KidsMD Health Topics

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's most common in Jewish and Islamic faiths.

    In the United States, newborn circumcision is an elective procedure. The National Center for Health Statistics estimates that about 64 percent of newborn boys undergo circumcision. However, this number varies among socioeconomic, racial and ethnic groups.

    Should I have my baby circumcised?
    Whether or not you have your child circumcised is a deeply personal choice, and deciding if its right for your family will require consideration of many factors. But in addition to the personal, cultural and religious aspects associated with the decision, you may have medical questions as well.

    The following are answers to many of the most common questions Richard Yu, MD, PhD, of Boston Children's Hospital's Department of Urology hears when counseling families on this matter.

    What are the potential benefits of circumcision?
    If your baby is circumcised, the penis becomes very easy to clean for parents and ultimately for the child, which helps reduce the risk of infection from bacteria.

    Other potential benefits include:

    • near-elimination of the lifetime risk of penile cancer
    • nearly 100 percent reduction in the risk of urinary tract infections (UTI) during infancy
    • reduced incidence of balanitis and phimosis, both conditions affecting the foreskin of the penis

    Most researchers generally accept that circumcised men are less likely to acquire and transmit HIV and some sexually transmitted diseases. However, if your child is not circumcised, but he is able to fully pull back his foreskin around the time of toilet training and takes care to keep the entire penis clean with soap and water every day, he should also do well.

    How common a practice is circumcision?
    Circumcision is common. The Centers for Disease Control and Prevention recently reviewed the current trends of newborn circumcision in the US, and the national rate was almost 60 percent. According to the data, circumcision rates are highest in the Midwest and Northeast and lowest in the West.

    How old should my child be for circumcision?
    Circumcision can be done at any age. However, the safest time to do it is right after your baby is born, when he is about 2 days old. Because the process is painful, we use a cream to numb the area and perform the surgery while your baby is still awake.

    If the baby is older, we recommend that he be given some sort of anesthesia so there is less risk of injury to the penis. As babies get older, they become more aware of their sexual organs, so there is more psychological impact associated with the surgery, and some kids tend to perceive it as some sort of punishment.

    What are the risks associated with the procedure and how often do they occur?

    • The reported complication rate is low—2 to 3 percent—and most of those are minor issues, such as bleeding or infection.
    • The most common complication is that not enough foreskin is removed, leading parents to request a second circumcision procedure.
    • Serious or life-threatening problems such as damage to the penis or hemorrhaging are extremely rare.

    Are there any medical conditions that would make circumcision unsafe for my baby?
    If your baby has active issues with heart or lung function, or a bleeding disorder, circumcision may be unsafe and should be delayed. There are also congenital findings that may require more extensive repair. Circumcision should be delayed if the opening of the urethra is located on the bottom of the penis, the penis is notably curved, or the penis is relatively small. Always consult a pediatrician when weighing whether or not you wish to circumcise, or when establishing a timeline of when you wish to have the procedure done.

    How is circumcision performed?
    Most newborns are kept still by holding them or by placing them into a circumcision brace. The baby is comforted and may receive a local anesthetic (numbing medication) to reduce discomfort. The skin covering the head of the penis is removed with a protective device and then gauze with petroleum jelly or antibiotic ointment is applied. In older children and adults, the procedure is commonly performed under general anesthesia.

    Is it extremely painful for the child?
    Despite what many people may believe, this is not an extremely painful procedure. If local anesthesia is given, the child will feel pressure and movement but not pain. The child may be briefly upset while he is being held in place. If the circumcision is performed under general anesthesia, he will not experience any pain during the procedure. Once the procedure is completed the child will not have pain with urination since the urethra is left untouched during circumcision.

    What is the recovery process like and how long does it last?
    Newborns and infants recover very quickly from the procedure, usually within 12 to 24 hours. Young children recover in 1 to 2 days. Older children and young adults recover in 3 to 4 days. After circumcision, there may be temporary skin bruising or mild swelling that can last for 1 to 2 weeks.

    Is it only done on newborns?
    Circumcision can be performed at any age. Newborn circumcisions are normally performed while the child is awake. When the child is more than 3 months old, parents should consider having the procedure performed under general anesthesia.

    If you would like to speak with an expert in Boston Children's Department of Urology about circumcision, or any other urological concern, please visit our Urology department or call 617-355-7796.

  • Richard Yu MD PhDCaring for an uncircumcised infant

    By Richard Yu, MD, PhD

    Circumcision is the surgical removal of the skin covering the head of the penis. It has been performed for thousands of years, dating all the way back to Egyptian times, and continues to this day. Some families choose to have their child circumcised for personal, cultural or religious preferences, while others opt not to. Unfortunately, there is a lot of conflicting information available for parents about how to care for an uncircumcised child, and it's not always reputable. The following are the answers to some of the most common questions I hear when counseling families who have decided to forego circumcision.

    Is circumcision medically necessary?
    No. Some studies have linked circumcision to reduced rates of transmission of sexually transmitted diseases in Africa, but this doesn't appear to apply to North America. However, there is data that shows circumcised infants have a lower risk of urinary tract infections in the first year of life.

    How do I take care of an uncircumcised infant?

    Babies are born with a sheath of skin that covers the entire head of the penis. The inner part of the sheath is normally attached to the head of the penis, preventing foreskin retraction. Regular cleaning of the penis with warm water and soap is all that is needed. Forceful retraction of the foreskin to expose the entire head of the penis should not be done on an infant.

    There's a yellowish discharge coming from my baby’s penis. Is he OK?
    The discharge is called smegma; it's a waxy substance that is normally produced by tiny glands within the foreskin fold that covers the head of the penis. It is not pus and is not normally associated with significant swelling, redness, or pain. A soft washcloth with soap and water can be used to gently remove it. Sometimes the smegma can be seen behind a thin veil of foreskin. This is normal.

    When should I start to retract my son’s foreskin to clean the area?
    In some children, the foreskin will be retractable at around 2 years old. In others, the skin will remain attached to the head of the penis (called a penile adhesion). Begin by gently retracting the foreskin at about 2 years old and cleaning the head of the penis. For children with adhesions, gently stretch the adhesions and try to gradually separate the attached skin away from the head of the penis. In areas where skin has released from the head of the penis, cover the area with a light coating of petroleum jelly to prevent re-adhesion. Once he's old enough to do it on his own, your son will need to pull back his foreskin and clean the area in the fold on a daily basis, just like they need to clean any other skin fold everyday (e.g., armpits, groin fold, buttock crease.)

    What would happen if I just left my son’s foreskin alone?
    Some pediatricians recommend this, but keep in mind that uncircumcised foreskin is folded on itself, resulting in a space between the skin and the head of the penis. In this space, debris, smegma, bacteria and urine can accumulate over time. If you or your child does not clean this area routinely, this may make your child more prone to itching or infection. The chronic inflammation can make the foreskin even more difficult to retract in the future.

    If you would like to speak with an expert in Boston Children's Department of Urology about circumcision, or any other urological concern, please visit our Urology website or call 617-355-7796.

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