The What, Why and How of Circumcision

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​What is circumcision?

Circumcision is a surgery to remove a fold of skin, called the foreskin, from the head (glans) of the penis. Boys are born with this fold of skin. In circumcision, the foreskin is removed, exposing the end of the penis.

How do I choose?

Circumcision is not necessary but it is also not harmful to a boy’s health. The American Academy of Pediatrics (AAP-the organization of children’s doctors) does not recommend for or against circumcision. As a parent, you need to choose what is right for your child.

For some families, the choice is simple because of their culture or religion. However, for others, the right option is not as clear. Before you make a decision about circumcision, you should talk to your child’s doctor and consider some of the issues.

About 1.2 million newborn boys are circumcised every year in the United States. Circumcision is much more common in the United States, Canada, and the Middle East than it is in Asia, South America, Central America, and most of Europe.

Although circumcision has some medical benefits, it also has some risks, just like any other surgical procedure. These risks are small, but you should know the possible pros and cons, and risks, before you make your decision.

What are possible pros and cons?
  • Circumcised infants are less likely to get a urinary tract infection (UTI) in the first year of life. About one out of every 1,000 circumcised boys has a UTI in the first year; about one out of every 100 uncircumcised boys has a UTI in the first year.
  • Circumcised men may be at lower risk for cancer of the penis. However, this cancer is rare in both circumcised and uncircumcised males.
  • Circumcision probably helps defend against sexually transmitted diseases (STDs), particularly HIV, which causes AIDS.
  • It is easier to keep a circumcised penis clean, although uncircumcised boys can learn how to clean beneath the foreskin once the foreskin becomes retractable (able to slip back over the head of the penis toward the abdomen). The foreskin becomes retractable usually before age 5. However, some uncircumcised boys do end up with infected foreskins as the result of poor hygiene.
  • Some say that circumcision either lessens or heightens the sensitivity of the tip of the penis, decreasing or increasing sexual pleasure later in life. However, neither of these has been proven.
What are potential risks or complications?

Complications of newborn circumcision are uncommon. They occur between one in 200 and one in 500 cases. The most frequent complications are minor bleeding and local infection. Your child’s doctor can easily treat both of these complications.

If you decide to have your child circumcised, it is best to perform the operation within the first two or three weeks of life. Circumcision is more complicated as a child gets older.

In some cases, the doctor may delay the procedure or decide not to do it at all, based on the unique needs of each baby. Premature or medically unstable babies are not circumcised until they are ready to leave the hospital.

What about pain?

Newborn babies DO feel pain. Although the circumcision can be painful, pain medications given to the area of the surgery can greatly reduce your baby’s discomfort. If you decide to circumcise your son, talk with your child’s doctor about pain management.

How is circumcision performed?

Your child is given medication to make him a little sleepy and a sugar-dipped pacifier to help reduce his level of stress (and yours). He will also be secured in a padded restraint device. Used together, these methods can decrease discomfort by more than 50 percent.

There are two different techniques used for circumcision. 

The Gomco technique uses a device that clamps the foreskin and holds it away from, and protects, the glans. This allows the doctor to safely remove the foreskin. The doctor then removes the device and covers the incision with an antibiotic ointment and some gauze coated with petroleum jelly.
If you choose this option, you should not immerse your child in the bath for 24 hours. After the procedure, your child’s penis may have a soft, yellow scab for a few days. This is normal. Do not remove it, but do wash gently. The doctor may also apply a bandage to the incision, which you may need to replace each time you change the baby’s diaper. In total, it usually takes been seven and 10 days for a penis to heal with after this procedure.

The other method available for circumcision is the Plastibell technique. For this procedure, the doctor applies a device that clamps the foreskin edge as it heals then slowly detaches it from the penis. Your child will go home with this plastic cap in place, with a string tied around it to secure it in place.
This string and bell will normally fall off in five to eight days. One section of the bell may become detached before the other section, but this is okay. If this occurs, gently place the bell back over the penis until it falls off completely.

Parents who elect to use the Plastibell technique can bathe their baby as usual and should notify their doctor if there are any signs of bleeding.
How do I keep my son’s penis clean?

Whether you choose circumcision or not, it is important to keep your son’s penis clean. Whether he is circumcised or not, wash his penis with soap and warm water when you bathe him. You do not need to use cotton swabs, astringents, or any special bath products.

With an uncircumcised boy, never forcibly pull back the foreskin to clean beneath it. Instead, gently tense the foreskin against the tip of the penis and wash off any smegma (the whitish “beads” of dead skin cells mixed with the body’s natural oil). Over time, the foreskin will retract on its own so it can be slipped back over the glans toward the abdomen. This happens at different times for different children, but most boys can retract their foreskins by the time they are five years old.

As your son grows up, teach him to wash beneath the foreskin by gently pulling it back from the glans, rinsing the glans and the inside of the foreskin with soap and warm water, then pulling the foreskin back over the head of the penis.

When should I call the doctor?

If your son was circumcised, watch for the following signs or symptoms that may need medical attention:
  • Persistent bleeding – a spot larger than a 50-cent piece or if the blood drips like a nose bleed, is not OK. (smaller blood spots in the diaper are OK)
  • Redness around the tip of the penis that gets worse after three days
  • Fever
  • Signs of infection such as the presence of pus-filled blisters
  • Not being able to urinate (pee) normally by six to eight hours after the circumcision
  • Skin edges that are separated more than 1/4 inch
If you notice any of these signs or symptoms, call your child’s doctor right away. Almost all circumcision-related problems are easily treated if taken care of right away.

Be sure to check with your doctor to address the unique needs of your child as you determine if circumcision is the right decision for you and your baby.