The Circumcision Discussion

[jmspeach]

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 husband says yes, it's better medically in the long run. My gpa who just turned 70 had to have a circ. due to endless complications lately.

As nurses in this area, is the medication that they use good? And what are some questions to ask my Dr. about it. I already know that my hospital i'll be at uses a med. when they perform it, I"m just wondering what you all think.

Thanks

Jen :)

[Elvish, BSN, DNP, RN, NP]

Lowering the incidence of HIV spread is still not a reason to circumcise baby boys.

If adult men want to line up for it, more power to them. I don't see that happening either.

[vashtee, RN]

Lowering the incidence of HIV spread is still not a reason to circumcise baby boys.

Well, I guess we simply disagree.

I have to ask, though, do you also oppose girls having the HPV vaccine?

[dawngloves, BSN, RN]

I'd much rather that there were education programs in Africa teaching the use of condoms and abstinence then telling them circumcision will give them a 50/50 chance.

As health care professionals it is our job to teach this and teach it again. If HIV is on the rise in this country we need to look inward. What kind of message is our population getting if we tell them things like "Circumscision cuts your baby's risk of HIV in half."?

Aside, my daughter will get the HPV vaccine. Unlike HIV, there is no reliable test for men and you can be married to a man for years and turn up with it, even if your husband had earlier tested negative.

[labcat01, BSN, RN]

I gotta agree with Dawngloves...you follow the teachings of the Catholic Church regarding condoms, but not abstinence?

Yes! In South and Central Texas there are many "catholic" men that do not follow the church's teachings on abstinence but do not use condoms because it is a sin. Just FYI - nothing to do with circumcision really

[Elvish, BSN, DNP, RN, NP]

Well, I'm not opposed to the HPV vaccine per se. I will, however, wait until some of the kinks get worked out of the vaccine before I would recommend it to anyone. I don't have any daughters so don't have to make the choice for my own family. However, there is a big difference between vaccinating an 11- or 12-yo girl -- very small needle prick -- and taking a clamp and crushing a part of a baby boy's body that has many many nerve endings. You can explain to the girl what's being done and why. You can't do that with a baby.

Would you recommend routine appendectomies on all babies to eliminate the risk of possibly-fatal appendicitis later on?? Different disease, same argument.

[TrudyRN]

I really wonder if God really told Abraham to, as a John Wayne-imitating comic once put it, "lop off a piece of your pecker, Pilgrim". Not disparaging anyone's religion, I happen to be Jewish myself. I just think, from what I have seen, that it is barbaric and unnecessary.

I have seen the error my husband's doctor made on him - he has a hypospadias because of circ. And the internet can probably yield lots of botched circ result pictures.

In this day of soap and water, we don't need it for hygiene. And the original religious order for it - I wonder if God meant to remove the entire foreskin or to just nick and remove a small portion of it.

As for how I have seen it done as a nurse - a group of innocent babes was carried to an absolutely freezing room, stripped naked, strapped onto the boards, left to freeze while the doctor had yet to arrive. I covered them up and the other nurse told me not to and I told her they'd be left to freeze over my dead body and I didn't care what the doctor preferred. According to her, it was his preference to strip, strap and freeze them. I told her I doubted it and told her I'd go straight to Admin if she uncovered any of them before it was their turn. She took the threat and the look in my eyes seriously because, at least for that one day, no babes were allowed to freeze. It was bad enough they had to be strapped down too early.

When the doc finally did arrive, he had just gotten the clamp on one little guy when he was paged STAT to Delivery Room. He jumped up, left the clamp on, ran to DR. I was horrified. He returned in about 5 of the longest minutes of my life. The staff nurse I was with (I was agency and had never worked there before) said we did not need to page STAT for another doc to come to circ (torture) chamber, as he'd be right back so I guess this was routine. Of course, I doubt the parents were informed of the mishap.

To OP - just say NO.

[TrudyRN]

That would be great, except that the Catholic Church doesn't allow condoms. As for abstinence, yeah, right....

Yes, Natania. Abstinence does work. And we can all abstain if we decide to.

[vashtee, RN]

Would you recommend routine appendectomies on all babies to eliminate the risk of possibly-fatal appendicitis later on?? Different disease, same argument.

I don't think that is the same argument at all. Appendicitis is not a sexually transmitted disease that could be avoided by abstinence.

Anyway, I don't have a problem with people who decide against circumcision, but I don't think it's as awful as some would like to make it sound. I've seen three done (at a bris, not in the hospital), and they really weren't awful (although I expected them to be). Maybe the ones in the hospital are more traumatic... I dunno.

For the record, my daughter is getting the 3rd of her HPV vaccine today, and she says its a painful injection compared to the other boosters she had to have for admission to camp.

[vashtee, RN]

Yes, Natania. Abstinence does work. And we can all abstain if we decide to.

Yes, we can... but *do* we? Not in large numbers, we don't.

[Elvish, BSN, DNP, RN, NP]

Appendicitis is not a sexually transmitted disease, but you can still die from it. We could solve the problem by doing appies on every baby. That way nobody could get it later on. It is the same argument. And I'm not for it.

If you want to recommend circumcision as a way for ADULT MEN to reduce their risk of HIV infection/transmission, fine. But let them get circed as ADULTS, or whenever they become sexually active. Like I said before, if my son comes to me at 18 (shoot, maybe even 16) and says he wants a circ, fine. I'll make the appt and pay for it. But the whopping difference is that he is old enough to decide for himself. I'm not taking the choice away from him while he is small.

[rn/writer, RN]

Comparing "not circing" with "circing under the worst conditons"--improper analgesia, poor technique, etc.--is stacking the deck. Of course, no parent would want their child handled poorly. Perhaps more care should be taken to check out how the procedure is going to be done and more education and evaluation is needed among the practitioners.

I'm sure the horror stories are out there. What percentage do they account for? Who knows? I suspect that, like plane crashes, the ones that are done badly attract a lot of attention, while the many that do not have problems barely register.

At any rate, using the "botched circs" for comparison is one argument. Comparing not circing with a carefully done circ is an entirely different discussion.

As I mentioned earlier, I work in a large urban hospital where most of our male babies are circed. The procedure room is warm. The babies are properly medicated, both before, during and after using Sweet-Ease, local blocks, and Tylenol. The meds are given time to work. The docs use good technique. The babes are then returned to mom to nurse or be bottle fed. They are given additional Tylenol as needed. I have never seen a baby arch or scream. In fact, many of them drop off to sleep.

My question is, apart from the procedure itself, is there any harm known to come from having been properly circed? Are there any maladies that circumcised males are disproportionately prone to?

[KYCNM]

Perhaps if more people were aware of the evidence based practice guidelines for circumcision, there would be less furor.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1552-6909.2002.tb00062.x