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Circumcision

What is circumcision?

Circumcision is the surgical removal of the foreskin, which is the skin covering the tip of the penis. It’s common in the United States and parts of Africa and the Middle East, but less common in Europe and some other countries, according to recent estimates.

The procedure is typically done on a newborn for personal or religious reasons. Circumcision in older children and adults may also be done for the same reasons. Additionally, older children or adults may need circumcision to treat several conditions, including:

  • balanoposthitis (inflammation of the tip and foreskin of the penis)
  • phimosis (inability to retract the foreskin)
  • paraphimosis (when the foreskin is retracted and can’t be returned to its original position)

In healthy newborns, there is no medical need for circumcision. However, families may choose to have their sons circumcised a number of reasons. One of the most common reasons is religious tradition. The religious laws of both Judaism and Islam require that newborn boys be circumcised. Other reasons to circumcise include:

  • personal choice
  • aesthetic preference
  • resulting lowered risk of some conditions
  • the desire of some fathers to have their sons look like them

In Judaism, the ritual circumcision is called a brit milah and is typically performed as part of a religious ceremony at home or in a synagogue by a mohel. A mohel receives religious and surgical training to perform ritual circumcision. The procedure is almost always done when the baby boy is 8 days old. However, it is also sometimes performed in the hospital.

In Islamic culture, the ritual circumcision is called khitan. In some parts of the Islamic world, the procedure is performed as part of a religious ceremony. In other parts, it’s done in a hospital setting. In most Islamic countries, the khitan is performed in infancy, but it may be done when the boy enters puberty.

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Pros and cons

Pros and cons of circumcision

There are health-related reasons to circumcise newborn males. Most of them aren’t factors until young adulthood, however. Circumcision is a decision best left to parents. Doctors can help parents better understand the benefits and risks.

Despite rumors to the contrary, circumcision has no effect on a man’s fertility, and there are mixed results of the few studies of how circumcision affects sexual pleasure. Some found no effect, while others found increased sensitivity.

Here are some of the pros and cons of male circumcision:

Pros of circumcision

  • decreases risk of urinary tract infections in infancy
  • decreases risk of penile cancer
  • decreases risk of sexually transmitted diseases, including female-to-male transmission of HIV
  • decreases risk of cervical cancer and some infections in female partners
  • prevents balanitis, phimosis, and paraphimosis
  • creates easier genital hygiene

Cons of circumcision

  • may be seen as disfigurement by some
  • may cause pain, although safe and effective medications are administered to reduce pain
  • has few immediate health benefits
  • may cause rare complications, including cutting the foreskin too long or too short, poor healing, bleeding, or infection
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Preparation

How to prepare for a circumcision

Circumcision is often done while newborns are still in the hospital. Different practitioners are trained to perform circumcision in newborns, including pediatricians and obstetricians. If you choose to have this procedure performed on your newborn, you’ll be asked to sign a consent form.

For older children and adults, the procedure is usually performed in a hospital or surgery center on an outpatient basis. This means that you would go home on the same day. Proper consent is also needed.

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Procedure

How a circumcision is performed

Circumcisions are usually done by a pediatrician, obstetrician, family medicine doctor, surgeon, or urologist. Circumcisions that are performed for religious reasons are sometimes done by others trained in the procedure.

During the newborn circumcision, your son will lay on his back with his arms and legs secured. An anesthetic is given via injection or cream to numb the penis. There are several techniques for performing circumcision. The choice of which technique is used depends on the physician's preference and experience. The three major methods of circumcision are the Gomco clamp, the Plastibell device, and the Mogen clamp. Each one works by cutting off circulation to the foreskin to prevent bleeding when the doctor cuts the foreskin.

The procedure takes about 15 to 30 minutes.

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Follow-up

Follow-up and recovery

After the procedure, your baby may be fussy. The doctor or nurse will provide instructions to decrease any discomfort. Healing time for a newborn’s circumcision is about 7 to 10 days.

It’s normal for the penis to be slightly red or bruised for a few days after the circumcision. You can wash the penis and change the dressings with each diaper change. Keep the diaper slightly loose to help the tip of the penis heal.

Call your child’s doctor if your child has any of the following:

  • continued fussiness (in babies)
  • increased pain (in children)
  • trouble with urination
  • fever
  • foul-smelling drainage
  • increased redness or swelling
  • persistent bleeding
  • a plastic ring that doesn’t fall off after two weeks

Recovery in adults

Your doctor will give you specific instructions on how to care for your incision and lessen your pain.

In general, you should return to work and daily activities when you feel comfortable. Avoid strenuous exercise, such as jogging or weight lifting, for the first four weeks of your recovery or until your doctor gives their approval. Walking is the best way to exercise during your recovery. Try to walk a little more than usual each day.

You should also typically avoid sexual activity for six weeks after the procedure. Follow the instructions from your doctor about sexual activity.

Call your doctor if you have any of the following:

  • increased pain
  • trouble urinating
  • bleeding
  • signs of infection, including fever, increased redness, swelling, or drainage 
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