CIRCUMCISION

The removal of the foreskin of a young male is a custom dating back centuries. It has been shown in the past, that in the setting of poor hygiene (i.e., the American frontier or wandering in the desert for forty years), the risk of penile cancer is reduced by circumcision. In this day of easy access to soap and water, this is much less of an issue. The reason circumcision is done these days is frequently because the father is circumcised. There is also concern that since most males in this country are circumcised, when the child gets older, he may not feel like one of the guys if he is in the minority in the locker room. These issues can both be overcome with communication and honest answers to the child's questions.

Why do a circumcision then? Well, in some children the procedure ends up having to be done anyway, when the child gets older, because the foreskin may not retract or the child develops infections under the foreskin. There also appears to be fewer bladder infections in boys that have been circumcised. The surgery on an older child is a lot bigger deal, requires a general anesthesia, and stitches on the penis. My father had it done when he was in his 60s. Ouch.  Circumcision also decreases the risk of a male acquiring HIV by about 60% if exposed.{See Circ Article}

What are the risks of having it done? When the circumcision is done shortly after birth it is a minor procedure, but the procedure has the same risks that any surgery. The other primary risks of surgery are bleeding, infection and injury. The foreskin has a very good blood supply, which is sealed off by one of several types of clamps. There can still be some minimal bleeding which very rarely may require a stitch on the tip of the penis (I have never needed to do this). Infection is also uncommon because the area does have such a good blood supply. The body generally fights off infection quite well in that area.  Anesthesia can cause rare allergic reactions. I use local anesthesia even though the child will not remember the circumcision, I feel without anesthesia a circumcision is inhumane. The last risk is an unplanned injury. This is a surgery, and any time you expose skin to scalpel, things can go a wry. If a doctor was doing a circumcision in San Francisco when the earthquake hit there is no telling what would have happened. Despite all this the procedure takes about ten minutes and is generally quite simple.

How is it done? There are two common ways of performing this procedure: the Plastibell and the Gomco clamp. The Plastibell is placed within the foreskin and tied in place with a string. The string cuts the foreskin over the next few days and the device and the foreskin fall off. There will occasionally be a little bleeding when this happens, but this although sometimes frightening, is universally self-limiting. I use the Gomco clamp because, when I'm done, it's done and the tip of the penis looks the way it will look. If it doesn't bleed then it won't bleed later.

When is the procedure done? It is done after the pediatrician has examined the child and has given me the O.K. This is usually when the baby is somewhere around 24 hours old. The infant is frequently circumcised on the day of discharge. After the surgery the baby is observed for about an hour before discharge.

Why doesn't the pediatrician do the circumcision? Some do, it's up to you who does it. This procedure is a family's decision and I don't push either way. I offer it to all my patients that deliver male infants. In some circles this is a very heated issue and I don't want to cut it short (so to speak). If you have any questions that this has not answered give me a call.

 

FRED CREUTZMANN, M.D. CARROLLTON

972-394-7277 or www.DrCmd.com

Medical Info