Saw a circ today// need to educate nursing students

[USAmma]

I'm a nursing student and we are in our OB rotation. I watched a circ today. I almost refused to watch but I wanted to see exactly how barbaric it is. It was pretty bad. The baby at least did not seem to be upset-- he had good pain meds, but wow, they cut off a lot of skin and totally traumatized the tissue! They teach us so much about infection control and wound care, and then to do this on purpose . .

and we have this thing in our book about female circ and how bad it is, and then in the male circ section it talks about all the benefits.

So, my assignment is to put together a pamphlet on a subject related to OB/babies. I chose circ because I want to educated my classmates. However it has to be mostly geared towards nursing care of the circed and uncirced penis, not about pros/cons. How can I "sneak" some info in that might make some of my classmates think twice about the procedure?

I was hoping that watching it would change their minds, but they all feel like it's still okay to do that. A few of my fellow students are moms of boys, and one is a future dad who has decided that any sons of his will be circed.

Help!

[Baby~Braatens~Mama]

I can't really help, but I think it's awesome that you are going to try to educate your class! I wish you the very best of luck and will to see what other posters say.

[an_aurora]

I'm in nursing school too. Here's what I would add:

~death rate (average of 114 neonates a year die from complications from circs, compared to 117 from SIDS, 8 from car crashes, 44 to suffocation) link
~after care (circ= watch for infection, apply vaseline, pull back to avoid adhesions; intact = wipe off like a thumb and leave it alone)
~the fact that the AAP does not recommend it because of no proof of medical benefit
~amount of skin taken off equals to a 3 x 5 in index card on the adult male

[USAmma]

Originally Posted by an_aurora

I'm in nursing school too. Here's what I would add:

~death rate (average of 114 neonates a year die from complications from circs, compared to 117 from SIDS, 8 from car crashes, 44 to suffocation) link
~after care (circ= watch for infection, apply vaseline, pull back to avoid adhesions; intact = wipe off like a thumb and leave it alone)
~the fact that the AAP does not recommend it because of no proof of medical benefit
~amount of skin taken off equals to a 3 x 5 in index card on the adult male

Thanks!! I appreciate the link, too.

I'm doing some research on the periodicals website and will post any articles I see there (so far it's mostly about female circ).

[ElliesMomma]

i would go into detail about all of the side effects caused by circumcision -- all of the many many things that can go wrong. and then just let the facts speak for themselves.

for example, detail that X number of babies DIE from it.

excessive bleeding. infection. MRSA. hidden penis. meatial (sp) stenosis... just do paragraph after paragraph, detailing all of the extended care, including need to *recircumcise* after circumcision. skin bridges. etc., etc. loss of sensation -- talk about how circumcision strips away a male's important erogenous tissue... that you are circumcising a *baby* who is non-sexual... but the effects are lifelong and eventually adversely affect a grown male's sexuality. give links or print out pictures showing all of the "botched circumcision" examples.

and then for the intact penis part -- you can be nice and brief. be sure sure sure to point out that the child's penis should never be retracted -- not even by nurses or doctors -- not even to apply a catheter -- and how it should be washed only like you would a finger. note how medical professionals retracting baby penises is a leading *cause* of infections... and, ironically (or not) leads to more circumcisions.

note that the instance of UTIs in an intact penis is nearly identical to that of a circumcised penis... that it is one tenth of one percent greater likelihood... really, that is such a low benefit. you could point out how the risk of spreading HIV and other STDs is not lower in circumcised men... oh and don't forget penile cancer... how that disease affects only 1 in 100,000 *elderly* men... so is really an unlikely benefit.

[glongley]

If the subject is going to be care of the intact penis, you have a chance to educate about the anatomy, and development, and hands off care of the intact penis (i.e. the importance of not retracting, and that the boy should be the first to retract). Make sure your talk about the foreskin as "normal," and "natural," and refer to it as an "intact" rather than an "uncircumcised" penis - all of this emphasizes that the foreskin is a NORMAL part of the body. WHen you write about the development (tight, fused foreskin is normal in childhood) you can include info on some of the protective functions of the foreskin (protects from abrasion, irritation, keratinization; and designed to keep out contaminants by sphincter action and regular flushing outward with urine, which is sterile as it leaves the body). You can point out how the foreskin is PERFECTLY DESIGNED. Also talk about how EASY it is to take care of (avoid scary associations with disease, claims that circed penises are easier, or admonitions that intact boys have to pay much closer attention to penile care). You can specifically state that the belief that intact penis is hard to take care of is a MYTH. Make sure you include education about NEVER FORCIBLY RETRACTING, and list some of the harms that can happen when the natural protective covering of the glans is disturbed prematurely.

Also in re: circed penises, you can make the comparison that with the loss of the foreskin parents will over the early years of life need to watch out for meatal stenosis which is a result of irritation and inflammation due to exposure of the urinary meatus (7-10% of circumcised boys, doesn't happen in intact). Also in re: the circed penis, parents need to be told about the risk of adhesions in 15-30% of circed boys where the raw surfaces of the cut foreskin can grow back onto the raw surface of the glans where the foreskin was ripped away (a way to educate about some of the realities of the procedure itself). They need to be told that this can lead to inflammation and difficulty cleaning in pockets or tunnels where the adhesion has occurred (debunks the myth that circed is easier to clean - see Van Howe's article on how penile inflammation is more prevalent in circed than intact. http://www.ncbi.nlm.nih.gov/pubmed/17475991). They can be told that it has been suggested that adhesions can be prevented by pulling back the foreskin remnant regularly with diapers changes and applying vaseline underneath for the first few years of life (again, debunks the hygiene myths) http://www.cirp.org/library/complications/gracely1/.

This is not an exhaustive list, just ideas off the top of my head. Certainly there's other basics of what to do, what to look for, e.g. in the case of the circed penis, that can highlight some of the unpleasant realities of the results of circumcision - observing for infection, bleeding; dealing with post-circ pain; using gauze and vaseline to prevent sticking and painful rubbing in the diaper; what to do if the dressing gets embedded in the wound; observing for slippage of the Plastibell ring; making sure the baby is peeing regularly.

Nurses are in a very important position to educate not only parents but their colleagues as well. Brava to you for doing your part to shift the knowledge base and the culture among the students and teachers you are in with. BTW, most of the medical/nursing lit on care of the intact penis is not very good. E.g. there is often bad info about the true age range at full retractability, which can lead to bad advice and improper handling of the foreskin.Feel free to PM me if you want to talk more on these ideas.

Gillian RN

[USAmma]

Thank you very very much for your input and suggestions! I will make a copy available to email to people when I'm done with it, and I'll let you know how it goes! The presentation is next week. I really hope to educate-- there is so much lack of info out there.