Sunday, May 6, 2012

Denuding the Shaft

I have written about this before, in the context of a discussion about arrogant mohels, and in the context of a bad story I was told by a baby nurse I worked with, and I hinted to it when I recounted a conversation I had with a urologist-grandfather with whom I worked directly. And I mentioned here why I would personally do my research in this regard were I to look for a mohel myself. Alas, being a mohel, I knew who was going to circumcise my sons.

But now I am calling it what it is.
Because I had a conversation today with a woman who recounted vivid details of her son's bris 5 years ago. She kind of laughed it off "because he's fine now" but I could tell that the trauma of her experience (not to mention her son's experience - my GOD!) is something she still carries with her. And I would readily admit that if a person has an emotionally difficult reaction to the bris - this is normal. A woman is post-partem, her baby has surgery, he cries during the bris, etc. It's not easy. But in a normal case, most people can talk about "how I (the parent) did not do well the day of the bris.. But, when I saw everything was fine, and everything happened exactly the way the mohel said it would, and the baby was calm after the bris" and leave it at that.

But when the mohel does a tremendous disservice to the baby, causing a terrible loss of blood, and making the penis look horrifically unlike how it should look after the bris, on account of a BAD JOB - this information needs to get out. The problem is: No One Talks About It

It does not matter that the urologist grandfather I mentioned above said "The penis is a very forgiving organ." This means that somehow, when it heals, things tend to work out nicely. That does not excuse poor choices made by a mohel.

The Skinny

The penis as an organ does not change in size in any significant way from birth until a child is at least 10. shaft may get a little fuller from newborn to age 3, but the real major changes come with the onset of puberty. This is why even when there seems to be skin (ie membrane) climbing on the edge of the glans in a youngster, puberty will likely remedy that aesthetic inconsistency.

Many years ago I had a conversation with a mohel (who is probably 35 years older than I) about what is the proper amount of skin to remove in a bris. We were discussing longer term consequences, and different scenarios were raised, which mostly stem from the fact that every baby has a different size and shape penis (the ingredients are the same, but the amounts are different from baby to baby): some have a very long shaft, some have a very short one; some have a very pronounced glans, some have a glans that is hardly distinct from the rest of the shaft; some seem to have all-glans-no-shaft, and some have a more ratio-d proportion of shaft to glans; the angle of the glans (dorsal and ventral sides) change from baby to baby.

What is "Denuding"?


He asked me, "How do you know how much to skin to remove if the shaft is longer or shorter?" I told him that I mark the edge of the foreskin where I see the edge of the glans pre-circumcision. He laughed and said, "And you follow the mark?" I affirmed. [He didn't believe me.] He said, "What happens when you see that you undershot?" (It could happen that in the prep-room I will underestimate how much skin is to be removed, usually on account of the fact that the skin is so maleable and it literally can shift from second to second.) I told him that when it happens (as it does every now and then) I will leave myself a little cautionary room to take a little more off the dorsal side, because, as every mohel knows, taking a little more off the dorsal side is OK. This is where the penis is most forgiving. But I will still follow my mark on the ventral side. I don't want to risk denuding the shaft.

He said, "When the organ is smaller, you want to take off as much skin as you can. Otherwise the penis will sink into itself. When the organ is longer, you want to take off the absolute minimum because otherwise, you'll end up denuding the shaft." [He told me that it sounds contrary to logic, and it does seem that way, but while I don't completely agree with him, I do agree that there is basis to the argument.]

I had a similar conversation recently when a mohel colleague (much closer to my age, though I think I've been working a few more years) asked me my opinion regarding if its better to leave more or less of the original shaft skin. I told him that the reason I use the marker is to ideally leave the baby with as much of his original shaft skin as possible. We are removing the FOREskin, not ALL of the shaft-skin.

I told him what the older mohel told me, which parts I agree with, and which parts I disagree with. Mostly I think there isn't necessarily a one-size-fits-all. Every baby needs to be "diagnosed" for the best angled and planned bris the mohel can give him. Leaving him as much original skin, and less "scar tissue," than he should have to deal with.

All this is why the mohel I mentioned in the opening tale did a tremendous disservice to the family in question. He did not inform them of his method of doing bris. He did not share any information with them.

And they too did themselves a disservice by not doing more research. That "everyone uses him and we therefore thought everything would be OK" does not justify a lack of research.

This is a violation of rule #10, 7, 6, 5, 4, 2, 1

From my conversation, I know exactly what the man did. He wrongly estimated the end of the foreskin (did not mark), he grabbed the foreskin and ended up taking ALL of the shaft skin, and he did NOT use a shield. Thank God he did not amputate the glans! But he also left right after the bris (he flew in from NY to do their bris in a different state), and did not give ample instructions or leave an adequate bandage that made everything palatable to see afterwards. The mother described the "bloodiest diaper. It was a horror."

NO ONE SHOULD EVER HAVE AN EXPERIENCE LIKE THAT!

No mohel is an expert from the get-go. But every mohel should have a decent sense of the proper precautions to take to avoid disaster. And every mohel, with time, hopefully gets better and becomes more efficient at what he is doing.

But the denuding of the shaft is wrong, as at least a minimal amount of skin should remain climbing up the shaft from the scrotum and from the belly. The remains of the membrane will fill in the rest of the shaft with time.

DON'T LET THIS HAPPEN TO YOU OR YOUR SON! MAKE SURE YOU KNOW WHAT PRECAUTIONS THE MOHEL TAKES TO MAKE SURE HE REMOVES THE RIGHT AMOUNT OF SKIN AND PROTECTS YOUR SON'S GLANS.

BE INFORMED, TAKE CHARGE, AND DON'T BECOME THE VICTIM OF A FOOL MOHEL WHO SHOULD NOT BE PRACTICING (on account of his not marking or using a shield), WHO CARES MORE ABOUT HIS STATS (AS IN, HOW MANY BRISSES HE'S DONE - a number he apparently shared with the mother) THAN ABOUT EVERY BABY UPON WHOM HE HAS PERFORMED A BRIS.

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