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 :)

[deege58]

Congratulations, what a lucky boy. :)

:yeah:I'm with Joe, congrats on your little(intact) boy, so happy for you!!

[Belinda-wales, RN]

Been away for a while and delighted to see the debate still in full swing although the pro argument is amusing world war 11 I believe the UK was in that one no massive out break of infection affecting the status of the country and you know we old people as well and men are intact and flooding the NHS with massive problems.:wink2: In simple in UK circumcision is seen what it is barbaric. I compare it with the cutting of epitomes - why do that I know just in case they tear- and of course may save a few minutes of the providers time. Circumcision is nothing more than a money making process - plan and simple - the empire has new clothes people.

[Valerie Salva, BSN, RN]

this should rarely to never be an issue, the problem is staff is unaware/unwilling to give appropriate care.

Wrong.

Strictures of the foreskin are in no way caused by anything staff does or does not do.

[AirforceRN, RN]

Wrong.

Strictures of the foreskin are in no way caused by anything staff does or does not do.

And are usually fixed in infanthood

[Joe12]

Wrong.

Strictures of the foreskin are in no way caused by anything staff does or does not do.

I don't think I agree with this. Premature retraction by Doctors and other medical staff, which is any retraction that occurs before the child knows he can do it himself, can cause tears and scaring which may cause problems for him down the line. In most cases, staff should not do any retraction of an intact boy.

[morte, LPN, LVN]

I don't think I agree with this. Premature retraction by Doctors and other medical staff, which is any retraction that occurs before the child knows he can do it himself, can cause tears and scaring which may cause problems for him down the line. In most cases, staff should not do any retraction of an intact boy.

i think she was referring to my post, in response to her post, about elderly men........and i would think i have a point.....if unable to do his own care, and it isnt provided, infection, which i thought was her point, would be more likely.......also, joe, you obviously know more about this subject than i do. I thought i had read somewhere that SOME elderly men's foreskins become unretractable and that you could do damage in trying to do that as well as in a child.......yes/no?

[AirforceRN, RN]

"In adult men, paraphimosis typically occurs in the elderly. The condition is associated with poor hygiene and chronic balanoposthitis. The chronic infection is postulated to cause a contracture of the opening of the prepuce (phimosis). This contracture forms a fibrotic ring of tissue, which leads to constriction when the foreskin is retracted over the pliable glans."

I stand corrected. Apparently it happens late in life too.

[consult2]

http://www.emedicine.com/med/topic2874.htm

Paraphimosis is a relatively uncommon condition and occurs less often than phimosis.

Paraphimosis is almost always an iatrogenically or inadvertently induced condition. The condition occurs more often in hospitals and nursing homes than in the private community. In the private community, either the affected individual or a parent often retracts the prepuce and then inadvertently leaves it in its retracted position. In most cases, the foreskin reduces on its own and therefore precludes paraphimosis; however, if the slightest resistance to retraction of the prepuce is present, leaving it in this state predisposes it to paraphimosis. As edema accumulates, the condition worsens.

According to the National Hospital Discharge Survey, a trend in the United States over the last 30-40 years has been toward noncircumcision. Circumcision rates, which were at an all-time high of 78-80% in the mid-to-late 1960s, decreased to 55-60% in 2003. With more uncircumcised individuals, paraphimosis has the potential to become more common. Because paraphimosis is a condition that is almost always iatrogenically or inadvertently induced, simple education and clarification of proper prepuce care to parents, the individuals themselves, and health care professionals may be all that is required to prevent this problem.

[meluhn]

http://www.emedicine.com/med/topic2874.htm

Paraphimosis is a relatively uncommon condition and occurs less often than phimosis.

Paraphimosis is almost always an iatrogenically or inadvertently induced condition. The condition occurs more often in hospitals and nursing homes than in the private community. In the private community, either the affected individual or a parent often retracts the prepuce and then inadvertently leaves it in its retracted position. In most cases, the foreskin reduces on its own and therefore precludes paraphimosis; however, if the slightest resistance to retraction of the prepuce is present, leaving it in this state predisposes it to paraphimosis. As edema accumulates, the condition worsens.

According to the National Hospital Discharge Survey, a trend in the United States over the last 30-40 years has been toward noncircumcision. Circumcision rates, which were at an all-time high of 78-80% in the mid-to-late 1960s, decreased to 55-60% in 2003. With more uncircumcised individuals, paraphimosis has the potential to become more common. Because paraphimosis is a condition that is almost always iatrogenically or inadvertently induced, simple education and clarification of proper prepuce care to parents, the individuals themselves, and health care professionals may be all that is required to prevent this problem.

I saw this condition once. The man had fluid building up in his retracted foreskin. It was like a big bubble on one side and to a lesser extent, all the way around like a donut. I told the MD right away because I had never seen anything like this. When the urologist came in later that day he was mad that no one had called him earlier. He said that the man's member could have become necrotic and possibly... I shutter to think.

He ended up squeezing the poor pt member and pulling the foreskin back down. Judging by the way the man yelled, it was very painful. The poor guy had had a stroke and couldn't take care of his own br/hygiene needs.

[Valerie Salva, BSN, RN]

I don't think I agree with this. Premature retraction by Doctors and other medical staff, which is any retraction that occurs before the child knows he can do it himself, can cause tears and scaring which may cause problems for him down the line. In most cases, staff should not do any retraction of an intact boy.

I'm not talking about children-

I had posted that I have had a number of elderly, male nursing home pts who been circumcised as elderly, adult males- due to problems woth foreskin strictures. One poster reponded that the problems were probably due to lack of care by nursing home staff. This was not the case. Many alert, male nursing home pts refuse hygeine care- it has always been a battle with many of them.

Seeing (and smelling) an 80+ yr old man with his foreskin stuck to him in a layer of filth is a memorable event. Trying to clean it up is even more memorable.

I also had a male family member who got circumcised @ age 34 because of problems with strictured foreskin.

I've known of pts who've beed cicumcised as adults because of recurrent yeast infections. Some people have this problem, despite good hygeine.

[Equinox_93]

... You're saying that the problem was that they refused care. This is not a problem with the foreskin- it is a problem with staff being unable to effectively encourage cooperation with basic hygeine requirements. (They may not be doing anything wrong- or neglecting the resident- but the point is that infection is caused by care not given. The care isn't being given if the care is refused.)What policies/procedures are there for residents who refuse *other* hygeine requirements? The combative resident who is laying in excrement, or who keeps refusing mouth care, for example. The problem IS with lack of proper hygeine care by nursing home staff- as the smegma and possible infection buildup due to lack of hygeine provided is what causes the strictures in most cases in nursing home residents. Does the resident have a right to refuse? Sure. But at the same time- there are ways to encourage acceptance of care. The concern can also be raised by the nurse to the doctor who can consider various other methods of gaining compliance if the nurse is having difficulty. In MOST cases the foreskin need never be removed. In young adults with strictured foreskin, MOST cases are easily correctible via non-surgical means. Recurrent yeast infections can often be cured by dietary changes, possible supplementation, medication etc. Also, it is not only intact males who can acquire yeast infections. If a person suffers from recurrant untreatable yeast infections- they may be predisposed to it and circumcision may not cure the problem. I'd first pursue all NON-surgical methods before removing a body part due to a yeast infection. MHO. (Infections can also be caused by leaving a bit of soap in between the foreskin/member- or in women not cleaning all soap from the labia- which is VERY easy to do if one isn't very careful about it.) In residents who are elderly and lacking manual dexterity- this can be a very big issue. (They may be alert, but that doesn't necessarily mean that they are cleaning properly)

I'm not talking about children-

I had posted that I have had a number of elderly, male nursing home pts who been circumcised as elderly, adult males- due to problems woth foreskin strictures. One poster reponded that the problems were probably due to lack of care by nursing home staff. This was not the case. Many alert, male nursing home pts refuse hygeine care- it has always been a battle with many of them.

Seeing (and smelling) an 80+ yr old man with his foreskin stuck to him in a layer of filth is a memorable event. Trying to clean it up is even more memorable.

I also had a male family member who got circumcised @ age 34 because of problems with strictured foreskin.

I've known of pts who've beed cicumcised as adults because of recurrent yeast infections. Some people have this problem, despite good hygeine.

[CEG]

I'm not talking about children-

I had posted that I have had a number of elderly, male nursing home pts who been circumcised as elderly, adult males- due to problems woth foreskin strictures. One poster reponded that the problems were probably due to lack of care by nursing home staff. This was not the case. Many alert, male nursing home pts refuse hygeine care- it has always been a battle with many of them.

Seeing (and smelling) an 80+ yr old man with his foreskin stuck to him in a layer of filth is a memorable event. Trying to clean it up is even more memorable.

I also had a male family member who got circumcised @ age 34 because of problems with strictured foreskin.

I've known of pts who've beed cicumcised as adults because of recurrent yeast infections. Some people have this problem, despite good hygeine.

Keep in mind that in the US circumcision is our first solution to problems with the intact member. In countries with lower circumcision rates, health care providers are more accustomed to working with a normal member and do not jump to circumcision as a first line cure. Oddly, the rate of adult circumcision is LOWER in countries where infant circumcision is not the norm, which is the opposite of what I would expect. It's all about perspective.