What is Circumcision?

Circumcision is the surgical removal of the foreskin, which is the skin covering the tip of the penis. It’s fairly common in the United States and parts of Africa and the Middle East, but less common in Europe and some other countries.

Some families have their sons circumcised for religious reasons, but circumcision can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, circumcision seems unnecessary or disfiguring. After circumcision, it isn’t generally possible to re-create the appearance of an uncircumcised penis.

Circumcision is usually performed on the first or second day after birth. The procedure becomes more complicated and riskier in older babies, children, and men.

Why is Circumcision done?

The procedure is a religious or cultural ritual for many Jewish and Islamic families, as well as certain aboriginal tribes in Africa and Australia. The use of circumcision for medical or health reasons is an issue that continues to be debated. The American Academy of Pediatrics (AAP) says the health benefits of circumcision outweigh the risks, but the benefits are not great enough to recommend universal newborn circumcision.

Circumcision might have various health benefits, including:

• A decreased risk of urinary tract infections.
• A reduced risk of some sexually transmitted diseases in men.
• Protection against penile cancer and a reduced risk of cervical cancer in female sex partners.
• Prevention of balanitis (inflammation of the glans) and balanoposthitis (inflammation of the glans and foreskin).
• Prevention of phimosis (the inability to retract the foreskin) and paraphimosis (the inability to return the foreskin to its original location).

What are the Risks?

The most common complications associated with circumcision are bleeding and infection. Side effects related to anesthesia are possible as well.

Some problems associated with circumcision are:

• Pain
• Risk of bleeding and infection
• Irritation of the glans
• The foreskin might be cut too short or too long
• The remaining foreskin might reattach to the end of the penis, requiring minor surgical repair

• Increased risk of meatitis (inflammation of the opening of the penis)

How is a Circumcision performed?

Circumcisions are usually done by a pediatrician, obstetrician, family medicine doctor, surgeon, or urologist. It is usually performed in a hospital nursery, usually within the first 10 days of the child’s birth. For older children and adults, the procedure is usually performed in a hospital or surgery center on an outpatient basis. In all of these cases, you will be asked to sign a consent form.

During the newborn circumcision, your son will lay on his back with his arms and legs secured. An anesthetic is given via injection or cream to numb the penis. There are several techniques for performing circumcision. The choice of which technique is used depends on the physician’s preference and experience. The three major methods of circumcision are the Gomco clamp, the Plastibell device, and the Mogen clamp. Each one works by cutting off circulation to the foreskin to prevent bleeding when the doctor cuts the foreskin.

The procedure takes about 15 to 30 minutes.

After the procedure

It usually takes about seven to 10 days for the penis to heal. The tip of the penis is likely to be sore at first, and the penis might look red, swollen or bruised. You might notice a yellow crust on the tip of the penis as well.

If your newborn is fussy as the anesthetic wears off, hold him gently — being careful to avoid putting pressure on the penis.

It’s OK to wash the penis as it heals. For newborns, change the bandage with each diaper change, and apply a dab of petroleum jelly to the tip of the penis to keep it from sticking to the diaper. Change your baby’s diaper often, and make sure the diaper is loosely fastened. If there’s a plastic ring instead of a bandage, it will drop off on its own — usually within about a week. Once the penis heals, wash it with soap and water during normal bathing.

Call your child’s doctor if your child has any of the following:

• Continued fussiness (in babies)
• Increased pain (in children)
• Trouble with urination
• Fever
• Foul-smelling drainage
• Increased redness or swelling
• Persistent bleeding
• A plastic ring that doesn’t fall off after two weeks

Recovery in adults

Your doctor will give you specific instructions on how to care for your incision and lessen your pain.

In general, you should return to work and daily activities when you feel comfortable. Avoid strenuous exercise, such as jogging or weight lifting, for the first four weeks of your recovery or until your doctor gives their approval. Walking is the best way to exercise during your recovery. Try to walk a little more than usual each day.

You should also typically avoid sexual activity for six weeks after the procedure. Follow the instructions from your doctor about sexual activity.

Call your doctor if you have any of the following:

• Increased pain
• Trouble urinating
• Bleeding
• Signs of infection, including fever, increased redness, swelling, or drainage