Saturday, May 11, 2013

Gentle Touch Circumcision, Dr. Green, how circumcision promoters work

Dr. Stephanie Green
I have been visiting the website of Dr. Stefanie Green, who promotes and offers circumcision services in Victoria BC serving patients throughout Vancouver Island, from Greater Victoria, Duncan, Nanaimo and Comox. 

What strikes me as funny, in other words fishy, is that in the pages about the Pros and Cons of circumcision, there is no mention whatsoever about the position of the College of Physicians & Surgeons of British Columbia (CPSBC). There is, however, mention of the American Academy of Pediatrics, followed by a mention of the current position of the Canadian Pediatric Society (CPS), which is likely to change in the short term.

Why is it important to overlook the position of the CPSBC? 

Could it be because it has recommendations such as "Advise parents that the current medical consensus is that routine infant male circumcision is not a recommended procedure; it is non-therapeutic and has no medical prophylactic basis; it is a cosmetic surgical procedure; current evidence indicates that previously-thought prophylactic public health benefits do not out-weigh the potential risks", "Provide objective medical information about the risk of complications and potential harm in infant male circumcision" and "Discuss the new ethical considerations of infants’rights and proxy consent in a nontherapeutic procedure"?

Could it be because it's better to parrot the AAP's mantram that "the benefits outweigh the risks"?

And since they take the time to reference the AAP while ignoring a Canadian institution, why stop there? Why not quote the Royal Dutch Medical Associaton (KNMG), which states that "Non-therapeutic circumcision of male minors is contrary to the rule that minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child, as in the case of vaccinations" and "Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity."

Perhaps because those institutions do not support the benefits touted by Dr. Green?

What about some numbers referred by Dr. Green that would be extremely difficult to prove at all? Let's see:

Dr. Green states, without a reference, that "Between 1954 and 1989, fifty million circumcisions were performed in the USA. Three deaths were reported due to circumcision. Two babies had bleeding disorders and one was a premature infant weighing only 1.9kg.". In reality, many more deaths in the United States (and Canada) have been linked to circumcision, and the American Academy of Family Physicians estimates one death in 500,000 procedures - which would represent 2 or 3 deaths per year in the United States. Other sources estimate higher mortality.

Dr. Green repeats the 60% risk reduction of contracting HIV, without mentioning that this only applies to heterosexual transmission and under the specific conditions of Africa. This number is the result of Randomized Controlled Trials (RCTs) executed in Africa, and cannot be directly extrapolated to a different population, as the possibilities of transmission and the risk/benefit estimations will immediately change. Dr. Green does not mention that this risk reduction does not apply to males who have sex with males (MSM), does not protect females from a circumcised infected male, and does not apply to non-sexual transmission of HIV. And of course she does not mention that the RCTs have been challenged by other health professionals due to methodological issues.

Dr. Green states that circumcision "Eliminates Phimosis". This is what I call "prevention by obliteration". Any organ removed from the body can no longer develop pathological conditions. However any organ removed from the body also ceases to provide its functions. In that sense, preventing phimosis by circumcision is not proportional, especially when most men will not develop phimosis, and those who do develop it may be able to overcome it with different and much less invasive treatments.

Dr. Green indicates without any explanation that circumcision makes "Easier hygiene". This is the worst fallacy of circumcision. Hygiene of an intact penis is extremely simple. In a child: leave it alone; rinse the outside as if it was a finger. Never pull the foreskin back. In a person who can retract the foreskin (generally, teenagers or adults): retract, rinse, replace. Takes less than 10 seconds. Avoid soaps to avoid disrupting the beneficial bacteria of the foreskin and the delicate pH. Soap residues and strong antibacterial soaps can cause irritations and infections of the foreskin. - Are there any other body parts that physicians recommend cutting off so you don't have to wash them?

Dr. Green repeats another one of the bigger lies of circumcision, that circumcision "Virtually eliminates risk of cancer of the penis". First, the risk of cancer of the penis is in itself extremely low (even the AAP said so on page 14 of their Technical Report: "The clinical value of the modest risk reduction from circumcision for a rare cancer is difficult to measure against the potential for complications from the procedure. In addition, these findings are likely to decrease with increasing rates of HPV vaccination in the United States" based on the estimation that in order to prevent a single event of penile cancer, 909 to 322,000 babies would have to be circumcised and there would be 2 to 644 complications - in other words, it's not proportional). Second, once phimosis is considered, the presence or absence of foreskin does not increase the risk of penile cancer; it's only in cases of adults with phimosis that there is a higher risk, and those individiuals can get treated for their condition. Third, a better preventive measure is to avoid promiscuity and practice safe sex to reduce the risk of contracting HPV. And finally, penile cancer can occur in circumcised men, and in fact there are documented cases where penile cancer occurred on the site of the circumcision scar!

Dr. Green says that "Some studies suggest less sexual dysfunction later in life" - however, some other studies suggest the opposite, that circumcised men have 4.5 more chances of developing erectile dysfunction. A 2011 study in Denmark showed that "Circumcision was associated with frequent orgasm difficulties in Danish men and with a range of frequent sexual difficulties in women, notably orgasm difficulties, dyspareunia and a sense of incomplete sexual needs fulfilment"

Dr. Green states that "some estimate between 6% and 10% of boys will require circumcision in their lifetime due to medical reasons". However, in 1980 Edward Wallerstein documented that in Finland, where Routine Infant Circumcision is not practiced, approximately 1 in 16,667 men requires adult circumcision for medical reason. A far number from the 6% to 10% that Doctor Green mentions, which begs the question what is so defective about North American penises.

Dr. Green states that "The overall risk of complication from this procedure is between 0.2% (2/1000) and 0.6% (6/1000)." This would be a tough number to prove. In fact, the AAP in their technical report on circumcision states that "The true incidence of complications after newborn circumcision is unknown, in part due to differing definitions of “complication” and differing standards for determining the timing of when a complication has occurred (ie, early or late). Adding to the confusion is the comingling of “early” complications, such as bleeding or infection, with “late” complications such as adhesions and meatal stenosis."

In the Research page, Dr. Green references the article "A 'snip' in time: what is the best age to circumcise?". I leave the reader the task of checking the authors in our circleaks wiki: Brian J Morris, Jake H Waskett, Joya Banerjee, Richard G Wamai, Aaron AR Tobian, Ronald H Gray, Stefan A Bailis, Robert C Bailey, Jeffrey D Klausner, Robin J Willcourt, Daniel T Halperin, Thomas E Wiswell and Adrian Mindel

Dr. Green final reference is what she affectionately calls "The Male Circumcumcision Guide for Doctors, Parents, Adults and Teens" - circnet, the page of Brian J. Morris. It is important to know that Brian Morris is not a medical doctor, he is a molecular biologist who has publicly stated that he would like to see circumcision become compulsory - so he is hardly an unbiased researcher. He is also associated with circlist, a group known for exchanging not only medical expertise, but also erotic content known as circumfetish.

Reviewing her consent form, I noticed that she omitted several important risks, such as concealed penis, meatal stenosis, development of skin bridges, skin tags, dispareunia (pain during sex), damage to the dorsal nerve (which can leave a man sexually insensitive), damage to the frenulum, long term damage to the glans due to keratinization (this always occurs)...

After reading this, would anyone still believe that her website contains complete and unbiased information about circumcision?

1 comment:

  1. "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"~Upton Sinclair

    Admit the truth?

    And quit her business?