Circumcision

Circumcision is a surgical removal of skin that covers the tip of the penis. It is a fairly common surgery in newborn boys in some parts of the world for cultural reasons.

Foreskin development

The sheath of skin at the tip of the penis is called the foreskin. For the first few years of life, a baby boy's foreskin does not retract or pull back - this is normal. At around age 3, it starts to separate naturally from the glans (the head of the penis). It fully separates in most boys by age 5, but failure to do so until a later age does not necessarily mean there is a problem.

When the foreskin starts to separate, it can balloon out when the boy passes urine. This can sometimes lead to balanitis (infection), but the ballooning usually settles with time. Parents should not try to separate the foreskin manually as this can be painful for their son and they could damage the skin.

Is circumcision of the tip of the penis good or bad?

According to the American Academy of Pediatrics AAP, the benefits of circumcision outweigh the risks. However, it is not something the academy recommends to all parents. The AAP leaves the circumcision decision, i.e., whether or not to get their son circumcised, up to parents. Parents should carefully consider the benefits and risks. In infants who do undergo circumcision, the American Academy of Pediatrics recommends use of anesthesia. There are similar recommendations from the NHS in the UK.

Why do boys get circumcised?

In some cultures, such as Jews, Muslims, and some aboriginal tribes in Australia and Africa, circumcision is considered a religious or cultural ritual or family tradition. Some people weigh the benefits and risks of circumcision and decide to have their baby boys undergo the procedure for reasons of hygiene and medical benefits. However, others consider it disfiguring or unnecessary.

In some cases, circumcision is medically necessary, for example, when the foreskin on the tip of the penis is tight and retracted (pulled back). In some parts of Africa and other places, older boys and men undergo circumcision to reduce the risk of sexually transmitted infections.

Medical reasons for circumcision

Circumcision is rarely performed for medical reasons because less risky treatments are usually available. However, circumcision may be required for the following medical conditions:

• Phimosis is a condition in which the foreskin is too tight to be pulled back over the head of the penis. It can cause pain in an erect penis or problems passing urine.
• Paraphimosis is the inability to return the foreskin to its original position after pulling it back. The penis can become swollen and painful. The condition requires immediate treatment to prevent serious complications due to restricted blood flow to the penis.
• Balanitis is an inflammation and infection of the penis. Circumcision may be recommended for recurrent balanitis.
• Balanitis xerotica obliterans is a condition in which there is a tight foreskin, inflammation, and scarring.

Circumcision is not recommended in patients with a condition called hypospadias, where the urinary outlet is on the shaft instead of the tip of the penis.

What to expect with circumcision?

Preparation

Circumcision is usually performed as a day procedure and does not require an overnight stay in the hospital. The patient should not eat or drink anything for several hours before the procedure. Circumcision is done under general anesthesia, so the patient is asleep and does not feel any discomfort or pain.

Circumcision procedure

A routine circumcision procedure is relatively simple. The surgeon removes the foreskin just behind the top of the penis with surgical scissors or a scalpel. If any bleeding occurs, it is controlled with cautery. The edges are stitched using dissolvable stitches. A dressing is put on the wound to protect it. The dressing usually falls off by itself in 24 hours. The patient is usually allowed to go home after he has passed urine for the first time after the procedure, which can be a little uncomfortable.

Aftercare and recovery

The doctor will prescribe an ointment for the penis which can be inflamed for a few days. Pain medicines (paracetamol or ibuprofen) are needed for around 3 days for pain relief. Bathing is permitted the day after the procedure. You can dab some petroleum jelly at the end of the penis to reduce discomfort.

The doctor will give other instructions and information for the recovery period. For example, riding a bicycle or sitting on toys should be avoided until the swelling subsides. For the first few days, it is easier to wear loose clothing or leave the penis bare for an infant boy. Passing urine in the bath or shower can be less uncomfortable. An older boy can return to school about a week or 10 days after the operation. It can take up to 6 weeks for the penis to fully heal.

What is a good age to get circumcised?

Experts recommend that it is better to perform circumcision in babies who are less than a year old, meaning, within the first year of life. If parents want to get their son circumcised, newborn circumcision is recommended because babies seem to tolerate this surgical procedure better than older males.

Can a grown man be circumcised?

Adult circumcision is not as common but it can be performed later in life. It is a simple surgical procedure. However, it is a larger operation than circumcision in a baby boy. People choose to have circumcision done as adults for various reasons - social, religious, or medical.

Medical benefits of circumcision

According to the American Academy of Pediatrics AAP and the American Urological Association in the United States and the NHS in the United Kingdom, male circumcision can have several health benefits, including:

Better hygiene

A circumcised penis is easier to clean. Males with an uncircumcised penis must practice good hygiene and clean regularly under the foreskin with soap and water.

Lower risk of urinary tract infections

Men have a low risk of urinary tract infections, and the risk is even lower in men with circumcised penises.

Lower risk of sexually transmitted infections

Circumcision reduces the risk of some sexually transmitted diseases, including HIV and human papilloma virus HPV. However, getting circumcised does not mean that safe sexual practices are not essential.

Prevention of penile problems

Uncircumcised males can occasionally develop problems with the foreskin such as phimosis or balanitis. These problems can be prevented by circumcision.

Lower risk of penile cancer

Cancer of the penis is rare. Circumcision can reduce the risk further. Cervical cancer is less common in female sexual partners of men who have been circumcised.

Risks of circumcision

The most common risk associated with circumcision is bleeding, both during and after the procedure. Circumcision is therefore not recommended in families with a history of blood clotting disorders. The surgeon will cauterize any bleeding at the time of the operation. Any remaining bleeding is absorbed by the dressing. Petroleum jelly can help reduce discomfort. Parents should be vigilant for continued bleeding and should seek medical advice or see the family doctor right away if this occurs. Other potential complications of circumcision include pain, infection, and scarring.

Finding a provider for circumcision

The MeTime app makes it easy to find surgeons and and other healthcare providers in your area. You can click and upload pictures and have suggestions sent directly to you. Want to find a provider who performs circumcisions near you? Try the MeTime app now!