Briefwechsel mit einem Urologen

Briefwechsel mit einem Urologen

This German urologist with 20 years BW experience wrote to me on 3/11/2012 in English. This is my reply to him with his writing in between (I keep his name secret in respect of him, as he shows a lot of understanding for the concern about medical abuse in the German armed forces)

Dear Mr Xxxx,

Thank you very much for your e-mailed letter of 3rd November 2012. I have been away, therefore this delayed reply.

<I am a German urologist and was not aware of the fact, that there is a problem of this scale in this context. I spent 20 years in the German Navy and I have never perceived the physical examination from this point of view. Therefore I am truly thankful for your view on things.>

Forgive me, but I find it surprising that somebody who not only seems to understand the basic serious concerns mentioned in my letter but also have spent twenty years as a Navy surgeon can be unaware of what is going on and has been going on for years within the BW and it’s draft and recruitment offices. I choose to believe that your unawareness (until now) must be based in the fact that you personally must have treated your patients in a decent and professional way and have been unaware of what else was going on around yourself, all due to the mutual secrecy (including both perpetrators and victims) that is always surrounding sexual abuse. I thank you for that. But, as you will understand, this whole question is nothing new, and, though few will admit to it, most all people know. Often I hear German officials, when being addressed about this issue, resort to talk about the “musterung examinations’ fifty-seven year history” as if it all started in 1955 (in the western part of the country: they all leave out all mentioning of the GDR as if the “new” States aren’t part of the present Federal Republic’s united history). No, unfortunately – apart from two breaks, one after the first and another after the second WW (in the west) – German authorities have sexually abused their young male citizens ever since the Emperor’s time and probably long before that. A short lesson in the development of German musterung scenarios you will see if you have a look at the first three photos here: . German soldiers today will not risk ending up in WWI trenches and sacrifice their lives in order to satisfy the emperor’s and his friends’ territorial expansion plans or, for that sake, march after Hitler’s swastika, but, to be honest with you, for myself I would prefer one of the first two scenarios to the third. What about yourself?

Only a couple of weeks ago a young German man contacted me and described his experience six years ago roughly as in that third picture. I will leave out the verbal abuse he was exposed to here. But his final words in this initial contact with me were roughly as follows: “this experience has ruined me mentally; I suffer from sleepless nights and nightmares; my relationship with my partner suffers; I cannot get away from the memories of this humiliation.” I have heard the same thing many times before. We are talking about a mental trauma that hundreds of thousands of men struggle with every day only in your country. Most of them have nobody who can help them come to terms with what these people once did to them in the name of their state. And it does not go away: many who contact me are in their forties and older. Another example of the effect this abuse has on young people in your country: I seriously think this has to be stopped.

In order to discuss this in a serious way we need to have our history and facts right. It started long before testicular cancer-prevention was even thought of, and it started long before a reason you will give yourself in the following, cars (!), even had been invented. All these excuses are only desperate explanations which have been constructed to defend the indefensible. Sexual abuse can never be justified. It was a crime; it is a crime, and it will remain a crime. It took years before the abuse within the Catholic church was out in the open; it might take years for this as well, but, I assure you, that day will come.

But, it is not only Germany that employs a system of mass abuse of young men with detrimental physical and psychological results. There are other examples, though that shall not be seen as an excuse, something to hide behind. In the western world I presume the system reached its peak during the Vietnam era. Only this morning I received an email from a Vietnam veteran who among other things wrote:

I’m 72, and I’m now prepared to link this syndrome (which is, as you say, abusive, it’s manipulative, it’s venal, it’s nasty, it’s bitchy) with the origins of male violence. Looking this up, I came across your site on the German military induction system, and it all just clicked. It’s as if the male military establishment used the German woman to effect this ‘boot-camp’ brainwashing. In the US, the American woman was perfectly capable of doing this herself, dominating the patriotic volunteers of the Selective Service system where American males are put the “rigors” of being humiliated with female clerks and nurses and shoppers (!) wandering by naked men for an all-day examination. I’m 72, and still teeth-grinding angry about this business … I lived through that, and it wasn’t the Kong most men complained about but about the way they were treated by the American military. I lived it. I listened to them for every scrap as I fought AGAINST that stupid war.”

The anger and mental anguish is everywhere under the surface. But, suffering men are not taken seriously; there are hardly any help services for them to help heal their wounds. All this leads to hate, and, though I am not claiming it is the sole reason, domestic violence. It’s a vicious circle we as human being must stop. In Germany you, with your background and basic understanding, will have a special duty to stand up and defend coming generations against further abuse. The abusers hide behind the taboo, the taboo that prevent people from standing up on a soap box and speak out.”

>In fact I am personally caught in the middle of the different statements on the subject. For one I accept your personal feelings on the issue. It is also a very good point to address the subject of personal shame and dignity in a much stronger way, than it has been done in the past. And there can be no disagreement at all, that no type of misuse and particularly sexual misuse should ever take place in a medical examination.>

Only one comment to that: as you will know, these are not only my personal feelings, they are shared with hundreds of thousands of men in your country (and sadly beyond). What you call ‘personal feelings’ is what I call a strong refusal to accept the idea of medical staff abusing their ‘patients’ in acts of sexual harassment. How can you be ‘personally caught’ in the middle of different statements on that subject’? You do express your own ‘personal feelings’ that ‘no type of misuse and particularly sexual misuse should ever take place in a medical examination’ and I take that for an agreement around this issue and that there should be no need for you to feel ‘caught in the middle’. Do not remain on the fence, come down and speak out for justice.

>I also understand, that you are not happy with the replies of the DGU to your subject.>

That is true: no I am not happy with their declarations that a urological examination MUST (he, Stefan Mueller, claims that!!) include a total strip (!!) of their patients. This is a perverted view and I am disgusted that it is proclaimed by the man at the top – on behalf of the board of DGU. And, I am not happy with the fact that the same board of DGU has refrained from commenting on two of their members’ comments to me: one, a woman, who declared that humiliating examinations of young conscripts was unacceptable but that it was different with ‘mercenaries’ (as she called professional soldiers and ‘freiwillige Wehrpflichtige’) and another who used Nazi language in his abusive letter to me. I am still waiting for their views on this. As I am not sure in what capacity you write, if it is purely private or representing either the DGU or the BW, so I will leave my next step on that question till I have heard back from you. Thereafter I will follow those questions up with whoever wants to listen.

<But I would also like to state a few aspects that in my view give good reasons for a physical examination of young men including the genitals when joining the military. In Germany testicular cancer is the most common cause of death in men younger than 35 years of age following car accidents. Germany has the highest incidence for this disease worldwide (my underlining), followed by Denmark. As the treatment is so effective, that close to 100% of these patients could be saved if diagnosed on time and treated sufficiently, it is hard to accept that there is such a high number of deaths from this disease. The explanation is: because of feelings of shame young men do not go for a medical examination when they find something changes about their testicles and genitals. Statistically the majority of the men seeing a doctor in time were sent by their sexual partner and would not have come on their own behalf, as the disease usually is painless.>

Thank you for delivering my strongest argument against this humiliation. Appreciated. A heavy burden on the armed forces.

<Testicular cancer is a speciality of the military in all countries, because the biggest group of young males in society within the typical age of risk are soldiers. Or at least they were the biggest group during draft-times. In my view it should be a part of any healthcare-system, military or civilian in my eyes, to offer an examination for testicular cancer to young men and it should be included in the test for physical health on joining the military. There should be physical examination of the testicles without clothes above it and it should include ultrasound with at least a 7.5 megahertz probe.>

As you say, it should be offered as a service (in a decent and respectful way with only the small part being examined undressed). Testicular cancer has nothing to do with military defence. To claim that military establishments have a real and honest interest in men’s health is nothing but absurd – ridiculous. It has always been used as an excuse for humiliating young men ever since excuses were needed to be found. I completely agree with the idea of improving availability of health care for men. However, as we all know, regular self checks – combined with personal TRUST in the system not to be humiliated if seeking help for any discoveries – is by far the best way of improving men’s chances of survival of a, as you say, a very much treatable condition. As it is now, these humiliating examinations bear the guilt for lot of deaths of young men in your country.

>The most common surgical procedure worldwide is hernia repair. From a medical pint of view someone should not jump parachutes, if they have a hernia that might have the intestines incarcerated in a hernia. Therefore I think it should be part of any medical examination in the military to have a patient to cough during his physical examination to see if there is a hernia.>

I have never disputed the worth of a hernia check as part of an all-round medical. However, even here: there is no reason whatsoever to have the patient totally naked. In fact, he won’t even need to pull down his underpants. However, to explain all this abuse away with parachute jumping, I find, sorry to say so, ridiculous.

>I agree though, that a patient does not need to be completely naked for the purpose of this investigation. I also agree, that the risk for a disease of the anus or rectum is so low in a young man, who does not have any pain or symptoms from it, that a rectal examination does not have to be mandatory.>

I appreciate that.

>In fact two aspects could be added here, too, though. If there was a wish for early recognition of malignant melanoma, a complete check of the skin were necessary. But here the risk is really low before the age of 40.>

Again, nothing of that has anything to do with military forces – only an excuse for abuse. And even if a patient ask for a dermatological examination there is no need for him or her to undress completely. Parts of the body can be presented.

>Another military particularity is the so called pilonidal sinus or “Wiily’s jeep disease”. Young men, who constantly ride cars as drivers of vehicles can have hair between their buttocks turn inward to cause painful and long lasting infections that quite frequently need surgical treatment. In early stages these do not cause pain are hard to see for the patient even if a mirror were used. To estimate, whether a soldier training to be a driver might run into a problem here spreading the buttocks could be considered a senseful examination. I agree though, that not everyone would have to undergo this and that it does not have to be mandatory.>

I leave it to yourself to make sense of all that. Yes, all these guys on picture nr.10 are probably future drivers, or? Interesting. After all, cars were not even invented as this practice was introduced… and I have never heard that taxi and lorry drivers are regularly called in for checks of their back sides as are their vehicles. But that might come, a drivers MOT (or, as the Germans say, TÜV)? Mr Blum, we need to be serious when discussing this extremely serious topic about abusive behaviour in medical practice. Will you suggest a brain scan carried out on all new recruits, as just an example of other possible areas which might need to be looked into? Or, will you suggest X-rays all over the body without any complaints suggesting the need for them – just in case something might have gone undetected? How many different non existing conditions will you accept being looked for? Of course over the whole body…  After all, if they are really interested in just everything possible, why is it then always around the men’s private parts where non existing problems (without complaints) seem to be looked for? I looked this up for your information:

Muss ein Pilonidalsinus behandelt werden? “Bei Beschwerdefreiheit ist keine Behandlung notwendig. Bei Beschwerden ist ein operatives Vorgehen erforderlich.”  Der vorliegende Text wurde den Leitlinien und Patienteninformation der Deutschen Dermatologischen Gesellschaft (DDG) und der Deutschen Gesellschaft für Koloproktologie (DGK) entnommen.

>In terms of growth-pattern of hair and the connection of hernia and testicular cancer to the male genitals I see good reasons to differ in terms of the examination of physical health between women and men here without seeing a discrimination in them.>

I am astonished. I do wonder who asked you to write to me. The BW? The DGU? Or, could it really be your own initiative? It is interesting for me to notice that whenever I discuss this topic with a German man (apart from those coming to me as victims), he will always talk or write about it as if it only concerned others… never himself. This despite all men in your country until two years ago were exposed to this abuse (i.e. most likely also yourself) – and not, as now, ‘only’ those career-minded military people and those trying to escape civilian unemployment. This amnesia I find remarkable. But, as already said more times than I can possibly count, I have no problems with any necessary and useful examination as long as it is performed with the patient’s full and informed consent and under decent conditions protecting the patient’s dignity at all time. I am astonished that this seems to be so difficult to understand.

<An equivalent debate in terms of personal rights should go along similar lines referring to a gynaecological examination for young women. I do not see any reason for a mandatory examination there. Whether a questionnaire on pregnancy would interfere with personal privacy any more than in a civilian setting I am not quite certain.>

I will not comment on that. Only mention that one of your female colleagues a short while ago invented her own reason for the anus checks: to detect anal fistulas which would prevent marching…  There are no anatomic reasons for a woman not to suffer from that (and, if anybody did suffer, they would quickly look for help from a doctor of their own choice, I am pretty sure about that), so why didn’t she suggest them all to be checked? Interesting, the need to guess reasons for a humiliating tradition/treatment of male soldiers which has gone on since the Emperor’s time and also take place elsewhere, as shown on the pictures mentioned above.

>I hope I did not take up too much of your time in trying to state, that on one hand I completely agree with your view on dignity and human rights in this setting, but that I see parts of the examination that might be of a much higher health-benefit for the examined person, than the trouble a soldier usually would have to undergo for the examination>

As you claim yourself, Germany is in top of fatal testicular cancer. The reason is obvious. We need action. We need people like you to stand up for your patients not cowing to the military establishment’s desperate attempts to find reasoning behind their abusive behaviour.

<It is an unresolved topic though, if the prevention of a possible future disease warrants the mandatory interference with the zone of privacy of an individual. There are multiple views on this, as reflected in the mandatory vaccinations for professional soldiers. Here one could also argue, that a soldier could not be forced to endure an injection against their will. The military states, that certain vaccinations are prerequisites for particular duties in foreign countries. A number of soldiers have tried to get around to these assignments abroad be refusing the vaccinations so they would not be fit to go. As far as I know the German military has always made its point in court in making these vaccinations mandatory. But these were professional soldiers and not drafted civilians and I think the situation is not quite as clear, as it may seem.>

To that I would only say: I think we have seen enough of German soldiers in other countries in the past. Your military has nothing to do in foreign countries. Therefore there is no reason for your earlier parachute explanation either. Where would German soldiers jump?

I thank you again for your effort and wish you good success>

Please let me know what you personally will do to improve German young men’s health and survival rates when it comes to testicular cancer. And thank you for, by not mentioning it, agreeing with me that checks for phimosis on grown up people who have not asked for it is a sexual assault. As one young man mentioned to me recently: it was as if she forced me, stark naked in front of a window with free view to close by buildings (!!!!), to imitate masturbation by pulling the foreskin back and forth. I am sure you will agree, this has to stop. People like you have to help stop it.

Looking forward to your response and what actions you will undertake within you professional association of urologist in order to save the reputation of your profession. Catholic priests have had their time in the limelight, the turn will come to this as well. The mental suffering out there is massive. The perpetrators must be held to account.


Lars G Petersson