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1st April 2025. Harry Potter was circumcised!

Most of us know that Daniel Radcliffe, who played Harry Potter in the movies, is circumcised. But now, apparently, JK Rowling has explained that the fictional Harry Potter was circumcised. What's more the wizard circumciser was drunk and left him with a badly scarred penis. This caused him some trouble during his early days at muggle school, and later in his relationship with Ginny Weasley. Read the whole story at The Toronto Harold. NB - this is the Toronto Harold, not the Toronto Herald.

Thanks to reader AT for supplying an appropriate story for this particular day.

9th March 2025. Thermocautery or cut?

Thernocautery uses heat rather than a knife to cut the skin, in the process sealing blood vessels so that there should be no bleeding. But is it better overall? That is a question that a group of Turkish paediatricians led by Bedreddin Kalyenci set out to investigate in a retrospective study of 7041 childhood (age 6-11) circumcisions. Three methods of conventional cut were distinguished - forceps guided, dorsal slit followed by circumferential cut, and sleeve resection. The thermocautery cases were all forceps guided.

The thermocautery operations, not surprisingly, had the fewest bleeding problems, but the longest healing time and the greatest risk of serious oedema (swelling). Among the cutting operations sleeve resection was easily the best, with lowest incidence of bleeding and oedema and fastest healing. Forceps guided was the worst. Read the abstract at PubMed or the full paper at PubMedCentral. Thanks to JH for the link.

26th February 2025. How (not) to care for an uncircumcised penis

In a paper in Canadian Family Physician, Leeson and his two (male) colleagues state: "As neonatal circumcision rates decline, the importance of educating patients on proper foreskin care becomes increasingly vital to avoid complications later in life." True enough but it is clear that none of the authors has ever brought up an uncircumcised son or grown up with uncircumcised peers, so they rely on the literature. This inevitably exposes them to the numerous 'studies' from intactivists. One dead give-away is the claim that smegma helps retraction (Err, how could it? It accumulates in the coronal sulcus). They do say that infant circumcision should be a parental decision, then try hard to discourage it. OK, they do admit that if a boy reaches 10 or 11 without being able to retract, he is in trouble, but steroid cream is the only option they offer, even though they admit that it has a low success rate. (And treating a boy who is going into puberty with steroids seems pretty iffy.) No mention of circumcision which gives a 100% solution. One could go on, but you get the picture.

Read the abstract at PubMed or the full paper (open access) at Canadian Family Physician where, being Canadian, it is available in either English or French. Thanks to JH and BM for the link.

24th February 2025. Comparing three methods for neonatal circumcision

In Nigeria circumcision of boys is well-nigh universal. A team of surgeons led by Victor Modekwe set out to define a gold-standard for hospital circumcisions with the (hinted at) aim of keeping infants out of the hands of untrained traditional circumcisers, who apparently have a rather poor reputation.

They rejected Plastibell, partly because of the risk of complications, but also because of strong parental objection to their babies coming home with a plastic ring on their penis. So their choices were Gomco or forceps guided. They used two different types of forceps - simple artery forceps or more elaborate bone cutting forceps. The bone cutting forceps performed best, with shortest operation time, fewest complications and best cosmetic result. Gomco wasn't far behind but had the longest operation time. The artery forceps technique had most complications, worst cosmetic outcome and was not recommended.

Read the abstract at PubMed or the full paper (free access) at PMC. Thanks to JH for the link.

12th February 2025. Device-assisted or manual for adult circumcisions?

A recent study in Spain (Rojo et al., Device-assisted versus manual circumcision: a prospective, comparative, multicenter study. Journal of Sexual Medicine, 10 February 2025) looked at this question. 200 adults scheduled for circumcision were divided into two groups, one to be circumcised with an all-in-one device (the Chinese CircCurer) and the others for freehand (sleeve resection). Patients could choose which group they went into, and the authors admit that this could have caused some bias, since older patients tended to choose the manual group (average age 50) and younger ones (average age 38) the device group.

The primary aim of this trial was to see which technique was more satisfactory for the patient, and here it was clear that the appearance of the device circumcision had a higher approval rating. A secondary aim was to look at complications, and here the results are not so clear-cut. Six men in the nanual group and nine in the device group had problems at 1-week follow up - the difference was not significant statistically but it is worth noting that in one of the device group men the site had become infected. However, at the 1-month follow-up 26 of the 100 men in the device group had retained staples which had to be removed manually. Easy enough in a controlled trial, but imagine that in the real world!

The full paper is behind a paywall but you can read the abstract at JSM. Thanks to JH for the link.

6th February 2025. Complications in Ghana.

Ciircumcision is almost universal in Ghana - 96% of males are circumcised. So you would thimk they'd have learned to get it right. Not so, says a new paper in PLOS Global Health "Clinical outcomes of circumcisions and prevalence of complications of male circumcisions: A five-year retrospective analysis at a teaching hospital in Ghana" by Boakya and Obeng. The figures are horrifying. Circumcisions performed by doctors had a complication rate of 4.3%, which is pretty high compared with 0.5% in the US, but it gets worse. Complication rates were 39.1% for circumcisions performed by nurses and 34.8% for those done by traditional circumcisers. And these weren't all minor complications - urethrocutaneous fistula (cutting into the urethra) was common. The paper is open access so you can read the whole horror story in PLOS

Thanks to JH for the link.

30th January 2025. Glasgow and Clyde NHS.

The Glasgow and Clyde NHS district has traditionally been willing to provide circumcisions for religious, cultural and social reasons as well as medical need. Generally in the UK circumcisions are only carried on infants older than three months (and of course older children and adults) but more recently Glasgow and Clyde introduced neonatal circumcision using Plastibell. They have now released a breakdown of results for 2024. Note that they do not distinguish between the different reasons for circumcision.

In total 1297 circumcisions were performed in the year. 825 of these were traditional circumcisions, 547 under general anaesthetic, 278 under local. 472 were neonatal Plastibell circumcisions. The neonatal service is new, introduced in May 2023, so last May they published a review of the first year, which you can read here. Only 139 Plastibell circumcisions were carried out that year, and complications were few. They list 7 complications (~5%) but in fact only one required medical attention (for a trapped ring), the others resolved spontaneously.

Thanks to JLC for the information.

24th January 2025. Former paediatric surgeon jailed for five years for unsafe child circumcisions.

Mohammad Siddiqui has been joiled for five years and seven months on a horrendous list of charges. In 2012 and 2013 he wass working as an NHS Clinical Fellow but on the side ran a mobile circumcision service, operating in people's homes in unsafe and unsanitary conditions. He continued this even after being struck off. Quite why it took 10 years to bring him to justice is a mystery. You can read a paragraph giving more details at the BMJ website. The BBC has a fuller account.

Thanks to BM and AK for the news.

2nd January 2025. Complications of ritual cirumcision in Egypt.

"Spectrum and the management of glanular-preputial adhesions after ritual male circumcision" is the title of a recent paper by Fahmy et al. in BMC Urology. The problems they describe go beyond simple adhesions to complete occlusion of the glans by fibro-phimosis. (This occurs when the circumcision scar mobilizes over the glans and then shrinks). The rate of such complications seems terribly high, and shockingly seems to be as high among circumcisions done by doctors as ones done by unqualified circumcisers.

Read the abstract at Pubmed or the full paper at BioMed Central. Be warned, some of the images are horrific, and the spelling is terrible! (Doesn't BMC have sub-editors?) Thanks to Prof. Brian for the link. A somewhat gloomy start to the New Year.

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