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Complications of Circumcision
For a fuller list of Reasons Not to Circumcise, click there. Death now has its own page.
Strictly speaking, a disease has complications, surgery such as circumcision has side-effects.
Risks vs Benefits
An article in Pediatrics in January 2000 attempts to compare the benefits of circumcision with the risks. However, the only risks considered are the direct complications of surgery - and only some of those.
"Complications" are defined very conservatively, including only those that are noticed before the baby leaves hospital or that lead to him being brought back to the same hospital or doctor. They don't include aesthetic results so bad the parents take him back for more surgery. Nor do they include the ones the penises' owners learn to live with - after all, part of the rationale of circumcision is horror of the penis, so the mother of a cut baby probably doesn't get to see or attend to a significant proportion of uneven cuts, scarring etc.
The researchers did not cite two of the main studies of complications, those of William and Kapila or Patel.
Benefits are defined very generously, using a lot of the work of Wiswell, rather than those who estimate the benefits more conservatively, such as To.
No intrinsic worth is assigned to having intact genitalia, or to not performing invasive surgery, or to having a choice.
The same is true of a study published in New Zealand, sometimes cited as supporting an overall advantage to infant circumcision. A cohort of all the boys born in one city over a period of months in 1977 were followed for eight years. (They are still being followed.) This study is potentially valuable, because only one quarter of the 590 boys were circumcised at birth. Few US studies include enough intact boys to achieve statistical significance.)
It seemed to find that circumcised boys had more penile problems in their first year, intact boys in the longer term, with a difference of "marginal significance" in favour of circumcision. Closer examination shows that boys not circumcised at birth continued to be counted as "uncircumcised" throughout the study, and their "penile problems" included complications of post-neonatal circumcisions!
"The estimated 1% to 3% incidence of complications after newborn circumcision covers only the immediate postoperative period prior to the infant's discharge from the hospital. The reported risks are hemorrhage in 1%, infection - occasionally leading to sepsis - in 0.5%, meat[iti]s and meatal stenosis, u[r]ethrocutaneous fistula, adhesions between the glans and remaining prepuce, secondary phimosis, and cosmetically unsatisfactory results. The rate of subsequent repeat surgery to correct adhesions of the glans, meatal stenosis, fistula, and phimosis with buried penis is unknown, but our practice at Children's Hospital of Philadelphia includes
about two such cases per month. While this is not a large percentage of
the total number of circumcisions preformed, it is a significant number of
children undergoing surgery for the complication of this operation. "
- Schwartz, et al. "Pediatric Primary Care: A Problem-solving Approach" pp 861-862.
(At 1.25 million circumcisions of newborns in the US per year, a 0.5% infection
rate amounts to 6000 cases per year, and a 4% overall rate of
complications requiring treatment represents 48,000 patients experiencing
avoidable morbidity.)
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Where facilities are scarce, the position is much worse.
Bungoma district, Kenya: Assessment of traditional and medicalised male circumcision
The study, which was conducted to establish a pre-training baseline assessing safety of male circumcision in resource-poor settings found high rates of adverse events for both medical (17%) and traditional circumcision (35%). The most common were profuse bleeding, infections, pain, insufficient foreskin removal and torsion. The study findings highlight what could go wrong if providers are not well trained and adequately equipped to perform male circumcision in hygienic settings with good post-surgical follow-up.
UNAIDS/CAPRISA Consultation
on
Social Science Perspectives
on Male Circumcision for HIV Prevention
18-19 January, 2007
Summary Report
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Linus Okeke, Adanze A Asinobi and Odunayo S Ikuerowo
BMC Urol. 2006; 6: 21.
Published online August 25 2006
Abstract
Background
The number of infants managed for neonatal circumcision injuries in our unit has been on the increase over the past 16 years. In our search for the sources and reasons for these injuries, we were unable to identify any previous studies of circumcision injuries from our environment. We therefore decided to carry out this study in order to shed some light on this growing problem.
Methods
The patients were made up of 370 consecutive consented children attending our infant welfare clinic for immunization over a period of 3 months. Information on their demographic data, their age at circumcision, where, why and who circumcised them was obtained from their mothers. They were clinically examined for the presence and type of complications of circumcision.
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). [That is, doctors were no better at circumcising than nurses.]
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. [The complication rate could also be reduced by reducing the circumcision rate.]
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The following complications are listed in approximately increasing order of severity.
Aesthetic damage
Unaesthetic outcomes of circumcision are seldom reported. One purpose of circumcision is to create a "maintenance-free penis" and mothers are less inclined to inspect it than mothers of intact sons. Click here for pictures of
In Reuters, via Medscape:
Most Penile Adhesions Resolve Spontaneously
After Neonatal Circumcision
[The real headline:
More Than Two-thirds of Circumcised Babies have Penile Adhesions]
WESTPORT, Aug 03 (Reuters Health) - Penile adhesions are common after neonatal circumcision, but most do not require any intervention, according to researchers from the Cleveland Clinic Foundation, in Ohio.
Dr. Lee E. Ponsky and colleagues looked for penile adhesions in all
circumcised boys who presented to their pediatric urology clinic. In total, 254 boys were examined, ranging in age from 1 month to 19 years, 8 months.
The prevalence of penile adhesions declined with age, the investigators
found. [That, or the incidence of penile adhesions has been increasing over the last 20 years.] All told, 71% of infants had adhesions compared with 28% of boys ages 1 to 5
years, 8% of those ages 5 to 9 years and 2% of older boys. About one third of infants had adhesions more severe than grade 1, compared with 10% of boys ages 1 to 5 years and none of the boys older than 5 years.
Seven of the patients had been treated for adhesions, and three of these had recurrences, Dr. Ponsky and colleagues note.
The findings indicate that most penile adhesions resolve spontaneously with time, the researchers write. Although the study did not address the reasons for spontaneous resolution, they point out that possible mechanisms include "an increased number of erections with age, penile growth, hormonal influence on local tissue and keratin pearl formation." [This indicates ignorance of the normal development of the intact penis, and how it might be affected by circumcision.]
Based on their findings, the Cleveland researchers advise against routine lysing of penile adhesions, except perhaps when they involve the circumcision line. [Another conclusion is that these adhesions could be prevented by not circumcising.]
"Adhesions that involve the circumcision line may be more likely to cause skin bridges," they note. [How else do they think skin bridges are caused?]
J Urol 2000;164:495-496.
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Phimosis
Blalock et al. found phimosis in 2.9% of 521 circumcised boys, two-thirds of them (10/15) with buried penis. Since "phimosis" (usually a misdiagnosis of the normal infant attachment of the foreskin to the glans) is a common reason for circumcision, this is ironic indeed.
Hairy shaft
The shaft of the penis is normally hairless, but erection of a tightly circumcised penis can pull hairy scrotal skin on to the shaft, causing discomfort on intercourse.
One sufferer is shock-jock Howard Stern. He discussed it on May 4, 2006 at 6.15am.
Haemorrhage
Patel found 35 cases of haemorrhage from 100 circumcisions, mainly just oozing, but a baby's body has pitifully little blood (a breakfast-cup to a soft-drink can full, 300-350ml), and so a tiny loss, 30ml, about two tablespoons, may call for a blood transfusion.
Circumcised baby 'almost died'
By LORNA KNOWLES
14 June 2000 Daily Telegraph
(Sydney, Australia)
A SYDNEY GP circumcised 14 infant boys without adequate anaesthetic and caused one baby to "almost bleed to death", a tribunal heard yesterday.
Dr Aladdin Matter is accused of professional misconduct over the
circumcisions of the babies, aged from 32 days to eight months at his Greenacre rooms between March 1996 and July 1998.
The Health Care Complaints Commission alleges the procedures were contrary to a condition of his registration imposed by the
Medical Board in 1996. The commission alleges in
circumcising an eight-month-old boy, identified as Child N, on May 31 1997, Dr Matter: failed to provide adequate analgesia or anaesthetic; removed an excessive amount of the outer foreskin; failed to remove part of the inner foreskin; failed to stop the bleeding and failed to provide adequate post-operative care.
"He (the baby) was admitted to the New Children's Hospital, having almost bled to death," Lisa Stapleton for the commission alleged.
The hearing continues.
(September 17, 2000)
Dr Matter was convicted and banned from medical practice for three years.
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"He almost died": A mother's story.
If a baby proves to be haemophilic (having blood that doesn't clot, leading to uncontrollable bleeding), circumcising him can be catastrophic.
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Damon Courtenay was born in Sydney in 1966:
By the time we'd had Damon home ten days and he was due to be taken back to hospital for his circumcision, we were into a routine. ... I think it was simply a common social custom which we took more or less for granted, happy to let the hospital undertake the inconsequential operation. After Brett and Adam, we knew circumcision wasn't a big deal and we brought Damon straight back home from the hospital.
[That night at a wedding reception, his father has a premonition and they hurry home.]
I pulled the blanket away from my sleeping son and reached down for him. Then I saw that his nappy was soaked with blood.
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Damon proved to be haemophilic. He was given an HIV-infected blood transfusion some time before 1985 and died of AIDS complications on April 1, 1991, hence the title of his father's book about him:
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| - April Fool's Day: A Modern Love Story
by Bryce Courtenay
(Also sold as April Fool's Day: a Modern Tragedy)
Read reviews and order
from Amazon.com:
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Meatal stenosis, meatal ulcer
In babies:
A baby's long foreskin prevents the re-entry of urine. Ammonia from stale urine attacking the meatus, the opening of the urethra in the glans of a circumcised baby, is believed to attack the delicate surface, creating an ulcer. Bacteria like E. coli may also play a part.
This can lead to narrowing (stenosis) of the meatus, which may have to be corrected by surgery; meatotomy. Patel found 31 cases of meatal ulcer and 8 meatal stenoses in 100 circumcisions. Meatal ulcer can cause urinary retention and if untreated, kidney failure.
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In adults:
A pathologist writes:
A patch of surface necrosis [dead tissue] is commonly seen
on the glans of adult circ patients. In all the ones I have seen, the
necrosis (which appears as a dark purple area) was in the ventral
aspect from about the attachment of the frenulum up to and partly
surrounding the meatus; I have never seen necrosis in the dorsal
aspect. Even if the frenular artery is not severed (standard methods
caution about taking care not to cut this artery by damaging the
frenulum, hence the noticable increase in numbers of cut boys with an
intact frenulum over the last decade or two), the disruption of the
venous drainage via the paired frenular veins would have the same
effect of preventing circulation across the extensive capillary
plexus [network] in the skin of the glans and meatus. This disruption is
inevitable as all the superficial veins (including the frenular) are
cut in any form of circumcision, but I suspect that the dorsal surface has
other alternative routes via the deeper veins.
Loss of circulation
through the glanular skin would take some days for the capillary bed
to undergo angiogenesis [growth of blood vessels] in the healing sequence, during which time
the epithelial [top layer] cells would die, which in turn would expose the
underlying [layer], and that is exactly how an ulcer is defined.
Once the
dermis is exposed, abrasion with clothing etc. will irritate and
impair/delay healing. Healing of this ulcer increases the collagen in
the tissue as part of the repair process which we see as a scar, this
being increased with any irritation or extension of the healing time
and the loss of stretch capacity leads to [narrowing] of the meatal
opening. |
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The lump partially blocking the meatus is a consequence of meatal ulcer, a very common result of circumcision. |
A series of cases were reported a few years ago in J Urol using
topical anesthesia for meatotomy. Most cases are done under general anesthesia. It costs about $1500 to have it done as
an outpatient.
De-gloving
(Where the outer skin layer slides out of alignment with the mucosa, like a glove coming off a finger)
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From the PSOT blog
To Plastibell or Not To Plastibell?
Comment for the STFM procedure list dialog on Circumcison Techniques.
I have been unhappy with the Plastibell device...
Mogen is the easiest and fastest with excellent safety, but lack of fundamental skills with needle and thread intimidate many from being able to do these procedures past the newborn period.
...
REPLY MF-MD I would still vote that residents need to learn Plastibel, too. I did more Plastibels than Gomco's in residency, and am much more comfortable with them, and faster. A Urologist that has helped us with complications we've had with Gomcos said he sees far more complications with Gomco's than Plastibel's. And I've had 2 situations lately where we started one procedure, and for various reasons switched to the other (one each way!). And sometimes you go to do a Gomco and find the size you need isn't available... Just my thoughts. Mary
REPLY -WMR I've never seen a long term complication from a Gomco, but continue to believe that the procedure is not medically indicated. What are the complications you witnessed that required care of a urologist, and could you give me an estimate of their frequency?
REPLY MF-MD
I see residents differentially pull too much of the outer skin through, leading to a "de-gloving" problem which distresses the parents. [It probably distresses the babies, too.] I've also see residents inadvertently separate the two layers as they get the skin off the bell, again leading to bleeding and a "de-gloved" appearance. Obviously this is a teaching issue, and we work to prevent it. I see/hear this about once a year, overall. The only complication I've had with a Plastibel in 18 years (18 years mine and 3 years residency teaching) was once when we probably used a ring that was slightly too large and it slipped up onto the shaft after it separated and required some imagination to get it off! Mary
REPLY-FORMAN The only complication I used to get from a Gomco was the occasional bleeding, easily sutured with some gut suture.
REPLY WMR--WE have seen the degloved effect once every 70 Mogens in the hands of inexperienced physicians, but it is easily identified. It does not require urological consultation, but you do need to identify the correct anatomical plane and reapply the clamp.
...
Wm MacMillan Rodney MD
Adjunct Professor of Family Medicine
Meharry/Vanderbilt School of Medicine
Medicos para la Familia
Memphis and Nashville, Tn.
www.psot.com
See also Ethics for more admissions from this doctor.
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Urethrocutaneous Fistula
| J Pediatr Surg 2003 Apr;38(4):642-3
A very late onset urethral fistula coexisting with skin bridge after neonatal circumcision: A case report.
Yazici M, Etensel B, Gursoy H.
Adnan Menderes University, Department of Pediatric Surgery, Aydin, Turkey.
Complications of neonatal circumcision are generally minor and occur early; a few reports exist on the late or serious kind. The authors describe a case of urethrocutaneous fistula occurring 13 years postcircumcision. The patient also had a skin bridge, another late complication of circumcision. The authors suggest erections in puberty as the triggering factor for onset of fistula. To our knowledge, neither such a late occurrence of fistula nor coexistence of
these complications have been reported.
J Pediatr Surg 38:642-643. Copyright 2003, Elsevier Science (USA). All rights reserved.
PMID: 12677587 [PubMed - in process]
[Lack of reporting of these complications has more to do with failure of follow-up of circumcision, than actual rarity. Skin bridges are remarkably common.]
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Infection
Making a wound on a newborn near the source of faeces presents a significant risk of infection. Patel found 8 infections from 100 circumcisions. Infection can lead to meningitis and death.
Staphlococcus
Enzenauer RW, Dotson CR, Leonard T, et al. Male Predominance in Persistent Staphylococcal Colonization and Infection of the Newborn.
Hawaii Medical Journal 1985;44(10):389-90, 392, 394-6.
The authors conclude:
The increased incidence of staphylococcal colonization and pyoderma in
males may be associated with circumcision performed after the first 24 hours of life in the nursery.
Circumcision is performed on approximately 90% of the male infants horn at our hospital.6 In our study population, 87% of the males were circumcized. Circumcision, by its very nature, requires more staff-patient "hands-on" contact. The infants are all lined up and tbeir stomachs lavaged [pumped] clear in preparation for the procedure. The circumcisions are done daily, as a group, in a small area, using reusable circumcision restraints. Postoperatively, there is also more handling of the diaper area in caring for the fresh, hemorrhagic wound.
A larger study. involving more infants, is required to validate the hypothesis that circumcision is the culprit responsible for the increased rate of staphylococcal colonization and infection in newborn males. This may be due to the remarkably high rate of neonatal circumcision done in the United States. A much smaller study would be satisfactory if it were performed in Great Britain or one of the developed countries of Europe, where the incidence of noncircumcision is more equal to the rate of circumcision in the U.S.
Gellis eloquently indicted circumcision, noting that the infant "has
enough portals of entry for organisms as it is," referring to the infant's nose, mouth, conjunctiva, and the cut end of his umbilicus. "It seems totally unnecessary to aid and abet lurking bacteria by adding a raw wound to his genitalia."19
Tuberculosis & Airborne Disease Weekly
Tuesday, April 4, 2000
Staphylococcus Rash in Babies Linked to Health Care Workers
2000 APR 4 - (NewsRx.com)
An outbreak of Staphylococcus aureus pustulous rash in a group
of newborn, circumcised babies has been linked to medical workers
in the neonatal nursery.
The outbreak occurred in the newborn nursery of a 150-bed naval
hospital in eastern North Carolina and lasted from August to
January of 1999.
"Cases were newborn males who had undergone a circumcision
procedure and post-discharge required anitmicrobial treatment for
severe postulous diaper rash," reported K.K. Hoffmann and
colleagues. Seventeen cases out of 36 total were cultured, and
all 17 showed methicillin-sensitive, erythromycin-resistant S.
aureus.
As usual, the article is at pains to blame the health workers, not the circumcisions.
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In one hospital in Long Island, in October 2003, four baby boys contracted antibiotic-resistant staph. infections after being circumcised.
Doctors Opposing Circumcision warns (23 October, 2005) that the risk of Methicillin-Resistant Staphylococcus Aureus (MRSA) is now too great to allow non-medically indicated ciricumcision to continue:
... The advent of MRSA in epidemic proportions increases risks associated with male neonatal circumcision beyond those previously contemplated and further increases the desirability of the non-circumcision option. MRSA and other antibiotic-resistant varieties of SA, such as vancomycin-resistant Staphylococcus aureus (VRSA), increase risk, including death, to newborn circumcised boys. In view of this increased risk, the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists should review their policy (2002) of offering elective medically unnecessary non-therapeutic neonatal circumcision at parental request.
... Medical practitioners must consider the epidemic status of MRSA and exercise their independent judgment regarding the performance of non-therapeutic neonatal circumcision. There is an ethical duty to not perform scientifically invalid medical treatment, especially when it puts the patient at risk. Doctors must act in the best interests of their child-patients regardless of parental requests. Doctors may conscientiously object to the performance of non-therapeutic circumcision of children.
Complete text
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Hepatitis B
Turk J Gastroenterol. 2002 Mar;13(1):1-5
Hepatitis B seroprevalance and risk factors in urban areas of Malatya.
Kurcer MA, Pehlivan E.
Inonu University Medical School, Department of Public Health, Malatya.
BACKGROUND/AIMS: To determine the prevalence of hepatitis B viral markers
and to assess possible risk factors in urban areas of Malatya.
METHODS:
This was a sero-epidemiological, community based cross-sectional study and
included 646 participants( female 352, male:294) from 192 houses. A face
to face questionnaire was carried out and HBsAg, anti-HBc and anti- HBs
markers were analyzed from blood samples using Micro ELISA technique.
RESULTS: The prevalence of HBsAg, anti-HBc and anti-HBs were found to be
6.0%, 29.3% and 30.3% respectively. In the final logistic regression, HBV
infection (=anti HBc+) was independently associated with the age group of
21 years and older (OR=3.7, 95% CI=1.884-7.494), in illiterate subjects
(OR=2.1, 95% CI=1.180-3.326), in farmers and labourers (OR=2.8, 95%
CI=1.042-7.953) and in these with multiple sexual partners (OR=2.1, 95%
CI=1.574-8.168). In addition, HBV infection was significantly higher in
circumcised male children compare to uncircumcised ones ( chi2=5.58,
P=0.01), in ones who gave birth to child at home compare to in ones who
gave birth to a child at hospital ( chi2=13.86, P=0.0001).
CONCLUSION: The
results of our study indicate that Malatya province has a moderate
endemicity with regard to HBV infection.
PMID: 16378266 [PubMed]
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Neuroma
Destruction of the large number of the nerve-endings of the prepuce is inevitable in circumcision. Human and animal studies show that when a nerve is cut, the cut end swells up greatly and the fibre sprouts and branches, resulting in "a disordered tangle of axons, Schwann cells and fibrous tissue" instead of the original receptor. According to Cold and Taylor, studies of circumcision sites show amputation neuromas - well-known for causing sensations of pain. It may be speculated that a confusion between these pain sensations and sexual pleasure are an outcome of circumcision.
- based on Cold, CJ and Taylor, JR, The Prepuce
in BJU International 83, Suppl 1, 34-44 (1999)
Blockage of the urethra
A baby born in Saskatchewan was circumcised with a Plastibell TM at six days old. In the next two days his bladder swelled to the size of a tennis ball (in a newborn, that's big). This put pressure on his inferior vena cava, the main vein draining the lower body, which caused his lower body to swell and turn blue.
Click on the thumbnail for a full-size image
Going in through the baby's belly, doctors drained 200 mL of urine. When they removed the Plastibell TM, they found it was embedded in his glans. The baby passed more than 600 mL of urine in the following 12 hours. It took him two days to recover.
One study of 2000 PlastibellTM circumcisions found a complication rate of 1.8%.
- Linh Ly and Koravangattu Sankaran
Acute venous stasis
and swelling of the lower abdomen
and extremities in an infant
after circumcision
CMAJ 2003; 169: 216-217
Another baby, in Ontario, was not so lucky.
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Buried penis
This condition may arise from natural causes and/or overly "aggressive" circumcision. The shaft of the penis is buried below the surface of the
pubic skin. A true congential buried penis is rare. It is caused by an abnormally large pad of fat over the pubic bones and dense tissue that holds and pulls the penis inward. The skin of the shaft is pushed forward over the glans, giving the appearance of an unusually long foreskin. Circumcising an unrecognized buried penis can remove shaft skin as well as the foreskin, making the case even worse. If the penis was not buried already, removing too much shaft skin when circumcising can bury it by pulling it down into the pubic fat. A second circumcision may be incorrectly performed on patients with various causes of concealment, preventing repairs made by using the remaining shaft skin or foreskin. Instead the boy will need a skin graft.
By: thirdkane, posted on SueEasy
2008-04-26
I'm a 35 y/o male with a lifetime disfiguration as a result of
circumcision as a child. My penis is inverted inside my body and as a
result have faced a lot of distress emotionally and socially. It has
effected my life negativly in so many ways, love life, school to where
I missed years worth of school because i was ashamed of my disfigurment
to avoid manditory showering with my peers. |
Boys with a buried penis are often told that they will grow out of it, and many cases will improve, but some will never have a penis that looks as long or works as well as it might. A boy with a deeply buried penis may be ridiculed by other boys. If he has no visible penis when he is standing up, he may have to sit down to urinate.
Buried penis can be corrected by (more) surgery, cutting out pubic fat and sewing down the skin of the groin and scrotum.
Penoscrotal Webbing
If too much skin is taken, the skin of the scrotum is pulled up the shaft of the penis, making it appear shorter and hairy. The "webbing" arises from the raphe of the scrotum being pulled ahead of the rest of it. It can be corrected by more surgery ("Z-plasty")
Deformity
Click here for a case of gross deformity due to circumcision.
Necrotising Fasciitis
Click here for pictures of galloping gangrene from circumcision (Not for the squeamish.)
Priapism caused by necrosis
Zhonghua Nan Ke Xue. 2005 Jul;11(7):544-7.
[Integrated treatment for priapism caused by circumcision: a case report] [Article in Chinese]
Jin BF, Huang YF, Shao CA, Xia XY, Guan FG, Li G, Wang J.
Department of Andrology, Nanjing General Hospital of Nanjing Command, PLA,
Nanjing, Jiangsu 210002, China. hexiking@126.com
Priapism [permanent erection] is rare on clinical condition with complicated pathogenesis which is very difficult to cure. The paper reported a case of a long-time priapism, complicated local skin necrosis [tissue death], which was caused by circumcision. After the failure of routine therapy, we treated the patient with traditional Chinese therapy, such as TCM herbs combined with bone scraping and depletion therapy,
and achieved the satisfactory effect.
PMID: 16078678 [PubMed - in process]
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Oxygen deprivation
1.
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The State
Columbia, South Carolina
July 10, 1975
Boy in coma most of his 6 years dies
A boy who was in a coma for more than six years while a legal
battle raged around him has died ...
Allen A. Ervin was born in July 1985 and had been on life support since December 1985, when his brain was damaged from oxygen deprivation during circumcision. He died at Spartanburg Regional Medical Center on Wednesday, three weeks before his 7th birthday
... The anesthesiologists who attended to Allen during the circumcision
settled the case for $435,000 and agreed to lifetime payment of his medical
bills.
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2.
From the webpage of WILLIAM E. ARTZ, P.C.
The infant Plaintiff, age 20 months, was scheduled for an elective circumcision on 5/18/92. Upon arrival at the hospital, the infant Plaintiff presented with a fever of 100.4 degrees, runny nose, and a dry cough for one week. Rather than cancel surgery, the anesthesiologists cleared the patient. Upon induction of anesthesia, the infant Plaintiff went into laryngospasm and required a paralyzing drug and intubation. Concern arose that the infant had developed pulmonary edema and might need transfer to a tertiary level facility better able to manage the airway. After 2 ˝ hours of observation in the operating room, a discussion ensued as to whether the infant Plaintiff needed transfer at all. The pulmonary edema was largely resolved, the arterial blood gases were dramatically inproved, and the child's O2 saturation levels and lung function were close to normal. Nevertheless, a decision was made to transfer.
Upon arrival at the second hospital, the child came under the largely unsupervised care of an anesthesiologist in his fellowship (one year after residency) on rotation from a neighboring hospital. The treatment plan called for continued intubation and periodic medication which both sedated and paralyzed the child. The arterial blood gases taken at 2:50 p.m. on 5/18 showed virtually normal lung function, making the child a candidate for extubation (tube removal). The anesthesiologist fellow nevertheless decided to continue with intubation and sedation. The sedation was being administered hourly, but the amount was effective for only 30 minutes. Thereafter, the child, by virtue of his agitation and thrashing about, self-extubated at approximately 6:00 p.m. As a result, O2 from the ventilator was delivered down the esophagus into the stomach, causing projectile vomiting at 6:10 p.m. With the tube out of the trachea and the child unsedated, the infant Plaintiff was able to breathe on his own. At 6:20 p.m., the anesthesiologist fellow administered sedation and a paralyzing drug. At 6:25 p.m., the child's heart rate dropped to 47, and then into the 30's. Instead of removing the endotracheal tube and reinserting a new tube, the anesthesiologist fellow administered atropine and epinephrine pharmacologically, causing the heart rate to rise and then drop again. At 6:40 p.m., he finally removed the tube and reintubated the child. Ventilation improved dramatically, but the infant Plaintiff sustained severe hypoxic brain damage as a result of the 15 minute delay in correcting the airway. The infant remained hospitalized for two additional months and was eventually discharged home, where he is cared for by his parents and three sisters.
The infant Plaintiff's cognitive level will not develop beyond first grade level. He has cerebral palsy of the lower extremities, but is expected to be able to walk with tendon-lengthening surgery and a walker. As of age 4, he was not potty trained.
The medicals incurred as of settlement were $175,000, and the lost wage claim totalled $713,000. Cost of future care, were the infant to be placed in a full service school, exceeded $5.6 million by projection, although defense experts felt the child's needs could be fully met with a present value annuity costing $3 million.
The defendants were two hospitals and an anesthesia group, plus two individual anesthesiologists.
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Brain Damage
Click here for the settlement in the case of the brain damage to Jacob Sweet in Anchorage, Alaska.
Clamp injuries
| Tuesday August 29 2001 5:34 PM ET
US warns of circumcision clamp injury risk
WASHINGTON (Reuters Health) - Reports of complications associated with certain kinds of circumcision clamps have spurred the US Food and Drug Administration (FDA) to issue a letter to physicians warning them of the potential for injury if the clamps are misused.
In the letter, doctors are advised not to substitute or interchange clamp components and to ensure that clamps appropriately fit the patient.
"Although research suggests that circumcision is generally a safe procedure, we are concerned that some serious device-related complications have occurred," the FDA said in the letter. Between July 1996 and January 2001, the agency has received 105 reports of injuries involving the clamps, including cuts and bleeding, penile amputation, and urethral damage.
Clamps are used during circumcision to protect the penis while the foreskin is being removed [implying that the foreskin is not part of the penis].
"The use of...clamps that have been reassembled by users with parts from different manufacturers, or that have bent parts or mismatched components, has led to clamps breaking, slipping, falling off during use, tearing penile tissue or failing to make a tight seal," the FDA said.
The agency points out that "although...clamps may appear to have interchangeable parts, these parts may not always be safely interchanged because they may vary slightly in dimensions."
The injuries associated with other types of clamps, meanwhile, stem from the use of clamps "that have jaw gap dimensions greater than those in the manufacturer's specifications, or use of clamps inappropriately sized for patients." This may "allow too much tissue to be drawn through the opening of the device, thus facilitating the removal of an excessive amount of foreskin and in some cases, a portion of the glans," the FDA said.
For this type of clamp, the agency recommends that surgeons "ensure that the clamp being used is appropriate for the patient size," noting that "some manufacturers have two sizes of clamps, one for adults and the other for infants."
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NYTimes
Oy! Did You Hear the One About the Overzealous Mohel?
11/13/06
11:59 AM
Court Reporter
Plaintiffs: L.G., a minor, by and through his parents and next
friends, Dror Gerges and Sivan Gerges
Defendants: Daniel J. Krimsky; Mogen Circumcision Instruments Ltd.
Accusation: An Oceanside, Long Island, rabbi is accused of lopping
off the head of an 8-day-old's penis during a Bris on December 16,
2004.
According to the federal complaint filed last week in Central Islip, New
York, not only was Daniel Krimsky unqualified to perform a Bris, but the
circumcision tool he used — called a "Mogen clamp" for the overly curious
— was faulty, and instructions failed to warn against the (seemingly
obvious) risk of severing. What's worse, the rabbi then tried to hide his
error, and the boy's injuries only came to light when a physician
attending the Bris noticed something was wrong and spoke up.
"L.G. was required to undergo corrective surgery ... which was not
entirely successful," reads the complaint, which is a delicate way of
saying doctors were unsuccessful in reattaching the boy's penis. "(He) has
been permanently disfigured and mutilated, and will suffer forever from a
disfigured and mutilated penis, and from the loss of sexual feeling and
function."
So, what price for a partial penis? [implying a cirmcised penis is not "partial"] Plaintiffs seek $150,000 in
damages from the rabbi and another $150,000 from the makers of the
"Mogen clamp." Only time will tell if the boy will consider that a
fair trade when he grows up.
Disposition: Awaiting response from the rabbi and the clamp
manufacturer, who will likely seek to have the case tossed like poor
little L.G.'s foreskin.
You can read the complaint here.
— Nick Divito
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Loss of glans
Savage Love
by Dan Savage
[Village Voice] October 26th, 2004 1:00 PM
Q. I am 24 years old and lost my entire glans penis, the head of my dick, in a botched circumcision. Basically I have a shaft but there's no head at the end. Unfortunately, I was left with my balls so I still have a sex drive, but it's nearly impossible for me to climax. ...
To the original message (offsite) Email me when this link fails.
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As an infant, I underwent the usual (then) curcumcision procedure. ... I'm from the upper-midwest US area where this was common practice. ... It seems something went wrong during the suposidly "simple" procedure. My glans was sliced off. Apparently there was an attempt to re-attach it with out success. So I was left without the usual head on the end of my member. ... Apparently the doctor who performed the mis-hap, felt a bit guilty about the whole affair (as he well should have) and at some point later in my infancy modified my ramaining foreskin, (which was apparently fairly long) so that I would appear to have a normal intact penis. ... The skin at the tip of my penis had a small opening, so I was not able to retract it at all. ... I didn't have the usual bulge at the end. There seemed to be a few bumps at the end, suggesting the remnants of a coronal ridge, but that is all.
- Bostel's blog, July 8, 2006 |
Major damage, unspecified
Posted by C.A.S.S.I.D.Y. on Myspace on November 22, 2006
Yesterday was Haydens circumsion, and it went horribly wrong. We got him home and went to change his wrap and there was too much blood, we rushed him back to the doctors and Hayden almost bled to death. He was so pale, and wouldnt react to any stimulation hardly. They spent 1 hour trying to get it to stop, the doctor kept pushing and pushing and I just kept crying. It looks horrible. They had to use 5 gel things to stop the blood when the doctor said only one will do. All the nurses were waiting when we left to see how he was. His penis looks hideous, swollen, deformed, and it appears the doctor cut too much. Later on around 11pm hes breathing got really rapid so we rushed him to the ER and the doctors looked at it. They said if there was no bleeding theres nothing they can do, and only time will tell if the doctor cut to much or damaged his penis. (we took him to phx childrens hospital, and they got us in immediately it looked so bad) We have another check up today, and one Friday. All I can say, is honestly, if you want your son circumsized you are taking a huge risk, no matter the doctor. This doctor has preformed tons, in fact I believe he is Jewish even. I won't even touch Hayden, I feel so horrible, my mom has to feed him, change his clothes, his diapers, his wrap, ect... Its the most horrible feeling knowing you just fucked up your own kid. I blame Matt, he is the reason Hayden has welfare insurance, other wise he would of been done the next day at the hospital. Also they ripped his umbilical cord off in the process. His balls look like golf balls, and there is so much bruising at the base of the penis. I will include a picture. The whole time the doctor kept saying, oh he cant feel any pain, hes just mad, and I kept saying no he can, I can tell by my sons cry, ive never heard this tone and pitch before in his life. My mom said your going to give him cardiac arrest. It was just horrible. I kept saying should we take him to the ER? And he said what are you asking me, no he is fine. I felt like saying this is my son, i know when hes fine, and hes not. But I knew we had to stop the bleeding first. Now Hayden is having nightmares, whimpering in his sleep, and I am afraid to even look him in the eye because I remember how his eyes looked, just like help me mom. Just everyone pray that it heals well, and nothing is done to his penis, theres no permanet damage and hes okay. What also upsets me, is Hayden just got nursing down. Hes been nursing for an hour every 3 hours except at night the past 2 days, and now he just gets so frantic he wont nurse. If your going to get your son circ. theres no amount of research that isn't enough, and after this, I wouldn't ever suggest it.
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| WARNING: DISTURBING PICTURES |
| Picture of Hayden's penis 1 | Picture of Hayden's penis 2 |
| In a later post, she wrote that her son has received permanent damage and that his penis will likely never look "right." |
Ablation (removal) of the penis
The tragedy of David (initially named Bruce) Reimer of Winnipeg, Manitoba, is seldom blamed on circumcision, as it should be.
Bruce was born one of normal identical twin boys in Winnipeg in 1965. Seven months later, his mother noticed that "their foreskins were closing, making it hard for them to urinate," a doctor told her that they had phimosis, and both boys were scheduled for circumcision at St. Boniface Hospital.
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(In fact foreskins do not normally close, and true phimosis is not diagnosable in boys as young as seven months, since the foreskin has usually not yet separated from the glans. The facts as given do not stack up. One probability is that the mother had been wrongly instructed to retract their foreskins, and that this caused tearing and scarring, leading to the closure. This is a common excuse for circumcision.)
A power surge in the electocautery needle (used to seal blood vessels by heat) burnt off Bruce's penis, and it was decided to reassign his genitals surgically and raise him as a girl, Brenda. There is a strong suspicion that his being an identical twin was a factor in the decision, and the case was widely used by Dr John Money for the next 15 years to demonstrate that gender is completely malleable, under purely social control.
Brenda was subjected to castration at the age of 22 months, but she was a troubled tomboy throughout her childhood. From the age of eight onward, she steadfastly refused further surgery, and at puberty she resisted taking hormones. Her sexual desires, closely monitored by Dr Money, were towards females, and her parents were made to face the possibility that their daughter was a lesbian.
At 14 she refused to live as a girl any longer and was told the truth about his gender. At 16 he had a penis reconstructed, but the outcome was unsatisfactory and teasing by his peers led to two suicide attempts. At 21 he had another reconstruction with a better outcome. He met a woman with three children, abandoned by their three biological fathers, who was somewhat disillusioned with men's pride in their penile prowess. For some years he was a happily married adoptive father, but he said:
"It was like brainwashing. I'd give just about anything to go to a hypnotist to black out my whole past. Because it's torture. What they did to you in the body is sometimes not near as bad as what they did to you in the mind - with the the psychological warfare in your head."
- The true story of John/Joan
by John Colapinto
Rolling Stone December 11, 1997
(David was called "John/Joan" in the medical literature.)
"It only added to the young couple's misery that [brother] Brian's phimosis had long since cleared up by itself, his healthy penis a constant reminder that the disastrous circumcision on Bruce had been utterly unnecessary in the first place."
Colapinto also discusses another very similar case, also reassigned as female by Dr Money.
In March, 2004, David Reimer committed suicide.
Colapinto has written a feature article for Slate analyzing his motives. (email here if this article becomes unavailable.)
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A more detailed, scientific account of the case of "John/Joan/John" is at the CIRP library. It refers to his circumcision as "phimosis repair by cautery".
David was not born intersexed (hermaphrodite). For issues of intersexuality, see the Intersex Society of North America website. Nor was he transsexual (having a gender identity different from his physical gender at birth). Intactivists in general have no objection to voluntary sex-change surgery performed on adults.
It seems gender identity (what sex we think we are) is laid down in the brain, as is sexual orientation (what sex we are attracted to), and each is distinct from biological gender (XX, XY or other chromosomal makeup, and/or the appearance of the genitals or secondary sexual characterisics) - though all three may be affected by environment, including upbringing. |
Other cases of penis ablation from circumcision (commonly through the use of unipolar electocautery) are reported by Williams and Kapila and Bradley
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A partial ablation is reported from New York in 1995. A three-year old Jewish Russian immigrant child was circumcised by a mohel in a
urologist's outpatient clinic. Consent had been given for the urologist to perform the circumcision. Instead, the mohel negligently amputated the head of the boy's penis. The urologist attempted to reattach the head and transferred the boy to Bellvue hospital by ambulance. Four-fifths of the head of the penis necrosed (died) and came off. After a one-month long trial, the family was awarded a total of $1,000,000. The mohel declared bankruptcy.
Bronx County N.Y.
Plaintif Nozik #20875/90
November 22 1995
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Ouch! Boys Lose Too Much in Circumcision Slip
Updated 3:22 PM ET June 9, 2000 ANKARA (Reuters)
Health workers carrying out a mass circumcision on more than 200 children in western Turkey cut off more than they should have when they got to the last two on Friday.
"Whether it was because of their anatomy or through carelessness, too
much was cut off," Anatolian news agency quoted Manisa health service
chief Ismet Nardal as saying.
Doctors in the hospital where the two-day circumcision marathon was
carried out immediately operated on the pair to try to rectify the
error.
"The children's stitched organs have held, the operation was
successful," Nardal said. "They appear to be alright, but it will
only become apparent later if they have lost their sexual function."
Young boys are circumcised in overwhelmingly Muslim Turkey before
they reach puberty, according to Islamic tradition.
(This item - about a lifetime catastrophe for the two boys involved - was widely reported in the "joke" sections of papers, as the headline suggests. That in itself is part of the psychopathology of circumcision, helping as it does to prevent questioning of the operation itself.)
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Jerusalem Post
Monday, August 14 2000 12:48 13 Av 5760
Baby recovers from 'brit mila' amputation
By Judy Siegel
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AFULA (August 14) - A baby whose penis was
accidentally amputated below the corona by the mohel
(ritual circumciser) and reattached by microsurgery a
month ago was declared fully recovered yesterday at
Ha'emek Hospital in Afula.
Hospital spokesman Danny Brenner said the baby is now
able to urinate normally, and the penile blood vessels and
nerves are fully functioning. The hospital reported the
highly unusual incident to the Health Ministry, but
Ha'emek still doesn't know the identify of the mohel, as
the family refused to give his name and have not yet filed
a complaint.
The parents rushed the baby to the hospital four weeks
ago carrying a plastic bag with the glans penis kept in ice.
Dr. Ya'acov Rosenman, deputy head of the urology
department, and Dr. Boris Lachman performed the
painstaking operation, which took more than eight hours.
Rabbi Yosef Weisberg, the ministry's national supervisor
of ritual circumcisers, had not yet been informed of the
case. "If asked, our committee will investigate. |
Such a
thing is extremely rare, but I have heard of one or two
other cases here over the year. Any mohel who does
such a thing must be blind, have taken a drink, or been
pushed while performing the brit mila," he said.
The fact that there is no circumcision law, "due to
pressure from American Conservative, Reform, and
female circumcisers who are afraid they'll be left out,"
means there are unlicensed mohelim, Weisberg said, but
he could not estimate how many there were out of the
total of several hundred practicing mohelim in the country.
Brenner said that it was possible the family would
complain to the police or sue the mohel for damages now
that the child had recovered, "or maybe they received
payment from the circumciser to keep quiet about the
incident."
Although amputation of the penis is rare in children, said Brenner, the world's top medical experts in reconnecting
adult penises are in Thailand, as nearly every day,
disgruntled wives cut off their husband's organs in a fit of
anger or jealousy.
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J Sex Med. 2007 Dec 14 [Epub ahead of print]
Restoration of the Penis Following Amputation at Circumcision: Shaeer's
A-Y Plasty.
Shaeer O. Department of Andrology, Faculty of Medicine, Cairo University, Egypt.
Introduction. Male circumcision is one of the most commonly performed
procedures worldwide. It has an estimated complication rate ranging
from 0.1% to 35%. Amputation of the shaft is one of the most
devastating complications reported, resulting from entrapment of the
phallus between the blades of the clamp or from thermal injury due to
the application of unipolar diathermy.
Aim. In this work, I describe
the guidelines I adopted in the management of 32 male patients
afflicted with amputation of the shaft of the penis upon circumcision.
Methods. "Shaeer's A-Y plasty" was performed for all patients, whereby
the proximal corpora and crura were released from their attachment to
the pubis and were advanced forward by insetting a specially configured
fat flap into the resultant cavity. Skin grafts were used to cover the
released penis.
Results. In all 32 cases, the released penis was within
the normal range of penile length, and was cosmetically and
functionally acceptable.
Conclusions. "Shaeer's A-Y plasty" is capable
of restoring the native phallus [No, it replaces it with a facsimile] following amputation, with preservation
of both gender identity and physiological characteristics of the penis
to a large extent.
PMID: 18086176 [PubMed - as supplied by publisher]
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Death
Deaths from circumcision are now on a page of their own. The autopsy report on Ryleigh McWillis, who died of blood-loss, is on yet another page.
Here are references for more than 25 other mishaps, mainly ablations.
The Circumcision Information and Resource Centre has a further compilation of complications.
Back to the Intactivism index page.
