Circumcision is the removal of the foreskin. The most common reasons for circumcision include personal preference, improvement in hygiene, prevention of infection, cultural customs, or religious beliefs.
There are benefits as well as risks for this procedure, just like any surgical procedure. The main benefits of circumcision are reduced risk of urinary tract infections in infancy and sexually transmitted diseases in adulthood, and virtual elimination of risk of penile cancer. The most common medical indications for circumcision are: inability to retract the foreskin (phimosis) at an age when it should be retractable, penile infections, urinary tract infections, chronic inflammatory changes of the foreskin, or the presence of a congenital urinary tract abnormality that increases the risk of urinary tract infections.
Contraindications: There are certain situations when circumcision should not be performed in the office setting. These are typically congenital penile conditions and include: the presence of abnormal penile curvature and/or twisting, buried/hidden/concealed penis, micropenis, abnromal development of foreskin, or hypospadias. In most of these conditions, circumcision is performed at the same time the more serious penile condition is repaired. We usually wait till the boy is old enough to tolerate general anesthesia well, typically after 4-6 months of age, depending on the child’s general health condition and the penile condition to be repaired.
In Office Circumcision
Newborn circumcision can be performed in our office with local anesthesia in newborn boys who are healthy, weighs less than 12 lbs, and younger than 6-7 weeks old at the time of the circumcision. Often, a premature boy who has stayed in the NICU for more than a few days misses the opportunity to have the circumcision done at the pediatrician’s office. We may still be able to do the circumcision in the office provided the boy meets the above criteria.
The procedure typically takes between 15-30 minutes. Infants may be fed half-way just prior to the procedure. He should also be given a small dose of acetaminophen, typically 1.25 mL of the acetaminophen 160 mg/5 mL liquid that can be bought over the counter at any pharmacy.
In the office, we allow parents to be present during the procedure, but it is not required. As soon as the procedure is completed, the parents are able to hold and feed the baby. The parents are given written instructions for post procedure management and are also given verbal instructions by the physician and the staff. Most post procedure pain can be managed with small doses of acetaminophen.
Complications of Circumcision
The most common immediate complication of newborn circumcision is bleeding; less common is infection. The most common intermediate term complication is penile skin adhesion. Most of the time, bleeding is limited and can be controlled with gentle manual compression of the bleeding site for 10 minutes. If bleeding does not stop, please call our office immediately. No antibiotics by mouth or applied locally is needed as the infection risk is low. The key is to keep the area clean through regular bathing with warm water and non-irritating baby shampoo (the “no tear” kind).
Typically, we will see the child again in two weeks to make sure the circumcision has healed properly.
What we look for mainly are signs of infection and penile skin adhesion. If adhesion develops, it can usually be treated fairly easily at this stage with application of a steroid cream. Sometimes, gentle manipulation of the skin to separate the adhesion may be necessary.