Circumcision: To Circumcise or Not to Circumcise
If you are a new parent to a son and you don’t have any religious or social restriction to go for the circumcision of baby boy, you might be really confused about whether to have your son circumcised or not. Deciding to have your baby circumcised or not can be painful and difficult, where parents are often put under pressure from peers or family members.
Circumcision is a debated topic among medical experts. The AAP ( American Academy of Paediatrician) issued a policy statement in 2012, saying ‘the benefits of male circumcision exceed the small risks of the procedure’. They mentioned health benefits which may not compel all males to undergo circumcision, but they were notable enough to ascertain all who want could get it.
What is Circumcision?
Circumcision is a procedure of the removal of the foreskin from the head of the penis, exposing the glans. The most common method is to open and remove the foreskin from the glans using circumcision clamps.
In neonates, it is an elective surgery consented by their parents. At birth, the foreskin or prepuce is attached to the glans or head of the penis. Usually, it’s done with in the first few days of birth under local anesthesia to reduce the pain and physiological stress. The baby would be wide awake and the required area will be numbed, all baby can feel is some tugging due to stitches.
Why Circumcision is Done?
The exact origin and intent are disputed until today. The oldest recorded evidence comes from ancient Egypt. The practice of circumcision has traveled from prehistoric times till date. Circumcision is celebrated in religions like Islam, Judaism, Christianity, Ethiopian Orthodox Church. For the followers, it’s mandatory and ceremonial for males to get circumcised.
Besides religion, Circumcision is done for various reasons like social, cultural, personal preference, and medical benefits. In countries like America and Australia, circumcision is done on all male babies. The reason for this is, a healthy penis is developed when the foreskin is taken away minimizing the risk of infection.
Benefits of Circumcision
There are immense benefits of getting your baby circumcised. These benefits are backed with studies and surveys.
- Circumcision provides invulnerability against penile cancer and lowers the chances of cervical cancer in female sex partners.
- Protection against UTIs and other infections.
- Low possibilities of penile skin conditions like balanitis and balanoposthitis (inflammations of foreskin and glans).
- Low Risks of phimosis ( inability to retreat the foreskin) and paraphimosis (inability of pulling the foreskin back to the tip of the penis).
- Protection against STDs like HIV, HPV, genital herpes, and syphilis.
- Makes it easier to maintain genital cleanliness and hygiene.
- Few studies indicate sexual sensitivity increases after circumcision in men. Other studies contradict this.
Risks of Circumcision
Like all surgical processes, circumcision also has associated risks but such cases are rare. Complications arise mostly when circumcision is carried out of hospitals and not under professional guidance. Though reported only 0.2%, the risks of circumcision are:
- Pain and distress.
- Risks of infection and bleeding.
- Removal of too much or too little foreskin.
- Chances of meatitis (swelling of the opening of the penis which makes passing urine painful).
- Inflammation of glans.
- Accidental Injury and deformity to the penis.
If you are planning to get your baby circumcised make sure the surgery is performed by a qualified medical expert in a scrupulously clean setting.
When to Get Baby Circumcised
Circumcision can be done 24-48 hours after the birth of a healthy baby. This can delay if the baby is diagnosed with any medical issues like premature, underweight, jaundice, etc. Look for the health, activity of baby, and contraindications before circumcision.
If the baby is circumcised in initial months, the wound heals faster and the risk of infections is less. The procedure becomes complicated and riskier as time pass. Older babies play with their limbs and can injure the wound. Though circumcision can wait if you want it to be ceremonial.
How to Prepare for Circumcision
Newborns are circumcised when still in the hospital. Make the decision to circumcise or not. Once you have made up your mind talk to the doctor about the procedure they will do, contraindications, risks, benefits, and all your doubts. Tell the doctor about any family history of bleeding disorders. If you don’t understand anything ask the doctor to explain it to you. Once you are satisfied, you can sign the consent form.
Circumcision can be done by pediatricians, obstetrics, pediatric surgeon, neonatologist, or urologists. Healthy babies can be circumcised after 24-hours of giving birth. It can be delayed if any medical condition is diagnosed. After circumcision, the baby can go home if the doctor permits.
What Happens During Circumcision
During the circumcising procedure, A small incision is made in the foreskin of the penis. This will help loosen the foreskin from the glands and the tip of the penis. The special devices are used to clip off the extra skin carefully and this is it.
The surgery begins by laying the newborn and fastening his hands and feet gently. The penis is cleaned thoroughly and numbed using local anesthesia, either by injecting medicine or applying lidocaine creams to numb the area. A small cut is made in the foreskin and the skin is removed from the crown of the penis using a scalpel and clamps. bleeding and deep wounds are cauterized. The edges of the foreskin are sutured. An antibiotic medicine or vaseline is applied and the wound is covered or left open as per the requirement.
It takes 10-15 minutes to circumcise the newborn.
What to Expect After Circumcision Procedure
- After the procedure, the glans may look raw and sensitive. This is normal
- You may see a yellowish substance. Don’t try to get rid of it. This will act as a catalyst in healing.
- It is okay to see some bloodstain diapers or the wound may seem bleeding a little.
- The baby may be feverish and distressed in the initial days of circumcising.
The most practiced techniques of newborn circumcision prevent damage to penis. Sophisticated devices are use to minimize injury. The most-used methods are:
1. The Gomoco Clamp Method
The Gomoco Clamp is the most used method for new baby circumcision. A small cut is made in the foreskin and the foreskin is shifted back enough to show the head of the penis. This will loosen foreskin which is then retracted back. Then a bell is placed on the penis head to safeguard the penis. The clamp is tightened around the foreskin and the extra skin is cut off and removed. The doctor usually leaves the wound open. Vaseline is applied to the diaper to prevent penis rubbing against it.
2. The Mogen Clamp
Here the foreskin is loosen using hemostats like in Gomoco method. The Morgan clamp is slid over the crown. Foreskin is pulled up and clamped. The extra skin is sliced off after making sure its free from glans. No sutures are required in most of the cases.
3. The Plastibell Technique
After making the incision, a Plastibell plastic ring is inserted beneath the foreskin and secured with a string ligature. The extra skin is cut off. The tail part of the plastibell is disposed of. The ring remains and falls off after the penis has healed completely. If the ring doesn’t fall off after eight days, call your pediatrician. If the ring slips down the shaft of the penis or there’s any swelling, these are also the reasons to call the doctor.
Taking care of the newly circumcised penis is easy.
- The gauze dressing can generally be removed with the first diaper change. If it sticks don’t pull it, instead soak the dressing with a warm wet cloth until it comes off easily.
- Clean the area with lukewarm water and pat dry gently.
- Avoid bathing the baby in the bathtub until the wound heals completely. A sponge bath can be given.
- Always wash your hands before touching the newly circumcised penis.
- Vaseline may be applied with each diaper change for the first 24 hours or as recommended by your doctor. After that, you may continue to apply Vaseline to the penis to keep it from sticking to the diaper for several days until the redness goes away.
- Tuck the penis down while diapering. Diapers can brush against the glans, making it sore.
- Apply betadine solution in case of bleeding and Framycetin cream in case of swelling followed by redness caused by a bacterial infection.
- Hold the baby’s legs for as long as you can. Leg movements can make the wound worse and it can bleed.
- Ask the doctor what to be given to numb the pain.
- Find your baby some loose and comfortable clothes to wear.
- If the baby poops clean gently with moist cotton.
Newborn’s circumcision heals itself within 7-10 days or two weeks maximum. Schedule a follow up with the doctor to check the situation of the wound. Check for the stitches if the wound was sutured.
- Be patient. Babies are stressed and fussy for about a week after circumcision.
- Cuddle, pacify sing, touch, and feed your baby to calm him down. Breastfeeding work wonders in calming baby.
- Change diapers frequently.
- Keep the wound clean. Wash with lukewarm plain water until the penis heal.
Circumcised vs Uncircumcised Baby
|Appearance||penis is without foreskin in both erect and non-erect form||The foreskin covers the tip of the penis. This skin shift back when penis is erect and return to its position when not-erect|
|Problem in urination||Passing urine is as normal as before||Same|
|Effects on sex||No negative effect on sensation, pleasure, or sexual function. No pain during intercourse.||Same|
|Hygiene||Easy to clean and maintain hygiene||urine drops, bacteria, and body fluids collect under the skin. Adults can pull back skin to clean. It is difficult for kids.|
|STIs||Lower risks of HIV, HPV, genital herpes, chlamydia and syphilis||Highers risks of sexually transmitted diseases. The worst is diseases often go unnoticed as glans are not exposed|
|Skin diseases||Penile problems are rare. Though Meatitis may occur on the circumcised penis.||Higher possibilities of infection and Phimosis, paraphimosis, balanitis, balanoposthitis|
|Fertility||No effect||No effect|
Circumcision: When to Call Doctor
If your gut feeling says the wound don’t look fine. Take no risk. Call doctor immediately as babies can’t tell their problem and discomfort. Check for these signs too.
- Exessive bleeding
- Yellow discharge even after a week
- Inflammation or swelling
- Baby is fussy and crying inconsolably
- Redness persist for 10+ days
- High fever
- Trouble peeing
- The unusual smell from the penis
- If the plastic ring stays for more than two weeks