Circumcision is a surgical procedure to remove the skin covering the
end of the penis, called the foreskin. In many cultures, circumcision
is a religious rite or a ceremonial tradition. It is most common in
Jewish and Islamic faiths. In the United States, newborn circumcision is
an elective procedure. The National Center for Health Statistics
estimates that about 56 percent of newborn boys undergo circumcision.
However, this number varies among socioeconomic, racial, and ethnic
groups.
Current understanding of circumcision:
The American Academy of Pediatrics (AAP) issued a policy statement in
1999 on the use of circumcision. The policy statement was reaffirmed in
2005. The statement reported information from studies of both
circumcised and uncircumcised males and found the following:
- Problems with the penis such as irritation can occur with or without circumcision.
- There is no difference in hygiene, as long as proper care is followed.
- There may or may not be difference in sexual sensation or practices in adult men.
- There is an increased risk of urinary tract infection in
uncircumcised males, especially in babies younger than 1 year of age.
However, the risk for urinary tract infections in all boys is less than 1
percent.
- Newborn circumcision does provide some protection from cancer of the
penis. However, the overall risk of penis cancer is very low in
developed countries, such as the United States.
The report found scientific evidence that there are potential medical
benefits of newborn circumcision. However, the AAP did not find enough
information to recommend circumcision for all babies as a routine
procedure. The AAP recommends that parents should be given information
on the benefits and risks of newborn circumcision and that parents
should decide what is best for their baby.
How is circumcision performed?
Circumcision is usually performed by the obstetrician in the
hospital. When it is done for religious reasons, other persons may do
the surgery as part of a ceremony after the baby is discharged from the
hospital.
Circumcision is performed only on healthy babies. Because the
procedure is painful, the AAP recommends using some type of local
anesthesia for newborn circumcision. Several types of anesthesia are
available, including a numbing cream or injecting small amounts of
anesthetic around the penis. Although there are risks with any
anesthesia, these are generally considered very safe.
There are several ways to perform a circumcision. Some methods use a
temporary clamp device while others use a plastic bell that stays on the
penis for a certain length of time. Each method requires separating the
foreskin from the head of the penis, cutting a small slit in the
foreskin, and placing the clamp on the foreskin. The clamp is left in
place for a few minutes to stop the bleeding. The foreskin can then be
cut and removed.
How to provide care after a circumcision:
Circumcisions performed by a qualified physician rarely have
complications. Problems that occur are usually not serious. The most
common complications are bleeding and infection. Proper care after
circumcision helps reduce the chances of problems.
Your baby's physician will give you specific instructions on the care
of the circumcision. It is important that you keep the area clean.
After the procedure:
- There may be a gauze dressing with petroleum jelly or an antibiotic
cream. This may be removed at the first diaper change. Your baby's
physician may recommend applying a new dressing.
- The head of the penis may be very raw and red looking.
- There may be a small amount of blood at first or yellow-colored drainage later. These are part of normal healing.
- Your baby may have some discomfort with diaper changes the first few days.
- Keep the penis clean with soap and water.
- Circumcisions usually heal within one to two weeks.
Your baby may be fussy after circumcision. Cuddling him close and
breastfeeding can help comfort him. Most boys do not require special
care of the penis after the circumcision is healed.
How to provide care to the uncircumcised penis:
A newborn boy normally has foreskin tightly fitted over the head of
the penis. As long as the baby is able to pass urine through the
opening, this is not a problem. It is not necessary to clean inside the
foreskin, only the outside, as part of a normal bath.
As the baby grows, the foreskin becomes looser and is able to be
retracted (moved back). This may take many weeks or months. Do not
retract the foreskin on your baby boy. Your baby's physician will check
this as part of your baby's checkups and will show you how to retract
the foreskin. This allows cleansing of the area. As a boy grows, he
should be taught how to retract the foreskin and clean himself. The
foreskin should never be retracted forcibly. Do not allow the foreskin
to stay retracted for long periods as this may shut off the blood supply
causing pain and possible injury.
In some children, the foreskin cannot be retracted causing a
condition called phimosis. This condition may require circumcision later
in childhood.