During my residency, I was trained to do circumcisions. Circumcisions are a barbaric practice in which perfectly good skin is removed from a helpless infant who is too young to consent. We feel perfectly good about this, but I am sure there are other civilizations who are criticizing or who will criticize us for our mutilation of our children. Now, here is my question: if Ob/Gyns spend their whole training on learning female anatomy, how is it that we are expected to do surgery on MALES? Very important surgery, as any man will tell you. We did the circs when I lived in Atlanta. We do them here in Alabama. Why do the pediatricians not do these? Why do the urologists not do these? The urologists do circs on older children and adults; why can they not do the newborns? Is it that they just can’t be bothered? Ask any Ob/Gyn and they’ll tell you that circs are among their most hated procedures. The whole thing is just disturbing. First there is the ridiculousness of the preop “Time Out”. On adults, this makes sense. You verify the patient’s identity by asking them. You then ask them if they know what procedure they are having done and the name of the doctor that is doing it. A typical Time Out for an infant circumcison might go like this: “What is your name?” Baby: “waaah”. What procedure are you having done today? Baby: “waaah”. Who is your doctor today?” Baby: waaah. Great time out guys, I feel so reassured that the baby is OK with this. The baby’s arms and legs are strapped down tightly to something called a “circ board.” The babies hate that as much as anything, and they start to yowl and cry as soon as they are strapped down. They are numbed with a cream or with a needle into the foreskin, which really must hurt. Then they are painted with cold iodine prep, and the cold shocks them and makes them cry again. Then the foreskin is grasped with two mosquito forceps at the upper outer corners, and another mosquito forcep is spread open repeatedly under the foreskin to break down any adhesions between it and the penis. This is not a hit with the baby. The third forcep is then clamped up the middle anterior third of the foreskin to create a pinched bloodless area where a scissor cut will be made. Again, not a hit with the baby. The foreskin is then peeled back, something one of my colleagues refers to as “skinning the grape”. A metal bell with a handle is then selected to be the correct size to just cover and protect the penis. This is placed on the head of the penis and the foreskin is pulled back up over it. A safety pin is used to perforate and hold the two edges of skin together around the bell. Essentially, the baby gets his first body piercing. Then the bell is locked into a mechanism that cranks a plate tightly in a circle around the foreskin, with the penis protected underneath. A knife is then used to cut off the newly isolated foreskin. The gadget is then removed and the foreskin arranged and wrapped with vaseline gauze to prevent sticking. May I just say that the infants are not pleased with this arrangement. They are given sugar water to suck on during the procedure because apparently studies were done that show that the baby’s pain response is blunted by the pleasure of sucking on the sweet stuff. I’m not convinced. How did they find out that the baby’s pain response is blunted? Did they ask the baby? Because I think the baby would say differently. The babies don’t pee for several hours afterward, we think because they fear the burning afterwards. We may be overly reading in to this. Anyway, the whole procedure is a bit disconcerting for everyone involved. I know the studies show decreased penile cancer and decreased transmission of sexually transmitted diseases, but I bet some day another culture will be looking at us and wondering what the heck we thought we were doing.