The Circumcision Discussion

Specialties Ob/Gyn

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Specializes in Psych, Med/Surg, LTC.
We should require that the parents watch. I saw one in nursing school and it was classically horrible -- the baby strapped down, no anesthesia, the foreskin crushed off, not cut, no comforting or breastfeeding afterward...

I'm not squeamish and it was pretty upsetting to me and it wasn't my baby. I can only imagine how freaked I would have been if I was the mom.

I watched while they lanced my newborn's foot in the ER three times for a bilirubin and he was crying like mad and trying his best to wriggle free. I was totally hormonal and started FREAKING OUT. They had to pull me away. Maybe if moms and dads had to see what really went on...

Being required to watch a few in nursing school turned me against circumcision, too. They were also strapped down, no anesthesia, and the poor kids were SCREAMING then passed out. Then I later learned there is really no point in doing it.

Joe12

39 Posts

While I don't think that is a bad idea (making parents watch first) I don't think it solves the problem. It kind of implies that if it can be done painlessly it would become ethical to circumcise a boy. I'd say that in addition to watching something like that, it should be made clear that any benefits are in fact quite trivial, if they exist at all. I think at this point many doctors and other medical professionals, including many nurses, overstate these potential benefits. Personally, I'd like to see it stopped out right but realistically, I know it will take a lot of education, courage, and time.

lamazeteacher

2,170 Posts

Specializes in OB, HH, ADMIN, IC, ED, QI.
We should require that the parents watch. I saw one in nursing school and it was classically horrible -- the baby strapped down, no anesthesia, the foreskin crushed off, not cut, no comforting or breastfeeding afterward...

I'm not squeamish and it was pretty upsetting to me and it wasn't my baby. I can only imagine how freaked I would have been if I was the mom.

I watched while they lanced my newborn's foot in the ER three times for a bilirubin and he was crying like mad and trying his best to wriggle free. I was totally hormonal and started FREAKING OUT. They had to pull me away. Maybe if moms and dads had to see what really went on...

Jewish families do watch the circumcision being done, along with their families and friends, at a party given at their home for the occasion. The fainters aren't usually the parents, in fact I've not heard of that, but males attending the ritual (called a briss) have fallen many times and take the subsequent ribbing. It's because they hold their breath, watching. Blood can't oxygenate the brain, so knocking them out is the only way their bodies can resume breathing, on automatic pilot.

So if you freak out again, breathe deeply and it will pass. Jews don't get to choose about circumcision, and so far, except in psychoanalysis, there haven't been many who are adament about that. It's a fact of life. When they become parents, they'll probably choose to have it done for their boys, just as their parents did for them, to be a part of "the covenant with G-d".

I'm very much for anaesthetizing any part of anyone who is about to have a needle or knife shoved into them. It is barbaric that heel sticks are done without EMLA patches applied for an hour before it is done, as well as for the foreskin before it departs. 20 years ago, that was determined necessary at a conference I attended at Stanford. I've been passing the word, but everyone needs to do that.

It's abusive to do any pain causing procedure without EMLA being used. At ritual circumcisions the baby gets sweet wine on a ball of gauze satuyrated in it, with a lkong tail of gauze attached to prevent swallowing the ball of gauze.

Joe12

39 Posts

it's abusive to do any pain causing procedure without emla being used. at ritual circumcisions the baby gets sweet wine on a ball of gauze satuyrated in it, with a lkong tail of gauze attached to prevent swallowing the ball of gauze.

i read an interesting article about emla last week. apparently it has been linked to some pretty serious side effects even when used in the recommended amounts. apparently, these included: seizures, irregular heartbeat, difficulty breathing and rarely death.

an interesting side note to this was until june of 1999, the makers of emla had this as part of their warning, required by the fda:

"emla® cream (lidocaine 2.5% and prilocaine 2.5%)

prescribing information

pediatric use: controlled studies of emla cream in children under the age of seven years have shown less overall benefit than in older children or adults...

due to the potential risk of methemoglobinemia and the lack of proven efficacy, emla cream is not recommended for use prior to circumcision in pediatric patients."

that was removed and replaced with:

emla is not recommended for use on mucous membranes.

of course the foreskin is, mucous membrane. i am not sure what's on there now. i'll also add kind of tongue and cheek, i'd want quite a bit more than a bit of wine before something like that.

consult2

67 Posts

"Jews don't get to choose about circumcision, and so far, except in psychoanalysis, there haven't been many who are adament about that. It's a fact of life. When they become parents, they'll probably choose to have it done for their boys, just as their parents did for them, to be a part of "the covenant with G-d"."

I am sorry, but this covenant excuse does not fly..this "covenant" was an invention of the priests circa 550BCE...

http://home.comcast.net/~consult2/index.html

"It's abusive to do any pain causing procedure without EMLA being used. At ritual circumcisions the baby gets sweet wine on a ball of gauze satuyrated in it, with a lkong tail of gauze attached to prevent swallowing the ball of gauze."

I am sorry, but even when the BEST pain treatment is used, the pain is only REDUCED, so Elma and wine cannot provide any significant relief at all--it can only allow the parents to feel better.

ANY "unnecessary" pain is abusive!

meluhn

661 Posts

Specializes in acute rehab, med surg, LTC, peds, home c.

Bob is right, They strap that little guy to a board while he screams his head off. I watched it in nsg school, it was awful.

I went out with a guy for 4 yrs who wasn't circumsized. I was young so I didn't have enough experience to notice that it looked different. But now that I am older and wiser, I realize that it looked a little funny but functioned the same as any other member. He never had a problem with infections or anything like that.

The people/person who does see your sons member eventually will probably not care if he is uncircumsized and so few people will see it, does it really matter?

Specializes in CT ICU, OR, Orthopedic.
Medical reasons can be, an increase in UTIs, Yeast infection, increase in penile cancer. All small percetages. My Grandfather also had to have his removed when he was older.

I know the do use an anesthetic, can't think of it to save my life right now.

Read up, think about it. Do what you feel is right. Good luck!

I had to make the same decision about 7 months ago. It was awful. I hated being put in that position. My husband was like, no big deal. My reasons, for having it done were due to my experience in the OR. We do circumcisions, all the time on older children and adults. Yes, anesthesia is used, but still, I wouldn't want to have the memory of that. It really killed me to have to do it, but I figured better now than when he is two, or worse even, 22!:twocents:

I will say though, that when it was done, they took him out of the room, and they did not bring him back until he was calm. He slept most of that day. It is a hard decision to make, but in my opinion, it was the right decision for me. If I have another boy, I will have it done, but I will feel just as bad!:cry:

Joe12

39 Posts

I had to make the same decision about 7 months ago. It was awful. I hated being put in that position. My husband was like, no big deal. My reasons, for having it done were due to my experience in the OR. We do circumcisions, all the time on older children and adults. Yes, anesthesia is used, but still, I wouldn't want to have the memory of that. It really killed me to have to do it, but I figured better now than when he is two, or worse even, 22!

I am very suspicious when I hear this. Having spoken about this with friends in the respective fields in those countries that don't routinely circumcise, they say it is very unusual that a medical circumcision is performed. I've been told the rate is at worst 1 in 15,000 or so. It also seems that the rates vary depending on the country's history with circumcision. Those that have no history have by far the lowest rates of 'medical' circumcision for example most of continental Europe it is almost unheard of.

Some 'in the middle' countries have had relatively higher rates of medical circumcision which decreases with the years. For example, Britain, which largely abandoned circumcision in the late 40s, had a relatively higher rate of medical circumcision. However, as doctors become more familiar with conservative treatment, that rate continues to fall even 60 years after they dumped circumcision. A study looked at circumcision in Scotland over the 10 years from 1990 - 2000 and found a significant drop that accelerated of the second half of the timeframe. This seemed to indicate increasing familiarity with differentiating between natural development and actual problems and also conservative treatments when there are problems.

I get the feeling that in the US we treat any anomoly as needing circumcision and it is important that we fix that problem too. It's kind of like a dentist who always pulls teeth with cavities rather than drilling and filling.

consult2

67 Posts

"My reasons, for having it done were due to my experience in the OR. We do circumcisions, all the time on older children and adults."

Yes, but this occurs only in America where doctors are woefully ignorant about the normal member and its care. In foreskin-educated countries, it is almost never needed.

First of all, for a man who was not circumcised as an infant the chances of him having to get circumcised as a adult are extremely rare. In fact it's only 6 in 100,000. (0.006%)

Health officials of each Scandinavian country were queried about adult circumcision.. None of the health officials could provide precise data, because the numbers were so small that they weren't worth compiling. Each official stressed that foreskin problems were present but said they were largely treated medically-surgical solutions were extremely rare.

"in Oslo, Norway, over a 26-year period in which 20,000 male babies were cared for, 3 circumcisions were performed-a frequency rate of 0.02%.

In Denmark. 1968 children up to the age of 17 were examined over a period of several years. In this group, 3 circumcisions were performed-a frequency of 0.15%. In this study, in retrospect, the physicians believed that all three operations might have been avoided. Both of these studies related to the infrequency of circumcision and puberty, they did not deal with the issue in adulthood.

Wallerstein, Edward, Circumcision: An American Health Fallacy. pg 128

In Finland -- a non-circumcising country -- the operative rate is only a tiny fraction of this percentage. A male's risk of being circumcised for any reason during his entire lifespan is less than one in 16,000.

http://www.fathermag.com/health/circ/circumcision/circumcision4.shtml

The Finnish National Board of Health provided national case records for the year 1970 for both phimosis and paraphimosis. A total of 409 cases was reported for males 15 years and older,which represents only

2/100ths of 1% (0.023%) of the total male population in that age group. This means that 99.97% did NOT develop a problem. Moreover, according to Finnish authorities, only a fraction of the reported cases required surgery– a number too small to reliably estimate.

Wallerstein, Edward, CIRCUMCISION: AN AMERICAN HEALTH FALLACY p.128

http://www.sciencebasedmedicine.org/?p=269

The problem is NOT the normal member--it is the ignorance of the American medical Industry.

consult2

67 Posts

"I will say though, that when it was done, they took him out of the room, and they did not bring him back until he was calm. He slept most of that day."

There is a reason for this calmness and sleeping--it is called trauma-induced coma..

HARM CAUSED BY CIRCUMCISION

The increasing doubts about Jewish circumcision are based on the understanding that it causes harm. Anatomical, neurochemical, physiological, and behavioral studies confirm what mothers already know: infants feel pain. Drs. Anand and Hickey, in a comprehensive review of recent medical literature on newborn pain, conclude that newborn responses to pain are "similar to but greater than those in adult subjects."11 This study is accepted by virtually all medical authorities and is often cited in the literature whenever there is a discussion of infant pain. As a surgical procedure, circumcision has been described as "among the most painful performed in neonatal medicine."12 Studies of infant responses show that the pain of circumcision is not like that of a mere pin prick. It is severe and overwhelming.

The relationship between infant pain and vocal response needs explanation. The cry may be reduced by the effect of anesthetics given to the mother during labor.13 These anesthetics enter the infant's body and, according to pediatrician T. Berry Brazelton, it can take over a week to leave.14 Other factors can also account for minimal vocal response. Justin Call, infant psychologist and professor-in-chief of child and adolescent psychology at the University of California, reports that "sometimes babies who are being circumcised . . . . lapse into a semi-coma."15 Tonya Brooks, president of the International Association for Childbirth at Home and a midwife, observes, "In four of the nine circumcisions that I have seen, the baby didn't cry. He just seemed to be suddenly in a state of shock!"16 Studies demonstrate that even though an infant may not cry during circumcision, the stress hormone level in the blood still increases dramatically, and medical researchers consider this change to be the most reliable indicator of pain response.17 Therefore, lack of crying does not mean that the infant feels no pain. It could mean that he is withdrawing from unbearable pain.

http://www.circumcision.org/spectator.htm

http://www.cirp.org/pages/parents/circ-why/

PAIN, STRESS AND RISKS

Until recently it was believed babies felt no pain due to their immature nervous systems. Studies however, indicate that babies experience physical and psychological stress both during the circumcision and for hours thereafter. The procedure is undeniably painful. Some babies cease to cry or lapse into a deep sleep or coma which is how they are able to cope with the traumatic experience.

Some babies are so severely traumatized by the experience that they fall into a semicomatose state. Some circumcisers still pretend that these babies are just falling asleep! Nothing could be further from the truth. No one falls asleep when his sex organs are being cut with a knife. Because he is tied down, a baby has no way to escape, no matter how much he thrashes. Going into a comalike state is one way for the baby to distance himself from his agony, but it has dangerous consequences for the brain, as you will read below.

http://www.nospank.net/fleiss1.htm

consult2

67 Posts

"It is a hard decision to make, but in my opinion, it was the right decision for me. If I have another boy, I will have it done, but I will feel just as bad."

Outside of some very rare need for having it done later, what makes you believe it was the right decision for HIM?

Believe me, HE will feel worse having it done than you ever will--unless you have your genitals damaged.

dnp2004

106 Posts

I had to make the same decision about 7 months ago. It was awful. I hated being put in that position. My husband was like, no big deal. My reasons, for having it done were due to my experience in the OR. We do circumcisions, all the time on older children and adults. Yes, anesthesia is used, but still, I wouldn't want to have the memory of that. It really killed me to have to do it, but I figured better now than when he is two, or worse even, 22!:twocents:

I will say though, that when it was done, they took him out of the room, and they did not bring him back until he was calm. He slept most of that day. It is a hard decision to make, but in my opinion, it was the right decision for me. If I have another boy, I will have it done, but I will feel just as bad!:cry:

I am not sure I am following you. Based on your experience in the OR, why do you think circumcisions are so necessary? As a nurse, then as a OB/GYN in several countries, I had to be involved with four, yes 4, medically necessary circumcisions on newborns in over 40 years as a health care provider! I have never participated in medically unnecessary circumcisions on a boy or girl. Even when the cost was my job. Also I am not sure why you think your sons would need a circumcision by age 2 or even 22? Foreskin maintenance adds less than 10 seconds to a daily cleaning regiment.

In my experience as a nurse and later as an OB/GYN, I know that over a patient's lifetime, the female labia is far, farmore prone to problems than the male foreskin. That doesn't mean I feel it is ethical to preemptively remove labia tissue from my newborn girl patients to prevent the possible of future problems. When I have had to remove tissue from patients of any age due to disease or deformity, I have always used anesthesia. No one has ever proven to me that a newborn's nervous system is too undeveloped to feel pain. As a mother and a health care provider I would not let someone cut off parts of my son or daughter without a pretty d*mn good reason!

Here are a few points I would like to make that I am sure I will get flamed on but here it goes:

  • Many health professionals believe the foreskin/glans member combination is a nightmare that has to be removed from birth to prevent trouble. For some reason, those same professionals apparently think the labia is less problem prone and should remain intact.
  • Most U.S. healthcare professionals have not actually talked to many males who have had circumsisions in adulthood. So most of their opinions are based on hearsay, religion and tradition.
  • Based on a WHO report many actually believe the foreskin makes transmission of HIV much more possibe. Yet how many of you have really looked at the numbers. Look at this link from Consult2 on this thread: https://allnurses.com/ob-gyn-nursing/the-circumcision-discussion-195222-page100.html#post3498869
  • When the discussion is about performing male circumcisions in the U.S., the politically correct thing to do is to offer "parent choice" and to provide objective "unbiased pros and cons" about the procedure. When the discussion is about performing female circumcisions in the U.S., the politically correct thing to do is to call the authorities to have the "poor girl" taken in to State custody to prevent genital mutilation.
  • The foolproof way to avoid an uncomfortable discussion or choice you have to make about circumcision is to bring up freedom-of-religion or culture background. Health care providers absolutely hate to offend a culture, much less a religion. Actually, foolproof and absolute are a bad choice of words on my part because the above only applies to male circumcisions. No matter what religion or culture you are from you will be hard pressed to find a health care professional who will even make a small slice in to a newborn female's genitals without a medical reason.

Many of my female colleagues who have circumcised their sons oppose female circumcision because they say it removes sensitive tissue that prevents a woman from enjoying sex and/or having orgasms. When I asked them how many "circumcised" female patients they have actually ever dealt with I almost always get a blank. Unfortunately, I have personally dealt with well over a 1000 such cases throughout my career. Many of these women can enjoy sex and do have orgasms. Of course many cannot, it depends on many factors. Just don't offer medical opinions on something you have never studied or seen in the field, it is irresponsible. I would never try to teach any of you Brain or Heart Surgery because that is beyond my scope of knowledge/practice.

Many of these same female colleagues say that removal of the foreskin does not have an effect on a males sensation or ability to orgasm. To which I reply, "HOW COULD YOU POSSIBLE KNOW, YOU ARE A WOMAN?!" At this point I am usually flamed and called a female sexiest (ha,ha,ha)! After a while most of them see my point. No matter how many medical degrees I have, as a woman, I can't possible know what it is like to a have a foreskin. Much less to have one removed without anesthesia, though I don't want to even think about that one. So at the risk of sounding offensive, I have to say that an uncircumcised man's opinion has more weight on this topic than anyone. As a mother, when it comes to pregnancy and childbirth, I am sure my opinion counts more than any males. No offense intended for my male colleagues.

I mentioned earlier that I was involved with few medically necessary circumcisions. When I was overseas I talked to many male patients who had the procedure performed on them as adults for religious, cultural and spousal acceptance reasons (long story). I had not had children yet and wanted "unbiased" opinions. The vast majority told me it did reduce their sensation and made orgasm more difficult. They said the glans became very irritated and painful after the procedure because it was no longer "protected" from direct contact with clothing. Then they said the skin on the glans changed "texture", became thicker and was much duller in sensation than it was before the operation. If pre-circumcision feeling was at 10, they said within a few months after the operation they were averaging between 3-6. They were not the only ones who noticed problems. Their spouses were complaining too because they were aware that something changed. Some wanted to reverse the operations. Though back then...

I have more to say on this but I will cut it short for now. I did not circumcise any of my boys or girls. Its very simple:

  1. Always practice "do no harm".
  2. If it ain't broke don't fix it.
  3. Baby boys and girls aren't designed with non-essential throw-away parts.
  4. Babies feel pain too.
  5. Just because a practice is old doesn't mean it is right.
  6. When a child turns 18, they can make their own medical choices.

DNP2004

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