Hello yaw,
I need to start working on my southern draw, although I’m not so sure they have it in Texas. Anyway, today I will be writing about cirumcisions and why you may want your child to get one, and why you may not. As always, I hope you find this information useful and would like to encourage your participation.
CIRCUMCISION -
There are many differing schools of thought on this subject, we will look at them all as we go over the facts. You’ll need to weigh the risks versus the benefits and other factors such as culture, religion and personal preference will affect your decision.
First and foremost, what is circumcision ? It is a procedure in which a pediatrician removes the prepuce of the foreskin, or the skin that covers the tip of the penis. This is usually done 18-24 hours after birth.
During circumcision the infants arms and legs are restrained. A local anesthetic is generally used, and the pediatrician does the procedure in about 5-10 minutes. The foreskin is loosened from the glans of the penis, and a Gomco clamp is used to protect the glans of the penis from any injury. Sometimes the Dr. can use other methods such as a Mogen clamp, or a plastibell procedure. Ask your pediatrician which one they use and they can answer any questions you may have.
After the procedure, if a Gomco clamp ( the most common method ) was used, you will need to use vaseline and gauze for 2-3 days after, with each diaper change. This protects the sensitive skin of the glans from the pressure of diapers and the ammonia in urine.
Pro’s and Con’s -
Several potential benefits of circumcision appear to be supported by most studies. Boys who have been circumcised are less likely to have urinary tract infections, ( UTI’s ). Also, it appears to reduce the risk of STD’s in men , protects against penile cancer later in life and may reduce the risk of cervical cancer in female sex partners.
There are some disadvatages also. The infant may experience pain, have increased bleeding or infection at the site and scarring/malformation of the penis is rare but also possible. Also, parents may feel some guilt.
If you choose not to have your son circumcised, there are some things you’ll need to know. Keeping the area clean with soap and water helps reduce the risk of problems and infections. In older boys and men, the foreskin slides back and forth over the penis allowing for cleansing, but from birth through age 3-4 it DOESN’T RETRACT. Don’t force it to retract or you could cause damage and problems to the penis. Once he is older he can be shown how to detract the foreskin and cleanse his penis properly.
I know that deciding is not easy, but with this information I hope it helps make it a little bit easier. As always, feel free to input your comments and experiences.
God bless always,
Meredith – RNC
11 comments
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July 20, 2008 at 1:08 am
darcy
Parents may feel some guilt…. but more importantly the baby when he grows up may not have wanted part of his penis cut off. I’m surprised this didn’t get any mention as it’s something parents should be considering. If it’s medically necessary than that’s one thing, but cutting off healthy bits of boys genital anatomy without their consent doesn’t respect their rights over their own body. Parents need to make decisions for their children but maybe this is a decision that should belong to the individual. If its unwanted its indefensible. What if a guy doesn’t want part of his penis cut off and scarred?
Also, UTIs can be easily treated with medicine. Female infants get them far more frequently than both circed and uncirced males and there’s no need for pre-emptive surgery on female infants. The rest of the ‘pros’ listed are related to adult sexual behavior – a male would be perfectly able to book a circumcision for himself if he wanted the tiny degree of protection it may afford him.
BUt usually what it boils down to really is ‘looking like daddy’, no? And the small medical benefits (which can all be achieved without surgery) are there as rationalizations. I wonder if doctor’s would permit some parents to consent to labioplasty for their female infant daughters ‘to look like mommy’ and for hygeine.
July 20, 2008 at 2:56 am
labornurse
Hi darcy,
Thank you for contributing to this post, i’m sure everyone appreciates your input. As always, I like to remind people that this is what the procedure is in a hospital, and also that it is the parents decision. As I stated, many have their reasons whether it be for religious beliefs or whatever. As for the baby, if you’ve never had something, you’re not going to miss having had it. Since a newborn has no ability to remember ever having had it. I obviously am not speaking from personal experience here, but my husband doesn’t seem to be missing his “foreskin” much. Anyway, that’s why I wanted to include both sides of whether or not to consider it, and why you may choose either.
Either way, thanks again for your input and I would like to encourage anyone else who would like to comment on this subject.
Take care.
Meredith – RNC
July 20, 2008 at 4:48 am
Joe
Labornurse a few thoughts on your posts. First I would like to address more completely your discussion of care of intact boys. You mention separation at 3-4 years but in fact only about 50% of intact boys are able to retract their foreskins by 11. This is quite normal and by 15 or 16 nearly all are. Before that point it is just a wash what you see and even when they are fully retractable at earlier ages it isn’t necessarily the case that the need to retract and rinse daily every now and then just to get into the habit is fine. More on that can be found at http://www.aap.org/publiced/br_uncircumcised.htm or even better: http://www.cirp.org/library/hygiene/
For the very few boys that don’t retract by their mid to late teens there are a number of effective non-invasive treatment options such as betamethasone 0.05% cream for 4 to 6 weeks. By the way I like that you mentioned not to force it, in fact nobody should be trying to retract it even a little.
What seems to happen around the age of 2 – 5 is that boys do start the process of separation and sometimes that process causes mild soreness and irritation. Parents should be aware that most of the time this is a transient issue that is due to separation. I can possibly speak more to this if desired.
Now as to your list of purported benefits I think that it is important to point a few things out. First UTIs are easily treatable and occur at a very low baseline for boys anyway. Recurrent UTI’s in boys are almost always due to a congenital anomaly of the urinary track and not the foreskin.
Like you said the notion of any purported protection viz STDs is equally weak. Interestingly enough, there was a study recently published in the the March 2008 Journal of Pediatrics, “Circumcision and Risk of Sexually Transmitted Infections in a Birth Cohort” by N. P. Dickson, T. Van Roode, P. Herbison and C. Paul, J Pediatr 2008;152:383-7, shows that circumcision does NOT prevent STDs. These findings are consistent with recent population-based cross-sectional studies in developed countries such as Britain and Australia which found that early childhood circumcision does not markedly reduce the risk of the common STIs in the general population in such countries. Circumcision is very rare in all three of those countries (Britain, Australia, and New Zealand). As mentioned in the abstract they confirmed the results of some pretty large studies yet most people didn’t hear about this when it was published, I often wonder why.
You also suggest the circumcision is a useful prophylactic against penile cancer. Now setting aside the fact that this is the rarest form of cancer in men, 1/100000 I believe, and the fact that it is known that in many countries that don’t practice circumcision, the rates of penile cancer are less than that in the US, according to a recent publication from the American Cancer Society they say: “The consensus among studies that have taken these other factors into account is circumcision is not of value in preventing cancer of the penis.” (www.cancer.org/docroot/CRI/content/CRI_2_4_2X_Can_penile_cancer_be_prevented_35.asp) You could also google the quote it should take you right to their page.
Pointing out some of the possible long term consequences of circumcision might have been useful too. Such as the Meatal Ulceration and Meatal Stenosis I knew people who suffered that. I also remember as a boy on the play ground other boys taking about getting erections and ‘running out of skin’ it seemed to be a common complaint. And of course there are other complications.
Then there are the ethical considerations. I feel I must mention ethics because of your reply that they won’t remember it anyway doesn’t sound ethical to me. That always leads me to ask, then what else can I do to someone if they won’t remember it? Is that an ethical justification? Some are upset about it: http://adamisrestoring.blogspot.com/
The AAP Committee on Bioethics report states, “Pediatric health care providers. . . have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. . . . The pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent.” American Academy of Pediatrics Committee on Bioethics. “Informed Consent, Parental Permission, and Assent in Pediatric Practice.” Pediatrics 95 (1995): 314 Somehow though circumcision falls through the cracks, I haven’t figured out how though. Dr. Margaret Somerville has an interesting chapter on circumcision in her book the Ethical Canary, the excerpt can be read here: http://www.intact.ca/canary.htm
Finally, you didn’t mention that routine infant circumcision isn’t recommended by any pediatric organization. Not the AAP, not the CPA, not the British, or the RACP. Anyway just my 2c.
July 20, 2008 at 1:34 pm
Paul
Meredeth and others reading,
“if you’ve never had something, you’re not going to miss having had it” :
Not the best reason to go amputate healthy, functional, nerve enriched tissue from a helpless infant.
Does daddy have a scar on his arm? Should the baby also have one “to look like daddy”?
I am not trying to sound mean here but there is some really faulty logic on the side of people who see little wrong with removing the most sensitive part of their son’s penis with out his permission.
Just because everyone else in your community does it doesn’t make it right. There are plenty of advanced countries, Sweden, Germany, Japan where baby boys are left intact. Those are very advanced science-oriented countries and would practice circumcision if it had real health value but they don’t because it doesn’t.
July 20, 2008 at 2:40 pm
ml66uk
You might also want to check out the following:
Canadian Paediatric Society
http://www.cps.ca/english/statements/fn/fn96-01.htm
Recommendation: Circumcision of newborns should not be routinely performed
http://www.caringforkids.cps.ca/babies/Circumcision.htm
Circumcision is a “non-therapeutic” procedure, which means it is not medically necessary. Parents who decide to circumcise their newborns often do so for religious, social or cultural reasons. To help make the decision about circumcision, parents should have information about risks and benefits. It is helpful to speak with your baby’s doctor.
After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.
Royal Australasian College of Physicians
http://www.racp.edu.au/download.cfm?DownloadFile=A453CFA1-2A57-5487-DF36DF59A1BAF527
“After extensive review of the literature the Royal Australasian College of Physicians reaffirms that there is no medical indication for routine neonatal circumcision.”
(those last nine words are in bold on their website, and almost all the men responsible for this statement will be circumcised themselves, as the male circumcision in Australia in 1950 was about 90%)
British Medical Association
http://www.bma.org.uk/ap.nsf/Content/malecircumcision2006?OpenDocument&Highlight=2,circumcision#Circumcisionformedicalpurposes
British Medical Association: The law and ethics of male circumcision – guidance for doctors
“to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”
National Health Service (UK)
http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=649
“Many people have strong views about whether circumcision should be carried out or not. It is not routinely performed in the UK because there is no clear clinical evidence to suggest that it has any medical benefit.”
It’s worth remembering that we wouldn’t even be having this discussion if it weren’t for the fact that 19th century doctors thought that :
a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tubercolosis etc), and
b) circumcision stopped masturbation.
Both of those sound ridiculous today I know, but if you don’t believe me, then check out this link:
http://www.noharmm.org/docswords.htm
Over a hundred years later, circumcised men keep looking for new ways to defend the practice.
July 20, 2008 at 4:50 pm
labornurse
Hello,
I didn’t mean to strike such a nerve with that comment, ( the whole never had it, won’t miss it part ) I apologize for that, I didn’t mean to be insensitive. Anyway, as I stated throughout the post, not everyone chooses to have their son circumcised and was just trying to point out a few reasons for both.
Also, NOT everyone else in my community does it, there are plenty of people who don’t. It’s up to the parents.
Also, read above, joe had some very good comments and information, I appreciate that and would like to encourage it. He also has included numerous links to research.
Joe, I only wanted to outline some information in this post, because as you see it can get quite long. I really only intend to outline most of this information, which is information I cover in Labor and Delivery classes.
Thanks for your comments and the information you have shared,
God bless,
Meredith – RNC
July 20, 2008 at 10:20 pm
Hugh7
You say “it’s a parent’s decision” and on the surface of course that’s true, but many parents report having been pressured to decide to circumcise – right up until they leave the hospital. (see http://www.circumstitions.com/coerce.html ).
The four ailments you mention, UTIs, STDs, penile cancer and cervical cancer in the partner, are all quite rare (and penile cancer very rare indeed, rarer than breast cancer in men), and when circumcision is considered on a Number Needed to Treat basis, a vast number of circumcisions are performed in vain for every ailment prevented. (And the science behind all those claims is disputed. The most recent study of STDs found no protective effect.)
Circumcision has risks of its own, up to and including death, but even minor aesthetic damage – which often goes unreported – can cause major unhappiness to the penis’s owner.
The question arises whether it should be the parents’ decision, or that of the person most attached to the part in question.
July 20, 2008 at 10:35 pm
labornurse
I can’t remember the name of the movie, I know Sandra Bullock was in it, I think it was 28 days or something like that. It was the one were she was an addict and was in rehab, anyhow, there was another actor in that movie, he’s pretty funny actually, although his name escapes me at the moment. My husband just looked over my shoulder as I was reading your response and said ” I want my Foreskin back, nobody asked me if they could have it, they just took it ” : ) I suppose if you’ve seen the movie then you know what I’m talking about.
Anyway, I understand. I’m sure that many health care providers push for it, but I have never personally ever seen that where I work.
God bless,
Meredith – RNC
July 21, 2008 at 12:03 am
Julie
Oh boy, circumcision! Lots of strong opinions on either side.
I’m a l&d/pp RN also.
Where I work, we don’t assist w/ circs, the nursery nurses do.
I’m anti-circ for my own kids but I don’t have a strong opinion on what other parents do I guess.
My husband is circumcised but after seeing my first circ in nursing school I knew there was no way any child of mine was going through that! I have two uncirced boys and a girl.
I would just like to touch on a few points that I’ve either run across due to my work or because I’m a mom to two uncirced boys:
Circing for religious reasons: I’m not Jewish but sometimes parents in the hospital say they’ll go ahead and circ after birth because they are Jewish. From how I understand it, this doesn’t really count as the religious covenant that it’s supposed to be. I think it’s required to be done by a rabbi/mohel and I believe it has to be accompanied by blessings and prayers and all ceremonial. A hospital circ for religious reasons is void (again, from what I understand from my Jewish friends). Another thing – Christians aren’t commanded to circ, Christ did away with that (sometimes Christian parents will say their religion requires it, which it does not).
Cancer: Circumcision will abolish all risk of cancer of the foreskin, to be sure, because the foreskin is no longer present. However, I’ve recently read some studies that circed men can get cancer on their circ scar. So circ doesn’t wipe out penile cancer completely. Fortunately, cancer of the penis is very rare for both circed and uncirced men.
“Look like Dad/look like boys in locker room” – From the experience in my own home and that of friends, this just isn’t an issue. Men/boys don’t seem to notice since penis comparisons don’t normally happen at home or at school. If they do notice, nobody seems to care or lose sleep over it.
I still get plenty of boys at work whose parents want them circed but it’s not as many as it was 10 years ago. I’d say about 35% of the white boys born where I live are uncirced and about 70% of the Hispanic boys are uncirced. I live & work near the TX/OK border. My sister-in-law is a pedi nurse in OR and she said only about 40% of the boys there get circed.
That’s a far cry from the almost automatic circ a boy received being born in the 60’s or 70’s.
I’m just of the school of thought that you shouldn’t mess with something unless it’s broken, you know? But some parents just can’t imagine having a boy with a foreskin. To each their own. But I’m pretty sure if all parents saw a circ most would change their mind. Of course, if most saw a lot of what we saw on a daily basis I bet we wouldn’t have as many pregnancies either! ha ha!
Julie – RN (not C but hoping to be soon)
July 21, 2008 at 12:25 am
labornurse
Julie,
Amen to that !! On the pregnancy issue that is ! Goodluck with the RNC, I am currently working on moving to the Brownsville area of Texas, my sister is a nurse at a hospital in that area, I hope we will like it.
Thanks for your input.
God bless,
Meredith – RNC
July 21, 2008 at 4:25 am
Joe
Labornurse, thank you for your reply and complement. I appreciate that you posted my comment also I didn’t realize you taught L&D. I am sure you teach more than you posted here but I wanted to add some additional thoughts that I think should be discussed with students when discussing circumcision.
One thing that always bothered me is that when health care professionals talk about circumcision, they often characterize the risk as rare but just as often don’t properly characterize the purported benefits they same way. And the truth is that while immediate complication may be fairly rare they can be serious when they happen sometimes requiring more surgeries. Even more common complications, like Meatal Stenosis, also often require surgical intervention. Conversely, true medical indication for circumcision is extremely rare and most of the purported benefits are easily treatable with non-invasive techniques, such as a round of ABX for a UTI.
Also it should be known that not only is routine infant circumcision not a recommend procedure, as a previous poster referenced, it is also quite rare outside the US. From the ethical perspective I do find it bothersome that a part of my body could have been removed for no particularly compelling reason; it is something that I can’t square with what I know about traditional western medical ethics.
I realize that this is a substantial topic and I too had to think about how much I wanted to write in my reply. I hope that, as with my previous post, this will add substance and that your readers will consider it. I don’t think I saw the movie you referenced so I am not quite sure if the situation you describe is a pejorative one I’ll go rent it.
BTW, Thanks for your post Julie I am glad to hear your input regarding the rates of circumcision in those parts of the country. Though, excluding a pressing medical need, I’ll disagree with whom I think this choice belongs.