Frequent Questions about Circumcisions
During the administration of the analgesia by an injection there may be some bleeding at the place where the injection is done. This is almost very minimal and never really needs any special means to control. A small bruise however may be produced.
It is important to recognize that the penile area is very vascular with a lot of blood supply so concern about too much bleeding is very important.
In about 75% of the circumcisions done in our office there is no bleeding or just a very few drops of blood. In about 20 percent the bleeding is a little more and does need some simple pressure for a few minutes to control.
In about 5 % the bleeding can be more than we would like and needs a special dressing to control. This is applied by a dressing we have used for 25 years as well as a special powder that is applied.
In over 25 years and over 40,000 circumcisions we have had three patients that bled enough that a transfusion was required.
Bleeding is the most serious complication and all patients are given an emergency telephone number to call with any concerns.
There are many claims made about the function of the prepuce. Some feel it is part of our immune system. Some feel it somehow protects the glans. Protection of the glans against a condition called meatal stenois where the opening of the urethra on the glans can become too tiny is probably true. This complication is more common in circumcised boys than those not circumcised. Meatal stenosis if severe can need a minor surgical repair needing to be done.
BEST EVIDENCE AS TO THE FUNCTION OF THE PREPUCE
The best evidence is that the function of the prepuce is to stimulate rapid ejaculation. Some men develop too rapid an ejaculation and seek a circumcision to help with this. The evidence also suggests that the pleasure from an ejaculation is the same in men who have been circumcised compared to those who have not.
There is a great deal of information on the Internet that is confusing and unreliable. On one side there are those who oppose circumcision and consider it to be a “mutilation” and a violation of the rights of the newborn. They offer all types of non-scientific claims and report horror stories of cases where the procedure did go wrong as if this was what happens in most cases.
On the other hand there are those who claim medical benefits for circumcision that are not proven and so rare that they should not be a factor in the decision of the parent. They claim the procedure is “painless” and that bleeding almost never happens. We do not agree with this.
Our aim is to provide you with reliable scientific information about the circumcision procedure we do in our office. We are neither for nor against circumcision. We will explain what benefits appear to be proven and which are not proven.
Some people claim that circumcision is a painless procedure. It is true that the time of the actual circumcision the procedure can be almost all painless. However, with the issue of pain one has to examine the actual procedure itself as well as the next 2-3 days. In that context no one can really claim that the entire circumcision procedure is painless.
Some physicians use a local analgesic cream to numb the area. We do not. We consider this to be unnecessary and adds over 30 minutes to the time the baby has to be in the office. One of the creams, EMLA can have serious side effects if it is left on for too long. Some physicians use topical Lidocaine and overall it is safer but once again not necessary.
Dr. Murray Katz of Montreal Quebec developed our technique. It is the most effective way to have the procedure done with the least amount of any pain. This technique is called the superficial dartos faschia block. An injection of xylocaine is made on either side near the base of the penis. We wait ten minutes and then the procedure is done in less than a minute. There are no sutures used. From our experience over 90% of babies do not cry.
The baby is also given a sugar ball dipped in juice to suck on. This is a very important way to control pain.