Letter to my pediatrician - Page 5

[MCatLvrMom2A&X]

Even if every child did scream bloody murder the damage would already be done so you would have to deal with the aftermath.

Again I am not saying that the foreskin is a delicate thing that will fall apart if you breath on it what I am saying is that there are valid reasons to not allow the Dr. to touch your ds's penis and you must keep that in mind when you visit the Dr. Even ones who have never tried to retract before at all will do so when the child is X age because they are falsely taught that it should be retracting by that age.

[Pirogi]

TWWS 

Originally Posted by MsFortune 

Yep.  I didn't circ my son but I didn't really think much about the aftercare aspect of it.  I started reading this thread and started to worry about penis care, and infections, and felt my head start to explode.  I thought, jeez, maybe I should have just circed.  I didn't know it was this big of a deal.  

I think I'm calmed down now, but DS is at an age where he is doing a lot of tugging and now I'm going to worry all the time that he is pulling and micro-tearing, and getting infected.  I don't want to stop him from playing with it (at home, in private) but now I am worried and it will be hard to relax.

Also, I thought my ped was pretty savvy, and listened to his advice on how to manage the foreskin and cleaning.  Now I am wondering if he is really undermining me.  
 

If anyone has any questions about proper care of the intact penis, or infections, or head-exploding worry, this forum is the place to be!  Nice ladies and gents here, most of us.

*Edited to remove some rudeness*

Don't worry, I am sure that your ped's advice is fine.  Then again, a savvy parent might consider double-checking anything they feel is questionable.

Edited by Pirogi - 8/14/11 at 5:05pm

[tennisdude23]

Then what should be advocated on this board is a "hands off" policy, not a "non-retraction" policy because those two are very different.  Clearly, there is no specific definition of retraction and new posters on this board should be informed of this.  In all honestly, if definitions are going to be thrown around, they should come from physician's associations, not from posters using the dictionary.  I also don't buy the notion that many doctors are necessarily ignorant on this topic.  I just think that the orthodoxy that is being presented on here by some is not what most people interpret retraction to be.  Indeed what bothers me most about this is that a lot of fuss is being made about something that causes no issues, period.  Second, a doctor taking a look at the urethra and forcing the foreskin back are two different things and done properly can be mutually exclusive.  If a parent is uncomfortable about any part of an exam, they have a right to say no.   

[MCatLvrMom2A&X]

You are right in that retraction is a very subjective thing and open to interpretation.

To me a hands off policy is the same as no retraction since you cant do one without the other.

So far I havnt found anything from a physicians orginization talking about anything other than forced retraction. I will keep looking though.

I did find the following:

Care of the Intact Penis
by James E. Peron, Ed. D.

In a society where routine circumcision has been common for many years, even parents who choose to protect their sons from routine circumcision may have questions regarding hygiene of the intact penis.

Should the young child's foreskin be retracted for proper cleaning? At what age should the child's foreskin be retractable?

* Leave the foreskin alone; wash only what is external and readily visible.
* Never forcibly retract your son's foreskin and don't permit anyone else to do so.
* Make certain your son's medical attendants understand his foreskin is not to be retracted or tampered with.
* Always stay with your son during his doctor visits and exams.
* When teaching the child to bathe and care for himself, let the child retract his own foreskin if he wants to. He will not retract it beyond the point of discomfort.
* A child's foreskin does not need to be retracted regularly for cleaning until the end of puberty. It should not be retracted during early childhood.*

Physicians Guide to the Normal (Intact) Penis

Mothers need to warn doctors, nurses, and others, before an intact child is examined, not to retract.

[Pirogi]

Here is some more info on retraction from different medical texts and one medical historian.  It was given to me by DOC (yes, yes, I understand they aren't a professional organization, just a group who happens to believe that manipulation of the foreskin backwards is usually harmful.  I have been given permission to share this.

SHORT WARNINGS ABOUT FORCIBLE FORESKIN RETRACTION

1) The American Academy of Pediatrics:
“Until separation occurs, do NOT try to pull the foreskin back — especially an infant’s. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding, and tears in the skin. ”

2.) Pediatrics, a reference text by Rudolph and Hoffman, details the typical timetable for the natural desquamation of the child’s balano-preputial lamina, and warns: “The prepuce, foreskin, is normally not retractile at birth. The ventral surface of the foreskin is naturally fused to the glans of the penis. At age 6 years, 80 percent of boys still do not have a fully retractile foreskin. By age 17 years, however, 97 to 99 percent of uncircumcised males have a fully retractile foreskin… in particular, there is no indication ever for forceful retraction of the foreskin from the glans. Especially in the newborn and infant, this produces small lacerations in addition to a severe abrasion of the glans. The result is scarring and a resultant secondary phimosis. Thus it is incorrect to teach mothers to retract the foreskin.”

3.) Roberton’s Textbook of Neonatology also warns:
“All newborn males have “phimosis”; the foreskin is not meant to be retractile at this age, and the parents must be told to leave it alone and not to try and retract it. Forcible retraction in infancy tears the tissues of the tip of the foreskin causing scarring, and is the commonest cause of genuine phimosis later in life.”

4.) Avery’s Neonatology issues a similar warning:
‘Forcible retraction of the foreskin tends to produce tears in the preputial orifice resulting in scarring that may lead to pathologic [i.e., in this case, iatrogenic, or physician-induced] phimosis.”

5.) Similarly, Osborne’s Pediatrics notes that:
“[phimosis or paraphimosis] is usually secondary to infection or trauma from trying to reduce a tight foreskin…” “circumferential scarring of the foreskin is not a normal condition and will generally not resolve.”

6.) Avery’s Neonatology: Pathophysiology and Management of the Newborn, MacDonald (ed) Lippincott, (2005:1088):
“Because circumcision is so common in the United States, the natural history of the preputial development has been lost…”

7.) Darby –A medical historian writing in 2005 notes the following about the invented and erroneous suggestion of need for aggressive male infant hygiene:

“To appreciate the scale of the error, consider its equivalent in women: it would be as if doctors had decided that the intact hymen in infant girls was a congenital defect known as ‘imperforate hymen’ arising from ‘arrested development’ and hence needed to be artificially broken in order to allow the interior of the vagina to be washed out regularly to ensure hygiene.” (Dr. Robert Darby, A Surgical Temptation, The Demonization of the Foreskin and the Rise of Circumcision in Britain, Univ. of Chicago Press, 2005:235.)

None of this defines retraction, other than "pulling back."  I think it's probably an exercise in futility to find a definition for retraction, since medical providers disagree on what is and is not retraction.

[tennisdude23]

Peron is giving perfect advice.  I also absolutely agree that the foreskin should not be tempered with because all you have to do is leave it alone.  The problem is that when physician touches the penis (e.g.: to visualize the urethra), he/she may slightly push back the foreskin.  That in my book is not tampering, retracting, whatever you might want to call it.  If you, however, feel that this does constitute tampering, then you have a right to say no to the examination in question, end of story.  Unfortunately, by having all of this discussion about what may happen when the penis is touched, the impression is given that the foreskin is some kind of ticking time bomb and that's what I am trying to point out.  If you are against circumcision, you are shooting yourself in the foot with these type of arguments.  

[Pirogi]

Also, some people seem to be ignoring the fact that the preputial orifice is a sphincter.  Sometimes the sphincter may be relaxed, and in that case it may be possible to move the foreskin enough to see the meatus, if the foreskin is the right length.  (My son's foreskin is much too long for that to be the case ... it would have to be pulled backward to see the meatus.)  But if the sphincter is tightly closed (like maybe if they were in a cold exam room with a stranger touching their private parts and pulling on their testicles), it is likely that this opening movement could tear the tissues.

Does that mean that the foreskin is delicate, and we should all sequester baby penises and make boys wear gloves on their hands at all times until adulthood so they don't break their foreskins?  Of course not.  That would be obtuse.  Little boys can touch and pull on their own penises.  Docs should keep their hands off.

[tennisdude23]

Originally Posted by Pirogi 

Here is some more info on retraction from different medical texts and one medical historian.  It was given to me by DOC (yes, yes, I understand they aren't a professional organization, just a group who happens to believe that manipulation of the foreskin backwards is usually harmful.  I have been given permission to share this.

None of this defines retraction, other than "pulling back."  I think it's probably an exercise in futility to find a definition for retraction, since medical providers disagree on what is and is not retraction.

You are right on this point, which is why I and some 20+ posters don't understand why you phrased your letters the way you did and why you have been pursuing this case against your doctor, stating a malicious accusation that she provides dangerous care, which I really hope stays confined to you and this board.  

[ieatcheese]

Pirogi, thank you for the posting of your letters and account of your experience. I am startled by some of the reactions on this thread. I have had a fair amount of poor luck with doctors, I've had to insist I not be administered a drug I was allergic to, as well as had to argue to not be given a lethal combination of drugs (they even had a warning right on the label). So I am a believer in being your (and your DS) best advocate.

This talk of the hospital/MD taking legal action seems a little farfetched, I have caused a doctor to be suspended (probably saved lives) and have caused more than a couple to face board review and various disciplinary actions. I have never received other than an apology letter for writing a letter rather than filing a lawsuit.

I thought your letter was politely worded and gentle in general. The sad fact that the MD couldn't learn from the experience is unfortunate and could cost the MD heavily if they are sued for retracting a child in the future.

Imcompetance, and that's what this is, needs to be addressed for the safety of every child this person treats, the MD's pride does not outweigh the welfare of their patients.

If a doctor succeded in retracting the foreskin on a child of mine their would be immediate legal consequences and they would not be limited to civil action.

[Pirogi]

Have you read the entire thread, tennisdude23?  I specifically stated that if I send the letter, I will rephrase that to indicate that if the doctor believes that retraction is ok, she is putting children at risk.  Which is true.

[PeterJ]

I feel it's a case of striking a balance, and I'm glad that we are having this discussion.  I do feel that on occasion, it is very apparent that the no-circ group creates (albeit unintentionally) a certain degree of paranoia when it comes to handling the foreskin, which leads to these kinds of situations were we are discussing the minutiae of what constitutes retraction and what may cause harm.  The answer is that every boy is different and every case is different - there's a surprise!  I do think the 'leave it alone' rule is a valuable one to teach, but I also feel that it is, on occasion, hammered home so forcefully that it becomes counter productive and causes us to second guess ourselves constantly about whether everything looks ok (hence the head exploding with worry post).  I have also witnessed many posts where an anguished parent describes symptoms, pain and discomfort, and a strong no-circ advocate will actively tell the parent not to visit the doctor.  I personally feel this is irresponsible.

Not surprisingly, a strong supporter against circumcision is going to advocate a 100% "hands off" approach with regard to the foreskin.  Broadly, I agree with this.  But it doesn't always fit every situation, and leads to a great deal of confusion and worry that Doctors are harming children by simply pushing back the foreskin slightly, without retraction.

Ultimately, the parent has to educate him/herself and decide on what is best for their son.  They have every right to see their wishes carried out and respected.

[MCatLvrMom2A&X]

Originally Posted by PeterJ 

I feel it's a case of striking a balance, and I'm glad that we are having this discussion.  I do feel that on occasion, it is very apparent that the no-circ group creates (albeit unintentionally) a certain degree of paranoia when it comes to handling the foreskin, which leads to these kinds of situations were we are discussing the minutiae of what constitutes retraction and what may cause harm.  The answer is that every boy is different and every case is different - there's a surprise!  I do think the 'leave it alone' rule is a valuable one to teach, but I also feel that it is, on occasion, hammered home so forcefully that it becomes counter productive and causes us to second guess ourselves constantly about whether everything looks ok (hence the head exploding with worry post).  I have also witnessed many posts where an anguished parent describes symptoms, pain and discomfort, and a strong no-circ advocate will actively tell the parent not to visit the doctor.  I personally feel this is irresponsible.

Not surprisingly, a strong supporter against circumcision is going to advocate a 100% "hands off" approach with regard to the foreskin.  Broadly, I agree with this.  But it doesn't always fit every situation, and leads to a great deal of confusion and worry that Doctors are harming children by simply pushing back the foreskin slightly, without retraction.

Ultimately, the parent has to educate him/herself and decide on what is best for their son.  They have every right to see their wishes carried out and respected.

In the bolded for me is the bottom line. With the OP she shouldnt have had to have told the Dr. over and over no retraction.

I have thought about the retraction thing a time or two and it did cross my mind how being so hard line about it can give the impression that the foreskin is so delicate it cant handle anything and I have always tried to phrase my posts in a way to make it understood that isnt the case but I also want to get across that there is a risk of harm if retraction is done. It colors your perceptions a lot when it has been your child harmed by it happening and you have dealt with Dr.'s who obviously have no idea how to deal with the intact penis.

[Adaline'sMama]

Originally Posted by Pirogi 

I am completely floored that this is the response I am getting in this forum.  ;I won't be recommending it to friends anymore.

Yes, tennisdude23, it was my interpretation of events.  You know, just like everything we experience in life is an interpretation of events.  Cogito ergo sum and all that.

TCMoulton - how am I supposed to answer that?  Are you implying that I have intentionally misrepresented what happened?

I'm going to take a break from this thread.  Thank you all for your responses.

See, the bolded indicates the real problem here. You arent really interested in solving any problems or understanding where other people are coming from. You have a disagreement with your ped over a three second issue, and you throw a big fit, bash her, and try to ruin her rep at the local hospital. You dont hear what you want on a message board, so you arent going to recommend it to your friends anymore. Are you big on punishment? It sure seems like it.

In the above post, you state that you are taking a break from this thread, but the four post you have made in the past 1.5 hours leads me to believe otherwise. What changed your mind?

[PeterJ]

Originally Posted by MCatLvrMom2A&X 




In the bolded for me is the bottom line. With the OP she shouldnt have had to have told the Dr. over and over no retraction.

I have thought about the retraction thing a time or two and it did cross my mind how being so hard line about it can give the impression that the foreskin is so delicate it cant handle anything and I have always tried to phrase my posts in a way to make it understood that isnt the case but I also want to get across that there is a risk of harm if retraction is done. It colors your perceptions a lot when it has been your child harmed by it happening and you have dealt with Dr.'s who obviously have no idea how to deal with the intact penis.
 

I have always found your posts exceptionally helpful, especially after my son was forcibly retracted some time ago.  You tend to keep a good balance in your posts of warning of the dangers, but countering any unnecessary fear with realism.  I am absolutely sure that there are multitudes of parents out there who have breathed a sigh of relief and considered themselves more educated, after reading your advice and guidance.  Thank you.

[PhoenixMommaToTwo]

Originally Posted by Pirogi 

TWWS 

If anyone has any questions about proper care of the intact penis, or infections, or head-exploding worry, this forum is the place to be!  Nice ladies and gents here, most of us.

If you're having problems relaxing, I've heard diazepam works wonders.  Maybe you should ask your doc?

Don't worry, I am sure that your ped's advice is fine.  Then again, a savvy parent might consider double-checking anything they feel is questionable.

That was rude. And totally making light of some people's mental issues. Way out of line, imo. Some people were trying to offer you some perspective and point out to you that perhaps you shouldn't try to ruin this dr.'s career over something that did not happen. Your son was not retracted! Your initial letter and response while rude and condescending should be sufficient.
 

[Pirogi]

Adeline'sMama, I became aware of some information about where some of the posts were coming from, and that changed my mind.  I realized that, like everywhere on the interwebz, MDC is not immune from people who like to go around and stir stuff up.  If you'd like more info, PM me.

Pheonix, how do you know what happened?  Were you there?  Have you been following the discussion?  Do you have a medical definition of retraction as it pertains to the intact penis of a non-retractable boy?  Because from where I sit, my son's foreskin was manipulated backward toward his torso.  Also, I find your response rude.

Everyone:  Once again, I am not interested in ruining anyone's life or career.  If there are further steps that should be taken, I will do so.  If there are not, I will not.  

[tennisdude23]

Originally Posted by MCatLvrMom2A&X 




In the bolded for me is the bottom line. With the OP she shouldnt have had to have told the Dr. over and over no retraction.

I have thought about the retraction thing a time or two and it did cross my mind how being so hard line about it can give the impression that the foreskin is so delicate it cant handle anything and I have always tried to phrase my posts in a way to make it understood that isnt the case but I also want to get across that there is a risk of harm if retraction is done. It colors your perceptions a lot when it has been your child harmed by it happening and you have dealt with Dr.'s who obviously have no idea how to deal with the intact penis.
 

Not to beat a dead horse, but having established that there is no single definition for retraction, what should have been said is "hands off," because the very word, retraction, is open to interpretation.  I only say this because the word retraction is thrown around this board, but no explanation is given, especially for new parents/posters.  

Originally Posted by Pirogi 

Have you read the entire thread, tennisdude23?  I specifically stated that if I send the letter, I will rephrase that to indicate that if the doctor believes that retraction is ok, she is putting children at risk.  Which is true.

My point is that you concede that medical personnel can interpret the word retraction in multiple ways.  As such, you could also concede that the doctor according to her interpretation was not retracting (you actually confirmed this in a previous post).  Therefore, you cannot say that she way being incompetent in any way, having given her no other specific instructions.  Accordingly, you should not write or send any letters to the hospital because there is no basis to your claim.  Previously, you said you wanted to educate but your original letter had the opposite effect, the reasons for which are stated above.  This at the very least should make you reconsider your approach with this doctor and when dealing with a new health provider.  

[Pirogi]

Originally Posted by tennisdude23 

My point is that you concede that medical personnel can interpret the word retraction in multiple ways.  As such, you could also concede that the doctor according to her interpretation was not retracting (you actually confirmed this in a previous post).  Therefore, you cannot say that she way being incompetent in any way, having given her no other specific instructions.  Accordingly, you should not write or send any letters to the hospital because there is no basis to your claim.  Previously, you said you wanted to educate but your original letter had the opposite effect, the reasons for which are stated above.  This at the very least should make you reconsider your approach with this doctor and when dealing with a new health provider.  

Every other person I have showed the letter to (in hopes of editing to make it better), apart from this board, believes it was appropriate and educational, and even a little too tame.  I find that interesting.  And actually, I don't know for sure that the letter wasn't educational for the doc.  I wasn't given a reason for my dismissal.

You believe there is no basis to the claim that the belief that forced premature retraction is appropriate puts non-retractable boys at risk?

[tennisdude23]

Originally Posted by Pirogi 

Every other person I have showed the letter to (in hopes of editing to make it better), apart from this board, believes it was appropriate and educational, and even a little too tame.  I find that interesting.  And actually, I don't know for sure that the letter wasn't educational for the doc.  I wasn't given a reason for my dismissal.

You believe there is no basis to the claim that the belief that forced premature retraction is appropriate puts non-retractable boys at risk?

There is no evidence to the claim that forced premature retraction took place or was going to take place based on what was stated in this thread.  I can say this because you yourself admit that you, I, and health care providers can have different definitions of retraction, keeping in mind that you provided no specific instructions to your doctor other than saying "no retraction," which you admit is open to interpretation.  So, yes, I stick by my judgment call that you have no claim whatsoever.  Ultimately, all actions in this matter are up to you, but don't get mad if other people give you well intentioned advice, which you clearly don't want to hear.  Regarding, the appropriateness of your letters, many people on here, some of who are in healthcare and have experience dealing with these type of complaints, have provided you with some very good pointers on what to do.  Again, whether you take their advice is up to you, but at the very least, I was reconsider all of this very carefully.  

[PuppyFluffer]

I have to say, I am quite surprised at the responses telling Perogi that she should not procede with this action.

Members of the forum have been all over supporting the parents and child when a retraction has happened.  In this case, we have an educated parent who refused to allow retraction to take place to view the urethral meatus (a completely unnecessary thing to view in absence of any medical indication).  We have a parent who is interested in sharing education respectfully with a doctor, a doctor who has dismissed the patient consequently and a mother who wishes to inform others in the medical community that this doctor is not intact friendly, thus putting other boys at risk. 

When we have the opportunity to educate a potential parent or a pregnant mother/father, we do.  We don't wait until a mother has circumcised a son to tell her that it has negative effects for the boyif it can be shared with her before hand.  I understand the mission of this forum is to educate parents on the effects of circumcision so they can be informed and keep their son's whole penis intact and to keep their intact penis safe from harm from medical ignorance.  This mother's goal is to help protect other babies.  She's educated enough to protect her own son but her former doctor is NOT educated enough to protect those entrusted to her care.  Thank you Perogi for taking the time and caring enough to do this!  I think you will find that Doctors Opposing Circumcision will be in suppport of your further contact and efforts.