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Definition
Removal of the foreskin, a flap of skin that covers the tip of the penis.
Circumcision
2008 Nucleus Medical Art, Inc.
Parts of the Body Involved
A circumcision involves only the penis.
Reasons for Procedure
In the United States, circumcision is mostly done for cultural and/or religious reasons. It is usually performed on babies within the first few days of life, although circumcision may be done on older boys or men if there is a medical reason.
Certain health benefits are thought to be associated with circumcision, but many health professionals believe these benefits are negligible. Circumcision may be associated with decreased risks of:
- Urinary tract infection
- Foreskin 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
Risk Factors for Complications During the Procedure
- 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 to make sure he is in good health and that the penis appears normal.
- Blood and/or urine tests may be performed.
- An anesthetic cream may be applied to the penis 60 to 90 minutes before the procedure to begin numbing the area. An injected anesthetic is also sometimes used.
During the Procedure
- No medications or IV fluids are necessary during circumcision
- A pacifier that has been dipped in a sugar solution may help keep the baby calm during the procedure
Anesthesia
Research shows that the best anesthesia prior to circumcision is a penile ring block.
Description of the ProcedureThe baby is carefully restrained on an infant board or by a chosen individual, if the procedure is done as part of a religious ritual. The anesthesia is injected and the penis is cleaned with an antiseptic solution.The doctor pulls the foreskin away from the body of the penis while sweeping away any areas where tissue still adheres to the penis and putting pressure on blood vessels in the area that would otherwise bleed. Then the excess, unwanted foreskin is cut away. When circumcision is performed on adults or children other than infants, stitches may be used to sew the remaining bit of foreskin into place on the skin of the penis.The foreskin can be removed by a number of different procedures. Some doctors use a simple scalpel to remove the foreskin, while others may use one of several devices designed to simultaneously ensure an even circumcision and clamp blood vessels in the area to prevent bleeding. These devices include the Gomco clamp, Plastibell device, or Mogen clamp. The Plastibell device is left in place instead of a bandage and falls off on its own within 5 to 8 days. Petroleum jelly or antibiotic ointment is smeared generously on the penis and a bandage is sometimes applied. After ProcedureNo special medications are necessary after circumcision.
How Long Will It Take?The procedure lasts 15 to 30 minutes. Will It Hurt?With appropriate anesthesia, the baby should feel only minimal pain. Possible ComplicationsInfectionBleedingAnesthetic reactionsUnsatisfactory cosmetic outcome, due to removal of too little or too much foreskin, or uneven appearanceMeatitis and meatal stenosis (irritation or narrowing of the opening of the urethra)Penile skin bridgesDecreased penile sensationLoss of excessive penile skinBuried penisNeed for further surgery Average Hospital StayThere is no hospital stay associated with circumcision. Postoperative CareChange the bandage and clean the circumcised area at every diaper changeApply petroleum jelly or an antibiotic ointment to prevent the diaper or the bandage from sticking to the penis OutcomeThere 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 If Any of the Following OccursA bloodstain larger than the area of a quarter on the baby's diaperThe Plastibell device has not fallen off within 10 daysThe penis or the area of the incision appears red, swollen, hot to the touch, or is oozing a yellowish dischargeThe baby develops a fever or appears to be in painThe baby does not have a wet diaper within about 6 to 8 hours of the procedureThe head of the penis appears blue or black RESOURCES:
The Circumcision Resource Centerhttp://www.circumcision.org Circumcision Information and Resource Pagehttp://www.cirp.org/ CANADIAN RESOURCES: Circumcision Information Resource Centrehttp://www.infocirc.org/welcome.htm The Child, Youth and Family Health Networkhttp://www.reseaudesanteenfant.ca/page.asp?intNodeID=15386 References: American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html . 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. 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 November 2007 by A. Carmack, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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