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Circumcision

Why is circumcision done?
Circumcision is one of the oldest operations performed. Sometimes it is done because a specific problem with the foreskin (prepuce) exists, and other times it is done for family, cultural, or religious reasons. Although routine circumcision was once advocated for all newborn males, the current feeling is that it is not necessary for all baby boys. Most boys will do fine later in life if their foreskins are not removed. A few may eventually need circumcision because of narrowing at the tip (phimosis), infections (posthitis), or irritation. The foreskin may be a source for urinary tract infections, and circumcision may be a good idea in boys with any underlying kidney abnormality.

How do you care for the uncircumcised penis?
Care of the uncircumcised infant is easy. We do not recommend pulling back on the foreskin to expose the tip of the penis (glans penis).As the boy gets older, the natural processes of erections and accumulation of old skin remnants between the inner foreskin and glans cause the foreskin to eventually separate from the tip of the penis. By age 5-6 years the foreskin should pull back easily, but it is not until puberty that it is necessary for boys to pull the foreskin back daily to clean the penis.

When is circumcision recommended?
Circumcision may be indicated for certain medical reasons: vesicoureteral reflux, kidney or bladder infections, posthitis (inflammation of the foreskin), or true phimosis (narrowing of the foreskin). Parents for family, cultural, or religious reasons may request circumcision. Although circumcision is often done shortly after birth, the procedure may be delayed for certain reasons: the newborn infant may be too ill, in which case an elective circumcision when the infant is well can be arranged, the infant may have an abnormality of the penis such as hypospadias or chordee, in which case the foreskin should be left in place for use in later reconstructive surgery.

Where is circumcision done?
In very young babies circumcision can be performed in the clinic with local anesthesia and a clamp. In older infants and children general anesthesia is preferable.

How is the penis cared for after circumcision?
Vaseline is applied to the diaper with each change. Starting 24 hours after the circumcision, the skin should be pushed back each day to prevent adhesions.

Information for Parents
Circumcision is a surgical procedure in which the skin covering the end of the penis is removed. It is usually performed by a doctor in the first few days of life. An infant must be stable and healthy to safely be circumcised.

Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics (AAP) to recommend that all infant boys be circumcised. Parents may want their sons circumcised for religious, social and cultural reasons. Since circumcision is not essential to a child's health, parents should choose what is best for their child by looking at the benefits and risks. Many parents choose to have their sons circumcised because "all the other men in the family were circumcised" or because they do not want their sons to feel "different." Others feel that circumcision is unnecessary and choose not to have it done. Some groups, such as followers of the Jewish and Islamic faiths, practice circumcision for religious and cultural reasons. Since circumcision may be more risky if done later in life, parents may want to decide before or soon after their son is born if they want their son circumcised. As noted above, research studies suggest that there may be some medical benefits to circumcision. These include the following:

  • A lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.
  • A lower risk of getting cancer of the penis. However, this type of cancer is very rare in both circumcised and uncircumcised males.
  • A slightly lower risk of getting sexually transmitted diseases (STDs).
    Includes HIV, the AIDS virus.
  • Prevention of foreskin infections.
  • Prevention of phimosis.
    A condition in uncircumcised males that makes foreskin retraction impossible.
  • Easier genital hygiene.

Just as there are reasons parents may choose circumcision, they are reasons why parents may choose NOT to have their son circumcised:

  • Possible risks. Complications from circumcision are rare and usually minor. They may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.
  • The belief that the foreskin is necessary to protect the tip of the penis. When removed, the tip of the penis may become irritated and cause the opening of the penis to become too small. Rarely, this can cause urination problems that may need to be surgically corrected.
  • Some people believe that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life. This has not been proven by any medical or psychological study.

Almost all uncircumcised boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and sexually transmitted diseases.

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