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Phimosis and Forcible Retraction

Messing with the foreskin of a child is like messing with the closed eyes of new-born kittens; it just causes pain, injury, and problems.

Walabio at YouTube, October 14, 2008

The pseudo-diagnosis of "phimosis" (muzzling) is often used as an excuse to circumcise a child or adult. Phimosis is generally defined as the inability to retract the foreskin behind the glans. At birth the foreskin is usually (but not always) fully attached to the glans, and can not retract at all. For that reason:

Do not retract your son's foreskin
or allow anyone else
- doctor, nurse, grandparent or babysitter -
to retract it.

He will retract it himself in his own good time.
When he does is the time to teach him to wash underneath it.

You can download a sheet of stickers with this message in Word (*.doc) format or in .pdf format (which requires Adobe Acrobat Reader ) (with a circumcision refusal form):

Sticker: This Baby must NOT be circumcised...  Small rectangular sticker: This Baby must NOT be circumcised...

 

Incidence:

The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only 2/100ths of 1% (0.023%) of the total male population in that age group. [In other words, less than 3 in 10,000.] This means that 99.97% did NOT develop a problem. Moreover, according to Finnish authorities, only a fraction of the reported cases required surgery - a number too small to reliably estimate.

Edward Wallerstein, Circumcision: An American Health Fallacy p.128

 

Age

The age at which it "ought" to be able to retract is contentious. Certainly far too many "authorities" have defined such an age based on nothing other than their own prejudice, usually much earlier than the statistical average, one "authority" even saying it must be retractable by the end of the first week of life! Forcing it before it has detached creates a wound that unites the foreskin and glans in a so-called "adhesion" (that the forcing itself was intended to correct). The damage this causes is then often used as an excuse to circumcise.

The inside of a non-retractable foreskin can easily be cleaned by sluicing with water or squeezing the opening shut during urination and allowing it to "balloon". "Ballooning" in childhood is normal, and harmless unless it causes pain.

So at what age should it retract?
The anecdotal evidence is that the foreskin can almost always move freely behind the glans by puberty. (When the first retraction coincides with the first adolescent erection, it's a memorable experience!) But a significant number of men never experience full retraction, and have no complaints. One has sent his story with pictures. A Hungarian porn "actor"'s foreskin never retracts. They are shown here.

Be advised:

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ALTERNATIVES

Topical steroid

In Mumbai, India, Reddy et al. found "Local steroid therapy is safe and successful in alleviating symptomatic tight foreskin in a large majority of children."

The Beauge Method

Dr Michael Beauge found that when adolescents presented with phimosis (unable to retract a separated foreskin), they had been in the habit of masturbating (if at all) by some other method than pulling the foreskin back. His treatment involves learning to masturbate in the conventional way, which by itself encourages lateral tissue growth of the foreskin. Dr Beauge has treated hundreds of young men successfully this way.

Dr Mark Reiss of Doctors Opposing Circumcision reports:

In August of 2007 I got a phone call and several emails from a distraught young man in his 20s, in which he complained of phimosis, the degree of which was affecting his ability to have and maintain an erection and causing embarrassment in his sex life. He seemed to be profoundly depressed. Of course all the urologists he saw recommended circumcision, but he wisely contacted a number of us, who recommended Dr. Michael Beauge's stretching technique:

I just got the following email from him, which is very gratifying. I recommend that his experience be cited for similar situations.

Hello, Dr. Reiss

I am the young man who contacted you over a year ago about having phimosis.

The study I read about Dr. Michel Beauge was incredible and very profound. Especially his analysis on certain conservative cultural tendencies toward self-stimulation.

The method that Dr. Beauge implies in his paper worked wonderfully for me.

I was relieved 110% [sic] of my phimosis and it is absolutely incredible. My personal life has improved dramatically.

My stance against pre-emptive non-therapeutic circumcision has become more solidified after having applied the Beauge method.

I just wanted to let you know that anyone who has phimosis should definetely try the Beauge method.

A young man has posted on Vimeo (after YouTube removed it) "A Field Guide for the Modern [Intact] Male", an artistic version of how he successfully eased his foreskin back.

Do-It-Yourself Devices

A mechanical retractor, "the Glansie", is designed for self-treatment of phimosis.

Glansie (offiste)

This has had at least one negative review.

An Australian-made device, the Novoglan GFS (Gentle Foreskin Stretcher), involves a tiny balloon that is inflated within the foreskin. It costs $Aust108 (inc GST).

This has has at least one negative review.

The Phimocure is a series of five silicone rings, 18 - 26mm in diameter, each successively larger size to be worn for a week to hold the foreskin open.

A navy surgeon successfully used small artery forceps for 2-3 minutes a day for two weeks.

Small artery forceps

Surgery

Kaye et al. describe how skin-grafting is successful where phimosis is combined with frenulum breve.

Foreskin resection ("circumcision") is very rarely needed:

Pediatrics
May 2016

Foreskin Morbidity in Uncircumcised Males [who else?]

Ida Sneppen, Jørgen Thorup

Abstract

OBJECTIVE: As a consequence of the discussion on whether the health benefits of newborn male circumcision outweigh the risks and the discrepancies in reported figures of complications, we evaluated the incidence and morbidity of foreskin surgery due to medical indications in boys from the Capital Region of Denmark in 2014.

METHODS: Medical records from all boys operated on the foreskin due to medical reasons in the Capital Region in 2014 were reviewed. Patients with hypospadias, ritual circumcision, and redo-surgery because of complications to nontherapeutic circumcision were excluded.

RESULTS: A total of 181 patients were included. The cumulative risk of undergoing [any] foreskin operation before 18 years of age was 1.7% [one in 59]. Forty patients had histologic verified balanitis xerotica obliterans (BXO) corresponding to a total risk of 0.37% [one in 270] of developing BXO. Mean age at surgery was 10.1 years (range 1–17). Phimosis was the most frequently reported indication (95.0%). The remaining 5.0% underwent surgery because of frenulum breve causing problems during erection. Before surgery, 27.1% had foreskin-related voiding problems and 17.1% had at least 1 episode of balanitis. Circumcision was initially performed in 44 cases. The remaining 137 patients had a foreskin-preserving operation performed. Nine boys had secondary circumcision after initially having foreskin-preserving operation. [A total of 53 "circumcisions" performed, making the risk of that 53/181 x 1.7% or one in 201]  Fifty patients initially had preputial histology performed. BXO was verified in 37 patients. Of the 9 patients with redo-surgery due to recurrent phimosis, a further 3 had histologically verified BXO.

CONCLUSIONS: Childhood foreskin-related problems in a region with no tradition of newborn male circumcision should not be neglected. [The real conclusion: Childhood foreskin-related problems are so rare, the likelihood of needing infant male genital cutting  ("circumcision") is negligible.]

  

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