Crack in Newborn's foreskin...needs circumcision?

[pumpkinhead]

My beautiful newpher was born just over a week ago. He has an incomplete foreskin. Essentially, on the underside there is a gap where no foreskin has formed and you can see the underside of the head of the glans.

They recently took him for his 1 week check up and the Doc told them it was like this because he was 3 weeks early (apparently preemies lack proper foreskins, and I wasn't aware of this?) and ecause it will prob cause him problems down the road for him , the best option is circumcision.

Does this seem off to anyone? Can anyone reccomend some good info wrt to this? Frank? ANYONE?!

THANKS!

[crysmomofthree]

I wouldn't think it would be a good idea to circumsize just because there is a piece missing, and if they are considering it they should be super cautious. My third son was born with quite an odd shaped foreskin, it hangs on one side and sort of rotates, we were referred to a pediatrician because of the concern for hyposadius (sp?) he asked if we were going to circ we said no and he said good because if there are any deformities on the head of the penis or urethral opening they can use some foreskin to repair if needed.
I can't see why this baby would need to be circumsized just because his penis looks different, I would wait and see if any problems occur, If they do the hospital can do the circ under gen anesthesia after the age of one, at least that would eliminate one trauma although poor baby

[pumpkinhead]

Their family Doctor isn't the brightest crayon in the box, but they've known this for some time. However, they live in a very rural area where most are not terribly educated and a Doctor's word is still gospel. Circumcisions aren't routine here any longer and it isnt covered by MSI in Canada, so if you want it done, you have to find a ped to perform it and then pay 200$ for the 'pleasure'. I can only hope that she'll refer them to a urologist instead of taking matters into her own hands. She has a bad track record of trying to treat things herself when her patients should be passed on to a specialist.

Thanks CMOT for your response. I'm really afraid for this little baby and I haven't been able to find much on foreskin abnormalities...

[hummingbear]

Do you know if he has hypospadius? I don't know much about this. I do know a boy who was born with some degree of hypospadius. His parents opted for reconstructive surgery and circumcised him at that time, maybe sometime after his first year(?). Though I have read here that circumcision is not necessarily needed with hypospadius.

Here is a link to a question about a 6 yr old boy with hypospadius and whether surgery is indicated (it doesn't address circumcision or intactness).

http://www.medhelp.org/forums/urology/archive/2391.html

If I find other links I will edit to add them.

Here is an earlier thread from this forum started by mother of a boy diagnosed with hypospadius: post #12 has a few links as well as some in other posts.
http://www.mothering.com/discussions...ht=hypospadius

PS It seems really unlikely to me that 3 weeks early could be a cause to what you describe.

[Teresa]

Just weighing in that I don't think 3 weeks early can cause this kind of thing. Usually the last three weeks they are gaining weight, but the genitals should be completely formed by then. (I know that most midwives consider 37 weeks fairly safe--don't know what the hospital/medical types say).

Tell them to leave him whole, intact and natural and see what happens. I don't think that even the most devout circumcision apologists will harm true 'preemies'.

I would also want to talk to a pro-intact urologist, and someone specializing in 'preemies.' I'd be concerned that this is connected to or an indicator of a genetic syndrome of some sort.

Just think of how illogical it is for a doctor to say, 'He doesn't have enough foreskin--let's circumcise him.'

Strange.

[Frankly Speaking]

Usually this type of deformity is part and parcel to hypospadius but it can also be aposthia, a complete or partial absence of a foreskin.

If he is circumcised, he is definitely going to lose sexual sensitivity. The amount he loses depends on the severity of the deformity. If the gap is all of the way down to the coronal succulus, (the groove under the glans) he is most likely missing his frenulum and frenar band. However, the frenular delta could still retain it's sexual sensitivity. If both are missing, he is already at about 60% of his full quotient. If there is still frenular sensitivity and an operating frenar band, He still has 90%+ of his sexual sensitivity. In either case, if he is circumcised, he will only have about 40% of normal sexual sensitivity.

This had absolutely nothing to do with prematurity. The foreskin is present from the time the genital tubercle begins forming at about 8 weeks, long before he was born. His development will be no different than a boy with no abnormalities. There will be no problems associated with this alone even though there could be some problems if it's associated with hypospadius. However, those problems would still be present even if he is circumcised. There will be no difference in the care and maintenance than with a normal intact child. He most likely will become retractile earlier than a normal child depending on the severity of the problem.




Frank

[pumpkinhead]

Thank you all for your replies. Yeah, I knew that this had nothing to do with him being 3 wks early. It just goes to furthur show the sheer incompetence of their family Doc.
Hummingbear, thanks for the links. Theresa, yeah, I agree with you. It's nuts. this doctor is nuts!

Frank, I haven't seen a lot of pictures of hypospadias but it really doesn't look like he has a severe case of it, if at all. The urethral opening seems to be right where it should be. It's just like someone took out a piece of his foreskin. On top, it's on the short side, but intact and attached as it should be. He's not retractable (nor would one expect him to be). I'd say about a 6th or an 8th of it is 'missing'. Anyhow, I'll do some looking for stuff on aposthia.

Thanks so much for your insights!

[Sarah]

I am shocked by that doctor's lack of knowledge about fetal development... 3 weeks early is HARDLY early... and to make a statement about the foreskins of preemies like that- OMG- that's just so off the wall!!

Children with penile anomolies are NEVER candidates for circumcision- sometimes circumcision makes it worse, and sometimes the foreskin is needed to repair a problem.

This idea of it "probably cause problems down the road" is nothing short of coercive salesmanship of snake oil. If this doctor thought that the unusual foreskin was such a problem- why didn't he suggest that CORRECTIVE surgery be done to fix the gap in the foreskin?

I am sure this Doctor suggests circumcision for all babies. Did he explain what about the anomoly would be the source of those "probles" or why there are no medical treatments for a problem should one arise? Isn't he a DR?

rggg I'm ticked.

I think- State medical board- full report.

Love Sarah

[Frankly Speaking]

With so little missing, I suspect that child has all of the parts in perfect working order and will grow up to function totally normally. That being the case, you have to consider whether the option of surgery with it's attendant risks, 40% remaining function after the surgery and a surgical scar is worth it to have an organ that cosmetically resembles what now, less than half of society considers a normal appearance or to do nothing and retain full sexual function with a slight cosmetic imperfection is the better choice. I think that anyone who understands and looks at the rammifications of either action will quickly say "NO" to surgery.

Of course, the ability to think with reason and logic is in short supply.




Frank

[karlin]

My son was 6 weeks early, and his intact penis is perfect. What a silly thing for a DOCTOR to say!!!! Like Frank said, all the body parts are formed very early on. I had a complicated pregnancy, and at my 15 week ultrasound we could tell he was a boy....the penis was already perfectly formed.

If it was my son, I'd take him to a Dr. in another town.

[pumpkinhead]

Well, I just spoke w/ SIL. The GP has referred them to a urologist!!! YAY!!!

The thing is, this child was checked over by two ped's at the hospital and both just commented and said 'There's a crack in his foreskin' but made no mention of circumcision. This GP is a QUACK imho. I'm very glad she had enough sense to refer them to a specialist.

Thanks all!

Does anyone have any good links on foreskin abnormalities that I can pass along to SIL? Understandably, she's a bit overwhelmed by all of this. If he doesn't need to be circ'd, she doesn't wanna do it, but she'll do whatever the urologist says is best....and this worries me somewhat. I'd like to arm her w/ whatever info I can!

TIA!

[hummingbear]

Originally Posted by pumpkinhead

If he doesn't need to be circ'd, she doesn't wanna do it, but she'll do whatever the urologist says is best....and this worries me somewhat. I'd like to arm her w/ whatever info I can!

TIA!

Yay that she does not want to circumcise. And beware the physician even if he is a "specialist". My nephew had an enlarged kidney, urinary reflux, a bad UTI, and a forceably retracted foreskin and the advise was to circumcise which she did not do and her DS is doing well.

[Frankly Speaking]

You're justified in being worried. Urologists are by definition, surgeons and as such are more likely to recommend surgery including circumcision. The ignorance doesn't end just because they are specialists. He/she is likely to see that abnormality as a opportunity to show off their surgical skills as opposed to seeing a penis that works properly but doesn't look exactly right. It's also money in their pocket that won't go there if there is no surgery and that's a strong motivator.

She should be extremely cautious if surgery is recommended or even hinted at.




Frank

[pumpkinhead]

WEll, I guess I've come the the end of what I can do for her. SIL comes from a very rural community, and as I said before, the almighty physcian is the be all and end all. She doesn't wanna circumcize him, but if the ALMIGHTY specialist says it's best, they'll do what he/she says. If I were a doctor (which I'm not) they might listen to me, but I'm only a research scientist w/ a degree or two, so what do I know, right?! My words do carry some weight...enough that she'll actually ask WHY instead of blindly just accepting what they say (or at tleast I hope so), but she won't go against a Doctor's reccomendation just on my say so. EVEN tho she ended up with an unnecessary c/s and isn't able to BF her baby because of these quack's from this same hospital.

*Sigh* It's rather like banging your head into a brick wall. They're just not educated peole. THey're good people, and they want the best for their kiddo....but they just don't get it.

Thanks for sharing your words of wisdom and encouragement, folks! I really do appreciate it.

[Sarah]

Punkinhead- How about a second opinion?

And then, just for "your peace of mind" you ask them to document with photographs the before condition, it's NAME, and the doctors' recomendations and explanations. The doctors should have to be accountable for these recomendations - tell them to get the doctor to SIGN on these explanations (I doubt they will)

Tell them that they need to get clear pictures of the condition for several reasons- because it may help them to explain to their son why they circumcised him, and because it should be something that is recorded that he and his wife understand before he has children. Also if the circumcision is botched or causes some problem, the fact that this "problem" was inconsequential and NOT causing problems should be documented so that the doctor can be rightly sued for putting the boy in a situation which was worse than before surgery. All of this pre-circumcision events should be well documented and preserved, including the consent form which the parents will sign and the current medical society policy statements - your nephew deserves to have a complete record of this because he may wish to persue a lawsuit when he turns 18. This information would help him.

Love Sarah

[hummingbear]

what physicians say

Originally Posted by pumpkinhead

WEll, I guess I've come the the end of what I can do for her...... but if the ALMIGHTY specialist says it's best, they'll do what he/she says.

Oh please don't give up. Let her know about my sister and her experience and choice (posted above). Really her son is doing very well with his foreskin.

Another story about her experience to demonstrate that even what doctors say is not always the only choice. She was advised to put her son on a low dose long term antibiotic to prevent a UTI (which it didn't) and sometime after the UTI she said to the physician that she wanted to discontinue the antibiotic and the physician said that would be fine. It turns out that there is no clear evidence that antibiotics used in this way actually are helpful. She was livid. For months she had been combating a raging yeast infection in both her and her son (due to antibiotic use) and the UTI he got was an antibiotic-resistant strain because he had been exposed to them for so long.

[hakunangovi]

I have no medical training, but I have to ask why can't the 'split' be repaired ? After all surgeons repair cleft palates all the time, and I would have thought that would be far more difficult than joining two sides of a 'cleft' foreskin.
I agree with the others - Don't let her give up !!! And "Good luck" !!

[boingo82]

Originally Posted by howard smith

I have no medical training, but I have to ask why can't the 'split' be repaired ? After all surgeons repair cleft palates all the time, and I would have thought that would be far more difficult than joining two sides of a 'cleft' foreskin.
I agree with the others - Don't let her give up !!! And "Good luck" !!

ITA.
I don't get doctors, and how they think the solution to EVERY penile problem is circumcision. (I saw once, a mom being told to circ because her son's foreskin was "too short". What, circ makes it longer?!?) We don't chop off the whole lip when there's a cleft. If it's even such a big problem as to necessitate surgery, then why not have corrective surgery, instead of amputative?

[Benji'sMom]

I don't think having no foreskin is better than some foreskin. Doesn't make sense.