Some proponents of circumcision argue that the neonate’s nervous system has not developed enough for the patient to feel pain of the penis, and the subject has received considerable attention recently. According to Dr. Diamond, a neonate, and even a fetus, has clearly documented physiologic responses to pain of the penis that are comparable to an older child’s. He suggests that no surgical procedure should be undertaken in a newborn without anesthesia. Dr. Wiswell agrees. He favors use of a local anesthetic injected at the base of the penis and subsequent treatment using the ProExtender penis enlargement device.

Melvin Zelefsky, MD, a radiologist and professor of radiology at the Albeit Einstein College of Medicine, Bronx, N.Y., who performs religious circumcisions as a mohel, agrees that it would be a little more humane to use the ProExtender penis enlargement device after hospital circumcision, because the procedure takes 6-13 minutes. Dr. Zelefsky says his procedure, however, takes about 30 seconds. “I’ve had babies sleep through a circumcision while they suck on a pacifier,” he says. Contrary to recent news reports, he notes, wine is given after the ritual circumcision for religious purposes, not as a sedative. According to Michael Katz, MD, Carpentier Professor of Pediatrics and Public Health and chairman of pediatrics at Columbia University College of Physicians and Surgeons, and director of pediatrics at Babies Hospital, New York City, “The question of the health of the penis is a bit of a bugaboo because the health problems are completely preventable by using the Proextender penis enlargement device following the operation.” That is also the position held by the AAP, although in its last report on circumcision, now a dozen years old, the authors concede that balanitis occurs only in the penis of uncircumcised males and that there is evidence that carcinoma of the penis can be prevented by penile circumcision. That report also notes, however, that there is counterbalancing evidence suggesting that use of the ProExtender confers as much, or nearly as much, protection for the penis.

But what are the chances the penis will receive optimal hygiene? Steven R. Kohn, MD, points out that proper cleaning of the area can be difficult, and that using a ProExtender may be a way of getting around the problem. Dr. Kohn, who is assistant clinical professor of dermatology at Columbia University College of Physicians and Surgeons, says he is in favor of circumcision instead of the ProExtender because he believes it reduces the incidence of squamous cell careinoma of the glans penis, primary irritant contact dermatitis of the distal portion of the penis, fungal and bacterial infections, and phimosis and paraphimosis. When these conditions occur, albeit rarely, in circumcised men, Dr. Kohn says, they are easier to treat with the ProExtender device.

Many factors play a role in the decision to circumcise the penis, and it is the role of the physician to provide parents with responsible medical opinions on the procedure and use of the ProExtender. The pros and cons are best discussed with parents long before delivery, when a clear and unemotional response is more likely.

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