Sunday, January 28, 2007

Whacked

I had spoken with the father before and knew he didn't speak English very well, so it was a bit of an adventure when he came up to the desk and tried to tell me something. Fortunately, his son was doing well and we hadn't needed to have any major serious conversations.

"You are Muslim?" he said.

"Me? No," I replied. Why he would think that? Then I understood. "O, you are Muslim," I said, wondering where this was going.

He smiled broadly and nodded. He said something about his baby that I didn't understand. Seeing my quizzical expression, he tried again. He held up his index finger and moved his other index finger around it in circles. "My baby," he said, "You will cut?"

I got it, having had these kinds of conversations before. Dad wanted to make sure one thing was done: he wanted his baby circumsized. It's pretty important to some people, so important that they're worrying about circumcision while their baby is still on a ventilator or something. It's so important that although they won't try to ask about anything else in their broken English, they will try anyway they can to communicate their desire that their kid get whacked (my personal term for the event.)

I assured him that yes, we could have his baby circumsized before he went home. "Tomorrow?" he asked hopefully. I tried to tell him that we should really get his baby off of CPAP before circumsizing him, but I'm not sure he understood. He might have gone home that night expecting his kid to weigh just a little bit less the next day.

I know that some people get pretty excited about circumcision. I guess there are some legitimate arguments on both sides of the issue, but as long as they use anesthesia, I can't get too worked up about the whole thing. It's rare that parents even ask me my opinion about circumcision; the decision is usually made well before birth. I don't like doing the procedure myself, personally, so I'm glad the obstetricians do them in our area. And in cases like the one above, I'm glad they get the "informed" consent, too.

53 Comments:

Anonymous Chris and Vic (CAK) said...

If you put this "issue" in perspective, you could wonder

*if/why circumcision might come ahead of choosing a ped

*and ahead of concern for a basic issue, such as breathing (in your example of a baby still on CPAP);

*why circumcision is "approved" (being, as it is, an unnecessary surgery) while the Ashley X surgery does not meet with blanket approval (but bariatric surgery and breast reduction/augmentation, elective c-sections, tongue piercing and tattoos are okay);

*how it EVER got religious associations (yes, yes, I know, it is endorsed in the Old Testament);

*and why people don't ask doctor's opinions about it.

I wonder, if it was not so widely accepted and taken-for-granted, if it would pass muster with a medical ethics board.

I also wonder why/if the man who so wanted his son "whacked" attended at the circumcision, at his son's side, to comfort him.

Like you, Neonatal Doc, I do not get so bent out of shape about it as I once did, but I DO try to avoid assisting the doc whenever I can. Circs are still basically barbaric in my eyes.
Chris and Vic

4:39 PM  
Blogger Carol said...

Aren't there benefits (in the long run) for circumcising, such as better hygiene, less urinary tract infections, less chance of sexual diseases and cancer? Why would you be against it? (If in fact, you are, sounds like it from your post, but you don't actually say so). Is it because of the pain and possible infection that accompanies it? If so, is there alot of pain for baby boys? Just curious.

Enjoy your blog!

5:28 PM  
Anonymous Anonymous said...

Studies have also shown that circumcisions help the prevention of HIV.

6:03 PM  
Anonymous Anonymous said...

Take a good look at those studys, the real thing, not the abstract, and see what you think about their methods.

6:12 PM  
Anonymous Julie said...

My son Charlie was born at 29w5d and spent 42 days in the NICU. The week before he was discharged, a nurse took us aside and said, "If you'd like your son circumcised, I want to show you how it's done." She showed us the board a baby is strapped to. Before she could show us anything more, we assured her that we'd decided long before his birth that we didn't want him circumcised. (Even if we'd planned to, I imagine his early days, when he was so small and sick, might have changed our minds.)

The nurse was relieved to hear it. She said, "You wouldn't believe how many parents of tiny, sick babies ask us when we'll do the cut before the baby's even stable."

I was kind of impressed by the subversiveness of her offer. She said that plenty of parents change their minds when they see the board.

6:59 PM  
Anonymous Anonymous said...

This is funny. As a mom to a 25 weeker, I can see the irony in thinking of something less important when the babys life is still in question. My son was circed after he went home. He had gtube/hernia/fundo surgery inpatient but the Dr wouldn't do the circ at the same time. We went to the ped, my son was put on the papoose board, got his shots to numb and went to sleep. Yep, he slept right through the procedure. Im not squeamish, didnt think in the grand scheme of things it was a big deal. My son showed no discomfort afterwards and we never gave it a second thought.

7:50 PM  
Anonymous Anonymous said...

People are weird, choosing cosmetic surgery on a newborn. I would never alter someone`s body without their permission. The normal penis just functions so much better, sexually it is light years ahead of a dry, keratinized, circumcised penis. They just look raw and scarred. Every parent I`ve ever met who was smart and educated left their boys alone, the way they were made.

9:17 PM  
Anonymous Helen Harrison said...

Our son was circumcised at age one when he had surgery for strabimus.

The pediatrician seemed to think he needed the circumcision for medical reasons, but I suspect he simply had a good idea of Ed's eventual developmental status and wanted to make life easier for us (or whoever would end up caring for Edward).

I didn't like the idea, but finally gave in.

When Ed woke up from anesthesia, he hardly realized any surgery had been done to his eyes.

The circumcision site was a bloody gruesome mess for well over a week, necessitating several follow-up MD visits. Ed was clearly in major pain.

At least the surgery itself was conducted under anesthesia, unlike many of Ed's surgical procedures in the NICU.

If I had to do over, I wouldn't put him through it.

9:27 PM  
Anonymous Anonymous said...

Why are there "legitimate arguments" for routine newborn circumcision in the USA? When the Canadians, the Australians, the New Zealanders, in fact pretty much the rest of the world don't do routine newborn circumcisions?

I've heard about research that shows circumcised infants show a stronger pain response to future pain, that the pain of circumcision actually rewires their brains somehow. Just so they look like Daddy and Mom thinks it's nice and clean.

Carol, if you had your fingernail ripped of your nail would it hurt?

It's sad, NICU babies go through enough pain with necessary medical treatment. Why don't you feel a need to advocate for these babies? It sounds like you know circumcision is an unnecessary cosmetic surgery. You can have an effect by simply stating your opinion on it to these parents (well at least the ones who understand English). At the very least, doctors should be more explicit about what happens during the circumcision procedure. I've heard some hospitals make parents watch a video. And finally, I think if the father can watch the birth or a c/s, he should damn well watch the circ if he insists upon it.

9:46 PM  
Blogger The Preemie Experiment said...

When I found out that baby #2 was a boy, the farthest thing from my mind was the circ. I was worried sick that he was going to be born as early as my daughter was (25 weeker). Wimpy white boys don't do as well. This was all I could think of!

The day before he was discharged from the NICU my OB asked if we wanted him circumsized. We said yes, mainly because hubby is and I guess I never really gave it much thought.

I asked to be with him during the procedure but the nurse wouldn't allow it. I pitched a fit (no, not me-hehe) and the OB told the nurse it was just fine for me to be there.

OMG!!! I had witnessed so many scary procedures with my daughter but this was horrific! Strapped to a board and mutilated!

Then, to make matters worse, the circ didn't heal correctly, something about fat pads and adhesions. We've been dealing with it ever since. It got redone and we pushed it back, just like we were told. It seems to do fine but as soon as we stop pushing it back, scar tissue forms and we are back to square one. It's been horrible. We are at a point where we are being told to just wait until he grows a little more and we will try again.

I have such immense guilt over what we allowed to be done to him!

9:49 PM  
Blogger ericales said...

Frankly, I'm glad my 2 boys are circ'd. I wasn't there for my first son's...he had his done while under general anasthesia for another procedure (ileostomy creation and g-tube placement, for those curious.) It healed just fine, and we actually got it done then because of the suggestion of the docs--they knew he had a tough road ahead of him and we wanted to minimize infection vectors.

For my 2nd son, they didn't strap him to anything. I'm the one who got to help hold him down, and give him the tylenol and sugar water. He didn't fight and it was over quickly...and it's one of the easiest procedures I've assisted with. Certainly much easier than replacing a blown g-tube, or doing a quick central line repair "in the field", and it caused a lot less trauma than many of the things we did to/for my older son in the regular course of his medical situation. Holding down your son for repeat lab draws and IV placements--our oldest got 14 in a 4 hour period once when he kept blowing his veins--is MUCH more traumatic than helping hold the kid for a circ.

It isn't a big deal. If we have a 3rd son, we're going to get him circ'd too, and you can bet I'll be there helping hold him--I don't want to leave that up to someone else. --lexi

10:21 PM  
Anonymous Anonymous said...

"Every parent I`ve ever met who was smart and educated left their boys alone, the way they were made."

That is an assinine and inflamatory comment. I am both smart and educated. I just made a choice you would not. Go back to being the troll you are.

10:39 PM  
Anonymous Kath said...

I've been to two bris' (Jewish Circumcision ceremonies) and in both cases the baby's slept thru it.

No boards, no holding down, no tears.

10:48 PM  
Blogger TLC Tugger said...

This comment has been removed by the author.

12:18 AM  
Blogger TLC Tugger said...

What monster could agree to a parent's request to amputate normal healthy sexual parts from a helpless infant?

Dude, get off the fence. You know it's harmful. You know your duty is to the patient, not some other agent who has a cosmetic preference about the patient.

80% of the world is intact and suffers no unusual health, hygiene or social problems. Only the US and South Korea cut a majority of minors for non-religious reasons.

The foreskin grows to about 15 square inches of exquisitely sensitive mucosa in the adult. It possesses over half the sensual nerve endings. The frenulum - usually crushed or severed in circumcision - is the neurological homologue to the clitoris. Circumcision removes the wonderful frictionless rolling/gliding mode of stimulation for a man and his partner.

Intact men say the foreskin is the best part of the penis. In Sweden, 1 in 10,000 males has an actual medical reason to be cut. In the US, the medical reason to circ is to bill the procedure. Just shut up if you don't know what you're talking about and start reading at http://Circumstitions.com.

Every mammal on earth evolved a foreskin before there was surgery or soap. HIS body, HIS decision.

12:20 AM  
Blogger munkeesmama said...

I'm against circing. Every one is fine to make their own choices but I personally would never circ my child. It is considered a cosmetic surgery. I have read more than enough studies. to you anonymous, coe out of your shell if you're going to post. Nothing drives me more batty. With that said I doubt the studies in africa for more than one reason, but the biggest is that for one, it was done in Africa, one of the world's leading countries for HIV/AIDS. Many people in Africa contract aids from other ways than sexually. I also HIGHLY doubt that any study done in Africa regarding AIDS could be a controlled stufy considering they can't/won't confine a group of people to make it controlled. I wouldn't weigh that study much.
You also have to consider the foreskin to be equivalent to the clitoris hood/clitoris. There aree TONS of nerve endings there. The foreskin is not only for sexual pleasure but rather is made to protect the head of the penis. It also helps to produce antibacterial lubricants. Diseases are not higher in circumcized men alone, so much as they are higher in uncirced men who are not taught how to PROPERLY retract their foreskin and keep it clean. This to me is no different than oral hygeine. If you're not taught how to brush your teeth and floss, of course your teeth will be diseased far more than that of a person who is anal about oral hygeine. Just some things to think about. Everyone is quick to jump on the studies bandwagon, but very few are will to take the next step, play devil's advocate and waste months/years researching both sides.

3:32 AM  
Anonymous Anonymous said...

Every dad wants his son to look like him. Period.

5:58 AM  
Anonymous Anonymous said...

Every dad does not want his son to look like him, that is ridiculous. My own dad is cut and when he learned circ was not even necessary--he couldn`t care less about his own son looking different, so he left him in one piece.

The whole looking like dad thing is stupid, it just proves that the decision to circ is based on emotion & the decision to leave a boy intact is based on solid common sense. When are all of these penis comparing occasions anyway, after Christmas dinner does everyone whip it out and compare? Or is it a weekly thing? Do my daughters and I compare vaginas? How ridiculous!

Plus, the new circs are done looser because so many problems were linked to tighter circs (erectile dysfunction, chordee, buried penis). The new circs don`t even look like dad anyway, so why bother?

9:11 AM  
Blogger Stacey said...

Doc, you must tell me your opinion on this one. I’m on the fence about this one.

Perhaps if my next child is another girl I won’t have to worry about the issue at all. Are there really no benefits to circumcision? I currently think that I would leave my son intact and if he wanted to have it done later, he could make that decision. But if I had it done, there would be no reversing that decision.

1:58 PM  
Anonymous Anonymous said...

I'm from the UK where circumcision is normally only done for medical or religous reasons. In fact to most british people the american position on this seems frightening, how did it become a cultural norm to inflict surgery on an infant with dubious reasons?
I'm not trying to insult anyone, I just genuinely don't understand, I have 3 sons and had I decided to have any of them circumcised by choice the decision would have been looked on with horror by most people I know, and also would not have been funded by the UK health care system as it is deemed an unecesarry procedure.

3:01 PM  
Anonymous Lori said...

There are medical reasons for circumcision. In our case, my son was born with midshaft hypospadias and chordee that he just had repaired 2 weeks ago. The surgeon was amazing and his penis looks wonderful. He was circumcised because they needed the foreskin for repair, so we wouldn't have really had a choice in the matter. His repair was necessary in our eyes as the midshaft opening would have made it nearly impossible to urinate standing up and according to the urologist more difficult to inseminate a future wife naturally.

I am unsure where I would have fallen on this issue had we not had the hypospadias to consider. I do know I am grateful he was under general anesthesia during the procedure and went home on good pain meds. Perhaps my son is very resilient, but I was shocked that he was crawling around seemingly in no pain the following day.

4:02 PM  
Anonymous Anonymous said...

The silent majority of US women (ok, the ones that I know who wouldn't bother posting about it) genuinely find an uncut penis repulsive. There is no worse foreplay surprise. Just, ick...

6:33 PM  
Blogger Judy said...

When I hear the anxious mom of a 25 weeker asking when her baby will be circumcised, I generally believe that she's asking IF he will live long enough for that to be possible.

OTOH, a college-educated acquaintance (mother of 4 boys) once asked if baby boys could urinate prior to circumcision, so I think a significant amount of education is needed regarding that particular procedure. I don't think it's happening.

6:33 PM  
Blogger clara said...

I really think conformity is the main reason this surgery is still around (for non-relig reasons).The circ rate is now 50% in this country so conformity is not so much of a reason anymore. If you look closely at the history of circ in America, it was propelled into the mainstream by doctors like Kellogg who thought it would stop boys from masturbating. They knew it took away a lot of sensitivity and that`s still true. If you learn about all of the functions of the foreskin and all of the nerve endings that are lost in a circ, its really hard to justify. Every decade another reason was given to justify this surgery and each time, it was proven to not be a real "benefit." Even with the new AIDS studies (which are deeply flawed) the benefits of keeping a foreskin greatly outweigh the "risks" of having one. The complication rate of neonatal circs is as high as 10% according to a urologist friend, and your child`s chance of a UTI (or Std or penile cancer) is so much smaller than that its ridiculous. You can make a much better case for removing breast buds on all girls to prevent breast cancer. Plus, they have antibiotics for infections. And, girl parts are way more prone to UTI`s and are way harder to clean and luckily, cutting girls never took off in this country or we`d be justifying that too.

I don`t think pain is the issue, its really more about why do you want to lose a body part that`s there for a reason and why not let the owner of said body part make the decision.

I have left all of my sons intact and never regretted it. I have known many parents of circed boys that regret it immensely, I`ve seen buried penis and horrible adhesions. Stacey, you are right, you can`t put it back once its done. Its good to think about it. If having a foreskin was so problematic we would see more of the world accepting routine circ as normal, yet we are the only country in the world that circs for non-religious reasons. That really says something to me.

6:36 PM  
Anonymous Anonymous said...

The women who find an uncut penis repulsive are just ignorant and sadly, missing out on much better sex.

Can you imagine if a man said that he was repulsed by the natural looking genitals of a woman? OOH, all those folds, I prefer them removed, so much prettier. You`re talking about a normal penis, that`s the design! I personally find a cut penis scarred and naked looking. All of the mammal males were built with foreskins, sex was designed to be a sheath within a sheath experience, smooth and subtle. Sex with a circed man is dry and dull pounding. Nature`s design is pretty smart!

6:44 PM  
Anonymous Anonymous said...

if we did surgery on unanesthesised cats we would be on the 6 0clock evening news because peta would throw a fit,but yet,we will do surgery on human baby boys with little or no anesthesia.what's the deal? what will it take to change this? barbaric,simply barbaric

7:13 PM  
Anonymous Anonymous said...

Every parent I`ve ever met who was smart and educated left their boys alone, the way they were made.

Christ, it makes me want to go out there, conceive a son, and have him circumcised just to piss off the sanctimonious anti-circ lobby that seems to have nothing to do but crawl the internet insulting those who chose to circumcise their sons.

7:29 PM  
Anonymous Bugs said...

it makes me want to go out there, conceive a son, and have him circumcised just to piss off the sanctimonious anti-circ lobby that seems to have nothing to do but crawl the internet insulting those who chose to circumcise their sons.

This is the best comment yet on this thread! I agree. I am an intelligent, caring parent of 5 sons, all of whom are circumsized. They still love me. The 2 oldest have thanked me.
To imply that I'm uncaring, ignorant and too lazy to teach my sons to properly care for their bodies shows such an ignorance I cannot begin to describe.

7:49 PM  
Anonymous Anonymous said...

I`ll rephrase it since it hits such a nerve. I`ve never seen a parent who was educated about the foreskin who circed. Once a parent knows about the foreskin`s functions and sees a circ done, they usually don`t circ. That is my experience,I personally have never known anyone choose to circ who really knew normal male anatomy.

Isn`t it funny how the anti-circ crowd is always painted as lunatics when the decision to circ is based almost entirely on emotion. Its also based on conformity, looking like dad, blindly following the herd, total ignorance of intactness.

Yet the decision to leave the boy alone is based entirely on reason and common sense. Like my dad (circed) says about circumcision, "it defies all logic."

8:20 PM  
Anonymous Anonymous said...

I'm a Jew, and we circumsize our boys--it's the sign of the covenant. It's not a medical thing, or an appearance thing--for us, it's simply a commandment.

But the real comment I wanted to make is that a bris (Jewish ritual circumcision) is done when the boy is 8 days old, AS LONG AS HE IS HEALTHY. If the boy isn't healthy, the circumcision is postponed as long as the pediatrician recommends.

9:25 PM  
Anonymous Anonymous said...

I`ll rephrase it since it hits such a nerve. I`ve never seen a parent who was educated about the foreskin who circed. Once a parent knows about the foreskin`s functions and sees a circ done, they usually don`t circ. That is my experience,I personally have never known anyone choose to circ who really knew normal male anatomy.

Well here's someone who knew normal male anatomy and its functions and chose to have it done to her son. And yes, I have personal knowledge of the difference in sensation bewteen having sex with a circ and uncirc'd man as well and am very happy being married to my circ'd husband, who happens to consider that it makes him a better lover (and although I think he would be pretty darned good regardless, I have to agree with him).

However, it was done partly for religious reasons (Jewish) and was done sympathetically by a Jewish doctor, our son being held by his father at the time. If our son would have had to go through the way that medical circs are conducted in the US, strapped to a board, etc., then there's no way I could have contenanced it.

11:27 PM  
Anonymous Anonymous said...

I was never refering to religious circumcision, only the routine neonatal circ that is not recommended by any medical association in the world.

8:44 AM  
Anonymous whatsthebigdeal said...

A urologist with whom I used to work referred to the foreskin as "nature's glove". After seeing many of his patients who had intact "gloves" come in with recurrent and nasty yeast infections (balanitis), chancre sores, STD's, and so on - we most certainly opted to have our son circumcised shortly after birth. It was done with the use of local anesthetic and he did just fine. It was anything but barbaric or cruel.

To each his own. Different strokes for different folks.

10:13 AM  
Anonymous Anonymous said...

Actually, cutting off a body part because one day it could possibly have problems doesn`t make a lot of sense. We don`t do it with other body parts.

US doctors are still very ignorant about intactness, we are still considered a circed culture, so you see problems here that you don`t see in majority intact countries. And, until very recently, the only solution offered was circumcision.

Its like breastfeeding, in the US we are still a majority bottlefeeding culture, so you hear of horror stories and problems that you would never hear of in a breastfeeding culture. Think of how many moms give up on nursing during the first month, we do too much too soon, we are given formula samples, we expect nursing to go well and it can be hard. In a breastfeeding culture a mom has a month of seclusion where she is taken care of by female relatives & does nothing but lay in bed, nursing. Most problems are ironed out in time, and because these moms are feeding anywhere, on demand and sleeping close to their babies, low supply is almost never an issue. They also have generations of women who came before to ask for advice. We have generations that formula fed for the most part. We make breastfeeding so complicated here.

Its the same with the foreskin, for the last century, doctors haven`t been taught much about the foreskin and treatment if there are infections. Its just, cut it off, its a problem. Its simple, we have more problems because it hasn`t been the norm-we have no clue what to with a foreskin for the most part. Very few people knew the answer was do nothing, wipe it like a finger and that`s it for a baby. We have caused infections by messing with it too much but we have solutions that are not surgical!!, If its too tight--steroid cream, infection--abx yeast--monistat! Now doctors are taught not to retract a fused newborn foreskin, but some nurses and dr`s still forcibly retract before its retractible, which is proven to cause infections. Also, boy parts are a lot like girl parts, in nature. You don`t get aggressively clean, no harsh soaps. Douching causes problems as severe as PID in women because the vagina is self cleaning. The foreskin in the young child is also self cleaning, one of its main purposes in being fused to the glans is to protect the glans from sitting in urine and feces. I`ve seen so many circed babies scream at every diaper change. My intact sons didn`t cry even one time during their first month of life. It is key to find a pediatrician who knows the benefits of not circumcising and who will protect your son`s forekin by not forcibly retracting. Once the boy is retractible, the foreskin is gently pulled back and rinsed off in the shower. Much easier than keeping a female clean!


How can we expect parents to be educated about normal male anatomy when some medical professionals still have such outdated knowledge?

Normally, we would never accept a surgical solution to a child`s problem that may never happen--prophylactic surgery seems to violate the Hippocratic oath, but... because its cultural, we`ll do or say anything to justify it.

11:11 AM  
Anonymous Anonymous said...

Retracting a fused foreskin is much like pulling back a fingernail. It hurts, it opens the area for infection, and it causes scar tissue to form.

Thankfully, if your infant son has had his foreskin forcably retracted, it can re-fuse with time and care.

11:33 AM  
Blogger Clark Bartram said...

Please raise your hand if you have either A. pulled back your fingernail to remove it from the nail bed or B. Remember what it felt like to have your foreskin adhesions busted without local anaesthesia or C. Both.

I imagine that pulling back an infants fingernail would make them cry.I don't know, I haven't tried it. Why do the vast majority of infants that I circ sleep or just make an occasional whimper but is quickly calmed with a little sugar water? Circ. Don't circ. I don't care. Just stop spouting misinformation please.

1:47 PM  
Anonymous Anonymous said...

I`m an intact man and I have intact kids. I don`t see much misinformation here. The facts about the history of circ are right on and I don`t think its about the pain, although I`ve seen some very upset babies getting circed in the NICU. Its about letting a person make their own decisions about their own body, especially regarding cosmetic surgery.

3:07 PM  
Anonymous Anonymous said...

just because someone is young and nonverbal doesn't mean they aren't sentient and they can't perceive pain. i have personally assisted at probably 3,000+ circumcisions and almost all babies scream as if someone were sticking hot needles in their teeny-tiny bodies,sweetease or not. the only circs i ever assisted with that didn't exhibit such behaviour were done by a lady doc who i called the 'circ queen' she did a local with lidocaine(?penile block?)and the babies slept through it with a little sweetease too.maybe that's what you're doing dr.bartram. but the majority screamed bloody murder. emla works so-so till you break down the adhesions and then it also fails. i envision one day the babies will have some type of communication device similar to what stephen hawking talks through and then won't we all be surprised. i try my best to minimize discomfort by supplying a padded circ board and a warmer and offering sweetease on a paci,and a snuggle afterwards,but my goodness,can't we do a little better? like i said ,we would be on the 6oclock news (peta would be after us) if we operated on a cat w/o anesthesia,but we aren't troubled by operating on human baby boys w/o any (or little) pain relief. and the docs i work with are excellent surgeons,working very quickly to minimize surgical stress.the fact of the matter is,we need better pain control and it may have to be mandated.

6:10 PM  
Anonymous Chris and Vic (CAK) said...

Yes, Anonymous, where I work, there are forms to be filled out by attendants (nurses), where they watch the clock to be sure the doc has waited a full 5 minutes for the penile block to be effective, before cutting or putting on the plastibel. (The nurse is supposed to tell the doc when the 45 minutes is up.) The babies also get a dose of Tylenol along with SweetEase. The Tylenol is given about 30 min prior to the procedure---the doc calls as s/he is driving in to the hospital.
CAK

6:31 PM  
Anonymous Chris and Vic (CAK) said...

Typo alert---I meant to say that the nurse watches the clock and tells the doc when the 5 min is up. (Not 45 min!!)
CAK

6:33 PM  
Blogger Clark Bartram said...

It is standard of care to employ a penile block with lidocaine or to use EMLA. I am not impressed with EMLA either and use lidocaine. I do admit that there is some degree of slowness in changing the way that circs are done, primarily with the older obstetricians. Also, in my limited exposre to pediatric surgeons doing them, I don't think that they wait long enough for the lidocaine to anything at all. They have usually done the circ in the time I take to slowly open up my tray and begin to apply the betadine. One thing we don't tend to do is to give tylenol but I am not against it. We are looking into its use. I'm not sure if it would make a difference or if it has been studied yet so ours might be the first and the results very helpful. There is no point in giving a drug with potential, albeit unlikely, side effects if it doesn't do anything.

7:40 PM  
Blogger neonataldoc said...

Doesn't anyone want to talk about fun with communicating with people who don't speak your language?

Chris and Vic, you ask excellent questions.

Why don't I speak up and advocate for my patients? Because in my neck of the woods, nearly every boy is circumsized. It's a safe enough procedure that I don't want to be resposible for Johnny getting laughed at in the locker room in fifth grade. And don't tell me it doesn't happen.

If any doctor out there is still barbaric enough to do circumcisions without adequate anesthesia - such as a penile block - he should be taken out, tied to a post, and given a circumcison without anesthesia. I'll bet he would use it the next time.

7:40 PM  
Anonymous Anonymous said...

Actually, cutting off a body part because one day it could possibly have problems doesn`t make a lot of sense. We don`t do it with other body parts.

Erm... mastectomy to prevent the possibility of breast cancer anyone?

1:46 AM  
Anonymous Anonymous said...

"It's a safe enough procedure that I don't want to be resposible for Johnny getting laughed at in the locker room in fifth grade. And don't tell me it doesn't happen"

I`m amazed people still think this way. This proves that it really is a Covenant with The Status Quo, as the british Journal of Medical Ethics wrote about 3 years ago:

ABSTRACT
This article offers a critique of the recently revised BMA guidance on routine neonatal male circumcision and seeks to challenge the assumptions underpinning the guidance which construe this procedure as a matter of parental choice. Our aim is to problematise continued professional willingness to tolerate the non-therapeutic, non-consensual excision of healthy tissue, arguing that in this context both professional guidance and law are uncharacteristically tolerant of risks inflicted on young children, given the absence of clear medical benefits. By interrogating historical medical explanations for this practice, which continue to surface in contemporary justifications of non-consensual male circumcision, we demonstrate how circumcision has long existed as a procedure in need of a justification. We conclude that it is ethically inappropriate to subject children—male or female—to the acknowledged risks of circumcision and contend that there is no compelling legal authority for the common view that male circumcision is lawful.

8:15 AM  
Anonymous Dilly said...

I am English and over here our boys stay as nature intended. I always knew that some religions see circumcision as normal and as part of their culture, but it was not until recently that I was made aware of the fact that it is common practice in the USA within all ethnic groups and I find that quite amazing.

Unless the child has an immediate problem with his foreskin why on earth would you do such a thing??!! Do people think God made a mistake with the design of the penis and it is up to us to correct him?

I would be interested to know what facts are available to support the claim that cut boys do not get as many STDs? Surely if that claim were true the USA would have far lower STD infection rates?

I found the following website, which has worldwide STD statistics.

http://www.avert.org/stdstatisticsworldwide.htm

I think everyone should have the right to choose what happens to their body but by performing this operation on newborns that right is removed. I also believe that piercing the ears of a baby is wrong too, as the right to choose has again been removed.

On a personal note, I have had an encounter with a circumcised man and found it quite disconcerting when fondling the member, as there was no give in the penis to play with! What do you do when there is no lubrication available? It feels dry and as if it must be chafing!

On a final note, is it completely inconceivable that this operation could be performed when a boy is older or is that not possible?

8:15 AM  
Anonymous Anonymous said...

Cutting off anything when you are facing a real health risk is totally different than cutting off a healthy functioning part of baby`s penis because you`re worried about the possibility of something like a UTI. Very few people who circ take the time to really look at the numbers, circ is not proven to be a cure for anything at all. Every single thing that they say circ prevents, STILL HAPPENS in circed men. In fact UTI`s after infancy are higher in cut boys. What about the risks of circ? Bleeding, meatal stenosis, chordee,buried penis, adhesions & skin tags? Its all about culture, and thankfully its going away.

NeonatalDoc, I think it would be harder to explain to a kid that more than half of his nerve endings were taken away for no good reason. My intact husband and brothers (both grew up in 90% circ rate eras) have never been made fun of in locker rooms. They both said the guy caught staring at your package is really the one that gets all the crap in the locker room. The only thing that my brother ever heard about it was a classmate told him he was so lucky b/c sex was going to be better for him with a foreskin. TMI for me:)

8:26 AM  
Blogger clara said...

Dilly, we have very high STD & HIV rates here and we have had a circumcizing culture, so that argument is pretty much shot in my opinion. The rate is changing
though, its near 50% in the US as more parents learn the facts.

Penn & Teller say it best, Circumcision is Bull$hit
http://video.google.ca/videoplay?docid=7772002181711601907&q=penn+teller+circumcision

8:45 AM  
Anonymous Anonymous said...

Dilly, if we waited till the boy was older, he wouldn't consent!

12:51 PM  
Anonymous Anonymous said...

Sorry I know this is an older post but I have to say that neither of my sons were strapped to a board. Their circs were done by a Moyel. My preemie hardly cried, my full term baby, well he cried until I could feed him, but the only pain medication was a wine soaked rag. The pediatrician said my sons have the two nicest circs he has seen.

2:28 PM  
Anonymous Sylvie said...

My son and his dad never went through the process of circumcision. And my son Locke looks heaps like his dad int face as a baby even the big smiles look alike!

11:49 PM  
Anonymous Anonymous said...

Here, Mother Nature should enjoy the benefit of the doubt: do nothing unless there is a clear medical problem. Do not resort to surgery unless more conservative treatments do not exist or are ineffective. This is the stance taken in all medically advanced countries other than the USA. Foreign doctors are not unclean or undereducated or anti-circ bigots.

Now that hospitals and doctors rarely urge routine infant circumcision, the practice continues because millions of USA parents think that the foreskin is foul and disgusting. They fear that other boys will make fun of their son in the locker room, that future young women will refuse to date their son when they learn he has a foreskin. When it comes to matters sexual, millions of earnest people dread even the possibility of nonconformity.

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