AAP and retraction, WTH is with their wishy washy wording? - Mothering Forums
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#1 of 8 Old 12-09-2011, 12:19 PM - Thread Starter
 
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I'm not sure how to link properly so this might be a messy post. Sorry.


On a local small parenting group on FB there is a pedi who is stating that a foreskin must be 'gently and not forcably' pulled back in order to clean it with soap and water at baths. This pedi keeps saying to retract until there is resistance. I am attempting to find info from the AAP or other medical group (not DOC though) that says to never retract. I keep finding crap like 'don't retract' and then a few lines down 'when you clean baby make sure to gently pull the foreskin in order to clean under the foreskin'. WTF? Reading it to a non-intactivist friend, though she's against RIC, she takes it to mean 'it's okay to pull back the foreskin but stop when you feel resistance because after that, it's 'retraction'" 

Am I the only one who is confused? Anyone have a link to a AAP type place that says to never retract? Someone else posted info from Dr Momma but I'm not sure if that is just going to come across as too 'extreme'. 


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#2 of 8 Old 12-09-2011, 01:36 PM
 
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I don't think you're going to find it. The AAP has never taken a strong stance against retraction, only mildly against what they term "forcible retraction". It was an improvement when the AAP first acknowledged that the foreskin adheres to the glans and generally does so for several years; before that it was like they were trying to deny even this anatomical fact. When faced with the reality that the first step in an infant circumcision is to run a probe under the foreskin to lyse the natural adhesions, they relented. Thanks, YouTube! Before that, parents had no idea and docs wanted to keep it that way.

 

The position of most American physicians can be summed up in an anecdote that a good friend of mine, a PhD in medical history and longtime intactivist, related a while back. He had been asked to address a conference about the anatomy and care of the foreskin, and he explained that only the outside should be washed and no attempts made to retract the foreskin. A young male doctor near the front row couldn't help blurting out, "But... but... that's completely counterintuitive! You have to wash everything! How are you supposed to see the glans?" By the end of the conference this MD (who mentioned he was circumcised) had been educated and convinced, but his gut reaction pretty much extends to much of the US medical profession. After 100 years of routine circumcision, American parents are conditioned to expect to see a head on the end of the penis and doctors can't really visualize what sort of postpartum development is taking place as the synechia breaks down on its own.

 

As we all know, nature did a superb job of designing the genitals and part of this remarkable, highly evolved design is that the penis generally does really well through childhood when left alone. There are years of nerve ending and mucosa development still going on which circumcision dramatically interferes with, and the organ is largely self-cleaning from the inside out. Even the dartos muscle with the foreskin develops differently if a boy is routinely retracted. But the urge to "do something" is still very great in our society. It's a mixture of curiosity, misplaced good intentions, and lack of understanding.

 

As a final note, never underestimate the fear of litigation. If the AAP were to come out specifically against retraction, their members could be sued left and right for failure to follow standard of care. They'd rather leave it up to each MD. Parents, be informed and be vigilant!

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#3 of 8 Old 12-10-2011, 10:40 AM
 
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I don't have anything, but perhaps Dr. Paul Fleiss has written about it?  What about another country's ped organization, such as a Canadian one, from Norway or some other culture where intact penises are normal?

 

Sounds like a very frustration situation.  Yet another reason why I'm not on facebook ;-).

 

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#4 of 8 Old 12-10-2011, 04:48 PM - Thread Starter
 
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Thank you so much for the thoughtful reply Brant. As it turns out, before I could give anyone information the Pedi pulled the 'Because I'm a DOCTOR and I'm RIGHT and smarter than YOU!' card. irked.gif


Cindy, joyful SAH mama to rainbow1284.gif William & Katherinefly-by-nursing2.gif Forever missing Amelia 7-12-09 angel3.gif  signcirc1.gifsaynovax.giflactivist.gif Ask me about my natural cesarean! 

 

 

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#5 of 8 Old 12-12-2011, 06:06 AM
 
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I thought Brant's post was great, but I'd like to elaborate on this.

While intactivists have been told over and over and over again that any sort of pulling on the foreskin is retraction and will cause incredible, unresolvable damage, the fact is that gently pushing the loose foreskin back until there's resistance is not going to hurt anything.  The kind of retraction that sometimes causes harm is where you break the synechiae (the physiological adhesion of the prepuce to the glans).  That can cause skin bridges or sometimes infection.  Even that doesn't always cause lasting problems, though it's very painful and very unnecessary. 


Even gentle retraction (to the point of any resistance but no further) is unnecessary.  However, stressing that even that much can/will cause damage causes many parents anxiety when it comes to diaper changes or baths.  I've seen it on this forum.  I wouldn't automatically dismiss any pediatrician that gives that advice, but I would be very wary that they'd recommend circumcision by a pre-determined age based on lack of retractability. 
 

Quote:
Originally Posted by WaitingForKiddos View Post

I'm not sure how to link properly so this might be a messy post. Sorry.


On a local small parenting group on FB there is a pedi who is stating that a foreskin must be 'gently and not forcably' pulled back in order to clean it with soap and water at baths. This pedi keeps saying to retract until there is resistance. I am attempting to find info from the AAP or other medical group (not DOC though) that says to never retract. I keep finding crap like 'don't retract' and then a few lines down 'when you clean baby make sure to gently pull the foreskin in order to clean under the foreskin'. WTF? Reading it to a non-intactivist friend, though she's against RIC, she takes it to mean 'it's okay to pull back the foreskin but stop when you feel resistance because after that, it's 'retraction'" 

Am I the only one who is confused? Anyone have a link to a AAP type place that says to never retract? Someone else posted info from Dr Momma but I'm not sure if that is just going to come across as too 'extreme'. 



 


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#6 of 8 Old 12-14-2011, 10:03 PM
 
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Quote:
'when you clean baby make sure to gently pull the foreskin in order to clean under the foreskin'

Sorry, this is nonsense.

 

One person's "gentle" is another person's "rough". I once read a circing doctor who referred to "gently" cutting the skin away.

 

Confusion is created by using the word gentle with retraction. No need for adults to do any retracting. You don't need to clean under an infant's foreskin.

 

I have an issue with retracting until there is resistance. Different people will have different views of when resistance is reached. Imagine pulling off a band-aid. Doing it quickly will produce a lot of resistance. Do it slow enough and you can pull the whole thing off with no resistance.

 

The AAP is a union that looks after its members. The people who said the AAP want to protect their members from being sued are right.


 
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#7 of 8 Old 12-16-2011, 09:38 AM
 
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My point is that retraction is stressed as so harmful that I've seen women on here who are anxious about basically anything touching their child's penis.  I think clarification needs to be made abou tthis.  Not all retraction, even forceful retraction, causes harm.  It's unnecessary and CAN cause harm, but it's not a guarantee.  I've seen parents speculate every time their child gets any infection that perhaps they were retracted without the parents knowledge.  Retraction has become a much bigger boogey man and problem than it really is.
 

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Originally Posted by serendipity22 View Post

 

Sorry, this is nonsense.

 

One person's "gentle" is another person's "rough". I once read a circing doctor who referred to "gently" cutting the skin away.

 

Confusion is created by using the word gentle with retraction. No need for adults to do any retracting. You don't need to clean under an infant's foreskin.

 

I have an issue with retracting until there is resistance. Different people will have different views of when resistance is reached. Imagine pulling off a band-aid. Doing it quickly will produce a lot of resistance. Do it slow enough and you can pull the whole thing off with no resistance.

 

The AAP is a union that looks after its members. The people who said the AAP want to protect their members from being sued are right.


 


 


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#8 of 8 Old 12-16-2011, 02:27 PM
 
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I quite liked the AAP's 2000 pamphlet. It's been revised by now, but I found the old one still online on the site of the South East Bay Pediatric Medical Group: http://www.sebpmg.com/educational_topics/Care_of_Uncircumcised_Penis.pdf

 

Or maybe you'll find a helpful article from a medical journal at CIRP: http://www.cirp.org/library/hygiene/

 

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