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Originally Published in November of 2011

Last summer, I attended the American Congress of Obstetricians and Gynecologist’s (ACOG) annual meeting in Washington DC, as part of my state-required continuing medical education.  It was nice to hear new perspectives on common OB and GYN topics, ie. VBAC, preterm delivery, PCOS, robotic surgery, etc.

While there, as expected, there were plenty of abortion protesters circling the convention center in their message-laiden vehicles.  I was surprised, however, to see dozens of protesters of male circumcision along the sidewalks flanking the building.  At first I was puzzled, thinking to myself, “Why would one spend all day for several days in a row protesting circumcision?”  I never thought of it as a hot topic for debate, unlike abortion, for which I can certainly understand the polarizing nature.

I also never thought of writing a blog post on circumcision until I saw a more popular OBGYN blogger recently comment on it.  After reading mine, please read his, as it is even more insightful than what follows below. 

I honestly never gave that much thought to the debate of “to circumcise or to not circumcise.”  I just figured it was a family’s decision.  Some make this based on religious or cultural beliefs, and others take a more secular approach, ie: what does the baby’s daddy’s penis look like.  I feel that most men, with exceptions I am sure, are happy with whatever “theirs” looks like.  And, I have never met anyone who has any memories of their circumcision. 

To me, it seems that circumcision is just something a man learns to accept as “it is what it is.”  And that is where many opponents to circumcision feel it is wrong; these young boys are not giving informed consent themselves for the procedure.  I cannot argue with that point; however, the paradigm of foreskins would change greatly if a man had to wait until age 18 to get a circumcision.  I don’t think there would be too many takers on the procedure then.  And if that were the case, would there be protesters outside ACOG meetings with signs opposite of those I witnessed? 

The evidence-based approach does not add that much insight.  There is literature to suggest a decrease in transmission of STDs and of penile cancers, but these effects are too small to warrant routine recommendation of circumcision.  Then there are the surgical risks of the procedure, which are rare in the hands of an experienced provider.  These include bleeding, infection, and damage to the penis, along with the possible need for a revision in the future. 

I believe I speak for most of the providers in Kamm McKenzie when I say that we support the ACOG and American Academy of Pediatrics stance on circumcision, which states there is insufficient evidence to routinely recommend neonatal circumcision and that parents should be given accurate and impartial information to help them make an informed decision.  Well, the above paragraph provides the unbiased information.  I probably did not change anyone’s opinion did I?

When it comes to circumcision, there is good evidence that analgesia leads to less pain and stress to newborns.  At WakeMed, newborns are swaddled, soothed with Tylenol, and some get a sweet sugary snack.  In addition, we all provide local anesthesia with a lidocaine penile block.  

Lastly, I would like to clear up the confusion on the different types of circumcision.  I am aware of three techniques; plasti-bell, gomco, and mogen.  In Kamm McKenzie, our providers only perform one of the first two methods.  More than I imagined, I have patients ask me which way I do the circumcision, or which way does another provider do them.  I usually answer, “the way they have done hundreds to thousands before.” 

When it comes to plasti-bell versus gomco, the important thing to know is that in a week or two, no one will ever know the technique used for the circumcision.  In the short term, there are pros and cons to each.  With the gomco, the foreskin is removed at the time of the circumcision, and the post-operative care is the placement of Vaseline on the penis with each diaper change.  For the plasti-bell, the foreskin is tied tight around a plastic bell and it will eventually just fall off in a few days.  These are lower maintenance at first but can be a nuisance if the foreskin “hangs” on by a strand.  In reality, either technique is equally good and neither is high maintenance.

Best of luck with your decision!  We will support you either way.  🙂

— Dr. B

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