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Rapid Responses: Rapid Responses published:
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Not always a "Minor Operation"
- T Chundrigar (24 May 1998)
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Alternatives to circumcision are possible and preferable
- Amryn (24 May 1998)
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Why was this done?
- George Hill (27 May 1998)
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Truth and Denial
- John D Dalton (2 June 1998)
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Children have rights too
- Janet Menage (5 June 1998)
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Foregone conclusions
- Read Schusky (15 June 1998)
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A totally odd article
- Tim Trent (17 February 2005)
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T Chundrigar, Assistant Professor, Surgery, consultant Surgeon Jinnah Med. Coll. and Meicare Hospital, Karachi
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There are many instances in which I often reflect on the term "minor" as applied to circumcision. What your son has gone through cannot be described as minor, and it is not an uncommon by any means post operative course. I am convinced that the psychological effects last a lot longer than the physical, which as in your case usually heal with good effect. This is a very forgiving organ, thankfully. |
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Amryn , lecturer
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I am pleased that your son's penis now looks beautiful and this cosmetic surgery pleases you. A fully functional penis might please your son more. There are much kinder and thoughtful ways of caring for a tight foreskin. A change in masturbation technique or a dorsal slit is preferable to cutting off a complex part of the penis. The foreskin is a natural part of the penis, capable of giving owner and lover much pleasure. The child could not retract his foreskin properly. It is usually the haste to force this issue and to probe around under the foreskin in the name of hygiene that causes the problems. |
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George Hill, NOCIRC of Louisiana Port Allen, Louisiana, USA
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To the editor: We should expect better from a person of Dr MacFayden's education and training. Circumcision is an unnecessarily radical, traumatic, and invasive procedure for a simple problem. Several researchers have found a more conservative approach satisfactory. All that is necessary is the lysing of the adhesions under some type of anaesthesia with application of vaseline to prevent readhesion during the healing period.[1-3] Even more troublesome is Dr Macfayden's surprise at her son's emotional reactions to his penile surgery. The tramatic nature of genital surgery has been known from the time of Sigmund Freud who coined the term "castration anxiety". There are ample reports in the analytical literature of the traumatic effects of circumcision.[4-6] A thorough airing of the trauma of circumcision has recently appeared in book form.[7] There should have been no surprises. 1 Cooper GB, Thompson GJL, Raine PAM. Therapeutic retraction of the foreskin in childhood. BMJ 1983;286:186-7. 2 Griffiths DM, Freeman NV. Non-surgical separation of preputial adhesions. Lancet 1984;2:344-5. 3 MacKinlay GA. Save the prepuce. Painless separation of preputial adhesions in the outpatient clinic. BMJ 1988;297:590-1. 4 Glover E. Int J Psychoanal 1929;10:90-93. 5 Kennedy H. Trauma in childhood. The Psychoanalytic Study of the Child. 1986;41:209-219. 6 Cansever G. Psychological effects of circumcision. Brit J Med Psychol 1965; 38:321-331. 7 Goldman R. Circumcision: The Hidden Trauma. Vanguard, Boston 1997. |
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John D Dalton, Researcher and Archiver, NORM-UK NORM-UK
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31 May 1998 The Editors British Medical Journal BMA Tavistock Square London WC1H 9JR Dear Sirs, SOUNDINGS - CHILDREN HAVE FEELINGS TOO Anne McFayden asks why she was so shocked by her son's response to circumcision. The answer lies within the strange blend of truth and denial that she presents. Her son's apparently mild adverse psychological reaction to circumcision should have come as no surprise. The documented consequences of circumcision include decrease in IQ, feelings of insecurity and inferiority, sexual identification disturbances, regressiveness, an increase in self-aggression, and other problems.[1] Nor should her son's post-operative infection have been a surprise since 10% of circumcisions result in some degree of infection.[2] McFayden observed her son's distress on being wounded by circumcision. She observed that the foreskin was prematurely separated from the glans. She will have seen that his penis is permanently altered and scarred. He has sufferred removal of specialised sensory tissue.[3] Despite this she still considers her son's penis to be "beautiful". She believes that it works effectively but the sole test of function was that he can pee up the bathroom wall. What of sexual function? Impotence has been observed as a complication of circumcision.[4] Should her son complain of erectile dysfunction as an adult no doubt his condition will be dismissed as "psychological" without any consideration that it may be secondary to the circumcision. How will her son react when he learns that intimate details of his personal medical history were disclosed in an international journal? Once circumcision has been chosen by parents or health care providers they may experience cognitive dissonance on receiving any information to show that circumcision is harmful. This leads them to reject the evidence of harm.[5] Doctors need to understand their own feelings before they can hope to understand those of child patients. Yours faithfully John D Dalton References 1. Cansever G. Psychological effects of circumcision. Br J Med Psychol 1965; 38:321-31. 2. Williams N and Kapila L. Complications of Circumcision. Brit J Surg 1993;80:1231-1236. 3. Taylor JR, Lockwood AP and Taylor AJ; The Prepuce: Specialized Mucosa of the Penis and its Loss to Circumcision. Brit J Urol 1996;77:291-295. 4. Stinson JM. Impotence and adult circumcision. J Nat Med Assoc 1973; 65:161. 5. Goldman R. Circumcision: The Hidden Trauma; Vanguard, 1997, ISBN 0-9644895-3-8. |
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Janet Menage, General Practitioner Warwickshire
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Dr.J.Menage Bulkington, Warwickshire 3.6.98 The Editor BMJ, BMA House Tavistock Square London WC1H 9JR Re: Children have feelings too; BMJ 23.5.98 Dear Sir/Madam Dr. McFadyen (1) is on the right track but, unfortunately, has missed the main point, which is that the medical profession should not be doing genital reduction surgery on unconsenting minors in the first place. Unless her son was suffering from BXO there was every chance that by the time he was 17 years of age his foreskin would have been retractable(2). The President of the British Association of Paediatric Surgeons stated to the Health Committee of the House of Commons in March 1997 that two thirds of circumcisions carried out on children in this country are unnecessary, mainly because of the ignorance of the surgeons carrying out the operation(3). Cansever demonstrated,through her research into the psychological effects of circumcision, that forced amputation of part of the penis is perceived as an attack by children and can be associated with developmental regression and a shift towards female gender identity(4). Freud was clear in his concern about castration anxiety in boys, although he failed to make the connection between anxiety engendered by fantasy and that caused by real-life fear of surgical cutting of the genitals. In my research into the effects of genital procedures on women(5) it was demonstrated that the risk factors for developing Post-Traumatic Stress Disorder after genital procedures are: lack of clear consent, lack of information, feelings of powerlessness, feelings of physical pain, and perceived lack of sympathy on the part of the doctor. I suggest that all of these factors apply in the situation of a child coerced into genital surgery, however well-meaning the motives. It is self-evident that children have feelings. However, it is not enough to pay lip-service to that fact on the one hand whilst riding roughshod over children’s rights to bodily integrity on the other. I doubt that Dr.McFadyen’s son would have agreed to have his foreskin amputated if given the choice. His rightful anger towards those who should have protected his body rather than damaged it may save him from developing PTSD. However, I have spoken to several men whose relationships with their mothers have been permanently damaged as a result of circumcision. The message to doctors should be that childen are entitled to keep their genitals intact until adulthood, that antibiotics are an appropriate treatment for infection and local steroids are effective in phimosis. Circumcision of males is psychologically no different from female genital mutilation, which is a sexual assault. It is time to take off the blindfold and appreciate the harm that is being done to the next generation by our profession. For those who are interested, The Fifth International Symposium on Sexual Mutilations: Medical, Legal and Ethical Considerations in Paediatric Practice’ takes place at the University of Oxford from 5-7 August 1998. Details from NORM-UK, PO Box 71, Stone, Staffordshire ST15 0SF. Yours faithfully, Janet Menage M.A. M.B. Ch.B. General Practitioner, Bulkington, Warwickshire REFERENCES: (1) McFadyen,A. (1998) Children have feelings too. BMJ, 316:1616 (2) Oster,J.(1968) Further fate of the foreskin; Arch Dis Child; 43:200-203 (3) Spitz,L.(1997) Fifth Report from the Health Committee, House of Commons; 23.3.97, xxviii-xxix (4) Cansever,G.(1965) Psychological effects of circumcision.Br J Med Psychol, 38:321-331 (5) Menage,J.(1993) Post-traumatic stress disorder in women who have undergone obstetric and/or gynaecological procudures; Joural of Reproductive and Infant Psychology; Vol.11; p221-228 |
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Read Schusky, College resident Canadian College of Naturopathic Medicine
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In my fairly recent student years I tried to find unbiased information on circumcision. My conclusion was that there was none published. Articles that I was able to locate always had a clear bias, either pro or con, and never effectively answered the concerns raised by the other side. I was disappointed that the original article was true to form, and am disappointed that the responses herein are too. |
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Tim Trent, Marketing Consultnat Freelance
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I read this article and the credentials of the author with interest. My feelings are that it has been placed inthe public domain to elicit esponse rather than as a real case study. It may well be that unhappy serendipity has led to the athor's 7 year old son having been circumcised, and that this article takes advantage of the poor boy's natural emotions to form an "interesting read". In 1998 there was almost never a reason for circumcising a healthy penis. One respondent has rightly noted BXO as probabaly the sole genuine medical need for a full circumcision. Nonetheless there are other reasons, and we do not know the history nor the (interestingly) circumcised status or religious status of the family general practioner, nor of the urologist who advised circumcision. While it is a generalism, those who are themselves circumcised are usually unaware of the seriousness of the removal of a forsskin both physically and psychologically, since they were usually circumcised neonatally. One respondent talks about bias. I suspect no man is unbiased. Nonetheless I will make the attempt. My bona fides are as a person who was uncircumcised until 22/23, and then required circumcision because of a totally intractable phimosis composed of 100% scar tissue, which was inelastic and did not allow retraction of the foreskin at all. I was born in 1952. That sets the perspective for the availability of alternative treatments to circumcision when I genuinely HAD to be cut. Prior to circumcision I had a gradual onset of phimosis. My belief is that it was caused (0.7 probability) by maternal insistence on retraction of foreskin, and (0.3 probability) by the relentless masturbation of the 11 year old male onwards. Masturbation split the tip of the forskin and scar tissue grew in its place. I am unable to make any statements about my foreskin prior to learning to masturbate since it was not of any real interest to me and I nver observed it. I want to state clearly that I had no desire to be circumcised. Equally I did not associate the operation with anything psychologically damaging. I simply neither wanted surgery nor was I particularly keen on the aesthetics of a circumcised penis. I thus contracted (pun intended) the phimosis at around the age of 13/14 and waited until I was 22/23 to have surgery. Drivers in the surgery were that it wqas imposiosble to use a condom in penetrative sex with a totally non retractile foreskin, and that I stank because cleanliness was near impossible. The surgery itself was embarrassing but non traumatic., It was very painful, and the urologist was pretty poor in his suturing technique, leading to a cosmetically unpleasing result with skin bridges and odd adherences. That led to my feeling that he was less than competent. But that was all. Post surgery and post healing the glans became less and less sensitive, but I was relieved to be free of stink and able to use condoms for sex. I regretted not the surgery but the necessity for the surgery. I am content that it was the lack of moderm remedies that led to my surgery and at no time was antagonistic to the medical profession over it because they had used the best techniques available to them at the time. Nonethless I do not like the circumcised penis as much as I liked the uncircumcised one. That is, to me, a matter of form and function. I woudl have infinitely preferred not to have required the operation but have not been damaged psychologically by having it. I hope this gives an unbioased account to counter the respondent who sees bias. I will now show some bias, however. I beleiev that all make children shoudl stay uncircumcised unless an duntil there is either a genuine medical need for intervention, or they make an informed choice about body modification. An adult has the absolute to indulge in cosmetic surgery. Routine Infant Circumcison, either for cultural or for religious reasons has no place in a modern world Competing interests: None declared |
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