The Women Rapists of Zimbabwe

What was your first reaction when you read that title?  Mine? I started to laugh, 'cause I'm human and a female - and there doesn't seem to be an epidemic of female rapists - in fact it appears at first thought that there can't have been many female rapists throughout history.  And a man being raped by a woman usually doesn't appear to involve extreme violence and pain. But that is another blog! A further cause for amusement is that this happened in Zimbabwe, a male dominated country.

From media reports, there was a gang of women operating in Zimbabwe, who were 'terrorising' men from 2010 until their arrest in 2011.  These women would pick up male hitch-hikers, and sedate them by spraying "some liquid" in their faces.  They would then be forced to "be intimate with women at gun point".  (Africa Review)  The women used condoms to harvest and save the men's sperm.  They used aphrodisiacs to cause the men to have an erection.

In one incident, a 30-year-old man was kidnapped by, and forced to be intimate with three women for five days,  after they drugged him.  At one stage a couple of men were assisting the women with their kidnapping activities.  Various other methods of capturing men were employed, including luring men with the offer of work.  One man was promised employment in the town of Mutare.  He met a man he knew,  in Harare, and was introduced to another man and two women who were described as 'friends'.   They headed for Mutare, where they had promised the victim  employment.  During the journey they bought drinks, with one of the women handing her unfinished drink to the victim, who drank the remaining liquid.

Zimbabwean Police

He "suddenly felt dizzy and started sweating before falling unconscious".  He awoke feeling weak, and  found himself in a wooded area near Magamba Training Centre in Mutare. At the time of his awakening, he found one of the women having sex with him.

Mutare, Zimbabwe

"The police spokesman added: “In that state, he was forced to have sex with both women who are said to have been wearing female condoms. (female condoms?) The alleged female rapists drugged him with a stimulant before they both had sex with him till about midnight.” (approximately twelve hours total)
 
The attack stopped when the man started “producing blood”, Inspector Chabata said, forcing a member of the gang to observe that he was “no longer useful”.
The man was dumped at the spot and did not regain consciousness until noon on Saturday. He was treated at Mutare Provincial Hospital."  (From Zimeye)
 
The media speculated that the attacks were made to gather sperm for either ritualistic purposes, or for traditional medicine.  I am wondering if it was for the purpose of selling on the internet, but maybe that is a bit way out as a theory!  Whatever the use, the returns appear to have been lucrative, by all reports.

The three women who were arrested

 
As often happens, the accused women were caught purely by accident - literally!  A male accomplice, Thulani Ngwenya (24) was apparently driving a car which was involved in a road accident.  The women reportedly rushed to the scene to collect their valuable loot, which was in the car - 31 or 33 (depending on the source) condoms, 4 of them containing sperm.  The women were unfortunate in that the police arrived at the scene before them, and discovered the condoms.  That's a big ooops, girls!  And after their arrest?
 
Harare, October 15, 2011 -A group of women accused of raping men around Zimbabwe at gunpoint brought the Harare magistrate court to a standstill on Friday.
The three women dressed in designer clothes and fancy hairstyles looked unfazed by the bizarre charges that they are facing. They were quite relaxed as they appeared in the dock.

Sophie Tendai Ngwenya, 26, Netsai Monica Nhokwara, 24 and Rosemary Chakwizira, 28, attracted a huge crowd of onlookers when they were brought before Harare magistrate Kudakwashe Jarabini on Friday.

Whatever the sperm was being 'harvested' for still remains a little mysterious.  The trial has been delayed because DNA evidence has yet to be produced by the State, apparently because of logistical difficulty in transporting the results from South Africa. 
 
And at the accused's first appearance in court?  Seventeen men, including a soldier and a policeman came forward, claiming that they were “raped” by the three women. 

One of the women accused of rape

 
In the most bizarre end note, the women, who claim to be busy prostitutes who didn't have time to dispose of the fruits of their labours, cannot be charged with rape because Zimbabwean law does not recognise that women can rape men.  I wonder how long it will be before that law is changed? 

The three suspected female rapists — Netsai Nhokwara, Rosemary Chakwizira and Sophie Nhokwara — shy away from the camera before their release from Chikurubi Maximum Security Prison 

And just for interest - here is a link to a very thought-provoking editorial about the bias being shown toward these women.

Why Not Tell The Truth?

You know everyone lies now and again, and we would be terrific liars if we said we never did!  We know kids lie, and the do it to keep out of trouble, or whatever.  But when an adult blatantly lies about things that are going to be found out, well that takes the bloody biscuit as far as I am concerned.

Wonder what I am thinking about?  I'll tell you because I can't tell HER.  To give you a little story, I have had the most rotten bad luck over the past few years with my mobile phones.  They are all made in the wilds of the Okefenokee Swamp I think, and are so infested with swamp bugs it isn't funny.  And if I have the spelling of the swamp wrong, that is tough.  Hard cheese Louise, and all that.  Because I am really over it.  So. Take a breath in, a breath out.

My daughter suggested I get an IPhone, to which I screeched 'what? and pay a grand? No way Jose" or similar gentle words.  She kindly said she could find one cheaper for me.  So she spent who knows how long online, going on different sites and looking for a second hand phone for me.  I stuffed up because she showed me a couple on "Gumtree".   Now you understand I am feeble-minded and old and basically dimmer than a 40watt - and so used to eBay crud like photos and the like, that I immediately said 'oh no, there are no photos on there, and I can't see how much it is, and it says email but then it says they won't answer emails, and ....... and ....."   blah blah.  Don't ever try and teach an old lady new tricks - moral of the story.

Poor kid tried to explain it to me, and I was ranting away in a total panic because she said you have to go to the seller's house.......aaagh I can't do that, I just can't.  This one is a long way away, I can't travel that far, blah blah.  (Here we go again, sigh.  Poor daughter).  She told me she would travel for me, and I got muddled and forgot.  No, I am not blonde, just dim. And old.  And some days not too well!  (ahem)

Yes madam, it is exactly your size, just pre-shrunk during manufacturing

Upshot was she went on eBay and bid for a 2nd hand IPhone for me.  All went lovely and that.  I paid me money the same night (or the next, I forget - soon as she got an email from the seller anyway).   So we wait.  And we wait. And ages later still wait. Daughter sends email or text to the seller to ask if she got the money.  Seller was away apparently.  Would post the phone on the day she got back, which we calculated as Thursday.  She was paid for Registered Post, said she would send it Express Post as well. Hmmm.  I should have received it last Friday.   No parcel.  Nothing Monday.  Nothing Tuesday.  hmmm (remember, we worked for Australia Post until not that long ago - the woman is pulling a fast one!). 

LIARS ARE UGLY PEOPLE

Now madame seller in Melbourne said she would send the tracking number to my daughter.  At one point my girl sent email or text and the seller replied in the vein of " yes, yes. And I am sending my purple case as well"  - something like that.  A bit, 'piss off, you are bugging me' type of thing?  uh huh.   So yesterday, being Tuesday and all, my girl sends a text asking for the tracking number please and thanks as no parcel has arrived.  Woman says she is at work and will send number when she gets home?  After that? Nothing, nada, no contact. uh huh. 

What happened this morning?  First thing?  An Australia Post Platinum Express Delivery arrives, to be signed for.   The absolute of the absolutely guaranteed NEXT DAY DELIVERY.  The lying cow didn't send it until YESTERDAY.   It has taken her about 2 weeks to send the phone, and when it arrived?   Contrary to her assertion that it is like new, like it was just out of the box - it has scuff marks and the glass front has chips out of it.  Lying cow.  And no little implement thing so I can put a sim card in it.  And NO purple case!  um.....   why lie?   Mind you, I didn't want a stupid purple case, but that is beside the point yeah?  I do NOT understand people like this.  I didn't pay a huge price for it, but I still feel that I, and other bidders, deserved the truth?    And that I deserved the truth about posting time.
 
Maybe it is me, maybe it is the way of the world now, where dishonesty is second nature to many. It is wrong, whatever the reason, and it has nothing to do with "what you get for buying from eBay".  It is all to do with that particular person, who cheated, and lied. You can be cheated and lied to by salespeople looking you in the eye as well....

Personally?   It stinks, and if you tell someone the truth they are more likely to be calm and patient, and will also have enormous respect for your honesty.  You get a lot further in life with honesty than with lies.  And don't forget that great thing, karma!  Melbourne lady?  It will come back and bite you fair on the bum.  You'll see.

There.  Gran has said her bit.

Circumcision - I Wouldn't Do It To My Child If You Paid Me - Part Five

I surely hope you aren't fed up with me by now!  Up to last night, we saw that 1. Medical Professions do not advocate routine circumcision for newborns, 2. Circumcision is painful in the extreme and 3.  It is dangerous to administer anaesthetic to very young babies, 4. There are adverse complications and even death associated with circumcision and 5. There is no significant reduction in UTI's for circumcised neonates.

There are many myths about the operation and I am surely not going to cover them all, especially in depth, as it is just too much.  There are a couple of myths that are dangerous ones, and which have recently been disproven and it is these I am going to address here.

The myth that circumcision prevents STD's and HIV-AIDS

World Health Organization (WHO) stated:

There is compelling evidence that male circumcision reduces the risk of heterosexually acquired HIV infection in men by approximately 60%. Three randomised controlled trials have shown that male circumcision provided by well trained health professionals in properly equipped settings is safe. WHO/UNAIDS recommendations emphasise that male circumcision should be considered an efficacious intervention for HIV prevention in countries and regions with heterosexual epidemics, high HIV and low male circumcision prevalence. Male circumcision provides only partial protection, and therefore should be only one element of a comprehensive HIV prevention package which includes: the provision of HIV testing and counselling services; treatment for sexually transmitted infections; the promotion of safer sex practices; the provision of male and female condoms and promotion of their correct and consistent use.

There has been no convicing evidence that the incidence of infection with STDs is reduced by circumcision.  The HIV and STD studies are normally done in poor and under-developed countries, and are not relevant to Australia, UK or USA.

Furthermore, circumcising an infant to reduce the risk of HIV and STDs is not justifiable - infants are not sexually active!
 
Myth - Circumcision prevents penile and cervical cancer

If you are exposed to strains of human papilloma virus through unprotected sex with multiple partners, or you smoke, these are the main risk factors for cervical and penile cancer.   Penile cancer is very extremely rare, there is less than 1 case in 100,000 men, and the median age of diagnosis is 64 years.   Circumcised men do develop cancer of the penis, and this can develop on the scar from the circumcision!  Strangely, breast and testiticular cancer is more common in men than is penile cancer.

From Wiki Commons - Prevalence of Circumcision by country

Myth - Circumcision is necessary to prevent phimosis and paraphimosis

The condition known as phimosis is where the foreskin can't be fully drawn back to uncover the glans.  Almost all infants and young boys have phimosis, which is normal for the infant and juvenile penis.   As discussed previously, the foreskin usually becomes retractable between ages 3 to 13, and nothing need be done unless the child is having discomfort or pain.  Phimosis does not need surgery unless conservative treatment fails.

Paraphimosis is a condition where the retracted foreskin has become stuck behind the glans, and cannot be brought forward again.  Using cold water and gentle compression this problem can usually be remedied.  In rare instances, where the skin is very tight, urgent medical attention is needed.

I do hope I have given a broad outline of the myths about circumcision, and the extremely strange reason why many still insist on circumcising their boys.   One aspect that keeps being dragged up is cleanliness - a good bath or shower with soap is all that is needed for cleanliness and hygeine.  When a boy is old enough he will normally pull back the foreskin and clean around under it himself.  
  
According to advocates of circumcision, there are many health benefits for the infant.  If this is so, if we are circumcising because way in the future this might prevent penile cancer - why then are we not operating on little girls to remove tiny breast buds?  The risk of a woman developing breast cancer is about 12% over her lifetime, which is a much higher risk than a man developing penile cancer.

Strangely enough, "the Australian Institute of Health and Welfare has found that Australian children have become significantly healthier as the incidence of circumcision has declined."  (Circinfo.org)   So much for circumcision having health benefits for the child.

There are psychological factors to consider as well, with circumcising infants - although I have actually seen these brushed aside as being unfounded, and anecdotal.  Of course evidence of psychological harm will be anecdotal - after all, the man is telling us of the harmful effect his circumcision has had on his mental wellbeing.  In a survey reported by Circumcision Information, they state that over 80% of 300 self-selected circumcised men said they had been harmed emotionally by infant circumcision.   Responses showed that at least one of the following feelings were reported:  anger, resentment, rage, hate, revenge, a sense of deficiency or loss, a diminished body image.  Disbelief, confusion, shame, embarrassment, feeling victimised, robbed, cheated, raped, violated, abused, mutilated, deformed.  They experience fear, distrust, withdrawal, sadness, pain and grief.   Some men have commited suicide.   Others have successfully sued for pain and suffering.

And a little fact that horrified me?  We saw before that the prepuce is rich in blood vessels.  This makes it likely to haemorrhage when it is cut.  The frenular artery is also at risk of being cut during the procedure.   An infant has only a very small volume of blood. For example a 4kg baby has only 340ml (or 11.5oz) of total blood at birth.   That is 85ml per kilo of weight.  An infant only needs to lose 68ml (2.3oz - about half a cup - go measure it) and he has lost 20% of his total blood volume - this is about all they can tolerate before hypovolemic shock sets in (shock from blood loss), which is quickly followed by death.  This has happened on many occasions.  A frightening fact is that the volume of blood loss that might kill a baby, which is 85ml, is easily concealed by disposable nappies (diapers).   You would not even know your baby was bleeding to death.

It seems to me that here we are in the year 2012, and for some unfathomable reason we are STILL following the dictates of some half-baked, unscientific and uneducated theory dreamed up by a long-forgotten prudish and sadistic doctor in the early 1800's - to stop men masturbating!   Sheer superstition still rules the day!  We may as well start burning witches again.

The phrase that keeps running through my head is the medical ethic "first, do no harm"  -

Nonmaleficence, which derives from the maxim, is one of the principal precepts of medical ethicsthat all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Another way to state it is that "given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good." It reminds the physician and other health care providers that they must consider the possible harm that any intervention might do. It is invoked when debating the use of an intervention that carries an obvious risk of harm but a less certain chance of benefit.

Thank you for staying with me on this very long blog. 

Circumcision - I Wouldn't Do It To My Child If You Paid Me - Part Four

Thanks again for reading these blogs!  Not much more to go now, and by the finish I hope you will have gained some understanding about circumcision - I know that when I did my months of research I learned so much.

Back to the myth busting.  So far we have seen that 1. Medical Professions do not advocate routine circumcision for newborns, 2. Circumcision is painful in the extreme and 3.  It is dangerous to administer anaesthetic to very young babies.

The next myth is that circumcision is just a tiny snip and that there are no risks attached.

On the contrary, there are many risks of circumcision - these include infection, bleeding, scarring, excessive skin removal, damage to the glans and frenulum, loss of the penis and even death.   The danger of this myth is that it is more risky to circumcise an infant than an adult, simply because a baby's penis is so very small, and is therefore difficult to operate upon, plus the fact that more skin is removed from an infant than from an adult.  This means that excessive skin removal is quite common and this problem can result in painful erections, and also (contrary to popular belief) restrict the growth of the penis at puberty.

Plastibell

 

The latest figures I can find for complications caused by circumcision are for the USA, where the rate is given as between 3% and 9% - which doesn't sound like a lot, but actually means tens of thousands of boys suffer from complications because of this surgery.   There are deaths even in such developed countries as Australia, The USA and Canada.   I believe that even ONE baby suffering from complications is one too many, and that a procedure which is unnecessary, and has the risk of death attached should not be carried out.

The frightening thing, from my point of view, is that in many cases there are no figures for death or complications following circumcision.  Many complications are not followed up at the point where the procedure was done, and therefore are not reported.

I checked some statistics at the webcite Circinfo.org, and was appalled to see the following, just from Australia:

1919 Tuberculosis contracted during circumcision
1943 Gangrene following circumcision
1953 "Begg noted that figures for deaths from circumcision were not available, but reported Gairdner's observation (1949) of 16 deaths annually in England and Wales for period 1942-1947 and commented "There was every reason to believe that a proportionate mortality would prevail in Australia".
1965 "Dr R Southby mentioned two neonatal deaths which had resulted from infection after circumcision in the last year, and other instances of surgical complications leading to litigation"
1966 Two deaths from haemorrhage.
1967 Commonwealth Statistician report of one death in 1963 and one in 1964. Statistician commented "Figures of deaths from complications of circumcision for other reasons (other than ritual or preventive) are not available."
1969 Official statistics reported two deaths from 1959 to 1969 but "There is probably no adequate record of morbidity (death)"
1977 Death from meningitis
1993 Death from anaesthetic overdose, Brisbane
And for the complications arising, we have dozens, including tuberculosis following circumcision, septicaemia and also pneumonia in one baby, staphlycoccus in another.  Infection leading to loss of a third of the penis. In 1970 as report of complications at 15.5%.

A letter from A. Clements, MJA in 1972 "Examining large numbers of children at school medical inspections over the last few years I am appalled at the phallic mutilations exhibited by many of these children, some of whom have even been subjected to a subsequent 'tidying up' procedure after being bady mauled in infancy".

Other complications include cases of meningitis, including one fatal, one mildly 'retarded' and one seriously 'retarded';  two Sydney babies suffered severe blood oxygen deprivation after the administration of prilocaine anaesthetic.

And just in case you are thinking this is all past news, and these things don't happen in this modern world, think again!  In 1997 a baby almost bled to death after circumcision, 2006 a doctor was deregistered for ten years by NSW Medical Board for misconduct..including an excessive incidence of circumcision complications.   And in 2010 a Melbourne doctor was suspended for three months (only) after "incompetent circumcision" - using a Plastibell device, resulting in severe injury to the penis and the need for plastic surgery, on a 2 year old boy.

And we have an "enviable record"? 

Other complications include:  meatal stenosis, which is a narrowing of the urethra, this can interfere with urination.  It may require further surgery to remedy.   Adhesions, where the remnants of the foreskin try to heal attached to the head of the penis, in an area where they are not supposed to grow. These adhesions are treated by doctors ripping them open, with no anaesthetic.  Buried penis, where the penis is trapped or buried because too much skin has been removed, forcing the penis inside the body.  Infection is also a serious risk with the prevalence of the modern drug resistant bacteria which can be picked up in the hospitals. 

Regarding the myth that circumcision is necessary to prevent Urinary Tract Infections in infants: 

This is a no-brainer, as research for this claim was based on one study, of babies born in one hospital in 1985.  According to Psychology Today, the study had "many problems, including that it didn't accurately count whether or not the babies were circumcisied, whether they were premature and thus more susceptible to infection in general, whether they were breastfed, whether their foreskins had been forcibly retracted".  This last can introduce bacteria and lead to infection.  Since this 'research'  there have been many further studies, some showing either no decrease in UTI's from circumcision, some showing an actual increase.  The generally accepted figures  state that around 0.188% of circumcised babies and 0.702% of intact babies develop a UTI.  Such a slight difference as this hardly matters.  The incidence for girls of UTI's is around 5%.   Also immediate breastfeeding apparently protects male and female babies from UTI's. 

Tomorrow I will look at the last of the myths I will cover, that of STDs and HIV - I think you will be quite surprised by the most recent findings.  I will also look at the long term and psychological implications of circumcision.  They aren't pretty in a lot of cases.

Circumcision - I Wouldn't Do It To My Child If You Paid Me - Part Three

A warm welcome back to those of you who are following this story, and thank you for staying with me.   We have looked at the general, simplified anatomy of the penis, and the main ways in which circumcision is performed.  Now I want to dispel a few myths, many of them perpetrated by the medical profession, and to enlighten you about the facts.

There are still staunch advocates for infant circumcision, but it is fact that there is no medical organisation anywhere which recommends this routine circumcision.  The Royal Australasian College of Physicians, The British Medical Association and the American Academy of Paediatrics are included in those organisations.  Routine neonatal circumcision has been declared unlawful in South Africa, Sweden (apart from on religious grounds) and Finland.

A myth still floating around is that doctors advocate routine circumcision of newborn baby boys.  The truth?
The RACP says, in their Policy Statement, in part:  After extensive review of the literature the RACP reaffirms that there is no medical indication for routine neonatal circumcision. The complication rate of neonatal circumcision is reported to be around 1% to 5% and includes local infection, bleeding and damage to the penis. Serious complications such as bleeding, septicaemia and meningitis may occasionally cause death.

The possibility that routine circumcision may contravene human rights has been raised because circumcision is performed on a minor and is without proven medical benefit.
 
Review of the literature in relation to risks and benefits shows there is no evidence of benefit outweighing harm for circumcision as a routine procedure in the neonate.

 
From Wikipedia:
The Royal Dutch Medical Association stated in 2010: "There is currently not a single doctors' organisation that recommends routine circumcision for medical reasons."  The Royal Dutch Medical Association issued a new policy in May 2010: "The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity. Contrary to popular belief, circumcision can cause complications – bleeding, infection, urethral stricture and panic attacks are particularly common. KNMG is therefore urging a strong policy of deterrence. KNMG is calling upon doctors to actively and insistently inform parents who are considering the procedure of the absence of medical benefits and the danger of complications."
 
The Fetus and Newborn Committee of the Canadian Paediatric Society posted "Circumcision: Information for Parents" in November 2004, and "Neonatal circumcision revisited" in 1996. The 1996 position statement says that "circumcision of newborns should not be routinely performed", and the 2004 advice to parents says it "does not recommend circumcision for newborn boys. Many paediatricians no longer perform circumcisions."
 
The British Medical Association's position (June 2006) was that male circumcision for medical purposes should only be used where less invasive procedures are either unavailable or not as effective. The BMA specifically refrained from issuing a policy regarding “non-therapeutic circumcision,” stating that as a general rule, it “believes that parents should be entitled to make choices about how best to promote their children’s interests, and it is for society to decide what limits should be imposed on parental choices.”
 
The American Academy of Pediatrics (1999) found both potential benefits and risks in infant circumcision, however, there was insufficient data to recommend routine neonatal circumcision. In situations involving potential benefits and risks, and no immediate urgency, they state that "parents should determine what is in the best interest of the child". They continue, "To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision." They said, "In the pluralistic society of the United States in which parents are afforded wide authority for determining what constitutes appropriate child-rearing and child welfare, it is legitimate for the parents to take into account cultural, religious, and ethnic traditions, in addition to medical factors, when making this choice." If a decision to circumcise is made, the AAP recommend using analgesia to reduce pain, and also said that circumcision on newborns should be performed only if they are stable and healthy.

 
The American Medical Association (1999) noted that medical associations in the US, Australia, and Canada did not recommend routine circumcision of newborns. It supported the general principles of the 1999 Circumcision Policy Statement of the American Academy of Pediatrics.
 
The American Academy of Family Physicians (January 2007) acknowledges the controversy surrounding circumcision and recommends that physicians discuss the potential harms and benefits of circumcision with all parents or legal guardians considering circumcision for newborn boys.

 
The American Urological Association (May 2007) states there are benefits and risks to circumcision, recommending that circumcision "should be presented as an option for health benefits" while acknowledging that "evidence associating neonatal circumcision with reduced incidence of sexually transmitted diseases is conflicting." It feels that parents should consider medical benefits and risks, and ethnic, cultural, etc. factors when making this decision.
 
So medical authorities are agreed that there are medical risks, and that routine circumcision of newborns should NOT be performed.  It is the old saying "if it ain't broke, don't fix it".   So much for the advocates.

Note that there is still no mention of the male having the right to make decisions about his own body?


A second myth is that it is less painful for circumcision to be carried out when the boy is a baby, rather than later in life.
 
Circumcision is extremely painful - and traumatic - for a baby. Just being strapped down is frightening for a baby. The often repeated statement that babies can't feel pain is not true. Babies are as sensitive to pain as anyone else. Most babies scream frantically when their foreskin is cut off. Some defecate. Some lapse into a coma. The reason some babies don't cry when they are circumcised, is that they can't cry because they are in a state of shock. Most babies are circumcised without anaesthesia. Anaesthetics injected into the penis don't always work. Being stuck with a needle in the penis is itself painful for a baby, just as if would be for anyone else. Babies are rarely given pain medication right after they are circumcised or during the week to ten days it takes for the wound to heal. Pain medication is not always effective and is never 100% effective. (Nocirc.org)

 
In 1997, doctors in Canada did a study to see what type of anaesthesia was most effective in relieving the pain of circumcision.  As with any study, they needed a control group that received no anaesthesia.  The doctors quickly realized that the babies who were not anaesthetized were in so much pain that it would be unethical to continue with the study.  Even the best commonly available method of pain relief studied, the dorsal penile nerve block, did not block all the babies' pain.  Some of the babies in the study were in such pain that they began choking and one even had a seizure  (Lander 1997). (Psychologytoday)
 
Tiny infants experience the most excruciating pain, both during circumcision and for weeks following the procedure.  They can exhibit changes in behaviour, for example avoiding physical contact, sleep disturbances, frequent crying and even reluctance to breast feed.
The last myth today (but not the last myth of all) is that of anaesthetics being used for newborns.

 
Most newborns do not receive adequate anaesthesia.  Only 45% of doctors who do circumcisions use any anaesthesia at all.  Obstetricians perform 70% of circumcisions and are least likely to use anaesthesia - only 25% do.  The most common reasons why they don't?  They didn't think the procedure warranted it, and it takes too long  (Stang 1998).  A circumcision with adequate anaesthesia takes a half-hour - if they brought your baby back sooner, he was in severe pain during the surgery. (Psychologytoday)
 
Oh, before I go any further, there is a doctor (who shall remain nameless) here in Australia who happily chops off foreskin from babies willy-nilly and has a huge website in favour of circumcision.  In my opinion he is a sadist, but he would probably dispute this. He also advocates the use of the EMLA patch.  There have been many very adverse results from the EMLA patch, and the reason is very very simple:
 
The following is from www.cirp.org:
 
THE CIRCUMCISION REFERENCE LIBRARY

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EMLA topical anaesthetic for neonatal circumcision

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This page presents information about risks associated with the use of EMLA cream for relief of infant circumcision pain. Although certain pediatric groups recommend its use, other authorities tell a different story.

"EMLA Cream is not recommended for use on mucous membranes because limited studies show much greater absortion of lidocaine and prilocaine than through intact skin. Safe dosing recommendations for use on mucous membranes cannot be made because it has not been studied accurately."

"EMLA Cream should not be used in infants under the age of one month, nor in infants under the age of twelve months, who are receiving treatment with methemoglobin-inducing agents (see Methemoglobinemia subsection of WARNINGS).

---

EMLA has added a new warning to their product inserts and their web site. The new warning states:
"EMLA Cream is not recommended for use prior to circumcision in pediatric patients."

and also:

The Canadian Nurse, August 1994, pp. 5-6

[Material in brackets added. CIRP]
Editor's note: Recently we received a copy of the following letter from Grace Boudreau, RN, Director of Quality Assurance, G. R. Baker Memorial Hospital, Quesnel, B.C. [British Columbia, Canada]. The letter was sent to all general practitioners, hospitals and pharmacies in Northern British Columbia on March 28, 1994. We have permission from the letter's author, Dr. Marie Hay, to print the letter in its entirety (bold type represents emphasis expressed in original letter.)

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Dear Doctor,
The Department of Paediatrics at Prince George Regional Hospital recently discussed the unfortunate case of a 21-day-old male child who was circumcised using Prilocaine as a local anesthetic agent. A few hours after the circumcision the baby developed significant Methaemoglobinaemia [reaction with the blood] due to the Prilocaine anesthetic.
The department of Paediatrics is issuing a strong warning to all physicians who perform circumcisions. We strongly advise that Prilocaine local anesthetic not be used under any circumstances for neonatal circumcision. It is also interesting to note that EMLA cream contains 2.5% Prilocaine. It also therefore should not be used on the mucous membranes of newborns when they are circumcised.
It is the Department of Paediatrics' recommendation that no infant under the age of 3 months gets Prilocaine or EMLA cream in any form because of the serious risk of Methaemoglobinaemia.
I understand from speaking with an Intensivist at B.C. Children's Hospital that two other cases of Methaemoglobinaemia due to Prilocaine have also been noted in B.C. in the past recent months. As you know Methaemoglobinaemia can cause brain damage and death in small infants.
 
Even the dorsal penile nerve block leaves the underside of the penis able to feel pain. Babies go into shock, and although this appears that they are quiet,  it  is their  body's  reaction  to  profound  pain  and distress.  Nurses will tell the parents "he slept right through it" so as not to upset them. Who would want to hear that their baby was screaming throughout in agony?

 
There are many risks involved with using anaesthetic on newborns, the above are just a small example of the outcome of using  EMLA (which by the way is NOT sterile) and prilocaine - which EMLA contains. 
 
More myth busting tomorrow night.

He Told Me I Was Ignorant

Just thinking about things from the past, as oldies are prone to do..and recalling some really quite nasty things my ex said to me.  What he proved by saying them was that he didn't know me at all.  The strange thing is that after 30 years of his being an 'ex'  he still has the same attitude towards me. Makes you wonder why he ever married me in the first place.  I mean, if you think someone is 'ignorant' and 'coarse' and 'common' and uneducated - why in hell would you marry them?  Perhaps he had to get married to keep up with his 'friends' - which is extremely odd, as we never saw them and he didn't keep in touch with them.  The whole TWO of them.

The one thing that sticks and now makes me want to ram it down his ugly throat is the contempt he felt for me, because I didn't have the education he had.  Bearing in mind that he was an only child, whereas I was one of three, and his mother got a full-time job to pay for his education it is not exactly surprising.  He repaid her when he went to college, by pissing away his first year drinking and doing things you would expect from a 10 year old kid.  And then failing his examinations.  Which shows the sense of entitlement he had, and still has.

Any road, as they say.  He was talking about his job one evening, when we had been married a couple of years.  I said that it was something I think I would love to do, especially as he was in the Merchant Navy and travelled all over the world.  His reply floored me.  He said (I quote, as I remember this vividly)  "Oh you couldn't do my job.  How do I put this nicely?  Um, you just don't have the education!"...................what a huge soul he has eh?  What he did forget to factor into his supercilious equation was that, although I had left school at age 15 I had never stopped learning.  I had attended night school.  I had read widely and voraciously.  And every subject I came across I would learn learn learn about.

 
Now that we are 30 years older, I believe I have 30 years more of learning under my belt.  He doesn't.  He doesn't even read.  He has no idea that I had even done the first year of Open University, and flew through it!  Sadly, my demanding job put the mockers on finishing.  It proved something to me though - that even though I had the minimum of formal education I could think, and learn, and had tucked more knowledge in my handbag than he had in his suitcase.  Arrogant pig.

Just because you are an autodidact (self-taught!) this does not mean you are ignorant or uneducated.  Lack of formal qualifications does not mean you don't have wide knowledge and experience.  And most importantly, just because a pompous, stuck-up Pommie prig says you are dim does NOT mean that you are.   I believe what it actually means is that he knows you are probably 10 times smarter than he is - and that he didn't know that you had a Mensa score IQ.  Ha!  Wonder if he STILL feels threatened by me?
 
Wouldn't that be a kicker!

 

Circumcision - I Wouldn't Do It To My Child If You Paid Me To - PART TWO

Thanks for sticking with me on this, and for reading what I have put up so far.  It is a bit of a rugged road, and a most controversial subject.  My thought on this is that there are millions out there who are not fully informed about the whole subject of circumcision.  So here we go, on our road to information, part two.

There are several main methods which are used to circumcise an infant, and remember I am not talking about places like Africa where there is no real hygiene and they carry out mass circumcision - with dire results.

A warning if you are squeamish - some of the pictures are graphic.

The first one I will talk about is the straight out cutting method.  This is probably having  its death knell sounded, although religious practices still seem to require this method.  There really doesn't seem to be a standard for which method of circumcision is used, although some countries prefer the Plastibell and some the Gomco Clamp. 

The so-called "simplest" method appears to have varied little from the "traditional" operation.  The foreskin is pulled forwards and gripped in a pair of clamping or crushing forceps, which are placed at an angle to match the slope of the back of the glans.  The skin is cut off in front of the blades of the forceps, then the inner skin is pushed back and fastened, with  stitches, to the outer skin on the shaft. In infants, the stitches are often not used. Their main purpose is to close off blood vessels, and crushing with the forceps is often enough to accomplish this.   How complete the circumcision is depends upon how hard the skin is pulled forward before  clamping. Making the cut while the skin is pulled over the glans provides a safeguard against removing too much. Much of the inner skin remains, so the scar, after healing, will be well down the shaft. It is usually rather irregular but very inconspicuous.

NO ANAESTHETIC CAN BE USED

Lidocaine is used. Note it is for after the operation. According to several nurses at University of Michigan, it does very little or nothing to alleviate the pain of circumcision.

Betadine is used to swab the penis and scrotum to help prevent infection

The foreskin is sealed down to the penile head and must be torn off in order to be retracted in infancy.

The foreskin is pulled up, clamped for several minutes to prevent excess bleeding, and cut along the clamp with a scalpel.

What you see is not foreskin, but skin from the shaft of the penis. The edges stick together because they are still "raw".

The distinction between shaft skin and where the foreskin was cut away is obvious. The part of the foreskin that used to touch the glans ("inner foreskin") is what is between the shaft skin and the penile head in the picture

Excessive bleeding is the most common complication of infant circumcision.

After the inner foreskin is removed, notice that half the shaft skin has been cut away-- altogether,about 2/3 of all the skin of the penis.

The remaining shaft skin is pulled up to meet the glans and attached with stitching.

The penis now has 1/3 to 1/2 less penile skin to accommodate erections and the glans is permanently exposed. The glans will lose its shininess and dark red coloring as the site heals within the next week or so. What was before an internal part of the body, is now external and it will grow a sort of callous over the glans as part of the healing process.

 Pictures from http://www.circumcisionquotes.com/magcirc.html

The Gomco Clamp, is an invention of Hiran Yelland and Aaron Goldstein, from 1934.  It is reported to be based on the tyre lever used for Model T Ford cars.  It is a metal ball, and a flat plate with a hole in it placed over both, to define the position.  These are brought together by a screw and apply circular crush and fusing force - of between 8,000lbs to 20,000lbs.
Circumcision with the Gomco clamp and the Plastibell device have many of the same features. The foreskin is grasped with two mosquito clamps at the 10 o'clock and 2 o'clock positions These clamps are used to hold the foreskin up. A third mosquito clamp is used as a probe to destroy any adhesions under the foreskin from the 8 o'clock to the 4 o'clock positions and is then clamped about 2/3rd of the way between the foreskin opening and the corona. This action creates the crushed area for the dorsal slit. The third clamp remains in place for one minute. The dorsal slit is then cut through the middle of the crushed area, using tissue scissors. The foreskin is peeled back, and any additional adhesions are destroyed using a blunt probe. 

 
The Gomco clamp was designed to crush about 1 mm of the foreskin around the circumference, while the Gomco bell protects the head of the penis from injury during removal of the foreskin. The bell is placed inside the foreskin, and the dorsal slit is secured over the bell with a sterile safety pin. This allows the handle of the bell to pass through the circular opening of the clamp, without the foreskin slipping out. The foreskin can be brought through the opening by grasping it with sterile gauze. The thumbscrew is tightened until snug, and the visible foreskin is removed using a scalpel blade distal to the junction of the bell and the clamp.  The clamp should remain secure for a total of five minutes, to allow the crush effect to be complete. This step is designed to reduce the incidence of bleeding after the clamp is removed.

Gomco Clamp

When the thumbscrew is loosened and the bell gently removed from the clamp, the foreskin will stick to the bell because of the crushing. The foreskin can be loosened by gently peeling with a gauze swab to liberate the glans and show the final result. The edge of the foreskin and the corona of the penis are then gently wrapped in precut petrolatum gauze, which remains in place for 12 to 24 hours.
 
The Plastibell is designed to cause circumcision by cutting off the blood supply to the end of the foreskin. Dead tissue falls off 7 to 12 days after the operation. No advantages of the Plastibell technique over other techniques have been documented, except "ease of use." Some studies have shown a small increase in the incidence of infection with the Plastibell device.

 
Ensuring that the correct size of the Plastibell is used is important. (N.B This is done by trial of different sizes) A fit too small can cause tissue strangulation and necrosis, and one too large may result in too much foreskin being removed and the penis being denuded of skin. After making the dorsal slit as outlined for the Gomco technique, the Plastibell device is placed on the glans and the cut foreskin is pulled over the top of it. 
The cut foreskin is brought over the top of the Plastibell until the tip of the incision is above the string placement guide on the device. The foreskin is clamped across the top of the Plastibell with a straight clamp. The string is placed around the foreskin and the Plastibell device in a groove that acts as a placement guide. The string is then tightened and tied in a simple square knot. An adequate result is obtained when the skin just distal to the string blanches without the string breaking. The excess foreskin is trimmed from around the bell using iris scissors . The handle is then broken off the device. 

Plastibell device

 
The Mogen Clamp - A blunt-edged probe is used to separate the glans from the preputial lining, taking care not to traumatize the frenulum. The prepuce is lifted upward and outward by the hemostat. This action causes the glans to retract towards the scrotum, preventing accidental amputation of the glans. The open jaws of the Mogen clamp are placed around the prepuce (grooved side facing the glans) as it is lifted upward.  The clamp is closed for one to one and one-half minutes. If the infant is more than six months old, the clamp should remain closed for five minutes.

Mogen Clamp

While the clamp is closed, the prepuce is cut away distal to the clamp. The clamp is then opened slowly and removed. Downward pressure is applied to the  skin around the corona, until the skin-mucosal seal is broken and the glans is liberated.  A blunt probe is used to remove any additional adhesions. Petrolatum gauze is applied to cover the operative site. The preputial skin around the corona of the glans will often have a "dog-eared" or asymmetric appearance. As the infant grows, this aspect becomes less prominent.
There are other methods used, e.g. the Tara Clamp, the SmartKlamp.  I believe the above will give you a fair idea of the procedure, without going into further clamp details.

 
Of course, the infant has to be restrained, and lo! there are manufacturers who have come up with the perfect solution.  One of these if Olympic Medica's very own 
 
Infant Immobilizer Circumstraint. Fast immobilization of newborns 4-16 lbs. Use during circumcision, transfusion, minor surgery, x-ray. Complete with four adjustable Velcro straps for securing arms and legs.
"In less than 30 seconds, a nurse can immobilize the struggling infant securely in the correct position with Circumstraint. It works on a proven principle of positive 4-point restraint. Soft wide Velcro straps encircle the infants elbows and knees, depriving him/her of leverage. "

 
"Circumstraint's comfortable contoured shape positions the infant, hips elevated, perfectly presenting the genitalia."
 
"He's held safely and securely without danger of escape."
 
"Always a fast, easy means of immobilizing newborns for circumcision..."

 
And the Stang

This light weight chair positions the infant comfortably while providing surgical access the the operative site."

"Newborn pain management is an issue of concern to many health care professionals today." 

"Any physician or nurse who has attempted to extend the arms and legs of a term neonate to strap him into a rigid restraint, realizes the resistance to extension that all neonates possess.

Positioning of the baby in the Circ Chair allows the infant to sit with his hips abducted and flexed, knees flexed, and head elevated at various positions up to 30-45 degrees. Soft velcro straps adjust to the baby's size. The instrument platform is designed to accommodate commonly used circumcision clamps."

The patient cannot understand, consent, refuse or escape.

And the 'struggling infant'  - hmm.  No anaesthetic.  Which I will cover in my next part of this blog, Part Three.