Everything you need to know about circumcision

Your scan reveals you’re having a boy and, from that moment, some parents immediately know they’ll circumcise their child. But for others the decision isn’t so easy. In some families, circumcision is done for religious traditions, while in others the procedure is done for health or hygiene reasons, or because parents want their son to look like his father.

What factors should be considered before you have your child circumcised? What is involved in the procedure, what are the health benefits and at what age should a baby be circumcised?

What does circumcision involve?

The head of the penis (glans) is covered by excess skin known as the foreskin (prepuce). During a circumcision the foreskin is loosened from the head of the penis and the excess skin is cut off. In young babies the head of the penis should ideally be numbed using a topical or local anaesthetic, but in older boys and men a general anaesthetic is required.

READ MORE: Common penis problems in infants & how to treat them

At what age should a baby be circumcised?

A baby is usually circumcised in the first 10 days of his life. In a hospital setting this is often done in the first 48 hours after birth. In the Jewish faith a boy is usually circumcised at 8 days old.

A circumcision can be performed at any age but the healing process is much easier in infants. In infants, healing usually takes 7 to 10 days.

Are there medical benefits to a circumcision?

• Urinary tract infections About 1% of boys under the age of 2 years suffer from urinary tract infections. Of this 1%, it is more likely to be a boy who is uncircumcised. The prevention of urinary tract infections is the most important medical reason for doing a circumcision but if only 1% of boys get a urinary tract infection then this risk is very low and is not always related to an uncircumcised penis.
• Penile Cancer It has been proposed that penile cancer is less likely in circumcised men but penile cancer is so rare that The American Paediatric Association has reported that 300 000 circumcisions in America would need to be performed to prevent a single case of penile cancer. Over and above this, at least a third of penile cancers are due to the Human Papilloma virus (HPV). These days we recommend all children be vaccinated against HPV to prevent both cervical and penile cancer.
• Sexually transmitted diseases Circumcision has been shown to lower the risk of diseases like syphilis, herpes and HIV. Having said this, most academics would agree that the use of a condom is way more effective in preventing the spread of sexually transmitted diseases than a circumcision.

What about non-medical reasons for circumcisions?

Circumcision dates back some 6000 years with the earliest records coming out of Egypt. Today circumcision is most common in the Middle East due to the fact that circumcision is a Jewish and Islamic tradition – 95% of boys are circumcised in these population groups.

Circumcision is also common in the United States but in Western Europe the rate of circumcision is less than 20%. Circumcision for boys who have no medical indication for a circumcision is highly controversial in Western Europe and children’s rights groups have proposed banning it.

ALSO READ: Antibiotics in children: when they’re necessary and when they do more harm than good

Interestingly, the South African Children’s Act prohibits circumcision of male children under the age of sixteen except in cases where there is a valid religious or medical reason. Although there are significant loopholes, it does give South African boys more legal protection than many other countries in the world.

We do have a significant Jewish and Islamic population and circumcision would be performed for religious purposes. In certain African cultures circumcision is part of the initiation into manhood. In my experience many families do still want their sons circumcised for the social and cultural reasons listed above.

Are there other times when a circumcision may be medically necessary?

There may be medical complications which would make circumcision of a boy necessary. These would include:

• Phimosis If the opening of the foreskin is too narrow and prevents the passing of urine, a circumcision is necessary.
• Paraphimosis If the foreskin gets stuck and swollen in such a way that it cannot be pulled back over the head of the penis, then an urgent circumcision is required to prevent the flow of blood being cut off from the tip of the penis.
• Recurrent balanitis This is inflammation or infection of the foreskin. Should this be a recurrent problem then your doctor may recommend a circumcision.
• Recurrent posthisis This condition causes inflammation of the head (glans) of the penis. If the condition is recurrent then a circumcision may be indicated.

What are the risks associated with a circumcision?

Circumcision does not always pose a problem but a recent study has concluded that “the rate of complication is much higher than previously recognised” (A Longitudinal Population Analysis of Cumulative Risks of Circumcision).

Following a circumcision, the penis needs to be cleaned then protected with petroleum jelly to prevent the penis sticking to the nappy. It is best to gently dab the penis with cooled, boiled water to clean away any poop.

If you do notice any redness, pus or swelling then baby may have an infection. A little blood is expected but if there is suddenly more blood then it may be due to a blood vessel having been cut.

Allergic reactions to the local anaesthetic are rare but parents should be aware of the possibility. The anaesthetic may cause skin irritation or bruising. A severe reaction may cause an irregular heartbeat or breathing problems.

Sometimes too much of the foreskin is left behind or may be uneven – this usually corrects with age but may need to be corrected surgically at a later stage. With the current precautions that a doctor takes, it would be unlikely that damage or injury to the head of the penis would occur. This is, however, a concern many parents have.

Your doctor may advise against circumcision in premature babies that require medical care in hospital. Families with a history of bleeding disorders would also need to consider the risks associated with a circumcision. Certainly a boy with any penile abnormalities should not have a circumcision as the foreskin may be used to correct the abnormality.

What advice do I give parents about circumcising their baby?

My advice to parents is always to consider why they are doing the circumcision in the context of their religious, social and cultural preferences. They need to consider the medical benefits versus the risks. Regardless of their decision, a little boy needs to be taught how to clean his penis and all parties involved should be acutely aware of medical problems that can arise and cause harm to a little boy.

References

https://pediatrics.aappublications.org/content/146/5/e20201475?download=true
https://pediatriccare.solutions.aap.org/chapter.aspx?sectionid=139978458&bookid=1626
https://onlinelibrary.wiley.com/doi/abs/10.1111/bioe.12714
https://www.mayoclinic.org/tests-procedures/circumcision/about/pac-20393550
https://pubmed.ncbi.nlm.nih.gov/30502236/
https://onlinelibrary.wiley.com/doi/abs/10.1111/bioe.12714
https://www.aafp.org/about/policies/all/neonatal-circumcision.html