Circumcision

Alternative names
foreskin removal; excision of penile foreskin; removal of foreskin

Definition
Surgical removal of the foreskin of the penis.

Description
Circumcision of a newborn boy is usually done before he leaves the hospital. A numbing medication (local anesthesia such as Xylocaine) is injected into the penis to reduce pain. Ring-type clamps are placed around the foreskin, tightened like a tourniquet to reduce bleeding, and the foreskin is removed below the clamp. The clamp may be metal or plastic (Plastibell). The Plastibell will fall off in 5 to 8 days, after the surgical site has healed.

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.

Indications
The common indication for circumcision is cultural or religious desire for circumcision.

Other indications (rare):

• treatment for inability to pull back the foreskin completely (phimosis)
• infection of the penis (balanitis)

Expectations after surgery
For both newborns and older children, circumcision is considered a very safe procedure with complete healing expected.

Convalescence
Healing time for newborns usually takes about 1 week. Apply petroleum jelly 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 take 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.
• 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 more than expected.

Risks
Risks for anesthesia are:

• reactions to medications
• breathing problems (general anesthesia)

Risks for any surgery are:

• bleeding
• infection

Additional risks include:

• injury to the penis