AAP recommended that insurers ahould pay - but do they?
The American Academy of Pediatrics has changed its policies over the years, becoming more and more in favour of circumcision as a preventative health measure. In 2012 it recommended that medical insurance should cover routine infant circumcision. A team of specialists, most of them from Chicago, set out to see if this had made a difference. They looked records of over 8 million baby boys, and foumd that circumcision rates had fallen over the study period, but did not change significantly post 2012. As expected there were strong regional and racial differences. The overall circumcision rate was 55%. Patients with lower incomes, and those on public rather than private insurance, were less likely to have their sons circumcised, implying that financial constraints are limiting acccess to a medically valuable procedure. Read the abstract at PubMed. Access to the full paper, in the Journal of Urology, requires payment.
Editor's comment - other studies have shown that there is a growing trend in the US to have infant circumcisions in office settings rather than the maternity hospital, but such circumcisions were not included in the above study.
Both JH and Professor Brian Morris send in this paper.
Does a plastic model really help?
Some time ago a 'circumcision training kit' was advertised on Amazon. It was eventually withdrawn. Now we have another kit, apparently developed in conjunction with the University of Wisconsin advertised by Anatomy Warehouse. It is available with or without a set of surgical instruments and in different skin colours (does this really make a difference?) The foreskin is apparently very realistic and six come with the kit - further replacements are said to be not expensive.
Is this really a useful training tool for medical students or just a toy for fetishists? Frankly. I'm not sure. But thanks to Claire for alerting us to this.
Clinic takes to the road.
The Covid-19 epidemic has put paid to the annual 'Tuli' circumcision season in the Philippines this year. The Hiñan City government decided to offer a mobile Tuli service using a converted dental unit. A doctor and nurse in full PPE travel in the vehicle to each house and the boy's temperature is checked before he enters the vehicle. A pre-screening check for vital signs, lidocaine sensitivity and foreskin retractibility is done and if this passes the circumcision goes ahead at no charge. Around 15-20 boys per day can be handled by the mobile service. A full circumcision is carried out, not the traditional dorsal slit of 'bush circumcisions'.
A video from news channel 24 Oras shows the mobile clinic in operation. The commentary is in Tagalog but there are enough English words to make it understandable.
Posted by 'Wang' in the InterCirc discussion group.
No, nor does it affect anything else.
A study of 1109 newborn boys in a US hospital found that circumcision had no negative effects on breastfeeding, nor did it affect neonatal jaundice or length of hospital stay. 849 ot the boys were circumcised (76.6%) so it really doesn't seem that claims the circumcision rates in the US are declining have any substance. Read the abstract at PubMed or at the journal Hospital Pediatrics. The latter gives you the option of downloading the full paper for a fee.
The authors of the above study claim this hasn't been researched before but in fact another study in the same journal found similar results back in 2016.
JH and Tom both sent in this story.
'Crude' operation lands baby in hospital
Father-of-six Philip Ogbewe, grocery shop owner of Drogheda, Ireland, has been charged with endangering a child after circumcising a 10-month-old boy. The boy subsequently spent two weeks in hospital. It appears that Ogbewe regularly practiced as a circumciser to the Nigerian community. The article says that he has been doing it for 50 years, which since he is now 55, must make him the youngest circumciser in history. However, this is Ireland. He charged €200 for a circumcision - one would think they could get it done in a proper clinic for that. Sentencing is set for today - I'll update this report if I find out the sentence. Read the report at RTÉ.
Ogbewe received a 3 year jail sentence, One has to feel that he made things worse for himself by continuing to perform circumcisions while on bail. Read the latest report in The Irish Times.
Both Tom and JT sent in the original story. Tom sent in the update.
Creative use of a lawnmover!
Police in Cornwall, UK, were using a drone so search for a suspect when they encountered this giant phallus image in a field. Of course they then posted it online (as one does).
This led to various comments:
"Must be a hardened criminal"
"That's just an arrow pointing to where the offender is hiding."
"someone hasn't just done it randomly they have actively planned this, procured a grass cutting apparatus, then made their way to this field and gave [it] a circumcision"
No word as to whether the suspect was eventually caught - maybe the police just lost interest after finding this!
Read the full story in the Sun (UK).
Thanks to Tom for the story.
What horrors hide under the foreskin?
A recent paper reports on what is said to be a rarely reported condition of multiple calculi (stones) found under a phimotic foreskin. It's a pretty gruesome sight. Read the abstract at PubMed or the full paper in the International Journal of Surgery Case Reports.
Editor's comment - while this is an extreme case I suspect a few such stones are often encountered when a teenage boy finally manages to retract a problem foreskin. I knew one such case in my teenage years.
JH and Brian Morris both sent in this story.
A kinder cut for baby boys
In Nigeria most boys, Christian and Muslim, are circumcised (in hospital) between 2 and 30 days old. Typically this has been done without anaesthesia, on the presumption that neonates are not very sensitive to pain. Now a Nigerian randomly controlled study has shown that on every measure babies given a local anaesthetic experience much less pain. Not exactly a surprising conclusion but the fact that it was done in Nigeria by Nigerian doctors probably means that it will now become normal practice there. As well as giving baby boys a kinder cut it will also encourage any parents who might have resisted circumcision to get their babies done, with corresponding benefits to public and individual health. The paper is in the Nigerian Medical Journal but full text is available free at PubMed Central.
Thanks to Professor Brian Morris for the link.
But you have to go to South Africa for it
Western Cape province is now advertising free circumcision for anyone over 15. One interesting feature is that they ae promoting it for better sex benefits as well as its health benefits:
"Medical Male Circumcision (MMC) is the most hygienic, safest way to be circumcised, and the only way to ensure that you get the full sexual and health benefits."Whether the offer would extend to circumcision tourists is not clear! In any case both tourism and the circumcision program are temporarily on hold for Covid-19 lockdown. Read the full story in the brochure issued by the Western Cape Government.
Thanks to reader JE for alerting us to this.
Meanwhile Eastern Cape has banned all traditional circumcision schools and imigidi (homecoming) celebrations for the duration of the crisis. Originally the ban only applied to March and April but one imagines it will have been extended by now. This hasn't gone down well with the traditional operators:
'Mike Kopisani of the Kampala Initiation school in St Albans near Port Elizabeth, who circumcises hundreds of boys every year, said: “This is shocking and disappointing because we were never consulted. We were not even taught or given a chance on how we can fight this virus at initiation schools.”'Most practioners are going along with the ruling but a few cowboy operators are not.
'Provincial chairperson of the House of the Traditional Leaders Chief Mwelo Nonkonyana said there were already cases of illegal initiation schools being reported. “We have sent our teams to Chris Hani, Komani, OR Tambo and Port St John’s to rescue our boys after we received the reports that there were illegal circumcision schools in these districts. So far we don’t know how many boys were circumcised.”'Read the story in The South African
How do you preserve tradition during a lockdown?
In Britain, Orthodox and Progessive Jews have adopted different tactics. Traditionally the circumsision ceremony takes place a week after the birth, and at least four people are present (a grandfather and two godparents, as well as the mohel (circumciser). This is now against the law. The Orthodox community has opted to stick to the traditional time, but only the mohel and the parents will be present. Since British mohels are all medical doctors this is legal. The Progressives, though, have decided to postpone circumcisions until the crisis is over to minimise the risk of spreading disease. Read the full story in the Jewish Chronicle
Thanks to Tom for the story.
Neonatal circumcision is going up, infant operations are decreasing.
In 2012, the American Academy of Pediatrics (AAP) concluded that the health benefits of circumcision during the neonatal period outweigh the risks. Did this affect parental choice? The answer is that it did, big time. Circumcision in neonates increased from 39% to 58% between 2010 and 2017. Infant circumcisions meanwhile declined. The report makes it clear that neonatal circumcision is the best option, being more resource-effective tham performing the operation later in infancy. Read the abstract in PubMed. There is a link to the full paper in the Journal of Pediatric Surgery but reading this requires payment.
This only refers to the hospital system, and many neonatal circumcisions are performed as out-patient procedures, which do not get recorded. So these figures do not represent the overall circumcision rate in the US. Thanks to JH (who got in first) and Professor Brian Morris for the link.
What happens when COVID closes borders?
Norway does not have a single resident mohel (Jewish circumciser). So when Rabbi Tyson Herberger and his wife Rebekka had a son 10 days ago they planned to invite a British mohel over to perform his circumcision on the 8th (7th) day. Under Norwegian law a doctor has to supervise proceedings and they had a local Jewish doctor lined up for this. Then the border was closed. At this stage they are postponing the ceremony. It would be permissible for the boy to be circumcised by a medical doctor but apparently they feel that Norwegian doctors lack sufficient experience. There are going to be many repeats of this scenario.
This all begs the question of why no Norwegian Jewish doctor has formally trained as a mohel. After all, it's a bit of extra income. Read the story in the Times of Israel. Thanks to Tom for the story.
Don't be circumcised in a Hindu city
Several journalists have been forcibly debagged (had their pants pulled down) when covering riots in Delhi and Ahmedabad. Fortunately for them they all had foreskins. This now poses a problem for non-Muslim parents of sons with phimosis. Can they risk a circumcision? For this reason preputioplasty (enlarging the orifice without removing any skin) is coming into vogue, not to save a foreskin but potentially to save a life. Read about it in the Telegraph of India.
Thanks to Tom for the story
"Nuke Israel"? "Jesus wasn't circumcised"?
14 years ago, Bonnie Brown's brother killed and dismembered her father, leaving his body in the boot (trunk) of the family car. Now, somehow, she has decided it had something to do with circumcision and on Valentine's Day she plastered her home with anti-circumcision posters which, to put it mildly, go to the extreme. "Nuke Israel" was spashed with red paint to emphasize the point. The Fairfax County Sheriff has ordered their removal.
Bonnie is obviously unhinged, and has spent a few days in a mental hospital. But why circumcision? Read the story in the Washington Post
Thanks to Tom for the story.
Sex wasn't meant to be painful
Until about 1975 circumcision was pretty much universal in Australia. There was a decline to about 10% in the 1980s then a gradual increase to close to 20% today. Now Australia faces the problem of circumcised fathers not knowing what to teach their uncircumcised sons and, even worse, circumcised doctors just telling parents to leave it alone. Journalist and academic Jenna Price has tackled the horrendous problems this causes. She has picked up on a number of cases, including George Aroney who found that his first intercourse was anything but pleasurable. He got circumcised, of course but commented that high school sex education was all about pronouns and mentioned nothing about foreskins. (Personal comment - what can you expect? This curriculum is devised by feminists and the last thing they want is for boys to have a happy sex life.)
Circumcision rates in older children and teenagers have gone though the roof in Australia in recent years - we don't know the full story because free circumcisions (waiting list ~60 days) carried out in public hospitals are not recorded. Read the story in the Sydney Morning Herald or (essentially the same story) in the Brisbane Times.
Thanks to Brian Morris and Greenbean for this story.
Why many American families prefer a mohelet
Back on 21st August 2018 we reported that many US Jewish families were opting to have a femal mohel (mohelet, plural mohalot) circumcise their sons (see our News 2018 page). Reasons include that a male mohel will not let female family members be present, whereas a mohelet has the whole family there, and also that a woman will not be hidebound by tradition, and will do a gentler job. There is, of course, a biblical precendent - Zipporah, Moses' Midianite wife, circumcised their son (Exodus 4:24-26).
The New York Times took its time to pick up on this trend, but ran an article on 28th February. which you can read here. This provoked an absolute mailstorm - 428 messages, almost all anti-circumcision, anti-semitic, or both. Read about it in The Algemeiner.
Thanks to Tom and JT.
should it be free?
Belgium has one of the highest circumcision rates in Europe - over 30% - and it seems that this is partly because circumcision is available on demand free of charge. This also extends to the Muslim population - their boys are circumcised at no cost. (Muslims are only 6% of the population so they do not contribute a lot to the national total.) Goedele Liekens of the liberal democratic OpenVLD Party has now introduced draft legislation to axe the free service for religious circumcisions.
This would not affect the Jewish population directly since their boys are not circumcised in hospital but some see it as the thin end of a wedge to ban religious circumcisions - which would affect the Jewish population. Jewish MP Michael Freilich is therefore introducing legislation to protect the right to religious circumcision. Read the story in the Jerusalem Post.
Thanks again to Tom for the link.
They still suck babies' penises
Back in 2017 we reported on cases of ultra-orthodox Jewish mohelim in New York infecting babies with genital herpes. (See items on 10th March and 3rd April in News 2017.) This happens because ultra-Orthodox circumcisions include metzitzah b'peh where the mohel sucks blood from the penis after the operation. Formerly parents had to sign formal consent forms to allow this procedure, but that requirement was relaxed when the community agreed to health checks on mohels. It seems these checks aren't happening. The Wall Street Journal reported on 23rd January that 4 new cases have occurred recently, one last September and 3 more since 1st December.
The WSJ only lets you read the first two paragraphs without paying but you can find fuller accounts of the September case in Newsweek. Thanks again to Tom.
The church speaks out
The Church of Sweden is a Lutheran church with an unusual blend of formal traditions and liberal attitudes. Until 2000 it was officially the state religion. It has now weighed in to the debate about religious circumcision, issuing a statement strongly supporting the right of Muslims and Jews to practice 'non-medical circumcision'. (Of course there is really no such thing as non-medical circumcision - the medical benefits are there whatever the reason for the operation.) This is a very welcome counter to the vocal anti-circumcision movement in Scandinavia. Read the story in the Times of Israel.
Thanks to Tom for this story.
I no longer worry about my foreskin getting trapped
The Guardian has a bit of a reputation for opposing circumcision, but they have a feature "My life in sex" where readers can contribute their stories. On 17th January they ran a short piece about a man circumcised at age 20, and what a huge benefit it had been to his sex life. (I think it also appeared in The Observer, their Sunday paper, on January 19th). Read the story at the Guardian.
Thanks to reader DC for sending us this story.
Norwegian doctors get their foreskins in a knot
In 2015, alarmed at the risks of backyard circumcisions among the immigrant community, Norway pssed a law mandating public hospitals to perform circumcisions on request (for €400 - not free). There was much protest and so a conscience clause was included allowing doctors to opt out. A very recent (10th Jan) paper by Liv Astrid Litleskare and colleagues, set out to investigate doctors' reasons for opting out, particularly looking to see if a line could be drawn separating conscience and medical ethics. The paper, "Refusals to perform ritual circumcision: a qualitative study of doctors' professional and ethical reasoning" is available open access on BMC Medical Ethics.
The authors were only able to find 10 doctors from 3 hospitals willing to participate, which may suggest the 'protest' is somewhat overrated. One stated reason was to deny the medical benefits of circumcision, apparently on the basis that HIV prevalence in Norway is low. Infection rates in Norway are indeed low, 1 in 1,000 - the same as in Australia but better than the UK (1.7 in 1,000) and the US (1 in 300). But ... long before the HIV epidemic we knew that circumcision prevented urinary tract infections, phimosis, balanitis and penile and cervical cancer. Another was the circumcision was 'causing harm'. How do you get there from the list of medical benefits and the fact that it makes sex better? Perhaps the most bizarre reason cited was that circumcision in unethical and so it should only be performed in private hospitals. Er .. can we think that one through? One fact that was consistently ignored is that in Islam circumcision is not required as an abstract God-given covenant, as in Judaism, but for its health and cleanliness benefits (along with rules about washing your hands and cleaning your backside).
Thanks to regular correspondent JH for alerting us to the link.
For once, a good news story
As ever, we get horror stories from that part of the world at this time of the year, but not in Kisii Town, Kenya. Here the operation part of the traditional ceremony is carried out by medical professionals. A local businessman, Steve Arika, is providing sponsorship so that the local street kids aged 10-12 can also be included. This includes food supplies for their period of seclusion (for which a former street boy, Duke Ombati, is loaning a rural house). Read the story at KBC (Kenya Broadcasting Corp).
One ten-year-old boy was not so lucky. He wasn't a street kid but his parents couldn't afford the Ksh1,000 ($10 US) cost. Not wanting to be left out, he circumcised himself with a kitchen knife. He went to hospital but his parents couldn't afford the bill and took him away. He still has problems, but a local activist is seeking sponsorship for his treatment. Read about it at The Citizen.
Thanks to Tom for the stories.
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