This index contains information about the practical aspects of male circumcision, including:
how it is performed;
cost and reimbursement;
factors that may influence the decision;
cost-benefit analyses.
Introduction
Male neonatal circumcision is a radical invasive non-therapeutic procedure, that removes and destroys a body part having important physiological functions. Rosemary Romberg's classic book, Circumcision: the Painful Dilemma, is probably the best reference. It shows a circumcision procedure illustrated step-by-step with photographs and drawings (p. 162ff.)
There are illustrations of the circumcision procedure in Edward Wallerstein's classic, Circumcision: An American Health Fallacy, with a discussion starting on page 204. These pictures have been reproduced in other places, including Jim Bigelow's book The Joy of Uncircumcising, and Say No to Circumcision: 40 Compelling Reasons by Thomas J Ritter MD and George Denniston MD (both from Hourglass, PO Box 171, Aptos CA 95001).
There are documents describing the circumcision procedure:
Other known devices for infant circumcision are: The Ross circumcision ring (similar to Plastibell, but made of metal); the Yellen clamp (looks like a woodworking C-clamp, and works similarly to the Gomco); the Sheldon clamp (..looks like a nail clipper on steroids...). Some circumcisions are done with a scalpel by a freehand method. Anaesthesia is rarely used, and the pain is intense with all of these methods (see the section on Pain).
The Mogen clamp reportedly is favored by Jewish mohels because it is said to use the traditional method of ritual circumcision. It is also claimed to be faster and less painful by those who advocate its use.
If you would like to read more about the surgical risks of circumcision, the books of Wallerstein, and particularly Romberg (mentioned above) are very helpful. Both of these are unfortunately out of print, but should be available in a good University library. See also Complications.
Doctors: Please review this proposed consent form for infant male circumcision.
Articles
Child Circumcision
References
Circumcision Instruments
Gomco clamp Patient Care Magazine 1978; March 15:82-85. [ Note: The following reference dicusses the use of anesthesia with the Gomco clamp circumcision. CIRP cautions that the anesthesia used reduces but does not eliminate pain.]
Reynolds RD. Use of the Mogen clamp for neonatal circumcision. Amer Fam Physician 1996; 54:177-82.
picture of a Sheldon circumcision clamp[ Note: The Sheldon clamp is reported to have been withdrawn from the market by the manufacturer because of lawsuits.]
The Reimbursement Advisor gives advice to medical doctors on how to make claims for reimbursement9 while the Survey of Fees and Practices, reports a survey of the charges for a circumcision by obstetricians from around the United States.10 Mansfield reports on the additional cost of the hospital stay for circumcision.11Mansfield et al. estimate that in hospital circumcisions result in increased hospital charges for services of $234 million to $527 million in 1990-91. Van Howe reported the cost of a post neonatal circumcision to be $3009 to $3241 per case.12Bollinger reports data from HCIA-Sachs.15 HCIA-Sachs reports that the total cost of an in-hospital non-therapeutic neonatal circumcision in the United States has risen from $1154 in 1992 to $1869 in 1999, an increase of 62%. The total cost of all in hospital neonatal circumcisions in the United States is reported to be $2.1 billion in 1999. Wayne points out that circumcision fails to meet the HCFA requirements for reimbursement so may be fraudulent.14
Cadman et al. (1984) studied the benefits and costs of neonatal circumcision. They concluded that the benefit (alleged prevention of penile cancer) was insufficient to justify the cost, so public health insurance programs should not cover neonatal circumcision.16 Lawler et al.17 (1991) and Ganiats et al.18 (1991) independently concluded that the health effect of circumcision was essentially neutral, that they could not medically justify non-therapeutic neonatal circumcision, and that other factors must be used to support a decision to circumcise an infant. Lawler et al. and Ganiats et al., however, overlooked certain adverse consequences that have now come to the forefront. Chessare (1992) reported that non-circumcision has the highest medical-utility.19 A more recent study by Van Howe (2004) concludes that circumcision has an adverse effect on health, is not good health policy, and that it cannot be justified financially or medically.20
The following journal articles contain information about the factors that affect the circumcision decision. Hawa Patel (1966) may have been the first to formally study the reasons parents give for making the decision. 21 He found that the decisions are usually based on misinformation or medical myths.22 Daksha A. Patel (1982) reported low levels of physician information.22 He recommended establishment of educational programs.22 Taylor (1983) reported the factors associated with circumcision are a circumcised older brother, and prenatal health care delivered by an obstetrician. Factors associated with no circumcision are the fact that this male is the first born, prenatal health care by a general practitioner, and maternal age of less than 20.23 Metcalf's study (1983) in Salt Lake City found that the three most popular reasons for circumcision were hygiene, social custom, and a circumcised father.24 He also reported that one fourth of the mothers could not remember after six months why they had their son circumcised.24 Enzenauer (1986) found that videotaped counseling is much more successful than oral counseling in reducing the incidence of circumcision.25 Brown & Brown (1987) report that social reasons, including a circumcised father, are the most important reasons that parents choose circumcision.26 Parental education will have little effect according to this study.26 Tiemstra (1999) reported that conditions have not improved much in the fifteen years since earlier studies.27 Tiemstra studied the timing of the parental decision about circumcision. He found that parents tend to make up their mind before they have received circumcision counseling.27 He believes that counseling about circumcision should begin at first patient contact.27 This is much earlier than is commonly practiced in the United States.27
The following article illustrates the adult circumcision procedure. It is a radical, invasive, traumatic procedure with a long painful recovery time. It destroys the physiological functions of the prepuce; it is the most expensive treatment option; and it is the one procedure still promoted by many American doctors for almost any penile problem, even though newer treatment modalities are available. For information on newer effective, conservative, non-invasive, non-traumatic treatment options, see Conservative Treatment of Penile Problems.
Holman JR, Stuessi KA. Adult circumcision. American Family Physician 1999; March 15: 1514. (Link to www.aafp.org)
The Circumcision Information and Resource Pages are a not-for-profit educational resource and library. IntactiWiki hosts this website but is not responsible for the content of this site. CIRP makes documents available without charge, for informational purposes only. The contents of this site are not intended to replace the professional medical or legal advice of a licensed practitioner.
Note: The following reference dicusses the use of anesthesia with the Gomco clamp circumcision. CIRP cautions that the anesthesia used reduces but does not eliminate pain.]
The gomco circumcision: common problems and solutions. Am Fam Physician 1998; September 15:891. (link to www.aafp.org)
