Circumcision
What is circumcision?
Circumcision is a surgical procedure to remove the skin covering the end
of the penis, called the foreskin. In many cultures, circumcision is a
religious rite or a ceremonial tradition. It is most common in Jewish and
Islamic faiths. In the United States, newborn circumcision is an elective
procedure. The National Center for Health Statistics estimates that about
65 percent of newborn boys undergo circumcision. However, this number
varies among socioeconomic, racial, and ethnic groups.
Current understanding of circumcision:
The American Academy of Pediatrics (AAP) issued a policy statement in 1999
on the use of circumcision. The statement reported information from
studies of both circumcised and uncircumcised males and found the
following:
- Problems with the penis such as irritation can occur with or without
circumcision.
- There is no difference in hygiene, as long as proper care is
followed.
- There may or may not be difference in sexual sensation or practices
in adult men.
- There is an increased risk of urinary tract infection in
uncircumcised males, especially in babies younger than 1 year of age.
However, the risk for urinary tract infections in all boys is less than
1 percent.
- Newborn circumcision does provide some protection from cancer of the
penis. However, the overall risk of penis cancer is very low in
developed countries, such as the United States.
The report found scientific evidence that there are potential medical
benefits of newborn circumcision. However, the AAP did not find enough
information to recommend circumcision for all babies as a routine
procedure. The AAP recommends that parents should be given information on
the benefits and risks of newborn circumcision and that parents should
decide what is best for their baby.
How is circumcision performed?
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, these are generally
considered very safe.
There are several ways to perform a circumcision. Some methods use a
temporary clamp device while others use a plastic bell that stays on the
penis for a certain length of time. Each method requires 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.
How to provide care after a circumcision:
Circumcisions performed by a qualified physician 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 physician 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
physician 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.
How to provide care to the uncircumcised penis:
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 become looser and is able to be
retracted (moved back). This may take many months to years. Your baby's
physician 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.
In some children, the foreskin cannot be retracted causing a condition
called phimosis. This condition may require circumcision later in
childhood.
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