Advantages
Male circumcision is the surgical removal of the foreskin. Circumcision may be performed for various reasons such as medical reasons, religious and cultural reasons and HIV prevention. Firstly, circumcision might be done to treat the following conditions:
Phimosis is a condition wherein the foreskin is too tight to be pulled back over the glans penis. This can be a cause for pain during erection and may cause urination to be painful and difficult.
Recurrent balanitis is the inflammation of the foreskin and head of the penis.
Paraphimosis wherein the foreskin can’t be returned to its original position
Penile cancer
Aside from the medical reasons mentioned above, circumcision is a religious and cultural practice in Jewish and Islamic communities and in African communities. Also, there have been evidences that show male circumcision lower the risk for acquiring STD ("Circumcision In Adults").
Disadvantages
Men who are circumcised as adults report diminished sensitivity and penile gratification. Because circumcision is a surgical procedure, surgical risks are present such as excessive bleeding, infection, subsequent surgery, bruise at the site of dorsal penile nerve block injection site, or even death (Wiswell). Other disadvantages include meatitis in infants and of course pain.
The three different types of circumcision are: dorsal slit, shield and clamp, and excision. One type of method might be used or a combination of the three. In recent practice, shield and clamp method is commonly used as it adopts the use of a device instead of the use of a knife to effect circumcision. In the shield and clamp method, Mogen clamp is usually used. The foreskin is pulled out away from the glans. The foreskin is pulled away from the glans using a metal shield. The extra foreskin distal to the shield is then removed by a scalpel. The shield protects the glans. The inner layer of the foreskin may be placed posterior to the glans and it will be excised. This technique will make sure that the glans is fully exposed after healing. The glans penis and frenulum are protected by the shield thus are not affected by the scalpel. The wound is bandaged instead of stitched to achieve hemostasis. Bleeding is often the major concern following this method (Abdulwahab-Ahmed & Mungadi).
The dorsal slit method is commonly used in many techniques. In cases of acute inflammation, this technique is occasionally used alone. In this method, two forceps are placed on either side of the foreskin opening. A curved artery forcep is then used to dilate the opening and separate the adhesions between the glans and the foreskin. The glans penis is freed and the foreskin is everted. An incision mark is made on the inside of the foreskin creating a sleeve of 0.25-0.5 cm near to the corona. A circumferential knife skin mark incision is made on the penile skin nearest to the corona. A dorsal slit is then made from the foreskin to the penile skin mark. The prepuce is crushed with an artery forcep for 3-5 minutes to minimize bleeding. The proximal penile skin is then sutured to the coronal sleeve. A dressing is placed on the coronal suture line if bleeding is present. If none, the wound is left open (Lukong).
The third method is excision specifically sleeve resection. The foreskin is fully pulled back over the glans penis. A circumferential incision is made around the shaft. The foreskin is placed back to cover the glans and a circumferential incision is made around the shaft. A cut is made between the incisions and the strip of skin is removed. The edges left behind are sutured (Abdulwahab-Ahmed & Mungadi).
Nursing Role
Before
Prior to the procedure, the nurse must verify infant feeding or NPO status depending on the policy of the hospital. Acetaminophen must be administered. The topical anesthetic cream must be applied in advance. While the preparation is ongoing, the nurse must provide comfort and hold the infant. The infant must be positioned in semi-recumbent position on a padded surface with arms wrapped snugly. To prevent cold stress, proper thermoregulation must be maintained (American Society for Pain Management Nursing).
During
Breast milk or 24% sucrose should be administered orally 2 minutes before penile manipulation. In cases where breast milk or sucrose is contraindicated, pacifier should be provided for sucking (American Society for Pain Management Nursing).
After
Following the procedure, the infant must be removed from restraint immediately. The infant should be comforted and brought to the parent. Oral acetaminophen must be given for at least 24 hours around the clock. Health education regarding the care of the infant should be given to the family or SO such as: administration of acetaminophen, circumcision care and infant pain assessment and management (American Society for Pain Management Nursing).
Pain Response and Pain Management
According to the American Society for Pain Management Nursing, nurses and other HCPs should provide the optimal pain management throughout the circumcision. The parents should be educated about infant pain assessment and they should also be informed of the pharmacologic pain management therapies. Before the procedure, anaesthetic agents such as oral acetaminophen (15mg/kg) must be given one hour before the procedure. Also, topical anesthetic cream should be applied in advance. During the procedure, breast milk or 24% sucrose should be given orally before penile manipulation. Other anesthetic options include topical anaesthetic cream and injectables. Slow injection speed should be used using a small-guage needle and a warmed solution. Others recommend the subcutaneous block because it is easier to administer while other recommend the dorsal penile nerve block (American Society for Pain Management Nursing). After the procedure, the oral acetaminophen (15mg/kg) should be continued every 4-6 hours for at least 24 hours.
Works Cited
Abdulwahab-Ahmed, Abdullahi and IsmailaA Mungadi. "Techniques Of Male Circumcision". Journal of Surgical Technique and Case Report 5.1 (2013): 1. Web. 12 July 2016.
American Society for Pain Management Nursing (ASPMN),. Male Infant Circumcision Pain Management. 2011. Web. 12 July 2016.
"Circumcision In Adults". Nhs.uk. N.p., 2016. Web. 12 July 2016.
Lukong, ChristopherSuiye. "Dorsal Slit-Sleeve Technique For Male Circumcision".Journal of Surgical Technique and Case Report 4.2 (2012): 94. Web. 12 July 2016.
Wiswell, T.E. "Risks And Disadvantages Of Circumcision Circumcision, Disadvantages, Risks, Surgery". Circumcisioninformation.com. N.p., 1997. Web. 12 July 2016.
