Circumcision
Congratulations on the birth of your baby boy! When you found out you were having a boy, you probably started thinking about the decision regarding circumcision. The decision to have or not have your son circumcised may be a difficult one. You will need to consider the pros and cons of circumcision. Your culture, religion, and personal preferences will also affect your decision.
What is a circumcision?
Boys are born with a covering across the head of the penis (the glans) called the foreskin. During circumcision, the foreskin of the penis is surgically removed, exposing the glans. Circumcision is usually performed in the first two to three weeks after the baby is born. W
Making a Circumcision Decision:
The American Academy of Pediatrics does not find sufficient evidence to medically recommend circumcision or argue against it. Despite the possible benefits and risks, circumcision is not essential or detrimental to your son’s health. Typically the decision for a circumcision is usually based on religious beliefs, concerns about hygiene, or other cultural or social reasons. Circumcision is a common procedure 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 decline in circumcision at 56% annually in the United States. Circumcision is less commonly performed in Asia, South America, Central America, and most of Europe.
Before making a decision, you should understand how the procedure is performed, what risks are involved, and what the benefits are.
How is a circumcision performed?
Hospital/Doctors Office: The procedure may take anywhere from about 5 to 20 minutes and will usually be performed in the hospital before you take your baby home. Your baby will be placed in a padded restraint chair and should be given some sort of anesthesia. Several different types of procedures may be done, so ask your care provider what type they will be using. These may include the Plastibell, the Gomco clamp or Mogen clamp which require the use of a scalpel. All entail separating the foreskin from the glans with the device and then either cutting away the foreskin or causing it to fall off.
Home/Jewish Facility performed by a Mohel-Often called a "bris" or "holistic circumcision", this procedure is done in about 15-30 seconds. The foreskin is separated from the glans, often using the Mogen clamp, and then one cut with a scalpel is used to remove the foreskin. The baby is held by the parents during the procedure and then the mom is encourage to nurse within the first minute after the procedure is finished. This type of circumcision is usually performed on or soon after the 8th day of life, which coincides with the time that the "clotting factors" in the babies blood are at their highest.
When should the procedure be performed?
Most doctors recommend a circumcision procedure be done within the first few days of life; however, others will recommend you wait two or three weeks. When birth happens in the hospital, it is usually done within 48 hours. If birth happened in a birth center or as a home birth, it may be done up to two weeks after the birth either in your pediatricians office or with a Jewish Mohel.
How is pain controlled during the procedure?
The American Academy of Pediatrics recommends the use of pain relief measures for the procedure. Some types of local anesthesia that are used to make the procedure less painful 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 says the benefits of circumcision are not significant enough to recommend circumcision as a routine procedure, and circumcision is not medically necessary. As always it is important to discuss the decision with your doctor.
Circumcision may potentially offer some of the following benefits:
- Prevention of urinary tract infections in infants
- Prevention of penile cancer in adult men
- May reduce the risk of sexually transmitted diseases
What are the risks of a circumcision?
The risks of circumcision can be minimal, but as with any surgical procedure, they should be evaluated carefully. Circumcision should always be performed by a skilled person, should only be done on a healthy infant and should be done using careful techniques to prevent infections. The rate of complications range from 0.1%-35%, most of these related to infection, bleeding and not removing enough of the foreskin.
Bleeding and infection can occur from irritation. Irritation can result from friction by the diapers and ammonia in the urine. Application of petroleum jelly can often relieve irritation.
Other more serious complications include:
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Meatitis (inflammation of the penis opening) and meatal stenosis (disorders related to urination). Some studies report the occurrence of these to be as high as 8-21% in circumcised males.
- 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. Those who oppose circumcision feel that removal of the foreskin allows for desensitization of the adult glans and reduced sensitivity during sexual intercourse.
After the circumcision procedure is done:
- Clean the area with gentle warm water a few times a day.
- Replace soiled gauze and apply lubricants as instructed by your care provider.
- Scabbing, light bleeding and some yellow discharge may occur. Do not rub the area aggressively to remove any of these.
- Use pain relief methods instructed by your care provider. This may 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
- If your son does not urinate normally within 6 to 8 hours after the circumcision.
- If 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 may want to delay the procedure or chose not to perform it at all. Examples of these instances include:
- If your baby is premature or medically unstable
- If your baby was born with physical abnormalities of the penis that need to be corrected surgically (because the foreskin may eventually be used as part of a reconstructive operation)
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
