Risks vs benefits
 
(in ascending order of severity) Aesthetic damage
Phimosis
Hairy shaft
Haemorrhage
Meatal stenosis, meatal ulcer
De-gloving
Urethrocutaneous fistula
Infection, including MRSA
 Hepatitis
 Tetanus
Neuroma
Blockage of the Urethra
Buried penis
Penoscrotal webbing
Deformity
Necrotising fasciitis (Galloping gangrene)
Priapism
Oxygen deprivation
Clamp injuries
Loss of glans
Major damage, unspecified
Ablation (removal) of the penis
 David Reimer
 Others
Death
25 other mishaps

(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.)

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

Epidemiology of complications of male circumcision in Ibadan, Nigeria

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.]

In Reuters, via Medscape:

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.

Circumcised baby 'almost died'

Damon Courtenay was born in Sydney in 1966:

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:

LiveJournal, June 5, 2008

He had his circumcision yesterday and it was a NIGHTMARE.

... The procedure was done so we waited 10 or so minutes before he was to be checked again being told he was the first baby they had seen never cry during all of it. My doctor came back to check to see if there was any bleeding and as soon as he took the bandage off there was a lot of blood. The skin of the shaft had beccome completely seperated which i was told can sometimes happen but from the head to the shaft skin was almost a full inch! His skin was almost completely at the base of his penis. I watched as the docter tried pulling it up and could only help but think that it didn't seem normal for it too be that bad.

... They strapped him down again and we watched as the put a gel foam on him to adhere the shaft to the head. Screaming at this point, bleeding all over and me by this point lactating all over the place, practically through my breast pads. The gel foam took and they wanted us to stay another half hour.

... We stopped at the store for gauze and Vaseline and let him sleep for 10 minutes when we got home before i checked him and tried to ready him for a full feeding.

I opened his diaper to find that he had soaked through the guaze already and i had to get 2 napkins to control the bleeding. I yelled at my fiance to get the car to we could go to the hospital. Of course we get there, had to register, see the triage nurse, do insurance crap and FINALLY get into pediatric ER.

Doctors come in to see him and he is GUSHING blood, soaking gauzes, and they give me more gauze and tell me apply pressure here & there and then leave the room. At this point it is just my fiance and I with my screaming little boy holding him down watching him bleed all over. He's hungry again, I'm lactating like crazy again and we have to keep calling the doc's back in because he's going through so much gauze. I asked the doctors about stitching and the likeliness of it happening. One response was "Oh no, that wouldn't fix this".

... there were other kids in there but with (by the looks of it) only sprains and such. Not any others bleeding profusely. Especially not any babies. You'd think we'd get more attention. All the while asking me if any blood diseases ran in my family on the ocassion that they did come in. (Which they don't and i explained this 5 or 6 times)

... AGAIN NO HELP and me furious that nothing had been done yet, him still bleeding and i can't hold him and feed him.

So i get pissed and after a good 45-60 minutes of all of this and i said seriously, what the fuck are you waiting for?! Then they tell me that they are waiting for the right size suture. We had to demand to know this, were never informed. Then more waiting....and more aking from us of what the hell the hold up is. "Oh, we're still waiting for the sutures." FINALLY, the urologist comes in, straight to the point looks at it and knows he need a stitch or two because guess what.... THEY NICKED AN ARTERY. An artery! Which of course would explain the pumping blood and prove my other doctors IDIOTS.

The urologist and the lady with him were very quick to access and close him up, saving the day. They were kind, explained everything that was going on and very reassuring that he'd be okay. I had to watch him be stitched up at 6:30 close to almost 2 hours after we had gotten to the ER. Bleeding stopped almost immediately when they closed the artery and almost had to so his shaft so it would stay up. The bed, a pile of guaze, the bed, his clothes,blanket and myself all covered in blood. He was real pale so then they hooked him up to an IV and kept him on it for an hour and a half.

... Needless to say i am beyond upset. I was a scary calm the whole time and a nurse even commented on me 'taking this so well' being a first time mom. I couldn't cry, i couldn't do anything....i had to worry about keeping my son together because no one else was!

Oh, and then [the father] overheard the urologist say to the doctors that if my son had bled for 15 more minutes he would have gone into shock.

... How often do things like this happen with this procedure?

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.

Urol J. 2008 Fall;5(4):233-6

Lubrication of circumcision site for prevention of meatal stenosis in children younger than 2 years old.

Bazmamoun H, Ghorbanpour M, Mousavi-Bahar SH.
Department of Pediatrics, Division of Gastroenterology, School Of Medicine, Hamadan University Of Medical Sciences, Hamadan, Iran. dbazmamoun@yahoo.com

INTRODUCTION: Circumcision is one of the most common surgical operations throughout the world, and meatal stenosis is one its late complications. We evaluated the topical use of a lubricant jelly after circumcision in boys in order to reduce the risk of meatal stenosis.

MATERIALS AND METHODS: A randomized control trial was performed, in which 2 groups of boys younger the 2 years old underwent circumcision according to the sleeve method. The parents in the study group were instructed to use petroleum jelly on the circumcision site after each diaper change for 6 months. In the control group, no topical medication was used. The children were followed up regularly and evaluated for meatal stenosis, bleeding, infection, and recovery time.

RESULTS: A total of 197 boys in each group completed the study. None of the children in the study group but 13 (6.6%) in the control group developed meatal stenosis (P < .001). Infection of the circumcision site was seen in 3 (1.5%) and 23 (11.7%) children of the lubricant and control groups, respectively (P < .001), and bleeding was seen in 6 (3.0%) and 37 (18.8%), respectively (P < .001). The mean time of recovery in the lubricant group was 3.8 +/- 1.2 days, while it was 6.9 +/- 4.2 days in the control group (P = .03). CONCLUSION: Based on the findings of this study, it seems logical to use a lubricant jelly for reducing postcircumcision meatal stenosis and other complications.

PMID: 19101896 [PubMed - in process]

[Experimenting on children in this way would be utterly unethical in the western world.

The experiment shows that to prevent meatal stenosis, parents must use petroleum jelly on the circumcision site after each diaper change for 6 months. So much for circumcision making care easier.]

BRITISH JOURNAL OF UROLOGY, Volume 75, Number 1: Pages 91-93, January 1995.

Clinical presentation and pathophysiology of meatal stenosis following circumcision.

Persad R; Sharma S; McTavish J; Imber C; Mouriquand PD
Department of Paediatric Urology, Addenbrooke's Hospital, Cambridge, UK.

OBJECTIVE: To describe the clinical presentation and pathophysiology of meatal stenosis occurring after circumcision.

PATIENTS AND METHODS: The clinical presentation and operative findings are reported in 12 children who presented with meatal stenosis over a period of 3 years.

The cardinal symptoms of meatal stenosis were penile pain at the initiation of micturition (12 of 12), narrow, high velocity stream (8 of 12) and the need to sit or stand back from the toilet bowl to urinate (6 of 12). Following surgical correction with meatotomy there was no recurrence of stenosis after a mean follow-up of 13 months. Traumatic meatitis of the unprotected post-circumcision urethral meatus and/or meatal ischaemia following damage to the frenular artery at circumcision are suggested as possible causes of meatal stenosis.

Preservation of the frenular artery at circumcision, or the use of an alternative procedure (preputial plasty), may be advisable when foreskin surgery is required, to avoid meatal stenosis after circumcision.

...

DISCUSSION AND CONCLUSIONS
Meatal stenosis as a complication is often missed by the clinician because children do not usually have late follow-up after circumcision. The symptoms of pain are often mistaken for symptoms of a lower urinary tract infection and symptoms of distal urethral impairment of urinary flow are usually ignored for many months

... 88 circumcisions (and 91 preputial plasties) were performed at this institution: seven of these patients (8%) presented with meatal stenosis.

...

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.

The lump partially blocking the meatus is a consequence of meatal ulcer, a very common result of circumcision.

Picture of a de-gloved penis

(not for the squeamish)
doctors' comments
 

See also Ethics for more admissions from this doctor.

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.]

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.

... 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

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]

Bull Soc Pathol Exot. 2008 Feb;101(1):54-7

Post-circumcision tetanus in Dakar, Senegal
[Article in French]

Soumaré M , Seydi M , Dia NM , Diop SA , N'dour CT , Diouf L , Diop BM , Sow PS .

This study aimed at describing the epidemiology, clinical features and prognosis of post-circumcision tetanus at the infectious diseases clinic in Fann Hospital in Dakar.

Data were collected retrospectively for analysis from patients' files recorded from January 1, 1999 to December 31, 2006. 54 cases were included, accounting for 4% of all tetanus cases admitted to the clinic during the study period (54 cases/1291). The patients' average age was 9 +/- 3.7 years old (range = 1-17 years) and 52% of them were schoolboys.

In most cases (76%), tetanus symptoms occurred beyond 7 days after circumcision. The average delay from onset of the disease to admission was 2.3 days (range = 0-6 days). The circumcision took place at home in 39% of cases, in health center in 35% of cases and in unspecified area in 26% of cases. The majority of patients (85%) had never received tetanus vaccine and, in 72% of the cases, the circumciser was designated as a male nurse.

Generalized tetanus was observed in all cases, most of which was a mild form of the disease (63%). During hospitalisation, thirteen patients (24%) had complications among which diaphragmatic and intercostal muscle spasms (3 cases), bacteraemia (5 cases), respiratory infection (4 cases), urinary tract infection (4 cases), and fracture of the vertebrae (1 case). The case fatality rate was 7.4% (4 deaths).

Vaccination together with health education of the population as well as a better sensitization of the practitioners are necessary to eradicate tetanus after circumcision. [Not circumcising would also have that effect.]

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 Plastibell^TM 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.

Picture of Buried Penis

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.

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]

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.

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 ½ 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.

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."

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

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. When I was much younger, around 14 to 16, I could sometimes masturbate to a climax, but after a couple of years I stopped being able to do this. Some of the women I've been with never saw the condition of my penis, and failed to notice when I didn't come. Others have seen my condition before intercourse and refused to have sex with me, while still others found out afterward, after I wasn't able to come, and then never wanted to have sex with me again. Of course I never dare to ask anyone to suck me, although this might provide the necessary extra stimulation and actually help me climax. So my problem, Dan, is twofold: I can't come and I can't get anyone to stick around and help me try to come. Can you suggest any special techniques for someone in my condition? Any help would be appreciated. I'm very miserable, frustrated, and lonely. —MUTILATED AND COMELESS

A. OK, A.Z., after reading MAC's letter, and after insisting your husband read MAC's letter, is circumcision really something you want to risk? I know, I know, "complications," as it's delicately put, are rare after circumcision. But even if the odds are low—even if they're infinitesimal—the thought of having to look your glans-less son in the eye one day and say, "We're awfully sorry about that botched circumcision, son, but your father and I used to know this woman who once dumped a guy because he was uncircumcised, you see, and we didn't want to risk that ever happening to you . . . and . . . so. Sorry." Speaking parent-to-parent, A.Z., and speaking as a contentedly circumcised adult male who likes his dick just the way it is and has no truck whatsoever with hysterical anti-circumcision activists (whew!), I would rather teach my son to wash under his foreskin than assume even the tiniest risk of him losing the head of his penis in a botched circumcision.

OK, MAC, on to you. Jesus, Jesus, Jesus. Rarely am I left speechless or bereft of any suggestions at all after reading a letter, but Christ almighty, I haven't the faintest idea what to tell you. But I ache for you, kiddo, and so I'm throwing open the switchboards here at Savage Love HQ and putting out a call for advice from my resourceful readers. If anyone out there has any expertise on headless dicks or knows of any special techniques for people in MAC's condition, please write in. Write in right now.

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

Another case, in Mattoon, Ill, in 2007.

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.