BC man's foreskin op a success

News  National Review of Medicine (Montreal), Volume 3, Issue 12. Friday, 30 June 2006.

Jennifer Laliberté

Government pays to repair botched circumcision

In late April Paul Tinari became the first man in Canadian history to have the government pay for surgery to reverse a botched circumcision.

Armed with letters from a urologist and psychiatrist, the Vancouver engineer — who says he's been in pain for years — convinced the BC government to pick up 90% of the $12,000 tab. The final piece fell into place when he located Toronto plastic surgeon  External link Dr Robert H Stubbs, the only doctor in Canada who'd ever performed a foreskin restoration.

This is not something I went into lightly, says 48-year-old Dr Tinari of the complex, multistage procedure he began at the end of April. I assessed the risks [of the surgery] and was willing to take them. But I certainly wasn't willing to pay for it.

The  External link BC Ministry of Health says requests for funding for unlisted medical procedures are approved only if the care isn't available in the province and if a medical professional has confirmed there's a serious medical or mental health issue. There were no existing rules to deal with Dr Tinari's unusual case. Obviously, something like that would be granted coverage only in rare or extenuating circumstances, says ministry spokesperson Sarah Plank. We certainly don't have a billing code for it.

He got a big chunk because no one in BC does this and he had his urologist and psychiatrist on his side, observes Dr Stubbs, who specializes in genital cosmetic surgery. Some provinces are willing to do things like that for their citizens.

Restoration 101

Dr Tinari was a good candidate for the surgery, says Dr Stubbs, who says he doesn't know of any other Canadian physicians doing foreskin restoration. He had sufficient donor skin and was well aware of what he was getting into. I select my patients very, very carefully, he said. In fact, Dr Tinari is only the third patient he's agreed to take on. This is like climbing Mount Everest, he says. It's a huge procedure.

First, the skin is cut along the circumcision scar line and stretched open to create a graft site. Then, two parallel incisions are made on the scrotum — the donor site — leaving a sort of bridge with the two ends attached on either side. The penis is popped through the hole, with the skin bridge covering the defect you created, Dr Stubbs explains. Then we let that heal for at least three weeks. In stage two, the two ends of the bridge are cut, separating the penis and scrotum. You tuck those two pieces that are still dangling to the underside and keep your fingers crossed that enough blood vessels have grown in to ensure survival of the graft. Finally, when the swelling has subsided, the new skin is stretched over the penis with tape and traction weights to form a foreskin.

Personal Crusade

Dr Tinari sees this not just as a medical victory but a moral one too. He alleges that his circumcision was forced on him when he was eight years old by priests at his Montreal boarding school as punishment for masturbating. He says the circumcision left him depressed, suicidal and in chronic pain. He says his testicles would pull up onto the shaft of the penis during an erection; a segment of the glans healed to a small amount of remaining shaft skin, forming a  External link skin bridge; stretching of that bridge caused intense pain during erection, occasionally causing tearing and bleeding during sex. He adds that cleaning under the skin bridge was also very difficult, so he suffered from chronic infections for years.

Nowadays, Dr Tinari, who has a PhD in engineering, is the director of an environmental engineering company based in Coquitlam, BC. But he spends a lot of his time campaigning against circumcision and for wider access to foreskin restoration. People thought that I would go away after the surgery, but that was just the first step, he says. I did this to restore my own bodily integrity, but also to set a legal precedent.

Given the complexity of the procedure, Dr Stubbs doesn't expect to see a dramatic increase in patients. He's staying out of Dr Tinari's legal pursuits. I don't ask women why they come in for a breast implant, and I didn't ask him if he had an ulterior motive, says the surgeon. He may have an agenda that I don't know about, but this isn't something where the success or failure of his surgical procedure should make men consider this an option or not.

Meanwhile, Dr Tinari is still recovering; it's nearly two months since the surgery and his doctor is pleased with the outcome. We seem to have about an 80-90% graft survival, says Dr Stubbs. I transferred a strip about 7cm wide, so he should have plenty for an adequate foreskin. The patient is also very pleased. I've been working towards this for thirty years, says Dr Tinari. I'm feeling better every day.


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