Answers to Questions About Circumcision

What is a circumcision?

Circumcision takes off the loose stretchy skin that covers the head of the penis. The head of the penis is left uncovered.

An infant circumcision is a five minute procedure done under local anesthesia. Newborn is the simplest and safest time to do a circumcision. So, if you know you want your son circumcised, do it when he is a newborn. In a boy or a man, circumcision requires a surgeon, stitches and general anesthesia. Boys and men never forget the pain and discomfort.

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Should I have my son circumcised or not?

Should a baby boy be circumcised? Only the parents should decide this. Parents can and should ask the opinions of as many people as they can.

Wanting your son circumcised is enough reason to do it. Not wanting your son circumcised is enough reason not to do it. You don't have to justify your decision to anyone.

If you consider men the world over, the majority are not circumcised. Circumcision has been done for thousands of years, and is very common in some areas of the world. The US is one of the areas where it is common.

No Recommendation from the AAP

The American Academy of Pediatrics (AAP) assembles national experts about every ten years to re-examine the question of circumcision. In the thirty years that I have been involved, the AAP has never come out with a recommendation either for or against circumcision. There are some rare medical benefits, but none strong enough to recommend routine circumcision.

Hygiene

Will circumcision help with hygiene? Well, boys and soap and water don't mix very well. If an typical eight-year-old boy can go two weeks without a bath, he is in boy-heaven. So, yes, if there is no foreskin, the penis is less likely to collect dirt and junk around it that can start an infection.

However, teaching a toddler how to clean his penis isn't a big deal. I compare it to cleaning one's fingernails. If you never clean under your fingernails, yes, you are more likely to get infections ... foreskins are sort of like that. Cleaning under a boy's foreskin is something your pediatrician can talk with you about. Don't hesitate to ask.

There are rare situations when circumcision is physically contraindicated. Other than that, the only other time I won't do a circumcision is if the parents can't agree. Once it's done, it can't be undone.

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What are the risks of circumcision?

Circumcision is common, and complications are truly rare. Circumcision is a cut of the skin. As with of us, if we cut our skin, we could have bleeding or infection. Unlike getting a cut in the kitchen, a circumcision is planned, so the doctor uses antiseptic and sterile instruments. The penis has a very good blood supply, so it is resistant to infection.

Less than 1 time out of 100, there is trouble with bleeding. If bleeding occurs, it is controlled fairly easily within five minutes. You will be asked to stay for an hour or so after the circumcision to make sure there is no trouble with bleeding.

If you have any family history of bleeding disorders, especially hemophilia, you should talk to your hematologist (blood disease specialist) about the risks of circumcision before your baby is born.

lidocaine injection

Most doctors use lidocaine to numb up the baby's penis before starting the circumcision. Lidocaine is the same medicine a dentist uses before drilling on your teeth. If anyone in the family has a bad reaction to lidocaine, make sure the doctor knows this before the circumcision is done.

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How is a circumcision done?

First of all, the baby is numbed up. The doctor injects some lidocaine with a very small needle just under the surface of the skin around the penis. (Lidocaine is the medicine a dentist uses before they drill on your teeth. If you have ever had lidocaine at a dentist's office, you know how numb that is.)

Held for circumcision

The hard part for the baby is that his legs are held straight down for five minutes. Your baby wants to pull his legs up to his belly. So when he figures out he can't move his legs, he will probably start to cry. However, it really is only five minutes. In thirty years, no one has told me that they remember their circumcision as an infant.

If you agree, the nurse will give the baby a pacifier dipped in sterile sugar water. The sweetness distracts your baby and makes the procedure less stressful for him.

What the doctor does depends on what type of circumcision she is doing. There are three methods — Gompco, Mogen and Plastibell.

Circumcision Types

The difference in the methods is how they control bleeding before the foreskin is cut off with a sterile blade. With Gompco and Mogen methods, the instrument clamps down on the tissue of the foreskin before the incision. With the Plastibell method, a suture (sterile string) is tied to fit in a groove in a small plastic ring is left on the penis.

After the circumcision has healed completely, you can't tell which method was used to perform it.

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How do I care for my baby after circumcision?

The care depends on which of the three different methods of circumcision the doctor used.

Gompgo If your son had a Gompco or Mogen circumcision, the head of the penis is left uncovered. It will be dark red and raw looking for five to seven days. Since you can't really put a bandage on a penis, you cover it with lots of Vaseline each time you change the diaper. The Vaseline will be slippery and soft, so it will keep anything from sticking or rubbing. Be generous with the Vaseline. You really can't use too much of it.

Because of its tremendous blood supply, a penis heals up quickly. About 24 hours after the circumcision, there will be some swelling in a circle around the penis where the cut was. The head of the penis may have some yellowish streaks on it. These are where the foreskin was attached to the head of the penis. Each day, the swelling should look a little better so that, in a week or less, you won't need the Vaseline any more.

If your son has a Plastibell circumcision, a little plastic ring is left over the head of the penis after the circumcision is done. The ring is held on by a suture (sterile string). There is a little bit of skin outside of this suture that dries up like a scab. When the scab falls off, the plastic ring falls off and the head of the penis is left uncovered. You don't put anything over the plastic ring, just leave it open and dry.

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Thanks to Janelle Aby MD, Stanford School Of Medicine, Newborn Nursery, and Lucille Packard Children's Hospital for the use of occasional photographs.