circumcision

overview

what is circumcision?

circumcision is a surgery to remove the foreskin, a fold of skin that covers and protects the rounded tip of the penis. the foreskin provides sensation and lubrication for the penis. after the foreskin is removed, it can't be put back on again.

if circumcision is done, it's usually done soon after birth. it's sometimes done in older children and adults to treat problems with the foreskin of the penis (such as phimosis or paraphimosis) or inflammation of the tip of the penis (balanitis).

how will you know if circumcision is right for your child?

it's up to you whether you have your baby circumcised or not. this decision is often based on personal and cultural preferences. for example, you may want to consider your religious and family traditions.

you can talk to your baby's doctor about the benefits and risks.

keep in mind that circumcision isn't just done in newborns. it can also be done later in life if your child chooses to have a circumcised penis.

why might a circumcision not be done?

your doctor may not do circumcision if your baby has a medical condition that makes problems from the surgery more likely. for example, surgery may not be done if your baby is sick or unstable, has a family history of bleeding problems, or was born early and isn't yet able to go home.

what are the risks of circumcision?

problems from circumcision aren't common. if they occur, they usually are minor. the most common problems are:

• bleeding.
• infection of the circumcision site.
• irritation of the exposed tip of the penis.
• blockage of the opening of the urethra (meatal stenosis).

more serious problems are rare. they include damage to the opening of the urethra, heavy bleeding that requires stitches, severe infection, and scarring.

who performs circumcisions?

circumcisions usually are done by a doctor such as a pediatrician or urologist. circumcisions performed for religious reasons are sometimes done by others trained in the procedure. for your baby's safety, be sure the person is well trained, uses sterile techniques, and knows how to manage your baby's pain during and after the surgery.

what happens during a circumcision

circumcision is usually done by a doctor at a clinic, in the hospital, or at an outpatient surgery centre. during the procedure:

• the baby is placed on a firm surface. velcro straps are wrapped around the baby's arms and legs to keep the baby very still.
• the penis is cleaned.
• the surgical area is often numbed with a local anesthetic while the baby stays awake. a baby who is age 1 month or older may need general anesthesia. talk with your doctor about the best way to control pain in your child.
• a sterile circumcision clamp or device is placed over the head of the penis.
• the foreskin is removed using a sterile scalpel or scissors.

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what to expect after surgery

after circumcision, your baby's penis may look red and swollen. it may have petroleum jelly and gauze on it. the gauze will likely come off when your baby urinates. follow your doctor's directions about whether to put clean gauze back on your baby's penis or to leave the gauze off. if you need to remove gauze from the penis, use warm water to soak the gauze and gently loosen it.

the doctor may have used a plastibell device to do the circumcision. if so, your baby will have a plastic ring around the head of the penis. the ring should fall off by itself in 10 to 12 days.

a thin, yellow film may form over the area the day after the procedure. this is part of the normal healing process. it should go away in a few days.

your baby may seem fussy while the area heals. it may hurt for your baby to urinate. this pain often gets better in 3 or 4 days. but it may last for up to 2 weeks.

even though your baby's penis will likely start to feel better after 3 or 4 days, it may look worse. the penis often starts to look like it's getting better after about 7 to 10 days.

when to call a doctor

your child's penis will be checked during routine checkups. but it's important to call your doctor if your baby has problems after circumcision.

call your doctor now if after circumcision:

• your baby has a fever.
• you see signs of infection of the penis or around the circumcision site. signs may include severe swelling and redness; a red streak on the shaft of the penis; or a thick, yellow discharge.
• your baby bleeds more than the doctor said to expect or has a bloodstained area larger than the size of a quarter on a diaper or on the circumcision site dressing.
• your baby is very fussy or cranky, has a high-pitched cry, or refuses to eat.
• your baby has not passed urine within 12 hours after the circumcision was completed.

if a plastic ring was used for the circumcision, call your doctor if the ring has not fallen off after 10 to 12 days.

why it may be done

circumcision may reduce the risk of certain infections. those who have a circumcised penis may be less likely to get:

urinary tract infections (utis).

in the first year of life, utis happen less often in babies who are circumcised. but utis aren't common.

sexually transmitted infections (stis).

some studies done in men have shown that those who are circumcised are a little less likely than those who are uncircumcised to get or spread an sti, including hiv.

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risks

all surgical procedures have risks, but problems from circumcision aren't common. if problems occur, they usually are minor and short-term. the most common ones are:

• oozing or slight bleeding from the surgical site.
• infection of the circumcision site or at the opening to the urethra.
• irritation of the exposed tip of the penis (glans) as a result of contact with stool or urine.

possible long-term problems include:

• blockage of the opening of the urethra (meatal stenosis).
• scarring of the penis. this may occur from infection or surgical error. for example:
  • the entire foreskin may not be removed, leaving portions of it attached to the penis (skin bridge). this may cause pain during erection.
  • scar tissue can grow outward toward the tip of the penis from the cut edge of the foreskin. repeat surgery on the penis may be required to improve appearance or to allow normal passage of urine if the opening from the bladder has been blocked by this scar tissue.
  • the outer skin layer (or layers) of the penis may be removed by mistake.
  • the opening may be too small for the foreskin to retract over the penis (phimosis). this can happen if too little foreskin is removed.

major problems are very rare but can include:

• the removal of more skin from the penis than the doctor intended.
• too much bleeding. stitches may be needed to stop the bleeding.
• serious, life-threatening bacterial infection.

caring for your child after circumcision

activity

• let your baby rest as much as possible. sleeping will help with recovery.
• you can give your baby a sponge bath the day after surgery. ask your doctor when it is okay to give your baby a bath.

medicines

• your doctor will tell you if and when your child can restart any medicines. the doctor will also give you instructions about your child taking any new medicines.
• your doctor may recommend giving your baby acetaminophen (tylenol) to help with pain after the procedure. be safe with medicines. give your child medicines exactly as prescribed. call your doctor or nurse advice line if you think your child is having a problem with a medicine.
• do not give your child two or more pain medicines at the same time unless the doctor told you to. many pain medicines have acetaminophen, which is tylenol. too much acetaminophen (tylenol) can be harmful.

circumcision care

• always wash your hands before and after touching the circumcision area.
• gently wash your baby's penis with plain, warm water after each diaper change, and pat it dry. do not use soap. don't use hydrogen peroxide or alcohol. they can slow healing.
• do not try to remove the film that forms on the penis. the film will go away on its own.
• put plenty of petroleum jelly (such as vaseline) on the circumcision area during each diaper change. this will prevent your baby's penis from sticking to the diaper while it heals.
• fasten your baby's diapers loosely so that there is less pressure on the penis while it heals.