She was my favorite type of patient, young enough, educated enough, and from a background that left her vaguely enamored with the idea of power and always impressed by any women who wielded it, even very little. I also had the benefit of being fifteen years her senior and at least four inches taller than she was, and most of mothers at my clinic. Her blonde hair was cut into something like a bob-cut and she wore it well but the short style was a matter of practicality. I always pulled mine back to increase the severity of my look and I think it worked well. It was my clinic and a look of authority always softened the resolve of my patients or their parents. I had also maintained a trim look while a life of long hours at work had left my patient’s mother just slightly doughy though not unhealthy by any means and she wore unassuming clothes, a loose shirt that stretched past her abdomen and leggings, it was clearly an outfit designed for comfort over fashion or showing off. She sat before me in the guest chair of my office while I sat behind my desk, my own seat just slightly higher than her own.
“What did you need to discuss, is something wrong Dr. Galla?” she asked in a concerned, soft, voice marred slightly by creeping fatigue. She was concerned but sweetly composed.
“Well to start let me assure you that Casey is generally quite healthy, enviably so in some ways, he is fit and more than likely to have a good record on the wrestling team if he does join. However there is one thing I noticed, his foreskin seems a bit tight, and he had some minor difficulty retracting.” I told her this brusquely, in my most professional and detached form. I was the truth of course and interpretation becomes key after this.
“Is that an issue? He’s never come to me about it and he never had problems when he was younger.” She said this with concern and the alarm of guilt, clearly she felt this type of problem was a moral failing. It also indicated she might second guess he abilities. I found this a pleasing development and pushed onward in my task.
“Ms. McCallen I can assure you that your son does keep up with his hygiene, I don’t think that is an issue yet but a constricting of the foreskin, called phimosis, is a condition that can arise spontaneously in a young man and which can worsen rapidly with time. Do you know if your son masturbates, Ms. McCallen?” I asked her this bluntly and it had the desired effect, her face fell and she dropped eye contact with me. I had seen a few others turn red at this moment or stammer but she raised her eyes again and returned to form almost immediately. She was no stranger to the world.
“I haven’t caught him of course but I know he has for a while. I find tissues here and there, I can tell from the smell of his room sometime, I think he does it a lot.” She turned her gaze downward embarrassed and vulnerable at the unsurprising and common knowledge of her son’s habits.
“There is nothing wrong with Casey Ms. –” I began
“You can call me Jane if you prefer.” she interrupted
“Of course, there is nothing wrong with Casey’s personal habits, it’s not even really that important, it’s simply that usually one expects this to loosen the foreskin. It suggests even that some of the less invasive treatments are unlikely to work in Casey’s case as those involve stretching, albeit with the help of medicines. Simply put I can only see Casey’s condition worsening to the point where he will be unable to retract his foreskin at all when erect. As you can imagine at his age this would be a serious detriment to his health and not just his physical health but his psychological health. Imagine how humiliating it would be for someone his age to not be able to perform sexually and possibly for their first time. It would likely cause many relationship problems in the future. I realize this is not what you necessarily want to think about with your son but it does matter.” I finished my short speech and she looked down again breaking eye contact with me. I was not surprised at the pause but I shortly would be surprised with her answer.
“Actually, I understand a bit more than you might think. I once dated a man who could not entirely pull it back when hard. He was nice but it interrupted us all the time and it was painful for him and he had other troubles. I’d rather Casey, and his girlfriend, not have to deal with that. It was very unpleasant.” She seemed shocked at her self – at having revealed so much – but she did not break eye contact this time. Instead she looked me straight in the eye and suddenly seemed resolved.
“Can this be corrected, what are the options?” She asked me, she seemed coy now, like she was anticipating something in particular. I felt a happy calm in reaction to her, the shift in her demeanor was something I looked for in a patient’s parent but rarely did it happen so quickly. I was deeply satisfied to see her own experience would shift her thinking so quickly into alignment with my own. This was an exciting moment. I would give her my answer and I was sure she would be happy to hear it.
“Well as I mentioned stretching exercises, even with medical creams would not likely work since Casey does masturbate and that has not helped. What I would recommend instead is a circumcision. It is the only sure cure for this condition and carries a number of other benefits including the reduction of risk of certain STIs and improved ease of hygiene.” I said and prepared to continue but Jane interrupted me then.
“And they’re much prettier.” she said softly and then winced. I ignored it and continued but it was difficult to suppress my urge to smile at that moment. I was already victorious and perhaps had been from the very beginning. Perhaps my patient’s young mother needed no convincing at all. I was happy with that idea. I pushed onward.
“It’s a simple surgery, it requires only local anesthetic and is completely safe, it could even be done here and your insurance will likely cover it given that Casey does have phimosis.” I continued, Jane seemed to be fully invested in my words and I could see she was weighing her options.
“Well I do think it would be better for him in the long run. When he was born the doctor convinced me it was unnecessary to cut him but I wasn’t sure so I sided with him. I always did think it was much better for a man to circumcised though. I just worry he’ll regret it or protest.”
“Well luckily for all involved your consent is still all that is needed and not his. It would also allow you to be involved, and if I’m being realistic, the only time you’ll be able to ensure the quality of the procedure. I always attend to my patients with great care and I worry especially about circumcisions, it’s a surgery where the aesthetic results matter a great deal and I would never be lazy about something so critical. I can assure you we could even leave some foreskin although I don’t recommend that personally.” I finished my second diatribe with a practiced confidence. I often gave a similar speech to wary patients and weary parents. It was likely unnecessary for Jane who was currently thinking but I gave it anyway. In her case I hope it inspired confidence not in the idea but in my own abilities, that she would give control over to me. She soon answered my internal questions.
“No, I think we should do what is best, what do you recommend?” She asked me sweetly.
“Well in my own experience the best option is a decisive one as I have said. It would be a complete operation with the foreskin totally removed and most of the inner mucosa which is the site where STIs are able to penetrate. This would give him the greatest benefit. I will also remove what is called the frenulum, a small band of tissue connecting the glans – the head – of the penis with the shaft. This piece of tissue can easily tear during sex and lead to pain. I will also try to minimize scarring to make it appear as if Casey was never even cut.” I paused to let Jane think.
“It seems like this is the best course of action, you sound like you have a lot of experience with this. How long would it take to heal? Will it interrupt his school work at all?” I was sure that she would be less than thrilled to know how long it would take but chose to focus on the positives.
“He would be ready to return to school within a few days and mostly healed in two weeks. It would take about six before he could masturbate or be sexually active. If this gives you any pause I understand but given that we would soon need his permission now is the time to act if you want this done with an over. I assure you young men are not able to make these kinds of decisions easily. He might be angry at first but I can say with confidence none of my patients was ever unhappy in the long run and some have thanked me.” I exaggerated as so many of us do when we desire an outcome but one thing was true, I’d never gotten complaints. Jane mulled over what I had told her.
“So when you circumcise him he’ll look like other men, no hanging skin over his head, his glans?” Jane asked
“None at all, he will have no extra but I will leave enough to allow for a comfortable erection.” I said, Jane looked away but just briefly before answering.
“Good, it looks so ugly with the foreskin, even his. I hate that look.” She admitted shyly.
“Well this would certainly improve on that and I can assure you that I will do my best to give him a clean look with a neat scar.
“Could we schedule it during the winter break?” Jane asked.
“Of course, that would be a very good time to do it but won’t that interfere with wrestling? He will need almost a month of low physical activity.” I said, wanting to accelerate things, to be certain.
“Your right of course, how early could we do it?” Jane asked, I swear I detected just a hint of excitement in her voice.
“Next Friday is the earliest appointment provided you fill out the forms today.” I said
“Of course, I’ll do what’s necessary then.” Jane replied and I had a hard time not smiling then though I knew there would be one more question.
“How should I tell him though?” Jane asked me sheepishly.
“Don’t worry.” I said, still smiling as I handed her the necessary forms.
“Just bring him in and let me explain it after you’ve filled out the forms. I am a doctor and I can make him see the necessity of it. Besides it’s not like his objections matter yet. Even if he is upset you’re still his mother, and a woman for that matter, this is something where you know best.” She smiled at my confidence and took the form and the pen I had offered.
“Of course Dr. Galla, thank you for your time and thank you so, so much for telling me about Casey’s problem. It will be good to know he’s getting his treatment and frankly better late than never.” Jane said standing and offering her hand which I accepted and shook.
“It’s my job to help, just fill out the forms and set up an appointment with reception.” I said and as Jane turned and walked out of my office forms in hand I could felt the rising swell of victorious pride. Another had succumbed and another young man would lose his foreskin today. Things had be good today.
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