To Circumcise or Not to Circumcise, That is the Question

Parents who are considering circumcision for their newborn male should be educated about the procedure. It is imperative that the pros and cons of a circumcision are explained by physicians and/or nurses so that an informed decision can be made. Specialties Pediatric Knowledge

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To Circumcise or Not to Circumcise, That is the Question

You Are Having A Baby Boy!

Most women are ecstatic when they discover they are pregnant. Although some families choose not to have the sex of the fetus revealed to them during a routine ultrasound, many are counting the days until they can find out if they will be welcoming a baby boy or baby girl into the world. When the sex of the fetus is determined, parents begin making plans for the arrival of their precious newborn.  If the baby is going to be a biological male, circumcision is a procedure that may be discussed.

Nurses Often Asked About Circumcisions

Nurses who work in a hospital nursery or labor and delivery unit are frequently asked questions about circumcisions. Although information about the procedure may be given to parents by the pediatrician who will be caring for the infant or by the obstetrician caring for the pregnant mother, it is imperative that nurses are educated about the procedure as well so that they can give correct information when asked about it.  Most facilities have pamphlets or an educational handout on circumcision to give new parents or guardians.  This type of information may also be given to patients at prenatal visits.

Nurses who are taking care of newborns and/or the mother of the newborn have an awesome opportunity to educate the parents or guardians on the benefits and risks of a circumcision procedure.

Definition of Male Circumcision

A male circumcision is a surgical procedure in which the foreskin of a biological male individual is surgically removed.  The foreskin is the layer of skin that covers the head of the member.  This procedure was originally a religious ritual, but many parents still have their biological male infants circumcised today for a variety of reasons.

Pros and Cons of Male Circumcision

Although the American Academy of Pediatrics has stated in their guidelines that the health benefits of male circumcision actually do outweigh the risks associated with the procedure, the benefits are still not enough to recommend that a circumcision be performed on every biological male.  They are leaving that decision up to the parents or guardians.

One of the benefits of the male circumcision procedure is that there is a decrease in the risk of infants getting a urinary tract infection (UTI).  In fact, one source reports that the risk of UTI's is decreased by four-fold to ten-fold during the first year of life.   Also, the risk of cancer of the member is reduced by approximately three-fold in adult men who have been circumcised.  Other benefits of the procedure include a decrease in the risk of sexually transmitted diseases such as Human Immunodeficiency Virus (HIV) and syphilis, as well as the avoidance of a condition called phimosis in which the male foreskin cannot be retracted.  Although it was previously thought that circumcision improved hygiene, medical experts say that there is really no solid proof in favor of that argument.  Lastly, one study reports that men who have been circumcised remain sexually active for more years than men who have not been circumcised.

As with any other surgical procedure, male circumcision also has risks. Pain is probably the biggest risk. Although a topical analgesic can be used or other pain relief methods, such as a dorsal penile-nerve block where an analgesic is injected with a needle at the pubic symphysis area, or an even newer procedure called a subcutaneous ring block, the effects of these medications will diminish after a few hours, and the circumcised area will be sore and painful for a few days.  This is something to consider, especially when making decisions concerning a newborn.

Other complications of a circumcision procedure include excessive bleeding (although rare), infection, and impairment of the function of the member due to excessive or improper cutting by the physician who performed the procedure (very rare).  Also, those who oppose circumcision claim that the procedure causes less sensation in the member and argue that sexual pleasure is diminished. It has been reported by men who were circumcised as adults that this claim is true and that they experienced a significant decrease in penile sensitivity after their circumcision procedure.

Conclusion

Male circumcision is a procedure that should be thoroughly researched and discussed by parents or guardians before allowing it to be performed on a newborn.  Although some men will want to have their male infant circumcised just because they themselves have had the procedure done, it is still important to educate families about the benefits and risks of the procedure.  Nurses can be instrumental in assuring that those who will be caring for the newborn male infant have the information that they need to make an informed decision.  If parents or guardians do decide to have the procedure performed on their newborn, they will be taught how to care for the circumcised area before they leave the hospital where the procedure was performed.

References/Resources

Newborn Male Circumcision: American College of Obstetricians and Gynecologists

Cutting to the Point on Circumcision: WebMD LLC

First Few Days After Birth: Merck Manual for the Consumer

Neonatal Circumcision: What Are the Factors Affecting Parental Decision?: National Center for Biotechnology Information: National Library of Medicine

Dorsal Penile Nerve Block: National Center for Biotechnology Information: National Library of Medicine

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Angela Davis

About Angela Davis

My name is Angela Davis, RN, BSN. I have a total of 30 years of nursing experience. I worked for 10 years on a medical-surgical unit and 20 years in a small labor and delivery unit.

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Specializes in IT, psych, hospice.

My reaction to this subject is both personal and professional.

Nearly 40 years ago when I gave birth to a son in the US, I was up in the air and really nervous about having him circumcised. I was shocked to find out that the OB did the circumcision. Having grown up in a European country, male circumcision was to me not the norm (neither was a doctor rather than a midwife at the delivery, bottle feeding, or weaning after a few months).

In the early 2000's I did a short stint in L&D and got to "help" with a circumcision, which entailed me feeding this infant strapped to a molded tub of sorts and feeding him sweet milk from a dropper to "distract" him. The peds doc assured me the infant was in no pain. But when the instrument clamped down on his member, this little guy screamed bloody murder. I can't believe he wasn't in pain and I was horrified. I could only reflect on the fact that this was probably my own son's experience. I discussed it with him and apologized if it was a traumatic event for him, even though it happened when he was a newborn. His response was that he thought I made the right decision as he would not have liked to look different from his father or the other guys in school.

Mid-2000s, I worked in hospice for several years. More than once, I saw the downside of males not having been circumcised. Usually, problems would occur when they had a circulatory condition, such as congestive heart failure, among others, which would cause swelling below the waist. If the foreskin had been pulled back behind the corona, the swelling went unchecked, the prepuce would strangle the glans, only reversible with surgical intervention (which rarely happened). The other scenario that was a big problem was if the uncircumcised male had his foreskin pulled up over the end of his member and the meatus became extremely edematous, it became trapped inside the foreskin. Urine would collect in the pouch around the glans. Trying to cath a man in either situation was usually unsuccessful.

As barbaric as the practice still seems to me, I can see it does have some advantages. My own father had kidney stones and infections in the late 1960s and the doctor's wisdom at that time was to perform a circumcision although my father was in his 40s. I remember he was in a lot of pain and it took some time to heal. Probably longer than it would have if it had been performed when he was a newborn. BTW, his kidney stones and infections seemed to diminish afterwards but I suspect it had more to do with increased intake of fluids.

The sexual component of decreased/increased sensitivity has been reported to me by both men and women who had multiple partners that "uncut" was better, the only downside being if the male wasn't educated in how to keep that special area clean. Smegma could build up, making it most unpleasant to his partner.

 

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Specializes in Labor & Delivery.

Thank you for your comments!  I totally agree with you that it does seem barbaric, but I'm glad you brought out the positive aspects of a circumcision procedure as well.  Fortunately, today we have the topical anesthetic and the dorsal-penile nerve block that help with the pain while the procedure is being performed.  

My experience in a couple of nursing homes has caused me to favor the circumcision procedure much more than I used to.  Several of the elderly men in the nursing homes where I worked had problems if they had not been circumcised.  Some were the types of problems that you mentioned.

I hope this article will help educate anyone who might be considering a circumcision procedure for their make infant.  There are definitely pros and cons to the procedure.  There are lots of good articles on the internet if anyone is still undecided.  It's best to do lots of research on topics such as this so that the best decision possible can be made.
 

 

*that should be male infant, not make.  Sorry about the typo.

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Specializes in NICU.

The answer is Never ever circumcise...the majority of men are not.I worked in an area where we set up,circ board,supplies ,crummy medication if ordered,nothing really works because the pain comes later also during urination,] just to watch an OB come running/rushing  in ,mess up the proceedure,baby bleeding non stop, and worse.At leaset an adult can request proper pain medication,don't do it.

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