• Child Circumcision

    (Circumcision—Child)

    Definition

    Circumcision is the removal of the foreskin of the penis. The foreskin is a flap of skin that covers the tip of the penis.
    Circumcision
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    Reasons for Procedure

    Circumcision is most often done for cultural or religious reasons. It is usually done during the within the first few days of life. Circumcision may be done on older boys as a treatment for medical problems. Problems may include foreskin that is too tight or foreskin that cannot retract.
    Circumcision may be associated with decreased risk of:
    • Urinary tract infection
    • Phimosis (tightening of the foreskin, which can be severe enough to close off the opening to the penis)
    • Penile cancer
    • Cervical cancer in sexual partners
    • Certain sexually transmitted diseases, like HIV
    Talk to your doctor about the risk and benefits of circumcision for your child.

    Possible Complications

    Complications are rare, but may include:
    • Infection
    • Bleeding
    • Reaction to anesthesia
    • Unsatisfactory cosmetic outcome (foreskin is cut too short or left too long)
    • Foreskin does not heal properly
    • Decreased penile sensation
    • Damage to the tip of the penis
    Factors that may increase the risk of complications include:
    • History of bleeding disorders in the family
    • Chronic illness
    Talk to the doctor about these risks before the circumcision.

    What to Expect

    Prior to Procedure

    Your child will have a physical exam. The penis will be examined for any complications. Your child may also need blood and urine tests done.
    Your child may not be able to eat or drink after midnight the night before the procedure. Ask your doctor when your child should stop eating and drinking.

    Anesthesia

    General anesthesia will be used. It will be given through an IV and gas. Your child will be asleep for the entire procedure.

    Description of Procedure

    The anesthesia will be given. Once your child is asleep, the foreskin will be pulled away from the penis. The foreskin may have some areas attached to the head of the penis. The doctor will cut these attachments. The excess foreskin will then be cut away. If needed, stitches may be placed to stop bleeding.
    Petroleum jelly or an antibiotic ointment will be smeared on the penis. A bandage may be applied.

    Immediately After Procedure

    Your child will be monitored in a recovery room.

    How Long Will It Take?

    Less than one hour

    How Much Will It Hurt?

    Your child will have some discomfort. Anesthesia will help block pain. Your doctor may recommend medication to manage discomfort after the circumcision.

    Post-procedure Care

    There may be swelling of the penis. A clear scab may also develop over the area. The penis should heal within 7-10 days of the circumcision.
    At Home
    It is important to keep your child’s penis clean while the circumcision heals. Follow these steps to promote good healing:
    • If there is a bandage, follow your doctor's instructions on when to remove it. In general, replace the dressing after your child uses the bathroom for the first 36-48 hours after surgery.
    • Once the dressing has been removed, keep the penis clean with mild soap and water.
    • Supportive underwear may keep your child more comfortable.
    • If instructed, apply antibiotic ointment or petroleum jelly to the area
    • Ask your doctor about when it is safe for your child to bathe or soak in water.
    • Be sure to follow your doctor’s instructions.
    Your child may have some discomfort while urinating for the first few days. Use pain medication as prescribed.

    Call Your Doctor

    After arriving home, contact your doctor if any of the following occurs:
    • The penis or the area of the incision appears red, swollen, or is hot to the touch
    • Incision or penis is oozing a yellowish discharge after 3-5 days (some discharge is normal in first few days)
    • Fever
    • Pain is not controlled by the medicine recommended
    • The head of the penis is blue or black
    If you think you have an emergency, call for medical help right away.

    RESOURCES

    Family Doctor.org http://www.familydoctor.org

    Health Children.org http://www.healthychildren.org

    CANADIAN RESOURCES

    AboutKidsHealth http://www.aboutkidshealth.ca

    Canadian Paediatric Society http://www.cps.ca

    References

    Blank S, Brady M, Buerk E. Circumcision policy statement. American Academy of Pediatrics. Pediatrics. 2012;130(3):585-586.

    Caring for Your Son's Penis. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/ages-stages/baby/bathing-skin-care/Pages/Caring-For-Your-Sons-Penis.aspx. Updated October 24, 2011. Accessed January 8, 2013.

    Circumcision. American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/pregnancy-newborns/caring-for-newborns/infant-care/circumcision.html. Updated December 2010. Accessed January 8, 2013.

    Circumcision. American Academy of Pediatrics Healthy Children website. Available at: http://www.healthychildren.org/English/ages-stages/prenatal/decisions-to-make/Pages/Circumcision.aspx. Updated August 27, 2012. Accessed January 8, 2013.

    Circumcision. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 20, 2012. Accessed January 8, 2013.

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