Circumcision

Circumcision is the surgical removal of the foreskin of the penis. It is often performed in healthy boys for cultural or religious reasons. In the U.S., circumcision of a newborn boy is usually done before he leaves the hospital. Observant Jews perform circumcision in a ceremony on the eighth day of life.

The merits of circumcision are currently under debate. There is no compelling medical rationale for the procedure in healthy boys. Some boys have medical conditions where circumcision may be needed.

Many physicians, rather than routinely recommending circumcision for healthy boys, allow the parents to make the decision after presenting them with the "pros" and "cons."

How Is It Done?

A numbing medication (local anesthesia) is recommended during the procedure. It might be injected at the base or in the shaft of the penis, or applied as a cream to reduce pain.

There are a variety of ways to perform a circumcision. Most commonly, the foreskin is pushed from the head of the penis and clamped with a metal or plastic ring-like device.

If the ring is metal, the foreskin is excised and the metal device removed. The circumcision heals in 5-7 days.

If the ring is plastic, a piece of suture is tied tightly around the foreskin. This pushes the tissue into a groove in the plastic over the head of the penis. Within 5-7 days, the plastic covering the penis falls free, leaving a completely healed circumcision.

Sometimes a sucrose (sugar) pacifier is given to infants during the procedure, and Tylenol (acetaminophen) may be given after the procedure for any pain or anxiety.

Circumcision of older and adolescent boys is usually done while the child is completely asleep and pain-free (using general anesthesia). The foreskin is removed and stitched onto the remaining skin of the penis. Stitches that will dissolve (absorbable sutures) are used and will be absorbed within 7 to 10 days.

Considerations

Some faiths, such as Judaism and Islam, commonly have ritual circumcisions performed. For some areas in the world it is uncommon, such as Europe, Asia, and South and Central America.

There are varied opinions among physicians regarding the need for circumcision in healthy boys. Some place great value on the benefits of an intact foreskin, including a more natural sexual response during adulthood. However, some studies suggest that uncircumcised male infants have an increased risk for getting urinary tract infections. Other studies show correlations between uncircumcised males and penile cancer, some sexually transmitted diseases including HIV, infections of the penis, and phimosis (tightness of the foreskin, not allowing it to retract over the glans penis).

However, the overall increased risk for these conditions is thought to be relatively small. Proper hygiene of the penis and safe sexual practices can help prevent phimosis, penile cancer, cervical cancer, AIDS, and other sexually transmitted diseases. Proper hygiene is always important, but is thought to be especially important for an uncircumcised male.

The American Academy of Pediatrics revised their policy statement on circumcision in March 1999, and this policy is supported by the American Medical Association. Their summary of the policy is the following:

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided."

What Are The Risks?

The risks include:

• Bleeding
• Infection
• Localized redness
• Injury to the penis

For both newborns and older children, circumcision is considered a very safe procedure. There are significant complications in about 1 in 500 procedures.

Recovery

Healing time for newborns usually takes about 1 week. Apply petroleum jelly after diaper changes to protect the healing incision. Some initial swelling and yellow crust formation around the incision is normal.

Healing time for older children and adolescents may take up to 3 weeks. In most instances, the child will be discharged from the hospital on the day of the surgery. Suggestions for home care for older children include:

• Avoid vigorous exercise during the healing time.
• If the wound bleeds during the first 24 hours after surgery, apply pressure with a clean cloth for 10 minutes.
• For older children, use ice packs (20 minutes on, 20 minutes off) for the first 24 hours after surgery to reduce swelling and pain. Bathing and showering are usually permitted. The incision may be gently washed with mild, unscented soap.
• Change the dressing at least once a day and apply an antibiotic ointment. If the dressing gets wet, change it promptly.
• Use prescribed pain medicine as directed. Pain medication should not be needed longer than 4 to 7 days (use only acetaminophen for infants, as needed).

Call your pediatrician or surgeon if:

• Fresh bleeding occurs
• The entire penis looks red and swollen
• Pus drains from around the incision
• Pain becomes severe or lasts for more than expected

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