The Circumcision Discussion - page 45

I know this can be a HUGE debate, and I'm not looking to start any arguments. I was just wondering as you are OB nurses. I'm expecting a boy in July and not sure if we should circ. or not. My... Read More

  1. by   Spidey's mom
    Quote from rn/writer
    Our docs (OBs) use local blocks (and DO wait for them to kick in) and the assisting person gives several rounds of Sweet-Ease on a passy. The kiddoes get Tylenol immediately following the procedure and q 6 hours for 24 hours as needed (usually just one more dose). Many never let out a peep. Some fuss a little afterward--being moved around and redressed and such, but I have never seen a single baby scream or fight or arch or do anything else that would indicate severe pain. In fact, I have seen a fair share nod off and awaken only when they were diapered and dressed. Even then, they didn't seem traumatized.

    Truthfully, I have seen more reaction from Hep B injections, and even those are harder on the parents than on the babies. Most of the kids cry for 10 seconds tops, and many never cry at all.

    That said, I don't think anyone should have to assist with the actual circ against their will. Set-up and clean-up maybe, but not with the procedure itself. Better for all involved if the assistant is calm and relaxed.
    I already said this on this thread but my experience is the same. The babies rarely cry and never scream "bloody murder".

    steph
  2. by   RedWeasel
    Quote from crissrn27
    Please, please, stop trying to use that stupid tegaderm for emla on the penis. It is impossible! Do this, and the baby will have better pain control. Put the emla in a baby bottle nipple, (with the ring removed, of course) and slip the nipple over the penis. Apply the diaper snuggly over the nipple, so that it stays in place. This works great! Cream stays where it is supposed to, penis gets (hopefully) numb, and no fighting with tegaderm!
    Nice! Or how bout cutting a finger off of a glove-may come off when they void but heck you got a glove full of fingers to use.
  3. by   labcat01
    An uncircumzed male might not have problems at 2, 14, or 34, but when he's 80 and can't care for himself anymore it will BE a problem. So that's one of the reasons i'm for circs and it is my personal opinion.

    My advice to anyone is to do your own research and make your own conclusions. Look at PEER-REVIEWED sources for literature (AAP, JAMA, Pediatrics, etc) don't go to alarmist websites as so many have directed you too. That isn't going to give you the information you need to make an informed decision.

    Just my opinion
  4. by   mitchsmom
    Quote from labcat01
    My advice to anyone is to do your own research and make your own conclusions. Look at PEER-REVIEWED sources for literature (AAP, JAMA, Pediatrics, etc) don't go to alarmist websites as so many have directed you too. That isn't going to give you the information you need to make an informed decision.

    Just my opinion
    I strongly agree with this part of your post - cirp.org is from an anti-standpoint but it offers peer-reviewed literature from the above sources and others. No medical association recommends routine circumcision, here is a link to all the policy statements.
    (I don't agree with the first part though... most men in the world are not circ'd and they appear to be doing ok, even as older dudes Anyone could potentially have a problem at some point in their life (including women cleaning when they are older) but we aren't just going to start cutting off body parts just in case an unlikely thing happens. If they are feeble enough that they can't clean well, they simply need help, whether they are cut or not.
    Respectfully - just my opinion...
    Last edit by mitchsmom on Jun 23, '07
  5. by   bradleau
    Nothing quite like an old man with a foreskin so tight he has problems urinating. Then there are the INFECTED ones. Usually if the foreskin has been pushed back, the area cleaned on at least a daily basis, pulling the foreskin back down in place, that will keep a lot of problems from occurring.
    To put it plainly, guys do not keep themselves clean. I have seen several adult males, usually under 40 having to be circumcised due to problems.
    Both the Jewish and Muslim faiths require circumcision. There may be others. My grandsons were circumcised like their father, grandfathers, etc. My husbands uncle in WW2 caught a STD and had to be circumcised as an adult. Boys and men will have sex and the STD rate is much, much higher if NOT circumcised.
  6. by   pooh54
    Ok, I'm anti circ, son isn't and doing fine. I do feel that families must make their own decisions but must be educated on the pros and cons. The majority of men in the developed world aren't circed and are doing well. What I object to is having to assist when the doc will not use any anesthetic (except sweetease and a paci). I feel that this is violating my own beliefs and standards, that I should be able to opt out of assisting when these circumstances occur. These physicians r clueless!:trout:
  7. by   gradRN2007
    :spin: i have to comment on this one. being a mom of a 27 year old, being jewish and being a new rn. i watched in horror 25 years ago as a lab tech when a baby was circumcised in the nursery of the very large hospital where i worked. i was amazed that they (rn's) and doc left the baby totally alone afterwards, strapped to this cruel board and screaming. how traumatic, besides sometimes its the resident doing it for practise, the parents usually arent there.
    well, 2 years before that my son was circumsized in the jewish tradition of a bris at one week by a moil (a person who only does circumsicions, like thousands) in your home or hospital. my son was treated like a precious baby boy by the moil and his wife (helper), given a guaze pad to suck on that was soaked in mogen david wine wrapped around a raisen, (i hid in the bathroom crying i have to admit) but my father and fatherinlaw held the board and my son only cried for 2 minutes tops. he was then wrapped snuggly (vaseline and gauze on tip of penis) and given to me and we were put alone in the bedroon so he could nurse and he then slept for 6 hours, the moil also gave me written instructions and his phone number if i had any questions...all the family was present and it was a beautiful way of handling a touchy, scary surgury.
    i still work at the same hospital and know several people who have had new baby boys, docs, non-jewish, mutli- racial new parents who are using a moil in their home, i would only do it that way. hope this helps and i would definetly suggest it to new parents. you can always call a temple to see who they recommend.
  8. by   OldPhatMC
    In my OB rotation we saw one physician line up five babies for circumcision, using a block on all of them. It really wasn't supra pubic, it was more circumfrential around the base of the penis, thus the babies had this bloody lawn sprinkler effect which was disconcerting. Amazingly none of them cried from the blocks. One would think that would have been enough. What set off all the screaming was either the prep with betadine or strapping down. The procedure itself didn't seem to be that bad. All of the babies settled down after the procedure. I did have to be a wee bit evasive with the mom of one of the babies; she directly asked me if he cried (of course he did) but I stuck with "he did fine".

    Now for the male nurse perspective. I have long opposed circumcision. The arguments about UTI and phemosis are not based on good science. What does seem to be based on good science is the finding that the part of the prepuce that is proximal to the penis (say that three times fast, dare ya :trout is more easily penetrated by viruses. So there may be a compelling reason to circumcise after all. However, that vulnerability is predicated on the grown patient being sexually active and engaging in risky behavior. How do you predict that 14 years out?

    Ethically, I don't believe that circumcision withstands the test anymore. I believe that the religious reasons are an ethical exception that need to be scrutinized. I think cutting a boy to look like daddy is wrong, as would taking a child in to have his or her nose redone or even the modifying of the body through piercing. Earrings on a newborn are just so scary to me for the same reason. The child becomes something to decorate rather than nurture.

    This does not include surgery for any defect obviously.

    No one has ever seriously considered performing preventive mastectomies on newborn girls, although that too could be argued to be preventive. Is it that we're firmly committed to the idea that the foreskin provides no value to the male? Or are we comfortable with trading off sexual function for other "more important" health considerations?

    We used to think the appendix was without value to the body as well.:smiley_ab

    OldPhatMC sends.
  9. by   OldPhatMC
    Quote from labcat01
    An uncircumzed male might not have problems at 2, 14, or 34, but when he's 80 and can't care for himself anymore it will BE a problem. So that's one of the reasons i'm for circs and it is my personal opinion.

    My advice to anyone is to do your own research and make your own conclusions. Look at PEER-REVIEWED sources for literature (AAP, JAMA, Pediatrics, etc) don't go to alarmist websites as so many have directed you too. That isn't going to give you the information you need to make an informed decision.

    Just my opinion
    I fully agree with your comments about staying with peer reviewed sources. But one observation about your comment on the 80 year old males. I have not found anything peer-reviewed about the care of the elderly uncircumcised male, but this is an issue that resides in nursing's "tribal knowledge". It would be useful to see a study about that. Until I find a few good studies like that, I'll have to pick carefully through the alarmist sites.

    Having said that, let's also consider the idea that up until the patient is lacking in self-care ability, he should be able to enjoy a sexual life that includes the benefits of being intact. Sixty plus years of good need not be bypassed to prevent an issue in the last ten.

    random side note: I'm getting too politically correct. In the above paragraph, I kept wanting to type "he or she" when referring to the patient. :selfbonk:


    OldPhatMC
  10. by   kokosmom
    I witnessed the tail end of a circ week before last. Resident was finishing up with forceps and scizzors - baby was beet red, screaming at the top of his lungs. When finished, the baby was removed from papoose board, and held, placed in basinette. During the procedure the baby was given sugar water in a dropper/nipple contraption by nurse, which helped ever so slightly. Can't help but feel this was barbaric and it appeared that no anesthetic was given to the little one.
  11. by   cholul
    New research studies, out of South Africa and Kenya, show that circumcision reduces the risk for contracting HIV by as much as 60%. That's great news - but - this non-emergency, totally elective surgery then becomes a topic for the "ethics" column because the baby is not autonomous and cannot give consent. It ends up being a personal decision that we just have to respect, no matter which decision the parents make. Just be sure you have the latest research and are making an informed decision for your baby - and remember... if you decide yes OR no... you are making a decision for the man he will be someday (even if, today, he is your own baby).
  12. by   fergus51
    Quote from cholul
    New research studies, out of South Africa and Kenya, show that circumcision reduces the risk for contracting HIV by as much as 60%. That's great news - but - this non-emergency, totally elective surgery then becomes a topic for the "ethics" column because the baby is not autonomous and cannot give consent. It ends up being a personal decision that we just have to respect, no matter which decision the parents make. Just be sure you have the latest research and are making an informed decision for your baby - and remember... if you decide yes OR no... you are making a decision for the man he will be someday (even if, today, he is your own baby).
    Plus those studies are looking at transmission through heterosexual sex. Most HIV cases here are spread through IV drug use and homosexual sex. There is no evidence it would be protective for that...
  13. by   justme1972
    I am pro-circ, however, I would totally respect a co-workers choice not to assist in the procedure, and would GLADLY switch places if they asked.

    Everyone has individual things that they are passionate about, and I would expect someone to respect mine in the same token.

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