Circumcision

Introduction

Circumcision is a surgical procedure involving the removal of the foreskin from the male genitalia. This practice has been performed for thousands of years and holds significant cultural, religious, and medical connotations across various societies.

Historical Context

The history of circumcision dates back to ancient civilizations. Evidence of the practice can be found in ancient Egyptian art, and it has been a part of Jewish tradition since the time of Abraham. In ancient Egypt, circumcision was depicted in tomb art and considered a rite of passage. The practice was seen as a mark of purity and health.

Different circumcision techniques

The three major circumcision techniques include:

• Gomco clamp. The Gomco clamp is the most common method of performing a circumcision. The clamp separates the foreskin from the head of the penis. It also protects the head of the penis and helps stop bleeding (hemostasis). The provider then uses a sharp surgical knife (scalpel) to remove (excise) the foreskin.
• Mogen clamp. During this approach, the provider will use clamps that look like scissors or pliers (hemostat) to expose the head of the penis. Once they properly expose the head of the penis, they use a scalpel to remove the foreskin.
• Plastibell device. During a Plastibell approach, the provider places a plastic ring between the foreskin and the head of the penis. Next, they tie a string around the foreskin, which pushes it against the plastic ring. Finally, they use a scalpel to remove the foreskin. The plastic ring stays in place for about a week before it falls off naturally. The Plastibell approach isn’t as common because of an increased risk of infection.

Cultural and Religious Significance

Circumcision carries profound cultural and religious significance in many parts of the world. For Jews, it is a covenant between God and Abraham, performed on the eighth day after birth. Muslims also practice circumcision, although the timing can vary, with some communities performing it in infancy and others at puberty. In both religions, circumcision is a symbol of faith, identity, and adherence to religious law.

Jewish Tradition

In Jewish tradition, circumcision (Brit Milah) is a vital religious ritual. It is typically performed by a mohel, a person trained in the procedure, during a ceremony that includes prayers and blessings. The Brit Milah is considered a joyous occasion, often celebrated with a feast.

Islamic Tradition

In Islamic culture, circumcision (Khitan) is not explicitly mentioned in the Quran but is supported by Hadiths, the sayings and actions of the Prophet Muhammad. The practice is widely observed in Muslim-majority countries and is often seen as a requisite for religious purity and cleanliness.

Medical Aspects

There are various medical perspectives on circumcision, with some advocating its health benefits and others questioning its necessity.

Health Benefits

Proponents of circumcision argue that it offers several health benefits, including:

• Reduced risk of urinary tract infections in infants
• Lowered risk of sexually transmitted infections, including HIV
• Decreased risk of penile cancer
• Improved genital hygiene, as it is easier to clean the circumcised penis

Controversies and Ethical Considerations

Despite the reported health benefits, circumcision remains a controversial topic. Critics argue that:

• The procedure is medically unnecessary for most individuals
• It involves the removal of healthy tissue without the individual’s consent
• There are potential risks, including pain, bleeding, and infection
• It can lead to psychological and emotional consequences

Many medical organizations, including the American Academy of Pediatrics, suggest that the decision to circumcise should be left to the parents, taking into account the potential benefits and risks.

Modern Practices

Circumcision practices vary widely around the world. In some countries, it is a common routine procedure, while in others, it is less prevalent. In Western countries, circumcision rates have fluctuated over the decades, influenced by changing medical opinions and cultural trends.

North America

In the United States and Canada, circumcision is a common practice, though the rates have been declining in recent years. Many parents choose circumcision for cultural, religious, or perceived health reasons.

Europe

In Europe, circumcision is less commonly performed, with many countries viewing it as unnecessary. The practice is often limited to immigrant communities and religious groups.

Alternative Views and Practices

Some cultures and communities either do not practice circumcision or have alternative rites of passage. For instance, many European countries emphasize bodily integrity and consent, often waiting until the individual can make their own informed decision.

Nursing Care of a Patient with Circumcision

Circumcision, the surgical removal of the foreskin from the penis, is a procedure performed for various medical, cultural, and religious reasons. It is essential for nurses to provide comprehensive post-operative care to ensure proper healing and to address any complications that may arise.

Preoperative Care

Patient and Family Education

• Explain the procedure, its benefits, and potential risks.
• Discuss pain management options and what to expect during recovery.
• Address any cultural or religious concerns that the patient or family may have.

Informed Consent

• Ensure that informed consent is obtained from the patient or legal guardian.
• Verify that all necessary preoperative assessments and preparations are completed.

Postoperative Care

Pain Management

• Administer prescribed analgesics as needed, monitoring for effectiveness and side effects.
• Encourage the use of non-pharmacological pain relief methods, such as ice packs and distraction techniques.

Wound Care

• Instruct the patient on how to keep the surgical site clean and dry.
• Advise on the proper application of dressings or ointments as prescribed by the physician.
• Monitor for signs of infection, such as redness, swelling, or discharge.

Activity Restrictions

• Recommend limiting physical activities that may strain the surgical site for a specified period.
• Advise on a gradual return to normal activities as healing progresses.

Hydration and Nutrition

• Encourage adequate fluid intake to prevent dehydration and promote healing.
• Advise a balanced diet rich in vitamins and minerals to support recovery.

Emotional Support

• Provide reassurance and address any concerns or anxieties the patient or family may have.
• Offer resources for additional support, such as counseling or support groups if needed.

Follow-Up Care

• Schedule follow-up appointments to monitor healing and address any complications.
• Provide instructions on when to seek medical attention for any concerning symptoms.

REFERENCES

1. American Academy of Pediatrics. Circumcision. https://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/Pages/Circumcision.aspx. Last updated 3/12/2013.
2. American Pregnancy Association. Baby Circumcision. https://americanpregnancy.org/healthy-pregnancy/first-year-of-life/baby-circumcision/
3. American Urological Association. Circumcision. https://www.auanet.org/about-us/policy-and-position-statements/circumcision). Reaffirmed 10/2018.
4. FAQs: Newborn male circumcision. American College of Obstetricians and Gynecologists. https://www.acog.org/womens-health/faqs/Newborn-Male-Circumcision. 
5. Merck Manual, Consumer Version. First Few Days After Birth. https://www.merckmanuals.com/home/children-s-health-issues/care-of-newborns-and-infants/first-few-days-after-birth). Last reviewed 9/2023.
6. Morris BJ, Wamai RG, Henebeng EB, et al. Estimation of Country-Specific and Global Prevalence of Male Circumcision. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772313/). Popul Health Metr. 2016 Mar 1;14:4.
7. National Library of Medicine (U.S.). Circumcision. https://medlineplus.gov/circumcision.html). Last updated 3/22/2016.

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