I couldn't resist responding to some issues that were brought up in Spinaroonies Good News thread yesterday.
Some food for thought for those who may some day have to make this decision for their baby boy some day.
Pain is a big issue in neonatal/developmental psychology these days. It's a blossoming area that is only now just getting it's due.
For a long time it was maintained that neonates and premies did not have the capacity for pain. We know now that is not true. In fact, physiological responses to pain are often greater than that in adults though shorter lived. Because pain is such a subjective thing to the observer and babes cannot be asked to score their pain on a scale of 1 - 10 pain scales have been developed. Although they try to be objective even they have many downfalls.
Pain in babes is not only reflected by behavior changes but by cardiovascular and hormonal changes. It is measured through vital signs, oxygen saturations and facial expressions. The earlier the babe the less credit is given to facial expressions.
A word about a babes response to pain and stimuli. Not all respond with crying. Some will shutdown. That is stare or go to sleep. It's a withdrawal mechanism. Hiccups can also be a sign of disorganization caused by overstimulation and pain though not always.
Some people think that giving them a pacifier takes care of the pain. Not true. The physiological parameters stay altered. Sucrose has been shown to be helpful though.
We are only beginning to understand the longterm affects of pain on babies. Hopefully the least parents and hospital staff can do for circs in the first couple of days is lots of love, minimal stimulation and round the clock tylenol. Some docs still don't order in tylenol post-circ.
I was surprized at the age of this article from '87. There has been more since then but I don't have access to it here.
http://www.cirp.org/library/pain/anand/
Beyond pain the incidence of complications from circumcisions ranges from 0.2-10%. These are just estimates as there is no system for reporting and tracking this. One estimate for lifelong alterations as a result are about 1%. It's estimated that about 2% of all circs become infected. Lifelong alterations can range from chordee or bowing (a bend that I understand is quite painful with an erection), cheloids/scarring, alterations in the meatus (the opening) including altered placement or obstruction, cysts and loss of penis. Mostly I've seen bleeding, uneven cuts (which can lead to problems of bowing or chordee later) and excessive cuts requiring stitches (higher risk of scarring later). Fortunately rare there have been occasional deaths related to circs. I have found most physicians gloss over potential complications pretty quickly when getting consents for circs.
About 50-60% of all males born in the US are now circ'd making the "so they look like the other boys in the locker room" reason invalid.
Reasons for having a circ done include decreased risks for UTI's, penile cancer and STDs. Uncircumsized babies do get more UTIs but their overall risk is quite low at about 1%. Uncircumsized males are about three times more likely to get penile cancer but over all only 10 males out of 1 million men will get it. Uncircumsized males do have a higher STD rate but this has been shown to be preventable with good hygiene (not to mention a condom).
Then we come to sexuality. This was the biggest thing I did not want to take away from my boys. In infant circumcision the foreskin is removed from the glans prematurely. This naturally happens in most boys by age 5 but may take longer in some. The exposed glans then becomes desensitized. The foreskin itself is very sensitive. It also allows for the full extension of the penis during erection. There is also increased lubrication when the foreskin is present.
The bottom line is it's the parents decision. Hopefully they truly know all the pros and cons. Sure, in most males it might not make a huge dif whether he's circ'd or not but why risk complication? And just because a male thinks that their childhood circ hasn't made them different, how do they really know?
Some food for thought for those who may some day have to make this decision for their baby boy some day.
Pain is a big issue in neonatal/developmental psychology these days. It's a blossoming area that is only now just getting it's due.
For a long time it was maintained that neonates and premies did not have the capacity for pain. We know now that is not true. In fact, physiological responses to pain are often greater than that in adults though shorter lived. Because pain is such a subjective thing to the observer and babes cannot be asked to score their pain on a scale of 1 - 10 pain scales have been developed. Although they try to be objective even they have many downfalls.
Pain in babes is not only reflected by behavior changes but by cardiovascular and hormonal changes. It is measured through vital signs, oxygen saturations and facial expressions. The earlier the babe the less credit is given to facial expressions.
A word about a babes response to pain and stimuli. Not all respond with crying. Some will shutdown. That is stare or go to sleep. It's a withdrawal mechanism. Hiccups can also be a sign of disorganization caused by overstimulation and pain though not always.
Some people think that giving them a pacifier takes care of the pain. Not true. The physiological parameters stay altered. Sucrose has been shown to be helpful though.
We are only beginning to understand the longterm affects of pain on babies. Hopefully the least parents and hospital staff can do for circs in the first couple of days is lots of love, minimal stimulation and round the clock tylenol. Some docs still don't order in tylenol post-circ.
I was surprized at the age of this article from '87. There has been more since then but I don't have access to it here.
http://www.cirp.org/library/pain/anand/
Beyond pain the incidence of complications from circumcisions ranges from 0.2-10%. These are just estimates as there is no system for reporting and tracking this. One estimate for lifelong alterations as a result are about 1%. It's estimated that about 2% of all circs become infected. Lifelong alterations can range from chordee or bowing (a bend that I understand is quite painful with an erection), cheloids/scarring, alterations in the meatus (the opening) including altered placement or obstruction, cysts and loss of penis. Mostly I've seen bleeding, uneven cuts (which can lead to problems of bowing or chordee later) and excessive cuts requiring stitches (higher risk of scarring later). Fortunately rare there have been occasional deaths related to circs. I have found most physicians gloss over potential complications pretty quickly when getting consents for circs.
About 50-60% of all males born in the US are now circ'd making the "so they look like the other boys in the locker room" reason invalid.
Reasons for having a circ done include decreased risks for UTI's, penile cancer and STDs. Uncircumsized babies do get more UTIs but their overall risk is quite low at about 1%. Uncircumsized males are about three times more likely to get penile cancer but over all only 10 males out of 1 million men will get it. Uncircumsized males do have a higher STD rate but this has been shown to be preventable with good hygiene (not to mention a condom).
Then we come to sexuality. This was the biggest thing I did not want to take away from my boys. In infant circumcision the foreskin is removed from the glans prematurely. This naturally happens in most boys by age 5 but may take longer in some. The exposed glans then becomes desensitized. The foreskin itself is very sensitive. It also allows for the full extension of the penis during erection. There is also increased lubrication when the foreskin is present.
The bottom line is it's the parents decision. Hopefully they truly know all the pros and cons. Sure, in most males it might not make a huge dif whether he's circ'd or not but why risk complication? And just because a male thinks that their childhood circ hasn't made them different, how do they really know?
