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Circumcision

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Circumcision
Whetheryou'reexpectingababyboyorhavejustwelcomedyournewlittleguyintotheworld,youhave
animportantdecisiontomakebeforeyoutakeyoursonhome:whethertocircumcisehim.
Forsomefamilies,thechoiceissimplebecauseit'sbasedoncultural
orreligiousbeliefs.Butforothers,therightoptionisn'tasclear.
Beforeyoumakeacircumcisiondecision,it'simportanttotalkto
yourdoctorandconsidersomeoftheissues.

AboutCircumcision
Boysarebornwithahoodofskin,calledtheforeskin,coveringthe
head(alsocalledtheglans)ofthepenis.Incircumcision,theforeskin
issurgicallyremoved,exposingtheendofthepenis.

Wasithardtodecideif
youshouldcircumcise
yourson?
Yes
No

Vote
ViewResults

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Approximately55%to65%ofallnewbornboysarecircumcisedintheUnitedStateseachyear,though
thisratevariesbyregion(westernstateshavethelowestratesandthenorthcentralregionhasthe
highest).TheprocedureismuchmorewidespreadintheUnitedStates,Canada,andtheMiddleEastthan
inAsia,SouthAmerica,CentralAmerica,andmostofEurope,whereit'suncommon.
Parentswhochoosecircumcisionoftendosobasedonreligiousbeliefs,concernsabouthygiene,or
culturalorsocialreasons,suchasthewishtohavetheirsonlooklikeothermeninthefamily.
Routinecircumcisionisusuallyperformedduringthefirst10days(oftenwithinthefirst48hours),either
inthehospitalor,forsomereligiousritualcircumcisions,athome.
Ifyoudecidetohaveyoursoncircumcisedatthehospital,yourpediatrician,familydoctor,or
obstetricianwillperformtheprocedurebeforeyoubringyourbabyhome.Thedoctorshouldprepare
youbytellingyouabouttheprocedureheorshewilluseandthepossiblerisks.Circumcisionafterthe
newbornperiodcanbeamorecomplicatedprocedureandusuallyrequiresgeneralanesthesia.
Insomeinstances,doctorsmaydecidetodelaytheprocedureorforgoitaltogether.Prematurebabiesor
thosewhohavespecialmedicalconcernsmaynotbecircumciseduntilthey'rereadytoleavethehospital.
Andbabiesbornwithphysicalabnormalitiesofthepenisthatneedtobecorrectedsurgicallyoftenaren't
circumcisedatallbecausetheforeskinmayeventuallybeusedaspartofareconstructiveoperation.

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TheProsandCons
Ontheplusside,circumcisedinfantsarelesslikelytodevelopurinarytractinfections(UTIs),especiallyin
thefirstyearoflife.UTIsareabout10timesmorecommoninuncircumcisedmalesthancircumcised
infants.However,evenwiththisincreasedriskofUTI,only1%orlessofuncircumcisedmaleswillbe
affected.
Circumcisedmenalsomightbeatlowerriskforpenilecancer,althoughthediseaseisrareinboth
circumcisedanduncircumcisedmales.Somestudiesindicatethattheproceduremightofferanadditional
lineofdefenseagainstsexuallytransmitteddiseases(STDs)likeHIVinheterosexualmen.ForHIVin
particular,thefindingscomefromstudiesdoneonpopulationsofAfricanmen,andsomeexpertsfeel
thatthesedatamightnotbeasrelevanttomeninotherareasoftheworld,liketheUnitedStates.
Penileproblems,suchasirritation,inflammation,andinfection,aremorecommoninuncircumcised
males.It'seasiertokeepacircumcisedpenisclean,althoughuncircumcisedboyscanlearnhowtoclean
beneaththeforeskinoncetheforeskinbecomesretractable(usuallysometimebeforeage5).
Somepeopleclaimthatcircumcisioneitherlessensorheightensthesensitivityofthetipofthepenis,
decreasingorincreasingsexualpleasurelaterinlife.Butnoneofthesesubjectivefindingsareconclusive.
Althoughcircumcisionappearstohavesomemedicalbenefits,italsocarriespotentialrisksasdoesany
surgicalprocedure.Theserisksaresmall,butyoushouldbeawareofboththepossibleadvantagesand
theproblemsbeforeyoumakeyourdecision.Complicationsofnewborncircumcisionareuncommon,
occurringinbetween0.2%to3%ofcases.Ofthese,themostfrequentareminorbleedingandlocal
infection,bothofwhichcanbeeasilytreatedbyyourdoctor.
Oneofthehardestpartsofthedecisiontocircumciseisacceptingthattheprocedurecanbepainful.Inthe
past,itwasn'tcommontoprovidepainrelief.ButtheAmericanAcademyofPediatrics(AAP)
recommendsitandstudiesshowthatinfantsundergoingcircumcisionbenefitfromanesthesia,somost
doctorsnowuseit.Butbecausethisisafairlynewstandardofcare,it'simportanttoaskyourdoctor
aheadoftimewhat,ifany,painreliefyoursonwillreceive.
Twomaintypesoflocalanestheticareusedtomaketheoperationlesspainfulforababy:
1. atopicalcream(acreamputonthepenis)thatrequiresatleast20to40minutestotakeitsfull
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effect
2. aninjectableanestheticthatrequireslesstimetotakeeffectandmayprovideaslightlylonger
periodofanesthesia
Inadditiontoanesthesia,anacetaminophensuppositorycanbeinsertedintothebaby'srectum.This
helpsreducediscomfortduringtheprocedureandseveralhoursafterward.Givingapacifierdippedin
sugarwateralsocanhelpreduceababy'sstressanddiscomfort.

CaringforaCircumcisedPenis
Followingcircumcision,itisimportanttokeeptheareaascleanaspossible.Gentlycleanwithwarmwater
donotusediaperwipes.Yourdoctorsmayrecommendputtingadabofpetroleumjellyonthebaby's
penisoronthefrontofthediaperfor3to5daystoeaseanypotentialdiscomfortcausedbyfriction
againstthediaper.
Ifyoursonhasabandageonhisincision,youmightneedtoapplyanewonewheneveryouchangehis
diaperforadayortwoaftertheprocedure(putpetroleumjellyonthebandagesoitwon'tsticktohis
skin).
Itusuallytakesbetween7to10daysforapenistoheal.Initiallythetipmayappearslightlyswollenand
redandyoumaynoticeasmallamountofbloodonthediaper.Youalsomaynoticeaslightyellow
dischargeorcrustafteracoupleofday.Althoughthisisnormal,certainotherproblemsarenot.
Callyourdoctorrightawayifyounoticeanyofthefollowing:
persistentbleedingorbloodondiaper(morethanquartersized)
increasingredness
fever
othersignsofinfection,suchasworseningswellingordischarge,orthepresenceofpusfilled
blisters
noturinatingnormallywithin12hoursafterthecircumcision
However,withquickintervention,almostallcircumcisionrelatedproblemsareeasilytreated.

CaringforanUncircumcisedPenis
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Aswithapenisthat'scircumcised,anuncircumcisedoneshouldbekeptclean.Also,nocottonswabs,
astringent,soap,oranyspecialbathproductsareneededjustwarmwatereverytimeyoubatheyour
babywillsuffice.
Initially,donotpullbacktheforeskintocleanbeneathit.Overtime,theforeskinwillretractonitsownso
thatitcanbepulledawayeasilyfromtheglanstowardtheabdomen.Thishappensatdifferenttimesfor
differentboys,butmostcanretracttheirforeskinsbythetimethey're5yearsold.
Asyoursongrowsup,teachhimtowashbeneaththeforeskinbygentlypullingitbackfromtheglans,
rinsingtheglansandtheinsideoftheforeskinwithwarmwater,thenpullingtheforeskinbackoverthe
headofthepenis.

TheCircumcisionDecision
Afterreviewingmultiplestudiesoncircumcision,theAAPreportsthat"thehealthbenefitsofnewborn
malecircumcisionoutweightherisks."Butatthecurrenttime,thescientificevidenceisnotstrong
enoughfortheAAPtorecommendroutinecircumcisionofallnewbornboys.Instead,theAAPadvises
parentstolearnthefactsaboutcircumcisionandweightheprosandcons.
Inadditiontoconsideringthemedicalfactors,religiousandculturalbeliefsmightplayarole.Iftheseare
importanttoyou,theydeservetobeseriouslyconsidered.
Talktoyourdoctortohelpyoumakethechoicethat'srightforyourson.
Reviewedby:ElanaPearlBenJoseph,MD
Datereviewed:March2013

Note:AllinformationonKidsHealthisforeducationalpurposesonly.Forspecificmedicaladvice,
diagnoses,andtreatment,consultyourdoctor.
19952015TheNemoursFoundation.Allrightsreserved.
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