Circumcision

Circumcision refers to the surgical removal of the foreskin (prepuce) of the penis. In the United States, circumcision in infant boys is usually performed for cultural or religious reasons. In addition, infant circumcision provides some medical advantages. Studies indicate that uncircumcised boys under the age of five are 20 times more likely than circumcised boys to suffer infections of the urinary tract. Older boys undergo circumcision because of inflammation of the penis, for social reasons, to improve hygiene, and for a condition called phimosis (a tightening of the foreskin that may close the opening of the penis.) Often circumcision is done at the same time as other surgery. Beyond childhood, circumcised men are less likely to suffer phimosis. There are also indications that circumcised men are less likely to suffer from cancer of the penis or inflammation of the penis. There are also studies indicating that circumcised men have fewer sexually transmitted diseases. The medical advantages are considered to be slight, because conditions such as phimosis and cancer of the penis are rare even in men who have not been circumcised. Overall, the minor benefits of circumcision seem balanced by the minor risks, and the preferences of the parents usually determine whether a boy is circumcised or not.

Circumcision should not be performed on infants with certain deformities of the penis that may require a portion of the foreskin for repair. Also, infants with a large hydrocoele or hernia may suffer important complications. Premature infants or infants with serious infections are also poor candidates for circumcision. Circumcision should not be performed on infants with hemophilia or other bleeding disorders or on infants whose mothers were taking anticoagulant drugs (drugs that keep blood from clotting). In older boys or men, circumcision is a minor procedure. Therefore, it can be performed in virtually anyone without a serious illness or unusual deformity.

In infants, the foreskin is pulled tightly into a specially designed clamp, and the foreskin pulls away from the broadened tip of the penis (glans). Pressure from the clamp stops bleeding from blood vessels that supplied the foreskin. In older boys or adults, an incision is made around the base of the foreskin, the foreskin is pulled back, and then it is cut away from the tip of the penis. Stitches are usually used to close the skin edges.

Despite a long-standing belief that infants do not experience serious pain from circumcision, most authorities now believe that some form of local anesthesia is necessary. In older boys, the doctor will inject local anesthesia at the base of the penis, blocking key nerves.

Complications following newborn circumcision appear to occur 0.2-2% of the time. Most complications are minor. Bleeding accounts for about half of the complications, and it is usually easy to control. Infections are rare. There may be injuries to the penis itself, and in very unusual cases these can be difficult to repair.