Circumcision: Nursing

Circumcision is the surgical removal of the foreskin that covers the tip of the penis. It's a common procedure for infants with a penis.

Let’s first review the anatomy of the male external genitalia, which consists of the scrotum and the penis. The scrotum is a skin and muscle pouch that hangs outside the body and contains the testes. The penis is composed of the body, or shaft, which ends with an enlarged tip, the glans penis, that has an opening called the external urethral orifice at its very tip, where semen or urine are released outside the body. Around the glans penis, a cuff of loose skin makes up the foreskin or prepuce.

Now, there are various indications for circumcision, which can be religious, social, cultural, and personal. In fact, in some cultures, circumcision is a ceremony that is done outside the clinical setting, especially for those of the Jewish faith. On the other hand, other cultures have strong beliefs to keep the foreskin intact.

Other indications for circumcision include penile trauma and various deformities, such as phimosis, which is when the foreskin is too tight on the glans penis so that it can’t be pulled backward. A similar condition is paraphimosis, which is when the foreskin cannot be returned to its original position after retraction. Circumcision might also be indicated in clients with recurrent balanitis, which is inflammation of the glans penis, in addition to balanitis xerotica obliterans, which is a progressive inflammatory dermatosis of the foreskin and glans penis.

Finally, circumcision can also be done to prevent certain conditions, such as penile cancer, sexually transmitted diseases, including human immunodeficiency virus, or HIV, as well as to prevent urinary tract infections in infants with a type of congenital uropathy, where the flow of urine is obstructed..

The circumcision procedure starts under sterile conditions with the baby positioned on their back with arms and legs restrained. An anesthetic agent is then injected into the base of the penis, or it’s applied to the penis as a cream. Then, a device such as a Plastibell, or either a Mogen or Gomco clamp is used to remove the foreskin. After the procedure, an antibiotic or petroleum jelly ointment is applied onto the penis, which is then wrapped loosely with gauze.