An Interview with Dr. V
Dr. Valgardsdottir studied medicine at the University of Iceland and then moved to Sweden where she specialized in family medicine. In 2005, she moved back to Iceland and has worked in HSU Selfoss for twelve years. Dr. Valgardsdottir serves on the Your Whole Baby Advisory Board.
What kind of doctor are you and which country do you practice in?
I am a family physician. I studied medicine at the University of Iceland, and did my five years of family-practice training in Sweden. I work in the town of Selfoss, South Iceland, a 45-minute drive from the capital Reykjavík.
Is non-therapeutic infant circumcision covered under insurance? What is the procedure if a parent requests their son be circumcised without medical indication?
Our healthcare system is government-funded, with coverage for all citizens. If there is a true medical indication for circumcision, it is free for the patient. However, non-therapeutic circumcision is not available.
How often have you had to refer a minor or adult for a medically needed circumcision? How many times has a teen or adult asked for a referral to get himself circumcised?
In 20 years I have never referred a boy or a teen. Once an adult, and that only very recently. He was probably treated with a dorsal slit, because the foreskin is spared as much as is possible.
Do elderly men under the care of others have complications with infections?
That does not happen often. Usually an antifungal cream will clear the infection.
When a young patient sees you for a well visit, do you check their penis? If so, how and for what purposes?
When I do well-baby checkups, I remove the diaper, check for diaper rash, check the scrotum, and make sure there are two testes. I also feel the femoral pulses in the groin area.
Are people from your country aware of the United State's routine procedure of circumcising boys? If so, what are their thoughts on it?
I was not aware of how widespread this surgery is. Neither were my six colleagues at the health center where I work. We watched the Elephant in the Hospital lecture and were all in shock to see how often you cut your little boys' foreskins in the US. Here circumcision is a NON-ISSUE. No one thinks about it or ever asks for it for their children, and my nation is intact. Foreskin is a natural body part. When I do my well-baby checkups, I sometimes tell parents of little boys about this US tradition and they are simply flabbergasted: WHY do people in the US cut their boys? Why? Don’t they know it is totally unnecessary?
What do you, as a physician, think about the AAP's guidelines on circumcision?
Do you mean “Specific benefits identified included prevention of urinary tract infections, penile cancer, and transmission of some sexually transmitted infections, including HIV”? When I look at the evidence it is clear to me that this procedure causes much more harm than benefits, and therefore I cannot understand how the AAP can endorse this procedure in their guidelines. The risk for penile cancer and HIV from intact foreskin is extremely low, and does not justify foreskin removal of every boy. The risk of UTI might possibly be slightly higher in intact boys, but this is easy to cure with antibiotics and with lower risk.
I am astounded at the suggestion that you would cut away healthy functional protective tissue from a little boy (with all the possible complications that it entails) to supposedly hinder a disease or infection. Rather, I would treat the infection, should it occur. Also, what is the actual complication rate? These (seemingly unavailable!) statistics are paramount.
Have you ever diagnosed an infant, child or an adult with phimosis? Why not (if no), and how often if yes.
Only a few times in these past 20 years, and luckily it is quite easily treatable these days with strong steroidal creams which loosen the skin. As mentioned previously, I have only once referred an adult to an urological surgeon because of phimosis, and that was just recently. I think they did a simple dorsal slit and not a full circumcision, because here surgeons try to spare the foreskin as much as possible.