CIN (Circumcision Information Network) 3:7

Introduction
This weekly bulletin is a project of CIN, the Circumcision Information Network (formerly CIN CompuBulletin). The purpose of this weekly bulletin is to educate the public about and to protect children and other non-consenting persons from genital mutilation. Readers are encouraged to copy and redistribute it, and to contribute written material.
--Rich Angell, Editor.

BRITISH MEDICAL JOURNAL, Letter to Editor
Vol. 312, p. 377, 10 February 1996
Faxed to the U.S. by Dr. John Warren, M.D., typed by DYKS96A@prodigy.com
(GEORGE HILL)

Editor -- We are all adult men who believe that we have been
harmed by circumcision carried out in childhood by doctors in
Britain.  We are concerned about the ethics of this surgery on
children and that it is commonly carried out when it is not
essential.  We have read the BMA's ethical guidelines which give
no guidance to practitioners who are faced with a boy who has
been referred for circumcision. (1)  The possible future wishes
of the patient should be considered.

Although it was shown 28 years ago that preputial development
continues to the age of 17 and that only three of 1968 boys
needed surgery,(2) many British doctors still seem to be ignorant
of this research. (3)  The European charter for children in
hospital states that every child must be protected from
unnecessary medical treatment.  The United Nations Convention on
the Rights of the Child states that children have rights to self
determination, dignity, respect, integrity, and non-interference
and the right to make informed personal decisions.  Unnecessary
circumcision of boys violates these rights.

A non-retractile foreskin in a boy can be managed conservatively.(4,5)
 Circumcision should therefore rarely be necessary.  It would be
helpful if paediatric urologists could produce guidelines to
advise doctors how foreskin problems can be managed.  Preferably,
circumcisions should not be done until the patient is adult or at
least old enough to understand what is intended; then he has a
right to a full, illustrated explanation of the nature of the
operation and the reasons for it in advance, with the opportunity
to ask questions, and help in coming to terms with the alteration
of his anatomy afterwards.  If the patient is not satisfied with
the explanations his views should be taken into consideration.

It cannot be ethical for a doctor to amputate normal tissue from
a normal child.  In the case of disease, circumcision should be
used only when their is evidence that conservative treatment is
unlikely to be effective or that is it has failed.  Avoiding
surgery may be cheaper for purchasers of health care.  Doctors
should approach the child's foreskin with a combination of
good ethics, a recognition of the rights of children. and advice
based on evidence.

JOHN P WARREN, F DAVID SMITH, JOHN D DALTON, GRAHAM R EDWARDS,
MARC PODEN, ROBERT PRISTON, PHILIP G COOKSTON, JOSEPH ELLIOT, J S
PHILLIPS, JAMES WILLIAMS, MATTHEW MALLINSON-READ, IAN MORRIS,
JOHN BOWRING, ROB WARBURTON, JAMES BLAZERY, TONY PETERS, JOHN
MOORE. JOHN STEVENS

Norm UK
PO Box 71
Stone
Staffordshire ST15 03T

1. British Medical Association, "Medical Ethics Today:  Its
Practice and Philosophy."  London:  BMJ Publishing Group, 1993.

2. Oster J.  "Further fate of the foreskin."  Arch Dis Childh,
1968; 43:  200-203.

3. Griffiths D, Frank JD.  "Inappropriate circumcision referrals
by GPs." J R Soc Med 1992; 85: 324-325.

4. Wright JE.  "The treatment of childhood phimosis with topical
steroid."  Aust NZ J Surg 1994; 64: 327-328.

5. Cuckow PM, Rix G, Mouriquand PDE.  "Preputial plasty:  a good
alternative to circumcision.  J Pediatr Surg 1994; 561-563.

THE PREPUCE, SPECIALIZED MUCOSA OF THE PENIS, AND ITS LOSS TO
CIRCUMCISION British Journal of Urology, February 1996, Vol. 77, P291-5.
Contributed by dyks96a@prodigy.com (George Hill)
Article by R.TAYLOR, A.P.LOCKWOOD and A.J.TAYLOR, Department of
Pathology, Health Sciences Centre, University of Manitoba,
Winnepeg. Manitoba, Canada.
(First of a multi-part series.)

Objective:  To assess the type and amount of tissue missing from
the adult circumcised penis.

Materials and methods:  The gross and histological features of
the prepuces of 21 adults obtained at autopsy were assessed,
primarily focusing on the inner or mucosal surface of the prepuce.

Results:  Skin and mucosa sufficient to cover the penile shaft
was frequently missing from the circumcised penis.  Missing
tissue included a band of ridged mucosa located at the junction
of true penile skin with smooth preputial mucosa.  This ridged
band contains more Meissner's corpuscles than does the smooth
mucosa and exhibits features of specialized sensory mucosa.

Conclusion:  The amount of tissue loss estimated in the present
study is more than most parents envisage from pre-operative
counselling.  Circumcision also ablates junctional mucosa that
appears to be an important component of the overall sensory
mechanism of the human penis.

Authors J.R Taylor, MB, ChB, MRCPEd. FRCPC. Pathologist.
A.P. Lockwood, MD, FRCSC. Plastic Surgeon.
A.T. Taylor, RT, Pathology Assistant.

Correspondence: Dr J.R. Taylor.
Department of Pathology
Health Sciences Centre.
University of Manitoba.
770 Bannatyne Avenue.
Winnipeg. Manitoba,
Canada R3E OW3.

FOLLOWUP:  CHILDHOOD CIRCUMCISION SURVEY
Contributed by DonMorgan@gnn.com (Donald Morgan)

To all those who volunteered to take part in the survey and did
actually do so:  THANKS, your input was greatly appreciated!

To all those who volunteered to take part but did NOT actually do
so, your input would STILL be appreciated.  It would help to
provide valuable data in an area of study where the number of
willing subjects is quite limited.

As an alternative, I am also interested in knowing the reason(s)
that those who volunteered may have decided not to take part.
This would also provide useful feedback.

And finally, if there is anyone else out there who underwent a
childhood circumcision and would be willing to fill out a short
survey form regarding the experience and its outcome, please
e-mail me.

SCREAM OF THE WEEK
(Statements Documenting Infant Circumcision Pain)
Submitted by Johnny4444@aol.com

"...it has been argued that the infant suffers little or no pain
in the circumcision process.  The evidence offered is that in the
ritual Jewish circumcision, the infant, who is given an alcohol
teat during surgery, cries little and almost immediately goes to
sleep.  That argument shows an ignorance of the effects of
alcohol on infants and fails to acknowledge that 'sleep' may be a
response to pain."  ("Circumcision as Child Abuse: The Legal
and Constitutional Issues," by William E. Brigman, Journal of
Family Law, University of Louisville School of Law, Louisville, Kentucky)

FOR ADDITIONAL INFORMATION call NOCIRC, the National Organization
of Circumcision Information Resource Centers at (415) 488-9883,
fax (415) 488-9660.  Ask about the resource provider nearest you.
 For written information, write NOCIRC, PO Box 2512, San Anselmo,
CA 94979, with SASE and/or donation if possible.

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