Pediatric Circumcision

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. Circumcision is usually performed by a doctor in the first few days of life. An infant must be stable and healthy to safely be circumcised.

Because circumcision may be riskier if done later in life, parents should decide before or soon after their son is born if they want it done.

Medical benefits:

• A markedly lower risk of acquiring HIV, the virus that causes AIDS.  
• A significantly lower risk of acquiring a number of other sexually transmitted infections (STIs), including genital herpes (HSV), human papilloma virus (HPV) and syphilis.
• A slightly 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 all males.
  
• Prevention of foreskin infections.
• Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible.
• Easier genital hygiene.

Social reasons:

• Many parents choose to have it done because "all the other men in the family" had it done or because they do not want their sons to feel "different."

Religious or cultural reasons:

• Some groups, such as followers of the Jewish and Islamic faiths, practice circumcision for religious and cultural reasons.

Reasons Parents May Choose Not to Circumcise

The following are reasons why parents may choose NOT to have their son circumcised:

• Fear of the risks. Complications are rare and usually minor but may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.
• Belief that the foreskin is needed. Some people feel the foreskin is needed to protect the tip of the penis. Without it, the tip of the penis may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be surgically corrected.
• Belief it can affect sex. Some feel that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life.
• Belief that proper hygiene can lower health risks. Boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis and STIs.

What If I Choose Not to Have My Son Circumcised?

If you choose not to have your son circumcised, talk with your pediatrician about how to keep your son's penis clean. Keep in mind that the foreskin will not fully retract for several years and should never be forced. When your son is old enough, he can learn how to keep his penis clean just as he will learn to keep other parts of his body clean

A newborn boy normally has foreskin tightly fitted over the head of the penis. As long as the baby is able to pass urine through the opening, this is not a problem. It is not necessary to clean inside the foreskin, only the outside, as part of a normal bath.

As the baby grows, the foreskin becomes looser and is able to be retracted (moved back). This may take many months to years. Your baby's doctor will check this as part of your baby's checkups and will show you how to retract the foreskin. This allows cleansing of the area. As a boy grows, he should be taught how to retract the foreskin and clean himself. The foreskin should never be retracted forcibly. Do not allow the foreskin to stay retracted for long periods as this may shut off the blood supply causing pain and possible injury. Sometimes the foreskin becomes stuck in the retracted position and cannot be pulled back down. This is called paraphimosis and is a medical emergency.

In some children, the foreskin cannot be retracted because of a restricted opening, causing a condition called phimosis. This condition may require circumcision later in childhood if it doesn't respond to medical treatment.

Circumcision is usually performed by the obstetrician in the hospital. When it is done for religious reasons, other persons may do the surgery as part of a ceremony after the baby is discharged from the hospital.

Circumcision is performed only on healthy babies. Because the procedure is painful, the AAP recommends using some type of local anesthesia for newborn circumcision. Several types of anesthesia are available, including a numbing cream or injecting small amounts of anesthetic around the penis. Although there are risks with any anesthesia, local anesthesia is considered very safe.

At Children’s National, we use the Gomco clamp method of circumcision. We begin by separating the foreskin from the head of the penis, cutting a small slit in the foreskin, and placing the clamp on the foreskin. The clamp is left in place for a few minutes to stop the bleeding. The foreskin can then be cut and removed.

Circumcisions performed by a qualified doctor rarely have complications. Problems that occur are usually not serious. The most common complications are bleeding and infection. Proper care after circumcision helps reduce the chances of problems.

Your baby's doctor will give you specific instructions on the care of the circumcision. It is important that you keep the area clean. After the procedure:

• There may be a gauze dressing with petroleum jelly or an antibiotic cream. This may be removed at the first diaper change. Your baby's doctor may recommend applying a new dressing.
• The head of the penis may be very raw and red looking.
• There may be a small amount of blood at first or yellow-colored drainage later. These are part of normal healing.
• Your baby may have some discomfort with diaper changes the first few days.
• Keep the penis clean with soap and water.
• Circumcisions usually heal within one to two weeks.

Your baby may be fussy after circumcision. Cuddling him close and breastfeeding can help comfort him. Most boys do not require special care of the penis after the circumcision is healed.