If Your Son Is Not Circumcised... Beware the Well-Baby Check

Pediatricians forcibly retract foreskins for intact (uncircumcised) boys during well-baby checks throughout the U.S. every day because the health care provider doesn't know any better.
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Imagine this. It's the middle of the night and your baby boy has croup -- you are worried. So you take him to your local emergency room. The ER doc comes in, removes the boy's diaper, and forcibly retracts your child's foreskin, leaving the child screaming in pain and bleeding. Within a couple hours, his penis and foreskin are swollen. And you don't have a clue what to do. This just happened to a couple right here in my home state. And there wasn't a thing the parents could do about it. I want you to know why this is occurring all over the U.S. today, so you can protect your son!

As ludicrous as this might seem for an ER doctor to do this for croup in the first place, pediatricians forcibly retract foreskins for intact (uncircumcised) boys during well-baby checks throughout the U.S. every day because the health care provider doesn't know any better. The injury to the baby is called premature, forcible, foreskin retraction (PFFR), and, ironically, the trauma often requires that the child be circumcised after all, in order for the damage to be repaired.

Circumcision has lost favor in the U.S. in recent years so much so that now roughly 1 million newborn boys are not circumcised (each year). [1] Simultaneously, the American medical professionals appear to have lost the folk knowledge of parents who, for tens of thousands of years, once left their child's foreskin entirely alone, to develop normally by itself, the way Europeans do.

Without this folk knowledge, they refer to the current medical texts or organizations to understand normal penile anatomy and development. Unfortunately, some of these texts and organizations propagate out-of-date or inaccurate information.

One such error, known as "Gairdner's error," involved what some could consider a typo. The word "months" was substituted for the word "years" when referring to the normal time that the foreskin retracts. It's fully retractable in 98 percent of men by the age of 19 or so -- but is also not retractable in many boys until after puberty begins. Worse still, doctors have been led to believe that the foreskin is attached to the head of the penis by an abnormal "adhesion" that needs to be manipulated for the sake of "cleanliness."

Unfortunately, even the American Academy of Pediatrics continues to post incorrect and harmful information about this in their literature and on their websites -- telling parents that the foreskin should be retractable by the age of 3, and advising parents to retract and clean regularly with soap and water. Soap on mucosa destroys natural immune substances and upsets the pH balance, making the foreskin and glans vulnerable to infection. This kind of infection is incredibly painful to the urethra and can cause scarring -- all of which too often results in the iatrogenic need for circumcision!

One of the main reasons people choose to have their child circumcised is they've been led to believe that it's nearly impossible to keep an uncircumcised penis clean. Here are the facts: No special cleaning or retraction of the foreskin is necessary because the foreskin is attached to the underlying penile tissue by a normal membrane, which is analogous to the female hymen. This membrane is clearly protective -- and should be regarded as such.

The penis -- like the vagina -- is self-cleaning. The penis is bathed daily with sterile urine, which often balloons around the intact foreskin. The foreskin retracts when it's time -- just like the mucosa of a newborn kitten's eyelids changes over time, allowing the eyelids to open on their own. One would never consider forcibly opening the vagina of a baby girl (and washing it out with soap and water) to keep it clean, right? So why do we do this to baby boys?

My colleague Dr. George Denniston, founder and medical director of Doctors Opposing Circumcision (DOC), estimates that 100,000 toddlers are experiencing this trauma (of PFFR) every year at the hands of well-meaning health care providers -- and at a cost of $50 - $100 million. [2] Bottom line: Beware of ignorant medical personnel if you have an intact son. Don't let anyone attempt to retract his foreskin. And don't do it yourself!


[1] The birthrate for U.S. boys is available here, but is about 2 million males each year: http://www.cdc.gov/nchs/births.htm

Data for United States in 2010:

• Number of births: 3,999,386
• Birth rate: 13.0 per 1,000 population
• Fertility rate: 64.1 births per 1000 women aged 15-44 years

The latest rate of circumcision in the USA is 55.9 percent. See: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm

From the CDC: "For the period 1999-2010, the weighted analysis yielded 11,789,000 (59.1%; 95% confidence interval [CI] = 59.1%--59.2%) of 19,933,000 and 12,347,096 (57.8%; CI = 57.8% -- 57.8%) of 21,359,690 newborn males circumcised in the United States from NHDS and NIS, respectively. Of 2,339,760 newborn males recorded in CDM, 1,306,466 (55.8%; CI = 55.7% -- 55.9%) were circumcised."

[2] Doctors Opposing Circumcision (DOC) know anecdotally that a fixed percentage of Primary Care Providers (PCPs) forcibly retract intact boys because we have been tracking this practice and attending these cases, a couple weekly, for over a decade. The question is how many clinicians and how often nationwide. No one knows for sure.

The "100,000 injury cases each year" footnote, an estimate, comes from some simple math: there are about 80,000 pediatricians in the U.S., and around 200,000 more PCPs who attend infants. Thus, nearly 300,000 individuals attend boys every day. If only ONE CLINICIAN, ONCE PER YEAR, forcibly retracts a boy, that equals 300,000 injured boys, one-third of our claimed 100,000. Likely there are those who do so on a regular basis, and those who would never do so. The 100,000 figure is the lowest possible and most optimistic estimate. The upper limit is that each year there 45 percent of 2 million boys left intact, or 900,000 at risk month after month for many years.

Since PFFR -- forced foreskin retraction -- was standard medical practice for over a century, 1880-1980, it is very hard to believe the practice has been fully abandoned. Indeed, even the literature suggests the practice is far from dead.

DOC attends over 100 injury cases each year, the tiniest sliver of the problem, and so we know anecdotally that the practice is alive and well, especially since the offenders mention that what they did was entirely within their training, and many of the offenders are in their early 30s, suggesting their training is current. I have parents call me for a M.D. recommendation because all the docs they have called in their region say that they will not guarantee no retraction as it is "part of our normal well-baby exam, and required by our insurance regulations."

The fact is that the practice of forced foreskin retraction is epidemic in the U.S.

The cost of attending each injured child has to be at least a combination of the following times 100k:

1) Post-retraction follow-up clinic visit at $1-200;
2) Possible choice of new clinic and doctor, with first-time exam and work-up costs;
3) Possible second visit for emerging infection, with antibiotics;
4) Possible follow-up visit when infection resolves;
4) Possible ER admission at several thousand dollars.

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