A Botched Circumcision

Disclaimer: This post has no disturbing images, but may be uncomfortable to the sensitive reader.

It was my first day of Urology and I was sitting in on a colleague’s examination of a young man in obvious pain. I had missed the history-taking, and wondered why he was walking so tenderly and carefully to the examination bed. As he painfully undressed and started unwinding his bandages, I vaguely guessed whether he had had a late repair of hypospadias, or perhaps had sustained zipper-trauma. Suffice to say, I was not prepared for what I saw.

The young man had been genitally mutilated. There was little external penile skin, and the less than a millimeter of glans was visible. His external urinary meatus was not visible.

Xhosa initiates – just an image, not the patient!

He had been for his Abakwetha Circumcision Ceremony, also known as initiation (into manhood) and going “to the bush” – because it is about more than circumcision: the young men are also given several tasks of surviving independently without a lot of food or water.

In South Africa, healers who perform traditional circumcisions have to be registered and trained, but many have evaded this law. Many young men still frequent these “illegal” traditional healers. I wrote before about the injuries and deaths in our country due to traditional circumcision.

When a circumcision is not performed by a trained person, it is usually not in the sterile environment required, and thus these young men are prone to infections – including necrotising fasciitis, which the patient in question had developed recently. Surgical debridement had cost him even more of his precious skin. Untrained individuals also do not use sutures, and thus wound healing becomes fibrotic and the skin becomes stiff and retracted.

Last year during my rural family medicine rotation, I wrote about my day assisting in circumcisions. These were hospital-based, thus with all appropriate equipment, expertise and sterility. Some people were dismayed by my “participation”. The more I have been reading up about it, the more I realise that what we have been told about circumcision may not be entirely true. Still, I do not feel guilty about those procedures, because none of the young men were under-age and they had all given informed consent. Furthermore, had we not provided the opportunity to be circumcised at the day hospital, they would have had it done “in the bush” and could have been exposed to all the horrible complications.

Nevertheless, over the past year I’ve become more aware of protest against circumcision – especially against circumcision before a child can make an informed decision by himself (which I understand), but also against adult, non-medically indicated circumcisions.

I thought the comic, Foreskin Man, was pretty interesting. It makes for reasonable comic book reading and is available online for free here. The bias is quite obvious, where the person circumcising is always depicted in horrible or evil ways, and the antagonists are heroic, beautiful people. It also has a tendency to come across as antisemitic. But I think if one is aware of potential biases it is still worth a look-over.

As with all debates, there is also the sub-group of ridiculously emotional activists (or “intactivists”, as they like to call themselves) who turn the debate into a subjective mess. I try to ignore them so I can focus more on figuring out what is ethically and medically acceptable.

On that note, I must go. I will write a more focused post soon regarding what I have learned so far regarding latest evidence, as well as cultural considerations. In the meantime, if you are interested, check out this “foreskin IQ” questionnaire. You might be amazed at some of the answers.

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9 thoughts on “A Botched Circumcision”

  1. In America, it’s part of the normal discharge procedures for baby boys. The circumcise the infant about an hour before they release the baby from the hospital. It’s unusual for it not to be done. When I had my son in 2008 I didn’t really know that you could refuse to have the procedure and I’m a bit sad that I didn’t research it more. It’s interesting the different practices in different countries.

    1. I met a few guys from the USA while I was traveling who basically said the same thing. It’s a real pity that parents are seemingly not given the opportunity to question and decide for themselves and their newborns!

  2. Anybody that is against circumcision (done in a medical setting of course) should attend a lecture on paraphymosis, prepucitis or penis cancer.

    1. Well yes, there are several medical indications for circumcision before a child is of consenting age, and many men may decide that for them the benefit of the procedure is worth it. I sure hope that nobody is advocating banning circumcision for all indications.

      The argument is more that perhaps parents should not have the right to make the decision for baby when it comes to snipping a piece of their body that they may miss. I have quite a few friends who wish their parents had left the decision up to them, especially when studies like the Orange Farm study have been shown to be insufficient to warrant a prophylactic approach. One does not cut off every body part that may present with disease, although a fair number will ultimately decide to do so.

    1. Currently there is some evidence that boys up to the age of 6 months suffer fewer UTIs when they are cicrumcised… but that’s a pretty small benefit compared to the circumcision, and in a country with a good healthcare system it is almost impossible for a healthy baby boy to suffer severe morbidity from a UTI.

  3. I did my research before my son was born in 1994 and while the myths stillexist the rate of UTIs for little girls is higher than uncirced boys. It is an unneccesary procedure that is still fonbed on parents becausethe medical waste foreskins are sold to other companies to make skin creams and artificial skin because the foreskin, being an incomplete structure, still has valuable stem cellls! My DH wanted our son done but i told him mo he used the same argument on me as the Dr- want the boy to looknlike daddy? DH has never seen his own fathers penis so he learned real fast how stupid that argument is! Do not do it by the time your son is 40 he will be having sexual issues just like my DH and he now says he is glad we didnt circ our son!

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