Circumcision
Circumcision is the surgical removal of the foreskin (the skin covering the head of the penis). It is frequently performed soon after birth by the mother's obstetrician.
For various reasons, circumcision may not be performed at birth. A baby may not be a candidate for a circumcision due to an acute health care problem. Or, the obstetrician may have found an anatomical reason that requires an evaluation by a pediatric urologist. As with any surgical procedure, there are risks and benefits.
Role of the Foreskin:
The foreskin on the penis protects the glans (head of the penis) against urine, feces and other types of irritations. It protects against infection and scarring of the urinary opening and protects the sensitivity of the glans.
For people of Jewish and Islamic faiths, circumcision is a religious rite. Between 1920 and 1950 non-religious circumcisions became popular in the English speaking countries. Circumcision is not common practice in Asia, South America, Central America and most of Europe. Over 80% of the males in the world are not circumcised.
Benefits of Circumcision
- Decrease the risk of urinary tract infections. The risk of urinary tract infections in boys during the first year of life is low. However, these infections are more common in uncircumcised boys. The risk even in uncircumcised boys is low.
- Prevent or relieve the following penile problems: Phimosis is a condition in which the foreskin is tightly covering the head of the penis and it can not be retracted (pushed down exposing head of penis). Phimosis is uncommon and an attempt can be made to treat with a topical medication. Balanitis, inflammation of the head of the penis can occur, but is also uncommon. If this conditions occurs repeatedly, circumcision can be undertaken.
- Lowers the risk of penile cancer in older men. Even though this cancer is very rare, it is less common in circumcised men. It tends to occur in males who do not practice good hygiene.
Surgery
When our urologists perform the circumcision, it is performed on an outpatient basis at the main hospital or the Outpatient Mason facility. The surgery lasts 45-60 minutes and general anesthesia is used. The technique our doctors use is different than the newborn circumcision in which a clamp or plastibell is used. Our urologists use a "free hand" technique.
The incision (area that was cut) is closed with either dissolvable sutures or dissolvable sutures and a topical skin adhesive.
Pain Control
During the procedure your child will be given a local anesthetic in addition to the general anesthetic. This numbing medicine will be given via a penile block (injection of local around the base of the penis) or a caudal block (given by the anesthesiologist). A caudal block is a one time injection of local anesthetic into the tailbone region. Both of these blocks provide pain relief for 6-8 hours.
For pain control, over the counter acetaminophen (Tylenol") can be given every four hours, but do not exceed 5 doses in 24 hours. Patients that are at least four years old may be given a prescription for a stronger pain medicine. Use this prescription only for significant discomfort and administer as directed.
We advise the patient to receive pain medication on schedule for the first 24 hours after surgery. After that time period, only administer medicine if needed.
After Circumcision
After the circumcision, the tip of the penis may look raw. Also, it will be discolored and swollen for a few weeks. Frequently, there will be a yellowish mucus or crust covering the head of the penis. This will slough off with time. Do not attempt to wash or scrape it away as it is a natural part of the healing process.
The type of dressing used will depend upon the individual surgeon. There may be a clear plastic dressing called tegaderm or opsite wrapped around the penis. If this is present, you will be instructed to remove it in 24-48 hours. If, however, your son does not urinate within 8 hours of surgery or if the bandage rolls down and forms a tight band, remove it right away. Do not be alarmed if the dressing falls off early.
Once the bandage is off, start applying Polysporin" ointment or Neosporin" ointment to the area which was cut, with every diaper change for a week for infants, or three to four times a day for a week for the older, potty trained boy.
Instead of a bandage; the surgeon may apply a topical skin adhesive. This adhesive will flake off in a week or so. You may notice stitches under the skin. Do not be concerned if they do not dissolve right away. It can take a few weeks for them to go away. They are only a concern if they cause discomfort or irritation. You may apply polysporin or neosporin ointment to the glans (tip of the penis) beginning 24 hours after the surgery.
Avoid the use of powders or lotions in the groin area after surgery, to minimize potential irritation to the unhealed penis.
Do not bathe or sit the child in water (tub bath) for 5 days. A sponge bath is okay. If your son is old enough for a shower, this is fine even immediately after surgery.
For two weeks, do not place your child in an exercise saucer or a walker and refrain from carrying the child across your hip bone. For the older child, avoid riding a bike, climbing a jungle gym or participating in gym class for 2 weeks. It is fine to place the child in a car seat and high chair.
Your child may return to school or daycare when comfortable and not requiring prescription pain medicine, usually in 2-5 days.
When to Call the Doctor
After surgery call the doctor for the following situations:
- Inability to urinate after 8 hours following surgery
- Temperature of 101° F. or higher
- A green or yellowish discharge from the suture lines along with increased redness, swelling and pain
- Vomiting more than 3 times, inability to keep liquids down
- Extreme pain, not relieved by pain medication
Bleeding not controlled by continuous pressure. If you notice slow oozing of blood, this is normal. If it is a continuous drip, hold firm pressure for 15 minutes without peeking and without letting up on the pressure. If the bleeding continues, call the office or the urology doctor on call immediately.
Contact Us
For additional information on this or any Health Topic, please call the Family Resource Center, 513-636-7606, or your pediatrician.
Written 1/08
