A circumcision is a procedure that removes the foreskin surrounding the glans (head) of the penis.
It is normal for the foreskin to be attached to the head of the penis initially and then gradually separates as the child ages. The majority of children are able to retract the foreskin completely by age three. This is necessary during voiding as well as cleaning to maintain hygiene. Not all children require a circumcision. Many parents choose to circumcise their child in the newborn period, often before leaving the initial hospital stay.
Indications for Circumcision
Although a circumcision is not necessary for most boys, there are some benefits for boys to undergo a circumcision. Boys under the age of one are at an increased risk for urinary tract infections. Boys with other urologic issues, such as vesicoureteral reflux or urinary obstruction, are at higher risk for urinary tract infections including infections to the kidney that may have long-term implications on the health of the kidney.
Circumcision may also help prevent sexually transmitted infections (STIs) and invasive penile cancer later in life.
Possible risks associated with circumcision that may include scarring, bleeding, or infection are generally considered mild. According to the American Academy of Pediatrics, the benefits associated with having a baby circumcised outweigh any of the possible complication risks. The final decision should still be left to parents to make in the context of their cultural, religious, and ethical beliefs.
There are some conditions that may require a circumcision if medical management with the use of a topical steroid fails. These include:
- Inability to retract the foreskin (phimosis) with significant scarring of the foreskin.
- Ballooning or bulging of the foreskin during urination causing voiding dysfunction.
- Recurrent urinary tract infections or infections of the foreskin.
In-Office Circumcision (Neonatal Circumcision)
Many children circumcised in the newborn period are circumcised by pediatricians or obstetricians. Many parents are not aware that pediatric urologists also perform this and our office does offer in-office procedures to children up to approximately three months of age. Boys who are candidates for an office circumcision typically are determined by age, weight, and should have no other medical issues precluding them from having an office procedure, such as heart or lung issues. The pediatric urologist will examine the patient and determine if the child is amendable to an office circumcision. If any abnormalities of the penis are present, such as curvature, inadequate foreskin, or abnormal placement of the meatus, then a circumcision under a brief general anesthetic when the child is older may be recommended.
Local anesthetic is used to minimize discomfort during the procedure and two techniques are used by our fellowship-trained pediatric urologist: the gomco and plastic bell circumcision. The entire procedure takes approximately thirty minutes. If the plastic bell method is used, which three of our specialists use, the plastic bell will remain on the penis for a few days after the procedure. If the gomco technique is used (one specialist in our office), there will not be a plastic bell on the penis.
What Happens After Newborn/In-Office Circumcision?
- After circumcision is performed, your child’s doctor will make sure there is no bleeding and will give you specific instructions on how to take care of your child after their circumcision.
- Antibiotic ointment and gauze can sometimes be used, but your doctor will tell you specifically how to take care of your baby after his circumcision.
- Acetaminophen (Tylenol) may be recommended to help a child deal with pain that may occur after the circumcision, but generally it is not needed for any prolonged period of time.
When Should Circumcision Not Be Considered?
A pediatric urologist may recommend delaying circumcision if a baby has other medical conditions, such as heart or lung issues, that take precedence and require immediate attention, bleeding disorders, or congenital abnormality of the penis, including curvature, incomplete formation of the foreskin, or abnormal location of the urethral opening (meatus or “pee hole”).