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 :)

[Jo Dirt]

When I was in nursing school when I did my OB rotation I remember them doing a circumcision. They brought the poor little baby in the nursery and I remember them taking out this board and strapping the little guy to it. I couldn't watch but I remember the screaming.

This happens to be the hospital where I will deliver. I think my husband wants the baby to be circumcised but he is concerned about the pain as well.

Do they generally use anesthetic? Do most people opt out of circumcision anymore, at least at the hospital?

[CSLee3, ASN, BSN, LVN, EMT-P]

Okay, I will bite...tree huggers don't all attack me at once....speaking as a male...get the circ. Your child will thank you when he grows up in this cruel unfair world. This is a hot topic with a lot of schools, folks and so on. There is so much research and stats out there it can be confusing. Most reports I have seen are in support of the procedure, citing HIV rates and STD transfer rates as well as cancer. Of course we all know studies can be slanted any way the author intends. REALISTICALLY...my SO is L&D clinician..she says that at her facility the rates for circ run about 60% for and 40% not doing procedure. Some choices are based on education, research by the family, some by religion or culture, but quite honestly a good portion of these new moms can't even spell their name much less know the father and the rationale of circumcision or not is the last thing on their mind. These moms don't want the nurse to change the channel, casue Springer is on, or they need a smoke break. Getting back to your question...

Some docs use suprapubic blocks with lidocaine, some use local lido cream, emla cream pre and post procedure, yet others use nothing. To be honest, I can't remember my procedure, so it must not have caused too much trauma to me as some child experts would say. Usually if they are speaking out about it, they don't have one, or could be a hypocritacle view such as the PETA president talking about us evil meat eaters, and he is wearing a leather watch bank, belt and leather shoes...BUT...SPEAK to the doctor and make your wishes/demands be known. Start a rapport with him or her. (just make sure no epi finds it's way into the lido mix...things can fall off with vasoconstriction! LOL). There is Gomco, Mogan, PlastyBell and good old fashion custom carving! The Gomco procedure and Mogan are very popular in these parts. They go really fast, with minimal side effects. Depending on where you live, your family, friends, social circles...these may very well all have a part in your decision. Make it yours and not any one else's including mine. Most "boys" want to look like their dad..if this if the only reason, so be it. He might well thank you later. However, keep in mind that adults rarely undergo elective circs and once the baby is discharged it is almost impossible for medicaid or insurance, HMOs etc. to pay for it.

Tough decision but considering all the poor baby has to go through like being shoved into this mean world and getting their heels stuck with needles, injections in the thigh and meds in their eyes, etc. etc. the circ turns out to be another unpleasant experiences, if they are premies, they may even get lavage fed, frequent blood draws ,etc. so look at it as another procedure. If we stop one for the pain it causes, should we stop all??? The cord when cut, could transmit pain....hehe you never know what some will come up with.

Anyway...Hope that helps....hang in there and good luck with your new family member!

[dawngloves, BSN, RN]

If I can give you another spin on CSLee3's opinion, I let my husband decide since it was of no matter to me and he, being a man, had a better perspective.

He said "Hell no!" to a circ.I brought up the whole "looking like dad and the other kids", schpeil and he said that his son shouldn't be so privvy to what his father's member looks like and why are other guys checking out his son's member in the locker room?? OK. So no circ and no problems so far.

I do have a problem with CSLee3 comparing a circ to Vit K shots or a feeding tube inthe NICU. A circ is elective and non essential. Things like an ABG or eating are not optional in that setting.

Since your OB will do the circ you should talk to them about how they do it.

[htrn]

I have seen circs done both with and without analgesia. Most OBs I work with use a dorsal penile block with preservative free lidocaine, some even with buffered PF lidociane. I have seen some family practice use emla cream on the member 90 minutes prior to the procedure and 10mg/kg tylenol 2 hours prior to procedure for analgesia. As a side note - picture putting emla on a small moving target and then getting a tegaderm over it - that's one for americas funniest home videos:lol2:

All of the research out there is very confusing. The American Acadamy of Pediatrics recognizes circumcision as an elective procedure, but does not advocate either way. I personally don't know one pediatrician that does them.

There is a social stigma associated with circumcision - but I still think it is more a social stima with the parents than with the kids. My 17 year old has just informed me that it isn't a big deal in his locker room. My pediatrician told me I could explain it as simply as "Dad had a surgery that you didn't need to have."

Again, this is a very personal choice between you and your husband. The line came down on the side of cirucumcision in my house when my hubby so eloquently announced that he was a helmet head and he was not going to have any boys that are aardvarks. If I had to do it all over again, I'd tell hubby to get over it - aardvarks rule!!!

The circs do heal quickly and if the docs use analgesia during the procedure and you are able to use tylenol prn afterward for a couple of days, things should go well.

I would be very adament with the MD about analgesia before, during and after. Believe it or not, they do remember. Studies have been done on pain reaction in infants that were circumcised with and without analagesia and their response to pain (ie immunizations) up to two years after the circ. They remember and it does have long term effects.

Good luck - and there is no such thing as a wrong answer.

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

There are quite a few very good and very long threads about this issue in this forum.

At the risk of repeating myself, I'll just say I was against it and the father of my first two boys was for it (we divorced but not over this;)) My husband now, also wanted it done on our son. So all three boys are circ'd. I asked my adult sons if they are happy about it and if I should have fought harder to keep them intact and they both quickly said NO! They both said they would be very mad at me if I had won the argument.

It is normal during potty training for little boys to see their Dad's member - Daddy shows them how to pee. And boys do check each other out in the locker room - just like girls check out other girls' breasts. When my almost 6 year old was 4, he and a friend went into the bathroom at the playground and were peeing (with dh nearby) and they looked at each other peeing and noticed that one had a larger member than the other one and both mentioned it. (And the argument about looking like Daddy - boys don't look like Daddy until they are adults anyway . . .Daddy is bigger).

As to your question . . . most docs use anesthesia but we have one here who refuses. And he doesn't always tell the parents that.

You need to be proactive and tell the doc what you want. He is working for you.

steph

[indigo]

To circ or not to circ? I am an OB nurse who assists with circs and it is SO totally barbaric-seeming. The babies scream and cry and they come out with a swollen, bloody member. For what. I am also the mother of three uncircumcised sons and none of them have ever had a problem. I am so glad I didn't have them cut on when they were so brand new to the world. I feel so glad when new parents don't want to circ. It's about 50/50 where I work.

[ann945n, RN]

I think this choice is completly up to the parents for various reason like religion and personal preference. Who are we to say what is right or wrong for a family??

But for my personally opinion I would have it done to my sons. So what they cry and scream, babies cry and scream a lot. Its how they communicate, and of course they dont like. Kids also dont like shots for vaccinations or eatting their veggies yet we make them do it anyways.

[dawngloves, BSN, RN]

. Kids also dont like shots for vaccinations or eatting their veggies yet we make them do it anyways.

Because they need these things. There are very few men that need a circumcision.

[ann945n, RN]

Because they need these things. There are very few men that need a circumcision.

Ahhh but some people feel vacinations are not needed.... its all a matter of personal choice is what i was getting at, lets not impose our views on patients

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

I'm an ob nurse too . . . most of the babies don't cry where I work. Still, I personally don't like it.

steph

[dawngloves, BSN, RN]

Ahhh but some people feel vacinations are not needed.... its all a matter of personal choice is what i was getting at, lets not impose our views on patients

It's not my view. It's the AAP guidline that circumcisions are not needed.Vegetables are and I won't go OT on vaccines.

[ayla2004, ASN, RN]

from a uk pov it isn't routinely done at all except if there is a medical need, or religous or cultual reason. as a student i admitted a 19year old for same day surgery for a circ on medical reasons, poor lad fainted pre op. i have an older brother who was circ as a child (not an infant) on medical grounds.