Male circumcision is the surgical removal of all or some
of the foreskin of the penis. For Jews and Muslims, circumcision is a part of
their religious custom. Studies have shown that in many countries, more than 40%
of neonates are circumcised for nonreligious reasons.
The infectious bacterial colonization beneath the prepuce
or foreskin of penis is remarkably reduced by this procedure. This results in
minimal chance for urinary tract infections (UTI) mainly in the first year of
life, and STDs like gonorrhea and syphilis. Studies have suggested decreased
HIV infection for circumcised individuals. Circumcision could also reduce the
chances of penile cancer. However, in 1999, the American Association of
Pediatrics declared no evident medical benefits for circumcision.
The surgical procedure of
circumcision can cause pain; hence the patient should receive an anesthetic
during the procedure and a painkiller following the procedure. Topical
application of anesthetic agents like 2.5% lidocaine or prilocaine,
applied either alone or in combination for 60 to 90 minutes prior to the
surgery with or without occlusive dressing, have proved to reduce pain. A more
effective mode of pain management but invasive technique is nerve infiltration.
Dorsal Penile Nerve Block is given using 1% lidocaine at two
sites on the penile skin 3-5 minutes before the surgery. Epinephrine should not
be used in the injection. Alternatively, 0.8% lidocaine can be administered as
'ring' around the penis 8 minutes prior to the surgery to anesthetize the area.
Acetaminophen in a dose of 15mg/kg is given orally once every 4
to 6 hours for 24 hours postoperatively to reduce pain. Pacifiers dipped
in a concentrated solution of sucrose have soothing and pain relief properties.
Circumcision is contraindicated in premature neonates,
those with bleeding disorders or having a family history of the same. Bleeding
and infection are the common complications for this surgery for which direct
pressure and oral antibiotics with local wound care can be the respective
remedies. Phimosis or inability to retract the remaining foreskin is a
complication that needs topical steroids or repeat surgery for its cure.
The final decision for surgical removal of the prepuce of
male neonates should be taken by the parents as its medical benefits in the
long run remain blurred.
Drug Therapy Considerations in Circumcision; Rebecca Regen et al; US Pharmacist