Sydney Children’s Hospital Foundation attempts to hide the truth on circumcision

As I paced the hallways while waiting for my daughter to recover from her surgery at the Sydney Children’s Hospital in Randwick, Sydney, I read a poster on the wall which outlined the hospital’s policies around its care for its patients.Deleting reference to circumcision

I was reassured to read a number of points in relation to the quality of care that the hospital promised. In particular, I was pleased to read a point which was highlighting the right of bodily autonomy. While I can’t remember the exact wording, I recall that it was something like this:

“Children’s bodies are their own.”

Infant circumcision for non-medical reasons was banned in NSW public hospitals in 2006, and as the Sydney Children’s Hospital is a public hospital there should be no non-therapeutic circumcisions being performed there. However, the doctors who practise there can easily bypass this ban by operating out of one of the private clinics surrounding the hospital. I wondered how many of these doctors walked past these posters every day, then walked over to a private clinic to perform this life-changing and damaging procedure on a non-consenting infant.

Nonetheless, I was pleased to read that the hospital seemed to understand the concept of bodily autonomy – that children owned their bodies, and that in the absence of a clear and immediate medical need, they should get to determine what happens to them.

So I was surprised to see that for the foundation’s Gold Telethon 2015 they would be promoting a story of a child rushed to the emergency department as a result of a procedure that is an assault on that autonomy – infant circumcision. Here is a screen shot from the foundation’s website on 5 March 2015:

EliMarch5-highlighted

While the exact timing is unclear, sometime before 23 April 2015 (according the the web archive), the foundation updated the page to remove any reference to the circumcision. This is how the page appeared from that date, and still appears at the time this post was published:

Eli28112015-highlighted

Note that the red underlines have been added to both screenshots to highlight the differences.

When approached for an explanation, a spokesperson for the foundation responded with “We updated the original story as we believed the detail to be irrelevant to the focus of our story – Eli and his treatment for Haemophilia”.

It appears to be unlikely that this reason alone is why the story was changed. In my experience, these types of articles are updated to correct important omissions or errors, or to remove details that are distracting to the story – not merely irrelevant.

The two other stories used to promote the 2015 Gold Telethon also contained information that could easily be determined as ‘irrelevant’. Why were those details not also removed?

The real reason for the revision is open to speculation. An obvious response to the unedited story would be to question why (in its own words) a ‘perfectly healthy baby’ was subjected to unnecessary surgery in the first place. I imagine it was easier for the foundation to sweep this distraction under the carpet rather than address the issue.

The other obvious unanswered questions are ‘who?’ and ‘where?’. It would be difficult for the foundation to claim how heroic the doctors at its hospitals were in treating the child if the situation they were treating was caused by an unnecessary surgery performed by one of its own doctors. Through its spokesperson, the foundation confirmed that the procedure was not carried out at either Sydney Children’s Hospital, Randwick or The Children’s Hospital at Westmead, but they did not respond to the question of whether it was performed at a private clinic by one the doctors who also practises at one of its hospitals.

Paul Mason, Chair of the Australasian Institute for Genital Autonomy, said “This report and the hospital’s suppression of a central fact about the case are deplorable. All across the world “adverse events” from unnecessary genital surgery on babies and children are shrouded in mystery. It is simply not possible for anyone to pretend that any “benefits” outweigh the obvious risks of these dangerous practices if the risks remained hidden and unknown. Parents are entitled to know the truth and the whole of the truth.”

I hope that in the lead up to the Gold Telethon 2016, the foundation chooses a better example of how the medical profession is helping, rather than hurting children.

Image courtesy of Goldy at FreeDigitalPhotos.net

Canadian Paediatric Society faces potential child sex scandal

In order to maintain a perception of credibility, so-called ‘peak’ medical authorities in any modern society must ensure that they observe the highest possible standards when they disseminate information to the general public. The Canadian Paediatric Society (CPS) has recently let itself down in this regard by referring to source material that was originally published by a person who is currently serving time in jail for multiple child sex and child pornography offences.

CanadianPScropped1

In September 2015, the CPS released an updated ‘position statement’ on the issue of newborn male circumcision. The document ultimately concluded that the CPS ‘does not recommend the routine circumcision of every newborn male’ however the CPS position statement listed a brochure called ‘Circumcision: A guide for parents’ as one of its selected resources. The primary author of that brochure was Brian Morris, a prominent Australian pro-circumcision campaigner. The brochure was originally published by ‘The Gilgal Society’, a UK-based organisation which was principally maintained by Vernon Quaintance,

MorrisGilgal1croppedUnderlinedPart1

In April 2013, during a discussion that occurred on a Facebook page called ‘Response to Ignorance’, Morris confirmed that he had engaged Quaintance’s services in the publication of the ‘Circumcision: A guide for parents’ brochure. Morris badly contradicted himself during that conversation. In the first instance, he claimed that (quote) ‘I have never met Quaintance…nor have I ever spoken to (him)’. He then went on to confirm that (quote) ‘Quaintance offered to assist in production of professional quality brochures and I accepted his offer’.

MorrisApril19th2013Underlined1

In April 2012, Quaintance was convicted of possessing child pornography. The ‘Croydon Advertiser’ reported that Quaintance had been found in possession of three video cassettes which contained seven to nine hours of ‘graphic footage of child abuse ranked at the second-highest level of severity’. The court found that  boys as young as 11 years old engaging in sex acts were discovered on the videos. The judge in that case sentenced Quaintance to a 40 week suspended jail sentence. In October 2014, Quaintance faced court again, this time on multiple serious child sex offences. It was revealed that Quaintance had ‘targeted young boys and asked them to expose themselves’. On this occasion he was jailed for 2 years and 4 months.

QuaintanceMerge1

After hearing of Quaintance’s first conviction on child sex offences, Brian Morris attempted to distance himself from Quaintance and ‘The Gilgal Society’. He changed the name of the publisher of the ‘Circumcision: A guide for parents’ brochure to simply ‘Brian Morris’. He also deleted every reference to Quaintance and Gilgal from his website. This action represented nothing more than a desperate and futile attempt at re-writing history. It represented hopeless and cynical brinkmanship at its finest.

MorrisGilgal1croppedUnderlinedPart2

Great care, consideration and research are required when official documents are produced and published by ‘statutory authorities’. Referencing documents prepared by Brian Morris can never be a good look for any organisation which purports to provide balanced information to the public on the issue of male circumcision. Over many years, Morris has built himself a strong reputation for disseminating one-sided, agenda-driven propaganda on the issue. Professor Basil Donovan, a sexual/public health expert from the University of Sydney, has stated that Morris publishes information which is ‘dangerous’ and ‘amounts to a serious disservice to parents’. What is much more damning in this case however is that the Canadian Paediatric Society has referred to a document which was originally published by a twice convicted child sex offender. As such, the CPS has proven itself to be (at the very least) utterly careless in the preparation of its latest ‘position statement’ on newborn male circumcision.

Image sources:

1. ‘Canadian Paediatric Society’.

http://www.cps.ca/documents/position/circumcision

2 and 6. ‘Circumstitions News’.

http://circumstitionsnews.blogspot.com.au/2012/04/sydney-brian-morris-fails-to-erase.html

3. ‘Response to Ignorance’ Facebook page.

https://www.facebook.com/responsetoignorance

4. ‘Croydon Advertiser’, April 21st, 2012.

http://www.croydonadvertiser.co.uk/Croydon-circumcision-campaigner-caught-child-porn/story-15866127-detail/story.html

5. ‘Croydon Advertiser’, October 3rd, 2013.

http://www.croydonadvertiser.co.uk/Upper-Norwood-circumcision-fetishist-jailed/story-23040107-detail/story.html

Dr Andrew Rochford gets closer to the truth on circumcision

Dr Andrew Rochford on circumcisionLast month, Australian doctor, TV medical commentator and former ‘The Block’ winner Dr Andrew Rochford presented a report on circumcision on Channel 7’s news ‘The Healthy Truth’ segment, which was also packaged as a story on ‘Today Tonight’ in Adelaide.

The sentiments expressed in this latest report were significantly different to those expressed in Dr Rochford’s piece on circumcision on Channel 10’s ‘The Project’ in 2010.

This earlier report was in response to the publication of a journal article which suggested that circumcision should be promoted to lower the rate of HIV transmission in Australia. Much of the TV report showed the doctor repeating the opinions expressed by others, with most statements prefaced with phrases such as ‘some people believe’ or ‘some experts claim’.

Comments on the report on the station’s website and social media sites quickly highlighted the fallacies in many of those opinions, including the following:

A number of issues with the African clinical trials which were used to support the claims in the journal article.

Langerhan cells do not only exist in the foreskin.

–  A non-retractile foreskin is normal at birth and remains common until after puberty.

– The questionable credibility of the the authors Alex Wodak and Brian Morris.

– The absurdity of the ‘looking like Dad‘ reason.

– The lack of any discussion on ethical considerations.

This latest Channel 7 report showed a more confident and mature Doctor Rochford, who was unafraid to express his own thoughts, which in general were more strongly against the procedure. It may be that the feedback from the earlier report has shaped his opinion since then, or he may be reflecting the more recent public sentiments on circumcision, which has shifted away from the procedure, possibly due to more recent emphasis on ethical and bodily autonomy considerations.Dr Andrew Rochford on Circumcision Consent

While it’s disappointing that the Australian mainstream media is yet to highlight the functions of the foreskin, we applaud and thank Dr Rochford for bringing the ethical issues to the forefront, and bringing the Australian public one step closer to the truth on circumcision.

New intactivist website launched in Australia

IntactAus1We would like to congratulate our friends at ‘Intact Australia’, who launched their brand new website on August 1st 2014. ‘Intact Australia’ is a grass-roots organisation which has similar goals to those of us here at ‘Intactivists of Australasia’. Their mission statement quite rightly points out that ‘all human beings, regardless of age, sex, gender, ethnicity, size, background, family, or ability to defend themselves, come into this world with the basic human right to genital autonomy’. The ‘Intact Australia’ website is full of great information and resources including ‘intact care’, ‘functions of the foreskin’ and a ‘history of circumcision in Australia’. ‘Intact Australia’ are also seeking to create a list of ‘intact-friendly’ doctors across the country. We wish them all the best for their new venture and thank them so much for the work that they are doing to raise awareness about this important human rights issue. Click here to visit the ‘Intact Australia’ website.

New petition demands government action on male circumcision

Intact2Intactivists of Australasia have launched a new petition on change.org which calls for Australian governments (at all levels) to take action to prevent the non-therapeutic circumcision of male minors. Click here to sign the petition and show your support for this important human rights cause. If we reach our target of 100 signatures, the petition will be forwarded to all Federal, State and Territory health ministers. The timing of this petition is important, since the Federal Government is currently undertaking a review of the Medicare Benefits Schedule.

The Intactivists of Australasia petition reads as follows:

It is important that Australian Federal and State Departments of Health support the human rights of all people, regardless of their age or sex. Infant Male Genital Cutting (IMGC or “circumcision”) raises human rights issues. Many men hate that it was done to them before they could resist. Its medical benefits are highly debatable – slight reductions in rare and/or late onset diseases that can be better prevented by other means and/or treated as they occur. In the 1950s, IMGC was nearly universal in Australia and is now done to fewer than one boy in 8. Over the generation that this has happened, men’s health has improved and none of the ailments for which it was supposed to be effective have shown any significant increase.

No national medical association in the world (including the American Academy of Pediatrics) recommends IMGC, but the AAP’s position was so ambivalent and culturally biased, 38 paediatricians (heads and spokespeople for the paediatric associations of Austria, Britain, Denmark, England, Estonia, Finland, Germany, Iceland, Latvia, Lithuania, Norway, Sweden, and the Netherlands, and senior paediatricians in Canada, the Czech Republic, France and Poland) were prompted to write a rebuttal to the AAP journal “Pediatrics” (1) which concluded that:

“There is growing consensus among physicians, including those in the United States, that physicians should discourage parents from circumcising their healthy infant boys because non-therapeutic circumcision of underage boys in Western societies has no compelling health benefits, causes postoperative pain, can have serious long-term consequences, constitutes a violation of the United Nations Declaration of the Rights of the Child, and conflicts with the Hippocratic oath: primum non nocere: First, do no harm”.

Resources:

1. http://pediatrics.aappublications.org/…/12/peds.2012-2896

2. http://www.circinfo.org/Medicare_circumcision_review.html

Recommendations:

1. Withdraw any support for non-therapeutic infant genital surgery (including circumcisions done for “cultural reasons”) from all medical facilities in the Federal and State Departments of Health’s charge.

2. Ensure that the non-therapeutic circumcision of minors is not included in Medicare rebates.

3. Ensure that medical students in all teaching hospitals and medical schools are appraised on the structure and functions of the foreskin, and on proper care of normal boys, especially the avoidance of premature forcible foreskin retraction and unnecessary circumcision.

Want better, longer lasting sex? Advanced Medical Institute (AMI) vs foreskin restoration

Advanced Medical Institute (AMI) billboardMany of us would have seen those bright yellow billboards across the cities of Australia with confronting and sometimes contoversial messages including ‘want longer lasting sex?’, ‘want more sex?’ and more recently ‘oral strip: to last longer making love‘.

This latest advertising campaign appears to be an amalgamation of previous campaigns, and claims to help with both premature ejaculation and erectile dysfunction. According to the webiste of company behind the advertising, Advanced Medical Institute (AMI), “The new Oral strip technology for treatment developed by AMI is the World’s first for the treatment of Premature Ejaculation and Erectile Dysfunction (sexual dysfunction) in man.”

Can AMI actually deliver on those claims? Recent history would suggest that potential customers should take caution. In 2003 the ACCC prosecuted AMI over previous campaigns, and the NSW Office of Fair Trading has investigated numerous complaints against AMI over alleged unconscionable contracts and undeliverable guarantees. The late Ian ‘Turps’ Turpie, once an ambassador for the company’s nasal spray, also admitted that it didn’t cure his impotence.

Rather that putting their faith in oral strips and nasal sprays, perhaps Australian men should be asking a confronting question of their own: Could their circumcision be a contributing factor in premature ejaculation and other sexual dysfunction issues? And if circumcision is a factor, is there anything that can be done by circumcised men to reverse the damage?

The first thing to note is that is that circumcision significantly alters the form of the penis. Most estimates on how much skin is lost range between 10 to 15 square inches. In addition, what is lost is not just skin, but a complex set of structures including the frenulum, ridged band, frenal band, mucosal skin and other specialised nerves and structures. As most engineers will tell you, you can’t alter form without altering function, so with so many structures lost to circumcision, there is no doubt that the function of the penis is severly altered.

The most significant function of the foreskin, and the most relevant to premature ejaculation, is what is known as the ‘gliding’ or ‘rolling’ action. Without a foreskin, during sexual activity the foreskin will not ‘roll’ over the glans (head) of the penis in the way that it does on an intact penis. This results in an unnatural friction on the glans and can trigger ejaculation.

While premature ejaculation can be an issue for younger men, the opposite problem is more frequent in older men. A Danish study released in June 2011 concluded that male circumcision was “associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment.”

So if circumcision is a possible cause of these problems, is their anything that circumcised men can do? While there is nothing that can bring back all of the complex structures that are lost to circumcision, many Australian men are undertaking foreskin restoration to undo some of the damage. The restoration process is a non-surgical method which grows additional skin from what remains of the foreskin. There are many tools and methods, but each method involves tensioning the remaining skin which encourages the growth of new skin, to eventually cover the glans of the penis, recovering much of the function and appearance of an intact man.

The result is that many of the younger men who have undertaken foreskin restoration will say that the re-grown skin reduces the direct stimulation of their glans and allows them to last longer. For those with the opposite problem, the coverage regains the sensitivity of the glans, which had previously been de-sensitised from decades of friction against clothing.

Advanced Medical Institute has recently moved to also target females, by claiming that they can help with a range of sexual dysfunction issues for Australian females. The negative effects of male circumcision on female partners has already been documented in a study by Australian authors published in the Journal of the New Zealand Medical Association and in the website sex as nature intended it. Again it is mainly the lack of the gliding or rolling action in a circumcised penis that is to blame, causing too much friction. Female partners of restored men will often say that there has been an improvement in both comfort and pleasure.

The impact of circumcision on sexual function will always be a topic of debate. But for circumcised men, when comparing the options of using an oral strip or nasal spray with minimal amounts of an active ingredient, or restoring part of the penis that should naturally have been there, I know which option I think would be more likely to get results.

Understanding ‘phimosis’: truth, lies and appropriate responses

In the 21st Century, thankfully, most male babies leave Australasian hospitals with their genitals intact (uncircumcised). They are, however, still not assured of reaching adulthood (the age of consent) without being subjected to genital cutting practices. The most common ‘reason’ cited for the circumcision of post-infant boys is a diagnosis of ‘phimosis’. The predominant (traditional) view has been that having a foreskin which cannot be retracted is a medical condition which requires treatment, however modern, rational perspectives suggest that a tight foreskin is simply a natural variation of the norm, which hardly ever requires surgical intervention and, in the cases where such intervention may be required, any decision can (and should) almost always be left for the individual to make once they have reached the age of consent.

In recent times, accurate information about normal penile anatomy has become more readily available. The majority of new parents now learn that the foreskin is ‘fused’ to the glans (head) of the penis and that it remains this way for a number of years, sometimes until well after the onset of puberty. This makes a diagnosis of phimosis extremely problematic, especially in younger children. Despite this, (whether as a consequence of ignorance, or simply due to ‘taking the easy way out’), there are still some doctors in Australia and New Zealand who employ ‘radical prepucectomy’ (circumcision) as a front-line ‘treatment’ for a tight foreskin. In fact, in 2003, an Australian study provided clear evidence that nearly all of the circumcisions being performed upon minors as a consequence of a diagnosis of phimosis were unnecessary. It would appear then, that better education of physicians, and perhaps parents, with regard to foreskin development and management is still required.

In recent years, misconceptions about penile anatomy and health have been rightly refuted. Most health care professionals (and parents) now understand that no attempt to retract the foreskin should be made during a child’s formative years, especially given the well-documented protective functions that it serves. It is now broadly recognised that forcibly retracting the foreskin causes damage to the structure, including tearing, which can lead to a narrowing of the preputial sphincter and therefore ‘phimosis’.

Difficulty in urination is the most commonly cited indicator of phimosis in infants and young children. Inflammation or infections of the penis/foreskin have also been cited as indicators of phimosis, however these symptoms are rare, usually minor and generally resolve themselves without the need for surgical intervention. In either of these instances, caution and a conservative approach should be paramount. New parents are understandably worried if they notice that their young son ‘sprays’ urine, or has ‘ballooning’ of the foreskin when he urinates. In the absence of any sign of severe or lingering infection, those concerns are generally unfounded. The situation will almost always resolve itself as the child grows and therefore, the most appropriate front-line treatment is no treatment at all.

In cases where persistent symptoms of inflammation or infection are noticed, they are most commonly caused by external exposure to chemicals, including soaps and detergents (such as those contained in ‘bubble bath’ formulas) and highly chlorinated water. Halting exposure to these compounds is therefore the most appropriate front-line treatment in such situations. Regular changing of nappies is also important in order to prevent infections caused by exposure to fecal matter, as is good hydration, since dehydration can lead to the release of overly concentrated (acidic) urine.

There is some controversy over the role of anti-biotics and ‘pro-biotics’ in the resolution of infections resulting from a tight foreskin. Some experts use topical anti-biotic ointments in these situations, whilst others avoid them and believe that the infection can be treated by the ingestion of natural yoghurt, in order to correct the balance of microbial flora in the area.

Once a child reaches the point of ‘genital awareness’ (usually in the years just before the onset of puberty), they are in a position to have input into decisions that are made about their own sexual health. It is important to note that many boys reach adulthood and beyond without perceiving or experiencing any problems associated with having a foreskin that does not retract, however some teenagers do discover that they encounter difficulty with masturbation or pain/discomfort during sexual intercourse as a consequence of having a tight foreskin. Obviously, many teens in such a situation will feel embarrassed about discussing it with their parents or a doctor and will look to the internet for information. Sadly, in the past, accurate and helpful information on this issue has been difficult to find. Part of the aim of the publication of this article is to provide such a resource.

The simplest and most non-invasive method of resolving a tight foreskin in older children (and adults) is ‘manual stretching’. There are several methods of manual stretching that have been shown to be highly effective. One of the most popular methods requires no ‘devices’ or ‘equipment’ and is therefore completely cost free. All that is required is for the individual to adopt a daily routine in which the foreskin is pulled back as far as it can be without causing pain. Great care must be taken in the early stages of this process, to ensure that the foreskin is not retracted behind the glans prematurely, because doing so can result in so-called ‘paraphimosis’, a condition in which the foreskin becomes trapped and cuts off blood supply to the end of the penis. Patience is paramount. This process is most effective when repeated several times a day and often achieves good results within just a few weeks.

Some individuals have become creative and developed their own home made ‘equipment’, such as soft plastic rings or tubes, with which they gently stretch the foreskin. In many ways these manual stretching methods resemble the stretching of earlobes undertaken by many young people these days, in which increasingly larger ring-like jewellery is used to increase the size of the hole created by the initial piercing.

In the rare cases where specific forms of Balanitis have been positively diagnosed, the topical application of a steroidal ointment such as Betamethasone can provide good results. These ointments replicate the release of hormones that occurs during puberty which usually cause a natural dilation of the foreskin.

Profit-driven corporations are very good at identifying public demand for ‘goods and services’ and it is therefore hardly surprising that websites promoting products such as ‘Glansie’ and ‘Novoglan’ have recently started to appear on the internet. These products may well be effective in resolving concerns created by having a tight foreskin, however they may not necessarily be any more effective than the options referred to above and certainly incur a greater cost.

If the methods explored above do not have the desired impact, there is at least one surgical alternative to circumcision that can be considered. ‘Preputioplasty’ is a procedure that involves one or more incisions being made in the preputial sphincter, which are then sutured (stitched) to close the wound. Although preputioplasty is surgically invasive, it is certainly preferable to circumcision, since no bodily tissue is removed. A recently published study confirmed that preputioplasty provides a good outcome for the majority of boys who undergo the procedure.

Given all of the available evidence, surgical intervention in the form of circumcision, is almost never required to ‘resolve’ the issue of a tight foreskin in males of any age and, as such, it should be regard as a solution of last resort. Furthermore, the available evidence suggests that, in the overwhelming majority of cases, males should be allowed to reach the age of consent without being subjected to surgical intervention. Whatever course of action they decide to take once they reach the age of consent is a matter for them and them alone.