Newborn Circumcision

Circumcision is a surgical procedure to remove the skin covering the end of the penis, called the foreskin. In many cultures, circumcision is a religious rite or a ceremonial tradition. It is most common in Jewish and Islamic faiths. In the United States, newborn circumcision is an elective procedure. An estimated 55 to 80 percent of newborn boys undergo circumcision. However, this number varies among socioeconomic, racial and ethnic groups.

How should I initially evaluate and manage my patient?

The American Academy of Pediatrics (AAP) issued a policy statement in 1999 on the use of circumcision. This policy was most recently updated in 2012. The AAP recognizes the following information from studies of both circumcised and uncircumcised males:

Problems with the penis, such as irritation, can occur with or without circumcision.
There is no difference in hygiene, as long as proper care is followed.
There may or may not be any difference in sexual sensation or practices in adult men.
There is an increased risk of urinary tract infection in uncircumcised males, especially in babies younger than 1 year of age. However, the risk for urinary tract infections in all boys is less than 1 percent.
Newborn circumcision does provide some protection from cancer of the penis. However, the overall risk of penis cancer is very low in developed countries, such as the United States.
There is a decreased risk of certain sexually transmitted diseases (including HIV) in circumcised males.
The most current AAP report found that the health benefits to circumcision outweigh the risks. However, these benefits are not significant enough to recommend that all newborn baby boys be
circumcised. The AAP recommends that parents should be given information on the benefits and risks of newborn circumcision and that parents should decide what is best for their baby.

Initial Management:

What care is needed for an uncircumcised penis?

As the baby grows, the foreskin becomes looser and is able to be retracted (moved back). This may take many months to years. Your baby's doctor will check this as part of your baby's checkups and will show you how to retract the foreskin. This allows cleansing of the area. As a boy grows, he should be taught how to retract the foreskin and clean himself. The foreskin should never be retracted forcibly. Do not allow the foreskin to stay retracted for long periods as this may shut off the blood supply causing pain and possible injury. Sometimes the foreskin becomes stuck in the retracted position and cannot be pulled back down. This is called paraphimosis and is a medical emergency.

In some children, the foreskin cannot be retracted because of a restricted opening, causing a condition called phimosis. This condition may require circumcision later in childhood if it doesn't respond to medical treatment.

When should I refer my patient?

How can I refer my patient?

What can my patient expect from a visit to Children’s National?

Your patient will undergo a physical examination by one of the pediatric urologists. If the anatomy is conducive to newborn circumcision, then one can be performed the same day that the consultation is rendered.

How is circumcision performed?

Circumcision is usually performed by the obstetrician in the hospital. When it is done for religious reasons, other persons may do the surgery as part of a ceremony after the baby is discharged from the hospital.
Circumcision is performed only on healthy babies. Because the procedure is painful, the AAP recommends using some type of local anesthesia for newborn circumcision. Several types of anesthesia are available, including a numbing cream or injecting small amounts of anesthetic around the penis. Although there are risks with any anesthesia, local anesthesia is considered very safe.
At Children’s National, we use the Gomco clamp method of circumcision. We begin by separating the foreskin from the head of the penis, cutting a small slit in the foreskin, and placing the clamp on the foreskin. The clamp is left in place for a few minutes to stop the bleeding. The foreskin can then be cut and removed.

What care is needed after a circumcision?

Circumcisions performed by a qualified doctor rarely have complications. Problems that occur are usually not serious. The most common complications are bleeding and infection. Proper care after circumcision helps reduce the chances of problems.

Your baby's doctor will give you specific instructions on the care of the circumcision. It is important that you keep the area clean. After the procedure:

There may be a gauze dressing with petroleum jelly or an antibiotic cream. This may be removed at the first diaper change. Your baby's doctor may recommend applying a new dressing.
The head of the penis may be very raw and red looking.
There may be a small amount of blood at first or yellow-colored drainage later. These are part of normal healing.
Your baby may have some discomfort with diaper changes the first few days.
Keep the penis clean with soap and water.
Circumcisions usually heal within one to two weeks.

Your baby may be fussy after circumcision. Cuddling him close and breastfeeding can help comfort him. Most boys do not require special care of the penis after the circumcision is healed.