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Tuesday, January 31, 2017

Being Prepared for Out of the Ordinary Circumstances

As much as possible, I try to meet the baby a couple of days before the bris. It gives me a chance to speak with his parents face to face, and it also helps prepare me in terms of what to expect with the technical side of the circumcision.

In other words, not all male anatomy develops in the same way.

In examining a baby recently, I noticed that the glans was extremely close to the body in its natural state, while when pushed on the two sides of the shaft to elongate the penis, the entire organ seemed to emerge. I have seen situations in which the entire penis was inside the body, requiring a reconstructive surgery to draw everything out - which I was later privileged to observe in the operating room, under the skilled hands of one of the finest surgeons I have ever seen in action. But this was not so extreme at all, as everything was external, it just seemed pulled by nature to be less prominent.

I explained to the parents what I needed to do - to be as precise as possible in marking the foreskin, to avoid this problem, and to see to it that everything looks right after the bris.

As luck would have it, the marking went perfectly, the incision was precise, and it looked like all was going to be smooth sailing. However, as sometimes happens, I noticed afterwards that there was extra membrane, necessitating this quick touch-up.

But it turned out to be so much more. What is often a tiny piece of membrane tissue turned out to be a significant amount of below the foreskin webbing. It kept emerging, causing me to realize what was pulling the glans almost into the belly itself. 

Thankfully, it seems this was it. When it was all removed, the baby looked like every other baby post-bris, and the internal issue he had that was pulling his penis, making everything so retracted, was resolved. 

As I told the father, if we hadn't taken care of this now, he may have developed phimosis or the inability to have a complete erection, with internal membranes pulling him away from being able to do what he'll need to do one day.

Baruch Hashem, a good ending and a happy story. It's a warning to mohels to be humble and to remember that not everything is "textbook" every time. It is also a reminder to parents that mohels must treat each case as if it is the most important thing he is doing now. I have seen cases similar to this one in which the circumciser erroneously removed ALL shaft skin because he thought that was what was required due to the unique anatomy.

Thankfully that wasn't the case here, wasn't the approach tried nor the results achieved (which were actually quite impressive)!

May we be blessed to deal positively with all new situations, and be guided to always fulfill the mitzvah of bris milah properly, including in non-textbook circumstancs. 

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