Circumcision

Circumcision is the surgical removal of the foreskin, the skin that covers the tip of the penis.


General information
Although circumcision has been practiced in the Jewish and Muslim religions for thousands of years, it's only been popular in the United States since the 1900s. According to the American Academy of Pediatrics (AAP), the medical benefits of circumcision aren't significant enough to recommend circumcision. If you're considering the procedure, discuss the risks and benefits with your son's doctor.

Patient preparation
The penis and scrotum will be examined for infection or structural defects. Blood-clotting tests may be done if there's a family history of bleeding disorders.

Procedure
Although every surgery has its own standard procedure, your son's health history could play a role in any variation to the procedure. Discuss these issues with your son's doctor.
For healthy, stable babies, circumcision is often done during the hospital stay after delivery.

The AAP recommends the use of anesthesia during the procedure. Options may include a topical cream, a penile nerve block or a subcutaneous ring block.

There are different methods of circumcision, so be sure to ask your son's doctor or mohel (Jewish official who performs circumcisions) how the surgery will be done. To prevent movement during the procedure, your son may be placed in a molded plastic device. Another ring-shaped plastic device may be used to protect the head of the penis and minimize bleeding. Trimming the foreskin takes about five to 10 minutes. After the procedure, a sterile dressing or petroleum jelly may be applied to your son's penis. If the plastic ring is left in place, it typically falls off on its own within five to 10 days.


Postprocedure care
Check for bleeding often during the first few hours after the procedure, and then periodically over the next few days. The tip of your son's penis will be red and tender for a few days. Take off the sterile dressing 48 hours after the surgery and gently cleanse the area by dripping warm water over the penis at each diaper change. Apply petroleum jelly or an antibiotic ointment to the incision to prevent the affected skin from sticking to the diaper. If the plastic ring remains in place, follow any additional instructions from the doctor or mohel.
Complete healing may take about 10 days. Don't give your son a tub bath until his penis and umbilical cord have healed. Also avoid creams, lotions, powders or soaps in the area until it's completely healed.

Notify your son's doctor right away if:

your son doesn't urinate normally within six to eight hours after the circumcision
there are signs of infection, such as increased redness, swelling, foul-smelling discharge or fever (100.4°F rectally or 99°F under the armpit)
there's persistent or recurrent bleeding
your son appears to be in pain or ill while his penis is healing

Benefits
Circumcised babies have a lower risk of developing a urinary tract infection during the first year of life -- about one in 1,000, compared to one in 100 for uncircumcised babies.

Later in life, a circumcised man has a three times lower risk of developing penile cancer. The risk is relative, however -- in the United States, about 10 out of 1 million men develop penile cancer each year.

Some studies indicate circumcised men have a lower risk of developing sexually transmitted diseases (STDs), including HIV. However, the AAP has noted that risky behaviors appear to be far more important. Using a condom consistently and correctly significantly decreases the risk of STDs.

Circumcision eliminates the possibility of an infection under the foreskin and the inability to retract the foreskin. It also makes genital hygiene easier.

Risks
Risks are rare, but may include:
infection
scar tissue
decreased blood supply through the opening to the urethra (the tube through which urine and semen drain to the outside of the body)
urinary tract infection
bruising
bleeding
cutting the foreskin too short or too long

Considerations
Circumcision can be done at any time. Although it's most common for newborns, some parents prefer to have their sons decide for themselves when they're older. It's important to note that circumcision may require general anesthesia when done past infancy.
With proper daily hygiene, uncircumcised males rarely develop infections under the foreskin or the inability to retract the foreskin. As a child, an intact foreskin may help protect the penis from diaper rash. Some people believe an intact foreskin allows for greater sexual pleasure, but researchers haven't found this to be the case.