Neonatal circumcision of male infants has been a controversial topic in the United States for at least 30 years. Even so, scientific evidence supports several medical beneits that include prevention of phimosis, paraphimosis, and balanoposthitis. Circumcision also lowers the incidence of penile cancer and of cervical cancer among their sexual partners. Previously, the American Academy of Pediatrics Task Force on Circumcision (1999) concluded that existing evidence was insuicient to recommend routine neonatal circumcision. It seems that this policy has had only a negligible efect on practices in this country. Speciically, the Centers for Disease Control and Prevention (2011) estimated that the newborn male circumcision rate declined during a 12-year period from approximately 60 percent in 1999 to only 55 percent in 2010.
Other studies have endorsed health beneits of circumcision.
In large randomized trials from regions of Africa with a high prevalence of human immunodeiciency virus (HIV), male circumcision was found to lower the risk of HIV acquisition in the adult by half (Bailey, 2007; Gray, 2007). And, male circumcision was also reported to decrease adult incidences of HIV, HPV, and herpes infections (Tobian, 2009). In its subsequent policy statement, the American Academy of Pediatrics Task Force on Circumcision (2012) concluded that health beneits of newborn male circumcision outweigh the risks. hus, access to the procedure is justified for families who choose it. The Task Force stopped short of recommending circumcision for all newborns.
Circumcision is performed only in a healthy neonate. Other contraindications include any genital abnormalities such as hypospadias and a family history of a bleeding disorder, unless excluded in the newborn.
The Task Force (2012) recommends procedural analgesia.
Various pain relief techniques include lidocaine-prilocaine topical cream, local analgesia iniltration, dorsal penile nerve block, or ring block (Arnett, 1990; Stang, 1988). The dorsal penile nerve block or the ring block is superior to topical analgesia (Hardwick-Smith, 1998; Lander, 1997; Taddio, 1997). he use of a paciier dipped in sucrose is a useful adjunct to these methods (Kaufman, 2002).
After appropriate penile cleansing, the ring block places a wheal of I-percent lidocaine at the base of the penis and then advances the needle in a 180-degree arc around the base of the penis. The needle is advanced first to one side and then to the other to achieve a circumferential ring of analgesia. he maximum dose of lidocaine is 1.0 mL. No vasoactive compounds such as epinephrine should ever be added to a local analgesic agent or circumcision.
The most commonly used instruments are shown in Figure 32-5 and are Gomco and Mogen clamps and the Plastibell device. Compared with the Gomco procedure, Kaufman and colleagues (2002) reported that the Mogen technique required
FIGURE 32-5 Three different tools used for circumcision.
A.Mogen clamp. The arms of the clamp open to a 3-mm maximum width. B. Gomco clamp, assembled. C. Plastibell device.