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 :)

[danissa, LPN, LVN]

We go in asap after the doc leaves and REMOVE that gauze - the RN's and CNA's hate it because it sticks to the raw head of the member. We simply slather the member in petroleum jelly and usually there isn't a problem.

NO GAUZE.

steph

Steph, what do the wee guys have for pain relief following procedure?

And are they not screaming when they pee? Just interested, have no fixed opinion here

[rnin02]

No gauze? We slather gauze with vaseline (I really, really pile it out) and put that gauze on. I would think that would do a better job of keeping the poop away somewhat...no gauze seems to be asking for trouble. And the majority of babies I have seen scream like the devil when they pee on a fresh circ, they really scare their parents sometimes. Especially the brand new parents who are already freaked out by the way a baby cries when you change a diaper anyway, poor parents. Our babies get sweet-ease before and during the circ, lidocaine block before the circ (or rarely emla cream) and then a one time dose of tylenol after the circ.

[danissa, LPN, LVN]

And the majority of babies I have seen scream like the devil when they pee on a fresh circ, they really scare their parents sometimes. Especially the brand new parents who are already freaked out by the way a baby cries when you change a diaper anyway, poor parents.

See, thats horrible!

[rnin02]

And the majority of babies I have seen scream like the devil when they pee on a fresh circ, they really scare their parents sometimes. Especially the brand new parents who are already freaked out by the way a baby cries when you change a diaper anyway, poor parents.

See, thats horrible!

yeah, i agree, it makes the babies a little unhappy and not themselves for at least a day. my husband is not circ'd, and has not had any issues ever...should we ever have a little boy, he will not be circ'd.

[danissa, LPN, LVN]

so, would these babies be given even paracetamol as a follow up pain relief?

[KYCNM]

OK. Yes, the circumcision rates have been falling since 1987. However, the rate of circumcision in the US is still above 50%. An online article (Declining Rates in Male Circumcision amidst Increasing Evidence of its Public Health Benefit) found increased rates of STIs in uncircumcised males, but their study was flawed because only males visiting an STI clinic were included. They didn't go out on the street and examine guys there to see if they had an STI or were circumcised, so the findings cannot be generalized to the population.

Further, the major decline has been over the past decade, and I hardly think 10 year olds are contributing to the major increase over the past year.

[Spidey's mom, ADN, BSN, RN]

Steph, what do the wee guys have for pain relief following procedure?

And are they not screaming when they pee? Just interested, have no fixed opinion here

Nothing for pain after - they just get the lidocaine prior and the procedure takes about 10 minutes.

We've not noticed any screaming with peeing.

What has happened is the gauze that the doc places gets stuck, even with petroleum jelly. And trying to pull that off does cause pain for the baby and sometimes bleeding. So, we take it off before it gets stuck. And slather on petroleum jelly.

steph

[Elvish, BSN, DNP, RN, NP]

Based on what I am reading on this thread, I guess that isn't necessarily the case in the hospital. (The hospital I am working in does not do circumcisions on newborns.)

The hospital I work at gives Tylenol beforehand - a big loading dose, more than what you'd give for a fever. They also get local anesthesia. They also get sucrose before, during, and after prn. And they still scream. The scream of a circumcision is different than the scream of hunger or a wet diaper.

The bottom line for me is that there are other ways to prevent STD transmission that do not involve irreversibly messing with the genitalia of baby boys. The foreskin is a NORMAL body part.

But if you want to follow that line of reasoning, maybe we ought to just do penectomies. Bet that would REALLY cut HIV transmission.

[crissrn27, RN]

The hospital I left a few months ago did sweet ease immediately prior. Thats it. I did notice screaming during and after (especially with pee). No Tylenol, no nothing. Wait, we did have one doc that did EMLA 1 hour pre.

We did jelly gauze until 1st diaper change, then jelly in diaper only. I did notice that the gauze would sometimes stick, so I tried to get to the gauze before the doc, and really load it up for them, and that seemed to work better. Think it is too little jelly that causes the sticking.

I always have to say (and have gotten in trouble for this) that the AAP no longer recommends routine circs, when asking if they want a circ. That is all I say, cause I catch enough grief even for this, but most of the docs do NO teaching. They ask if they want it, then they put the $$ in their pockets, do the circ and walk away. I would love for a doc to do actual teaching and see if that would change pts minds.

At my old hospital it was $200 out of pocket. I work with Arwen now. How much is where we are Arwen? I can't remember what I was told, something like $600-700. Medicaid and lots of insurances are not covering this now. Docs don't want circs to go away, they are making big money on this. All that cash for a 5-10 min (hopefully) procedure.

[Spidey's mom, ADN, BSN, RN]

The hospital I left a few months ago did sweet ease immediately prior. Thats it. I did notice screaming during and after (especially with pee). No Tylenol, no nothing. Wait, we did have one doc that did EMLA 1 hour pre.

We did jelly gauze until 1st diaper change, then jelly in diaper only. I did notice that the gauze would sometimes stick, so I tried to get to the gauze before the doc, and really load it up for them, and that seemed to work better. Think it is too little jelly that causes the sticking.

I always have to say (and have gotten in trouble for this) that the AAP no longer recommends routine circs, when asking if they want a circ. That is all I say, cause I catch enough grief even for this, but most of the docs do NO teaching. They ask if they want it, then they put the $$ in their pockets, do the circ and walk away. I would love for a doc to do actual teaching and see if that would change pts minds.

At my old hospital it was $200 out of pocket. I work with Arwen now. How much is where we are Arwen? I can't remember what I was told, something like $600-700. Doc don't want circs to go away, they are making big money on this. All that cash for a 5-10 min (hopefully) procedure.

I had a handout with questions to ask the doc . .. .with the AAP info and pain questions. I always gave it to the parents.

Surprisingly, most parents still opted FOR circumcision.

But at least they had the info.

steph

[Elvish, BSN, DNP, RN, NP]

At my old hospital it was $200 out of pocket. I work with Arwen now. How much is where we are Arwen? I can't remember what I was told, something like $600-700. Medicaid and lots of insurances are not covering this now. Docs don't want circs to go away, they are making big money on this.

Hey Criss!

Where we are it is $673 if you're paying out of pocket. It amazes me how many people can't find $30 for a corificeat but still want that little boy's foreskin cut off. If I were on the fence, that would make up my mind right there!

I have seen only 2 docs at our facility who actually educate new moms on circ. And one of them is anti, which is (I think) why he in particular does such a thorough job.

And you know steph, I'm with you. I give parents the info, whether anyone above me likes it or not (actually, my immediate supe is anti, so she's ok with it). And even if they decide for circ, I obviously don't agree with it but I'm much better about them making up their minds with more than just "yeah, I guess we oughta do it".

[crissrn27, RN]

Hi Arwen

Arwen, I will say that most of the residents do a 30 second spiel along these lines, right after birth, when they get the do the form for you guys. It goes like this.

Doc: Do you want me to circ your son?

Mom: Yes, are you going to do it right now? (lol, most really do say this)

Doc: No, we will do it later. There is a less than 1% chance of infection or bleeding. Are you sure you want it?

Mom: yes

That is about it, haven't heard anything but that, not even a description of the procedure, but to be honest the moms don't ask.

That is a lot of $$ for a circ. It was $150, then changed to $200 right before I left the other place. I have had pts ask to see SW for help with a corificeat, formula, etc, but they usually find some way to get the money for the circ. Most of the docs there would actually take the money and put it in their pockets too. Literally, mom hands doc the cash. Only a couple require that it be paid in the office.