Advice Please!

[mim]

I took my 3 (nearly 4) year old DS to the doc because we were worried that his foreskin was too tight. She took a look and said that he will need to be circumsied and gave us a refferal to a pead surgeon. We are going to see him next week but I just want some advice from someone who has been there. I really dont want to have to get him done, obviosly if he really needs it, I won't hesitate to get it done but are there any other options? help! :eek:

[angcaltam]

Hi Mim,
I hear you. We had to have our eldest son done when he was 4 years old. But his skin was to tight and he kept getting infection after infection. The Pead Surgeon tried a cream first to see if that would stretch the skin. I'm not sure what the cream was but can try and find out for you if you would like me to. The cream sort of worked for him but if we stopped using it a day or so later it would be tight again. So the only other option we had for him was to get him circumcised. We were worried about it esp at his age, but he was fine. We hardly had to give him pain relief after.
If there is anything else just ask.
Let me know how you go.

[mim]

Hi Katherine
Thanks, you've put my mind at ease! I'll ask the doc about the cream. Hopefully it'll work.
When your son was done did they give him a general or was he awake?

[angcaltam]

They gave him a general. We told him what was going to happen and he was ok. It is only day surgery so we got to bring him home that night.
The cream was a steriod cream but I'm not sure of the name.
Keep me posted on how you go, and if there is anything else you want to know just ask.

[mim]

Thanks!
I was hoping they used a general, I was thinking they might just give him pain med only! Least if it has to be done he won't remember much.
I just saw your post. Congratulations on baby #3! :D

[talon]

Just thought I would say that I am also going through this at the moment. My son seems to have a tight foreskin but the pediatric urologist says it isn't classed as abnormal as yet. His penis balloons up when he pees. He keeps getting UTi's as a result and is currently on number 3 or 4. He is booked in to get circumcised on Monday and am feeling a little better about it after reading this post. Thank you! Nice to know I am not alone. My son is getting a general also and will have a cystoscopy at the same time (where they put in a little camera and have a look around) and check to make sure there are no abnormalities in his urethra.

Katherine - just wondering, did your son have the plastibell or stitches?

[madvoice]

My best freind's son had to be circumcised at 3 months of age because his foreskin was too tight. Their GP gave them the cream to try but it didn't work. He was none the wiser after it was done and didn't require any pain medication. He was circumcised under a general. Let us know how it goes.

[talon]

Does anyone know how they administer a general anasethic (sp?)??? Is it gas or an iv?

[Caitlin's Mum]

Hi just thought I would share my story with you - last time I asked for advice on this subject I received many negative and positive thoughts - the negative being quite vicious!! Anyway I had my son (4 weeks old) circumcised by Dr Terry Russell using the plastibell technique. I just had to apply cream 2 hours before the procedure to numb the penis. The whole thing took only 10 minutes and he didn't even cry. He didn't appear to be in any pain afterwards either (because he wasn't crying). I would definitely recommend this technique to anyone considering circumcision. Hope this helps.

[mim]

:) thanks for the advice. We are going to see the pead surgeon tomorrow.......... I'll let you know how it goes
Kriscee, good luck for Monday!

[angcaltam]

Kriscee,
My son had stitches which came out all on their own. He has not had another infection since and we are really glad we had him done.
Please let me know how your son goes.

Mim thanks, we are so excited. We went to Canberra this weekend to tell my family and they are over the moon.
Let me know how you go with your son's appointment.

I'm thinking of you both.

[talon]

Thanks mim - will also let you know how it goes today so you have some idea of what to expect.

DS has to be admitted at 12 noon and he can only have milk up until 7:30am and clear fluids until 9:30am. Then nothing until after the procedure. He hates drinking plain old boiled water so he will be one hungry baby by the time midday rolls around. I think I'll need a stiff drink by that stage!

Am unsure if they will go ahead with it today as he seems to have developed a dry cough over the weekend and the ped. urologist says that if they have anything that is affecting his respiration then they won't go ahead with it. Apparently there are dangers involved with the general anasethic if they have any sort of respiratory problems at the time of the procedure. Will wait and see...

[talon]

Thanks Katherine for the well wishes... was it painful for your baby with the stitches? Am just a bit concerned that if he has to get the stitches that it will be really uncomforable for him. If they postpone the procedure then he will have to have the stitches...

[angcaltam]

Hi Kriscee,
Angus was fine with the stitches but he was 4 years old when he had it done so we could explain to him what was happening. Go luck and please let us know how he goes.
Thinking of you both.

[talon]

Well, our day was pretty full on. Got up and made sure DS was fed by 7:30am. Tried to feed him some boiled water at 9:15am but he just screwed his face up at me and refused to drink it - don't blame him really.

Left for the hospital at 10:30am. Admission was for midday (we live a fair distance from the hospital. I didn't think DS would cope very well without a feed for so long but he did amazingly well. Was admitted at midday and told we were second in line as they do the youngest first and there was a baby who was younger then DS so that baby would be going first. So they told us we were looking at about 2 - 2:30pm for the procedure. We got a private room for the day in the women's unit and all the nurses were really lovely. Took all his vitals etc. and everything was fine. Healthy boy.

The anaethetist popped in at about 1pm to ask a couple of questions and give me the estimate for the bill (yay! :( ). He was great - really friendly and easy to talk to.

We were then told that the pedeatric urologist had had to book in another baby before us (12 week old for a hernia) and therefore we were knocked back to third in line so we didn't actually get in until 3pm. By this stage DS was starting to get a little bit cranky as he was tired and hungry but was still really good.

I walked down to the theatre carrying DS and got dressed up in the very fashionable theatre gown, cap and shoe covers and sat with DS on my lap while the nurses played games with him. The urologist came over and told me that it wouldn't be long and explained how to look after him once all of this was done.

Carried DS into the theatre with the anaethetist and a couple of the nurses and was able to stay with DS until they knocked him out with gas. They just put the gas over his mouth and he slowly drifted off over a couple of minutes. The anaethetist tried to keep my mind otherwise occupied with some stories about his kids etc. Once DS was out to it, I went back to our room and waited about 30 mins.

Got called back to the recovery room and took his bottle with me. He was crying when I got there but mainly because he was hungry and also a bit because of the after effects of the anaesthetic. They let me jump on the trolley bed and put him on my lap and I fed him there and then. He was still pretty groggy from the whole thing so drank a bit, dozed, drank a bit more. They monitored him for the next 20 minutes or so. While he was in theatre they had put a drip in his arm and one in his foot for fluids. They had taken the one out of his arm before I got there and left the one in his foot for fluids. But it wasn't bothering him at all.

The nurse showed me what they had done with the circumcision while I was in recovery with him and it is actually quite neat. I was expecting blood and gore but there wasn't any. Just a clear plastic ring tied off with some sort of string. That was it.

So we were then wheeled back to our room and told that we needed to wait another hour and a half before we could go just to make sure that he recovered from the anaesthetic alright. Which he did.

So my instructions are to put a cream on the ring 3 times a day until it runs out. Am also supposed to put some vaseline on a nappy liner everytime I change his nappy to make sure nothing sticks. If it does I have to soak him and the nappy to get it off. Am to keep putting the vaseline on for another month and have to go back to the doc in two weeks to make sure everything it ok. Was also told DS will be a bit cranky for the next 24 hours and to keep up the panadol if this is the case. Also, the ring will fall off anywhere between 7 - 10 days and as it starts to fall off it will get a bit red and swollen.

So that's my day. I know this is a long post but I wanted to get everything down because I wished I had been given details like this before I had it done to DS so that I knew what to expect. All in all, was a lot less traumatic then I expected. Will wait and see how DS is tomorrow though. He is sleeping at the moment. Hopefully will get a full nights sleep.

[mim]

Kriscee
I'm so glad it all went well today, I'm wishing your DS a quick recovery. :)

We went to see the pead today, and what a huge relief! He gave us the steroid cream so we will know in about six weeks if it works. The doc isn't too worried, he said even if the cream doesn't work, he'll still give it time before a circumcision, because DS hasn't had any infections. Yay! don't know what I was so worried about really :)
I'll post later and let you know how the cream goes.

Thanks so much guys for all the help and advice, it's been invaluable.

THANKYOU :D

[madvoice]

Its good to hear that your little boy coped so well. I wish him a speedy recovery.

[dna13]

Thank you so much for sharing your experience! We are getting our DS circumcised in October when he will be 6 months old. It is great to hear how you all coped and what to expect.

I am glad to hear that your DS coped really well and i hope the recovery process is quick for you both.

Thank you once again.

:p Angela 24
:cool: DH 27
:D DS Coban 3/4/05

[talon]

Glad I could help.

DS is coping really well this morning. He did wake up at about 3:30am and I changed him and gave him a feed. He usually doesn't need to be fed at night anymore but he wouldn't have gotten his quota of milk yesterday seeing as he was fasting.

I would actually say that he is pretty much his normal self today. I am not letting him roll around today just to give him a bit of healing time - don't want him bumping the ring and hurting himself. It is really hard to judge how sore it would be. But his nappy isn't annoying him at all, which I thought might have been a problem. The nappy liner is essential and I was told that you can never use enough vaseline!

Let me know if you have any questions - I might be able to answer. :rolleyes: :confused:

[angcaltam]

Kriscee,
I'm so glad everything went great. I hope he has a speedy recovery.
Keep us posted on how he is going.

Mim,
That's good news. I'd say it would be the same cream as we tried with Angus, it worked at first but as soon as we stopped using it a few days later the skin was back to being tight. I hope that your DS is different. And at least you have time to spare before you have to think about getting him done, Angus always had bad infections so there was no time for us.
I have everything crossed that the cream will work for him. Keep us posted on how it is going.
Hope to hear from you soon.

[christyc]

I hope this info will help with your decision...a lot of parents dont know that the foreskin may not retract until the teenage years! here is info and a site for extra info prepared by doctors and nurses:
http://www.nocirc.org/publish/4pam.pdf
answers to your questions about your sons intact penis


Newborns:
Care of the
Uncircumcised Penis
Guidelines for Parents

American Academy
of Pediatrics


--------------------------------------------------------------------------------

At birth, the penis consists of a cylindrical shaft with a rounded end called the glans. The shaft and glans are separated by a groove called the sulcus. The entire penis - shaft and glans - is covered by a continuous layer of skin. The section of the penile skin that covers the glans is called the foreskin or prepuce. The foreskin consists of two layers, the outer foreskin and an inner lining similar to a mucous membrane.

Before birth, the foreskin and glans develop as one tissue. The foreskin is firmly attached - really fused - to the glans. Over time, this fusion of the inner surface of the prepuce with the glans skin begins to separate by shedding the cells from the surface of each layer. Epithelial layers of the glans and the inner foreskin lining are regularly replaced, not only in infancy but throughout life. The discarded cells accumulate as whitish, cheesy ``pearls'' which gradually work their way out via the tip of the foreskin.

Eventually, sometimes as long as 5, 10, or more years after birth, full separation occurs and the foreskin may then be pushed back away from the glans toward the abdomen. This is called foreskin retraction. The foreskin may retract spontaneously with erections which occur normally from birth on and even occur in fetal life. Also, all children ``discover'' their genitals as they become more aware of their bodies and may retract the foreskin themselves. If the foreskin does not seem to retract easily early in life, it is important to realize that this is not abnormal and that it should eventually do so.



[The Function of the Foreskin: The glans at birth is delicate and easily irritated by urine and feces. The foreskin shields the glans; with circumcision this protection is lost. In such cases, the glans and especially the urinary opening (meatus) may become irritated or infected, causing ulcers, meatitis (inflammation of the meatus), and meatal stenosis (a narrowing of the urinary opening). Such problems virtually never occur in uncircumcised penises. The foreskin protects the glans throughout life.

Infant Smegma: Skin cells from the glans of the penis and the inner foreskin are shed throughout life. This is especially true in childhood; natural skin shedding serves to separate the foreskin from the glans. Since this shedding takes place in a relatively closed space - with the foreskin covering the glans - the shed skin cells cannot escape in the usual manner. They escape by working their way to the tip of the foreskin. These escaping discarded skin cells constitute infant smegma, which may appear as white ``pearls'' under the skin.

Adult Smegma: Specialized sebaceous glands - Tyson's Glands - which are located on the glans under the foreskin, are largely inactive in childhood. At puberty, Tyson's Glands produce an oily substance, which, when mixed with shed skin cells, constitute adult smegma. Adult smegma serves a protective, lubricating function for the glans.

Foreskin Hygiene: The foreskin is easy to care for. The infant should be bathed or sponged frequently, and all parts should be washed including the genitals. The uncircumcised penis is easy to keep clean. No special care is required! No attempt should be made to forcibly retract the foreskin. No manipulation is necessary. There is no need for special cleansing with Q-tips, irrigation, or antiseptics; soap and water externally will suffice.

Foreskin Retraction: As noted, the foreskin and glans develop as one tissue. Separation will evolve over time. It should not be forced. When will separation occur? Each child is different. Separation may occur before birth; this is rare. It may take a few days, weeks, months, or even years. This is normal. Although many foreskins will retract by age 5, there is no need for concern even after a longer period. No harm will come in leaving the foreskin alone.Some boys do not attain full retractability of the foreskin until adolescence.

Hygiene of the Fully Retracted Foreskin: For the first few years, an occasional retraction with cleansing beneath is sufficient.

Penile hygiene will later become a part of a child's total body hygiene, including hair shampooing, cleansing the folds of the ear, and brushing teeth. At puberty, the male should be taught the importance of retracting the foreskin and cleaning beneath during his daily bath.

Summary: Care of the uncircumcised boy is quite easy. ``Leave it alone'' is good advice. External washing and rinsing on a daily basis is all that is required. Do not retract the foreskin in an infant, as it is almost always attached to the glans. Forcing the foreskin back may harm the penis, causing pain, bleeding, and possibly adhesions. The natural separation of the foreskin from the glans may take many years. After puberty, the adult male learns to retract the foreskin and cleanse under it on a daily basis.

Copyright © 1984, 1990. American Academy of Pediatrics

[shanz]

And in some cases this simply will not happen by itself, angus had an opening at the tip of his penis that was a little larger than a pin head, we werent asking for advice on which way to chose but making a medical decision that needed to be done. I had a friend that was told the same as you have just posted and his son is 11 years old and the peads have now decided to circumsise. I think that will be far more traumatic at his age. Sometimes these things happen and they can only be assisted. the pead also told my sister that the foreskin can be pulled back but never to force it further than it wants to go.

[Dr Terry Russell]

Hi Christyc,

If you look at the bottom of your posting from the American Academy of Pediatrics, you will notice that it was copyrighted in 1984, and it was probably a reasonable attitude at the time.

The American Academy of Pediatrics began saying in the 1960s that circumcision (and cleaning under the foreskin) is unnecessary and should be discouraged! That was probably a reasonable attitude at the time because there was very little research to support it. But over the last 20 years, the research has become quite overwhelming.

As a result, the Academy withdrew its opposition in 1989, and I have in front of me now a paper which reads: "In 1999, 65.3% of all male newborns born in hospitals were circumcised." (Up from 60.7% in 1988) That is, 65.3% are circumcised before leaving hospital. About 85% are circumcised by puberty.
http://www.cdc.gov/nchs/products/pubs/pubd/hestats/circumcisions/circumcisions.htm

About Smegma - Smegma is a mixture of old mucus and dead skin cells. (The "cheese" which accumulates under the foreskin.) It acts as a focus for infection (bacteria converting smegma to pus), but also it is home to bacillus smegmae, and bacillus smegmae is the natural host for wart virus (HPV) types 16 and 18 - implicated in the causation of cancer of the penis later in life, as well as cancer of the cervix in female partners.

[andrewJ]

The American Academy of Pediatrics began saying in the 1960s that circumcision (and cleaning under the foreskin) is unnecessary and should be discouraged! That was probably a reasonable attitude at the time because there was very little research to support it. But over the last 20 years, the research has become quite overwhelming.

Nobody has suggested that we should not clean the penis. In 2005 the The American Academy of Pediatrics view is this;

"When your son is old enough, he can learn how to keep his penis clean just as he will learn to keep other parts of his body clean.
The foreskin usually does not fully retract for several years and should never be forced. The uncircumcised penis is easy to keep clean by gently washing the genital area while bathing. You do not need to do any special cleansing, such as with cotton swabs or antiseptics."

What has been suggested is that the infants foreksin should not be forcefully cleaned. Of course just cutting it off is easier, but its hardly fair.


I have in front of me now a paper which reads: "In 1999, 65.3% of all male newborns born in hospitals were circumcised." (Up from 60.7% in 1988) That is, 65.3% are circumcised before leaving hospital. About 85% are circumcised by puberty.


The fact that 65% of american men are circumcised does not prove that it is necessary, or even beneficial. you seem to be trying to suggest that attitudes have changed, i.e that now, we think that cleaning under the foreskin should be done, and as a result 65% of american men are circumcised.
Its true that attitudes have changed, circumcision rates in america used to be much higher.

The way you present these figures is misleading. It implies that of the boys who were not circumcised, many more will go on to have the procedure by puberty (perhaps you are trying to demonstrate that it is necessary)
Newborns from 1999 have not yet reached puberty, so it is impossible to tell how many more of 65 percent will be circumcised bu puberty.
The 85% of men and boys circumcised by puberty includes those who were circumcised at birth from earlier years, when the circumcision rate was much higher than 65.3 percent anyway.

Of course there will be some who become circumcised after birth, but nowhere near the figure that you are trying to imply, and of these, many would not need the surgery, and could well be simply cosmetic for a significant proportion.

About Smegma - Smegma is a mixture of old mucus and dead skin cells. (The "cheese" which accumulates under the foreskin.) It acts as a focus for infection (bacteria converting smegma to pus), but also it is home to bacillus smegmae, and bacillus smegmae is the natural host for wart virus (HPV) types 16 and 18 - implicated in the causation of cancer of the penis later in life, as well as cancer of the cervix in female partners.

what is your opinon on why America has a much higher rate of penile cancer than countries where circumcision is almost unheard of?

I would also like to point out the American Cancer Societys opinion on smegma and penile cancer;

"Some studies suggest that smegma may contain cancer-causing substances, but most recent studies disagree. Still, many doctors feel that when a man doesn't keep this area clean, he is more likely to develop cancer of the penis."

[andrewJ]

Sorry to carry on, but your whole explanation was very misleading.

you say that in 1960s the american academy of pediatrics said that circumcision was not necessary, then you say that over the past 20 years, we have learned differently, and the academy "withdrew its opposition".

The official stance of the academy TODAY is "circumcision is not essential to a child’s health"
It was hardly opposition in the first place, and despite what you say has been learned, their policy remains essentially the same. in 2005, routine circumcision is not recommended for a belief in potential health benefits.
..and remember the possible health benefits are only potential, whereas the loss of a normal part of the body is a guarantee.

Of course you are entitled to your opinion, but you should not pretend that the american academy of pediatrics agrees with you.

[myf]

So many boys who were not circumcised as babies are having to undergo the procedure as toddlers, young lads and teenagers due to skin tightening, repetative infection, UTI's and other problems. Of the remaining male population, some opt to undergo the procedure for cosmetic reasons, surely then the percentages for male circumcision will never substantially decrease.
I agree that it would seem that the percentages have decreased since the 60's. But the figures seem to be static since the late 80's at around 60-65%
Circumcision is never going to be a thing of the past.
The procedure will be carried out for ever more regardless of those anti circ.
They may as well accept it; 65% v's 35% Read between the lines!

[andrewJ]

the 85% of men that are circumcised by puberty is not a measure of puberty age boys, i.e those born pretty recently. But includes men of all ages who happened to have been circumcised by the time they reached puberty. This means that this figure does include those who were born in a time when circumcision rates were much higher.

you mention that the percentages for male circumcision will never substantially decrease.

Despite what I have said, this may well be true, for America at least. but it does not suggest that circumcision is necessary or beneficial. In logical terms, for the sake of this argument,the following is a meaningless statement. It is purely descriptive. i.e that" a certain percentage of american men are circumcised by puberty."


Circumcision is never going to be a thing of the past.
The procedure will be carried out for ever more regardless of those anti circ.
They may as well accept it; 65% v's 35% Read between the lines!

Well the 65% percent figure refers to america. Here the rate is thankfully much lower. In Britain where the craze for senseless circumcision started and then spread to America, they did actually manage to reverse the trend after realizing their mistake.
I would hope that circumcision does not ever become a thing of the past, because like other surgeries, sometimes it really is medically necessary, also I would not want to restrict individuals personal, religious and cosmetic values.

[myf]

I would hope that circumcision does not ever become a thing of the past, because like other surgeries, sometimes it really is medically necessary, also I would not want to restrict individuals personal, religious and cosmetic values.[/QUOTE]

I wish more people had these open and logical opinions. You have some fair and reasonable points on a subject which is so very controversial but never-the-less very current in todays society.
And no it won't go away!

[talon]

thought i would just post again to update on what happened post-op to finish off my other post...

Oh, and before I get slayed, this is my experience only. I am not implying that it would be the same for all those who have this procedure performed because obviously this would be different for everyone. And I am certainly not putting my post forward as either for or against circumcisions. this forum thread is for "Positive advice and support for those investigating circumcision" for those with questions and i leave it up to those considering the procedure to make their own decisions based on advice they have seeked from a variety of sources. Here it is...

After the op I gave DS salt baths twice (sometimes three times) a day. was paranoid about him getting an infection which can be one of the complications with circumcisions. also kept putting the ointment on three times a day and new nappy liner with vaseline at every nappy change.

it is quite worrying to go through because you don't know what to expect or how well your child will cope with the procedure. in my case, DS coped really well. he never once cried from any sort of pain from the procedure in the following days. As the plastibell started to separate from the rest of it, it got quite red and swollen and where the plastibell was tied off, the dead skin goes white. It also starts to look a bit weepy/pus-like as it separates also. The plastibell also tended to slide out a bit when I gave DS a bath and about 12 hours after I noticed the separation starting it came off completly in the bath. DS bumped it and the last bit let go. Almost had a heart attack!

Checked him over (i got a bit of a shock when it came off) and all seemed to have healed alright although I did notice that the underside was quite red and raw looking - a bit bloody in fact. I started to stress about that and worried that he might have an infection. Worried all night about it, DS wasn't though. Ended up ringing the doc this morning to see if he could check it for me to make sure it had healed alright. Doc said it was fine and that rawness would go away after a few days. Doc also advised to keep pulling the foreskin back to make sure it doesn't re-adhere to the glans (which can happen) and to clean out all the smegma left underneath. Am to keep up the ointment until my second tube runs out and the nappy liners with vaseline and go back for another checkup in a month.

That is about it. Again, this is my situation and I posted it for those who are needing some information. Is a big decision to make and unfortunately in my situation i didn't end up having a choice - was my sons health at risk.

[mim]

hey kriscee,
thanks for the update, i'm really glad it's all going okay for you and your DS. we've just started using the cream so it's fingers crossed. i'd still love to hear how you get on so maybe you could send me a PM and let me know? i don't think anybody is going to want to post here.


The reason I started this thread was just to get some help, not so that everyone who was kind enough to give me and others their advice could get a debate shoved down their throats and their decisions questioned.
Lay off a bit guys :(

[talon]

thanks mim - let me know how you go with the cream. Have you started to see any change yet?

Also, just wanted to post what it cost me to get the procedure done so people have a ball park. I don't know how much it varies across doctors - might be a lot. Really not sure.

Hospital - nothing. We have an excess of $200 but because DS is a child/infant they don't charge the excess for us. Was at a private hospital.

Anaesthetist - $329.05 for 42 minutes. After private health and medicare we only have to pay $58.50 gap.

Peadiatric Urologist/Surgeon - Cystourethroscopy was $288.25 (where they put a camera inside the urethra and have a look around) and the circumcision using the plastibell (for child under 6 months old) was $39.70. Not sure what I will get back from private health/medicare as haven't done that yet. All up $316.95

Also, swelling has gone down a lot since yesterday.

[~Chick79~]

Hi Kriscee!

Was just wondering, you say you put vaseline on the nappy liner every nappy change, i am assuming that is for when you use cloth nappies but what about with disposals??

Thanks!

[talon]

my son is in disposable nappies, so i would say that you would use nappy liners for both types. i think the main purpose is to ensure that nothing sticks to the nappy while it is healing. i fold the nappy liner into quarters and then cover a patch with the vaseline - place the nappy liner over his bits so that the vaseline lands in the right place and then put the nappy on as you would normally.

hope this helps :)