of_Light]

16. More men should speak up who had it done as adults.

More grown men should speak up about this. Men who had this done to them as infants have nothing to compare it to.

John F Kennedy said that he felt "castrated" after he was circumcised as an adult.

I think it's barbaric in any case, and I'm a grown woman.