An elective surgical procedure, circumcision is usually performed on boys when they are infants, often within the first few days of birth. The procedure involves the removal of all or part of the foreskin, the piece of skin covering the tip of the penis. As a result of the procedure, the tip of the penis (called the glans) as well as the opening (called the urethra) are exposed.
Circumcision has been practiced for thousands of years as part of different religious and cultural traditions. Toward the end of the nineteenth century, however, American doctors began to advocate circumcision for all boys. This position grew from the belief (never scientifically proven) that the foreskin could easily harbor infection.
At present, most physicians take no strong stand for or against circumcision. While the procedure is still routinely performed in most hospital nurseries, the American Academy of Pediatrics advises against routine circumcision for all boys and suggests that parents need to make a personal decision after meeting with a physician to discuss the procedure's pros and cons.
HOW IS CIRCUMCISION PERFORMED?
Circumcision is usually performed by a physician in a hospital about three days after birth. Virtually all hospitals with maternity departments provide the service. It can be done by an obstetrician, pediatrician, a family practitioner or a specially trained rabbi. Some doctors choose not to do the procedure and will refer parents to a colleague.
The procedure, which takes about five minutes, should be performed only on healthy, stable infants. Sometimes families prefer to delay circumcision for a number of days for religious reasons.
For the procedure, the baby is placed on a plastic board lying on his back. His arms and legs are strapped down, his genitals are scrubbed, and his body is covered with paper drapes, leaving the physician access to the penis. The foreskin is pulled forward and placed in a special cutting instrument that quickly severs it from the glans. After the surgery, a light dressing may be placed on the penis. This dressing comes off the next time the baby urinates.
Because local anesthesia can cause complications in infant circumcisions, it is generally not used.
PROS AND CONS OF CIRCUMCISION
Pros
• Circumcised males face less risk of urinary tract infection during infancy.
• There may be less chance of cancer of the penis, a rare disease that occurs almost exclusively among uncircumcised adult males.
• Female sex partners of circumcised men may have less risk of developing cervical cancer than those of uncircumcised men.
• Many people believe that circumcision reduces susceptibility to sexually transmitted diseases, although there is no known evidence to support this belief.
Cons
• In rare cases, the incision results in severe bleeding or becomes infected.
• The procedure may be painful.
• Many people believe the foreskin serves a useful purpose in protecting the sensitive membrane of the glans.
• Some people believe that the removal of the foreskin decreases sexual pleasure in adult life.
CARING FOR A BABY AFTER CIRCUMCISION
• If possible, stay with the baby during the circumcision. If that is not possible, make sure the baby receives parental comfort right afterward.
• The penis should heal within ten days. During that time, the exposed glans at the tip may be somewhat red and sore, and there may be minimal bleeding and some yellow secretion around the incision, neither of which is a problem. Until healing has finished, place petroleum jelly on the glans at each diaper change. Keep diapers loose, and change them frequently. Try to keep the baby off his stomach. If the baby seems feverish or the glans develops painful blisters and sores, call your doctor.
• After a circumcision has healed, the penis requires no special care, although it's important to keep the area clean. (This also holds true for a child who has NOT been circumcised.) During an uncircumcised child's first few years, the foreskin will naturally separate from the glans. At that time, it will be possible to gently retract the foreskin while cleaning the area.
