Baby Circumcision: Should You Go For It?

Baby Circumcision

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If you are expecting a boy or have just given birth to your little son, one major decision that you will now have to take is about circumcision. Most times, new parents make this decision even before taking their baby boy home because if you choose to go ahead with circumcision, the earlier it is done, the better it is for everyone involved. In most cases, the decision to circumcise is a religious requirement. If that is the case, you don’t have to make any decision or discuss it with your partner. It is a foregone conclusion that your little one needs to get circumcised due to your religious or cultural beliefs. It has to happen, so the discussion is around when to do it and how to go about it. Nevertheless, it is important to understand the procedure to make sure that you know how to care for your boy later.

What Is Circumcision?

Baby boys are born with a hood of skin covering the tip of their penis. This tip of the penis is called the glans, and the skin covering is known as the foreskin. Circumcision is the process of surgically removing the foreskin, thereby exposing the tip of the penis. The foreskin is a double layer skin fold with a mucus membrane. It acts as a protective layer for your baby’s penis as it protects the glans from dryness or irritation caused due to wee and poo.

About 55% to 65% newborn boys undergo the circumcision every year in the US alone. The procedure is more widespread in the US, Canada, and the Middle East than in Asia, Europe, and Central and South America.

The procedure of circumcision is a ritual or a ceremony. In Islam, it is referred to as Khitan whereas the Jews call it Brit Milah (Bris). Rarely, will your baby require circumcision for medical reasons before the age of five.

In most cases, the decision to circumcise is religious, but many parents also consider circumcision because of hygiene concerns. After you decide your baby son should have a circumcision, doctors and health experts recommend a routine circumcision within the first 48 hours of birth, or before taking your baby home. It is usually a pediatric surgeon or obstetrician who will perform the routine circumcision at the hospital. The sooner you carry out the procedure, the fewer the complications.

There may be some cases, though, when the doctors may ask you to wait to conduct the circumcision. This is usually when the baby is premature, or there are medical issues with the newborn. In this case, the doctors may require you to wait till your little one is healthy enough to undergo the procedure.

On rare occasions, babies are born with physical abnormalities of the penis. In such cases, the doctor will advise against circumcision. This could be because your baby may eventually require reconstructive surgery to correct the penile abnormality.

[ Read: Fever In Babies ]

Making The Decision:

According to the American Academy of Pediatrics (AAP), the health benefits of newborn circumcision outweigh the risks associated with the procedure [1]. However, there is no substantial scientific evidence to this. Hence, the decision to circumcise baby boy rests solely with you.

Apart from the medical reasons, it is also the religion and culture that play a role in deciding whether your little one needs a circumcision. Typically, this is an elective procedure, and your health insurance may not pay for it. Very rarely do babies require circumcision for medical reasons.

Why Do Some Parents Choose To Have Their Sons Circumcised?

There are many hygiene-related reasons involved apart from religious beliefs and cultural values that make some parents opt for circumcision.

Circumcision is done on medical grounds among adult men, and it is unlikely to happen with babies. This procedure is done when other less risky procedures are not effective. Circumstances when circumcision is required are (2):

  • The foreskin is too tight to be pulled back from the penis. The condition is called phimosis and circumcision is opted if it does not subside through steroids.
  • The foreskin can be pulled back but cannot come to its original position. This is called paraphimosis and makes the penis swollen and painful.
  • Foreskin and the top of the penis are inflames and infected, in a condition called recurrent balanitis.
  • The person is suffering from balanitis xerotica obliterans, which causes phimosis and could lead to scars and inflammation on the penis.
  • Tests done in Africa have shown that circumcision helps avoid the risk of spreading HIV infection.

 Beliefs:

Muslims and Jews perform circumcision as a ritual and on religious grounds. There may also be times when parents choose circumcision because they do not want their son to be any different from the father or other boys.

Why Do Some Parents Choose Not To Have Their Sons Circumcised?

In most cases, parents do not choose circumcision for their son because of the pain involved. It is a surgical procedure of their son due to the pain. They are not comfortable with causing pain to their little bundle of joy. Also, they are worried about the risks involved with the surgery.

Other parents may feel it is not their decision to make. They prefer leaving the decision of circumcision to their son, who can make it when he is older. However, this may not be a practical choice, as performing circumcision later in life can cause complications.

You may decide not to get your son circumcised because of the impact it may have on him.

Decided To Circumcise – What Next?

After choosing to have your baby son circumcised, the next thing you have to decide is how and when to have the procedure. As stated earlier, the sooner you perform the procedure, the better is for you baby.

  • In some States of the US, obstetricians will consult you on whether you want to get a circumcision done the moment you know you are carrying a boy or immediately after the childbirth. In case, you choose to have your neonate circumcised at the hospital, the obstetrician may as well perform the minor surgery or get a pediatric surgeon to do it.
  • On the other, if you opt for circumcision due to your religious beliefs, a trained religious leader may perform it at the hospital or home. While this is a minor surgery, make sure the leader performs it in sterile conditions to prevent chances of infection.
  • There is a general perception that circumcision involves pain, but there are pain relief options that you can consider. You may want to check with the surgeon about pain management before you going ahead with the procedure. The more you discuss and gather information, the fewer apprehensions and doubts you will have. Also, you should discuss this issue with your partner so that you are on the same page.
  • Many parents often get stressed about this decision. You may be in two minds wondering whether circumcision is right for your son. It is important to realize whether you decide to circumcise or not, your boy will do just fine, as long as you teach him the basics of personal hygiene.

[ Read: Hygiene Tips For Babies ]

When Is Circumcision Performed?

Circumcision is usually performed during infancy. This is when your baby will be able to manage and overcome the pain better. At this age, your baby will be unable to move around or even move his legs. The lack of movement encourages quick healing.

  • If you have decided to get your son circumcised, doctors may recommend conducting the process before taking your baby home, which means within 48 hours of birth. However, since a majority of times, circumcision occurs due to religious and cultural beliefs, the age you choose to have your baby circumcised may depend on these rituals as well.
  • Newborn babies can be circumcised anytime. In Jewish culture, circumcision takes place when the baby is mere eight days old. In Islamic culture, there is no restriction on the age, but the process is mandatory. Most Islamic families opt to get the procedure in early infancy.
  • In Scotland, doctors recommend the use of general anesthesia to perform circumcision. Using general anesthesia is advisable if your baby son is more than six months and there are no health problems. Typically, in Scotland circumcision takes place when the baby is between six and nine months.
  • Circumcision can also be performed in older children or adults. However, it takes longer for the wound to heal, and the associated risks also increase with age.

How Is Circumcision Performed?

Circumcision is a surgical procedure. It is hence, advisable to be performed by a medical practitioner. Though it is a minor surgery and does not take too long, hospital care is essential. There are some cultures that require the circumcision be done at home, but this is not advisable.

A pediatric surgeon performs the procedure. But even an obstetrician or a general physician can carry out this procedure. In Jewish tradition, a trained circumciser, or mohel, carries out the ritual ceremony at home or in a synagogue. However, to prevent an infection, it is best to conduct the baby circumcision procedure under sterile conditions.

When doing the circumcision, the surgeon will most likely use local anesthesia to numb the area. This is a topical application, but at times, the doctor may opt for an injectable. If the physician chooses a topic anesthetic cream, he will apply it an hour prior t the procedure to give the penis adequate time to get numb. In the Jewish faith, the circumciser usually makes use of anesthesia.

There are several methods of conducting circumcision, but there are three that are the most popular. These three methods include the plastibell method, gomco method, and mogen method.

1. Plastibell Method:

The plastibell method is the most commonly use circumcision method. It is suitable for babies who weigh at least 5.5 lbs. In this procedure, the physician places a clear plastic ring tightly around the head of the penis. The baby’s foreskin is then removed by cutting it across and trimming the excess skin beyond the ring. The procedure takes around 10 minutes, and the surgeon will keep the plastic ring stays on the penis’ head to prevent bleeding after the surgery. The ring then falls off within seven days on its own.

2. Gomco Method:

This method of circumcision is suitable for babies who weigh up to 11 lbs. In this process, the surgeon uses a Gomco clamp. This clamp firmly holds about 1 mm of the foreskin. The foreskin is then cut. The Gomco protects the head of the penis from getting injured while the doctor removes the foreskin. The clamp is kept for about five minutes to prevent bleeding, and then the surgeon removes it to bandage the baby’s penis.

3. Mogen Method

This method of circumcision is for babies who weigh up to about 11 lbs. In this technique, the Mogen clamp is firmly fitted to hold the foreskin without cutting it. The surgeon then pulls the baby’s foreskin forward and through the slit of the Mogen clamp. The surgeon will then cut along the front surface of the clamp. This technique takes about 30 seconds to perform [2].

Regardless of the type of method your doctor recommends, you can always be present with your baby if you like. Of course, your baby will be in pain, but you should make sure that you keep your emotions under control so that you can soothe your baby. If you are breastfeeding, it is advisable to give your baby a feed after the procedure as this will calm him as well as help him feel secure and safe. Speak to your doctor about medication that is apt for your baby to help him deal with post-operative pain.

How To Prepare Your Son For Circumcision?

There is no significant preparation required when your baby is going to have a circumcision. However, you can do a few things before the procedure.

  • You can change your baby’s nappy and keep a fresh one handy.
  • Feed your baby so that it makes him less cranky and fretful during the surgery. However, consult your surgeon beforehand. If your infant gets general anesthesia, the doctor may ask you to refrain from feeding him before the surgery.

Apart from these, there are no other preparations needed. However, it is important that the baby is not ill and is in a stable, healthy condition. To perform the surgery, the doctor will place the baby on a special table. He will then clean the baby’s diaper area. The table will usually have clamps to hold the baby’s legs in place. This will reduce any complications during the procedure.

Pros and Cons Of Baby Circumcision:

There are both pros and cons to performing circumcision on a baby. Typically, babies who are circumcised have a lower risk of contracting urinary tract infections (UTIs) during their first year of life. UTIs are 10 times more common in boys who are uncircumcised [4].

Circumcision also reduces the likelihood of men developing penile cancer in their life. Also, penile problems such as irritation, inflammation, infections as well as the risk of sexually transmitted diseases (STDs) are more common in uncircumcised males. Moreover, it is a lot easier to clean and maintain hygiene in circumcised males.

According to the American Congress of Obstetricians and Gynecologists, there are some medical benefits of circumcision. Circumcised baby boy are at a reduced risk of:

  • Foreskin related infections
  • Sexually transmitted infections
  • Urinary tract infections
  • Penile cancer
  • Phimosis (a condition where the foreskin doesn’t retract) [3]

Although circumcision has medical and hygiene benefits, there are some risks involved too. Just like any surgical procedure, there are risks associated with newborn circumcision. These risks include:

  • Hemorrhage, which occurs in 35% cases
  • Wound infection in 10% newborn boys
  • UTI in about 2% cases
  • Meatitis in 8 to 20% neonates
  • Insufficient removal of the foreskin

[ Read: UTI In Babies ]

Here are a few more reasons that may prevent parents from considering circumcision for their newborn baby boy:

  • Surgical complications, such as infection of the surgical wound
  • Penile damage – cutting off too much or too little of the foreskin
  • Some people claim circumcision may reduce the sensitivity of the penis, and this may have an adverse impact on sexual stimulation

Of course, there is the element of pain that your baby will have to deal with during the procedure. Previously, doctors preferred not to give the neonate anything while getting circumcised. However, that is changing now, with the American Academy of Pediatrics (AAP) recommending pain relief. Today, many surgeons use the following while performing neonate circumcision:

1. A topical cream that needs about 20 to 40 minutes to become effective

2. An injectable anesthetic which starts acting almost instantaneously

Some doctors also suggest using an acetaminophen suppository that helps reduce the discomfort during the procedure and for several hours after the surgery. You can also keep your baby calm after the circumcision by giving him a sucrose-dipped pacifier.

What Happens After Circumcision?

After circumcision, your baby may experience some swelling, pain and redness. These side effects will eventually subside. A quick tip to alleviate discomfort is to make sure that you point your baby’s penis in the downward direction while changing his nappies. This will prevent rubbing and chafing of the glans, thereby reducing irritation. It will also help to give your baby some nappy-free time. The wound should heal in about 10 days.

Complications after the surgical circumcision done by experts under sterile conditions are not common. However, if you notice heavy bleeding or any sign of an infection, don’t panic. Instead, take your newborn to the ER right away. Early diagnosis and treatment can prevent further complications.

Caring For A Circumcised Penis:

Once the circumcision occurs, it is important to exercise a little extra caution in the initial few days as the penis will be prone to infections. Maintaining cleanliness is critical. Use warm water to gently clean the penis rather than wet wipes. Unlike what many mothers may think, it is better to use a diaper as this will keep the penis protected from any kind of injury. Also, keeping the diaper on will also protect the newly circumcised penis from germs and hence, preventing infections. However, when using a diaper, make it a point to change it often.

Your surgeon may recommend applying petroleum jelly on the penis so that there is less friction with the diaper and hence, less discomfort. Be sure to follow this advice or speak to your healthcare provider about using petroleum jelly.

If the surgeon bandages your baby’s penis, you may have to change the bandage whenever you change the diaper for at least three days after the surgery. Penis of newborns tends to heal in less than seven days, so that is a blessing in disguise. You may notice swelling of the penis or even bloody discharge in the diaper. Again, don’t panic. This is common and will resolve in a few days. However, if you following symptoms persist, you should rush your baby to the ER without delay:

  • Persistent bleeding
  • Increase in redness and swelling in the penis instead of subsiding
  • Fever
  • Pus discharge
  • Not urinating normally eight hours after the surgery

These complications may occur in a few cases, but quick medical intervention will almost always resolve them. The American Association of Pediatrics states that severe complications in neonates are rare [5].

[ Read: Baby Diaper Brands ]

Quick Tips On Newborn Circumcision Care:

It is rather natural that you will be a little nervous when your baby has a circumcision. The fact is that your baby’s penis may appear too fragile but it isn’t. Whether a doctor or religious circumciser performs the surgery, as long as they use sterile instruments and equipment, the chances of complications are minimal. Nonetheless, you can help the healing and recovery of the penis.

Here are a few tips to facilitate healing of the penis after circumcision:

1. Keep the diaper area clean. Do not wipe but wash with warm water.

2. Allow the penis to air dry after cleaning it

2. Apply petroleum jelly or OTC antibiotic cream to prevent the penis from adhering to the diaper. Be liberal with the application

3. You may try using double diapers to provide a cushion to your baby. If you sense your infant is in too much pain, you can keep some ice between the two diapers to reduce the pain

4. Give your baby acetaminophen after checking with your pediatrician for the pain

5. Keep a check on the wound to see any first signs of infection and to be sure that it is healing well

6. Do not scrape off any crusting on the penis. It will fall off on its own [6]

Caring For An Uncircumcised Penis:

Cleanliness and hygiene are important whether the penis is circumcised or not. In fact, it becomes more critical if you decide to leave your little one’s penis uncircumcised.

You will not need any extra cotton swabs, any particular soap or astringent to clean an uncircumcised penis. Using warm water will help you clean your baby’s penis thoroughly.

When your son is small, it is not advisable to pull back the foreskin and clean beneath it. The foreskin will retract on its own as your baby gets older. After it starts retracting, you will be able to pull back the foreskin and clean under it. Usually, this occurs by the time your baby reaches the age of five.

As your boy grows, you will need to teach him to thoroughly clean his penis by washing underneath the foreskin. Teach your son how to pull back his foreskin and clean the glans and surrounding area and then pull the foreskin back over the head of the penis.

Risks Of Circumcision:

If an experienced surgeon performs the circumcision, you needn’t worry about complications, as they are rare. However, if complications occur, let your healthcare provider know of them. Some complications that can develop after circumcision include:

  • Oozing of blood from the surgical site
  • Infection around the urethra
  • Irritation of the exposed glans due to contact with urine or stools

Long-term or severe risks are rare. These risks usually do not occur in routine circumcisions.

Circumcision is a lifelong and irreversible procedure that will have an impact on not just the medical or physical health of your son, but also his psychological health. So think through before opting for it. Remember, there are advantages and disadvantages of circumcision. Weigh both with care and then make an informed decision.

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