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]

:yeah:

The difference is he can choose to abandon his faith for another...can't say the same for a circumcised boy

:yeah::yeah: Thank you!!!

[Balder_LPN, LPN]

Ok, now I have to ask..WHAT are these FACTS that support circumcision--by facts, I mean those that can be scientifically supported?

In the end one must decide for THEMSELVES--not make this decision for non-consenting infants.

If one cannot be swayed by the facts, woe be to them--them are choosing to remain irrational!

You can find paper after paper of peer reviewed, published, scientific studies that support both. Several have shown a lower incidence of HIV infection in areas of Africa for men who are circumscised.

Thats why it's a personal choice, and parents make many choices for their children who are not yet competent to make thier own. I am sure glad mine was done as an infant when I don't remember it. I would certainly have wanted it done as a teen (90% of my peers were cut), but would not likely have choosen to go thru the painful procedure.

BTW I have assisted with a few and the babies get a local (most doctors these days) and they Don't always scream, nor do we feel that we have been Maimed. The first TWO i was present for had no screaming, just a little boy sucking on my gloved finger.

It surprises me how militant some of these voices seem, and they seem to be almost exclusively women. maybe they can let the men police this almost exclusively male issue. I dont know of any support groups for men who feel they are maimed, or deformed by having been circumscised, nor do I know of any male, personal or professional knowledge, that has any issues with being cut (although I am sure I will hear of several any second now)

[Equinox_93]

Sorry, but if I carry someone around in my womb for 9 months and then push or have them cut out of my body and am responsible for raising them for 18 years, you better damnwell believe that I'm going to have a say in what happens to that person, whether they share my gender or not. :)

Further- my husband was circ'd, and he was even more adamant than myself that our son NOT be cut.

Do a google search on foreskin restoration... You'll read several accounts of adult men who do have issues with having been circ'd. You will also find those support groups for men who do feel that they have been maimed and that the choice had been taken from them.

http://www.norm.org/

Just because you haven't heard of it doesn't mean it's not out there :)

It surprises me how militant some of these voices seem, and they seem to be almost exclusively women. maybe they can let the men police this almost exclusively male issue. I dont know of any support groups for men who feel they are maimed, or deformed by having been circumscised, nor do I know of any male, personal or professional knowledge, that has any issues with being cut (although I am sure I will hear of several any second now)

[consult2]

"You can find paper after paper of peer reviewed, published, scientific studies that support both. Several have shown a lower incidence of HIV infection in areas of Africa for men who are circumscised."

Sure you can, there is a 100 year history of studies CLAIMING benefits for circumcision, and none of them have ever found to be scientifically credible.

And these studies have yet to be supported by the empirical evidence in the real world! In fact, the empirical evidence contradicts this claim, so don;t try to use this as an excuse..find a scientifically-PROVEN benefits and then come back.

As for "personal choice, this is a tired old oxymoron when this choice was taken away form the person owning the member.

" I am sure glad mine was done as an infant when I don't remember it."

WHY? there is no benefit and you are missing 3/4 of your penile sensations and sensitivity? Sure doesn't sound rational to me.

[consult2]

"BTW I have assisted with a few and the babies get a local (most doctors these days) and they Don't always scream, nor do we feel that we have been Maimed. The first TWO i was present for had no screaming, just a little boy sucking on my gloved finger."

Nonsense! all methods of anesthesia only REDUCE the pain..and as for not screaming, many go into a trauma-induced come.

whether or not one does not "FEELS maimed", hardly means one is not!

How about a FEW who are not happy with having been circumcis-- or rather how about MILLIONS!!

http://www.noharmm.org/synopsis.htm

http://www.noharmm.org/bodyimage.htm

http://www.noharmm.org/bju.htm

This survey indicated there are 52 million men in the US that are dissatisfied with their circumcision. This number almost exactly duplicates a study in Journeyman in 1992. It must be fairly accurate.

192 respondents (average age 44 years,85% circumcised

circumcised intact

Satisfied 38% 78%

Dissatisfied 20% 3%

Ambivalent 41% 17%

[consult2]

"BTW I have assisted with a few and the babies get a local (most doctors these days)"

Sure they do...

A recent retrospective study was performed at a top hospital in Chicago.

Publlshed October 11, 2004, by Peggy Peck, this study is titled "Analgesia Underused for Management of Circumcision Pain".

In this study, a researcher went back through 5 years (1999-2004) of hospital records and checked whether anesthetic use had been recorded.

Out of 108 circumcisions, only 8 were marked for anesthetic.

The researcher couldn't believe it, so they checked the pharmacy charts to see whether anesthetic had been ordered.

They found that anesthetic had been ordered from the pharmacy, for only 35%-40% of circumcisions.

An excerpt from the study:

Of 191 male infants identified in the review of 400 charts, "56% underwent circumcision," .....

.....

All circumcisions were performed by obstetricians. "Dorsal penile block was used in seven infants and subcutaneous ring block was used in one infant,"...

....Another telling finding, he said, was that the medical charts indicated no discussion of circumcision pain management with parents.

If you want to view it instead of just taking my word for it, first you must register here:

https://profreg.medscape.com/px/registration.do?cid=med

Then click this link:

http://www.medscape.com/viewarticle/491035

[xokissmekatexo]

I'm only a nursing student but I just finished my clinical rotation in OB. There wasn't a whole lot going on for us to get involved in so when circumcisions were being performed, we all watched. I think in the 12 weeks of clinical rotation I probably saw 8 circumcisions. Every doctor I observed performing a circumcision used a numbing agent. It is standard now (that's what the doctor told me). Babies are unable to localize pain, so when they are hurt, they feel it everywhere. That's why nurses (good nurses) will keep the baby swaddled and only take out a leg when they give injections. When the baby boys are strapped down in the nursery to have the circumcision performed, they are upset with the fact that they can't pull their arms and legs in towards their bodies. They are most likely NOT crying because they are in pain. The initial poke of the injection causes some discomfort. The nurses I watched all had a pacifier with sugar water ready because glucose (sugar) is shown to have an analgesic effect on infants.

I don't know the specific name of the medication the doctors used to numb, but I know it works, because I watched one little boy sleep through his circumcision!

Hope this helps!

[consult2]

"I don't know the specific name of the medication the doctors used to numb, but I know it works, because I watched one little boy sleep through his circumcision!"

It is called lidocaine--and it only REDUCES the pain..

"In summary, analgesia is safe and effective in REDUCING the procedural pain associated with circumcision " (emphasis added)

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/686

EFFECT OF NEONATAL CIRCUMCISION ON PAIN RESPONSE

THE LANCET, Volume 349 Number 9052: Pages 599-603, March 1, 1997.

Meritcare (Internet) states that "Besides anesthesia, securing your child in the padded restraint chair and giving him a sugar-dipped pacifier can help reduce his level of stress (and yours). Used together, these methods can decrease discomfort by more than 50%."

http://www.meritcare.com/kidshealth/PageManager.asp?dn=MeritCare&ps=104&article_set=22652&cat_id=177&lic=19&pg=3

http://www.nichd.nih.gov/cochrane/BradyFryer/BRADYFRYER.HTM

None of the studied interventions completely eliminated the pain response to circumcision

As for when it is used, what didn't you understand about the rate of usage I posted above.

Sleep through it?

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

"They are most likely NOT crying because they are in pain. The initial poke of the injection causes some discomfort. The nurses I watched all had a pacifier with sugar water ready because glucose (sugar) is shown to have an analgesic effect on infants."

I can't believe medical people are still trying to use this tired old rationale.

http://www.cirp.org/news/cin/1995.04.12

993; 270: 850-53 [benni F et. al] Their study confirmed the permanent psychological damage inflicted on infants subjected to unanesthetised penile reduction surgery. The severe and unalleviable pain of circumcision permanently alters the neural pathways in an adverse fashion. From JAMA 1988; 259: 1507-11 [stang HJ, et. al] They found that an injection of lignocaine hydrochloride reduced the plasma cortisol concentration slightly, but left the babies with a concentration of 331nmol/L, whereas a content infant at rest has a plasma cortisol concentration of 28-138 nmol/L. Sadly, the Benni group found that EMLA (lignocaine/prilocaine local anesthetic cream) could only reduce the circumcised child's heartbeat from 180 to 160 beats a minute. No infant's heart should beat at 160 beats a minute, nor should his plasma cortisol concentration be 331 nmol/L. These rates are consistent with torture. With or without anesthetic circumcision will cause psychoneural damage.

Note: the change in the heartbeat rate is 60 bpm.

The above values includes this increase. Therefore the delta rate of 60 must be added to ANY resting rate to determine the absolute values. Then the comparison of rates can be done with other procedures.

PEDIATRICS, Volume 71 Number 1, Pages 36-40,

January 1993.

Physiologic Stress Reduction by a Local

Anesthetic During Newborn Circumcision

Paul S. Williamson, MD, FAAFP, and Marvel L. Williamson, RN, MSN

http://www.cirp.org/library/pain/williamson/

http://www.cirp.org/library/anatomy/cold-taylor/

Although most neonatal and childhood circumcisions are performed with no anaesthesia [37], the complicated innervation of the member explains why a dorsal penile nerve block provides incomplete pain relief for neonatal male circumcision [37,38].

Likewise, a penile ring block cannot block the visceral afferent fibres from the cavernosal nerve nor the posterior scrotal somatosensory branches of the perineal nerve [38]. A eutectic mixture of local anaesthetic cream (EMLA) does not relieve the pain associated with circumcision because of the complexity of penile innervation and the multiple layers that would have to be penetrated by the topical cream in the newborn member [39]. Amazingly, some modern urology textbooks even recommend wine as an anaesthetic for newborn circumcision [24].

"Pain and its Effects in the Human Neonate and Fetus." By K.J.S. Anand & P.R. Hickey. New England Journal of Medicine, November 19, 1987. Page 1325 states: "Most recently the motor responses of 124 healthy full-term neonates to a pinprick in the leg were reported to be flexion and adduction of the upper and lower limbs associated with grimacing, crying, or both, and these responses were subsequently quantified. Similar responses have also been documented in very premature neonates, and in a recent study, Fitzgerald et al. found that premature neonates (

"Symptom Management: Acute Pain, Chapter 3 - Pain in Preverbal Children." United States National Institutes of Health, Publication Number 94-2421. June 1994.

Accessed at http://www.nih.gov/ninr/research/vol6/preverbal.pdf in September of 2002. Page 2 cites one possible reason why younger humans are more sensitive to pain: "Serotonin (5HT) is a biogenic amine transmitter that serves an important role in pain modulation. … Serotonin levels in the young infants are low and may limit the effectiveness of the endogenous pain control mechanisms (Fitzgerald 1991b)."

[Joe12]

You can find paper after paper of peer reviewed, published, scientific studies that support both. Several have shown a lower incidence of HIV infection in areas of Africa for men who are circumscised.

Thats why it's a personal choice, and parents make many choices for their children who are not yet competent to make thier own. I am sure glad mine was done as an infant when I don't remember it. I would certainly have wanted it done as a teen (90% of my peers were cut), but would not likely have choosen to go thru the painful procedure.

There has been a lot of discussion about those studies and the bottom line is that even if they are accurate the prevalence in the US does not justify the use. But let me ask you about the bold part. How can you justify authorizing a procedure for someone when you yourself wouldn't go through it? That is one of the primary considerations of proxy consent, the substitute judgment test and why when have procedures performed with proxy consent it is necessary that the least invasive, reasonably effective option always be taken first. Hint, circumcision isn't it.

BTW I have assisted with a few and the babies get a local (most doctors these days) and they Don't always scream, nor do we feel that we have been Maimed. The first TWO i was present for had no screaming, just a little boy sucking on my gloved finger.

It surprises me how militant some of these voices seem, and they seem to be almost exclusively women. maybe they can let the men police this almost exclusively male issue. I dont know of any support groups for men who feel they are maimed, or deformed by having been circumscised, nor do I know of any male, personal or professional knowledge, that has any issues with being cut (although I am sure I will hear of several any second now)

I am a guy most people I knew were cut I wouldn't have wanted it done and I think it's abuse. I also have several friends who while not openly hostile are irritated that they were 'cut' for no good reason and would have preferred the choice. Standard medical ethics should have stepped in to give them that choice but for some reason there is an exception to circumcision in the code of medical ethics.

Let me ask you this, if I surgically removed a infant's earlobes, and of course I would use ELMA or Lido so it wouldn't hurt, would you find that acceptable? Why or Why not?

ETA: And you should google foreskin restoration. There are more than a few people who are making a very comfortable living selling devices to help restore.

[Joe12]

I'm only a nursing student but I just finished my clinical rotation in OB. There wasn't a whole lot going on for us to get involved in so when circumcisions were being performed, we all watched. I think in the 12 weeks of clinical rotation I probably saw 8 circumcisions. Every doctor I observed performing a circumcision used a numbing agent. It is standard now (that's what the doctor told me). Babies are unable to localize pain, so when they are hurt, they feel it everywhere. That's why nurses (good nurses) will keep the baby swaddled and only take out a leg when they give injections. When the baby boys are strapped down in the nursery to have the circumcision performed, they are upset with the fact that they can't pull their arms and legs in towards their bodies. They are most likely NOT crying because they are in pain. The initial poke of the injection causes some discomfort. The nurses I watched all had a pacifier with sugar water ready because glucose (sugar) is shown to have an analgesic effect on infants.

I don't know the specific name of the medication the doctors used to numb, but I know it works, because I watched one little boy sleep through his circumcision!

Hope this helps!

Same question: If I surgically removed a infant's earlobes, and of course I would use ELMA or Lido so it wouldn't hurt, would you find that acceptable? Why or why not?

[natusia84]

We have circs done A LOT in our hospital. I think, personally, I would want my son to be circumcised only if I knew the OB had a good reputation for making the procedure as quick and painless as possible, because I have seen way to many Residents doing a job gone wrong.

[dnp2004]

we have circs done a lot in our hospital. i think, personally, i would want my son to be circumcised only if i knew the ob had a good reputation for making the procedure as quick and painless as possible, because i have seen way to many residents doing a job gone wrong.

if you son has a healthy foreskin why would you want him circumcised at all? i am an ob/gyn and only have had to perform four medically necessary circumcisions in my whole career. i'm in my 60's.

i never have performed them based on parental requests. when i was overseas it was considered a cosmetic procedure that was forbidden unless it was to correct a disorder.