There has been a great deal of discussion about circumcision in medical and lay circles in recent years and information presented here is an effort to make our position clear and to summarize the medical information available for people considering circumcision.
Over 20 years ago on the information then available, most physicians in the U.S. felt circumcision was indicated and urged parents to have it done in the newborn period. Since then the medical evidence has swung the other way. Now about half of boys are circumcised.
UNCIRCUMCISED PENIS CARE
In a newborn and beyond, the uncircumcised penis needs no special care. During routine bathing the penis and foreskin need to be washed with no special attention. The foreskin needs to be retracted as far as it goes very easily with no discomfort, which in a newborn and the first few years of life is usually not very far. Natural oils and shedding of dead skin sometimes form little white, cottage cheese-type secretions that may come out from under the foreskin in chunks. These lumps and the little pockets under the foreskin they come from are normal and should cause no particular concern. Pretty much left alone, the uncircumcised penis will do fine. There is no need to have the foreskin pulled back by first grade or any other arbitrary age.
CIRCUMCISION DISCUSSION
For religious purposes, Muslims, Jews and some other groups have practiced circumcision for thousands of years. Circumcision became popular in the United States early in the 1900's and by the end of World War II the vast majority of men were circumcised. However, old theories about less cancer in the circumcised male or his sex partner or better sensation have been disproved. There has been some evidence that circumcised men are less apt to catch sexually transmitted diseases if they have multiple sex partners. In a truly tropical zone uncircumcised men may have infections of the foreskin. There is no significant increased risk of foreskin infections in the United States. Some adolescents or grown men express regret they were circumcised; some wish they were and a few have it done later in life. The vast majority of men accept their parents decision about circumcision without second thought.
Circumcision in the first few weeks of life carries some risk. There is a small possibility of infection or significant bleeding. Though quite rare, these risks can lead to extended hospitalization or the use of medication. Also, though I use a local anesthetic, a circumcision causes some pain or discomfort and some babies may be fussy for a day or two afterwards. The least expensive time to do a circumcision is in the newborn period. The chance of a circumcision needing to be done later in life for medical reasons in the United States is less than 1/2 of 1 percent.
Most parents who decide to have a circumcision done do so for personal or religious reasons. Family pressure should not be an important factor in deciding to circumcise.
I will do a circumcision usually after the baby is at least 12 hours old and up to six weeks of age. It can be done in the hospital or in my office. In the hospital, in addition to my fee for doing the circumcision, there is a hospital charge of about $35.00 for the use of their facilities, supplies and equipment. Medi-Cal and some insurances do not cover the cost of circumcision.
If a circumcision is to be done in my office, do not feed the baby for 2 hours before the procedure. The procedure takes about 15 minutes and we may ask you to stay in the office for another 15 minutes to be sure there is no significant immediate bleeding.
AFTER CIRCUMCISION CARE
After circumcision, the Vaseline gauze needs to be unwrapped and removed in an hour. The penis or diaper may be kept lightly lubricated with a little Vaseline or Neosporin ointment for the first day or two. No other special attention is necessary. Light bleeding leaving a spot in the diaper is fairly common in the first day or two. Also a yellow-white membrane may form in patches over the head of the penis and around the cut edge. After about ten days there should be no discharge or bleeding and the circumcision should look pretty well healed. The underside of the penis is usually the last to heal. If there is redness going down the shaft of the penis onto the abdomen or if there is a rash with blisters or the baby's behavior changes remarkably, let us know. You may give the baby 40 mgm of Acetominophen (up to the first line on the infant dropper) every four hours if the baby seems uncomfortable.
Baby boys, circumcised or not, grow up. How they do in life depends on many considerations, and whether they are uncircumcised or circumcised will likely not be a very important factor in the long run. We'd be happy to discuss these things further with you if you have questions or if other concerns about circumcisions should arise.
822-2441
this information last updated 10/00