Potentially under-recognized late-stage physical and psychosexual complications of non-therapeutic neonatal penile circumcision: a qualitative and quantitative analysis of self-reports from an online community forum.

The removal of non-pathogenic foreskin from the penis of healthy neonates and infants for non-religious reasons is routinely practiced in many parts of the world. High level data from well-designed randomized controlled trials of circumcision in neonates and infants does not guide clinical practice. Reliable counts of immediate and short term circumcision complications are difficult to estimate. Emerging evidence suggests routine neonatal circumcision could lead to long term psychological, physical, and sexual complications in some men. The stigma associated with discussing circumcision complications creates a prevalence paradox where the presence of significant circumcision complications is higher than reported. Prior to the Internet, there were very few forums for men from diverse communities, who were troubled about their circumcision status, to discuss and compare stories. To investigate the long term consequences of circumcision, we reviewed 135 posts from 109 individual users participating in a circumcision grief subsection of Reddit, an internet discussion board. We identified three major categories of complications: physical such as pain during erections and lost sensitivity, psychological such as anxiety and violation of autonomy, and sexual such as feeling that the sexual experience was negatively altered or being unable to complete a sexual experience. We also identified a "discovery process" where some men described coming into awareness of their circumcision status. These findings suggest that neonatal circumcision can have significant adverse consequences for adult men. The removal of normal foreskin tissue should be limited to adult men who choose the procedure for cosmetic reasons or when medically indicated.

Youth Perspectives on Their Medical Team's Role in Screening for and Addressing Social Determinants of Health.

PURPOSE: Little is known about adolescents' and young adults' desires and preferences surrounding healthcare-based social determinants of health (SDOHs) interventions. To assess these preferences, we surveyed youth regarding their perspectives on their medical team's role in addressing SDOHs. METHODS: We conducted a national text message survey of youth aged 14-24 years. The survey asked five open-ended questions about SDOHs and SDOH interventions. Qualitative data were analyzed independently by two investigators using thematic analysis. Prevalence of codes was summarized using descriptive statistics. RESULTS: Among 1,156 participants, 1,038 responded to at least one survey question (response rate = 89.8%). Respondents were 19.2 (standard deviation: 2.4) years old on average, 48.9% male, 62.1% non-Hispanic white, and 38.9% qualified for free or reduced lunch. A large majority of our sample (81%) indicated that they think it is important for their doctor or medical team to ask about SDOHs. The most commonly reported barrier to seeking or receiving SDOH assistance was embarrassment (30%). Youth wanted their providers to help with SDOHs not only by providing information about resources (25%) and referrals (13%) but also by offering general advice (22%) and listening (11%). Approximately half (51%) of our sample preferred to receive information about SDOH assistance in person. DISCUSSION: Most youth believe it is important for their medical teams to ask about and address SDOHs. Implementation of healthcare-based SDOH interventions for youth should optimize opportunities for face-to-face discussions about assistance during clinical encounters.

The impact of retained bullet fragments on outcomes in patients with gunshot wounds.

BACKGROUND: Nationally, 115,000 non-fatal firearm injuries occurred in 2017, with many such victims possessing retained bullet fragments (RBFs); however, the impact of RBFs has not been well studied. METHODS: An institutional trauma database from an urban, level one trauma center was queried for patients presenting with gunshot wounds (GSWs) to the ED in 2017. GSWs were stratified by the presence or absence of RBFs. Groups were compared using t-tests, chi-squared, and logistic regression. RESULTS: Of 674 patients with GSWs who met inclusion criteria, 394 had RBFs versus 280 with no RBFs. Patients with RBFs were more likely admitted from the ED (57.4% vs. 41.8%, p < 0.001), had significantly higher rates of return to the ED within six months (30.7% vs. 18.6%, p < 0.001), and higher rates of subsequent GSW in the next year (5.1% vs. 1.8%, p = 0.03). On return to ED, 17.6% of those with a RBF had symptoms associated with their RBF. CONCLUSION: RBFs may represent an unrecognized risk factor for both repeat ED visits and subsequent bullet injury.