What is circumcision?
Circumcision is an elective surgical procedure where all of the penile foreskin, also known as the prepuce, is surgically removed. Circumcision is most commonly performed on newborns, usually in the first few days of life, or ritually on day 8 of life in the Jewish faith — this is called a bris. Circumcision is highly prevalent amongst Jewish and Muslim men and is much more common in the United States than in Europe. Circumcision is sometimes medically necessary in men, usually as adults and due to recurrent infections of the foreskin.
Circumcision is usually performed
The most common reasons for circumcision are:
- Elective choice — usually as a newborn
- Recurrent foreskin infections — balanitis
- Phimosis — the inability to retract the foreskin
- Paraphimosis — the inability to put the foreskin back over the penis
- Penile skin diseases — lichen sclerosis and rarely penile cancer
Although not universally agreed upon, hygiene in the circumcised male is generally felt to be easier, as the head of the penis is readily cleaned and the foreskin is not present to trap debris, called smegma. Circumcised infants are at slightly lower risk of urinary tract infection than uncircumcised boys. In addition, sexually transmitted infections are less common in circumcised men, especially those who have sex with women — HIV, herpes, HPV, and syphilis are less common in circumcised men. Finally, although very rare, penile cancer does not occur in men who are circumcised.
As with all procedures, there are some risks. Newborns and adults have some similar risks and some that are unique. Newborn circumcision is usually done in the newborn nursery and with local anesthesia. Adults often need general anesthesia for circumcision.
The main risk is bleeding and sometimes a newborn will be diagnosed with a bleeding disorder because of persistent hemorrhage after a circumcision — hemophilia is an example. Infections are relatively rare after circumcision. In adults, the penis can be very sensitive after circumcision or conversely, may have some numbness after for a period of weeks. These issues are usually transient.
In newborns the opening of the urethra can scar after circumcision, something called meatal stenosis. This is less common in adults, but in adults, the urethra can be damaged. In some children, not enough skin is removed and a revision of the circumcision is needed, usually around 1-2 years of age. If too much skin is removed, erections can curve, something called chordee.
Contraindications to Neonatal Circumcision:
- Unstable or significantly premature infants
- Congenital penile abnormalities –hypospadias is the most common
- Bleeding dyscrasias
- Infants who have not yet received vitamin K supplementation
- Infants who have not yet voided
In adults, uncorrected bleeding disorders and poor surgical risk are contraindications to circumcision.
Patients with congenital penile anomalies who should NOT proceed with
Circumcision (Circumcised Penis) include:
- Ventral curvature of the penis
- Penile torsion
- Penoscrotal webbing aka webbed penis
- Significant penile edema
In the United States, there is some concern about whether or not Circumcision (Circumcised Penis) should be universally performed on all male infants. As of 2012, the American Academy of Pediatrics claimed that the health gain for newborn male circumcision is greater than the risks. However, the American Academy of Pediatrics
In newborns, most circumcisions are performed with a clamp device. In adults, the foreskin is usually removed freehand and the penile skin sutured with dissolvable stitches. To begin with, the surgeon (often an OB/GYN or pediatrician in newborns and in adults a urologist) opens the foreskin, adhesions are removed, and the foreskin is separated from the glans. After that, the surgeon places a circumcision device in newborns and then the foreskin is cut off. There are three commonly used devices for neonatal circumcision: the Gomco clamp, Plastibell device, and Mogen clamp. The Gomco is very safe but takes longer to perform the procedure than the Mogen clamp. The plastibell is placed on the foreskin and the baby goes home with it and it falls off a few days after placement, with the foreskin.
In adults the foreskin is excised, usually with a scalpel and then bleeding is carefully stopped with cautery — in children, the clamp crushes all the blood vessels. Dissolvable sutures are used to reconstruct the penile skin and they fall out a few weeks after surgery.
Post- Circumcision care is similar to that of most surgical procedures. Prevention of infection and swelling is essential. Ice packs can be helpful in adults. Most surgeons suggest placing antibiotic ointment or petroleum jelly on the incision as it heals for a few weeks. In babies, checking the incision with diaper checks is suggested. One unique issue in adults is erections, these can be very painful and can be minimized with medications. Sexual activity should be avoided for a few weeks after circumcision as well. It can take 3-6 months for all swelling to subside after adult circumcision.
Complications of circumcision:
- Infection at the surgical site
- UTI-Urinary Tract infection