Boyd Winslow, M.D.
Editor’s Note: The following article was released on Monday, August 27, 2012 related to this topic. It adds additional information regarding the risks and benefits of circumcision: “Peditricians Decide Boys are Better Off Circumcised than Not”
Finding out that you are pregnant is exciting. Learning the gender of your soon-to-be-born baby is even more exciting. And welcoming your newborn baby into the world and holding him in your arms is priceless!
But when “it’s a boy” – many parents are confused and concerned about the circumcision decision and procedure.
Is it really necessary? Will it hurt my baby? Should I wait until he’s older? What are the risks? Who is best equipped to perform the procedure? How do I care for my baby after the procedure?
There are dozens of questions that must be answered.
For decades, the American Academy of Pediatrics viewed circumcision as unnecessary or held a neutral view on the subject. But lots of things have changed and science has taught us enough about the benefits of circumcision to make it not only an easier decision, but also a responsible decision.
We sat down with Boyd Winslow, MD, of FACS, FAAP, Children’s Urology of Virginia, PC at Stony Point Surgery Center. Dr. Winslow specializes in children’s urology and circumcision. Dr. Winslow was educated at Harvard College and Harvard Medical School, and trained at the Massachusetts General Hospital in adult and pediatric urology.
He provided us with valuable insights into the pros and cons of circumcision, and the best time to have the procedure done on a newborn.
RMOM: Dr. Winslow, what are the most recent studies telling us about circumcision of newborns?
BW: There is an evolving scientific body of data and evidence that demonstrates the benefits to the individual and the public at large when it comes to circumcision. The World Health Organization and the Centers for Disease Control provide evidence that the prevalence of sexually transmitted diseases (STDs) are markedly higher in uncircumcised men. This means they are also subjecting their partners to STDs, and the increase in cervical cancer increases with uncircumcised partners too. Since HPV, which is the driver of cervical cancer, lives and thrives under the uncircumcised foreskin, there is much greater risk for this group of individuals.
RMOM: Knowing the scientific facts is one thing. But what about moms and dads who worry about inflicting pain and surgery on such a fragile young life?
BW: This is an excellent question and it’s one more reason why parents should give thoughtful consideration to not only WHO conducts the surgical procedure, but WHEN it is performed. Circumcision performed under appropriate levels of anesthetic and by a highly skilled professional in this area of medicine is the best way to ensure the greatest comfort for the baby. With 31 years of experience in this field, I know how important it is to offer comfort to the newborn and his parents and we have the resources and experience to do it extremely well. Waiting until the child is older or becomes an adult will be even more uncomfortable and painful with greater risk of complications.
RMOM: You say the first 1-3 days is not the best time, but isn’t that when most doctors perform circumcision – while the baby is in the hospital nursery?
BW: Traditionally, this has been the case but as science evolves, we learn better ways of doing most everything. During the first few days of life, a newborn is adjusting to the world around him – learning to eat is just one important process he must master. His legs are flexed, he has immature clotting factors, and he will lose weight during the first week of life. Rather than subjecting the newborn to yet another challenge at this turbulent stage in his life, we recommend circumcision between the 2nd and 4th weeks for full-term babies. It is safer and we get a much better result. For premature babies, the window of time for circumcision is a bit longer, but within 44 weeks of conception.
At about 2-4 weeks of life, the baby is usually easily soothed by eating, and by feeling and hearing his parent’s voices and touch. The parents can be present when the circumcision is done and they help the baby through this process. Being able to eat is a soother for babies and clotting characteristics have typically matured so there is less risk of bleeding.
RMOM: What are the risks?
BW: There are risks with any surgical procedure, but risks are minimized when specialized experts in the best possible environment perform the procedure. Like any procedure, parents should seek out the doctor with the most experience in this area of medicine. We do everything possible to minimize bleeding and other risks. And of course the worry of pain for the baby is a parent’s concern too – we ensure the baby receives the necessary and appropriate anesthesia for the greatest comfort. We even have some babies who have slept through the procedure as moms caress them and hold their tiny hands.
RMOM: You have the parents present during the procedure? Is this done in your office?
BW: Yes, we perform the circumcision in our offices where we have specially equipped facilities to handle everything – from magnifying optics, to enhanced lighting, specialized equipment, and expertly trained staff who assist with this procedure. We work with parents to schedule the optimal time for the procedure by roughly 44 weeks from the point of conception, or within 4 weeks of age for a baby born at full-term (40 weeks). For preterm babies, waiting a few weeks for a circ allows them to focus on gaining weight and overcoming challenges of being born early.
RMOM: How do a mom and/or dad make arrangements with your office?
http://www.stonypointsc.com/Kids/index.php
BW: We are available to talk with the parents before the procedure is done. All they have to do is contact our office and talk with our scheduling coordinator to schedule the procedure. We are very sensitive to the needs of performing the procedure within these time constraints, and we work with the parents to get the baby on the schedule quickly. Allowing parents to come in for a consultation and get to know who is doing the procedure and what to expect is a distinct advantage of our services. The parents are also more settled in with the newborn and they are able to better understand how to care for the baby and the site of the circumcision post-surgery.
RMOM: Is there anything else parents need to know before making a decision?
BW: We don’t perform the procedure and leave the rest to mom. We’re here for education on wound care, follow-up, consultation, support, and help whenever they need it. Fees for the actual circumcision are dictated by medical codes and we work with insurance companies to handle billing.
I respect the job of obstetricians and pediatricians who provide medical care and support for moms and their newborns. I also know that the specialized services we deliver offer our patients and their families the best possible services and outcomes when it comes to the delicate circumcision procedure. Making sure it’s done right the first time will help ensure a healthier and happier life as the baby grows.
To learn more, or to schedule a consultation with Dr. Winslow, or his partners John D. Edmondson, MD, or Frank R. Cerniglia, Jr., MD, FAAP, you can reach their office at Stony Point Surgery Center by calling 804.272.2411. You can also talk with their experienced nurse practitioner, Valre W. Welch MSN, CPNP by calling the office. The best time to schedule an appointment is once you learn you are having a boy, or as soon as the baby boy is born.
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