Wednesday, May 15, 2013

To Circ or Not To Circ, That is the Question...

The question of whether to circumcise a male child arises from a variety of cultural, traditional and medical perspectives.  The majority of babies around the world are in fact NOT circumcised, although certain religious groups like Muslims and Jews have adopted the practice as a ritual over the centuries.  By and large, the medical benefits are small overall, although some interesting research out of Africa has actually shown lower rates of transmission of HIV and other STDs in the circumcised male population versus the uncircumcised.  Urinary tract infections and penile cancer are slightly decreased in the circumcised population as well.  Uncircumcised boys need to be trained in how to keep themselves clean under their foreskin, but this is not usually difficult to do.

The medical risks of circumcision, like any surgical procedure, include infection, bleeding, scarring, and damage to adjacent tissues.  Fortunately, these are all fairly rare.  Sometimes a baby's penis is developmentally slightly asymmetric, or a little "twisted" which can sometimes make the circumcision a little uneven in the end.  Occasionally there can be a condition of the male urethra called hypospadias or epispadias, and circumcision is postponed until after the urologist assesses the situation (as a surgical repair may require the use of some of the foreskin).  Prematurity, jaundice, or other medical conditions of the infant may require a circumcision to be delayed.

In our practice we routinely use buffered Lidocaine solution injected at the base of the penis, which makes it numb in a few minutes.  The nurse also lets the baby suckle a sucrose solution which really does a good job at distracting the babies during the procedure.  We use a device called a "Gomco" for the procedure, which comes in a variety of sizes.  Vaseline on gauze is used between the penis and the diaper the first few days after the procedure to keep the raw skin from sticking to the diaper.  The glans (tip of the penis) is usually rather "hot pink" after the procedure but grandually become the same color as the rest of the penis.

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