Pros and Cons of Newborn Circumcision

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  • Identify and explain positions other than the lithotomy in which a pelvic examination can be performed.
  • Why are women at a higher risk of UTI than males?
  • What would you educate to decrease the risk of UTI?
  • Summarize the pros and cons of newborn circumcision.
  • Describe the following signs on a female examination:
    • Goodell
    • Hegar’s
    • McDonald’s
    • Chadwick
  • Name the characteristics of the following type of hernias:
    • Indirect inguinal
    • Direct inguinal
    • Femoral

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in proper current APA style with support from at least 3 academic sources.

pros and cons of newborn circumcision

Positions for Pelvic Examinations

Though the lithotomy position is the most common for pelvic examinations, alternative positions may be used, depending on the patient’s physical condition or comfort level. These include:

  1. Lateral (Sims’) Position: The patient lies on her side with her knees drawn up. This is useful for patients with mobility issues, obesity, or back pain.
  2. Knee-Chest Position: The patient kneels with her buttocks elevated and chest down. This allows gravity to help with internal visualization.
  3. Standing Position: The patient bends at the waist with her feet shoulder-width apart, useful in some situations like prolapse examinations.
  4. M-Position: The patient lies on her back with her knees bent and legs apart but feet flat. This is sometimes more comfortable for patients who struggle with the lithotomy position.

Why Women Are at Higher Risk of UTI Than Men

Women are more susceptible to urinary tract infections (UTIs) due to anatomical differences. Key factors include:

  • Shorter Urethra: Women have a urethra that is shorter and closer to the anus, allowing bacteria like E. coli to travel more easily to the bladder.
  • Proximity to Bacteria: The urethral opening in women is closer to the anus, making bacterial contamination from the bowel more likely.
  • Sexual Activity: Sexual intercourse can introduce bacteria into the urinary tract, increasing the risk of infection.
  • Hormonal Factors: Changes in estrogen levels, especially during menopause, can alter the vaginal flora, increasing susceptibility to infection.

Education to Decrease UTI Risk

  1. Proper Hygiene: Educating patients to wipe from front to back to prevent bacterial spread from the anus to the urethra.
  2. Hydration: Drinking plenty of water to flush out the urinary tract and reduce bacterial growth.
  3. Urination After Intercourse: Encouraging urination after sexual activity helps to flush out any bacteria that may have entered the urethra.
  4. Avoid Irritants: Avoiding the use of irritating feminine products, such as douches and scented sprays, around the genital area.
  5. Cotton Underwear: Wearing breathable cotton underwear helps keep the area dry and reduces bacterial growth.

Pros and Cons of Newborn Circumcision

Pros:

  • Reduced UTI Risk: Circumcised males are at a lower risk of developing urinary tract infections.
  • Reduced Risk of Certain Infections: Circumcision can reduce the risk of sexually transmitted infections (STIs), including HIV.
  • Cancer Prevention: Circumcision reduces the risk of penile cancer, although this is a rare condition.
  • Hygiene: Some argue that circumcision makes it easier to maintain cleanliness.

Cons:

  • Pain and Complications: Even though local anesthesia is used, circumcision can cause pain. Complications, though rare, may include bleeding or infection.
  • Ethical Concerns: Some argue that circumcision should be a decision made by the individual when they are old enough to consent.
  • No Strong Medical Necessity: The American Academy of Pediatrics (AAP) states that the health benefits of circumcision are not compelling enough to recommend routine circumcision for all newborns.

Signs on a Female Examination

  1. Goodell’s Sign: A softening of the cervix, typically occurring at around 4 to 6 weeks of pregnancy.
  2. Hegar’s Sign: A softening of the lower uterine segment just above the cervix, usually noticeable between 6 to 12 weeks of pregnancy.
  3. McDonald’s Sign: The ease in flexing the body of the uterus against the cervix, a sign of pregnancy.
  4. Chadwick’s Sign: A bluish discoloration of the cervix, vagina, and labia resulting from increased blood flow, often visible around 6 to 8 weeks of pregnancy.

Characteristics of Hernias

  1. Indirect Inguinal Hernia:
    • Occurs when abdominal content protrudes through the internal inguinal ring.
    • More common in males and can present in the scrotum.
    • Typically congenital and may be present from birth.
  2. Direct Inguinal Hernia:
    • Results from a weakness in the abdominal wall and occurs near the external inguinal ring.
    • Common in older adults due to muscle weakening.
    • Usually does not extend into the scrotum.
  3. Femoral Hernia:
    • Occurs when tissue pushes through the femoral canal near the groin or thigh.
    • More common in women, especially those who are pregnant or obese.
    • At higher risk for complications like strangulation due to the narrow femoral canal.

Conclusion

Pelvic examinations can be performed in various positions based on patient needs, and understanding the anatomical differences between genders helps address risks like UTIs. Educating patients on preventive measures is crucial, and while circumcision has potential benefits, it also comes with ethical and medical debates. Recognizing hernias’ characteristics is important for effective diagnosis and management in clinical practice.

References

  1. Gandhi, J., et al. (2016). Urinary tract infections in women: Current trends and management. Urology, 10(5), 675-681.
  2. Morris, B. J., & Krieger, J. N. (2017). Penile circumcision: An evidence-based evaluation. The Open Access Journal of Urology, 9, 91–115.
  3. U.S. Preventive Services Task Force (2019). Circumcision for the prevention of infection. JAMA, 321(4), 388-395.
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