Why do parents choose to circumcise their sons?

There are cultural and religious reasons for circumcision, as well as various health benefits. In some families, circumcision is performed as a family tradition, with sons being circumcised because their father is. Some families have their sons circumcised for the health benefits that have been well documented in medical literature.

Some health benefits of circumcision include the following:

• Circumcision reduces the risk of urinary tract infection.

• Circumcision reduces the risk of penile infection, known as balanoposthitis.

• 6% of boys will require a circumcision later in life, due to various reasons, including phimosis (an overly tight foreskin). Infant circumcision therefore eliminates the need to do it later in life.

• An adult circumcision is a more costly, riskier procedure, that may require general anaesthetic and is more painful. Infant circumcision therefore eliminates the need for adult circumcision later in life.

• Circumcision reduces the risk of some sexually transmitted diseases, including Human Papilloma Virus (HPV), as well as HIV.

• Circumcision reduces the risk of penile cancer, and cervical cancer in partners.

• Circumcised men are at a lower risk of sexual dysfunction later in life.

1. Uncircumcised penis with the foreskin covering the glans.

2. The same penis as in the first figure, but drawn as if the foreskin is transparent.

3. The same penis after circumcision when the foreskin has been removed. Note that the cut edge of the skin retracts to just behind the base of the head of the penis. This is the site of healing.

Potential Complications of Circumcision

Circumcision is a safe and frequently performed minor surgery. Although rare, with any surgical procedure there is the small risk for complications. Please contact Dr Stearn if you are concerned about complications, or if you have any questions about the appearance of the penis after circumcision.

Heavy Bleeding

Your baby’s diaper needs to be checked for bleeding every hour for the first 24 hours following circumcision. If there are small patches of pink or light red blood stains on your baby’s covering gauze when you open the diaper, this is normal. However if you see heavy red bleeding on the covering gauze, the treatment is as follows:

• Apply pressure to the penis for 2-3 minutes, by grasping the penis between your thumb and two fingers over the covering gauze.

• Without removing the gauze inspect the area for continued bleeding and repeat the pressure application to the penis for a further 2-3 minutes if there is still heavy bleeding.

• Leave the covering gauze in place and close the diaper, as removing it may cause more bleeding.

• Do not wipe a wound with a gauze or cloth, as this may cause renewed bleeding.

• If bleeding continues after the above discussed pressure technique is done twice, or if the penis is dripping blood and you cannot stop the bleeding with pressure, please call Dr Stearn for further assistance. Most bleeding stops after applying pressure to the penis.

Infection

Infection is very rate, although it may occur in isolated cases. Some signs of infection include the following:

• a pus like discharge

• a foul smell

• excessive swelling or redness

• local warmth

• a fever

• a rash anywhere in the area of the penis

If you notice any signs of infection, or if your son has not urinated in over 12 hours, please contact Dr Stearn immediately.

Concealed Penis

The penile shaft may be greater than its diameter, or there may be a good amount of pubic fat, which may cause the penis to retract inward. This is normal. This typically is only a concern in the first month or two following circumcision, as the healing circumcision can adhere to the surrounding skin, resulting in what is a called a concealed penis.

If your baby’s penis is concealed following circumcision, it is recommended that you apply a thin layer of Vaseline to the entire glans once a day, for the first 1-2 months after circumcision. This reduces the chance of a concealed penis.

Place gentle downward pressure on either side of the base of the penis, in order to expose a glans that has retracted inward. Please contact Dr Stearn if the penis cannot be fully exposed, or if you notice any bridges of connecting skin forming between the shaft skin and the head of the penis.

Sticking Dressing

Dr Stearn will wrap a long gauze strip around your son’s penis after circumcision. This gauze strip needs to be removed after 24 hours. If it falls off within the first 24 hours, please leave it off and do not replace it. If after 24 hours the gauze strip is still in place and appears stuck, please do the following:

1. Apply a good amount of Vaseline over the stuck surface.

2. Close your baby’s diaper and wait 15 minutes for the bandage to soften.

3. Gently peel away the surfaces of the bandage that are no longer stuck, and repeat this process as necessary.

If bandages still won’t come off, please contact our office and book an appointment with Dr Stearn to remove the bandages.

What are the risks of circumcision?

Circumcision is a routine and low risk procedure. However, with all surgery there may be some risks:

• Significant post-operative bleeding requiring medical attention of any kind (1/400).

• Phimosis, which is a narrowing of the shaft skin opening over the head of the penis requiring medical intervention (1/500).

• Buried or trapped penis, where the penis gets partially buried in the abdomen and requires medical intervention (1/800).

• Infection requiring antibiotics (1/1000).

• Suboptimal cosmetic result (1/500).

• Meatal stenosis, which is a narrowing of the urethra requiring medical intervention (extremely rare).

• Trauma resulting in permanent damage to the head of the penis (extremely rare).

• More serious complications including death (extremely rare).