wrongful-foreskin-retraction

Help for Wrongful Foreskin Retraction



First aid | Helpful articles | How to file a complaint | Supporting documents

As an international physicians’ organization, we deeply apologize for the conduct of our fellow professional, and for the unnecessary injury done to your son. American health care professionals are often not well trained or familiar with the normal, intact penis, which can lead to inappropriate and even harmful care or advice. Though the possible consequences of premature, forcible foreskin retraction (PFFR) can be serious, most boys recover without a problem, although they have lost a protective membrane and may be at risk for some complications.

Immediate first aid

We are available by phone for first-aid advice in the immediate aftermath of an incident of PFFR. Our telephone is (206) 465-6636, 9-5 Pacific Time (or even later), 7 days a week.

  • If your child’s foreskin has been left stuck behind the head of the penis (called paraphimosis), it must be returned to the forward position immediately. Click here for information on manual correction of paraphimosis. If you cannot return the foreskin forward, SEEK MEDICAL ATTENTION IMMEDIATELY.
  • Reassure your child as best you can. He needs to feel acknowledged for his feelings of violation, and he needs to feel safe and protected.
  • DO NOT PULL BACK his foreskin (despite obsolete advice about applying a barrier ointment like Vaseline).
  • Change his diaper promptly after he defecates to reduce the chance of infection.
  • Your son may urinate incompletely and complain due to stinging of the urine on his raw tissue. Peeing in the bath or a cup of warm water, to dilute the urine, may help.
  • Bathe him normally, avoiding contact with soap or bubble bath (which will sting). Remember: “Only clean what is seen.”
  • Stay alert to signs of infection: excessive redness, swelling, or unusual discharge. There may be some blood or swelling initially, but these should resolve over the first few days.
  • In the longer term, your child may develop adhesions from the body’s attempt to repair the trauma. Leave the foreskin alone and any adhesions should disappear in time. [Ponsky 2000]

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Helpful articles on forcible foreskin retraction

We encourage you to read the following articles for good background information on the problem of premature forcible foreskin retraction. The more you know, the more you will be able to protect your son.

Your rights as the parents of an injured child

Sadly, we at Doctors Opposing Circumcision are asked to intervene in over 100 cases of premature, forcible foreskin retraction (PFFR) each year. Unfortunately, a warning or educational letter to the provider – by itself – has not proven effective in preventing further occurrences of PFFR. You may wish to file a formal complaint, if only to protect other boys. You have that right.

We can help you to file your formal complaint, according to the following instructions.

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How to file a formal complaint

First, some important considerations

  • Do you have alternate medical providers? If you live in a small town or are tied to a single clinic or single medical system by insurance restrictions, you should consider whether you need to protect your son’s access to future medical care. You may wish to explore alternate provider arrangements, making sure they are “foreskin-friendly,” before you confront your current provider.
  • Was the retraction serious enough to warrant a complaint? Some knowledgeable doctors – those who understand the anatomy of the intact penis and take extreme care – could safely examine a child’s penis by gently retracting the foreskin only to the boundary where it attaches to the head of the penis. While this exam technique is usually medically unnecessary, it is not in itself harmful enough to warrant a formal complaint. Signs of a more serious retraction are pain, excessive redness, torn or raw tissue, bleeding, and swelling.

Your alternatives

  • File a formal complaint with your state’s medical regulatory authority, attaching the documentation we provide. (Recommended.)

– AND/OR –

  • Send your complaint to the offending medical provider, and other suggested contacts. (Again, this alone is less likely to protect other boys.)

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Checklist of steps to file a complaint

Step 1: Request a customized cover letter from D.O.C. to submit with your complaint. (Optional)

Step 2: Prepare your story of what happened.

Step 3: Print out our supporting documents.

Step 4: Take close-up photographs of your injured son’s genitals. (Optional)

Step 5: Send packet, with all of the above, to your state’s medical regulatory authority and/or other suggested recipients.

  • IMPORTANT NOTE: Your State’s medical regulatory authority may require additional forms or actions. Follow the directions on the regulatory authority’s website.

Step-by-step instructions for filing a complaint

Step 1: Request cover letter from D.O.C. (Optional)

A customized cover letter from D.O.C. – carrying the credibility of a physicians’ organization – will help your complaint to be taken more seriously.

To generate a customized cover letter for you, we need certain information on the incident and the parties involved. All information provided will be kept confidential.

Click here to submit this information to us and request the cover letter. Your customized cover letter will be sent as an attachment to the email address you provide. You will then add this as a supporting document when you file your complaint.

Step 2: Prepare your story

You will need to gather relevant names and addresses, and write up a comprehensive and detailed history of exactly what occurred. Include details on when, where, what occurred, by whom, and what the result was. To receive the best consideration, your story should include the following items:

Basic data

Full name of your child, place of birth, and birth date

Parents’ full names, addresses, and emails

Reason you took him to the doctor (for example, well-baby check, immunization, suspected infection, fever, earache, urinary problems, etc.)

Date (and time, if possible) of the incident

Name of the offending doctor, nurse, or other medical professional

Name and address of the clinic

Details of the story

Whether you asked the medical professional not to retract your son and were ignored

Whether or not you observed the doctor washing his/her hands

Whether s/he wore surgical gloves

How aggressively the doctor retracted your child’s foreskin

How far was your son retracted? All the way to the base of the glans (corona)?

Your child’s reaction at the moment of retraction

Was your child left with his foreskin fully retracted behind the glans (paraphimosis)?

Your child’s condition over the next few days or weeks

Whether your child bled, had swelling or discharge, or other signs of trauma or infection

What efforts you made to relieve your child’s distress

Notes about your own distress and worry

Whether you had to take your son to another medical professional or an Emergency Room

The advice (good or bad) that you were given about penile hygiene and bathing techniques for intact boys, and by whom

Step 3: Print out the following supporting documents from D.O.C. (or attach PDFs, if filing your complaint electronically)

Cover letter from D.O.C., if you requested it from us. Click here to request this optional cover letter, if you have not already done so above.

Core document “Memorandum of Evidence-based Medicine” on the lack of necessity and harm caused by PFFR, with citations and quotes from the best medical texts and studies. If you send only one of our documents with your complaint, THIS IS THE ONE TO SEND!

Key background articles

D.O.C pamphlet: “The Development of Retractile Foreskin in the Child and Adolescent”

Pamphlet: “Foreskin Care: A Parent’s Guide” describing the proper care of an intact boy, from Boy’s Health Advisory

STEP 4: Take photos of your child’s injury (Optional)

Photos of your injured son are very compelling evidence. If it has been only hours or a couple of days and the injury is still obvious, consider taking photos of your son – just his genitals or torso close-up, without his face. Print these out and send them with your complaint. Keep the original photos in electronic form.

STEP 5: Where to send your story, documents, and photos

Most important place to send your complaint:

Send to the medical regulatory authority in your state or province.

  • Each state or province has an agency that regulates the licensing of all medical professionals. This is where to file your complaint. The offending medical provider will be sent a copy of your complaint.
  • If you live in the United States, click here to find your state’s complaint address.
  • If the link for your state on the above site is broken, or you live in Canada, you can find the correct authority by Googling your state or province name with the words “complaint about medical care or physician.” Then look for “File a Complaint” and follow the site’s instructions for filing.
  • NOTE: You may be able to file electronically, but be sure to attach our supporting documents by pdf, if you can. IMPORTANT: If you cannot file our documents electronically, print them out and mail them directly to the state agency.

Other suggested places to send your complaint:

Send to the offending medical provider and each clinic partner of the offending professional.

  • A wide broadcast of your complaint to other members of the clinical staff of the particular medical facility where the PFFR incident occurred may be an effective deterrent. If you send your complaint only to the offending physician, it may have little effect, or never get read.
Send to the Risk Manager of the facility.

  • This person is responsible for handling complaints filed against the clinic, to avoid lawsuits. Large clinics or hospitals generally have a designated full-time Risk Manager. Find out the name, title, and address of this person.
Send to the hospital where the doctor has admitting privileges.

  • Maintaining hospital admitting privileges is important to physicians. If possible, copy your complaint to Chief Medical Officer (CMO) at the hospital where the offending doctor has privileges. This is especially important if the PFFR occurred on the grounds of that hospital.

Please feel free to contact us at D.O.C. if you have any questions or problems with filing your complaint. (206) 465-6636, 9-5 Pacific Time (or later), 7 days a week.

Published April 2016

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