Circumcision procedure

What is Circumcision?

Circumcision is the surgical removal of foreskin from a baby’s penis. Usually, babies undergo circumcision shortly after birth. Circumcision began as a religious rite. Today, people get circumcised for religious, medical and cultural reasons.

Many baby boys get circumcised, usually within the first week of life. Adults can get circumcised as well, though it’s less common.

What is the foreskin?

The foreskin is a piece of skin that covers the round tip of the penis. When a baby is born, the foreskin is completely attached to the penis. Over time, the foreskin separates from the head of the penis and is able to be retracted, or pulled back. Sometimes, the foreskin doesn’t separate when it should and remains tight, a condition called phimosis. Usually phimosis requires further intervention or circumcision to correct it.

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Before Circumcision Surgery

Why it's done

Circumcision is a religious or cultural ritual for many Jewish and Islamic families, as well as certain aboriginal tribes in Africa and Australia. Circumcision can also be a matter of family tradition, personal hygiene or preventive health care.

Sometimes there's a medical need for circumcision, such as when the foreskin is too tight to be pulled back (retracted) over the glans. In other cases, particularly in parts of Africa, circumcision is recommended for older boys or men to reduce the risk of certain sexually transmitted infections.

Circumcision might have various health benefits, including:

. Easier hygiene. Circumcision makes it simpler to wash the penis. However, boys with uncircumcised penises can be taught to wash regularly beneath the foreskin.

. Decreased risk of urinary tract infections. The risk of urinary tract infections in males is low, but these infections are more common in uncircumcised males. Severe infections early in life can lead to kidney problems later.

. Decreased risk of sexually transmitted infections. Circumcised men might have a lower risk of certain sexually transmitted infections, including HIV. Still, safe sexual practices remain essential.

. Prevention of penile problems. Occasionally, the foreskin on an uncircumcised penis can be difficult or impossible to retract (phimosis). This can lead to inflammation of the foreskin or head of the penis.

. Decreased risk of penile cancer. Although cancer of the penis is rare, it's less common in circumcised men. In addition, cervical cancer is less common in the female sexual partners of circumcised men.

The risks of not being circumcised, however, are not only rare, but avoidable with proper care of the penis.

Circumcision might not be an option if certain blood-clotting disorders are present. Also, circumcision might not be appropriate for premature babies who still require medical care in the hospital nursery or for babies born with abnormalities of the penis.

Circumcision doesn't affect fertility, nor is circumcision generally thought to enhance or detract from sexual pleasure for men or their partners.

What are the risks of circumcision?

Circumcision is a routine, safe procedure. As with any surgery, there are some risks, though. These include:

. Bleeding.

. Infection.

. Reaction to anesthesia.

. Pain.

. Cutting the foreskin too long or too short.

. Irritation on the tip of the penis.

. Meatitis (inflamed opening of the penis).

In rare cases, the foreskin doesn’t heal properly and can adhere to the end of the penis (penile adhesion). If that happens, the child may need a second procedure.

Who should not have a circumcision?

Your provider may recommend delaying circumcision or not doing it at all if your baby:

. Has medical concerns.

. Has physical problems with the penis that may need surgery. (Sometimes, surgeons will need the foreskin to correct the problem.)

. Was born prematurely.

Is circumcision painful?

Like any surgery, circumcision can cause some pain. But using pain medications and anesthetics can reduce discomfort. These can help both during the procedure and afterward.

Can an adult get circumcised?

Yes. People who were not circumcised as babies may choose to undergo circumcision as an adult. Generally, the procedure is the same for older boys and adults as it is for babies.

You’ll likely have the procedure in the hospital, using anesthesia. The surgery may take slightly longer than it does for infants. You will need stitches after the circumcision, too. Your healthcare provider will talk to you about recovery, including when you can resume having sex.

How to prepare for a circumcision

Circumcision is often done while newborns are still in the hospital. Different practitioners are trained to perform circumcision in newborns, including pediatricians and obstetricians. If you choose to have this procedure performed on your newborn, you’ll be asked to sign a consent form.

For older children and adults, the procedure is usually performed in a hospital or surgery center on an outpatient basis. This means that you would go home on the same day.

Before circumcision, the doctor will explain the risks and benefits of the procedure. Whether you're planning to have your son circumcised or you're pursuing circumcision for yourself, you'll likely need to provide written consent for the procedure.

During Circumcision Surgery

During the procedure

Newborn circumcision is often done in the hospital nursery, usually within 10 days after birth.

For newborn circumcision, your son will lie on his back with his arms and legs restrained. After the penis and surrounding area are cleansed, an anesthetic will be injected into the base of the penis or applied to the penis as a cream. A special clamp or plastic ring will be attached to the penis, and the foreskin will be removed.

Afterward, the penis will be covered with an ointment, such as a topical antibiotic or petroleum jelly, and wrapped loosely with gauze. The procedure generally takes about 10 minutes.

Circumcision is similar for older boys and adults. However, the procedure might need to be done under general anesthesia, recovery might take longer and the risk of complications might be greater when done later in life.

After Circumcision Surgery

After the procedure

It usually takes seven to 10 days for the penis to heal. The tip of the penis is likely to be sore at first, and the penis might look red, swollen or bruised. You might notice a small amount of yellow fluid on the tip of the penis as well.

If your newborn is fussy as the anesthetic wears off, hold him gently — being careful to avoid putting pressure on the penis.

It's OK to wash the penis as it heals. For newborns, change the bandage with each diaper change, and apply a dab of petroleum jelly to the tip of the penis to keep it from sticking to the diaper. Change your baby's diaper often, and make sure the diaper is loosely fastened.

If there's a plastic ring instead of a bandage, it will drop off on its own — usually within about a week. Once the penis heals, wash it with soap and water during normal bathing.

Recovery in adults

Your doctor will give you specific instructions on how to care for your incision and lessen your pain.

In general, you should return to work and daily activities when you feel comfortable. Avoid strenuous exercise, such as jogging or weight lifting, for the first four weeks of your recovery or until your doctor gives their approval.

Walking is the best way to exercise during your recovery. Try to walk a little more than you usually do each day.

You should also typically avoid sexual activity for six weeks after the procedure. Follow the instructions from your doctor about sexual activity.

Does circumcision affect fertility or sexual pleasure?

Circumcision doesn’t affect fertility (ability to produce a biological child). And researchers believe it doesn’t hurt or enhance sexual pleasure.

Problems after circumcision are uncommon. Contact the doctor if:

. Normal urination doesn't resume within 12 hours of the circumcision

. There's persistent bleeding

. There's foul-smelling drainage from the tip of the penis

. The plastic ring remains in place two weeks after the circumcision

Sources:

. https://www.mayoclinic.org/tests-procedures/circumcision/about/pac-20393550

. https://my.clevelandclinic.org/health/treatments/16194-circumcision

. https://www.healthline.com/health/circumcision