Newborn Circumcision, With a Twist

Abstract

Newborn Circumcision, With a Twist Joyeeta G. Dastidar While I'm currently an internal medicine hospitalist taking care of adults on the inpatient side, my residency entailed dual training in both Internal Medicine and Pediatrics. For four years, I'd switch every three months between working in the adult and pediatric hospitals. My first rotation was Newborn Nursery, where I rounded on healthy newborn babies. There was an aide whose job it seemed, was to swaddle and cuddle the babies. I had a flash of envy regarding how much more time the aides actually got to spend with the babies when compared with the pediatricians. During this time, and throughout my pediatrics residency, I had the opportunity to observe neonatal circumcisions. It seemed archaic: The baby boys had their arms and legs strapped down into place to give clear access to their penis. The restraints reminded me of a more sanitized version of medieval torture devices I'd seen at a museum. As the observer, I tried to help soothe the baby through shushing and patting and letting the baby lick sugar water from a syringe. These comfort strategies were not enough, and the babies invariably wailed during the procedure. They left the treatment room with a generous layer of petroleum jelly and an extra-padded diaper for protection. Years later, when my husband and I were pregnant with our son, we debated two things primarily. First, we didn't agree on what type of food to feed the baby. I'm vegetarian, whereas my husband is not. My husband won out in feeding the baby an omnivorous diet. Second, we debated whether to have the baby undergo a circumcision. On the one hand, we wanted the decision about circumcision to be up to our baby. However, we knew he'd only truly be able to decide much later in life, closer to adulthood. While we were aligned on this end, perhaps due to being male himself, my husband felt even more strongly than I on the point of preferring to let our son decide for himself. On the other hand, we knew it'd be much easier to get a circumcision done as a baby. As a bonus, if done as a neonate, our son would have no recollection of the procedure. In South Asia, where my family originated, the decision to circumcise often fell along religious lines. While grappling with agnosticism personally, I was raised in a staunchly Hindu household. In talking to my mother, she mentioned that circumcision was not something done in our faith. However, this was a one-time statement that my mother said in passing, knowing her input would be disregarded if we felt circumcision was in baby's best interest from a medical standpoint. [End Page 76] Our baby was born very premature and spent months in the NICU until he was closer to his due date. There were conflicting statements made regarding our baby's urologic diagnosis: Hypospadias was brought up by a pediatric resident rotating in the NICU. He mentioned it when he noticed the attending neonatologist taking a closer look at our son's penis. The attending wordlessly dismissed this with a brief nod of "No" and moved on to another part of the physical exam. Chordae was suggested by a general surgeon who examined our baby. During a well-child exam, nothing about the baby's penis was mentioned by his general pediatrician. Ultimately, when the baby's penis persisted in being an L shape, we went to see a urologist, where he was diagnosed with penile torsion. I researched penile torsion both in the medical and general literature. Wikipedia told me one in eighty males are born with torsion. That made it seem relatively common. More scientific papers told me that our son's counterclockwise rotation to the left was the most common variant. Because there was no functional problem with our baby's penis and the issue was cosmetic, social considerations were what drove the decision to proceed: namely, we didn't want the difference to affect our son's confidence or cause him to be the subject of teasing. After all, genitals are a sensitive matter...