Jamie - July 2002

First off, I want to tell you that I am a Registered Nurse that has worked in three major Boston hospitals in various obstetrics areas. For several years I have been in high risk antepartum, postpartum, labor and delivery, newborn nursery, and most recently ambulatory antenatal. The longest stint was in postpartum/newborn nursery, and I have seen and assisted in multiple circumcisions.

I am very aware of the growing feeling against circumcision. I personally do not have a feeling one way or another, and do not have any children myself as of yet to have a personal experience in it. As I read the "nurses" section on the site, I felt as though it was quite slanted and not given an accurate portrayal of what the procedure entails.

I will tell you what I have witnessed in the many circumcisions at one particular Boston hospital:

Parents are given info on circs in their prenatal care if they request it. Many doctors I have worked with feel as though it is a simple procedure but do not have a preference either way their patients decide. Once the family is on the postpartum unit, they are asked if they desire a circ on their newborn boy. If so, the MD has the patient go over the consent, which specifically lists the potential risks (i.e., infection, bleeding, mutilation). Then they are given a choice of pain control, if any. The options are a dorsal-penile block, EMLA topical anesthesia, nothing, and Tylenol post procedure for 24 hours.

Now, my personal experience with this at work is varied. This depends solely on the MD performing the circ. As far as anesthesia, I have unfortunately witnessed only one obstetrician perform the dorsal-penile block correctly. It is done with a tiny 30 gauge needle into the base of the penis where it meets the lower abdomen at the 10 and 2 o'clock positions. If injected in the right spots and allowed to wait the 5-10 minutes for it to take effect, then the infant does very well. Problem here is that I have only seen one MD do this as I have mentioned. Many MD's do not know how to inject it correctly or in the correct area, and/or do not take the time to wait for it to take effect.

The infants I have seen after the DPB, regardless of proper technique, do much better post-procedure when it comes time to change diapers, etc. This is also true of those who receive the baby Tylenol for the 24 hours following.

As far as the EMLA topical cream, I will definitely agree that this is an inadequate form of anesthesia. All of these infants have screamed through the procedure as if we did not apply anything at all.

(Word of note: I have personally used EMLA for myself for electrology treatments on my face and it was useless. I would never choose this for any procedure.)

The infants who do not receive any anesthesia are obviously in pain and uncomfortable following the procedure. However, in my experience, I have only witnessed parents choosing this method out of religious reasons (i.e., Jewish who have it done at a Bris). Although there have been an occasional parent here and there who willingly choose no anesthesia.

As far as the care of the penis post circ, I have NEVER heard of any MD, RN, or any other medical professional using rubbing alcohol on the site. All circs at the hospitals I have worked in use petroleum jelly for 14 days post procedure. And I have also NEVER witnessed an RN, MD, or other medical professional "rub in" the petroleum jelly onto the site. It is placed on either a gauze pad, the front of the diaper, or directly squeezed over the site (but done gently)!

I agree it is terrible to listen to a newborn baby cry out in pain. It is true that some "vomit" or spit up mucous left over from their birth while they are crying. However, as a nurse I have only witnessed this becoming a problem at feeding time when a bottle is used and the infant is unable to control the nipple flow and their suck coordination at the same time.

In my experience, I have seen most parents choose circumcision. When I have asked why they make this decision, many mother's say that they truly do not have a preference but that the father feels it is necessary. These fathers (many that I have met) feel as though the child would later be made fun of, or have self esteem issues if the procedure is not done. "What if they look around at their friends in gym class and they are the only ones that look different?" I have heard them say. Or even, "I'm circumcised, so my son should look like me too."

Many MD's are aware and admit to patients/parents that circs are not medically necessary. However, they continue to do them because there is still a demand from their patients. They would not make them so readily available if the demand was not there. If only a small percentage of their patients wanted it done, most would opt not to do them at all, and hospitals would not support the procedure because it would in turn not make any money for them. (Sad, but true. Hospitals will do only the procedures if it supports their pocketbooks.)

So perhaps, based on what I have seen, the "problem" lies within the culture. It is a cultural norm to be male and circumcised. And many men, in my experience, perpetuate this "need" to circumcise. Many men will tell you that they do not remember the circumcision, have no long term residual effects, and would hardly admit to having a "mutilated" penis just because they do not have their foreskin!

Thank you for you time.

Jamie Spencer, RN, BS

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