In Office Newborn Circumcision

Circumcision is the elective removal of the foreskin of the penis. The procedure is the oldest

human surgical procedure performed by the ancient Egyptians over 4000 years ago.

 

The current recommendation for circumcision is that the benefits of circumcision outweigh the

risks, but the evidence is not robust enough to justify routine circumcision. Therefore,

circumcision should be offered based on the best interests of the child regarding medical,

religious, ethnic, and cultural traditions.

 

I personally would recommend circumcision to families where most of the family is circumcised.

I feel as a parent the circumcised penis is easier to care for and to keep clean. However, this

does not mean that every kid should be circumcised. Quite the opposite, if most individuals in

the family are not circumcised, I would not recommend circumcision. I would not circumcise

without the patient having received a Vitamin K shot in the hospital or have started a course of

oral Vitamin K per European guidelines.

 

Circumcision has the benefit of decreasing the risk of transmission of HIV, urinary tract

infections, inflammation of the glans (head) of the penis, and the risk of certain penile cancers.

The risks include bleeding, infection, and a poor cosmetic result.

 

Since I will not be rounding in the nursery, we have decided to offer circumcision in the office as

an out-patient. I certainly approve of anyone wishing to get their circumcision done in the

hospital, but I feel the need to provide this service to the individuals who wish for me to do the

procedure.

 

The procedure entails the procurement of consent by the parents. The patient will then be

placed on a circumcision board where their legs will be restrained. The patient will then have a

circumferential nerve block placed with 1% Lidocaine. This is the only pain the infant should

have as after the block the procedure will be pain free. The adhesions will then be lysed, and a

dorsal crunch made to control bleeding. A dorsal slit will be performed, and any remaining

adhesions will be lysed. The Mogen clamp will then be used to complete the circumcision and

the foreskin will be removed. We will check for hemostasis and will provide silver nitrate if

hemostasis is not observed. We recommend Vaseline to be placed on the penis like a soft serve

ice cream cone with every diaper change for 3-5 days. The circumcision should be completely

healed in 1 to 2 weeks. We would have the parent monitor for bleeding in the following 24 to 48

hours and return to clinic if there are any questions.

 

We are happy and excited to offer this service to you and look forward to continuing to provide

you with the quality and excellence of care that we have provided for the past 23 years and that

we would expect for my own children.