Male Circumcision: Hashtag Campaign Raises Awareness of Bodily Integrity

circumcision-banner2A Florida mother has fled with her son Chase after a court ordered that she follow through on a signed a legal agreement between herself and the boy’s father Dennis Nebus, that the boy would receive a routine circumcision. The problem is that back in December 2011, Chase’s mother Heather Hironimus never followed through with the operation for which the father would arrange and pay for and she and her son are now opposed to the operation, despite the father’s wishes. Heather and Chase’s supporters and anti-male circumcision activists have created a Saving Chase fundraising and awareness campaign and matching twitter hashtag.

This topic isn’t anything new, and it will most likely be argued for decades to come, in such the way that vaccination or global climate change are the topics that are always hot button at the moment.

I always state, and I will reiterate again, that I am highly biased on many topics, including this one. However, in this particular situation, I don’t just believe that I am right, I know I am.

Some of you many know that I am a feminist, and as such, I am vehemently against any form of female genital cutting, culture and religion be damned. So then I wonder, how is it not possible for me to be just as outraged that we as a society, for merely a marginal improvement on health, can support and condone the ancient and ritualistic mutilation of an intact penis?

While trying not to impose my own western values upon other cultures, I am really torn on this issue. Political Scientist Rebecca Steinfeld reconciles my misgivings in an interview with Tove Lyssarides titled: Hysteria -– Male Circumcision is a Feminist Issue Too. She states, “To preserve the community, one sacrifices some individual rights, in this case those of the individual boy. The problem is that sacrificing basic concepts like individual rights and bodily integrity to a particular worldview focused on community could be a slippery slope. Plus, it would require re-thinking opposition to FGC, and perhaps even re-allowing it on the basis of parents’ religious beliefs or cultural preferences. In my opinion, this should be unconscionable.”

The ancient practice of male circumcision dates back to the Egyptians. After failed attempts at castration, which resulted in hemorrhaging and death, they discovered that male circumcision had safer outcomes and yet still emasculated the male slaves with “the indestructible marking and the distinctive feature of the slave”. (SOURCE: History of Circumcision from the Earliest Times to the Present, by Peter Charles Remondino).

Aside from religious rites, it has been used for many reasons including cleanliness, coming of age and to curb sexual urges, as written by J.H. Kellogg, the insane Victorian doctor and author of The Plain facts for young and old: Embracing the natural history of hygiene and organic life. There he states: “A remedy which is almost always successful in small boys is circumcision, especially when there is any degree of phimosis. The operation should be performed without administering an anaesthetic, as the brief pain attending the operation will have a salutary effect upon the mind, especially if it be connected with the idea of punishment, as it may well be in some cases. The soreness which continues for several weeks interrupts the practice, and if it had not previously become too firmly fixed, it may be forgotten and not resumed.”

While I can’t find conclusive data, the circumcision rate in Canada is about 30%, with very almost nil stats from Newfoundland and Labrador with the highest rates in Albert and Ontario. (SOURCE: Wikepedia).

My own family tried to persuade me toward circumcision of my two boys with an old story of dear uncle of mine who was in the war (not Afghanistan or Korea, I mean like World War II). He was never circumcised as a child because my mother’s family were Catholic, but while stationed for 2 years in India, he developed an infection during the war. This is an extreme case, I’ll tell you; my mother recalling pictures of him covered from head to toe with boils.

Infant circumcision takes away the choice from that human being, to decide for themselves what they want to do with their body when they are old enough to make that decision for themselves, for non-medical reasons such as aesthetics or religious beliefs.

Well, that’s what those who support male genital cutting are trying to sell. And for what reason? Health.

Why are they selling heath now as a reason to circumcise? Because, that is science and that is what any first world western nation stands by.  And yet, The Canadian Paediatric Society considers circumcision a non-therapeutic procedure and does not recommend routine circumcision for newborn boys, is no longer covered by most health care plans and fewer paediatricians are offering this paid service. The looked at both sides of the equation and formulated an opinion based on science. Here are the stats for the uncircumcised male so you can see for yourself (SOURCE: Canadian Paediatric Society):

• .7 % will be admitted to hospital for a UTI before they are one year old.
• .10 % will have a circumcision later in life for medical reasons. Older children who are circumcised may need a general anesthetic, and may have more complications than newborns.
• Circumcision slightly lowers the risk of developing cancer of the penis in later life. However, this form of cancer is very rare. One of every one million men who are circumcised will develop cancer of the penis each year. By comparison, 3 of every one million uncircumcised men will develop penile cancer each year.
• Will have a decreased risk of urinary tract infections.
• Will have a reduced risk of some sexually transmitted diseases in men. The CDC states that the benefits of male circumcision outweighs the risks, based upon rates of HIV transmission of uncircumcised men in Africa. While it America it states, “heterosexual transmission accounted for only 5% of infections. The potential impact of MC (male circumcision) on the U.S. epidemic through prevention of heterosexual transmission to men is, therefore, currently limited.
• Circumcision also makes it easier to keep the end of the penis clean.

There are anatomic contraindications (procedure should not be used as it may be harmful to the patient) for routine circumcision that includes some conditions such as webbed penis, hypospadias (present but malformed foreskin), chordee (curvature), ambiguous genitalia (genital ambiguity) and buried penis, but with an otherwise healthy child, here are an abridged list of rare complications from routine circumcision.(SOURCE: Stanford School Of Medicine):

• Bleeding is the most commonly encountered complication of circumcision with an incidence of 1% in a large retrospective review. (SOURCE: PubMed Central) The expected blood loss during neonatal circumcision is just a few drops, so bleeding that exceeds this expectation is a complication. Fortunately, almost all cases of bleeding with neonatal circumcision are very mild.
• Infection: Because newborns are relatively immunocompromised, infections in this age group can become serious problems. Although rare, meningitis, necrotizing fascitis, gangrene, and sepsis have all been reported as complications of infected circumcision sites.
• Insufficient foreskin removed: A more problematic situation can occur if the redundant foreskin slides back over the glans and scars down, creating a phimosis. In this case, surgical repair is necessary.
• Excessive foreskin removed: Because the foreskin is attached to the glans on the inner surface, it is possible to draw skin from the penile shaft up into a circumcision device and remove too much. In most cases the denuded area will epithelialize spontaneously and give a satisfactory end result, but the inital appearance can be quite distressing to both parents and practitioner.
• Adhesions/ Skin bridges: During the process of circumcision, these adhesions need to be lysed in order for the foreskin to be completely removed. If adhesions are not completely removed, the circumcised edge of the foreskin may be drawn up over one section of the corona and create an asymmetric appearance.
• Inclusion cysts: As the circumcision site is healing, inclusion cysts may form along the cut edge. These cysts are thought to either result from smegma accumulating in the incision or from the epidermis rolling in at the time of the procedure. Inclusion cysts may be asymptomatic or may become infected. If size or infection are problematic, surgical excision may be necessary.
• Abnormal healing: As with any wound, the possibility for abnormal healing is present with circumcision.
• Meatitis: When the urethral opening becomes red and inflamed, the condition is known as meatitis. This is typically a self-limited condition which resolves as the epithelial surface of the glans thickens post-procedure.
• Meatal stenosis: Meatal stenosis, a narrowing of the urethral opening, is an uncommon complication of circumcision that usually does not require treatment. It is thought to result either from chronic meatitis that leads to scarring or from mild ischemia of the glans during circumcision.
• Phimosis: When circumcision is performed on a boy with penile web or buried penis, the circumferential edge can pull together in a purse-string fashion and result in the penis being trapped under circumcision site, creating a secondary phimosis. In some cases, good outcomes have been reported with watchful waiting, but surgical correction may be necessary.
• Chordee: When chordee is not present at birth but develops as a complication of circumcision, it is thought to be due to uneven amounts of foreskin removal from the ventral and dorsal surfaces. In this case, the corporal bodies are normally formed — unlike “true chordee” — but the healing of the asymmetric edge causes the glans to deviate. Surgical correction may be necessary.
• Hypospadias: When not present at birth and noted as a complication of circumcision, it is thought to be related to injury from a clamp device that results in avulsion or splitting of the ventral glans. Surgical correction may be necessary.
• Epispadias: As a complication of circumcision, it is also rare but is possible if the device used to create a dorsal slit in the foreskin is inserted into the urethra inadvertently. Surgical correction may be necessary.
• Urethrocutaneous fistula: The creation of a fistula between the urethra and the skin is another rare complication of circumcision. It occurs when there is injury to the urethra. This is thought to be most likely if there is aggressive clamping or suturing on the ventral surface of the glans or penile shaft as the urethra lies quite close to the skin in this area. Surgical correction is necessary.
• Necrosis of the penis: Necrosis is also a rare complication, but it has been reported as a complication of circumcision in the setting of infection or injudicious use of an electrocautery device to control bleeding.
• Amputation of the glans: This is a rare but devastating complication of circumcision which has been reported with inappropriate placement of the Mogen clamp. The clamp is designed to allow the device to open only enough to allow the foreskin, and nothing else, into the area of compression, but if placed incorrectly with all or part of the glans admitted into this area, amputation will occur.
• Death: Death is an extremely unlikely complication of neonatal circumcision, but it has been reported. During a five-year period at the Massachusetts General Hospital, 7.4% of all visits to a pediatric urologist were for circumcision complications. This translated to an average total cost per patient for redo procedures of $1,617 and an estimated annual cost of $137,122 to the institution. (SOURCE: PubMed Central)

In conclusion, it is heartening that this topic has been brought into the forefront. As I mentioned earlier, I don’t think that it will be easily solved, and while I would personally like to see an outright ban in Canada of infant male circumcision, I don’t know if that will happen any time soon.

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