5/29/2015

Circumcision:LearnProsandConsoftheSurgicalProcedure

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Source:http://www.medicinenet.com/script/main/art.asp?articlekey=7826

Circumcision:TheSurgicalProcedure
MedicalAuthor:
DavidPerlstein,MD,MBA,FAAP

DavidPerlstein,MD,MBA,FAAP
Dr.PerlsteinreceivedhisMedicalDegreefromtheUniversityofCincinnatiandthencompletedhis
internshipandresidencyinpediatricsatTheNewYorkHospital,CornellmedicalCenterinNewYorkCity.
AfterservinganadditionalyearasChiefPediatricResident,heworkedasaprivatepractitionerandthen
wasappointedDirectorofAmbulatoryPediatricsatSt.BarnabasHospitalintheBronx.

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MedicalEditor:
MelissaConradStppler,MD

MelissaConradStppler,MD
MelissaConradStppler,MD,isaU.S.boardcertifiedAnatomicPathologistwithsubspecialtytrainingin
thefieldsofExperimentalandMolecularPathology.Dr.Stppler'seducationalbackgroundincludesaBA
withHighestDistinctionfromtheUniversityofVirginiaandanMDfromtheUniversityofNorthCarolina.She
completedresidencytraininginAnatomicPathologyatGeorgetownUniversityfollowedbysubspecialty
fellowshiptraininginmoleculardiagnosticsandexperimentalpathology.

ViewFullProfile
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5/29/2015

Circumcision:LearnProsandConsoftheSurgicalProcedure

Circumcisionfacts
Whatisacircumcision?
Isacircumcisionsafe?
Howisacircumcisiondone?
Whatshouldoneexpectafteracircumcision?
Isacircumcisionpainfulforababy?
Howcanthepainbereduced?
Whatarethecontraindicationstocircumcision(thereasonsagainstdoingit)?
Whatisthechanceofacomplicationfromacircumcision?

Circumcisionfacts
Newborncircumcisionisagenerallysafeprocedureifitisdoneunderpropercircumstances.
Circumcisionshouldbedonebyatrained,experiencedpractitioner.
Circumcisionshouldnotbedoneifaninfantissickorinunstablehealth.
Aprematureinfantshouldnothavecircumcisionuntilthebabymeetsthecriteriatobe
dischargedfromthehospital.
Infantswithgenitalanomalies(includinghypospadias)shouldnotbecircumcised.
Babieswithafamilyhistoryofbleedingshouldnotbecircumciseduntiltestsaredoneto
makesurethechilddoesnothaveableedingproblem.
Localanalgesiashouldbegiventoreducethepainassociatedwiththeprocedure.
Careoftheinfantaftercircumcisionissimpleandgenerallywelltolerated.

Whatisacircumcision?
Acircumcisionisasurgicalprocedurethatremovestheforeskin(theloosetissue)coveringtheglans
(roundedtip)ofthepenis.Circumcisionmaybeperformedforreligiousorculturalreasons,orforhealth
reasons.Newborncircumcisionisthoughttodiminishtheriskforcancerofthepenisandlowertheriskfor
cancerofthecervixinsexualpartners.Itisalsobelievedtodecreasetheriskofurinarytractinfectionsin
infantsandlowertheriskofcertainsexuallytransmitteddiseases,especiallyHIV.

Isacircumcisionsafe?
Circumcisionisgenerallyasafesurgicalprocedureifthefollowingconditionsaremet:

Thecircumcisionisperformedcarefully,usingstrictaseptic(sterile)technique
thecircumcisionisperformedbyatrained,experiencedpractitioner
thecircumcisionisperformedonlyonahealthy,stableinfantand
thereisnomedicalreasonnottohavecircumcisionperformed(seebelow).

Howisacircumcisiondone?
Thecircumcisionmaybeperformedusingsurgicalclamptechniquesorwithaspecialdisposableplastic
devicecalledaPlastibell.Theresultsareequallygood.
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Whatshouldoneexpectafteracircumcision?
Followingcompletionofthecircumcision,thepractitionermayapplygauzeimpregnatedwithpetroleum
jelly.Youshouldfollowanyinstructionsregardingthecareoftheinfantgiventoyoubythepractitioner,and
thesemightincludethefollowing:

Generallyitisrecommendedthattheareabecleanedseveraltimesadaywithwarmwater.
Ateachdiaperchange,youcanapplyasmallamountofunscentedpetroleumjelly,oryour
doctormightrecommendapplicationofanantibioticointmentaswell.Petroleumjellyshould
notbeusedonaPlastibellunlessdirectedtobyyourphysician.
Itmaytakeuptosevento10daysfortheincisionscabtosloughoff.
Afterthescabfallsoff,nofurthercareisrequiredexceptfornormalhygiene.
Atthefirstwellbabyvisitfollowinghospitaldischarge,thepenisshouldbecarefully
examinedbythedoctorandtheparentsgivenmoreinformationconcerningfurthercare.

Isacircumcisionpainfulforababy?
Newbornswhohaveacircumcisionwithoutanalgesia(forpainrelief)respondinwaysthatstrongly
suggestthattheydofeelpainandexperiencestress.Theyshowchangesinheartrate,bloodpressure,and
oxygensaturation,aswellaschangesincortisollevelsandbehavioralchanges.Thebehavioralchanges
includecryingatthetimeaswellaschangesinsleeppatternsandmotherchildinteractionsthatare
temporaryanddisappearwithin24hoursoftheprocedure.

Howcanthepainbereduced?
Analgesiahasbeenfoundtobesafeandeffectiveinreducingthepainassociatedwithcircumcisionand
shouldbeprovidediftheprocedureisperformed.AnalgesicmethodsincludeEMLAcream(atopical
mixtureoflocalanesthetics),thedorsalpenilenerveblock,andthesubcutaneousringblock.

Whatarethecontraindicationstocircumcision(thereasonsagainst
doingit)?
Unstableorsickinfant:Circumcisioniscontraindicatedifthebabyisunstableorsick.Circumcisionis
electivesurgeryand,aswithothermedicallyelectiveprocedures,itshouldbedelayeduntilthebabyis
well.Signsofstabilityincludenormalfeeding,wasteelimination,andmaintenanceofnormalbody
temperaturewithoutanincubatororradiantwarmer.
Aperiodofobservationaftertheinfant'sbirthmayallowforrecognitionofabnormalitiesorillnesses(for
example,seriousjaundice,infection,ormanifestbleedingdisorder)thatshouldbeaddressedbeforethis
electivesurgery.
Prematurity:Itisusuallybesttowaituntilaprematureinfantmeetsthecriteriafordischargefromthe
hospitalbeforeperformingcircumcision.
Genitalanomalies:Infantsbornwithgenitalanomalies(includingonecalledhypospadias)shouldnotbe
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circumcised.Theforeskinmaybeneededforthesurgicalcorrectionoftheanomalies.
Bleedingproblems:Wheneverthereisafamilyhistoryofbleedingdisorders,appropriatelaboratory
studiesshouldbeperformedtomakecertainthebabyhimselfhasnotinheritedthebleedingdisorder.

Whatisthechanceofacomplicationfromacircumcision?
Largescalestudiesindicatethattherateofcomplicationsislow,rangingfromonein200toonein500.
Themostcommoncomplicationsarelocalinfectionandbleeding.Complicationsduetolocalanesthesia
consistmainlyofhematomas(bruises)andlocalskinnecrosis(damageandloss).
Deathsattributabletonewborncircumcisionarerare.Nodeathsoccurred,forexample,inananalysisof
500,000circumcisionsinNewYorkCityor175,000circumcisionsinU.S.Armyhospitals.
TheAmericanAcademyofPediatricsstates:"Evaluationofcurrentevidenceindicatesthatthehealth
benefitsofnewbornmalecircumcisionoutweightherisks,andthebenefitsofnewbornmalecircumcision
justifyaccesstothisprocedureforthosedfamilieswhochooseit."

MedicallyreviewedbyMargaretWalsh,MDAmericanBoardofPediatrics
REFERENCE:
"Neonatalcircumcision:Risksandbenefits"
uptodate.com

MedicallyReviewedbyaDoctoron5/19/2015

2015MedicineNet,Inc.Allrightsreserved.
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