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17th June 2025. Who's aFreud? Circumcision in the phallic years.

Accorfing to Freud, the years betweeen 3 and 6 are the 'phallic stage' of development when a boy is very conscious of his penis. This has led some psychoanalysts to claim that circumcision performed in this period could cause lasting psychological harm. No problem for Jewish people, or for RIC in the Anglophone countries - that is carried out long before that time. Nor for traditional circumcision in areas such as Africa, the Phillipines and Polynesia, where it happens later. But it is a common age for medical problems which require circumcision, and it is also a popular age for Muslim circumcisions.

So a group of medical scientists in Ankara, Turkey, decided to find out if there was any truth in the idea. They gave questionnaires to adult men who had been circumcised before, during or after the 'phallic stage'. Their paper "Avoidance of Circumcision during the Phallic Stage: Myth or Reality?" is open access - read the abstract at PubMed or the whole paper at Archivos Españoles de Urología. Their conclusion? Not the slightest sign of any difference.

Thanks to JH for the link.

11th June 2025. Another device comparison - Mogen, Gomco and Plastibell

This time it's from the US, and apparently these three devices account for the vast majority of neonatal circumcisions in that country. The paper "Comparative Analysis of Postoperative Outcomes Following Various Neonatal Circumcision Techniques: Mogen Clamp, Gomco Clamp, and Plastibell Device" by Julianne C Mallinger et al. is in The American Surgeon. The abstract, in PubMed reveals that there were no significant differences in complications between the devices, but there were significant differences in the pain suffered by the baby. To find out the details one has to go to the full paper, which is behind a paywall (uuless you are in a university or have a friend in one). The Gomco was a clear winner there, followed by the Plastibell and then the Mogen. Once the babies were home, however, there was no difference. Cosmetic results were good from all three.

Both BM and JH sent this one - many thanks.

10th June 2025. Training in Gomco circumcision

Previous training schemes have been published, but the novelty of 'Neonatal Circumcision Simulation: A Resource for Beginners', by Basuray, Davila and Springer, lies in the use of a 3D printed model. New interns were first shown a video, then got to use real Gomco clamps on the models. They gave the course a high rating (4.9 out of 5). The abstract is available at PubMed and the full paper (open access) at PubMed Central. Neither tells you very much, the interesting stuff is in the appendices. Appendix A is full 3D printing instructions but of more general interest are Appendix C, a step-by-step guide, and Appendix D, the demonstration video (NB, a large download). The 3D-printed model does not bleed when cut, however.

Thanks to regular correspondent JH for the link.

9th June 2025. Circumplast vs Plastibell - pistols at 20 paces?

Knocking copy - directly attacking a rival product in your advertising - was once quite common, particularly in the US, but one thought that those days were long gone. Not so with the British company behind the Circumplast circumcision device. Their website directly attacks the rival Plastibell product. "Circumplast device is better than Plastibell." "The price of the Circumplast device is less than that of Plastibell." "There are a lot of low-quality Plastibell devices available in the market. ". They do of course outline why they feel that their product is better and one obvious, and interesting, feature is the presence of multiple grooves for the ligature so that the operator has some control over style. Circlist is not disputing their claims - just amused by their 'boots and all' approach.

There is a detailed description of the Circumplast and its use on our Instruments and Techniques page. Thanks to AK for the news.

5th June 2025. Alternative medicine eases post-circumcision pain ... Err, dream on!

A team from Bingöl University in Turkey investigated whether foot reflexology would alleviate post-circumcision pain and fear in young boys (aged 5-10). Foot reflexology 'works' by applying pressure to specific points on the soles of the feet that correspond to various parts of the body. (The middle of the heel maps to the genitals.) 84 boys were divided into age-matched experimental and control groups. The experimental group received foot reflexology after circumcision. One might think that the control group would have equivalent manipulation of a different part of the foot but no, they got nothing. Then, almost unbelievably, the experimental group got a total foot massage and again the control group got nothing. One would think that at the very least both groups would get this. Any parent knows that when a child is in pain stroking a different part of the body will take the child's attention away from the source of the pain. Not surprisingly, therefore, foot reflexology seemed to have benefit - but if you believe that you'll believe anything! How this paper got past peer review I can't imagine.

The paper "The impact of foot reflexology on postoperative pain and fear in children following circumcision: A randomized controlled trial", in Journal of Pediatric Urology, is behind a paywall but you can read the abstract at PubMed. Thanks to Prof. BM for this.

28th May 2025. Belgian police raid mohels

In the past week Belgian police raided the homes of several Antwerp mohelim (Jewish circumcisers) in the small hours of the morning, seizing circumcision instruments. No arrests were made and nobody has been charged. Antwerp's Jewish community mostly belongs to the very orthodox Charedi sect. It seems that the raids were based on a complaint that the mohelim were using the archaic practice of metzitzah b'peh - sucking the baby's penis after the operation. Most Jewish communities ban the practice, the mohelim, and the parents of boys they have circumcised, deny the accusation. (Parents are present at a Jewish circumcision). In any case how could raiding homes and seizing instruments in the early morning answer that question? It looks more like intimidation.

Read about it in the Washington Jewish Week, or a later and more detailed account in The Jewish Chronicle. Thanks to AT for the story.

27th May 2025. When baby is too big ....

In the US most baby boys are circumcised in the birth hospital but some are circumcised later in doctors' rooms. These, naturally, tend to be bigger and apparently there are problems with bleeding after Gomco circumcision with larger babies. Two American urologists, Carlos Villanueva and Stephen Leahy address this problem in a paper in Journal of Pediatric Urology " Strategies to reduce bleeding risk in office Gomco circumcisions for babies ≥ 5.5 kg". Their solution? To use sutures. But surely the whole point of the Gomco was that it removed the need for sutures?

The paper is behing a paywall but the abstract is available at PubMed. Thanks to JH for the link.

22nd May 2025. Circumcision, sexual pleasure and satisfaction.

"The Influence of Circumcision on Male Sexual Function: A Meta-Analysis of Satisfaction, Erectile Function, and Dyspareunia" is a new paper in Journal of Sex & Marital Therapy. The authors, both in midwifery departments but one in Turkiye and the other in Iran, conducted a very wide-ranging survey, and concluded that "male circumcision may have potential positive effects on certain aspects of sexual function, particularly sexual satisfaction and erectile function." The only aspect that was inconclusive was premature ejaculation. They do caution, however, that there was a wide spread in the results.

The full paper is behind a paywall but the abstract is available at PubMed. Thanks to BM for the link.

16th May 2025. Novel tissue glue for circumcision.

Cyanoacrylate tissue glue has become increasingly popular as a substitute for sutures in circumcision. A group of scientists at the South China University of Technology decided to develop a better one. The paper is heavy on chemistry but they claim that their product is more viscous, so less likely to go where it should not, adheres better to skin, and is flexible enough to cope with erections. As is common in China it was tested on dogs, Labradors this time, which were subsequently killed. Surely China is the only country to allow that? It has yet to be trialled on humans.

The paper, in Regerative Biomaterials, is open access. Thanks to JH for the news.

8th May 2025. Circumcision - there's an app for that.

At first I wasn't sure whether to take this seriously, but it seems to be for real. 'Circapproved' is a smartphone app developed in Indonesia to check whether a boy is suitable for circumcision. It directs you to take photos from different angles then uses AI (in the cloud) to identify if there are any abnormalities which would be contraindications for circumcision. It claims ~90% accuracy - but surely anyone competent to perform circumcisions could do better than that. And the paper doesn't seem to state whether the 10% of incorrect results were false negatives or false positives.

The paper, in the Journal of Pediatric Surgery, is behind a paywall but you can read the abstract at PubMed. Thanks to BM for the link.

30th April 2025. Chinese parents' attitudes to childhood circumcision

Circumcision is still a minority thing in China, with fewer than 20% of boys being circumcised (see our China page). However, the trend seems to be upwards. A team of pediatricians and urologists in Sichuan, China, conducted a survey of parents to assess their knowledge of, and attitudes to, childhood circumcision. The questionnaire was large and comprehensive, but key findings were that parents were aware of the benefits to penile health but less well informed about phimosis and redundant prepuce. 75% indicated that they were willing to have their sons circumcised.

You can access the paper (open access) at Frontiers in Pediatrics.

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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