Hello All, I am Dr. James Mitchell, a retired Pediatrician who specializes in the neonatal period and circumcision and have come to offer my advice and expertise on the subject. I have 4 sons, 6 grandsons, all circumcised, and I am also circumcised.
Over the course of my 4-decade career, I averaged about 1 circumcision per day, which if you do the math amounts to quite allot. When I was in school we were taught to do circumcision with the Gomco glamp and instructed to make sure that the entire glans was exposed. First starting out in the early 60's as a resident, circumcision was routine at birth, just as surely as cutting the umbilical cord. As soon as a boy was born, he was swaddled in a blanket, shown to the mother briefly (fathers were not allowed in), and moved to the nursery. (In fact, I don't think many mothers realized what an uncircumcised penis looked like.) The next morning the nurses would wheel him and many others into a special room designated for this purpose, where several other docs and myself waited. There were so many babies that we had to do them 3 at a time, assembly line fashion, clamping one and moving on to the next (I'm sure I don't need to describe the whole process now, but would be happy too if anyone requires it). After we were finished we would wrap the penis in gauze and leave the nurses to wheel them away.
Now for those of you who think a circumcision that leaves the glans completely uncovered (as it should) will result in painful erections because of a lack of skin, well you are mistaken. Let me explain… Towards the later 60's when I got out of residency, and into a practice, I stopped doing general hospital circs and switched over too doing only my own patients and patients from other docs in my practice. I would walk over to the hospital, check in on any patients in the hospital and then do a circumcision if necessary. I then spent the rest of the day seeing patients at the office. The advantage of this was that I continued to see many of the boys I circumcised until their teens. At yearly exams I had a look and made sure everything looked fine "down there" and they always had enough lose skin. I also was able to ask if they had any pain etc… None had any problems. My own sons, now grown men, who were circumcised in the same manner, have also never had a problem.
I decided to have my own sons circumcised for the obvious reasons of health and routine as well as looking like daddy, but also because I saw that they would be separated from there peers as most were circumcised. I spent about 6 months of my residency part time as part of an entry board for a local military academy. Another doctor and I were responsible for doing all the exams for new applicants so the administration knew who to accept and who to reject. I was instructed by the doc there, who was my senior, that all applicants had to be circumcised to be accepted because of hygiene and uniformity reasons. At this academy at least, they felt that if all the boys looked the same in the showers it would cause less problems. (This was the early 60's remind you. Of course this was not the official policy of the academy, but anyone who did not meet this private requirement was "passed over" because of the number of applicants) Now of course this was no big deal because all the boys were circumcised anyway. I mean I didn't even think about it, it was a routine: I would do 2 or 3 boys in the same room, who all stood in a row at attention-military school was great LOL! - (Privacy was not paramount) Check pulse; check the breathing "breath in and out"; check the ears, mouth, and nose; look at posture; "drop your shorts", quick check and palpitation "cough please" next! There was only one boy that I remember who when the shorts dropped greeted me with a foreskin, I had to mark him down for that and he never attended the academy. I was sure that I never wanted my sons to go through something like this so it just added to my conviction.
I continued to circumcise through the 70s, but in the 80's the RIC stopped and permission had to be attained. Throughout the 60's and 70's I think I only saw 3 or 4 minor circumcision complications, but it wasn't until the early and mid 90's (I retired in 96) that I began to see adhesions and other problems so commonly reported today. I attribute this to the rise of "dummy circumcision devices" like the plasti-bell, which any idiot can be trained in in a few days, and the rise of inflammatory painkillers. These two are a terrible combination. For one the plasti bell naturally gives a looser cut which can lead to adhesions as well as leaving a piece of plastic attached to the penis, and doctors who used them may not be trained as well making the circumcisions even worse. The injected pain relief then compounds the problem by swelling the foreskin making it even more difficult for the under trained operator, using an inferior instrument, to make a good cut. You can see where the problems lie. I say it is far better to use a method like the gomco clamp, which gives a better accuracy, leaves no bell behind, and requires a more skilled operator (its not like he has to go to college to learn it). This will help insure that there are no complications and the glans are exposed, as they should be. I used the gomco clamp from my starting day and didn't change a thing up to my last one, and I never had a problem with it.
I and the doctors of my generation were not taught to use anesthesia, and I never have. As I said, injected anesthesia causes the area to swell and complicates the circumcision, possibly harming the boy. Also, injections hurt, especially into the penis, and so an injected anesthesia causes almost as much pain as the operation itself, and mearly prolongs the operation. It is much easier on the boy to just do the operation, get it over with quickly and let him get on with life.
This was the philosophy of the time ok? However, I like anyone else in their right mind realize that as the AAP states pain relief is essential. If I were to go back into practice, I would be using pain relief on any infant that I circumcised! Forgive me for not being clear enough in my previous post, and I can see why you thought what you did! As I said in my origional post, I do wish to offer advice, however, anything I say should be corraborated by your own doctor. I mearly wish to point you in the right direction. I hope this clears things up for you!
Now as to the advice issue, I can no longer in practice, so the advice is off the record. Of course I don't expect you to follow it to the letter, I could be some old quack for all you know. I just hope you will take it into consideration so that it can put you on the right path and you know what to ask when you talk to your doctor. Because only you and your doctor know what is right for your child.
I hope I have not bored you all to death with the recollections of an old man, and I thank all of you who stayed with me. I ... hope my knowledge can help at least some of you.
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