Circumcision

What it is: The surgical removal of the foreskin that covers the tip of the penis performed by a MD. Considered a cosmetic procedure that a lot of insurance companies are now refusing to pay for. Estimated that 60%-75% of all males in the United States are circumcised (dependant on ethnicity and religion/culture).

Responsibility of the MD to discuss procedure and have parents sign informed consent for surgery. Responsibility of nurse to provide facts, aftercare instructions and time for parents to explore their feelings before signing the consent. Why perform procedure: Foreskin is not fully separable from the glans in about 96% of newborn boys. By 1 year of age, the foreskin can be retracted in 50% of boys and by 3 years, the foreskin can be retracted in 80%-90% of uncircumcised boys. prevents phimosis, paraphimosis, and balanoposthitis. increases the chance of meatitis. may result in a decreased incidence of urinary tract infections. may result in a lower incidence of sexually transmitted diseases and reduce HIV transmission. may lower the risk for cancer of the cervix in sexual partners. may decrease the risk for cancer of the penis.

What is involved: 3 methods of circumcision Plastibell, Mogen clamp, and Gomco clamp post-procedure care differs for each method Pain management for neonates during and following circumcision varies. Eutectic mixture of local anesthetic (EMLA) is a topical anesthetic used for minor procedures, such as circumcisions. Maximum effect when applied 30-60 min before Dorsal penile nerve block (DPNB) is effective in decreasing behavioral and physiological pain responses in the newborn. A 27-gauge needle is used to inject the 0.4 mL of 1% lidocaine, which is administered at 10-o'clock and 2-o'clock positions Teaching: teach parents to care for the circumcision and to observe for complications penile adhesion - the cut edges should be pushed back off the glans and a little petroleum jelly (Vaseline) smeared on the wound and glans each time the baby is changed to prevent the two fusing together and forming 'skin bridges' increased bleeding or drainage excessive swelling stitches have not fallen out after 14 days baby fails to settle

References Circumcision. Retrieved from http://www.nlm.nih.gov/medlineplus/circumcision.html Circumcision care. Retrieved from http://www.intellihealth.com/print-article/circumcisioncare Male circumcision. (2012, September 1). Pediatrics, 130(3), 756-785. http://dx.doi.org/10.1542/peds.2012-1990