Leaving Pediatrician Letter b/c retraction - Mothering Forums

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#1 of 3 Old 10-04-2007, 11:14 PM - Thread Starter
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I am leaving our pediatrician because her response to how to care for an intact penis was "gently pull back as far as it will go without forcing"
And she would have retracted him in his exam at 2 months, 4 months and 6 months had I not have STOPPED her...
I want to write her a letter and include the American Academy of Pediatrics letter.
Any suggestions as to what to include in the letter
I want to make a template others can use as well,
I am leaveing yet want to make sure she knows why so I can possibly prevent this with others...
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#2 of 3 Old 10-05-2007, 12:27 AM
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I saved a couple sample letters along these lines from elsewhere, as templates. Feel free to use, individualize, and improve upon them as you wish. The AAP care statement and the DOC pamphlet on foreskin retraction would be good to include:



On (date) you conducted my son's twelve-month well baby examination. I found you to be a caring and dedicated professional, and I appreciated your insight.

There was one aspect of the examination that concerned me, however, and I would like to pass along some information, in the hope that it will be helpful to you in your practice. My son has not been circumcised, and you stated that his foreskin should be retracted in order to clean the head of the penis. You then attempted, unsuccessfully, to retract my son's foreskin, which is still attached to the glans. I was surprised, as it was my understanding that until the foreskin becomes fully retractable on its own (which can take into the teenage years), it should not be retracted forcibly, as doing so may harm the penis. However, as I was uncertain of this, I lacked the confidence to say anything to you during the examination.

I have since reviewed various materials which confirm my understanding, including the enclosed American Academy of Pediatrics guidelines for care of the uncircumcised penis. I hope this information will prove useful to you in your care of intact boys.


Dear Dr. __________

At a recent appointment for my son __________ you retracted his foreskin against my wishes. Afterward, his foreskin was torn and irritated and he has been in pain. I have since learned that this practice can cause cumulative damage leading to a possible case of acquired phimosis and could lead to a circumcision later in life.

The AAP has an official policy statement that states young boys’ foreskins should not be retracted. Apparently, you are not aware of this statement and it causes me to be concerned about your overall level of expertise since this seems to be such a simple and well known issue. Therefore, I will be searching for another provider for my son's healthcare needs and will not be returning to your practice.


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#3 of 3 Old 10-05-2007, 02:28 AM
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Originally Posted by Farmingmom View Post
I want to write her a letter and include the American Academy of Pediatrics letter.
I did this with my pedi.. unfortunatly he went to the AAP website and foudn a place where it STILL recommends that doctors DO retract gently to visualize the meatus.... I'd like to see where he found it, but he didn't print it out and I know the aap site is a pain to search. I've looked a little and didn't find it (might be on well-child examinations). He was going to try to bring it to my dd's next check up in November.

I can share my letter, maybe it will help as a start. Right now I'm not sure where to go-- most of the literature is very clear on forced retration, but not so clear on gentle retraction. BTW, I used some short excerpts from posts about retraction in my letter- but no urls, names, etc.

I still think that his training was out of date and I was hoping he'd but open to change, but since the AAP still supports his training, he didn't feel it was necessary since he INSISTS he is veryy very gentle : He also was clear that once it was done ONCE it was not necessary to check again-- so I'm not sure why your doctor insists it has to be done so often. but that might have just been his way of doing things... he's pretty laid back.



Foreskin Retraction during well-child exam: Is it really necessary?

#1: What are you looking for that wouldn't show externally? If there is a problem a problem should be detected EXTERNALLY, such as external signs of infection or difficulty peeing. Statistically, problems of the foreskin are so rare that examination seems likely to be a waste of time and only perpetuates myths about the foreskin being problematic, unhygienic, or ‘needing’ circumcision.

#2. The AAP clearly states the foreskin should not be retracted. If done before it is ready it may “severely harm the penis and cause pain, bleeding and tears”.

#3: The glans should be considered INTERNAL till retractable. Today’s parents choosing intactness consider this and also know the AAP’s recommendation that the boy should be the first one to retract the foreskin. After retraction the boy/man can be asked to retract the foreskin himself for an exam, if necessary. With this distinction in mind, most parents would consider an internal examination to be unnecessary and invasive. Wouldn’t the same type of exam on a female child cause concern about the appropriateness??

#4 It is impossible for another person to determine how 'gentle' they are. For some boys even a gentle exam could cause a small tear. A small tear can lead to infection or further problems. In the past, most doctors told parents to gently retract the foreskin for cleaning and retracted the foreskin for examination. Perhaps, this is why American’s have seen an inordinate number of foreskin ‘problems’ when compared to intact cultures; another indicator that this practice needs to stop.

#5. Consider the American culture of circumcision when examining the issue… Not long ago the medical premise was that the foreskin needed to be circumcised, was problematic, unhygienic and required extra ‘attention’. Is the notion that there it is necessary to examine the foreskin a leftover from this era? It certainly seems plausible that retraction stemmed from these misconceptions and not from medical necessity.

#6 Anecdotal evidence or experiences from other parents:
In the last month alone, on a parenting forum that I am a member of there have been at least 7 posts about US doctors retracting the foreskin of a child. The experience of other parents has made me very concerned about this practice and makes me feel it is important to:
#1 protect my son from being retracted
#2 provide information to medical professionals
In all these cases there was no indication of a penis or foreskin problem, most children were in for a well-child exam and sometimes the physician insisted they were being gentle or did not consider what they did was retracting. Although injury from gentle retraction may be rare I believe all retraction to be unnecessary and ill advised. I’ve included a summary of these examples at the end of this information.

Medical Information:

“Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teenage years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. 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.”

Source: http://www.medem.com/search/article_..._typ=NAV_SERCH

*** here I want to include information that was in the post from John Geisheker from DOC I included some quotes:

Roberton's Textbook of Neonatology warns:
“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

'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.”

Other Information

“The tightness of the foreskin is a safety mechanism that protects the glans and urethra from direct exposure to contaminants and germs. The tight foreskin also keeps the boy's glans warm, clean, and moist, and when he is an adult, it will give him pleasure. As long as your son can urinate, he is perfectly normal. There is no age by which a child's foreskin must be retractable. Do not let your doctor or anyone try to retract your child's foreskin. Optimal hygiene of the penis demands that the foreskin of infants and children be left alone. Premature retraction rips the skin of the penis open and causes your child extreme pain. There is no legitimate medical justification for retraction. The child's discomfort is proof of that.”
Protect Your Uncircumcised Son: Expert Medical Advice for Parents
By Paul M. Fleiss
Mothering Issue 103, November/December 103

Is any special care required for my intact son?
Your son's natural penis needs no special care. During the first few years of life, the inside fold of his foreskin is attached to his glans, very much the way the eyelids of a newborn kitten are sealed closed. The tissue that connects these two surfaces dissolves naturally over time -- a process that should never be hurried. The foreskin should never be retracted by force….
As a young boy, you'll notice that your son will pull his foreskin outward. This is normal and natural and no cause for concern; he won't hurt himself. The first person to retract your son's foreskin should be the child himself. Make sure his pediatrician understands that you do not want his penis touched or his foreskin retracted, and then watch closely to be sure your instructions are followed. Many doctors do not understand how to care for an intact penis because they weren't provided with this information in medical school….
The white emollient under the foreskin is called smegma. All mammals have this beneficial, necessary substance. Smegma moisturizes the glans and keeps it smooth, soft, and supple. Its antibacterial and antiviral properties keep the penis clean and healthy.
Ask the Experts: Marilyn Milos

“Avoidance of premature retraction.
Care-givers and healthcare providers must be careful to avoid premature retraction of the foreskin, which is contrary to medical recommendations, painful, traumatic, tears the attachment points (synechiae), may cause infection, is likely to generate medico-legal problems, and may cause paraphimosis, with the tight foreskin acting like a tourniquet. The first person to retract the boy’s foreskin should be the boy himself.3”
Doctors Opposing Circumcison

Examples from an Online Forum

In the last month on a parenting forum that I am a member of there have been at least 7 posts about US doctors retracting the foreskin of a child. In all these cases there was no indication of a penis or foreskin problem, most children were in for a well-child exam. One example was a 2 year old that needed to have an orchioplasty and surgery on an inguinal hernia.

Though some of the examples are extreme, for example, certainly the surgeon had no business even examining the foreskin, about half of the examples are of doctors who would consider they were gently retracting the foreskin. In some examples, the doctor did not even consider the action to be ‘retraction’. While many parents may tolerate a gentle examination the consensus seems to be that it is unnecessary and ill advised. Furthermore, more and more parents consider this a violation of the child’s body, bordering on sexual assault. The logic being that a parallel exam on a female child would cause outrage and almost universal be considered unacceptable.

The forum has over 22,000 active members and I simply did a basic search of posts in July and August. There may have been other examples that came up that I did not find, but these are typical example that are posted. Of course, I understand the nature of online forums and that I cannot truly verify these cases are true. I would just like to present some examples that show the parents perspectives and in some cases the misinformation that doctors use to defend this practice.

The number of examples of retraction has prompted me to be diligent about protecting my son from misinformed caretakers, family members, and even medical professionals. Although injury from gentle retraction may be rare I believe retraction to be unnecessary and ill advised. I first assumed that circumcision was something that was necessary so I do understand the blinders that cultural norms place on us. In the past we have justified the violation of our sons genitals by claiming medical problems, hygiene issues, and the quick easy almost painless fix being circumcision. Now that more is known about circumcision, more parents are choosing to leave their son intact. However, much of the misinformation still lingers and the norms that we usually expect around genital integrity seem to be missing when it comes to this issue, and I think this is one of them.

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