OB-GYN-L Messages for January, 2006: Re: Circumcision

Re: Circumcision

From: Anna Meenan, MD

annam@uic.edu

Wed Jan 4 00:39:36 2006

My thoughts, all in one post, to avoid clogging mailboxes further.

Here in Illinois, at my hospital, circs are done by both OB's and peds, though most are actually done by FP's, since the FP residency does the majority of the low-income births, which seems to be a growing percentage. I have always done them with a gomco. Plastibells were introduced when I was a resident, but we decided to save ourselves a few phone calls from clinic patients by NOT sending the baby home with something that was going to fall off later. Have seen a Mogen clamp, never used one, though a partner I had briefly a few years back did use them. I gave up trying to talk people out of circs years ago. Decided I was wasting my breath. I was never impressed by the NoCirc people and always wondered what the president of that organization says when making small talk at cocktail parties and someone asks him/her "What do you do for a living?" (and hoping I never run into that person and unwittingly ask that question)

I always use a dorsal nerve block and wait at least 5 minutes before starting. That always works for me, and seems to cover the pain from breaking up the adhesions also. A resident taught me the nerve block technique. I'm never too old to learn new tricks.

An old doc i worked with when I was a student told me that OB's used to deliver the baby and then turn around, lay it on the table behind them, and do the circ while waiting for the placenta. Nowadays the baby has to be examined by the pediatrician or FP before the circ is done. I once did a circ on a baby at 12 hours of age. I did the newborn admit in the DR the night before so didn't re-examine the kid before the circ. Did discharge exam AFTER the circ and heard a LOUD murmur that wasn't there the night before. The kid started getting hypoxic within the hour and ended up in emergency cardiac surgery after crashing into CHF. Last time I ever circed a kid without listening to the heart right before.

I don't have too many parents request to watch. The two times I can remember having an audience (other than students), I had complications both times (bleeding that wouldn't stop and required extra sutures, as I recall). The scariest complication I had was in a kid with a really short little thingy and very loose skin on it. When I pulled the clamp off and the skin dropped back down, the whole ventral shaft was denuded, right down to the scrotum. Yikes! I called the urologist and he told me just tack the edge back up to the glans with some fine chromic and I did that. Then it was tethered down and I thought the kid would be peeing on his shoes the rest of his life but by his 2-week checkup he was fine (and I was a wreck from lack of sleep).

I have no problem letting students and residents do circs, because there really isn't much they can screw up if someone is watching. Once the Gomco is on, they can hack away at the foreskin without cutting anything else important.

And finally, to break the tension when i have a nervous student or resident doing his/her first one, I tell this joke: A Rabbi saved all the foreskins from all the circs he did and stitched them together to make a purse. If you rub it, it becomes a suitcase.

-- Anna Meenan, MD

P.S. I do believe babies shut down in response to overwhelming stimuli. I read it somewhere, but don't ask me where.

P.P.S. Hello Mats! Always good to hear from Scandinavia.

At Tue, 03 Jan 2006, fran wilson wrote: > >I have not been a supporter of circumcision, and still have very mixed feelings about it. The one thing that makes sense to me is that uncirc'd men have a higher risk of contracting HPV some strains of which have been shown to cause cervical cancer. Monogamy is the only thing that can prevent HPV, since it does not ONLY occur on the penis, but also around the anus and scrotum. There is no way of preventing those area's from contacting a woman's genitals during intercourse. >Monogamy may be what you hope for in your children, but in reality you may not have much to say about that at 15-16 yrs old. I am of the opinion that there will be a cure or a vaccine for HPV by the time boys born today are of that age, but it does give you something to consider - especially if you have teenage girls! And there is another new STD being discovered - or rediscovered - just about every year. >In this area, the circs are almost all done in the peds office. The peds who won't do them often refer pts to urologists. >Have you ever heard of the group No-Circ? They describe a technique to help grow the foreskin back if they are unhappy that they were circ'd when they were babies. They have alot of interesting literature. Propaganda to counteract the propaganda.... >Fran Wilson, CNMWild Rose Women's Clinic|Kennewick, WA > >From: GA12L@aol.comReply-To: ob-gyn-l@obgyn.netTo: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>Subject: CircumcisionDate: Tue, 3 Jan 2006 14:23:27 -0600 > >My youngest so was circumcised due to recurrent infections. It was very distressing for me as his mother to watch him being taken to theatre and again when he came round crying that they'd cut his penis off (he was 5 at the time). He was very subdued for a few days after too. > >Why, then, would anyone have their son go through surgery that wasn't necessary? Is the foreskin a mistake? Why is it there in the first place? > >I'm not arguing against or for it just wondering if it's done purely for cosmetic reasons. > >Gail >RM >

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