风流成性许飞无删版txt:包皮环切术的认识误区

包皮环切的确会给孩子带来伤害

Published on September 11, 2011 by Darcia Narvaez, Ph.D. in Moral Landscapes

达谢尔 纳瓦兹博士，2011年9月11日发表

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*First author is Lillian Dell'Aquila Cannon

第一作者是丽莲 DA 加伦

When I was pregnant with my first child, I just thought that circumcision was what you did, no big deal, and that every man was circumcised.  Then one day I saw a picture of a baby being circumcised, and everything changed.  Just one tiny, grainy photo was enough to make me want to know more, and the more I knew, the worse it got.  It turns out, circumcision really is a big deal.

当我怀着第一个孩子的时候，我认为割包皮不是什么大事，每一个男人小时候都经历过。直到后来有一天，我看到一张被实施割礼的婴儿的照片，我的看法改变了。仅仅一张小照片足以让我想知道更多关于这方面的知识。然而，我知道的越多，越让我心惊胆颤。事实证明，割包皮真的是一个大问题。

Part 1 - Circumcision Surgery Myths

第一部分：包皮环切术的认识误区

Myth 1: They just cut off a flap of skin.  

误区1：包皮环切不过是去掉一块皮而已。

Reality check: Not true. The foreskin is half of the penis's skin, not just a flap.  In an adult man, the foreskin is 15 square inches of skin.  In babies and children, the foreskin is adhered to the head of the penis with the same type of tissue that adheres fingernails to their nail beds.  Removing it requires shoving a blunt probe between the foreskin and the head of the penis and then cutting down and around the whole penis. Check out these photos: http://www.drmomma.org/2011/08/intact-or-circumcised-significant.html 

实际情况：事实并非如此。包皮不是一个无足重轻的皮瓣，而是阴茎皮肤的一半。一般成年男子的包皮有15平方英寸。婴儿和儿童的包皮粘连在阴茎头处，它们之间的粘连组织与使指甲附着在甲床上的组织完全相同。在去除包皮时，需要用一种稍钝的探头分离包皮和阴茎头之间的粘连，直到完全分离，然后将阴茎周围的包皮环切掉。你可以通过以下链接查看这些照片：http://www.drmomma.org/2011/08/intact-or-circumcised-significant.html

Myth 2: It doesn't hurt the baby.

误区2：婴儿施行包皮环切不会觉得痛.

Reality check: Wrong. In 1997, doctors in Canada did a study to see what type of anesthesia was most effective in relieving the pain of circumcision.  As with any study, they needed a control group that received no anesthesia.  The doctors quickly realized that the babies who were not anesthetized 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).

实际情况：错！1997年，加拿大的医生做了一项研究，想看看何种类型的麻醉最能有效地减轻包皮环切疼痛。和其它研究一样，他们设立了一个不接受麻醉的对照组。医生们很快意识到，没有施用麻醉的婴儿非常痛苦，以至于这项研究由于道德原因无法继续。即便是用阴茎背神经阻滞这种目前最好且最常用的疼痛干预手段，也不能完全消除婴儿的痛苦。在这项研究中，一些婴儿因为疼痛开始出现窒息，还有一个甚至出现了痉挛。（兰德，1997年）

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Myth 3: My doctor uses anesthesia.

误区3：医生为婴儿使用麻醉剂，因此他们不会觉得痛。

Reality check: Not necessarily. Most newborns do not receive adequate anesthesia.  Only 45% of doctors who do circumcisions use any anesthesia at all.  Obstetricians perform 70% of circumcisions and are least likely to use anesthesia - 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 anesthesia takes a half-hour - if they brought your baby back sooner, he was in severe pain during the surgery.

实际情况：不一定。大多数新生儿并没有得到令人满意的麻醉。只有45％的医生做包皮环切术时使用麻醉。70％的包皮环切术由产科医生施行，而他们是最不爱在这一手术中使用麻药的人，使用麻醉的比例只有25％。他们这样做最常见的原因是他们不认为麻醉剂在这一手术中能保证免除疼痛，另外，实施麻醉会增长手术时间（斯唐，1998年）。一个适量麻醉的包皮环切如果快的话，也需要一个半小时，婴孩在手术过程中极端痛苦。

Myth 4: Even if it is painful, the baby won't remember it.

误区四：虽然手术是痛苦的，但宝宝不会记得。

Reality check: The body is a historical repository and remembers everything. The pain of circumcision causes a rewiring of the baby's brain so that he is more sensitive to pain later  (Taddio 1997, Anand 2000).  Circumcision also can cause post-traumatic stress disorder (PTSD), depression, anger, low self-esteem and problems with intimacy  (Boyle 2002, Hammond 1999, Goldman 1999).  Even with a lack of explicit memory and the inability to protest -  does that make it right to inflict pain? Law requires anesthesia for animal experimentation - do babies deserve any less?

实际情况：身体就像一个历史资料库，它会记住一切发生过的事。包皮环切术的痛苦会使婴儿的大脑重塑神经元连接，导致他今后对疼痛更加敏感（托多，1997年，阿南德2000）。此外，手术还会引起创伤后应激障碍（PTSD），抑郁，愤怒，自卑及性功能障碍（博伊，2002年，哈蒙德，1999年，高盛1999年）。难道因为婴儿没有外显记忆,无法表达抗议,就可以置他们于痛苦之中吗?法律尚且规定动物实验须用麻醉以减轻痛苦,难道我们不应该减轻我们孩子的痛苦吗?

Myth 5: My baby slept right through it.

误区5: 宝宝手术全程睡觉，不会感到痛苦。

Reality check: Not possible without total anesthesia, which is not available. Even the dorsal penile nerve block leaves the underside of the penis receptive to pain. Babies go into shock, which though it looks like a quiet state, is actually the body's reaction to profound pain and distress.  Nurses often tell the parents "He slept right through it" so as not to upset them. Who would want to hear that his or her baby was screaming in agony?

实际情况：如果不是全麻，孩子根本不可能睡着，然而却又没有医生会对婴儿施行全麻。连阴茎背神经阻滞术也无法消除阴茎底部的疼痛。婴儿进入休克状态，虽然他看起来平静，但这实际上是身体对极度苦痛的反应。常常有护士为了不使孩子的父母担心，告诉他们“孩子在手术中睡得很好”。是啊，谁又愿意听到自己的孩子在手术中痛苦地尖叫呢？

Myth 6: It doesn't cause the baby long-term harm.

误区6：包皮环切术不会给孩子造成长期伤害

Reality check: Incorrect. Removal of healthy tissue from a non-consenting patient is, in itself, harm (more on this point later).  Circumcision has an array of risks and side effects.  There is a 1-3% complication rate during the newborn period alone (Schwartz 1990).  Here is a short list potential complications.

实际情况：错。从一个没有知情同意权的病人身上去除健康组织本身就是有害的（这一点将在后面具体谈及）。包皮环切术具有一系列风险和副作用。其中，在新生儿期有1-3％的并发症发生机率（施瓦茨, 1990年）。以下是可能出现的并发症列表。

Meatal Stenosis: Many circumcised boys and men suffer from meatal stenosis.  This is a narrowing of the urethra which can interfere with urination and require surgery to fix. 

尿道外口狭窄：许多术后的男孩和男子患有尿道外口狭窄。这会影响排尿，且需要手术修复。

Adhesions. Circumcised babies can suffer from adhesions, where the foreskin remnants try to heal to the head of the penis in an area they are not supposed to grow on.  Doctors treat these by ripping them open with no anesthesia. 

粘连。手术后，没有被割除的包皮会向龟头方向拉长生长，从而导致粘连。针对这一问题，医生只能在不使用麻醉的情况下分离它们

Buried penis. Circumcision can lead to trapped or buried penis - too much skin is removed, and so the penis is forced inside the body.  This can lead to problems in adulthood when the man does not have enough skin to have a comfortable erection.  Some men even have their skin split open when they have an erection.  There are even more sexual consequences, which we will address in a future post. 

隐匿阴茎。由于手术去除了阴茎的大量皮肤，阴茎会缩到身体里面，导致隐匿阴茎。这可能在孩子成年后产生问题，因为当他勃起时，会由于包皮过短产生不适感，有些甚至会出现皮肤撕裂。此外，还有更多的性方面的后果，我们将在以后的帖子中谈到。

Infection. The circumcision wound can become infected.  This is especially dangerous now with the prevalence of hospital-acquired multi-drug resistant bacteria. 

感染。术后伤口可能会感染。如今医院内获得性耐药细菌的流行使得这一情况显得十分危险。

Death. Babies can even die of circumcision.  Over 100 newborns die each year in the USA, mostly from loss of blood and infection  (Van Howe 1997 & 2004, Bollinger 2010).

死亡。包皮环切术甚至会导致婴儿死亡。美国每年有超过100名新生儿死忙，大多数是因失血过多和感染（范 豪1997年，2004年，布林2010）。

Isn't it time to think more carefully about whether we should be circumcising our boys? 

难道我们现在对孩子是否要施行包皮环切术还不三思而后行吗？