Circumcision

Consider both the pros and cons of circumcision. When you learned that you were having a boy you probably started thinking about circumcision. The decision to have your son circumcised can be difficult and can involve a number of considerations, including your culture, religion, and personal preferences.

What is a circumcision?

Boys are born with a covering over the head of the penis called the glans. This covering is also called the foreskin. During circumcision, the foreskin is surgically removed, exposing the glans. Circumcision is usually performed in the first two to three weeks after the baby is born.

Making a Circumcision Decision:

The American Academy of Pediatrics has not found sufficient supporting evidence to medically recommend circumcision or argue against it.  Despite the possible benefits and risks, circumcision is neither essential nor detrimental to your son’s health. Typically the decision to circumcise is based on religious beliefs, concerns about hygiene, or various other cultural or social factors. Circumcision is common in the United States, Canada, and the Middle East.

According to the National Center for Health Statistics, the latest numbers released through 2006 show a declining rate in circumcision at a current 56% of annual male births in the United States. Circumcision is less common in Asia, South America, Central America, and most of Europe.

Before deciding one way or the other, it is helpful to understand how the procedure is performed, the risks, and the benefits.

How is a circumcision performed?

Hospital/Doctors Office: The procedure can take from 5 to 20 minutes and will usually be performed before leaving the hospital.  Your baby will be placed in a padded restraint chair and usually be given anesthesia. Since there are several different types of possible procedures, you should ask your care provider to explain the type they will be using.  Procedures include the Plastibell, the Gomco clamp or Mogen clamp which all require the use of a scalpel. These procedures first separate the foreskin from the glans with a device followed by surgery with the scalpel to remove the foreskin.

Home/Jewish Facility performed by a Mohel:Often called a “bris” or “holistic circumcision”, this procedure takes about 15-30 seconds. The foreskin is separated from the glans, often using the Mogen clamp, and then a single cut with a scalpel is used to remove the foreskin. The parents hold the baby during the procedure. Afterwards, the mother is encouraged  to nurse within the first minute following the procedure. This procedure is usually performed on or shortly after the 8th day from birth when clotting factors in the babies blood are at their highest levels.

When should the procedure be performed?

Most doctors recommend that circumcision be done within a few days from the delivery of the baby. Some doctors recommend waiting two or three weeks.  When the birth occurs in a hospital, circumcision is usually done within 48 hours. If the baby was born in a birth center or if it was a home birth, circumcision can wait up to two weeks and can be performed either in your pediatricians office or with a Jewish Mohel.

How is pain controlled during the procedure?

The American Academy of Pediatrics recommends using pain relief measures for the procedure. Types of local anesthesia for reducing pain include a topical cream, a nerve block via injection at the base of the penis, and a nerve block via injection under the skin around the penis shaft.

What are the benefits of a circumcision?

The American Academy of Pediatrics states that there are not enough benefits from circumcision to recommend it as a routine practice and that it is not medically necessary. As always, it is important to discuss the subject with your doctor.

Circumcision can provide the following benefits:

  • Prevention of urinary tract infections in infants
  • Prevention of penile cancer in adult men
  • A reduction in the risk of sexually transmitted diseases

What are the risks of a circumcision?

The risks of circumcision are minimal. However, as with any surgical procedure, there should be careful consideration of the risks. Circumcision should always be performed by a skilled professional and only on a healthy infant, using proven  techniques to prevent infections. The rate of complications ranges from 0.1%-35% with most complications involving  infection, bleeding, and the failure to remove enough foreskin.

Bleeding and infection can occur from irritation as a result of friction from the diapers and ammonia in the urine. An application of petroleum jelly can often provide relief from irritation.

More serious complications can include:

  • Meatitis (inflammation of the penis opening) and meatal stenosis (disorders related to urination). Some studies report the rate of occurrence of these complications to be as high as 8-21%.
  • Injury to the penis such as partial amputation, penis necrosis and urethral fistulas.

In rare cases, too much skin is removed from the penis, leading to painful erections in adulthood. Some opponents of circumcision believe that removal of the foreskin causes desensitization of the adult glans with reduced sensitivity during sexual intercourse.

After the circumcision procedure:

  • Clean the area gently with warm water several times a day.
  • Replace soiled gauze and apply lubricants as instructed by your care provider.
  • Scabbing, light bleeding and some yellow discharge can occur. If you notice any of these symptoms, avoid aggressive rubbing of the affected area.
  • Use pain relief methods as instructed by your care provider. These can include increased breastfeeding, use of infant pain medication or topical creams.

When should the doctor be called?

After your son’s circumcision, you will need to contact your doctor if you notice any of the following symptoms:

  • Persistent bleeding
  • 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 or greenish discharge
  • Inability to urinate normally within 6 to 8 hours after the circumcision.
  • The Plastibell device (a device that may be used during the procedure) does not fall off within 7-10 days.

When should a circumcision procedure not be performed?

Your doctor might want to delay the procedure or chose not to perform it at all if:

  • Your baby was born prematurely or is medically unstable
  • Your baby was born with physical abnormalities of the penis that require surgical correction. In some cases, the foreskin may be needed as part of a reconstructive operation)
Last Updated: 01/2014

Compiled using information from the following sources:

American Academy of Pediatrics, http://www.aap.org/

Holistic Circumcision, http://www.easycircumcision.com

American Academy of Family Physicians, http://www.aafp.org

Medscape Reference, http://www.emedicine.medscape.com

www.circinfo.net

MedicineNet.com