Newborn Circumcision

Definition

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

Circumcision

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Parts of the Body Involved

  • Penis

Reasons for Procedure

In the US, the procedure is mostly done for cultural and/or religious reasons. It is usually performed on babies within the first few days of life. It may be done on older boys or men if there is a medical reason.

Certain health benefits are thought to be associated with circumcision. Many health professionals believe these benefits are slim. Circumcision may be associated with 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)
  • Penile cancer
  • Certain sexually transmitted diseases

Risk Factors for Complications During the Procedure

  • Infants with bleeding disorders
  • Infants with a family history of 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 performed
  • An anesthetic cream may be applied to the penis 60 to 90 minutes before the procedure to begin numbing the area
  • An injected anesthetic is also sometimes used

During the 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

Research shows that the best method is a penile ring block.

Description of the Procedure

The baby is carefully restrained on an infant board or by a chosen individual. The anesthesia is injected. 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. Pressure is applied on blood vessels. The excess, unwanted foreskin is cut away. Rarely, 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 ways. Some use a simple scalpel to remove the foreskin. Others may use one of several devices to ensure an even circumcision and clamp blood vessels. These devices include the Gomco clamp, Plastibell device, or Mogen clamp. The Plastibell device is left in place instead of a bandage. It falls off on its own within 5 to 8 days. Petroleum jelly or antibiotic ointment is smeared generously on the penis and a bandage is sometimes applied.

After Procedure

No special medications are necessary after circumcision.

How Long Will It Take?

The procedure lasts 15 to 30 minutes.

Will It Hurt?

With appropriate anesthesia, the baby should feel only minimal pain.

Possible Complications

  • Infection
  • Bleeding
  • Anesthetic reactions
  • Unsatisfactory cosmetic outcome, due to removal of too little or too much foreskin, or uneven appearance
  • Meatitis and meatal stenosis (irritation or narrowing of the opening of the urethra)
  • Penile skin bridges
  • Decreased penile sensation
  • Loss of excessive penile skin
  • Buried penis
  • Need for further surgery

Average Hospital Stay

There is no hospital stay associated with circumcision.

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 significant 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 to 8 hours of the procedure
  • The head of the penis appears blue or black

RESOURCES:

Familydoctor.org—The Academy of Family Physicians
http://familydoctor.org/

Kids Health
http://kidshealth.org/

CANADIAN RESOURCES:

AboutKidsHealth
http://www.aboutkidshealth.ca/

Caring for Kids
http://www.caringforkids.cps.ca/

References:

American Academy of Family Physicians website. Available at: http://www.aafp.org/online/en/home.html. Accessed July 16, 2008.

American Academy of Pediatrics (AAP) Task Force on Circumcision. Circumcision policy statement. Pediatrics.1999;103:686-93.

Brady-Fryer B, Wiebe N, Lander JA. Pain relief for neonatal circumcision. The Cochrane Database of Systematic Review. 2004;3.

Lander J, Brady-Ryer B, Metcalfe JB, Nazarali S, Muttitt S. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision: a randomized controlled trial. JAMA. 1997 Dec 24-31;278(24):2157-62.

Sorrells ML, Snyder JL, Reiss MD, et al. Fine-touch pressure thresholds in the adult penis. BJU Int. 2007 Apr;99(4):864-9.



Last reviewed November 2007 by A. Carmack, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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