whether, with severe disorders or deformities, to
continue the pregnancy.
To withdraw the sample of cells the obstetrician
may insert a needle through the abdominal wall
and into the UTERUS, similar to AMNIOCENTESIS, or
may guide a very small catheter through the
VAGINAand CERVIXinto the uterus. The obstetrician
first numbs either the site on the abdomen or the
cervix with a local anesthetic, then uses ULTRA-
SOUNDto help place the needle or the catheter.
After the procedure the woman may feel mild
cramping or experience slight bleeding, which are
the main risks associated with CVS. Rarely CVS
can cause spontaneous ABORTION(loss of the preg-
nancy), though the risk with CVS less than the
risk with amniocentesis, another prenatal diagnos-
tic procedure, because CVS does not require pene-
tration of the amniotic sac.
The findings available through CVS are not
always as definitive as the results of amniocente-
sis. The advantages of CVS over amniocentesis,
however, are twofold. First, the obstetrician can
conduct CVS in the first trimester though cannot
perform amniocentesis until well into the second
trimester. Second, the risk for complications,
including injury to the fetus and spontaneous
abortion, is lower with CVS. It is important to dis-
cuss and thoroughly understand the reasons for
either procedure.
See also ALPHA FETOPROTEIN (AFP); CONGENITAL
ANOMALY; PRENATAL CARE.
circumcision The surgical removal of the fore-
skin (prepuce), the thin hood of SKINthat covers
the end of the PENIS. The reason for circumcision
may be therapeutic, religious, ceremonial,
hygienic, cultural, or social. About two thirds of
newborn boys in the United States are circumcised
shortly after birth for nontherapeutic reasons.
Nontherapeutic circumcision should take place
within three weeks of birth when done in infancy.
Circumcision at an older age, and particularly in
adulthood, becomes a more significant surgical
procedure with increased risk for complications.
Infant (Neonatal) CircumcisionFor infant circumcision, the doctor applies an
anesthetic cream or injects a local anesthetic to
numb the penis, then applies a circumcision clamp
and cuts away the end of the foreskin. The proce-
dure takes about 10 minutes. Some methods leave
a plastic ring around the penis that seals the edge
of the wound; the ring falls off when the wound
heals (within 7 to 10 days). There are no sutures
(stitches). Minor bleeding for a day or so after the
procedure is common.Adult Circumcision
Adult circumcision is a minor surgery OPERATION
generally performed in a hospital operating room
or an aMBULATORY SURGERY FACILITY; it requires
regional anesthesia (anesthetic injected into the
NERVEthat serves the penis) and a general seda-
tive. The circumcision operation takes about 30
minutes; typically a urologist performs the opera-
tion. Sutures remain in place for five to seven
days after the operation. It is important to try to
avoid erections and sexual activity for four to six
weeks to allow the surgical wound to heal prop-
erly. There is often mild to moderate discomfort
during HEALING; the doctor may prescribe or rec-
ommend ANALGESIC MEDICATIONSfor PAINrelief.Risks and Complications
Risks associated with circumcision include exces-
sive bleeding, injury to the penis, too much or too
little foreskin removed, and postoperative INFEC-
TION. Infants who have a CONGENITAL ANOMALYof
the penis such as HYPOSPADIASor CHORDEEshould
not undergo circumcision. Health conditions for
which circumcision is therapeutic include PHIMOSIS
and PARAPHIMOSIS, conditions in which the foreskin
does not properly retract or return to its normal
position, and chronic or persistent BALANITIS(an
infection of the glans that develops under the
foreskin).Medical Debate about Routine Infant Circumcision
Despite its frequency, routine infant circumcision
is a matter of considerable debate among health
professionals. In 1999 the American Academy of
Pediatrics issued a position statement that there
are no medical or health reasons for routine cir-
cumcision of newborns. Numerous studies have
attempted to determine whether circumcision
provides health benefits. The findings are mostly
inconclusive, with the exception of a significantly
increased risk in uncircumcised boys for URINARYcircumcision 263