This blog post is a guest contribution written by the executive director and general counsel of a nonprofit physicians’ organization based in Seattle, Washington.
Summary: Doctors around Washington state are unnecessarily injuring boys’ uncircumcised penises by forcing back their foreskins. They are doing so based on inaccurate medical information. This problem does not receive enough attention.
Did you know there is a ‘male hymen’?
This essay is not about circumcision. That’s another (huge) topic. It is instead about an obscure and painful injury boys endure that you may be unaware of. It affects at least 2,000 boys in Washington state each year, and local hospitals like Seattle Children’s, Mary Bridge Children’s, and Group Health / Kaiser Permanente bear responsibility. To comprehend the injury you need to understand some basics of male anatomy.
A baby boy’s penis is under-developed at birth, and his foreskin cannot be retracted without trauma. His foreskin is fused to his glans by a protective membrane, the balano-preputial lamina. Left undisturbed, the natural, evolved membrane protects the boy’s erogenous tissue during childhood by guarding against ingress of feces, dirt, and abrasion. It can be thought of as the ‘male hymen,’ as it serves the same purpose for a male.
The thin membrane slowly disappears as a boy ages. Some boys can see their entire glans when younger than 10. For others it takes longer – even into their teens. There is no set timetable for natural, non-traumatic foreskin retraction, and there is no need to rush the process.
There is also no need for intensive cleaning underneath the foreskin. If the boy can pee a stream, he is fine until puberty. Sterile urine washes out his organ several times each day. In fact, the foreskin can be thought of much like an eyelid. We don’t shampoo our eyes because our tear ducts produce immune-active substances that fight incoming bacteria. The foreskin produces those same immune-active substances. Both eyelids and foreskins are largely self-defending and self-cleaning. Aggressively cleaning will ironically increase the risk of infection.
American physicians’ reluctance to accept natural anatomy
Unfortunately, American physicians from the 1850s onward considered the boy’s protective membrane a birth defect they called ‘adherent prepuce.’ They did not bother to explain why all boys are born with the same defect.
Eventually, in the 1940s, the medical community conceded this was natural anatomy, but they decided the membrane should be torn open to free the glans and enable aggressive hygiene.
If you’ve been paying attention, you might wonder: Why would you tear open a natural structure of the body in order to ‘clean’ what is already sealed and sterile from birth? That is a very good question. Would you remove an entire fingernail to clean the bed underneath?
Forced foreskin retraction injures boys
Over a period of 20 years I have consoled more than 1,500 families with toddlers sometimes injured so badly at ‘well-baby’ visits that they end up in the ER. ‘Forcible foreskin retraction,’ or FFR, is the most common unnecessary clinical injury inflicted on intact (i.e. not circumcised) boys except circumcision itself. A circumcised boy, of course, loses his protective membrane too as the exquisitely painful first step of his circumcision.
We at Doctors Opposing Circumcision estimate the incidence of this medically unnecessary and destructive FFR injury at over 100,000 cases each year in the United States. We joke, ruefully, that boys ‘take it in the shorts’ either way: a painful loss of critical, highly erogenous tissue by circumcision, OR forced foreskin retraction. To avoid both of these, a boy has to get past an obstetrician pushing circumcision on trusting parents, then must land by lucky chance at a pediatrician who knows FFR is a painful injury. He also needs to have parents who are skeptical that boys need aggressive genital hygiene or who practice ‘benign neglect’ by ignoring medical hygiene advice their instincts tell them is cruel.
Seattle Children’s, Mary Bridge Children’s, Group Health
I have provided consultation on many forced foreskin retraction injury cases in Washington state. Ironically, one of the reasons is our state’s low rate of circumcision (about 20% and dropping). The abundance of intact boys in Washington presents a ‘target-rich’ cohort who frequently end up at dangerous ‘well-baby’ visits.
My cases have come from large hospitals that should know better: Seattle Children’s, Mary Bridge Children’s, Group Health / Kaiser Permanente, and numerous smaller clinics. There is only one hospital in Washington I know of with a firm written policy against forcible retraction.
When asked to do so by parents, I have formally reported the offenders to the Washington State Department of Health. The DoH have routinely deflected my formal complaints and done nothing. Even my in-person appearance at DoH, as the lawyer for a family of an injured child, drew yawns. Letter campaigns to the local chapter of the American Academy of Pediatrics (AAP) have resulted in crickets. My detailed presentation about forced foreskin retraction at a local AAP meeting was greeted with shrugs. Writing letters to leading professors of medicine and nursing has produced no results.
Sad to say, the practice of injuring boys – for money – is deeply embedded in medical culture, even here in otherwise humane Washington state.
Note: If you are a parent reading this, write to me for a free packet of educational materials to help you prevent injury to your son. There is no charge for our services.
Sincerely,
John V. Geisheker, JD, LL.M
Executive Director,
General Counsel,
Docdirector.geisheker@gmail.com
Doctors Opposing Circumcision
DoctorsOpposingCircumcision.org
2040 Westlake Ave. N., Suite #420
Seattle, WA 98109