Circumcision is the removal of the foreskin of the penis. The foreskin is a flap of skin that covers the tip of the penis.
Reasons for Procedure
In the US, the procedure is mostly done for cultural and/or religious reasons. It is usually done on babies within the first few days of life. It may be done on older boys or men if there is a medical reason.
Certain health benefits are thought to be associated with circumcision. Many health professionals believe these benefits are slim. Circumcision may be associated with decreased risks of:
- Urinary tract infection]]>
- Phimosis (tightening of the foreskin, which can be severe enough to close off the opening to the penis)
- Penile cancer
- Certain sexually transmitted diseases like HIV infection
Complications are rare, but no procedure is completely free of risk. If you are planning to have your son circumcised, your doctor will review a list of possible complications which may include:
- Reaction to drugs used for anesthesia
- Unsatisfactory cosmetic outcome
- Decreased penile sensation
- Damage to the tip of the penis
Factors that may increase the risk of complications include:
- Infants with bleeding disorders
- Infants with a family history of bleeding disorders
- Infants whose mothers were taking blood thinners during pregnancy
- Infants with penile deformities whose foreskin may be needed to repair the deformity
- Premature infants
- Infants with infections or serious jaundice at the time of the circumcision
What to Expect
Prior to Procedure
- The doctor will carefully examine the baby. This is to ensure that the baby is in good health and that the penis appears normal.
- Blood and/or urine tests may be done.
- Your baby may be given a pacifier dipped in sugar water to suck on. This has been associated with decreased pain.
- An anesthetic cream may be applied to the penis 60-90 minutes before the procedure. This will help to numb the area.
- Injected anesthetic may also be used.
Research shows that the best method of anesthesia is a nerve block. This is an injection of anesthetic into an area around the penis where the nerves run to the penis. This causes the penis to become numb.
Description of the Procedure
The baby will be carefully restrained on an infant board or by a chosen individual. The anesthesia will be injected.
The doctor will pull the foreskin away from the body of the penis. Any areas where tissue still adheres to the penis will be swept away. The excess, unwanted foreskin will then be cut away. Rarely, stitches may be used to sew the remaining bit of foreskin into place. Petroleum jelly or antibiotic ointment will be smeared on the penis. A bandage may be applied.
The foreskin can be removed a number of ways. Some use a simple scalpel to remove foreskin. Others may use one of several devices to ensure an even circumcision and clamp blood vessels. These devices include the Gomco clamp, Plastibell device, or Mogen clamp. The Plastibell device is left in place instead of a bandage. It falls off on its own within 5-8 days.
How Long Will It Take?
About 15–30 minutes
Will It Hurt?
With appropriate anesthesia, the baby should feel only minimal pain.
After the procedure, be sure to follow your doctor's instructions, which may include:
- Change the bandage, and clean the circumcised area at every diaper change.
- Apply petroleum jelly or an antibiotic ointment to prevent the diaper or bandage from sticking to the penis.
There may be significant swelling of the penis and/or a clear scab over the area of circumcision. The penis should be healing well within 7-10 days of the circumcision. If a Plastibell device was left in place, it should fall off on its own within 10 days.
Call Your Doctor
After arriving home, contact your doctor if any of the following occurs:
- You find a bloodstain larger than the size of a quarter on the baby's diaper
- The Plastibell device has not fallen off within 10 days
- The penis or the area of the incision appears red, swollen, hot to the touch, or is oozing a yellowish discharge
- The baby develops a fever or appears to be in pain
- The baby does not have a wet diaper within 6–8 hours of the procedure
- The head of the penis appears blue or black
Familydoctor.org—The Academy of Family Physicians
Caring for Kids
American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html. Accessed July 16, 2008.
American Academy of Pediatrics (AAP) Task Force on Circumcision. Circumcision policy statement. Pediatrics.1999;103:686-93.
Brady-Fryer B, Wiebe N, Lander JA. Pain relief for neonatal circumcision. The Cochrane Database of Systematic Review. 2004;3.
Lander J, Brady-Ryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial. JAMA. 1997 Dec 24-31;278(24):2157-62.
Leef KH. Evidence-based review of oral sucrose administration to decrease the pain response in newborn infants. Neonatal Network. 2006; 25(4):275-284.
Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007 Apr;99(4):864-9.
Last reviewed October 2009 by ]]>Kari Kassir, MD ]]>
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