Circumcision is the surgical removal of the foreskin of the penis.

Foreskin removal; Removal of foreskin

The health care provider will usually numb the penis with local anesthesia before the procedure starts. The numbing medicine may be injected at the base of the penis, in the shaft, or applied as a cream.

There are a variety of ways to perform a circumcision. Most commonly, the foreskin is pushed from the head of the penis and clamped with a metal or plastic ring-like device.

If the ring is metal, the foreskin is cut off and the metal device is removed. The wound heals in 5-7 days.

If the ring is plastic, a piece of suture is tied tightly around the foreskin. This pushes the tissue into a groove in the plastic over the head of the penis. Within 5-7 days, the plastic covering the penis falls free, leaving a completely healed circumcision.

The baby may be given a sweetened pacifier during the procedure. Tylenol (acetaminophen) may be given afterward.

In older and adolescent boys, circumcision is usually done under general anesthesia while the child is completely asleep. The foreskin is removed and stitched onto the remaining skin of the penis. Stitches that dissolve are used to close the wound. They will be absorbed by the body within 7 to 10 days. The wound may take up to 3 weeks to heal.

Ciurcumcision is often performed in healthy boys for cultural or religious reasons. In the United States, a newborn boy is usually circumcised before he leaves the hospital. Jewish boys, however, are circumcised when they are 8 days old.

In other parts of the world, including Europe, Asia, and South and Central America, circumcision is rare in the general population.

The merits of circumcision have been debated. Opinions about the need for circumcision in healthy boys vary among health care providers. Some believe there is great value to having an intact foreskin, such as allowing for a more natural sexual response during adulthood.

Rather than routinely recommending circumcision for healthy boys, many health care providers allow the parents to make the decision after presenting them with the pros and cons.

There is no compelling medical rationale for the procedure in healthy boys, although some boys have a medical condition requiring circumcision.

In 1999 the American Academy of Pediatrics revised their policy statement on circumcision, and this policy is supported by the American Medical Association. A summary of the policy is below:

"Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided."

Risks related to circumcision:

• Bleeding
• Infection
• Redness around the surgery site
• Injury to the penis

Some research has suggested that uncircumcised male infants have an increased risk of certain conditions, including:

• Cancer of the penis
• Certain sexually transmitted diseases including HIV
• Infections of the penis
• Phimosis (tightness of the foreskin that prevents it from retracting)
• Urinary tract infections

The overall increased risk for these conditions is thought to be relatively small.

Proper hygiene of the penis and safe sexual practices can help prevent many of these conditions. Proper hygiene is always important, but is thought to be especially important for uncircumcised males.

Healing time for newborns after circumcision usually is about 1 week. Place petroleum jelly (Vaseline) onto the area after changing the diaper. This helps protect the healing area. Some swelling and yellow crust formation around the site is normal.

For older children and adolescents, healing may take up to 3 weeks. In most cases, the child will be released from the hospital on the day of the surgery.

At home, older children should avoiding vigorous exercise while the wound heals. If bleeding occurs during the first 24 hours after surgery, use a a clean cloth to apply pressure to the wound for 10 minutes. Place an ice pack on the area (20 minutes on, 20 minutes off) for the first 24 hours after surgery. This helps reduce swelling and pain.

Bathing or showering is usually allowed. The surgical cut may be gently washed with mild, unscented soap.

Change the dressing at least once a day and apply an antibiotic ointment. If the dressing gets wet, change it promptly.

Use prescribed pain medicine as directed. Pain medicines should not be needed longer than 4 to 7 days. In infants, use only acetaminophen (Tylenol), if needed.

Call your pediatrician or surgeon if:

• New bleeding occurs
• Pus drains from the area of the surgical cut
• Pain becomes severe or lasts for longer than expected
• The entire penis looks red and swollen

Circumcision is considered a very safe procedure for both newborns and older children.

Circumcision policy statement. American Academy of Pediatrics. Task Force on Circumcision. Pediatrics. 1999 Mar;103(3):686-93.