When circ's go bad...

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Has anyone seen a circ go really bad? I saw one today where the doc took too much foreskin off and the skin on the shaft ended up "degloving" from the fascia underneath. A urologist had to come in and do "damage control." The people I've talked with say they've never seen anything like this happen before.

Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER.
I've heard this reasoning a lot and I don't really understand it. I would rather an adult who can reason through an experience go through something painful, than an infant in his first days of life, still learning about the world and trust. Even though the procedure IS more painful, with longer recovery time, and of course, the vivid memory present for an adult, I would still choose that over an infant experiencing it. I know men don't remember the experience as infants, but I just worry about trust/mistrust, subconscious trauma and all that. Especially when the odds are in my favor that phimosis will never happen at all.

Then let me explain it then. As many adult and adolescent circumcisions i've seen, and how painful and sore it looks (not to mention the condition that caused them to need this done), i would rather that they be spared of that as an adolescent or an adult. My opinion was "no, no, no" until i saw the surgeries.

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One of the many reasons I work nights is because I don't have to do circumcisions. I don't like watching them and I think the insistance on them is baffling. I've had one mother whose baby was jaundiced, going under double bank, dehydrated and running a fever and the first thing she asked me EVERY time I came into the room was, "When does he get his circumcision?" One pt had a 32 weeker in the NICU and every day she asked about his circumcision.

My husband's family is of an ethnic group that doesn't circumcise and their family is just fine with that extra skin (so is my son). However, I don't make a big deal out of it at work, I've never said a single word against it to a patient. If I am required to assist with one I will - I just don't like it.

Melissa

I also don't believe that routine infant circumcision is necessary, and don't participate in them. Since I work nights it's pretty rare that I would be asked to do so- but we have one awesome ped who comes in at 5:40 am, and I usually see him once a week or so on one of my shifts. My coworkers are aware that in addition to having ethical issues about participating in circs, observing the procedure is about the only thing guaranteed to make me pass out , so someone else is always willing to assist if our LNA or nursery nurse is unavailable.

Sorry for the tangent- to the op- I've only been in LDRP since May '04, and I'd estimate 90% of the baby boys born with us are circ'd before discharge, There's one ped who doesn't believe they are necessary and does kind of a half-circ, leaving some of the foreskin. So besides those (which I'm sure those baby boys will be glad to have those extra nerve endings in the leftove tissue when they grow up!), I've only seen a couple mild bleeders and one in which far too much skin was removed.

I have also seen what happens to those babies who had far too much tissue removed and required fancy putting of things together when they become an adult, and he has a scar along the underside of the shaft that he & his mother don't remember him getting, bits of hair growning on either side of the scar, and decreased sensation on one side of that scar.

He has never been able to reach organism through intercourse.

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I've heard this reasoning a lot and I don't really understand it. I would rather an adult who can reason through an experience go through something painful, than an infant in his first days of life, still learning about the world and trust. Even though the procedure IS more painful, with longer recovery time, and of course, the vivid memory present for an adult, I would still choose that over an infant experiencing it. I know men don't remember the experience as infants, but I just worry about trust/mistrust, subconscious trauma and all that. Especially when the odds are in my favor that phimosis will never happen at all.

I agree with you here . . . . . having your appendix out hurts. Having a broken arm set hurts. Getting stitches on your forehead after falling into a cupboard hurts.

I had a cesarean - it hurts like heck. But then so did labor pains.

I'm not sure the argument about it being painful for an adult or adolescent has any real bearing on this for me.

Plus, there are pain medications available.

Just having to stand there while a baby is held down and the end of his member is ripped off without pain relief is getting to me. It reminds me of my arguing with my boy's dad when our first son was born - I didn't want him circ'd - Dad did. His argument was that the baby wouldn't remember it. I countered with "well, he won't remember being burned with a cigarette so why don't we do that too?". Or "how about we rip off his ears because his are gonna stick out and kids are going to make fun of him".

My (ex) husband was not thrilled with me . . . . :rolleyes:

All my boys are circ'd by the way.

steph

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I have not seen many circumcisions performed on our postpartum unit but I see what they look like afterward (horrible). Our hospital's circ rate is very high but the hospital I worked at before was only about 50% (only 30 minutes away, lots of Hispanics in that area). I think it depends on the area.

My husband is Puerto Rican and he and all his family are fine with foreskins. I think a lot of the kids that "have" to be circ'ed have mothers who are obsessed with cleanliness. Just sitting in the soapy bath is fine for kids whose foreskins don't retract and once they retract ON THEIR OWN, all is needed is to pull it back briefly to soap it up.

I don't get the mindset of "it MIGHT have to be done later so let's do it now while you don't remember". You don't see people prophylactically getting tubes in their ears (to prevent infection), getting masectomies (to prevent breast cancer), etc. There are LOTS of things that MIGHT happen to me later in life but I don't go lopping off chunks of myself to prevent them. This logic only seems to work when we are talking about circumcision, I guess because it's "just a piece of skin" and because they "won't remember it".

As far as UTIs and STDs and HIV - well just the fact that I am a woman makes me more likely to get a UTI, STD or HIV (through heterosexual sex since I am the "receiver") so I'm not too sympathetic to that argument either. Anyway, circumcision sure didn't seem to help Americans from getting HIV - either the circ'ed men or the women who slept with them.

Melissa

I guess this discussion may be somewhat futile because minds are made up. But let's not forget what originally started the discussion. A new graduates observation of a severely botched circumcision. And it is that little boy and future man who is going to have to live with the physical, psychological, and sexual implications of having a deformed member. Not you, not I, not the RN, and not the MD. This trauma was completely preventable.

I do agree with you on one point though. You comment about cosmetic surgery is correct, however, most cosmetic procedures are performed on patients who can consent to the operation, or as is sometimes the case, on minors who may be disfigured and the surgery is "reconstructive" as well as cosmetic. I believe in such cases, the pros far outweigh the risks and the parent does have the legal and moral right to make that decision on behalf of the child. Circumcision just doesn't meet that standard. Having a natural intact member is not a disease or a deformity that requires surgical intervention so I disagree that it is the parent's right to make this decision.

What if the parent decided to cut the child's ear lobe off? Would that be okay?

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You are right, most boys don't retract at age 3, so a dx of phimosis is impossible. My son is 19 months and as far as I know, it's completely attached. Then again, I haven't checked to see if it retracts. I figure all the yanking on it he does the minute I take his diaper off, he'll figure it out himself.

Melissa

I'm confused. Admittedly I don't have a member, but I though phimosis simply meant that the foreskin could not be retracted completely and that was fairly common up until about 5 years. According to this about 10% of 3 year olds will have phimosis

http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/urology/pandp.html (the site also differentiates between paraphimosis and phimosis).

Did your 3 year old have anything wrong other than not being able to pull the foreskin back? Just curious.

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I have in the past week seen two infants approx 10mos old return to peds (uncirced) with swollen a infected member because the parents weren't caring for it properly. One was on the verge of having to be circed and the father was upset because he wasn't. The uroligist explained to parents that it had to be properly cared for. We do have some idiots in our region don't care for them and let the foreskin grow shut.

What are you talking about? CARING for it? I don't even touch my son's member at all unless I'm wiping it because he god poop on. The foreskin doesn't "grow shut" it IS sealed to the glans at birth like your fingernail is sealed to your finger. It must be ripped or cut away (during circ) or it separates naturally over time so it can retract but this doesn't happen for YEARS.

Melissa

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What a lovely thoughtful post. I agree about the bris, very different atmosphere. I have no problem with Jewish circumcision done at a bris (preferably by an MD who is also a mohel)

Well, I do have a problem with the idea of metzizah bi peh (using the mouth, not a tube. But other than that, no.

Melissa

As an Orthodox Jew, I am required by halacha (Jewish law) to circumcise my son. It is considered a mitzvah, a commandment, from God.

Having said that, if I was not Jewish, I would NEVER circ my baby boy without medical reason, and I don't think it's a good idea.

The practice of mass circumcision began when doctors noticed a lower cervical cancer rate among Jewish women and thought it was because of circ. It wasn't. It was becuase of the practice of the laws of family purity. (I can give an explanation if anyone is wildly interested, but suffice it to say the laws surround the menstrual woman and when she and her husband are permitted to engage in marital relations.)

The practice of circ stuck, though, unfortunately.

I watched a circ in the hospital long ago and nearly fainted. It was awful to watch .... I'm able to deal with a bris, though. It's a very different atmosphere.

Anyway, my $0.02.

Alison

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Plus, there are pain medications available.

Just having to stand there while a baby is held down and the end of his member is ripped off without pain relief is getting to me. steph

There is pain relief for infants also. My son is circ'ed. He felt NO pain. They gave him a block. He wasn't even fussy days afterward either. Didn't cry or even flinch during the procedure.

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You don't see people prophylactically getting tubes in their ears (to prevent infection), getting masectomies (to prevent breast cancer), etc. There are LOTS of things that MIGHT happen to me later in life but I don't go lopping off chunks of myself to prevent them.

Melissa

Yikes! I just posted a response to this, but it disappeared so forgive me if I am repeating myself!

I work in oncology and yes, some women elect to have a mastectomy to prevent the cancer from coming back in the unaffected breast. Or I have seen in families where the breast cancer is running rampant (mom,sis, etc.)...a person who doesn't currently have cancer will have her breasts removed for fear that she will develop it. I personally don't know what I would do if I were in that person's shoes. I do understand their reasoning behind that though.

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Yikes! I just posted a response to this, but it disappeared so forgive me if I am repeating myself!

I work in oncology and yes, some women elect to have a mastectomy to prevent the cancer from coming back in the unaffected breast. Or I have seen in families where the breast cancer is running rampant (mom,sis, etc.)...a person who doesn't currently have cancer will have her breasts removed for fear that she will develop it. I personally don't know what I would do if I were in that person's shoes. I do understand their reasoning behind that though.

I was thinking of that too . . . .. but I'm sure she meant getting your breasts cut off for a very small chance of maybe getting breast cancer (like the chance for penile cancer or infection or any of the other reasons people have for circs).

I would definitely get mine removed if I had cancer . . .no lumpectomies for me. And I would also have them removed if there was was that family gene for breast cancer present.

steph

steph

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were you present for your son's circ? I didn't assist with them at my previous job, for ethical reasons, but I was present (in the nursery, doing something else) for many, many circs. It was very rare that a baby not react at all to the procedure- the process of getting the block seemed to be quite painful (though not as painful as being circ'd without, I'm sure) and being stapped down to the circ board seemed almost more traumatic than the procedure itself. When we started using sucrose in addition to the block, it helped tremendously, but there was still pain or discomfort evident. And the majority of infants demonstrated some sort of discomfort for at least the morning after, usually a little longer- but in my expereince, even most of the nurses didn't acknowledge it.

I hope you don't see this as an attack, I'm just surprised- and glad!- that your son's procedure was so pain-free.

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were you present for your son's circ? I didn't assist with them at my previous job, for ethical reasons, but I was present (in the nursery, doing something else) for many, many circs. It was very rare that a baby not react at all to the procedure- the process of getting the block seemed to be quite painful (though not as painful as being circ'd without, I'm sure) and being stapped down to the circ board seemed almost more traumatic than the procedure itself. When we started using sucrose in addition to the block, it helped tremendously, but there was still pain or discomfort evident. And the majority of infants demonstrated some sort of discomfort for at least the morning after, usually a little longer- but in my expereince, even most of the nurses didn't acknowledge it.

I hope you don't see this as an attack, I'm just surprised- and glad!- that your son's procedure was so pain-free.

I presume you are directing this post at moi? No, I don't take it as an attack :) I had my mom stay in the room with my baby. She has 3 sons, so she has seen it all :) I didn't want to stay in the room. I was in there until it was time to cut. When he was strapped down he was very tired (he was only a few days old), so he didn't act like he was being held against his will. I was expecting him to be uncomfortable after the procedure and the days coming, but nope...he was calm as always! Even when he gets his shots...cries immediately afterward, but that same day and even days later...never acts like his leg is hurting. Maybe he has a high pain tolerance like mommy!! I had a c-section with him and really didn't have much pain at all...slight discomfort.:)

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