The following inherent risks are iatrogenic (doctor induced), and result directly from the neonatal circumcision surgery.(1)(2) As noted earlier, Williams and Kapila estimate that a realistic rate of complications from neonatal circumcision ranges from 2% to 10%. To many men who become aware of the function and value of the prepuce, the fact that this genital sensory organ was amputated from them at birth is itself a complication of circumcision; in which case, the actual complication rate is 100%.
1. Hemorrhage: Considering that a 6.5 pound infant has a total blood volume of less than 8 ounces, bleeding from the frenular artery can quickly cause shock and sometimes death. Serious hemorrhage occurs in about 2% of infants. While death is a rare complication of circumcision, it does occur and represents an unnecessary risk at which to place a newborn.
2. Infections: Localized or systemic (e.g., bacteremia, meningitis, osteomyelitis, lung abscess, diptheria, tuberculosis, tetanus and necrosis of the perineum). [The same study by Williams cited earlier reports that a realistic infection rate is probably as high as 10%.] Serious infections can cause irreparable and lifelong harm.
3. Urinary Retention: Swelling from the trauma of the surgery, pain associated with attempts at urination, and sometimes the Plastibell device (if used) can cause the infant to retain his urine.
4. Laceration of penile and scrotal skin: to varying degrees.
5. Excessive penile skin loss: This occurs when the prepuce is drawn forward so much so that the entire penile skin sheath is removed. From puberty and beyond, penile bowing and pain occurs at the time of erection. Skin grafts are sometimes required.
6. Beveling deformities of the glans: Varying amounts of the glans are shaved off, leaving a scarred beveled surface, and at times the entire glans has been amputated.
7. Hypospadias: While this is more frequently a congenital defect, it can also result from circumcision. When the frenular area is drawn forward too far, 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 crushing clamp inadvertently is passed into the urethra and is closed, it crushes the upper portion of the urethra and the glans, creating a urethral opening on the dorsum (top) of the glans.
9. Retention of the Plastibell Ring: The Plastibell, which normally falls off in 10 days, may be buried under the skin, causing ulceration and/or necrosis. Loss of the glans has also been reported.
10. Chordee: This is often congenital, but can also result from circumcision. Dense scarring at the frenular area causes penile bowing upon erection; may require Z-plasty surgery to release the bowing.
11. Keloid Formation: Prominent scars can occur where the skin-mucous membrane has been incised, crushed or sutured.
12. Lymphedema: Chronic swelling of the glans due to infection or surgical trauma which can block lymphatic return.
13. Concealed Penis: The circumcised penis becomes hidden in the fat pad of the pubic area.
14. Skin Bridges: This is a common complication that consists of one or more thick areas of scar tissue that form bridges between the coronal edge of the raw glans penis (head) and the raw circumcision would on the shaft. For some men these can be quite painful during erection, restricting the free movement of shaft skin and pulling on the glans.
15. Phimosis of Remaining Foreskin: When only a segment of the foreskin is removed, the remaining tip sometimes becomes tight and nonretractable, often subjecting the child to 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 foreskin.
18. Loss of Penis: This can be caused by constricting rings such as the Plastibell or by the use of an electrocautery device. More frequently the loss is the result of infection, with the penis becoming increasingly necrotic until finally the entire organ sloughs. The proposed solution in many cases is gender reassignment.
19. Meatitis: Inflammation of the urethra, from loss of protective foreskin, which can lead to ulceration and meatal stenosis. Many infants and children suffer this after their loss of the 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.
Of particular note here is that while these complications can be apparent immediately or over the short-term, almost every one of these affects the male to some degree for a lifetime and can therefore be classified as long-term harm as well.
This list of complications may be of little immediate concern to the reader or even to the circumcisers who perform such surgeries. Given the number of circumcisions performed just in the past 50 years however, and from the view of men whose genitals bear evidence of these complications, the impact is enormous. As was acknowledged earlier in this report, penile complications resulting from neonatal circumcision are underreported and ignored. As stated earlier in this report, a conservative estimate of the incidence of physical complications among males born from 1940 to 1990 ranges from 1.3 million to almost 6.6 million. It must also be reiterated that these figures do not include subsequent sexual or psychological complications manifesting later in life.
Additionally, the most common complications of serious hemorrhage (2%) and infection (up to 10%) can have mild to severe long-term effects when they lead to secondary blood, brain, and nervous system disorders that are rarely reported as complications resulting from infant circumcision.
The consequences of hemorrhage were dramatically highlighted in the 1993 case of Demetrius Manker, a 6-month old Carol City, FL boy. As reported in the June 26, 1993 edition of "The Miami Herald", Demetrius was circumcised by pediatrician Robert D. Young and sent home. Demetrius' mother, Louse Manker, later noticed he was bleeding from the incision and called the doctor several times and a hospital once. "She followed the doctor's instructions to the letter," according to her attorney Patrick Cordero. The bleeding continued and paramedics were called, but Demetrius was pronounced dead at the hospital. "I can't express the way it has affected me emotionally," said the child's mother. "It's something I'll never get over."(3)
The serious consequences of infection were highlighted in a recent case, which is still ongoing. "John Doe" was born in Alaska in 1986. He was circumcised at birth and developed complications. The parents assert that the non-necessity of circumcision was never explained to them, nor were the surgical risks detailed. For "John Doe" the resulting damage from the "small risk of infection," as many physicians typically phrase it, has become a life-long ordeal, an ordeal brought into his young life by a surgery that was not necessary and to which he did not consent.
In a lawsuit filed in the Superior Court for the State of Alaska, August 28, 1987, parents claim that circumcision constitutes an assault and battery upon their son's body. The baby's wound became infected by bacteria while he was in the hospital. He was returned to the hospital for treatment of the acute infection, developed toxic shock, which led to seizures, and was improperly treated. The baby sustained profound brain damage, retardation, palsy, lack of brain growth, damage to his vision and other related damages. To add to the horror of the story, the boy was born with a condition that requires circumcision not be done. The parents say he would not have been circumcised had they been told the surgery is not necessary, causes pain, and has risks.(5)
The hospital where this tragedy occurred claims to have "lost" the medical records for the child. The suit in Superior Court was subsequently lost and no damages were awarded to the family. In a follow-up letter to NOCIRC dated June 25, 1989, one of the parents of "John Doe" wrote:
It's so hard for me to put my thoughts down, just tell your readers the truth. Our son will grow up to be a man in a wheelchair, he is blind, he may never speak, he may never say "Mommy, Daddy," or "I Love you."(6)
"John Doe" is now eight years old. Oral arguments were heard in January of 1994 in the Supreme Court of Alaska to appeal the earlier Superior Court ruling. A decision is expected within a year.
In 1993, just prior to Demetrius Manker's death of circumcision-related hemorrhage, another unidentified boy from California suffered circumcision complications. Little is known about this case because neonatal circumcision complications are rarely covered by the media and are most likely settled out of court in favor of the child and his parents. What is known is that in May of 1993 a newborn lost the tip of his penis while being circumcised at Marin General Hospital, north of San Francisco, and that the child was rushed to the University of California/San Francisco Medical Center for reattachment surgery. According to a July 8, 1993 article in the "Bay Area Reporter" by David O'Connor, "Hospital spokesperson Nancy Nickel said there was a circumcision complication and it is under review but she would not comment further. UCSF Medical Center spokesperson Andy Evangelista said he could not confirm whether the infant was treated at the hospital. He said it is common for the hospital to perform operations on infants' genitalia, including operations to correct botched circumcisions."
Whether the complication is death from serious hemorrhage, an infection-related tragedy, or mutilation to various degrees, all of these are long-term effects. For males fortunate enough to survive the surgery without immediate complications, there is a growing awareness among men of other delayed, long-term consequences of neonatal circumcision, which are only now beginning to be documented. In addition to a host of psychological effects documented later in this report, preliminary findings from the "Awakenings" survey indicate the following physical effects:
- Progressive loss of glans sensitivity (this is the most common complaint, whereby some men report stimulation needed to the point of pain to achieve orgasm)
- Sexual dysfunction, including impotence
- Increased incidence of nonspecific urethritis (NSU)
- Skin tags (small pieces of remaining prepuce)
- Skin bridges (shaft skin fused to the corona of the glans during healing, creating a "bridge")
- Prominent scarring
- Skin tone varience (between shaft skin and remaining dried membrane of inner prepuce)
- Bowing/curvature of the penis (from a tight, uneven circumcision)
- Painful erection (results from too much skin being removed during circumcision)
- Pubic hair on penile shaft (from a tight circumcision)
- Bleeding during sex (from being circumcised too tightly that shaft skin tears during erection and/or coitus)
(1) Ritter, Thomas J, JD. "Say No to Circumcision!"; pp. 5:1-6.
(2) Wilcox, N, RN. "Male Breast and Pelvic Exam, Introduction to Clinical Medicine, Clinical Skills Preceptorship." University of California/San Francisco School of Medicine, Winter Quarter 1994.
(3) "Infant bleeds to death after being circumcised" by Peggy Rogers, The Miami Herald, Section B, June 26, 1993.
(4) NOCIRC newsletter, Fall 1988, vol. 3, no.1, p.2.
(5) "Circumcision Nightmare." Truth Seeker, July/August 1989: p.52.
From Awakenings: A Preliminary Poll of Circumcised Men, NOHARMM, P.O. Box 460795, San Francisco, CA 94146.
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