Circumcision (male)

Circumcision (male)


Definition

Circumcision is the surgical removal of the skin covering the tip of the penis. Circumcision is fairly common for newborn boys in certain parts of the world, including the United States — making it the most common surgical procedure in newborn males worldwide. Circumcision after the newborn period is a more complicated procedure that may require general anesthesia.

For some families, circumcision is a religious ritual. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care. For others, however, circumcision seems unnecessary or disfiguring. After circumcision, it isn't generally possible to re-create the appearance of an uncircumcised penis.
Why it's done

Circumcision is a religious or cultural ritual for many Jewish and Islamic families, as well as certain aboriginal tribes in Africa and Australia. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care. Sometimes there's a medical need for circumcision, such as when the foreskin is too tight to be retracted over the glans. In other cases, particularly in certain parts of Africa, circumcision is recommended for older boys or men to reduce the risk of certain sexually transmitted infections.

The American Academy of Pediatrics (AAP) policy statement on newborn circumcision says the benefits of circumcision aren't strong enough to recommend routine circumcision for all male newborns. The AAP leaves the circumcision decision up to parents — and supports use of anesthetics for infants who have the procedure.

Circumcision may have various health benefits, including:
Easier hygiene. Circumcision makes it easier to wash the penis — although washing beneath the foreskin of an uncircumcised penis isn't generally difficult.
Decreased risk of urinary tract infections. The overall risk of urinary tract infections in males is low, but these infections may be more common in uncircumcised males. Severe infections early in life can lead to kidney problems later on.
Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis may be difficult or impossible to retract (phimosis). This can also lead to inflammation of the foreskin or head of the penis.
Decreased risk of penile cancer. Although cancer of the penis is rare, it's less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.
Decreased risk of sexually transmitted infections. Safe sexual practices remain essential, but circumcised men may have a lower risk of certain sexually transmitted infections — including HIV, the virus that causes AIDS.

Circumcision may not be an option if certain blood-clotting disorders or penis abnormalities are present. In addition, circumcision may not be appropriate for premature babies who still require medical care in the hospital nursery.

Circumcision doesn't affect fertility, nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners.
Risks

Circumcision poses various risks, including:
Surgical pain
Side effects related to anesthesia, particularly if general anesthetics are used
Excessive bleeding
Infection

Foreskin problems are possible as well. For example:
The foreskin may be cut too short or too long
The foreskin may fail to heal properly
The remaining foreskin may reattach to the end of the penis, requiring minor surgical repair
How you prepare

Before circumcision, the doctor will explain the risks and benefits of the procedure. Whether you're planning to circumcise your son or you're pursuing circumcision for yourself, you'll likely need to provide written consent for the procedure.
What you can expect Penis before and after circumcision


During the procedure
Newborn circumcision is often done in the hospital nursery, usually within one to 10 days after birth.

For newborn circumcision, your son will lie on his back with his arms and legs restrained. After the penis and surrounding area are cleansed, an anesthetic will be injected into the base of the penis or applied to the penis as a cream. A special clamp or plastic ring will be attached to the penis, and the foreskin will be removed. Afterward, the penis will be covered with an ointment, such as petroleum jelly, and wrapped loosely with gauze. The procedure takes about five to 10 minutes.

The procedure is similar for older boys and adults, but it may need to be done under general anesthesia with additional steps to prevent excessive bleeding or suture the affected area.

After the procedure
It usually takes about seven to 10 days for the penis to heal. The tip of the penis is likely to be sore at first, and you may notice a yellowish mucus or crust. A small amount of bleeding also is common the first day or two.

If your newborn is fussy as the anesthetic wears off, hold him gently — being careful to avoid putting pressure on the penis. For older boys or adults, the doctor may recommend an over-the-counter pain reliever to help manage pain after the procedure.

It's OK to wash the penis as it heals. For newborns, change the bandage with each diaper change, and apply a dab of petroleum jelly to the tip of the penis to keep it from sticking to the diaper. Make sure the diaper is loosely fastened. If there's a plastic ring instead of a bandage, it will drop off on its own — usually within a week. Once the penis heals, wash it with soap and water during normal bathing.

Problems after circumcision are uncommon. Contact the doctor if:
Normal urination doesn't resume within 12 hours of the circumcision
There's persistent bleeding or redness around the tip of the penis
There's foul-smelling drainage from the tip of the penis or crusted sores fill with fluid
The plastic ring remains in place two weeks after the circumcision
References
MY01023
Feb. 27, 2010

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