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- OLDER OR ELDERLY men
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What Does Nurse Gail Say About
Circumcision and Older or Elderly Men?
A Parent’s Decision:  Website Launched January 2014 - Updated February 2014, March 2014, September 2014 and October 2017
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Nurse Gail  earned her Bachelors of Science when she graduated cum laude from the University of Texas in Austin in 2004 and was a registered nurse for ten years.


She then enrolled in the Adult/Geriatric Primary and Holistic Nurse Practitioner programs at New York University.   


Today, Nurse Gail has a Masters of Science from New York University and is a practicing primary care provider in Manhattan.  

Page 1:  http://nursegail.com/circumcision_dementia_infection_elderly-population/ (link opens in a new window)


Circumcision–A New Perspective | Long Lasting Implications

Consider your son's health well into the future.

By Nurse Gail Ingram NP  :  February 03, 2014

I witness many conversations, both professionally and socially, regarding infant circumcision. In all of the discussions, no one mentions how circumcision, or the lack of, impacts a man when he has aged and can no longer care for himself.


One of the most gut wrenching experiences of my hospital career came when I was a nurse’s aide on a medical/surgical floor. A stoic elderly man was transferred to my unit from a nursing home and it was my responsibility to remove his street clothes and dress him in a hospital gown. The stench of gangrene filled the room and overwhelmed me when I removed his pants. He was too sick to communicate with words but looked at me with soft eyes and an apologetic face. I discovered a severe infection that fused the meatus inside the foreskin. I alerted the nurse to what I had found and she delegated the laborious task of cleaning to me. It took hours of warm compresses followed by excruciating crust removal. I apologized repeatedly and when tears flowed from beneath his thick horn-rimmed glasses, I cried too.


I will never forget this experience and I offer it to others when they consider circumcision. The elderly population, specifically 85 years and older, is growing at a rapid rate in the United States. Men are living longer than ever and the health care system is struggling to keep up. Hospitals, rehabs and nursing homes are filled with patients who need increasing assistance with activities of daily living. Dementia, incontinence, decreased sensation, and impaired vision are risk factors which can lead to infection in the uncircumcised elderly male. Lack of awareness in this area by family and/or overworked, underpaid nursing home staff contributes to the problem.


Parents who are considering circumcision should examine the consequences for a child at different stages of life. The discomfort of circumcision for an infant may be minor compared to the loss of dignity and pain experienced by the uncircumcised elder. Parents can honor their child by making a decision that outreaches their lifetime; one that allows their baby to face his twilight years with grace.

Page 2:  http://nursegail.com/circumcision-a-new-perspective-part-ii/ (link open in a new window)


Circumcision–A New Perspective II

It's no secret that the American health care system is struggling to care for the elderly.

By Nurse Gail Ingram NP  :  May 02, 2014


In response to a previous post, “Circumcision–A New Perspective | Long Lasting Implications ” - see above - a reader named Elizabeth wrote:


“Glad you gave your patient tender care. But I do think that this case points more what is lacking in the system (time, skilled attendants, knowledge) rather than that this gentleman escaped RIC. I can imagine infections/conditions of all kinds might thrive in a struggling system. For men and women. If these stresses on “the system” look unsolvable, maybe it would be more fair to offer adult circumcision upon being eligible for medicare. (If our leaders allow it to still exist) That way, men don’t miss out on a whole lifetime of benefits of having a foreskin. Was wondering if you are in communication with any nurses in Europe anywhere. Do they feel the same way? Most men in Europe are not circumcised, so I wonder how common problems are for them, as they age.”


My reply:


Elizabeth, thank you for reading and commenting. Many of my blog entries focus on “what is lacking in the system,” and my post is just as much about the state of U.S. health care as it is about circumcision.


To your point regarding elective adult circumcision, I just finished a contract at an ambulatory surgical center and I recovered many men in their 30s who underwent the procedure. All of the patients that I cared for were circumcised in an attempt to resolve chronic infections in which all other treatment options had been exhausted. Through conversation, each of them stated, in one way or another, that they would not have undergone circumcision if it had not been a last resort.


Medicare does not cover an adult circumcision to prevent future infections unless there is a documented history of infection. A costly, out-of-pocket adult circumcision to prevent an uncertain outcome secondary to aging is not recommended by doctors nor is it appealing to men. Fear associated with manipulating a man’s healthy penis far outweighs anything he can imagine happening in his twilight years.


You bring up a good point about infection rates in nursing homes in Europe. However, care for the elderly and the culture of aging is different, so much that a comparison is difficult. Families assume care of their elderly in the home and socialized medicine has altogether different priorities than American healthcare facilities. Owning a nursing home in America is a profitable business as long as staffing is poor, the pay is low, and education is minimal.


Also, there are no billable tracking codes to follow foreskin related infection rates in U.S. nursing homes and the only evidence is anecdotal; empirical data is needed. Therefore I offer my perspective on circumcision not as a directive, but as a discussion point.


Elizabeth, I’m glad you are continuing the conversation in a thoughtful way. I hope that others continue to do the same.



[For anyone considering the procedure, this is a link to the personal blog of a 22 year old Canadian man who elected to have the procedure because of visual and functional issues rather than infection.]




ORIGINAL BLOG ENTRY (now Page 1, above) DATED JULY 16, 2012


Circumcision–A new perspective | Elders at Risk for Infection          By  Nurse Gail  :  July 16, 2012


I witness many conversations, both professionally and socially, regarding infant circumcision.  In all of the discussions, no one mentions how circumcision, or the lack of, impacts a man when he has aged and can no longer care for himself.


One of the most gut wrenching experiences of my hospital career came when I was a nurse’s aide on a medical/surgical floor.  A stoic elderly man was transferred to my unit from a nursing home and it was my responsibility to remove his street clothes and dress him in a hospital gown.  The stench of gangrene filled the room and overwhelmed me when I removed his pants.  He was too sick to communicate with words but looked at me with soft eyes and an apologetic face.  I discovered a severe infection that fused the meatus inside the foreskin.  I alerted the nurse to what I had found and she delegated the laborious task of cleaning to me.  It took hours of warm compresses followed by excruciating crust removal.  I apologized repeatedly and when tears flowed from beneath his thick horn-rimmed glasses, I cried too.


I will never forget this experience and I offer it to others when they consider circumcision.  The elderly population, specifically 85 years and older, is growing at a rapid rate in the United States.  Men are living longer than ever and the health care system is struggling to keep up.  Hospitals, rehabs and nursing homes are filled with patients who need increasing assistance with activities of daily living.  Dementia, incontinence, decreased sensation, and impaired vision are risk factors which can lead to infection in the uncircumcised elderly male.  Lack of awareness in this area by family and/or overworked, underpaid nursing home staff contributes to the problem.


Parents who are considering circumcision should examine the consequences for a child at different stages of life.  The discomfort of circumcision for an infant may be minor compared to the loss of dignity and pain experienced by the uncircumcised elder.  Parents can honor their child by making a decision that outreaches their lifetime; one that allows their baby to face his twilight years with grace.


http://nursegail.com/circumcision_dementia_infection_elderly-population/



Perhaps you would like to read what Nurse Gail has to say on her Blog on this subject, as I think she makes these points much more clearly than I can.  


With Nurse Gail’s permission, I have copied her Blog entry below for ease.