Overview

Infant circumcision has been a time-honored ritual throughout many cultures and religions. (For example, circumcisions are considered to be a religious rite in Judaism.) Many advocates believe that circumcisions promote cleanliness and a lower incidence of penile cancer and disease. However, some critics - more notably in recent years and by pediatricians - claim it is an unnecessary surgical assault or a "rape of the phallus."

Unfortunately, hospitals often discharge newborn infants uncircumcised; whereby many return for a more expensive surgical circumcision months or years later. The most common reasons why parents readmit their children to be circumcised are:

• Inability to fully retract the foreskin (prepuce) from the glans to clean it
  
  
• Inflammation or infection of the prepuce
  
  
• Fear of embarrassment from peer ridicule at school in a gym locker room or shower

Uncircumcised men can also experience a common problem with the restrictive band on the underside of the penis. This band (properly known as the "frenum") connects the prepuce with the glans and obliterates the groove behind the glans flare. It may extend considerably onto the glans and can become thick and irritated from sexual activity. (This is is a major reason why teens and adults later choose to have circumcisions.)

[TOP]

Preparation

On the day of the surgery, the parent or patient should cleans his genitals with mild soap and water. Shaving is not necessary.

[TOP]

Procedure

Circumcisions for newborn infants up to three-months-old entail a simple gauze retraction-tear on the frenum, followed by silver nitrate bead touch for hemostasis. Then a Plastibell procedure is done (see below). No anesthetic is used for this procedure because the nerve endings have not yet matured.

Patients older than three months undergo an in-office Plastibell or Gomco procedure using a local dorsal penile nerve block (DPNB) anesthesia. For these procedures, the doctor surgically divides the frenum, using a unipolar cautery for hemostasis. The foreskin is removed by using either the largest Plastibell or a Gomco clamp instrument.

During the Plastibell procedure, the doctor:

	1. Uses two hemostats (clamp-like tweezers) to grip the foreskin and pull it over the head of the penis. 2. Uses a probe to separate where the foreskin adheres to the head of the penis.
	3. Spreads the foreskin with the hemostats and crushes the foreskin where he will make an incision.
	4. Makes a small slit in the foreskin along the crushed line. 5. Gently retracts the foreskin to free the remaining adhesions.
	6. Places the Plastibell apparatus over the glans and under the foreskin.
	7. Secures the bell apparatus while tying a string that holds it in place.
	8. Trims off the excess foreskin.
	9. Removes the bell's wishbone handle.

The largest Plastibell (1.7 cm) can often be used on patients up to one-year-old. Parents must remove the child's ring string-tie within 48-72 hours to encourage early ring separation and prevent infection.

[TOP]

Possible Complications

As with any surgery, the patient might experience one or more complications. Known complications for circumcisions that can be experienced include but are not limited to:

• Mild to moderate pain (analgesics are helpful)
• Swelling and discoloration from bleeding behind the ring
• Oozing from within the ring (parents are shown cleaning techniques)

[TOP]

Post-operative Instructions

Patients nearly always experience quick recoveries from our in-office surgeries. Patients having circumcisions should follow the post-operative instructions below and call the clinic if they experience an complications.

1. When necessary, administer a pain reliever as directed on product's label. Family Planning Center recommends Tylenol, Advil, or Motrin.
2. Bathe the genitals immersed in bath tub as usual.
3. Apply triple antibiotic ointment around outer edge of the circumcision ring after each bath. Ointment facilitates proper healing so do not neglect this step. If the patient is wearing diapers or pull-ups, change the diapers frequently and apply ointment with each change.
4. Call the office if the affected area is bleeding or oozing.
5. Children will sometimes hold their urine because they fear it might be painful. If you suspect that he is holding his urine, put him in a warm bath and let him urinate in the tub.
6. If the child is under 6 months old, the Plastibell ring should fall off in 5 to 8 days.
7. If the patient is older than six months, he should return to the office in two days to have the Plastibell ring removed.