Circumcision is a surgical procedure in which the foreskin is removed from the penis. This procedure has been performed for thousands of years according to cultural and religious traditions. Previously, approximately 90% of males underwent circumcision in the United States. This percentage is much smaller in other regions of the world, and has in fact decreased in this country in recent years. Medical opinions have changed over the years regarding the medical necessity of circumcision. There is some evidence that circumcision may reduce the risk of urinary tract infections. However, at present, there is no clear consensus that circumcision is medically required in otherwise healthy male newborns. The procedure is most often performed at the request of the family by obstetricians, pediatricians, family physicians and pediatric surgeons. Since circumcision may be more risky if done later in life, parents may want to do it soon after their son is born if they want their child circumcised.
In the first month of life, infants are small enough to undergo circumcision in the Pediatric Surgery Office with the aid of local anesthesia. The surgeon will first examine your baby for conditions that would preclude an office circumcision, or even make circumcision undesirable. If circumcision is appropriate for your infant, the procedure will be performed at that day’s office visit. A topical anesthetic cream is first placed on the foreskin and the skin just above the penis. After 30 minutes, the child is taken to the procedure room. Local anesthesia is injected through the anesthetized skin to block the nerve endings to the penis. Excess foreskin is removed using a clamp that protects the penis from injury. No follow-up visit is required, unless problems arise.
Patients older than a few months of age or those with other conditions requiring surgery undergo their circumcisions in the operating room. In many cases, the clamp is still used; alternatively, the procedure may be performed with the aid of dissolving sutures to control bleeding from the cut edge of the foreskin. Only in rare instances is circumcision performed for medical reasons such as infection of the foreskin (balanitis) or an unusually narrow opening of the foreskin (phimosis).
Reasons parents may choose to circumcise their child:
Research suggests there may be some medical benefits to circumcision. These include :
- A lower risk of urinary tract infections (UTIs). A circumcised infant has about a 1 in 1,000 chance of developing a UTI in the first year of life. An uncircumcised infant has about a 1 in 100 chance during the first year of life.
- A lower risk of getting cancer of the penis. This cancer is extremely rare in both circumcised and uncircumcised males.
- A slightly lower risk of getting sexually transmitted diseases (STDs) including HIV.
- Prevention of foreskin infections
- Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible
- Easier genital hygiene
Reasons parents may choose not to circumcise:
- Possible risks. As with any surgery, circumcision has some risks. Complications from circumcision are rare and usually minor. They may include bleeding, infections, cutting the foreskin too short or too long, and improper healing.
- The belief that the foreskin is necessary to protect the tip of the penis. When removed, the tip of the penis may become irritated and cause the opening of the penis to become too small. Rarely this can cause urination problems that may need to be surgically corrected.
- There may be some decrease in sensation to the tip of the penis, causing a decrease in sexual pleasure later in life. There have not been any studies proving this either medically or psychologically.
- Almost all uncircumcised boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis and sexually transmitted diseases.
Instructions for care of the circumcised infant:
- Your child was given some form of local anesthesia prior to his circumcision to decrease his discomfort during the procedure. Once this anesthesia wears off, he may respond by being very fussy. To keep your child as comfortable as possible, you may give liquid Tylenol drops for infants (usually 0.4 ml – the smallest amount marked on the dropper) every 4 hours. After a day or so, he should no longer need the Tylenol.
- The child’s penis may get swollen and discolored from the circumcision. He may also experience some oozing from the site, but no frank bleeding. If there is bleeding, apply firm pressure to the area of the penis that is bleeding using a gauze pad for a FULL 5 MINUTES. You will need a watch to time this. After 5 minutes has passed, remove the gauze pad and throw it away. The bleeding should have stopped. If there is frank bleeding, call your doctor immediately.
- The penis may develop a yellow film in 1-2 days. This is a part of the normal healing process as long as there is no odor or excessive swelling of the penis. Call your doctor if this occurs. DO NOT remove this film; it will come off on its own.
- Your child may have a normal bath this evening. When cleaning your child during diaper changes, please avoid the baby wipes that contain alcohol; alcohol not only stings, but can also cause bleeding. With every diaper change, it is important to apply a liberal amount of Vaseline to the penis. This will keep the penis from sticking to the diaper. No bandage or dressing is needed. Continue to apply the Vaseline for 7 days.
- After circumcision, the penis may seem to retreat into the skin on the shaft of the penis. To make sure that this does not become a permanent problem gently retract the skin two or three times a day, beginning tomorrow. This can be done by grasping the penis with your thumb and index finger and gently pulling the skin towards the baby’s body. It is important that this be done, but be sure to be very gentile. Continue to do this for 7 days.
- Your doctor would like to see your child back after 7 days to make sure that the penis is healing like it is supposed to. There is no charge for this visit, as it is included in the price of today’s visit. At that time he or she will tell you if it is okay to stop applying the Vaseline and if you may stop retracting the skin on the penis.
- If you have any questions, please feel free to call the office at (602) 254-5561.
Care of the uncircumcised penis:
No special care is required for the uncircumcised penis. No attempt should be made to forceably retract the foreskin. Forcing the foreskin back may harm the penis, causing pain, bleeding and possibly scar tissue. There is no need for any special cleansing with Q tips, irrigation or antiseptics. The foreskin is very easy to care for. The infant should be bathed or sponged frequently and all parts should be washed including the genitals. Soap and water externally will suffice.
Separation of the foreskin and glans evolves over time. Each child is unique in the timing of this separation, although many foreskins will retract by the age of 5. Some boys do not attain retractability of the foreskin until adolescence. This is normal.
Once the foreskin has separated from the glans, occasional retraction with cleansing beneath is sufficient. At puberty the male should be taught the importance of retracting the foreskin and cleaning beneath during his daily shower.
Infant smegma consists of discarded skin cells which come from the normal separation of the foreskin and the glans. It may appear as white “pearls” under the skin.
Adult smegma consists of an oily substance make by Tyson’s Glands under the foreskin mixed with shed skin cells. Adult smegma serves a protective, lubricating function for the glans.
Glossary of Terms:
- Foreskin – The skin that covers the head of the penis in uncircumcised males
- Phimosis – Narrowness of the opening in the foreskin that prevents the foreskin from being pulled back to expose the head of the penis. Phimosis is present in most newborns and usually resolves spontaneously with normal development by age 3.
- Balanitis – Infection of the foreskin of the penis
- Gomco clamp – A clamp-like device commonly used to perform circumcisions