Circumcision is the surgical removal of the skin (called the foreskin) covering the head of the penis. It is often done soon after birth by the mother's obstetrician.

For various reasons, a baby may not be a candidate for a circumcision soon after birth due to an acute healthcare problem or 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 head of the penis (glans) against urine, feces and other irritations. It protects against infection and scarring of the urinary opening and protects the sensitivity of the glans.

For people of Jewish faith, circumcision is a religious rite. Between 1920 and 1950 non-religious circumcisions became popular in 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

• Decreases the risk of urinary tract infections. The risk of urinary tract infections during the first year of life in those born male is low. However, these infections are more common in uncircumcised males. The risk even in uncircumcised males is low.
• Prevents or relieves the following penile problems: Phimosis is a condition in which the foreskin is tightly covering the head of the penis and it cannot be retracted (pushed down exposing head of penis). Phimosis is uncommon and an attempt can be made to treat it with a topical medication. Balanitis, inflammation of the head of the penis, can occur. It is also uncommon. If this condition occurs repeatedly, circumcision can be considered.
• Lowers the risk of penile cancer in older males. Even though this cancer is very rare, it is less common in circumcised males. It tends to occur in males who do not practice good hygiene.

Circumcision Procedure

When our urologists perform the circumcision, it is performed on an outpatient basis at the Burnet Campus or the Liberty Campus facility. The surgery lasts 45-60 minutes and general anesthesia or or spinal block is used. The anesthesiologist will talk to you about which anesthesia / pain control is chosen for your child. Our urologists use a "free hand" technique, which is different than the clamp or Plastibell techniques.

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, the child may be given a local anesthetic (numbing medicine) in addition to the general anesthetic. This numbing medicine is given via a penile block (injection of anesthetic 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 blocks give pain relief for up to six to eight hours after the local anesthetic is given.

If the procedure is done with a spinal block, the child is given a local anesthetic without general anesthesia. An anesthesiologist gives the spinal block. The spinal block is a one-time injection of local anesthetic (numbing medicine) into the back, below the spinal cord. This type of block gives pain relief during the procedure and for up to six to eight hours after the spinal block is given.

For pain control after the procedure, acetaminophen (Tylenol) can be given every four hours, but do not give more than five doses in 24 hours. Children who are at least 4 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, only give medicine if needed.

After Circumcision

After the circumcision, the tip of the penis may look raw. It will be discolored and swollen for a few weeks. Often, there will be a yellowish mucus or crust covering the head of the penis. This will go away 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 surgeon. There may be a clear plastic dressing wrapped around the penis that will be removed in 24-48 hours. If your child does not urinate within eight 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 child.

Instead of a bandage, the surgeon may apply a skin adhesive. This adhesive will flake off in a week or so. You may see 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 tip of the penis beginning 24 hours after the surgery.

Avoid the use of powders or lotions in the groin area after surgery. These may irritate the unhealed penis.

Do not bathe or sit the child in water (tub bath) for five days. A sponge bath is OK. If your child is old enough for a shower, this is fine even right after surgery.

For two weeks after surgery, do not place your child in an exercise saucer or a walker. Avoid 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 two weeks. It is fine to place the child in a car seat and highchair.

Your child may return to school or daycare when comfortable and not requiring prescription pain medicine. This is usually in two to five days.

Call Your Child's Doctor for These Symptoms

• Cannot pee after six to eight hours following surgery
• Fever of 101° F or higher
• A green or yellowish discharge from the suture lines with increased redness, swelling and pain
• Vomits more than three times; unable 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.