Whether or not you have your child circumcised is a deeply personal choice and deciding if its right for your family will require you to consider many factors. In addition to the personal, cultural and religious aspects associated with the decision, you may have medical questions as well. The following are answers to many of the most common questions that Richard Yu, MD, PhD, of Boston Children’s Hospital’s Department of Urology hears when counseling families on this matter.
Will circumcision make our baby healthier in any way?
Yes and no. If your baby is circumcised, the penis becomes very easy to clean for parents and ultimately for the child and adult, which helps reduce the risk of infection from bacteria. Circumcised infants also have a lower risk of urinary tract infections in the first year of life. However, if your child is not circumcised, but he is able to fully pull back his foreskin around the time of toilet training and takes care to keep the entire penis clean with soap and water every day, he also should do well. The foreskin should never be forcefully retracted, but you may gently retract the skin for general cleaning. Some pediatricians recommend that the foreskin is never retracted and to let things take care of themselves naturally. I would advise against this because boys can run into trouble with penile itching and inflammation due to the trapped debris within the foreskin in an area that can not be cleaned. If you decide to leave the foreskin alone, you should monitor your child for any signs or symptoms of penile discomfort or pain with urination. If this occurs, please bring it to the attention of your pediatrician.
How common a practice is circumcision?
Circumcision is common. The Centers for Disease Control recently reviewed the current trends of newborn circumcision in the U.S., and the national rate was almost 60 percent. According to the data, circumcision rates are highest in the Midwest and Northeast and lowest in the West.
What are the risks associated with the procedure? How often do they occur?
The most common risks associated with circumcision are bleeding and infection, but this only happens in 0.2 percent of cases, or about 1 in every 500 procedures.
Are there any medical conditions that would make circumcision unsafe for my baby?
If your baby has active issues with heart or lung function, or a bleeding disorder, circumcision may be unsafe and should be delayed. There are also congenital findings that may require more extensive repair. Circumcision should be delayed if the opening of the urethra is located on the bottom of the penis, the penis is notably curved, or the penis is relatively small. Always consult a pediatrician when weighing whether or not you wish to circumcise, or when establishing a timeline of when you wish to have the procedure done.
What does the procedure involve?
Most newborns are kept still by holding them or by placing them into a circumcision brace. The baby is comforted and may receive a local anesthetic (numbing medication) to reduce discomfort. The skin covering the head of the penis is removed with a protective device and then gauze with petroleum jelly or antibiotic ointment is applied. In older children and adults, the procedure is commonly performed under general anesthesia.
Is it extremely painful for the child?
Despite what many people may believe, this is not an extremely painful procedure. If local anesthesia is given, the child will feel pressure and movement but not pain. The child may be briefly upset while he is being held in place. If the circumcision is performed under general anesthesia, he will not experience any pain during the procedure. Once completed, the child will not have pain with urination since the urethra is left untouched during circumcision.
What is the recovery process like and how long does it last?
Newborns and infants recover very quickly from the procedure, usually within 12 to 24 hours. Young children recover in one to two days. Older children and young adults recover in three to four days. After circumcision, there may be temporary skin bruising or mild swelling that can last for one to two weeks.
Is it only done on newborns?
Circumcision can be performed at any age. Newborn circumcisions are normally performed while the child is awake. When the child is more than 3 months old, parents should consider having the procedure performed under general anesthesia.