Dr. Helen Salsbury, who performs about five circumcisions per month in her Pembroke Pines obstetrics office, lays down week-old Baby Emilio in the gingerbread-man-shaped indent of a white plastic board called a Circumstraint Newborn Immobilizer. Using its wide Velcro straps, she secures his wrists and knees so Emilio cannot move. No one wants him wiggling during this procedure.
Salsbury warns Emilio's mother about potential complications: hemorrhage, infection — even, she says, "loss of the penis." A less confident practitioner might not admit her own mistakes, but Salsbury goes into detail about the three instances in her career when she thought she might have removed too much or too little skin. In all three cases, she says, she sent the baby to a pediatric urologist, who deemed the babies just fine. Emilio's mom nods calmly and confirms that she wants the procedure. Later, she'll pay $150 out of pocket for the surgery, because Florida's Medicaid no longer covers it.
Salsbury dips the baby's pacifier in a dish of sugar before placing it in his mouth. She inches her hands into surgical gloves. She opens his diaper.
Earlier, in her office, Salsbury had said that many doctors do not numb the baby's skin before performing the procedure, but she prides herself on using a local anesthetic called lidocaine. "I'm probably the longest lidocaine-using doctor in Broward County. Circumcision is a brutal surgery. If you treated an animal the way we treat babies, you would be arrested for animal cruelty. We never remove a mole or a lump without lidocaine." She said circumcision without something to numb the pain would be "like removing your lips — squeezing the skin of your lips with Vise-Grips and cutting across that squeezed area. Very tender."
With a thin needle, she injects the lidocaine above and below the baby's penis, into the dorsal penile nerve, noting that he may later develop small bumps at the injection site.
Emilio howls. His chest heaves up and down as he lets out a cry and hyperventilates. His mom presses the pacifier back into his mouth.
The lidocaine takes effect after a minute or so, and the baby calms. Operating slowly and explaining as she goes, Salsbury inserts a hemostat, which looks like a long, skinny pair of pliers, through the tiny opening of the baby's foreskin. With sweeping motions, she separates the baby's foreskin from the glans, or tip, of his penis. Her tool pokes around under the surface of his skin like chopsticks beneath a balloon.
Then Salsbury picks up a Mogen clamp, a palm-sized, stainless-steel device with two sharp edges that swing open and shut on a pivot. Salsbury calls it an "antique." She pulls the baby's foreskin up over the tip of his penis, like the neck of a turtleneck sweater pulled high up over someone's head, and pinches the clamp just above. With a scalpel, she cuts off the flap of foreskin and places it on a surgical tray.
She releases the clamp, wipes away a trickle of blood, and presses her index fingers on either side of the baby's penis. The tip pops out like a bright, shiny red bulb. "A perfect little boiled peanut," Salsbury says. She piles a mound of Vaseline inside the baby's diaper and closes it.
"You should see the operations I've done on my kitchen table," Salsbury joked in her office, explaining that circumcisions are no big deal. But she acknowledged that "people have strong opinions for or against."
Indeed. A highly publicized conflict in California last year gave momentum to a small but dedicated group of people — a group that has some of its loudest proponents in Florida — who see circumcision as genital mutilation, a medically unnecessary amputation that should never be imposed on children against their will.
Although the foreskin has been enjoying something of a comeback in recent years as the national circumcision rate has dropped, these activists — or "intactivists," as many proudly call themselves — have decades of tradition and a massive medical establishment against them. With circumcision considered compulsory in some religions and now being touted as a powerful tool in the fight against HIV, the procedure is not going to disappear anytime soon.
Still, armed with blogs, business cards, and newborn-sized T-shirts that declare "anteater pride," the intactivists soldier on in evangelical fashion, out to save one baby penis at a time.
According to the Bible, Abraham was 99 years old and childless when God told him he would be the father of many nations. God required something in return: "This is My covenant that you shall observe between Me and you and your children after you, to circumcise your every male." God instructed that males should be circumcised on their eighth day of life and that the soul of any uncircumcised male "shall be cut off from his people; he hath broken My covenant."