Circumcision

---

Definition | Body Parts Involved | Reasons for Procedure | Complications | What to Expect | Outcome | Call Doctor If

---

Definition

Removal of the foreskin, a flap of skin that covers the tip of the penis

Parts of the Body Involved

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. These include slightly 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)
• Sexually transmitted diseases
• Penile cancer
• Cervical cancer in female sexual partners

Some proponents of circumcision believe that the circumcised penis is easier to keep clean, while opponents of circumcision feel that proper hygiene techniques for cleaning the uncircumcised penis are simple to learn.

Risk Factors for Complications during the Procedure

• Infants with 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 done
• An anesthetic cream may be applied to the penis 60-90 minutes before the procedure to begin numbing the area

During 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 - Local

Description of the Procedure - The 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 (adhesions) and putting pressure on blood vessels in the area that would otherwise bleed. Then the excess, unwanted foreskin is cut away. Absorbable 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 5-8 days. If a Plastibell is not used, petroleum jelly or antibiotic ointment is smeared generously on the penis and a bandage is applied.

After Procedure - No special medications are necessary after circumcision

How Long Will It Take? 15-30 minutes

Will It Hurt? With appropriate anesthesia, the baby should feel only minimal pain.

Possible Complications:

• Infection
• Bleeding
• Unsatisfactory cosmetic outcome, due to removal of too little or too much foreskin, or uneven appearance

Average Hospital Stay - None

Postoperative Care:

• Change the bandage and clean the circumcised area at every diaper change
• Apply petroleum jelly or an antibiotic ointment to prevent the diaper or the bandage from sticking to the penis

Outcome

There may be slight 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 Occurs

• A bloodstain larger than the area of a quarter on the baby's diaper
• The Plastibell device has not fallen off within 10 days
• The penis or the area of the incision appears red, swollen, hot to the touch, or is oozing a yellowish discharge
• The baby develops a fever or appears to be in pain
• The baby does not have a wet diaper within about 6-8 hours of the procedure
• The head of the penis appears blue or black

SOURCE:

American Academy of Family Physicians

American Academy of Pediatrics

---

Last reviewed February 2001 by Medical Review Board