In late April Paul Tinari became
the first man in Canadian history to have the government
pay for surgery to reverse a botched circumcision.
Armed with letters from a urologist
and psychiatrist, the Vancouver engineer — who
says he's been in pain for years — convinced the
BC government to pick up 90% of the $12,000 tab. The
final piece fell into place when he located Toronto
plastic surgeon Dr Robert H Stubbs, the only doctor
in Canada who'd ever performed a foreskin restoration.
"This is not something I went into
lightly," says 48-year-old Dr Tinari of the complex,
multistage procedure he began at the end of April. "I
assessed the risks [of the surgery] and was willing
to take them. But I certainly wasn't willing to pay
for it."
The BC Ministry of Health says
requests for funding for unlisted medical procedures
are approved only if the care isn't available in the
province and if a medical professional has confirmed
there's a serious medical or mental health issue. There
were no existing rules to deal with Dr Tinari's unusual
case. "Obviously, something like that would be granted
coverage only in rare or extenuating circumstances,"
says ministry spokesperson Sarah Plank. "We certainly
don't have a billing code for it."
"He got a big chunk because no
one in BC does this and he had his urologist and psychiatrist
on his side," observes Dr Stubbs, who specializes in
genital cosmetic surgery. "Some provinces are willing
to do things like that for their citizens."
RESTORATION
101
"Dr Tinari was a good candidate for the surgery," says
Dr Stubbs, who says he doesn't know of any other Canadian
physicians doing foreskin restoration. "He had sufficient
donor skin and was well aware of what he was getting
into. I select my patients very, very carefully," he
said. In fact, Dr Tinari is only the third patient he's
agreed to take on. "This is like climbing Mount Everest,"
he says. "It's a huge procedure."
First, the skin is cut along the
circumcision scar line and stretched open to create
a graft site. Then, two parallel incisions are made
on the scrotum — the donor site — leaving
a sort of bridge with the two ends attached on either
side. "The penis is popped through the hole, with the
skin bridge covering the defect you created," Dr Stubbs
explains. "Then we let that heal for at least three
weeks." In stage two, the two ends of the bridge are
cut, separating the penis and scrotum. "You tuck those
two pieces that are still dangling to the underside
and keep your fingers crossed that enough blood vessels
have grown in to ensure survival of the graft." Finally,
when the swelling has subsided, the new skin is stretched
over the penis with tape and traction weights to form
a foreskin.
PERSONAL
CRUSADE
Dr Tinari sees this not just as a medical victory but
a moral one too. He alleges that his circumcision was
forced on him when he was eight years old by priests
at his Montreal boarding school as punishment for masturbating.
He says the circumcision left him depressed, suicidal
and in chronic pain. He says his testicles would pull
up onto the shaft of the penis during an erection; a
segment of the glans healed to a small amount of remaining
shaft skin, forming a skin bridge; stretching of that
bridge caused intense pain during erection, occasionally
causing tearing and bleeding during sex. He adds that
cleaning under the skin bridge was also very difficult,
so he suffered from chronic infections for years.
Nowadays, Dr Tinari, who has a
PhD in engineering, is the director of an environmental
engineering company based in Coquitlam, BC. But he spends
a lot of his time campaigning against circumcision and
for wider access to foreskin restoration. "People thought
that I would go away after the surgery, but that was
just the first step," he says. "I did this to restore
my own bodily integrity, but also to set a legal precedent."
Given the complexity of the procedure,
Dr Stubbs doesn't expect to see a dramatic increase
in patients. He's staying out of Dr Tinari's legal pursuits.
"I don't ask women why they come in for a breast implant,
and I didn't ask him if he had an ulterior motive,"
says the surgeon. "He may have an agenda that I don't
know about, but this isn't something where the success
or failure of his surgical procedure should make men
consider this an option or not."
Meanwhile, Dr Tinari is still recovering;
it's nearly two months since the surgery and his doctor
is pleased with the outcome. "We seem to have about
an 80-90% graft survival," says Dr Stubbs. "I transferred
a strip about 7cm wide, so he should have plenty for
an adequate foreskin." The patient is also very pleased.
"I've been working towards this for thirty years," says
Dr Tinari. "I'm feeling better every day."
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