Penile Adhesions

Ha!!  Did that title get your attention??  But seriously, this is good info for those who may have a baby boy who is circed or who may be considering circumcising future children . . . 

First Do No Harm

Whenever I think of that creed that Dr's strive to abide by I can't help but think circumcision, and how ironic it is that the goal is to FIRST do NO harm . . . yet they are performing elective cosmetic surgery on a baby.  Without the procedure there is no harm, things are left perfect as they are, as God created them when He declared "it is good" (they have disproved supposed health benefits from circumcising).  The procedure has the potential to cause harm (or I would argue doesn't have the potential to not cause harm) . . . so it seems like there is a conflict here.

We all know there are complications with any surgery or any medical procedure period.  I am not talking about trauma or lingering pain or mental issues (much of which is also experienced)  . . . but actual physical issues as a result of the procedure.  Among the many potential complications you have things like infection, hemorrhage, buried penis, phimosis, deformity (can be caused by removing too much foreskin or actually cutting into the penis) along with more serious complications like amputation and even death.  Of course the more serious complications are very rare.  But rare or not, they do occur, and wouldn't otherwise, so it is right to acknowledge their existence.  In this article on the Estimated Incidence of Circumcision Complications in the US from 1940-1990 they estimate . . . 

At the present rate of over 1.25 million infant circumcisions annually, the estimated death rate of 1 in 24,000 translates to one infant death per week (52 deaths annually). An estimated death rate of 1 in 500,000 translates to one infant death every 152 days (between 2 and 3 deaths annually).

I know babies can die from any number of things, it is so terribly tragic, heartbreaking . . . but because this is due to an elective cosmetic surgery gives me pause.  In this case I refer you back to the first bold line of this blog post above.
Like I said though, serious life threatening complications from circ are rare.  But there are complications that are much more common, and adhesions are often either overlooked or catch parents by surprise.

What are Penile Adhesions

Penile adhesions occur when the foreskin, that has been ripped away from the glans of the penis during the circumcision procedure, adheres back to the glans in the days/weeks following the procedure.  Or if you want the words of a professional, here is a description by a nurse

When a circumcision is done, tissue which would normally be intact is split. Unless proper care is taken, the epithelium of the inner prepuce at the point where the foreskin was removed can reattach to the epithelium of the glans. The result of this is a penile adhesion.

 This has always been a complication, however I really believe that it is becoming more common. A study by Dr Van Howe showed that some 25.6% of circumcised babies had problems with adhesions and 4.1% had skin bridges.

With circumcision not being recommended by any medical establishment, and with the current trends in the culture today, I understand that a lot of Dr's are becoming more conservative and cutting off less of the foreskin.  At least this is what I am hearing from others as well as seeing first hand on children I know who have been circed and have much more of their foreskin remaining (especially compared to the dozens and dozens of preschool kids I worked with 15 yrs ago).  This is a step in the right direction, the less you cut off the better, however you are going to have the same recovery and pain issues as well as many other potential complications no matter how much is cut off.  So cutting off less doesn't make it "right" or somehow ok.  Nor can it serve as a compromise . . . a circumcision is a circumcision . . . period. 

The issue is that they are ripping the foreskin away from the glans to perform the circumcision (on an intact penis the foreskin will naturally separate in time, and should never be forced).  Then, instead of doing a "high and tight" as we may call it, and removing most of the foreskin (which can cause it's own problems like painful erections, harry penis and bent penis because, for some, there isn't enough skin left to allow for full or normal erection as adults) they are leaving more of the foreskin on.  This skin then adheres back to the penis wherever it may fall, which is where you have your adhesion issues.  The ultimate result of these more conservative circumcisions is a penis which requires the special care of a circumcised penis (especially in the first days and weeks) but you also have a good bit of foreskin remaining, that eventually, once healed and separated, must be cleaned like an intact penis (ultimately retracted and cleaned under).  I don't think parents realize this.  The circumcised penis requires more care than the intact penis during the first 3 years of life. 

As mentioned, the excess foreskin, if left alone, will adhere back to the glans causing adhesions.  Basically the remaining foreskin is just trying to do what it is supposed to do and what it would have done before it was forcefully retracted from the glans.  There are also other types of adhesions that are more serious, those involving the actual scar and the forming of bridges. Some dr's recommend constantly retracting the foreskin after birth, and doing it daily to prevent adhesionsa baby's intact penis is self cleaning and completely protected and requires no special care whatsoever . . . and I have 4 boys so I know this to be true from experience).

So it is a catch 22.  If you cut off a lot of foreskin you risk deformities, issues with function etc.  If you leave some on you have a good chance of having adhesions and it requires special care.  Seems that either way you slice it there are issues (OK bad pun, LOL, but you get the picture).

So what do you do if your baby has adhesions?   Many Dr's recommend forcibly retracting the foreskin (which would be excruciating initially unless some topical numbing cream was used) and applying ointment and repeating daily till the foreskin no longer adheres.  Remember, this is raw skin that is sticking together, I can't help but think that separating it over and over would have to be painful, especially if it is starting to 'stick'.  In my research on this I have read some message boards where parents have said that they have had to retract at ever diaper change till their child was out of diapers in order to prevent the adhesions from forming.  Yikes!!  This is backed up by a statement by Dr Van Howe . . .

There is little medical advice available on this problem but Dr. Van Howe writes that "the circumcised boy needs to have any skin overlaying the glans pulled back and cleaned regularly until 15-18 months of age to prevent adhesions from reforming and debris from accumulating." He says the debris consists of "lint, dirt, talc, stool and detritus." He found strong association between coronal adhesions and the presence of subpreputial debris. Dr. Van Howe state sthat most preputial adhesions in circumcised boys resolve by 24 months "afterparents were instructed to apply gentle retraction on the adhesion.

Some say leave it be and it will separate on it's own as they get older.  I tend to think the 2nd advice is the most sound (no surprise, I tend to take the most natural route).  Eventually, hormones will naturally cause the skin to separate as it does for an intact penis.  But there is the potential for more complications since it has been altered from it's natural state and excess skin may adhere anywhere.  Infections and debris getting caught inside, (see quote above)  skin bridges and pain etc. are all potential complications  There have been times where there have been referrals to urologists and a 2nd circumcision is recommended, HERE is one such story.  I don't know if these are always necessary or just the medical profession trying to 'fix' something they think needs fixing (something they messed up to begin with).  In fact 1 of my 5 brothers in law (who shall remain nameless) was circumcised for a 2nd time as a baby, because there were problems after the first circumcision.  His mother told me the heartbreaking story of hearing him screaming from down the hall as it was being done again. . . and 20+ yrs later she is still regretful and saddened by how needless it all was.  From the Van Howe study linked to several times above . . .

According to past studies, between 1%[2,3] and 9.5%[4] of boys circumcised at birth will have the procedure revised or redone

 I think many people think that circumcision is supposed to make things easier, it is supposed to be cleaner, it is supposed to look better (all of which is untrue by the way) and I am sure plenty of people have seen no outward issues at all after their sons circumcisions . . . but what we are doing is altering the body.  We are taking a functioning organ and removing it for no medical reason.  And we are doing it on a baby when the organ is 1/10th (shoot even smaller than that) the size it will be when that child is an adult.  Plastic surgeons won't even do many surgeries on children with deformities until they are older, because they know how much children's bodies change as they grow.

We humans try to improve on Gods design, but we can't!!  It is one thing if a child is born with an anomaly, but to alter a beautiful, perfect creation . . . there are often consequences, great or small (mental or physical).  I think back to the saying First Do No Harm and I can't imagine any procedure it applies to better than performing cosmetic surgery on a baby who is not deformed.

Here are some first hand accounts online from parents who have had to go through this, as well as some of the recommendations from their Dr's (which you will see vary greatly)

http://www.mothering.com/discussions/showthread.php?t=899206
http://pediatrics.about.com/od/weeklyquestion/a/05_pnl_adhesion.htm
http://www.henryfordhealth.org/19160.cfm
http://www.mothersagainstcirc.org/adhesions.htm (bottom of the page)

If you have a son who is circumcised and has adhesions, do your research and make sure to get a 2nd (or 3rd) opinion before deciding on something drastic like a 2nd surgery.
If you are pregnant or contemplating circumcising future sons, I encourage you to also research. While I can understand and respect that certain religions feel bound to circ (and any Christians reading need to understand that we are NOT commanded to circumcise in the Bible, nor is Circumcision spoken about positively under the new covenant), the fact is that no medical society in the world recommends circumcision.  I encourage everyone to consider their child and his rights, and consider allowing him to make this very sensitive and personal decision for himself.

More information

There is more information about circumcision and adhesions at the links included throughout the post.  More info can also be found at these links below (some are duplicates from above)
Penile Adhesion: The hidden complication of circumcision
Adhesions, what are they
Post Operative Complications of Circumcision 
Penile Adhesions after Neonatal Circumcision

Doctors Opposing Circumcision
Mothers Against Circumcision
Circumcision Information and Resource Pages


p.s. . . . If anyone wonders why there are sometimes weeks between my posts . . . it is because it sometimes takes me weeks to write them, LOL!!! (can't recall the number of times I fell asleep in bed trying to finish this one, I am only 1/2 awake right now, LOL!).