Explaining circumcision to mom....

Equinox_93 · Mar 3, 2009

... Well- this is one of those cases where you have to learn how to not share your own opinion- even when asked... There are some medical benefits to circumcision- but there are some risks as well... The risk/benefit ratio is a draw. The best course of action is to explain the risks/benefits- state that it is essentially cosmetic- and refer back to them by asking "what do you think?" I'd be VERY wary of offering opinions on ANYTHING medical that isn't in your scope of practice or relates to a personal opinion. MHO.

However- that said- you did share that opinion- and the doctor came down on you for it... You could then ask him to refute your facts- or to specify exactly what policy you were breaking by sharing that opinion. If he is a doctor you normally work with, you could then ask what he feels appropriate in situations where the patient is asking you directly for your advice/opinion. This may be to refer them to him for medical advice- but in cases such as this- it's touchy because it is an issue of giving medical advice but it's also an issue of being asked a parenting question that isn't solely related to the medical aspects...

This is why it's often better to NOT share ones opinion. Because doing so can get complicated.

rn/writer, RN · Mar 3, 2009

I have researched for myself that the AMA, the pediactric association (whatever it names itslef) and many other references all are acutally against the procedure.

The most recent statement I can find regarding the the AAP's (American Academy of Pediatrics) position is one of neutrality toward circumcision, neither recommending routine neonatal circumcision nor discouraging it. The AMA endorses the AAP's statement.

Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided.

There is a big difference between saying there isn't sufficient data to recommend something and coming out against it. If the AAP and AMA were truly declaring their organizations to be anti-circumcision, I doubt they would so readily leave the decision, in most cases, to the parents.

In your situation, the following sentence may give you some guidance:

To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision.

If you do not see yourself being able to offer unbiased information (meaning you can have a bias; you just can't allow it to show), then you might want to defer this part of your patient's care to either the ped/OB or another nurse who can explain the procedure and its risks vs. benefits in an impartial manner.

Another suggestion is that your unit provide parents with an information sheet that covers the topics with both the risks and the benefits presented in a factual, non-emotional manner. This could certainly include the AAP statement along with your unit's policy regarding pain management.

Incidentally, both the AAP and the AMA stress giving serious attention to adequate pain management before, during, and after the procedure.

dnp2004 · Mar 12, 2009

Yes, if most people were to look at the facts, I don't think they would circumcise a boy or girl. The problem is the issue isn't about facts. It is about religion, culture, appearance, & last but not least, hospital revenue. It is as if the foreskin was a mistake-in-creation or some form of Devine design flaw. As with other polarizing subjects such as abortion, stem cell research, opposite-gender intimate care, and racial attitudes, most people’s minds are made up before we healthcare professionals even see them. So quite honestly I don’t know if “patient education” is even warranted here.

Very soon height, skin color, hair texture, eye color, nose shape and bust size will be selectable. I have the feeling a few years in the future parents will be able to genetically engineer their newborns to be absent of religiously/culturally undesirable genitalia (foreskin, labia, privy parts, etc.). Maybe none of use will be having this conversation in the future.

Equinox_93 · Mar 12, 2009

Yes, if most people were to look at the facts, I don't think they would circumcise a boy or girl. The problem is the issue isn't about facts. It is about religion, culture, appearance, & last but not least, hospital revenue. It is as if the foreskin was a mistake-in-creation or some form of Devine design flaw. As with other polarizing subjects such as abortion, stem cell research, opposite-gender intimate care, and racial attitudes, most people's minds are made up before we healthcare professionals even see them. So quite honestly I don't know if "patient education" is even warranted here.
Very soon height, skin color, hair texture, eye color, nose shape and bust size will be selectable. I have the feeling a few years in the future parents will be able to genetically engineer their newborns to be absent of religiously/culturally undesirable genitalia (foreskin, labia, privy parts, etc.). Maybe none of use will be having this conversation in the future.

Well- given that it *has* been proven to decrease STD transmission, I don't think the issue is quite as simple as merely giving parents "the facts" and it being as clear cut as all that.

Also- the "divine mistake" point only works with those who are religious :wink2:

Personally, we chose NOT to circ our son- but as I do see "the facts" and they are as much for it as against it- a fairly even split- I can certainly see why some would choose to go for it- especially in areas where HIV and other STDs are especially rampant. People see that first hand and see a way to cut that risk for their child- even if it's not a guarantee- most parents view protecting their offspring as a high priority and will do anything they can to do so. Even if it means snipping a bit of skin and taking the risk of that surgical procedure. The point is that each parent has to do their own risk/benefit ratio for their own circumstance- and what they anticipate being issues for their offspring. Their own experiences and biases will play into that, of course- but when "the facts" are neutral with as many pros as cons- it becomes a personal decision and that risk/benefit ratio has to be applied individually.

mama_d, BSN, RN · Mar 12, 2009

To answer your post, I'd probably tell them that there is debate on the topic, and to discuss the pros and cons with their doctor. That way you were being factual and putting the ball back in his and their court, where it rightfully belongs.

I have to share my story about this topic, even though you'll all laugh at me about it....

When our oldest son was born, I hadn't even had a thought about becoming a nurse. Had no experience with the medical community at all beyond your typical doctor's visits as a child, then with my OB. At that point in my life, I had seen exactly three memberes...my baby brother's, my hubby's, and my step-son's. All were circumsized.

When DS was born, and I was out of the drug haze, I was almost hysterical...there was something wrong with my poor baby's member! My husband and my nurse almost died laughing, as they tried to explain to me that he just wasn't circumsized yet, and there was nothing wrong with it. I was so relieved!

Our sons are all circumsized, by the time I realized that there was a debate about the topic when our last baby was born, I had seen WAY too many nasty old men uncircumsized memberes from NHs, and figured that if I could give him a shot at avoiding that discomfort later on in life it was worth the quick snip. (They did give him something first; my OB and I were definately on the same page about that....she seemed shocked that I even asked to verify that there would be pain control during and after.)

Equinox_93 · Mar 12, 2009

... If nursing assistants and nurses were taught to take care of uncircumcised memberes correctly, then you wouldn't be seeing that problem with the "nasty old uncirc'd memberes" from the NH's...

To answer your post, I'd probably tell them that there is debate on the topic, and to discuss the pros and cons with their doctor. That way you were being factual and putting the ball back in his and their court, where it rightfully belongs.
I have to share my story about this topic, even though you'll all laugh at me about it....
When our oldest son was born, I hadn't even had a thought about becoming a nurse. Had no experience with the medical community at all beyond your typical doctor's visits as a child, then with my OB. At that point in my life, I had seen exactly three memberes...my baby brother's, my hubby's, and my step-son's. All were circumsized.
When DS was born, and I was out of the drug haze, I was almost hysterical...there was something wrong with my poor baby's member! My husband and my nurse almost died laughing, as they tried to explain to me that he just wasn't circumsized yet, and there was nothing wrong with it. I was so relieved!
Our sons are all circumsized, by the time I realized that there was a debate about the topic when our last baby was born, I had seen WAY too many nasty old men uncircumsized memberes from NHs, and figured that if I could give him a shot at avoiding that discomfort later on in life it was worth the quick snip. (They did give him something first; my OB and I were definately on the same page about that....she seemed shocked that I even asked to verify that there would be pain control during and after.)

dnp2004 · Mar 13, 2009

... If nursing assistants and nurses were taught to take care of uncircumcised memberes correctly, then you wouldn't be seeing that problem with the "nasty old uncirc'd memberes" from the NH's...

This is very true. When I was practicing in parts of Europe where circumcision was virtually nonexistent, we did not have a lot of foreskin problems. Besides, I wonder how many health professionals would advocate cutting off labial tissue to prevent lady partsl infections? Is the foreskin that much "dirtier", problem prone and a such a maintenance nightmare compared to the labia?

Equinox_93 · Mar 13, 2009

This is very true. When I was practicing in parts of Europe where circumcision was virtually nonexistent, we did not have a lot of foreskin problems. Besides, I wonder how many health professionals would advocate cutting off labial tissue to prevent lady partsl infections? Is the foreskin that much "dirtier", problem prone and a such a maintenance nightmare compared to the labia?

Yes!

I heard a story recently about a nursing home situation where an uncirc'd resident had to have crusted smegma soaked off because the staff just wasn't taught how to properly retract and cleanse the member and foreskin! It's all about education.

Since the foreskin reportedly has so many additional nerve endings and offers greater sensation, protection, lubrication etc. I'm amazed at how many advocate its removal... Women would be taking up arms if anyone suggested removing the labia- but who cares about the foreskin :rolleyes: Now certainly- if one were choosing to circ for individual reasons that made the decision more pertinant for their specific situation- OK whatever- but to do it just to do it? I fully support the personal decision aspect of the issue- however, I find far too many parents who make the choice "because everyone else is doing it" or "because Dad is" or "because it looks nicer" and not doing it for any sort of valid *medical* justification. :banghead:

vashtee, RN · Mar 13, 2009

WHO, I believe, is advocating circumcision to help reduce the HIV transmission rates.

rn/writer, RN · Mar 13, 2009

The OP asked about how to explain circumcision to parents.

Here is the thread in which to discuss the pros and cons of circumcision:

https://allnurses.com/ob-gyn-nursing/the-circumcision-discussion-195222.html

vashtee, RN · Mar 13, 2009

I believe if a person can't bring themselves to give unbiased information, they should defer any explanations to the PCP. To do otherwise is an abuse of your position of authority.