RSS

Circumcised or Uncircumcised?

15 Jul

Circumcised or Uncircumcised?

One of the many questions that you may be asked at some point during your hospital stay: “Do you want him circumcised?” Some parents have a strong opinion one way or the other, based on any number of factors, while others have no preference because they’ve never really thought about it or they want to make an informed decision which takes all of the facts into consideration. Either way, it’s a decision that you will make more than likely within the first week of your son’s life.

ARGUMENTS FOR CIRCUMCISION:

  1. Cleanliness. Research suggests that this procedure reduces the risk of AIDS/HIV and penile cancer as well as making it easier to clean.
  2. Culture. Religious tradition could mean pressure to follow the mandates of that religion. Also, many parents decide to circumsize their sons because other male family members on either or both sides are circumcised. Additionally, circumcision is commonly practiced in some societies and is even seen as a rite-of-passage in a few.

ARGUMENTS AGAINST CIRCUMCISION:

  1. Cruelty. Opponents of circumcision point out that whether or not the baby remembers this procedure, it still causes them unnecessary pain and emotional distress, bordering on barbaric.
  2. Complications. This, like any other procedure, isn’t without its risks. Infections, bleeding and deformity aren’t entirely unheard of, even if it is performed by a practitioner experienced in this procedure.

In the end, the decision is up to you as to what’s right for your son either based on the factors above or your own reasons. Only you can know what’s best for your child. But it’s recommended that the decision be made well in advance of his birth, so mother doesn’t have to add this decision to the many already undoubtedly sitting on her plate. If you do decide to circumcise your son, take the following into consideration.

GENERAL QUESTIONS

  1. When should my son be circumcised? It is recommended that you wait until a week after your son’s birth (until he has at least regained his birth weight). The delay will allow doctors to assess if there is an issue that would make circumcision unwise to pursue (such as if your son has a condition called anemia, which means he bleeds easily and can have extensive blood loss from thin blood). If your baby was born prematurely, some doctors might not perform the procedure until he reaches the point where he would have been full term (more than likely his due date or close to it). It’s recommended that it be performed before he’s 3 months old and definitely before 6 months old.
  2. Who should circumcise my son? Generally, it’s recommended that you choose someone who has extensive experience performing this procedure. I elected to have my pediatrician do it. She did a magnificent job and the wound has healed marvelously.
  3. Will my insurance cover the procedure? This varies from provider to provider, so definitely call yours prior to scheduling the appointment. Cost may factor into your decision as to whether you have it performed. For my husband and I, it was important enough to us that we decided we would find the money if we had to. Fortunately, our provider paid for 80% of the cost and we were left to pay only 20%, which amounted to about $87. If you’re lucky, you will have met your maximum out-of-pocket with the combined costs of your hospital stay, all those wondeful drugs they gave you during delivery, the pediatricians and nurses who spent all that time caring for your little one while you slept and your obstetrician’s charges for services rendered and you won’t have to pay a dime.
  4. What if I don’t have insurance? If you don’t have insurance, it might be worth it for you to check into AHCCCS or your state’s form of government-subsidized medical assistance, though I’d be careful with this as you may have to prove that the procedure is medically necessary and that can be tricky.

BEFORE THE SURGERY

  1. What are some ways that I can prepare my son for the surgery? Bath your son as usual right before the surgery. Be sure to wash his little wee-wee. Also, it’s recommended that you change his diaper just before the operation and keep a clean one on hand for after as well. Additionally, feed him normally up to an hour before the surgery.

METHODS OF CIRCUMCISION

  1. What are the most common methods of circumcision and how are they performed? The most common methods are Plastibell, Gomco and Mogen. All methods are preceded by either a shot of anesthetic to the base of the penis or a cream that is applied for pain management. Some doctors even offer a sucrose pacifer to comfort him. Post-surgery pain shouldn’t last for more than a day. For the Plastibell method, a plastic ring is tied around the tip of the penis. The foreskin is then removed and the ring stays in place to prevent bleeding after the surgery. It should fall off 4-10 days afterward. Clean the penis by washing three times daily or during diaper changes. For the Gomco or Mogen methods, take off the gauze and petroleum dressing 48 hours after the surgery and, as with the Plastibell method, clean the penis by washing three times daily or during diaper changes. 

AFTER THE SURGERY

  1. The tip of my son’s penis is blue. Is something wrong with it? No. In fact, the reason that it appears blue is the veins underneath the surface. These veins are more visible in babies because they haven’t yet built up their store of fat and muscle. As they mature, these stores will increase and the veins will be less obvious. (A fact that I learned from experience when I rushed my son to the emergency room in the middle of the night over this very thing.)
  2. What are the signs and symptoms that my son’s circumcized penis is becoming infected? While a blue tip is nothing to worry about and a little redness and swelling is to be expected (he just got his wee-wee cut at, for cripe’s sake!), if any part of the cut line is more swollen or red than the rest or if there is a puss-like discharge and crustiness accompanied by a foul odor and a fever higher than 100.4 taken rectally, there is a chance it is infected. If the Plastibell method was used, a dark brown or black area is absolutely normal and will disappear after the ring has fallen off. Also, the skin under the string may become soft and yellow, like the umbilical cord stump. Again, this is no cause for alarm. If in doubt, schedule an appointment with your doctor to have it examined. (On a side note, if you have any concern, take him in. Many new mommies fret over the smallest things with their little ones, so you’re not alone. A good pediatrician will understand this and will be happy to take the time to assuage your fears. As I always say, better safe than sorry. You may feel silly in the short term, but the relief will overwhelm any embarrassment.)
  3. How can I prevent my son’s circumcision from becoming infected? Most doctors will prescribe you an antibiotic as a precaution, though its not common practice. Don’t be afraid to ask your doctor for this antibiotic if they don’t offer it. Again, better safe than sorry. Nothing is silly when it comes to your little one’s health.
  4. How do I clean my son’s circumcision to prevent it from becoming infected? Use either Q-tips or cotton balls to first clean the cut line then to carefully apply petroleum jelly to the cut line all of the way around as well as the tip each time you change his diaper. This will promote healing, prevent his wee-wee from sticking to his diaper (ouch!) and prevent the formation of what is called a “skin bridge”. I’d recommend Q-tips because they allow you to get the jelly into the little places underneath the tip and it is in general an easier tool to handle. Use caution when bathing his penis following the surgery. If the dressing to the penis (if any is applied) has not fallen off within 24 hours, soak it in warm water. Remove the dressing slowly and if you feel any resistance, apply a little more warm water and allow the water to soak off the clotted blood before continuing. Once the dressing is off, give your son daily baths. Wash carefully around his wee-wee.
  5. Is there a way for me to make the healing process less painful for my son? Yes. You can provide him with liquid Tylenol at your doctor’s discretion. For babies 6-11 pounds, the recommended dosage is 1.25mL in a syringe and for babies 12 to 17 pounds, the recommended dosage is 2.5mL in a syringe. ALWAYS USE A SYRINGE TO MEASURE THE DOSAGE. NEVER GUESS. As the recommended dosage is based on WEIGHT not AGE, SEEK MEDICAL ADVICE BEFORE ADMINISTERING ANY DOSAGE AS TYLENOL CONTAINS ACETAMINOPHEN, WHICH CAN BE HARMFUL IF THE INCORRECT DOSE IS GIVEN. Don’t confuse INFANT DROPS with INFANT/CHILDREN’S LIQUID as the drops are three times more concentrated. Also, don’t exceed more than five doses in 24 hours and NEVER give acetaminophen to an infant taking other medications without your doctor’s consent. If you’re looking for a low-cost alternative, most store brands are okay. Just be sure that you compare the ingredients of both the brand name and the store brand. If they’re the same, then its a safe bet that the store brand will work just as well. As far as how to administer, press gently on the plunger and give him a drop or two at a time. If you try to give it to him all at once, he’ll only spit out the majority of the medicine, meaning you’ll have to administer more to compensate. 
  6. What are some other ways I can comfort my son after his circumcision? It definitely helps for him to be suckled or given his bottle afterward. Also, cuddle and reassure him as much as you can. He finds great comfort in your voice so talk to him and sing to him. Another trick I’ve found works for almost any incidence of fussing or discomfort, try a gentle “ch-ch-ch-ch-ch-ch-ch” sound repetitively. The noise is soothing, a reminder that you’re there.
  7. What else can I expect while the circumcision is healing? A little blood or staining of his diaper for a few hours afterward is normal. However, as a guideline, using the thumb and index finger, make a ring around the top of the penis and squeeze tightly for FIVE MINUTES. If the bleeding does not stop contact the doctor immediately for advice or go to the nearest ER. Additionally, if stitches were used, they should fall off withing 7-10 days and don’t require any special care.

Notify your doctor immediately if:

  • There is persistent bleeding
  • The plastic ring slips onto the shaft of the penis
  • There is excessive swelling
  • Urine drips out of the penis
  • The ring has not fallen off within 14 days of surgery
  • The baby fails to settle
CARING FOR THE UNCIRCUMCISED PENIS
If you decide not to circumcise your son, here are some easy tips for ensuring cleanliness and good hygiene:
You don’t need to pull back the foreskin for the first year of life. Once he’s one or two years old, you can partially retract the foreskin for cleaning. Pull it back gently, never forcefully, and wash it with soap and water. Your son can learn to do this for himself once he reaches age five or six.
So in the end, no matter which option you go with, staying informed in the care of his little wee-wee is the best thing you can do for him. Remember, if your son has a fever of 100.4 or higher taken rectally or shows any signs of infection, contact your doctor IMMEDIATELY.
SOURCES REFERENCED
  1. Julie Green. Circumcision: Arguments For and Against. October 23, 2010. Parenting Squad. <http://parentingsquad.com/circumcision-arguments-fore-and-against>
  2. The Gilgal Society. Preparation and After-Care for Your Infant’s Circumcision. September 2004. <http://www.circinfo.com/prepandcare/icc.html>
  3. The Permanente Medical Group, Inc. Newborn Circumcision Information. September 11, 2004. <http://www.permanente.net/homepage/kaise
Advertisements
 

Tags: , , , ,

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

 
%d bloggers like this: