The merits of circumcision are currently under debate. Many physicians, rather than routinely recommending circumcision for healthy boys, allow the parents to make the decision after presenting them with the pros and cons.  However, some boys have medical conditions where circumcision may be needed. 

Nowadays, we believe that circumcision -removal of the foreskin of the penis- operated on a newborn has potential medical benefits and advantages as well as disadvantages. Circumcision is generally a safe procedure when operated by an experienced physician on a newborn.

Immediate risks to circumcision are bleeding and infection, as well as complications recognized later like buried penis, downward arching of the male sex organ and poor cosmetic appearance. Some of these complications might require surgical correction. However, when operated on as a newborn, complications are very low.

Properly done  circumcision prevents phimosis, and is associated with a decreased incidence of cancer of the penis.  Also, there is a connection between the foreskin and urinary tract infections in a newborn. For the first twelve months of life, urinary tract infections are higher in uncircumcised than circumcised boys.

Circumcision may be requested for ethnic, cultural, religious and individual reasons after the newborn period, and normally requires general anesthesia. 
                      
Is the procedure beneficial, medically unnecessary, or harmful? 

Unfortunately, studies are controversial and under distinct interpretation too. Advocates of the procedure show studies that circumcised men have lower rates of penile cancer and AIDS. Many studies have also shown that urinary tract infections are more common in uncircumcised infants.

A number of studies have documented higher rates of cervical cancer in women who have had at least one uncircumcised partner. Also, the uncircumcised male is more prone to a buildup of smegma. This accumulation, may lead to odors aesthetically unpleasant.

However, circumcision may occasionally lead to serious bleeding or infection. Without circumcision, men may develop phimosis, when the foreskin gets stuck in a pulled back state. Phimosis usually requires circumcision to prevent recurrence, and circumcision carried out in adulthood is more difficult and more painful than when performed in infancy.

The pros and cons are based on reasonably solid fact.  There is indication that circumcised men experience higher rates of sexual activity, and that women with circumcised lovers are more likely to achieve simultaneous climax. Although circumcision is favored by women for appearance and hygiene, women report that an uncircumcised penis is easier to bring to orgasm by hand; also the circumcised penis was preferred for oral sex.

In surveys about their penile preferences, women say that a circumcised penis is cleaner; looks sexier; looks cleaner to touch; and that it smells better.  Even women who had uncircumcised partners preferred the look of a circumcised penis.  

As noted previously, there are some risks associated with circumcision. In addition to bleeding and infection there are mishaps in which too much or too little of the foreskin is removed. Occasionally there can even be injury to the penis itself. These problems are estimated to occur during approximately one in 15,000 circumcisions.

In 1971, the American Academy of Pediatrics Committee for the Newborn stated that "there are no valid medical indications for circumcision."  In 1975 that statement was modified to "no absolute valid", and in 1989 it was changed significantly to read that "New evidence has suggested possible medical benefits". 

Understanding the Controversy

Much of the circumcision controversy revolves around human rights and is concerned more with ideology than with health.  The National Organization to Halt the Abuse and Routine Mutilation of Males has a video promoting that circumcision causes psychological trauma. The producer, Tim Hammond, hopes that "a cultural shift will happen where we recognize and respect the right of all children to bodily integrity."

The National Organization of Circumcision Information Resource Centers, states in its literature that it opposes "the performance of a single additional foreskin.....amputation procedure" and that the only person who may consent to medically unnecessary procedures on themselves are "individuals who have reached the age of consent."

The debate about circumcision is bound to continue. If you're a parent wondering if you should circumcise your child, try to put the issue in perspective.

Medical Reasons To Be Circumcised As an Adult

"For men who can't retract their foreskin or who have recurrent infections, there's a clear indication," says Dr. Sharlip, a San Francisco urologist. "Actually, it's not just an indication, it's a need."

Dr. Sharlip says that if men are facing the prospect of circumcision, they are probably suffering from at least one of a number of medical indications.

·         Other foreskin problems: Tumors of the foreskin, loose foreskin, and tears in the fold of skin of the penis that attaches to the foreskin are all conditions that can be treated non-surgically.

·         Paraphimosis: The second most common reason for post-infancy circumcision, the foreskin is permanently retracted, constricting the shaft of the penis and causing swelling and pain.

·         Phimosis: The number one reason for circumcision after infancy is phimosis, a tightness of the foreskin that prevents it from being retracted. Phimosis can be normal in boys less than six months old. In males older than that, however, it can make urination and hygiene difficult and erection painful.

·        Recurrent infections: Balanitis, infection of the head of the penis, often caused by accumulation of secretions and  Posthitis, infection of the foreskin can be treated without surgery.  As a first measure, a urologist will likely prescribe an anti-fungal and anti-inflammatory ointment; there is often an associated yeast infection, which thrives in the warm, moist environment created beneath the foreskin. Unfortunately, these conditions often recur, and when they do, a circumcision is advisable.

Circumcision for Sexual Reasons

Less than 5% of men who undergo circumcision do so for non-medical reasons. Some of these men are prompted by their sexual partners or by expectations that being circumcised will provide enhanced feeling during sex. One 1997 study found that in comparison to circumcised men, uncircumcised men over 45 years of age are significantly more likely to lack enjoyment of sex, be anxious about their performance, and have difficulty maintaining erection. 

The Procedure

In newborns, circumcision takes only a few minutes, but the procedure in older children and adults is a more intricate operation. Local pain blocks are usually used, and the procedure itself is done on an outpatient basis, even in older men.

If phimosis or paraphimosis has caused a lot of swelling, the circumcision may require two procedures: one to make a slit in the foreskin that relieves the pressure and the pain, and another at a later date to finish the circumcision after the swelling has gone down.
                  
Risk Factors for Complications during the Procedure on Infants

• Infants whose mothers were taking blood thinners during pregnancy
• Infants with bleeding disorders
• Infants with infections or serious jaundice at the time of the circumcision
• Infants with penile deformities whose foreskin may be needed to repair the deformity
• Premature infants

What to Expect Prior to Procedure

• An anesthetic cream may be applied to the penis 60-90 minutes before the procedure to begin numbing the area.
• Blood and/or urine tests may be performed.
• The doctor will carefully examine the baby to make sure he is in good health and that the penis appears normal.
• During Procedure:  No medications or IV fluids are necessary during circumcision. A pacifier that has been dipped in a sugar solution may help keep the baby calm during the procedure.

Description of the Procedure

Local anesthesia is recommended during the procedure. The baby is carefully restrained on an infant board. The anesthesia is injected, at the base of the penis, or applied as a cream to reduce pain, and the penis is cleaned with an antiseptic solution. With appropriate anesthesia, the baby should feel only minimal pain.

There are a variety of ways to perform a circumcision. Most commonly, the foreskin is pushed from the head of the penis and clamped with a metal or plastic ring-like device.  If the ring is metal, the foreskin is cut off and the metal device removed. The circumcision heals in 5-7 days.

Also, the doctor pulls the foreskin away from the body of the penis while sweeping away any areas where tissue still adheres to the penis and putting pressure on blood vessels in the area that would otherwise bleed. The excess, unwanted foreskin is cut away. When circumcision is performed on adults or children other than infants, stitches may be used to sew the remaining bit of foreskin into place on the skin of the penis.

The foreskin can be removed by a number of different procedures. Some doctors use a simple scalpel to remove the foreskin, while others may use one of several devices designed to simultaneously ensure an even circumcision and clamp blood vessels in the area to prevent bleeding.

If the ring is plastic, a piece of suture is tied tightly around the foreskin. This pushes the tissue into a groove in the plastic over the head of the penis. Within 5-7 days, the plastic covering the penis falls free, leaving a completely healed circumcision. 

A sweetened pacifier or lollipop may be given to the baby during the procedure. This may reduce pain. Circumcision of older and adolescent boys is usually done while the child is completely asleep and pain-free -using general anesthesia-. The foreskin is removed and stitched onto the remaining skin of the penis. Stitches that will dissolve -absorbable sutures- are used and will be absorbed within 7 to 10 days.

Expectations after surgery

For both newborns and older children, circumcision is considered a very safe procedure.  The operation will take 15-30 minutes, no special medications are necessary after circumcision and, none hospital stay is necessary.

Among possible complications or risks are: 
      ·         Bleeding
      ·         Infection
      ·        Localized redness
        ·        Injury to the penis
        ·        Unsatisfactory cosmetic outcome, due to removal of too little or too much foreskin, or uneven appearance

Postoperative Care

•   Apply petroleum jelly or an antibiotic ointment to prevent the bandage from sticking to the  
    penis.
•   Change the bandage and clean the circumcised area at every diaper change. 

Convalescence

Healing time for newborns usually is about 1 week. Apply petroleum jelly -Vaseline- after diaper changes to protect the healing incision. Some initial swelling and yellow crust formation around the incision is normal.

Healing time for older children and adolescents may be up to 3 weeks. In most instances, the child will be discharged from the hospital on the day of the surgery. Suggestions for home care for older children include:

• Avoid vigorous exercise during the healing time.
• If the wound bleeds during the first 24 hours after surgery, apply pressure with a clean cloth for 10 minutes.
• Use ice packs -20 minutes on, 20 minutes off-  for the first 24 hours after surgery to reduce swelling and pain -only for older children and not newborn infants-. Bathing and showering are usually permitted. The incision may be gently washed with mild, unscented soap.
• Change the dressing at least once a day and apply an antibiotic ointment. If the dressing gets wet, change it promptly.
• Use prescribed pain medicine as directed. Pain medication should not be needed longer than 4 to 7 days. 

Call your pediatrician or surgeon if:

• Fresh bleeding occurs
• The entire penis looks red and swollen
• Pus drains from around the incision
• Pain becomes severe or lasts for longer than expected
• The plastic ring device has not fallen off within 10 days
• The baby develops a fever or appears to be in pain
• The baby does not have a wet diaper within about 6-8 hours of the procedure
• The head of the penis appears blue or black
• The penis or the area of the incision appears red, swollen, hot to the touch, or is oozing a yellowish discharge.

The Recovery

In most cases, men should refrain from sexual intercourse or masturbation for about six weeks after circumcision, until the incisions are healed and the sutures are removed. Some men experience frequent and prolonged erections in the first days after the surgery. After the first 48 hours or so, ointments or bandages aren't usually needed, but wearing loose clothing for a few days is recommended.

As with any surgical procedure, bleeding and infection are risks. Other more rare complications include blood clots, tearing of the sutures -usually due to erections- and complications from the anesthesia.

Making the Decision

If your medical condition warrants a circumcision, then surgery may be the right choice. But if you're considering the procedure solely for aesthetic reasons, think again; remember that there is no turning back.  Although a sexual partner may claim to prefer a man with a circumcised penis, your decision to have this procedure should not be based on another person's preference.

 

Trusted Health Information for You
 A service of the U.S. National Library of Medicine and the National Institutes of Health
Información también disponible en Español

Search MedlinePlus: