Circumcision

By Philip E. Gleason, MD

 

I would like to provide introductory information regarding a circumcision. This is typically considered for young boys. It is occasionally performed on older men. Historically, in the 1950's and 1960's, approximately 95% of boys were circumcised, In the 1970's, the pendulum began to swing against circumcision as perhaps an unnecessary procedure and the rate of circumcision dropped to approximately 50% of boys. In the 1980's and 1990's, there is again felt to be some medical benefit to circumcision, although small, and approximately 75% of boys are now circumcised.

The decision to consider circumcision involves 3 separate thought processes or considerations. These include medical considerations, religious considerations, and personal/family considerations. From a medical standpoint, there is small benefit to being circumcised. There is good evidence that boys who are circumcised have a lower chance of urinary tract infections (UTI's) than boys that are not. In addition, circumcision prevents eventual difficulties with balanitis which is an infection of the foreskin as well as scarring of the foreskin, phimosis, or paraphimosis. In addition, there has never been a reported case of penile cancer in men who were circumcised at a young age. There is, therefore, medical benefit from circumcision. However, all of these risks are, in fact, in and of themselves, quite small. The chances of infections, foreskin abnormalities, or penile cancer are all approximately 1% in boys and men. Therefore, while there is medical benefit, the amount of benefit is small.

Religious considerations are certainly important. I really will not discuss those here as those are typically self-evident.

Personal and family considerations are also important, Some families have a long history of having circumcision done while others do not. Certainly the parent and family wishes are important.

Circumcisions can technically be performed in different manners. In the very early newborn, the penis can be anesthetized with numbing medication and circumcision performed with a Gomco clamp. This is by far the most common technique used. It is typically performed by your obstetrician following the birth of your son. Once the child is more than a few weeks of age, attempts at local circumcision with a Gomco are quite difficult and poorly tolerated. We therefore typically consider pursuing this with an anesthetic. If the child is very young, we usually wait until 3-6 months of age to ultimately minimize anesthetic risk and perform circumcision on an out patient basis in the hospital. Typically the child comes to the hospital in the morning and receives a general anesthetic. The excess redundant foreskin is removed and skin edges are closed with chromic absorbable suture. The procedure itself takes approximately 45 minutes. The child is typically released from the hospital without any difficulties. They are oftentimes somewhat fussy, cranky, or uncomfortable for approximately 1-3 days. We offer pain medication including Tylenol with codeine. Approximately 50% of families use this for the first few days and think it does a very good job. Approximately 50% of families just use Tylenol or Advil and likewise think that does a very good job. After the third day, the children are usually recovered. The sutures last approximately one week to 10 days and will dissolve and disappear on their own. We oftentimes see the child back in our office approximately 2 weeks after surgery to make sure they have done well and gotten a good result.

In adult men, the circumcision can again be performed with local anesthetic on an out patient basis at the hospital. The penis is sterilely prepared and anesthetized. The foreskin is removed and skin sutures are placed. There is again prompt recovery. Fortunately, circumcision typically is very well tolerated and produces a very good cosmetic and functional result. Complications are exceedingly rare.

I hope this will provide some background information regarding considerations and the techniques of circumcision. I hope this will help you in your decision-making and care. If you have any questions, we would certainly be happy to answer those.

© 2005-2010, Dr. Philip E. Gleason, MD