Circumcision

Parenthood is filled with just as many questions as it is with decisions that need to be made. When it comes to having a son, one of the decisions parents make is whether the child will be circumcised. When considering circumcision before a child is born or later in life, it is important for caregivers to have all the facts to make a decision that best suits the child. The experts at the CHOC Children’s Urology Center have put together these informative documents below that provide information on the basics of circumcision and how to care for a child’s circumcised penis after the procedure.

We offer in-office newborn circumcisions and follow-up by pediatric fellowship trained urologists. We use local anesthesia for infants to minimize their discomfort during and after the procedure. Our office uses the plastic bell circumcision method. The procedure generally is done within 30 minutes and the child comfortably goes home. The plastic bell remains on the penis for a set amount of days.

Frequently Asked Questions About 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. According to the most recent data available through the Centers for Disease Control, approximately 57% of baby boys born in American hospitals are circumcised.
The American Academy of Pediatrics (AAP) issued a policy statement in 1999 on the use of circumcision. The policy statement was reaffirmed in 2005. 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 any 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.
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, it is 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.

If a circumcision is done after the newborn period, it is typically done at the hospital. At CHOC Children’s, circumcision after the newborn period is a day surgery in which the child comes to the hospital in the morning and leaves the same day. These circumcisions are done under general anesthesia. Due to the dramatic decline in anesthesia risks after 6 months of age, circumcisions are generally done when a child is at least this age if it is not done directly at birth.
Circumcisions performed by a qualified doctor 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. The baby's doctor will give you specific instructions on the care of the circumcision. It is important that you keep the area clean and follow the doctor’s specific instructions. Learn more about postoperative care after circumcision.
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 for an infant.

As the baby grows, the foreskin becomes looser and is able to be retracted (moved back). This may take many months to years. Your baby's doctor 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. If a child’s foreskin becomes stuck in the retracted position this condition is called paraphimosis and is considered a possible emergency and requires immediate care.

Postoperative Care for Circumcision

These instructions are general guidelines, and specific changes or instructions for each patient may differ. Please follow instructions given by the child’s surgeon and CHOC Children’s Urology Center staff.

A circumcision is a surgery done to remove the foreskin from the head of the penis. This information is intended for patients who will be undergoing a circumcision by one of the CHOC Children’s Urology Center specialists at our hospital. The procedure is considered an “outpatient” surgery, in which the child arrives in the morning and leaves the same day.

Before the Procedure

Please buy over-the-counter antibiotic ointment (i.e. Bacitracin, Neosporin, Polysporin) and ibuprofen, which can be generic or a name brand such as Advil or Motrin. The ibuprofen should be appropriate for your child’s age—infant, children or adult formula.

Pain Medicine

Some children may be sent home with Tylenol #3 to be taken as needed for pain. Most children need it for one to three days. If the doctor prescribed Tylenol #3 (with codeine) tablet or elixir, please try to give it to the patient as little as possible. Codeine causes constipation and can be very painful for the child. Should the child become constipated, we recommend using the over-the-counter stool softener, Miralax, for relief and to try using ibuprofen instead of the Tylenol #3. Do not take Tylenol #3 and regular Tylenol (also known as acetaminophen in its generic form) at the same time. Taking too much Tylenol (acetaminophen) can cause a harmful overdose. If needed, ibuprofen and ONE Tylenol product can be taken within the same time period.

Dressing Instructions

If the patient has a dressing or bandage, soak this off in the bathtub the day after surgery. Diaper the penis upwards against the abdomen, so it is pointing towards the belly button. Minor bleeding may occur, which is normal. Caregivers should expect to see clear or yellow oozing and scabbing, as well as bruising and/or swelling. If the bandage falls off on its own, simply start applying antibiotic ointment. The stitches used around the head of the penis will fall off on their own, usually in about 14 days.

Also, put crushed ice into a sandwich bag (Ziploc-style bags help prevent leakage) and place this in between the double diapers, or put over underwear to help reduce swelling and pain. Never apply ice directly to the skin.

Bathing Instructions

Start bathing the day after surgery and for one week after surgery. Bathe three to four times daily in plain water for 15 minutes and air dry. Apply over the counter antibiotic ointment at each diaper change, or four times each day for one week. At each diaper change, or four to six times each day, make sure the shaft (body) skin of the penis is not healing to the glans (head) of the penis. Gently pull the shaft skin down towards the body so that you can see the coronal groove all the way around the penis. It is normal for the skin to appear “attached” on the underside of the penis, this is called the “frenulum.” Apply the ointment in this groove to help keep the shaft skin from healing to the glans.

Diet

Start with clear liquids then progress to a regular diet as tolerated. The anesthesia can cause some stomach discomfort (nausea or vomiting) and a fever 24 to 48 hours after the procedure.

Activity Instructions

For two weeks after the procedure, the child should avoid trauma to the surgical area—no rough housing, contact sports, bicycle riding or physical education. Younger children should avoid walkers or straddle toys, such as bouncy chairs or rocking horses. At the child’s follow-up appointment about one week after the procedure, our staff will provide more specific directions as to when it is safe to return to activities. Patients can usually swim one week after surgery.