What is circumcision?
Circumcision is an elective surgery, meaning it is not essential. It removes the foreskin—the hood of skin covering the tip of the penis. It is safest when doctors perform it in the first 10 days of life. Ideally, parents should decide about the procedure within this timeframe. Undergoing circumcision later increases the risk of potential complications.
Why is circumcision performed?
Up to 65% of newborn boys are circumcised in the United States. Many parents choose circumcision for religious, social or cultural reasons. If other men in a family have been circumcised, parents may opt for circumcision so their sons look the same. However, there are also valid medical reasons for the circumcision procedure. This includes a decreased risk of the following:
- Irritation, inflammation, and local infection due to poor foreskin hygiene
- Penile cancer
- Phimosis, which occurs when the foreskin become impossible to retract, leading to inflammation
- STDs (sexually transmitted diseases), including genital herpes, HPV (human papillomavirus), and HIV (human immunodeficiency virus)
- UTIs (urinary tract infections). Males in general have a lower risk of UTIs compared to females. However, UTIs are 10 times more common in uncircumcised males during the first year of life.
The American Academy of Pediatrics (AAP) states that these benefits outweigh the potential risks of circumcision surgery. However, current evidence does not support routine circumcision of all newborn boys. Both the AAP and the American Urological Association believe parents should be offered the choice of circumcision. Each organization also has their own policy statement on the circumcision procedure.
Your pediatrician is best able to help you weigh the benefits and risks for your child. Talk with your baby’s doctor to reach a decision that is right for your family and circumstances.
Who performs circumcision?
In most cases, an obstetrician-gynecologist (Ob/Gyn) or pediatrician performs circumcisions. Ob/Gyns specialize in the medical and surgical care of pregnant women and their unborn babies. Pediatricians provide care for infants, children and adolescents. Choosing a doctor with plenty of experience performing circumcisions can help put your mind at ease.
When parents choose circumcision for religious reasons, a professional with experience in the ritual and procedure may perform the procedure.
How is circumcision performed?
Newborn circumcisions most often take place in the nursery. Doctors may also perform it in the office during the first 10 days after birth. For the procedure, staff will restrain your son’s arms and legs. After cleaning the area, doctors apply a special clamp to the penis and remove the foreskin. Another method uses a plastic ring placed tightly around the foreskin; after 5 to 8 days both the ring and foreskin will fall off. The whole appointment may take about an hour; the procedure takes about 10 minutes.
In the past, doctors did not routinely use anesthetic during a circumcision procedure. However, recent research has shown newborn boys benefit from having it. The AAP recommends using either a topical numbing cream or an injection of local anesthetic, along with acetaminophen (Tylenol). Because this practice is relatively new, talk with your doctor beforehand about your expectations for pain relief.
Once boys grow out of the newborn period, circumcision surgery becomes more difficult and requires general anesthesia.
What are the risks and potential complications of circumcision?
Like any surgery, circumcision carries the risk of potential complications.
Potential complications of circumcision
Complications are not common with newborn circumcision procedures. Up to 2% of cases may experience minor complications that are easily treatable such as:
- Injury to tissue on the penis
- Local infection
- Mild bleeding
Reducing the risk of complications
You can reduce the risk of complications by properly caring for your son’s circumcision wound:
- Gently clean the area with warm water and pat dry. Use a mild soap if necessary. Avoid diaper wipes until it has healed completely.
- Apply antibiotic ointment (some doctors recommend petroleum jelly) to the area after each diaper change for about a week, until it heals. This will prevent infection and keep it from sticking to the diaper and causing pain. If there is a gauze dressing, replace it with each diaper change as well.
- If a plastic ring is in place instead of a bandage, it should drop off by itself in about 5 to 8 days.
How do I prepare for circumcision?
The hardest part of preparing yourself for circumcision is knowing it might cause your newborn son pain. You can help put your mind at ease and prepare by educating yourself about the procedure.
Questions to ask your doctor
You may want to ask your doctor the following questions:
- What are the risks and benefits of circumcision?
- How long will my son be in the nursery? How soon afterwards can I see him?
- What kind of anesthesia will you use before the procedure? How can we manage his pain afterward?
- When should I follow up with you?
- How should I contact you after hours if I have a problem?
What can I expect after circumcision?
Knowing what to expect makes it easier to plan and prepare for a successful recovery for your son.
How long will it take to recover?
Your son’s circumcision wound should heal completely within a week to 10 days. It will likely look somewhat red and swollen for the first few days. You may also notice a small amount of yellowish fluid. All of this is normal and should resolve within a week as it heals.
Will my son feel pain?
Circumcision is painful. Using acetaminophen as directed after the procedure can help relieve pain. Hold your son in a way that avoids putting pressure on his penis while it heals. Swaddling helps comfort some babies.
When should I call my doctor?
Contact your pediatrician’s office if you have questions between appointments. However, you should call your doctor or contact the doctor on call for the following:
- No wet diaper within 12 hours of circumcision
- Persistent bleeding or blood in the diaper larger in size than a quarter
- Plastic ring, if used, is still in place two weeks after circumcision
- Signs of infection, such as redness or swelling that worsens after 3 to 5 days or increased discharge from the penis
How might circumcision affect everyday life?
After the circumcision wound heals, you can begin normal baths with mild soap and water.