Circumcision In Baby Boys: Benefits, Drawbacks, And Prevention

Circumcision in baby boys is the surgical removal of the upper layer of skin covering the penis.

This procedure might be done due to cultural, religious, or health perspectives. A decision on whether or not to get circumcision done for your baby boy is a decision you have to make but you should know that there are certain risks and complications involved in the process. Read on as we discuss circumcision, the procedure, the advantages, and the following complications.

What Is Circumcision?

Circumcision is the process of removing a section of foreskin covering the head (glans) of the penis. If we look at the anatomy of the penis, it is naturally covered by some skin for the protection of the tissue beneath it. The removal of the foreskin leaves the tip of the penis uncovered. While circumcision is a choice, a considerable number of boys go through the procedure every year.

What Percentage Of Baby Boys Get Circumcised?

The number of boys getting circumcised varies depending on the region. The practice is most prevalent in North America, The Middle East, and Africa. Circumcision is less common in parts of Asia, South America, and Europe, owing to the differences in religious orientations, culture, and traditions.

Why Do Parents Choose Circumcision?

Circumcision is done due to any of the following reasons:

• Religious and cultural beliefs: Sometimes it could be considered as a ritual and several parents choose to get their baby boy circumcised due to religious and cultural reasons.
• Health and hygiene beliefs: Some parents believe that circumcision prevents bacterial accumulation around the glans of the penis, and reduces the risk of urinary infections. Circumcision is also believed to bring down the risk of foreskin complications and infections.

• Family tradition: Sometimes it could just be a tradition to get all the male members of the family circumcised.

These factors also determine when the child gets circumcised. But can the procedure be done at any time?

What Is The Right Age For Circumcision?

Most newborn boys get a circumcision within a week of their birth. In some cases, it may be delayed if the baby has a medical problem or when an immediate circumcision can pose a risk to their health.

Is Circumcision Painful For The Baby?

Circumcision is painful but the pain can be alleviated with medication suitable for babies. If the baby is circumcised within the first few days after birth, then pain medication may not be necessary. Your doctor can perform the procedure using only a numbing cream at the site of operation.

However, if the circumcision is delayed by several weeks or even months, then it will be an elaborate surgical procedure with the use of local anesthesia. The wound will also require stitching, and the overall risk of the procedure is also higher (1).

Therefore, if you want to circumcise your child, it’s good to do it soon after birth. It means that you decide before the baby is born. To help you make an informed decision, we look at the benefits of circumcision for a baby boy next.

Can Circumcision Benefit Your Baby?

Circumcision offers the following benefits to a baby boy:

• Lower risk of UTIs: The American Academy of Pediatrics states that circumcised infants have a lower risk of developing urinary tract infections (UTIs) when compared to boys who are not circumcised (2). Uncircumcised infants are ten times more likely to develop UTIs in the first year of their lives when compared to those who have undergone circumcision.

• Reduced risk of foreskin complications: Since the foreskin is trimmed at the tip, there are fewer chances of complications of the foreskin. An example is the prevention of phimosis, which is a common medical condition where it is difficult to retract the foreskin. According to a systematic review published in the journal Pediatric Urology, phimosis’s prevalence was 5.6% (962 out of 17,136) in uncircumcised males. There is even a reduced risk of infection since urine and other germs do not get trapped between the foreskin and the glans.

• Easy to keep the penis clean: Parents may find it convenient to keep their baby’s penis clean because the tip is exposed and thus easier to clean.

Eventually, a circumcised man is at a lesser risk of contracting HIV and herpesⁱ  An infection caused by herpes simplex virus (HSV) that spreads through oral contact or physical intimacy and affects the mouth and genital area. and human papillomavirus (HPV)ⁱ  A common virus causing STD characterized by abnormal tissue growth in different parts of the body. through intercourse (3). Of course, these are long-term benefits that the baby will enjoy when he grows up.

Point to consider

Circumcision may also reduce the risk of some penile disorders, such as balanoposthitis (inflammation of the penis glans and foreskin) and paraphimosis (a condition where the foreskin is stuck behind the head of the penis) (10).

Are There Any Disadvantages Of Circumcision?

There are no disadvantages of circumcision as the penis will be the same, functioning as it should even in adulthood.

However, there might be surgery-related risks involved. We will talk about it later in the post.

Did you know?

Sexual partners of circumcised men are less likely to suffer from cervical cancerⁱ  Cancer of the cervix, the lower part of the womb connecting to the vagina. (10).

How To Prepare For Circumcision?

The first step to getting your little boy circumcised is talking to the baby’s doctor. Your doctor will suggest the best time for the baby’s circumcision, depending on the health of the newborn. Once the date and time for the procedure are determined, the doctor might tell you not to feed the infant at least four to six hours before the surgery (4).

What Is The Procedure For An Infant’s Circumcision?

The entire circumcision procedure takes about 15-20 minutes with the following steps:

1. Numbing the region:

• The doctor would use a numbing cream to anesthetize the tip of the penis and the entire foreskin. The cream takes about an hour to show effect (5). Most newborns only need numbing cream for pain relief during circumcision.
• Older infants undergoing circumcision would require anesthesia, which is injected at the base of the penis.

2. Cutting the foreskin:

There are three methods of circumcision viz. the Gomco Clamp, Mogen Clamp, and Plastibell Technique. In any method, the first step is to separate the foreskin from the glans using a probe. It makes it easier to cut the foreskin and prevents injuries to the head of the penis.

• The Gomco Clamp method uses a hollow tube that attaches to the tip of the penis after foreskin separation. The foreskin rolls over the tube. A clamp on the tube moves to the point where the foreskin is to be removed. It helps constrict blood supply to the foreskin thus minimizing bleeding. The doctor uses a scalpel to cut the foreskin around the edge of the clamp to complete the circumcision procedure.

• In the Mogen Clamp method, the foreskin passes through a metal clamp that closes and separates the section of the foreskin to be removed. A scalpel is used to cut the foreskin. The clamp is left at its place for a few seconds to reduce the blood supply to the region and reduce the risk of bleeding.

• In the Plastibell Technique, the tip of the penis is made to pass through a small ring. The foreskin then runs over the plastic ring. A line below the plastic ring is tied with a suture to cut away the blood supply. The doctor then uses a scalpel to cut away the foreskin above the suture. The stitches are removed, but the plastic ring remains at its place for about eight days after which it falls off on its own.

3. Completing the circumcision

• The doctor will apply a medicated ointment to the region and dress it with a gauze bandage. In the case of Plastibell technique, there is no need for dressing.
• Your doctor will give instructions and prescribe medicines to dress the area. You are allowed to take the baby home right after the discussion.

Usually, the procedure is completed smoothly and the child recovers from the surgery soon.

How Long Does It Take For A Circumcised Penis To Heal?

A circumcised penis completely heals in 7-10 days (6). In the case of Plastibell technique, the plastic ring will fall off on its own in about a week once the foreskin is completely dry and healed. But sometimes, complications could arise during or after the surgery.

Quick fact

While the penis is healing, it may appear red or swollen with a yellowish film on the tip (10).

What Are The Risks Of The Circumcision Procedure?

Circumcision is like any other surgical procedure and poses the following risks to the baby:

1. Infection: Infection is a common complication after surgery. The surgical wound could get infected and have inflammation around the tip of the penis.

2. Excessive bleeding: In very rare instances there could be more-than-normal bleeding, especially when the baby has a blood disorder.

3. Side effects of anesthesia: Babies who get circumcised under the influence of local anesthesia may display side effects like breathing problems and an allergic reaction. These side effects are rare and only happen when the baby has some other medical issues.

4. Damage to the penis or foreskin: If a qualified doctor does not perform the procedure, then there is a risk of injury to the head of the penis. That also increases the risk of the foreskin being trimmed unevenly, which could lead to complications later.

Medical experts state that infections and complications after circumcision are rare. But you must know how to spot something wrong.

When To Take The Baby To A Doctor?

The following are the signs of infection at the site of circumcision. Take your baby to the doctor in the following scenarios:

• The baby does not urinate six to eight hours after the procedure.
• Cries every time he urinates, indicating meatitis – an infection of the tip of the penis that can occur after circumcision (7).
• Redness around the tip of the penis that continues even after five days.
• Drainage of pus from the wound even after a week.
• Excessive inflammation of the foreskin and the tip of the penis.
• Chronic colic; a baby cries a lot thus indicating excessive pain.
• Fever.
• Presence of pus-filled blisters on the penis.
• Foul smell from the genitals.

You can prevent an infection of the penis by taking proper post-surgical care of the baby.

How To Care For The Baby’s Circumcised Penis?

Proper care of your baby’s circumcised penis is essential for smooth healing and prevention of infection. Here is what you should do:

1. Bathe your baby carefully: Your baby’s doctor may restrict bathing for a few days after surgery or even till the penis heals completely. In any case, whenever you start bathing your baby, remember to use mild shampoo or soap to clean him. Do not scrub or rub the tip of the penis to clean it. Instead, use warm soapy water to rinse the area to keep it clean. Do the same if stool from diapers gets on the foreskin.

2. Use petroleum jelly to prevent abrasions: Diapers may cause friction and discomfort to the baby. Apply petroleum jelly on the front of the diaper to avoid that. If your baby has a gauze on the penis, then it may come out every time he urinates or has a bath. Replace the bandage with a fresh one, after applying some petroleum jelly on it. The use of petroleum jelly is safe and recommended by pediatric experts to alleviate discomfort after a circumcision.

3. Give acetaminophen after doctor consultation: If the baby seems fussy due to pain and irritation, then administer acetaminophen (paracetamol). Only do so if you feel the baby is in too much pain and after consulting the doctor.

Sheryl, a mom vlogger, shares how she cared for her circumcised newborn. She says, ” I took a lot of extra care, almost not sleeping at all, to check the progress of healing…I have to cuddle him a lot and give him a lot of comfort, so it is a difficult time for him. He will have those medications straight for five to seven days. He had been prescribed medications, including analgesics or paracetamol for pain relief and an antibacterial cream to be applied once his skin dried off. For the first five to seven days, he followed this routine. On the third day after circumcision, I applied a pea-sized amount of cream on a sterilized gauze at the site of the circumcision. Regarding the care, I think I am just lucky that our baby didn’t experience any excessive bleeding. After 5 days, he was completely healed (i).”

Once your baby’s penis heals, it does not require any special care. If any loose remnants of foreskin remain, then let it dry naturally and shed on its own.

When Not To Have Circumcision?

Circumcision may not be an ideal choice if the baby suffers from the following conditions:

• Premature birth: Circumcision is delayed if the baby is born prematurely. The baby should have stable health with significant growth before he is ready for circumcision.
• Blood disorders: If the baby has blood disorders that can cause excessive bleeding during surgery, then circumcision may not be the right thing for him. Do note that the presence of these disorders could be determined through gene sequencing right after birth or if the condition runs in the family.
• Abnormalities in urinary system: Sometimes, the baby could have congenital urinary tract problems. like hypospadiasⁱ  A birth abnormality in boys in which the urethral opening is not present or correctly formed in the tip of the penis. .  It makes circumcision risky and unnecessary for the baby.
• Overall poor health at birth: The doctor may not recommend circumcision if the baby is born underweight or with some congenital diseaseⁱ  Structural or functional abnormalities that are present from birth. . Pediatricians state that circumcision is ideal only in completely healthy infants.

Next, we answer a few questions that parents often have about circumcision.

Infographic: What Medical Conditions Require Circumcision?

It is not necessary to do circumcision to maintain hygiene since there is no significant difference in the outcome. However, certain conditions and problems may make it necessary to perform the procedure to alleviate the symptoms or avoid complications. Go through the infographic to know the medical conditions requiring circumcision.

Illustration: The Bridal Box Design Team

This informative video will teach you how to care for your baby boy’s circumcision area with this helpful video! Get tips on how to keep it clean and healthy.

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Dr. Shashidhar AMD

   

Dr. Shashidhar is a qualified pediatrician and neonatologist with 14 years of experience in pediatrics and neonatology. Currently, he is practicing at St John's Medical College and Tiny Tots Clinic in Koramangala, Bangalore, and is a part of an accomplished team taking care of preterm and sick newborns until discharge and follow up.

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