Avoid These Mistakes When Considering Circumcision

In this post I’ll reveal several medical secrets regarding circumcision.

You may have heard stories of a child having circumcision complications or needing a circumcision revision (a second operation when they are older due to problems with the first).

Avoid circumcision complications and revision. Consider the following:

Consider first that when an OB provider does the procedure in the hospital that they will not be seeing your child later for a recheck.

That’s right, no recheck.

So when there are problems, it’s the pediatrician who is taking care of the patient. Consider asking, “Who will manage problems should they arise post op?”

I’m currently managing a toddler who was brought into clinic recently because of ongoing circumcision problems. After birth he had a circumcision but there was way too much skin left on and it reattached to the tip. I needed to prescribe him a topical medication and he requires daily retraction of the residual foreskin to help prevent permanent attachment and further complications.

“This has been absolutely terrible. No one should have to go through this, his mother said during a visit this week. I agreed.

Consider this too- Some doctors don’t use pain medication. Keep in mind that this is an operation and there is some pain involved. The use of pain medication is recommended by both pediatric and obstetrical medical societies.

I have watched more than one doctor do this procedure on several babies without pain medication and in my opinion there was more crying and fussiness involved during and after the procedure.

I always use pain medication. Some babies that I’ve done have slept through the entire procedure. So ask about pain medication when you are talking to the doctor. Medication should be injected with a syringe. No tylenol for this.

Consider that there are different techniques that your doctor can use to do the circumcision also. Ask them to even show you what device they are going to use.

Some have slightly better outcomes than others. The majority of the time in the hospital the doctor will use some variation of a metal clamp that is applied for some duration of time and the foreskin will be removed afterwards. Some of these clamps are straight which creates a problem when trying to create a circular cut. These clamps can sometimes lead to extra flesh on either side looking like “dog ears.”

A more modern technique employs the use of a plastic ring called a “Plastibell.” There is very minimal bleeding and there is little post op care. No Vasoline gauze to change, etc. Your baby will go home with the protective ring still attached and it will fall off in about 1 week. Easy-breezy.

Here’s another thing that you should know that I always discuss with my families during the consent process. There really is NO medical benefit to having this procedure done. It’s more of a cosmetic, cultural or sometimes religious decision.

A few years ago the American Academy of Pediatrics (AAP) made a policy statement recommending the procedure due to it’s health benefits but then the rest of the world, where this procedure is less frequently performed, responded with- “no, not really AAP.”

Even though I’m happy to perform this procedure for our families and even though I side with the AAP on most things, this is one instance where I think specialists in other countries got it right.

The AAP states that one “risk” of remaining uncircumcised it the increase risk of urinary tract infections (UTI) during infancy. But this is very infrequent to begin with in male infants and the risk is only lowered marginally by having the procedure. Also, UTI’s are treated with antibiotics, not with removing the foreskin from the penis. UTI’s and the other “risks” of remaining uncircumcised as stated by the AAP did not seem enough to warrant such a policy statement recommending it. I hope the AAP will change their mind.

In summary, if you plan on getting your son circumcised, have a dialogue with your provider about the procedure and keep this article in mind. Also, know that ultimately circumcision is a preference rather than a medical necessity.

Some parents are surprised to learn that we offer this procedure in our clinic for newborn babies and it’s easy to make an appointment for a circumcision after your baby arrives. In fact, I performed one this morning and the mother was very glad to have it done here.

-We use the Plastibell technique.

-We always use pain medication.

-We'll continue seeing your child so we want to make sure everything is done right and looks good the first time!

Dr. Dave

primarycarepeds.org

Millington, TN

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8222 Highway 51 North

Millington, TN 38053

Children are a gift from the LORD.
Psalms 127:3
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