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Introduction
Preparing For Circumcision
Plastibell Technique
Gomco
INTRODUCTION
Until recent years, it was a routine, common practice to circumcise an infant male. Whether done in the hospital, at a religious ceremony, or through other means it was widely held that the vast majority of males were, at some point, circumcised. However, today's families are not so quick to have the procedure done, and many question the effects of the procedure on an infant. In fact, North America has the highest circumcision rate in the world.
When you talk to women, most will admit that circumcision is their partner's decision. I will admit that I used to be one of these women until the birth of my third son (my fourth child). I left this decision up to my husband. He stated that, should we have a son, he will want him circumcised. Why, I do not know, but figured it was a "guy thing". I did not really think anything about it since I did not know exactly what they did during a circumcision. Because of this, my first two sons were circumcised in the hospital where I gave birth to them. My third son was born at home because I wanted a gentle and natural birth experience with him and for him. About 6 days after he was born, I asked a Naturopathic physician friend of mine to perform a circumcision on my newborn son (again, without doing any research or even thinking about it). He asked me a few questions and then agreed to do the surgery. This is where my horrifying education began. I assisted him (it was just the two of us) in the circumcision and saw first hand what it was, what it did, and how my beautiful son suffered through the process sending him into pain-induced shock. As I held him in my arms afterward, attempting to soothe him and comfort him from the intense pain and experience he had just endured... at my hands of all things, I swore I would never be naive about anything having to do with my children ever again. No more of my sons (or my grandson(s) either!) would ever go through this horrifying, painful, traumatic experience again as long as I had a breath of air left in my lungs.
So, to this day, I actively try to discourage any of my clients to follow through with this procedure and try to educate them about what it is, what it does and what to expect. I tell them that if they choose to do this procedure, they should be present at the circumcision and be there for their baby (and witness it first hand as well). I also tell them that this is a cosmetic surgery and has very little, if any useful benefits, and the it should be the little boy's decision when he becomes an adult. As an adult, he can have his own say about his body and if chooses to be circumcised, he will be given anesthesia for the surgery. Lawsuits have been filed against parents and/or the circumcision practitioner (physician or religious circumciser) by their sons after they had been circumcised at birth. These lawsuits have been won, especially if something had gone wrong and left the boy disfigured, mutilated or even worse, had the entire penis amputated by an inept circumcision practitioner. There have been cases in which the inept circumcision resulted in a son having to been changed into a daughter using reconstructive surgery because so much of the penis had been lost.
- Fathering Magazine: Botched Circumcision Horror Stories
- Fathering Magazine: Circumcision Death - Botched Circumcision
- Lawsuit Horror Stories
- Botched Circumcision Links About Mutilated Children
- Circumcision: Setting the Record Straight
- Stop Infant Circumcision - Horror Stories
- Male Circumcision in the USA: The Explosive Facts
- FOXNews.com: Routine Procedure or Child Abuse?
- The Common & Not-So-Common Complications of Routine Infant Circumcision
- Mother's Stories: Historical Medical Quotes On Circumcision
- Everything You Would Ever Want To Know About Circumcision
- The Truth About Circumcision
- Patients In ARMS
I find it interesting that most men (and boys) cringe with horror at the thought of having their penis or their testicles harmed in anyway, yet they actively choose to have this procedure done on their newborn baby sons without even an eye blink, just so the baby will grow up "looking like daddy". Circumcision is a cosmetic surgery. It began as a religious ritual (which I feel is as barbaric as cannibalization of your enemies or human sacrifice) and then moved into the mainstream of medical and societal acception within the last century. It is hard to bear in my mind the intensity of the pain the child must go through with this procedure. Studies have shown that, during circumcision, an infants' blood pressure rises so high that it could be considered dangerous. I don't find it all that unbelievable, when I consider what is being done. This is why some hospitals (now, but not years ago) offer (and many parents demand) some sort of sedative or anesthetic be administered during the procedure. However, this procedure is still done primarily without anesthetic of any kind since newborns can have very negative reactions to the medications used for numbing pain. There can be all kinds of complications associated with the procedure including damage to the penis itself even to the point of severing the penis off. Not all practitioners are adept at this procedure. Shock, mild to severe can occur. uncontrolled bleeding problems. Infection. Even death.
If you should happen to deliver in the hospital (or visit the maternity ward for any length of time) and have a room near the nursery, it is quite possible you will hear the babies in the nursery. It would be during these times that you will be able to hear the most horrific screaming from a child that you will ever hear. If you question the nursing staff, you will be told that it is an infant boy being circumcised. Most mothers (and hopefully fathers, too) would not be able handle listening to their sons in such terrible pain. People will tell you that the pain only lasts a short time, and that the babies don't remember it later in life. Just because they cannot verbalize it, I do not believe for a minute that they cannot remember it, even if it may be on a subconscious level. Otherwise, as birthing mothers, why are we trying to provide gentle birthing experiences for our babies? "They won't remember it anyway" could be an argument against gentle birthing experiences, which is not true, as we know and studies on newborns have supported. I do believe we all remember these things at some level of consciousness and it does affect our lives, our personalities, our perceptions of our world around us. And, stars forbid, something goes wrong with the circumcision, the child will have a permanent reminder that he will have to face every day of his life. But I know with all my heart, if you hear it (and see a circumcision), you will not forget it. The sound of my son screaming in pain will never leave my memory and I will carry it to my grave.
Many parents who choose to have their son's circumcised cite generally the same reasons for wanting the procedure done. These include wanting their child to "look" like their father, or most other males, religious issues, sensitivity issues, and beliefs that a circumcised penis is somehow "cleaner" than one with foreskin (although this isn't true). Many people also believe that circumcision is "just one of those things" that is done, when a baby boy is born. Although it considered a personal choice for parents of a newborn son to make, they really need to educate themselves about the procedure before choosing to have it done.
There are people out there, including myself, who are very much against circumcision (or any type of genital mutilation, be it male or female), and have strong beliefs as to why it should NOT be performed. These reasons can include subjecting an infant to unnecessary pain and discomfort for mere cosmetic purposes, having the procedure done because "everyone else does," an idea that removing the foreskin may desensitize the tip of the penis, and any risks that accompany a surgical procedure.
Regardless of your stance on circumcision, make an informed choice by doing research, talking to other parents, discussing your decision with your health care provider and with your partner. Do not feel pressured in any way, by anyone who is overly for or against the procedure, including myself. Obviously you want what you feel is best for your child, and you have every right to use your best judgment to make that decision. After all, you and your partner will be the one to live with your decision, but keep in mind....your son will have to live with the results.
WHAT HAPPENS DURING MALE CIRCUMCISION?
This information was obtained from Circumcision Information and Resource Pages (CIRP) - A valuable internet resource that provides information about All aspects of the genital surgery known as circumcision.
This is a Circumstraint. It has Velcro straps to restrain
the baby's arms and legs so that he cannot move.
The area is prepared with Betadine, an antiseptic.
A surgical drape is placed over the baby.
(In this illustration, the normal infant penis can be seen, with its foreskin covering.)
Some health care providers will use local anesthesia, but this is by no means common.
Anesthetic injections will cause the penis to swell, causing pain and
making the surgery more difficult. Both injections and topical anaesthetic
creams can be dangerous. General anaesthesia is never used on young babies
because of the risk of breathing problems.
The foreskin opening in a newborn is normally very small,
to prevent the entry of foreign matter (eg. fecal matter).
The first stage of circumcision is to grasp the foreskin with forceps, and widen the opening.
The foreskin is normally attached to the glans by a membrane called the synechia.
The glans and inner lining of the foreskin are still developing in the young child.
During circumcision, the synechia must be torn apart. Naturally, this is painful.
THE PLASTIBELL
The foreskin is clamped. A slit is made in the dorsal side of the foreskin.
The slit is separated and the foreskin is laid back,
exposing the raw and bleeding glans.
A PlastiBell of appropriate size is slipped over the glans,
and the foreskin is laid over it.
A ligature is tied in the ridge of the bell,
as tightly as possible around the foreskin.
Oozing will occur if the ligature is loose.
After one or two minutes to allow for crush, the foreskin is sliced off at the
distal edge of the ligature using a knife or scissors. The surgeon trims as much
tissue as possible to reduce the amount of necrotic tissue and the possibility
of infection. The handle of the bell is snapped off at this time.
The rim of tissue will become necrotic (dead) and separate with the bell in 5 to 10 days. Occasionally, edema (swelling) will trap the plastic ring on the shaft of the penis. In this case it's usually necessary to cut off the ring, using a guide and ring cutter, although application of ice will sometimes reduce edema enough to remove the ring.
Circumcision removes (on average) one third of the penile skin system (sensitive inner and outer preputial layers), including the peripenic dartos muscle, the frenar band, and part of the frenulum. To understand more about these structures and what they are for, please visit Foreskin.ORG (maintained by John A. Erickson).
The Plastibell procedure, like the Gomco Clamp Procedure, takes 10-12 minutes or more to completion.
See also: In Memory of the Sexually Mutilated Child by John A. Erickson
Reference: PlastiBell(TM) usage instructions, Hollister Inc.
"PlastiBell" is a trademark of Hollister Inc.
2000 Hollister Drive, Libertyville, IL 60048, USA.
"Circumstraint" is a trademark of Olympic Medical Inc., Seattle WA, USA.
PATIENT CARE MAGAZINE, March 15, 1978, pp. 82-85.
CIRCUMCISION PROCEDURE (GOMCO CLAMP METHOD)
The following directions are provided for conduct of circumcision operations with the GOMCO clamp:
THE GOMCO TECHNIQUE
- Stretch the preputial opening.
- Break preputial adhesions [synechial membrane] so that the foreskin is completely retractile. [Fig. A above.]
- Retract the foreskin until you can see the corona. Check the glans for any hidden adhesions.
- Apply a small amount of lubricant such as K-Y Jelly to the glans so it won't stick to the inside of the bell.
- Apply the bell-shaped plunger over the glans. [Fig. B above.]
The bell should fit easily over the glans so they cover the corona. Too small a bell may injure the glans and fail to protect the corona. If stretching the preputial opening does not allow the bell to be inserted in the preputial space and entirely cover the glans, a dorsal Slit may be necessary.
- Pull the prepuce over the bell. [Fig. C above.]
The foreskin should not be stretched or pulled too snugly over the bell. If it's pulled up too tightly, it's possible to remove too much shaft skin or to pull the urethra up so you get a tangential cut through the urethra as well as the skin.
- Judge the amount of the shaft skin left below the corona; the skin should be relaxed and supple.
- After you're sure of the dimensions, apply the plate of the clamp at the level of the corona. [Fig. D above]
- With everything in proper alignment, tighten the clamp. This squeezes the prepuce between the bell and the clamp to make it blood-free. Be sure the weight of the clamp doesn't distort the anatomy so there isn't a proper amount of skin in the clamp.
- Make a circumferential incision with a cold knife, not an electrosurgical instrument. [Fig. E above]
- Leave the clamp in place at least five minutes to allow clotting and coagulation to occur.
- Remove the clamp and apply antiseptic ointment (Betadine) to the crush line. Apply a light dressing or loin cloth arrangement to keep the ointment from rubbing off.
- If you remove the clamp prematurely, the crushed edges may separate and bleeding will occur. When this occurs, suture the mucocutaneous margin, being careful to avoid deep sutures that might penetrate the urethra. If the whole edge separates, treat as a freehand circumcision, placing quadrant sutures and sewing between them with fine stitches.
- Have the baby watched overnight for any signs of bleeding.
- If late separation occurs, it's best to keep the wound clean and let it heal secondarily rather than try to suture it and risk development of stricture or fistula. Skin of this area tends to re-epithelialize rapidly.
Cite as: The Gomco Technique. Patient Care Magazine 1978; Mar 15: 82-85. (Revised 25 August 1999)
HELPFUL LINKS
MALE CIRCUMCISION
- CIRP Home Page: An Excellent Resource About Male & Female Circumcision
- CIRP Reference Library: A Listing of Helpful Information
- Circumcision Resource Center
- Mothers Against Circumcision
- NOCIRC National Organization of Circumcision Information Resource Center
- Doctors Opposing Circumcision
- Circumcision: The Virtual Journal
- Circumcision Online Home Page
- Circumcision Issues Page
- Circumcision Web
- Circumcision Information Resource Center
- Circumcision.net: Ritual Circumcision (Bris)
- Circumcision: A Family Doctor Handout
- Hellenic Association Dermatology - Venereology: Circumcision
- Canadian Pediatric Society: Neonatal Circumcision Revisited
- American Academy of Pediatrics: AAP Circumcision Policy Statement
- MEDLINEplus: Circumcision
- Advocating Circumcision Today
- Fathering Magazine: Child Circumcision for Medical Reasons?
- Circumcision Resource Center: Questioning Jewish Circumcision
- Historical Medical Quotes on Circumcision
- The Male Circumcision Site
- MenWeb - Men;s Issues: Circumcision
- CompleatMother.com: Circumcision
- Circumcision: The Step to Becoming A REAL Man
- Circumcision Videos
- BirthPsychology.com: The Birth Scene - Circumcision Decision
- NORM Southern California - The Lost List
- Potential for Injury from Circumcision Clamps
FEMALE CIRCUMCISION & GENITAL MUTILATION (FGM)
- The Female Genital Mutilation Education & Networking Project
- Female Genital Mutilation - A Human Rights Information Pack
- Rising Daughters Aware
- WHO - Female Genital Mutilation Fact
- Female Circumcision Comes To America
- Female Genital Mutilation - Female Circumcision in Africa, Middle East, Far East
- Muslim Women's League: Female Genital Mutilation
- Knuckleheaded Islamic Thought: Female Circumcision
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