Dear Dr. G,

I am sure you are equally horrified when you learn about the botched circumcision in Malaysia that ended up getting more than 3 million ringgit compensation.

Although the amount of compensation is staggering, I am sure any man would agree no matter how much the pay-out, there is no consolation.

I am a father of two boys and thinking about sending both for circumcision.

With this news of severed manhood for the poor boy, I am having second thoughts and would like to weigh out the pros and cons of the operation.

I understand from your previous articles featured in the month of April mainly focusing on the benefits and different modalities of circumcision.

Although today is technically the month of May, I hope I can still put Dr. G on the issues of complications of circumcision.

Can you please tell me how common to have complications after circumcision?

Can you comment on what exactly happened to the botched case in Malaysia?

Under what circumstances is the circumcision considered a botched job?

How can that be possible, how can the doctors “accidentally” amputate the penis?

How common is that?

Can a severed penis unable to be reattached?

Are there any cases where a reattached severed penis be functional?

I am sorry for asking too many questions, but these are important for many concerned parents before putting their boys forward for the cut!

Yours sincerely

Horrified Han

It is absolutely tragic and sad to learn about the boy who lost part of his penis after complications from circumcisions. As I understand from the news media, a 22-year-old man, who lost the head of his penis during circumcision at the age of 10, was awarded damages of RM3.1mil in a negligence suit. Although this was one of the landmark compensations for medical negligence in Malaysia, our hearts still go out to the man and his family for the tragedy.

Circumcision is one of the commonest operations in medicine and is usually safe with low morbidity (0.2%-0.6%), ranging from bleeding and infection. Serious complications can occur when the intervention is performed in unregulated practice. However, even in a hospital setting, pediatric circumcision may not be so straightforward when the boy is chubby and especially with a small, retracted penis within the pubic “baby fat”.

A botched circumcision occurs when permanent disfigurement or unintended removal of part of the penis. Such complications usually stem from misjudgments on the part of the circumciser. Although partial or complete

amputation of the penis is rare, it is well documented in medical literature. El-Bahnasawy reported the largest series of pediatric penile injuries over twenty years, with sixty-four boys hospitalized following severe complications from circumcision.

The re-attachment of the glans penis is complex, and well documented in medical literature using the technology of microsurgery. The recovery cases published are mainly of the severed adult penises due to self-mutilation or irate spouses. Perhaps the most famous case would be John and Lorena Bobbit, the American couple whose relationship received international coverage when the wife cut off John’s penis with a kitchen knife while he was asleep in 1993. The penis was subsequently surgically reattached, and he went on to star in several pornographic films, which I guess was a good testimony to the success of the operation.

In a pediatric setting, the reattachment of the urethra, minute penile vessels and the nerves can be a near-impossible task. The success of the reattachment of the penises in children is not well recorded. Although the reproductive function of the child is preserved, the psychological and physical consequences to the boys are often immense. The re-attached penis may be deformed, shortened and depleted to the sensitivity for normal sexual functions. The outcome of the external genitalia following puberty is generally unpredictable!

The famous Harry Potter author, JK Rowling once said: “It is impossible to live without failing.” Similarly, when it comes to surgery, it is impossible to have an operation that has no failure or complications. Although the rate of a botched simple operation like circumcision is well-documented in the media, every such complication is still unfortunate and thankfully exceedingly rare. It is right for parents, and any individuals contemplating any form of operation, to carefully consider the proper indications and potential complications of the surgery.

Asking all the necessary questions before consenting to the procedure is often the key to minimising complications. Dr. G is often put on the spot by individuals asking too many “embarrassing” questions prior to circumcision, and wondering if the enquiry is necessary. His response is “Although it is impossible to have an operation without failure, but careful research and getting the right professional advice are the only ways to minimize the complication. After all, there can never be complete recovery for a severed manhood no matter how advanced is modern medicine”.

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