Circumcision The Surgical Procedure (cont.)
David Perlstein, MD, MBA, FAAP
Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
- Circumcision facts
- What is a circumcision?
- Is a circumcision safe?
- How is a circumcision done?
- What should one expect after a circumcision?
- Is a circumcision painful for a baby?
- How can the pain be reduced?
- What are the contraindications to circumcision (the reasons against doing it)?
- What is the chance of a complication from a circumcision?
Is a circumcision painful for a baby?
Newborns who have a circumcision without analgesia (for pain relief) respond in ways that strongly suggest that they do feel pain and experience stress. They show changes in heart rate, blood pressure, and oxygen saturation, as well as changes in cortisol levels and behavioral changes. The behavioral changes include crying at the time as well as changes in sleep patterns and mother-child interactions that are temporary and disappear within 24 hours of the procedure.
How can the pain be reduced?
Analgesia has been found to be safe and effective in reducing the pain associated with circumcision and should be provided if the procedure is performed. Analgesic methods include EMLA cream (a topical mixture of local anesthetics), the dorsal penile nerve block, and the subcutaneous ring block.
What are the contraindications to circumcision (the reasons against doing it)?
Unstable or sick infant: Circumcision is contraindicated if the baby is unstable or sick. Circumcision is elective surgery and, as with other medically elective procedures, it should be delayed until the baby is well. Signs of stability include normal feeding, waste elimination, and maintenance of normal body temperature without an incubator or radiant warmer.
A period of observation after the infant's birth may allow for recognition of abnormalities or illnesses (for example, serious jaundice, infection, or manifest bleeding disorder) that should be addressed before this elective surgery.
Prematurity: It is usually best to wait until a premature infant meets the criteria for discharge from the hospital before performing circumcision.
Genital anomalies: Infants born with genital anomalies (including one called hypospadias) should not be circumcised. The foreskin may be needed for the surgical correction of the anomalies.
Bleeding problems: Whenever there is a family history of bleeding disorders, appropriate laboratory studies should be performed to make certain the baby himself has not inherited the bleeding disorder.
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