Circumcision in newborn boys

Circumcision

Circumcision is an optional procedure to remove the foreskin covering the end of the penis. Parents choose whether or not to have their infants circumcised based on religious beliefs, health concerns, and/or ethical considerations. The operation is safest in infancy, and it’s usually done before a newborn leaves the hospital.

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What is circumcision?

Circumcision is a surgical procedure to remove the foreskin, a fold of skin covering the end of the penis.

The foreskin is a double-layered fold of skin and mucous membranes that protects the head (glans) of the penis from dryness and irritation that may be caused by contact with urine, feces, and clothing.

Why do some parents choose to circumcise their son?

Families may choose circumcision based on religious or cultural tradition, in response to concerns about health and hygiene, or simply because they want their son’s penis to look like his dad’s or other family members’.

Why do some parents choose not to circumcise their son?

Some parents don’t circumcise their son because they believe:

  • It’s unnatural
  • It inflicts unnecessary pain and harm on their newborn baby
  • The stated benefits of the procedure are not worth the risk of complications
  • It’s unethical to make this choice for their child

What do health experts advise?

The Pediatrics does not recommend circumcision as a routine procedure for every newborn boy.

From the Pediatrics: “Current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure’s benefits justify access to this procedure for families who choose it.”

The Centers for Disease Control (CDC) says: “Parents should be informed of the medical benefits – including reduced risk of future HIV infection – and the risks of male circumcision and should make decisions in consultation with a healthcare provider.”

The World Health Organization (WHO) recommends that male circumcision be considered for HIV prevention in countries with high HIV rates and low rates of male circumcision.

What are the health benefits of circumcision?

Circumcision may reduce the risk of urinary tract infections as well as cancer of the penis and some sexually transmitted infections. The AAP estimates that about 1 in 100 uncircumcised boys develops a urinary tract infection during his first year, while the risk is closer to 1 in 1,000 for circumcised boys.

Also, according to the CDC:

  • Circumcision may reduce the risk of cancer of the penis by as much as 30 percent. But this cancer is already rare, and the risk is further reduced for males who get the HPV vaccine (now recommended for boys at age 11 or 12).
  • Circumcision can reduce a man’s risk of acquiring HIV during sex with an infected female partner by 50 to 60 percent. However, circumcision has not been shown to reduce the risk of male-to-male or male-to-female HIV transmission, which are much more common ways to become infected.
  • Circumcised men are 30 to 45 percent less likely to get genital herpes than uncircumcised men.
  • Rates of certain sexually transmitted infections, such as bacterial vaginosis, trichomoniasis, and human papillomavirus (HPV), are lower in female partners of circumcised men.

How does circumcision help reduce certain health risks? Experts hypothesize that the inner surface of the foreskin and the protected skin of the penis underneath are susceptible to tears (especially during sex) – and such tears provide a way for germs to enter the bloodstream.

The foreskin can also create a moist environment that’s conducive to trapping and supporting the growth of bacteria and viruses.

What are the risks of circumcision?

Minor bleeding and swelling are the most common complications. Other less common problems include:

  • Adhesions, which can happen when residual foreskin sticks to the healing glans. This condition usually goes away on its own or with ointment.
  • A trapped penis, meaning the penis is encircled by a ring of scar tissue. If not treated, this condition can make it difficult to urinate and cause problems with hygiene and sexual function. A trapped penis is usually treated with steroid cream or surgery.
  • Infection, which is likely to be mild and treatable with antibiotics.

Severe complications are rare but can include:

  • Bleeding that doesn’t stop with local pressure. This may require stitches.
  • As with any surgery, there’s a small risk of sepsis, a dangerous blood infection.
  • Injury, such as the partial amputation of the head of the penis or the removal of too much skin. This might affect both the appearance and function of the penis.
  • Improper healing, which might lead to scarring or a shortening of the penis. This complication would cause an odd bend or shape of the penis or lead to discomfort when having an erection.

The rate of complications from circumcision procedures is less than 0.5 percent. The rate increases greatly (from 10- to 20-fold) for boys who are circumcised at a later age.

It’s also possible for too much foreskin to be left behind, and you may not be happy with how the penis looks after the procedure. In that case, you’d need to need wait until your baby is at least 6 months old to have an additional procedure done (under general anesthesia) to remove the remaining foreskin.

Are there disadvantages to being circumcised?

Some people believe that removing the foreskin reduces sexual pleasure. Because a circumcised penis doesn’t have a protective hood, over time the glans develops a toughened outer layer of skin, which some believe reduces sensation and sexual pleasure.

But according to both the CDC and WHO, men who undergo circumcision as adults generally report little or no change in sexual satisfaction or function. And a recent review of 36 studies concluded that circumcision has little or no negative affect on sexual function.

What kind of practitioner does circumcisions?

The AAP recommends using a trained and competent practitioner, using sterile techniques and effective pain management such as a cream or an injection. According to the, nonmedical comfort techniques like sucrose pacifiers and swaddling are not sufficient to prevent pain.

If your baby is circumcised as a newborn in the hospital, most likely the procedure will be done by a pediatrician or family physician. Obstetricians and nurse practitioners also sometimes perform circumcisions.

Circumcision may also be done as part of a ritual or ceremony, such as khitan in the Islamic community or brit milah (bris) in the Jewish community. In Jewish tradition, circumcision may be done by a mohel (someone trained in ritual Jewish circumcision; the mohel may also be a physician) at home or in a synagogue.

How is circumcision done?

First, the doctor is likely to use a local anesthetic to numb the area either by giving your baby an injection in the base of the penis, or by applying a cream about an hour before the procedure.

The doctor holds the foreskin in place with a specialized ring or a clamp and uses a surgical knife to cut off the foreskin. In some cases, excess skin will need to be trimmed afterward. The procedure itself takes between about 30 seconds and 10 minutes, depending on the method.

At what age can my baby be circumcised?

Infancy is usually the best time for elective circumcision because the foreskin is thinner. The procedure is often done before a baby leaves the hospital, but the timing may vary depending on religious or cultural beliefs.

For example, in Jewish tradition, circumcision is done when the baby is 8 days old. In some Islamic communities, circumcision is done in infancy, while in others it’s carried out when the child is older.

Rather than add the stress of the procedure to their other medical issues, premature babies are usually not circumcised until just prior to their discharge from the hospital.

Circumcision is sometimes done when a child is older because of medical problems – such as the foreskin not retracting properly, for example.

Is circumcision covered by health insurance?

Some insurance companies cover newborn circumcision, but check your plan to be sure. Circumcision is covered by Medicaid in most states.

The AAP says, “Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns.”

What happens after my baby is circumcised?

After your baby has been circumcised, he may have some pain and swelling. Check with his doctor to see if you can give your baby acetaminophen if he seems uncomfortable.

Some doctors recommend keeping a bandage or gauze on the penis until it’s healed, but others don’t. (You may need to change the dressing at each diaper change.) Sometimes a plastic ring is used instead of a bandage. This should drop off in five to eight days.

The most important thing is to keep your baby’s penis as clean as possible while it’s healing. Follow the instructions you were given for washing. Your baby’s doctor may also suggest that you put petroleum jelly on the area to reduce irritation. The wound should heal in seven to 10 days.

During that time, the penis should look less red and swollen each day. You may notice a little yellow discharge or crust around the wound during the first week – this is normal. But contact your baby’s healthcare provider immediately if:

  • You notice any bleeding, or redness or swelling spreading down the shaft of the penis.
  • The redness at the tip of the penis worsens after a few days.
  • Your baby doesn’t urinate within 8-12 hours after the circumcision.
  • Your baby develops a fever.
  • The yellow discharge lasts beyond a week.

Does a circumcised penis require special care after it heals?

Sometimes, after a circumcision, a little bit of foreskin remains attached at the base of the head of the penis. You might not be able to tell whether your baby has any leftover foreskin. But if leftover foreskin is present, it may adhere to the head of the penis.

To prevent this situation, your baby’s doctor might recommend doing the following each time you change your son’s diaper: Gently hold the head of the penis at its base and push the skin back. If there’s a fold of skin, clean underneath it with a wipe.

If leftover foreskin does adhere to the penis, the doctor may recommend waiting to see if it comes unstuck during a spontaneous erection or as your son grows. (You may be asked to apply a steroid cream.) If that doesn’t happen, the circumcision might have to be redone.

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