Does My Child Need a Circumcision?

About Circumcision

Circumcision is a procedure which involves removing the foreskin, the tissue which covers the head of a boy's penis. This procedure is usually done by a gynecologist or a pediatrician right after birth with a specific clamp, no stitches, and local anesthesia. Normally, this type of circumcision can be done only in the first week or two of life, and after that time it must be done under general anesthesia.

If you wanted your child circumcised at birth but he was not, it may have been because he was premature, ill or because he was thought to have a problem with his penis. When the urinary opening on the penis is in the wrong place or if the penis is partially attached to the scrotum or is bent, the doctor will usually advise that your child not be circumcised until you see a pediatric urologist.

The American Academy of Pediatrics recently stated that newborn circumcision may be beneficial, but may also be associated with problems.

However, not all the benefits of circumcision are achieved when a child is circumcised after the newborn period.

Why circumcision may be needed or beneficial in older children.
When a child is not circumcised at birth, medical problems may occur later in life that make it necessary to do a circumcision. In other cases, concerns are primarily cosmetic.

Phimosis
Phimosis means that the foreskin is too tight to be pulled back over the head of the penis. If it is pulled back and then not pulled forward again, the head of the penis may swell and become very painful. Many boys cannot move the foreskin all the way back until they reach 10 years of age or older. By the time boys are into puberty, they should be able to pull the foreskin back and forth easily. Therefore, most young boys do not need circumcision just because the foreskin will not pull back. In some cases, however, the foreskin is so tight that urine collects inside of it and balloons out every time they urinate. These boys need to be circumcised.

Birth defects of the penis
When the penis is severely bent, the skin is attached to the skin of the scrotum, or the opening is in the wrong place, surgery should be performed to correct the problem, and circumcision is usually performed at the same time.

Balanitis
Some boys get episodes of swelling and redness of the head of the penis, sometimes affecting the entire penis. These are infections that can be easily treated. However, if the problem recurs, circumcision is sometimes recommended.

Urinary tract infections
Some evidence suggests that uncircumcised boys are more likely to get urinary tract infections. After the first year of life, these infections are rare and tend to be mild when they occur.

Some adult problems are less common in men who were circumcised at birth.
Some studies have shown that urinary tract infections, venereal diseases (VD) and cancer of the penis are less common in men who have been circumcised.

Cancer of the penis almost never occurs in men who were circumcised at birth, but it is an extremely rare disease. In some countries where circumcision is rare, penis cancer is still rare, probably because people are familiar with the care of the uncircumcised penis. Although VD is very common, being circumcised does not protect against it.

Problems associated with circumcision. 
A circumcision can be performed in less than an hour, but in children it requires general anesthesia. Although rare, severe complications, including death, can occur from anesthesia. Bleeding, infection, scars between the head of the penis and the skin, and scarring of the urethral opening can rarely occur after circumcision. Boys may have significant pain after circumcision, and the pain medicine may cause nausea, vomiting and/or constipation.

The fear of surgery, particularly in the genital area, may be great in preschool boys. Also, boys may have trouble urinating after surgery or may regress and start wetting their pants or the bed even if they have already been toilet trained.

Care of the uncircumcised penis.
The foreskin should be left alone until it can be pulled back easily. In fact, the head of the penis does not need to be cleaned until a child reaches puberty. Since the foreskin is normally attached to the head of the penis at birth, trying to pull it back too soon may cause pain, bleeding, infection and scar tissue formation. The tissues slowly separate on their own as the boy grows older, and as they do, white pieces of dead skin (that may look like pus) can be seen on the head of the penis. These will fall off on their own.

Should your son be circumcised?
We believe that there are specific medical reasons to circumcise an older (beyond newborn) boy. These include inability to urinate, infections of the head of the penis and birth defects of the penis. When there is no medical reason to circumcise a child, it is probably not necessary. Circumcision in an older boy requiring general anesthesia should not be performed just to change the way the penis looks. If it is performed, it may be very unpleasant for the boy and may rarely lead to severe complications. We will be happy to discuss these issues with you further when you bring your child into our office.

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