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.

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.]

Facebook, May 10, 2013

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.]

miffyrabbit in The Guardian, May 12, 2010

... My parents decided to circumsize me as a toddler. ... they considered it to be more hygienic. Consequently through my life I've been blighted with bladder infections - two of which hospitalised me. Urinary tract infections are far more serious in men than women; obviously because of the difference in plumbing. Also, but less importantly, I have absolutely no sensation where it matters in my private parts because I had such an aggressive circumsition.

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 a buried penis
of unknown cause

Picture of a buried penis
caused by Tara KLamp in KwaZulu Natal

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.

British Medical Journal BMJ Case Reports 2012; doi:10.1136/bcr-2012-007096
October , 2012

Electrocautery-induced gangrene of the glans penis in a child following circumcision

By Gunalp Uzun, Yavuz Ozdemir, Murat Eroglu, Mesut Mutluoglu

Description
A 7-year-old child was brought to the hyperbaric [raised pressure] oxygen centre because of cyanosis [blueness] of his glans penis. He had been circumcised the same day with the use of a monopolar electrocautery device. Unfortunately, the electrocautery caused a severe burn injury on the glans of the child. On examination, he had necrosis [dead tissue] over the glans and shaft of the penis.
figure 1 [NSFW, Not for the squeamish]
"Necrosis of glans and penile shaft."

Circumcision is a religious and traditional ritual in some cultures and involves the removal of the preputium penis. It may be performed by a variety of techniques, and although it is regarded as a relatively safe procedure, it does, like any surgical procedure, carry the risk of complications. Choosing the most appropriate technique and giving the highest attention and care will avoid most of these complications. Bipolar electrocautery has been shown to be safe in circumcision. However, the use of a monopolar electrocautery, as was the case in this patient, has resulted in a dramatic accident. [Should it be called "unfortunate" or an "accident" when monopolar electocautery inevitably fries the penis like a hot-dog cooker] Indeed, when a monopolar electrode is used, the electrical current is carried by the small diameter of the penis, which may lead to tissue heating and thus thermal injury. Although adjunctive hyperbaric oxygen therapy was administered in the following days, the lesion worsened and resulted in significant tissue loss involving the whole glans and the distal parts of the penile shaft.
figure 2 [NSFW and not for the squeamish]
"Despite hyperbaric oxygen therapy and wound care, debridement [removal of dead tissue - in this case, most of the penis] was unavoidable."

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 by 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, 1992

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 circumcised 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

Journal of Pediatric Urology Volume 6, Issue 1, Pages 23-27 (February 2010)

Penile injuries from proximal migration of the plastibell circumcision ring

C.O. Bode and A.O. Ademuyiwaa
Pediatric Surgery Unit, Department of Surgery, College of Medicine University of Lagos / Lagos University Teaching Hospital, PMB 12003 Lagos, Nigeria

Abstract
Background
Although circumcision is the commonest surgical procedure performed on male neonates, complications still arise from all methods used by operators.

Patients and method
This was a prospective study of penile injuries resulting from proximal migration of the Plastibell device in neonate boys referred to the Lagos University Teaching Hospital, Lagos, Nigeria. The parameters measured were patients' biodata, presentation, management and treatment outcome.

Results
Twenty-three injuries resulting from circumcision with the Plastibell device all occurred from prolonged retention of the ring. In each case, the ring was retained and had migrated proximally. There was extensive skin loss in 17 (74%) babies. Urethrocutaneous fistulae were the result in nine (39%) of these cases, while partial necrosis of the glans penis occurred in four (17%). These complications resulted from the use of wrong-sized Plastibell kits, lack of follow-up by the medical staff, and inadequate maternal knowledge of ring fall-out time.

Conclusion
Proximal migration of the Plastibell ring can result from employment of an inappropriate size, causing grievous penile injury. Adequate information should be provided to mothers of circumcised babies about possible complications of the Plastibell kit when employed. There is a need to redesign the Plastibell kit to eliminate its migration up the penile shaft.

These pictures appeared on the web about the time this study came out, and may refer to it. (Not for the squeamish)

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 Alameda, CA, in 2006.

Another case, in Mattoon, Ill, in 2007.

Two other cases, in New York in 2013 and 2018.

(This article comes via Snopes, because the picture was used to illustrate an urban myth)

Severe Burn of Penis Caused by Excessive Short-Wave Diathermy

A 38-year-old man was admitted to this Hospital for severe penile burn caused by excessive short-wave diathermy. Five days ago, the patient visited a clinic for recurrent genital herpes simplex. Circumcision was performed and local short wave diathermy given immediately. The frequency of short wave source was 13.56 MHz with a penile exposing time of about 2.5 hours. Blisters and extravasation at the penile skin were seen 1 day and became black 3 days after short-wave diathermy. The patient could micturate [i.e., urinate] without hematuria [i.e., blood in the urine]. The whole penis was burned black and became indurated [i.e., hardened] with a clear margin with the normal skin at the base of the penis. He felt no pain in the penis even with needle puncture. Doppler sonography revealed no blood flow in the penis and severe burn and penile gangrene was diagnosed.

At day 31 after the treatment, the necrotic part of penis was resected with only about 1 cm of the penile stump left. Thrombi were found in the two deep arteries of the corpora cavernosa and deep dorsal arteries and the veins beneath Buck's fasica. Scrotal skin was mobilized and shifted to repair the penile stump. Pathological examination showed necrosis of the penis tissue and thrombi formation in the corpora cavernosa.

Convalescence was uneventful. The patient could micturate in standing position by pushing skin around the stump of the penis backward.

P the diathermy ablation (not for the squeamish)

A partial ablation is reported from New York in 1995. A three-year old Jewish Russian immigrant child was circumcised by a mohel in a urologist's outpatient clinic. Consent had been given for the urologist to perform the circumcision. Instead, the mohel negligently amputated the head of the boy's penis. The urologist attempted to reattach the head and transferred the boy to Bellvue hospital by ambulance. Four-fifths of the head of the penis necrosed (died) and came off. After a one-month long trial, the family was awarded a total of $1,000,000. The mohel declared bankruptcy.
Bronx County N.Y.
Plaintif Nozik #20875/90
November 22 1995

Ouch! Boys Lose Too Much in Circumcision Slip

Updated 3:22 PM ET June 9, 2000 ANKARA (Reuters)

Health workers carrying out a mass circumcision on more than 200 children in western Turkey cut off more than they should have when they got to the last two on Friday.

"Whether it was because of their anatomy or through carelessness, too much was cut off," Anatolian news agency quoted Manisa health service chief Ismet Nardal as saying.

Doctors in the hospital where the two-day circumcision marathon was carried out immediately operated on the pair to try to rectify the error.

"The children's stitched organs have held, the operation was successful," Nardal said. "They appear to be alright, but it will only become apparent later if they have lost their sexual function."

Young boys are circumcised in overwhelmingly Muslim Turkey before they reach puberty, according to Islamic tradition.

[This item - about a lifetime catastrophe for the two boys involved - was widely reported in the "joke" sections of papers, as the headline suggests. That in itself is part of the psychopathology of male genital cutting, helping as it does to prevent questioning of the operation itself.]

By Judy Siegel

AFULA (August 14) - A baby whose penis was accidentally amputated below the corona by the mohel (ritual circumciser) and reattached by microsurgery a month ago was declared fully recovered yesterday at Ha'emek Hospital in Afula.

Hospital spokesman Danny Brenner said the baby is now able to urinate normally, and the penile blood vessels and nerves are fully functioning. The hospital reported the highly unusual incident to the Health Ministry, but Ha'emek still doesn't know the identify of the mohel, as the family refused to give his name and have not yet filed a complaint.

The parents rushed the baby to the hospital four weeks ago carrying a plastic bag with the glans penis kept in ice. Dr. Ya'acov Rosenman, deputy head of the urology department, and Dr. Boris Lachman performed the painstaking operation, which took more than eight hours.

Rabbi Yosef Weisberg, the ministry's national supervisor of ritual circumcisers, had not yet been informed of the case. "If asked, our committee will investigate.

Such a thing is extremely rare, but I have heard of one or two other cases here over the year. Any mohel who does such a thing must be blind, have taken a drink, or been pushed while performing the brit mila," he said.

The fact that there is no circumcision law, "due to pressure from American Conservative, Reform, and female circumcisers who are afraid they'll be left out," means there are unlicensed mohelim, Weisberg said, but he could not estimate how many there were out of the total of several hundred practicing mohelim in the country.

Brenner said that it was possible the family would complain to the police or sue the mohel for damages now that the child had recovered, "or maybe they received payment from the circumciser to keep quiet about the incident."

Although amputation of the penis is rare in children, said Brenner, the world's top medical experts in reconnecting adult penises are in Thailand, as nearly every day, disgruntled wives cut off their husband's organs in a fit of anger or jealousy.

J Sex Med. 2007 Dec 14 [Epub ahead of print]

Restoration of the Penis Following Amputation at Circumcision: Shaeer's A-Y Plasty.
Shaeer O. Department of Andrology, Faculty of Medicine, Cairo University, Egypt.

Introduction. Male circumcision is one of the most commonly performed procedures worldwide. It has an estimated complication rate ranging from 0.1% to 35%. Amputation of the shaft is one of the most devastating complications reported, resulting from entrapment of the phallus between the blades of the clamp or from thermal injury due to the application of unipolar diathermy.
Aim. In this work, I describe the guidelines I adopted in the management of 32 male patients afflicted with amputation of the shaft of the penis upon circumcision.
Methods. "Shaeer's A-Y plasty" was performed for all patients, whereby the proximal corpora and crura were released from their attachment to the pubis and were advanced forward by insetting a specially configured fat flap into the resultant cavity. Skin grafts were used to cover the released penis.
Results. In all 32 cases, the released penis was within the normal range of penile length, and was cosmetically and functionally acceptable.
Conclusions. "Shaeer's A-Y plasty" is capable of restoring the native phallus [No, it replaces it with a facsimile] following amputation, with preservation of both gender identity and physiological characteristics of the penis to a large extent.

PMID: 18086176 [PubMed - as supplied by publisher]