What is circumcision?
Circumcision is the surgical removal of the sleeve of skin and mucosal tissue that normally covers the glans (head) of the penis. This double layer, sometimes called the prepuce, is more commonly known as the foreskin.
What are the functions of the foreskin?
The foreskin serves three functions: protective, sensory, and sexual. In most cases, the foreskin is still fused to the glans at birth and will separate over a variable period of time over the first few years. During the diaper period, the foreskin protects against abrasion from diapers and faeces. Throughout life, the foreskin keeps the glans soft and moist and protects it from trauma and injury. Parts of the foreskin, such as the mucosa (inner foreskin) and frenulum, are particularly sensitive and contribute to sexual pleasure. Specialised nerve endings enhance sexual pleasure and control. The inner foreskin (mucosa) is the skin directly against the glans. The foreskin provides ample loose skin for the penis to occupy when erect. It is a movable skin sheath for the penis during intercourse, reducing chafing and the need for artificial lubricants, and allowing the glans and foreskin to naturally stimulate each other.
What are some reasons that circumcision is performed?
Phimosis is the inability to retract the foreskin fully. In babies and young boys this is normal. As the baby grows older, the foreskin separates from the underlying glans penis. In some individuals, this separation does not happen fully or due to repeated infection in that area the skin becomes scarred. It might also happen later in life. When the foreskin does not retract, it predisposes to repeated infection in that area. Also, sexual intercourse may become painful and result in bleeding. The only treatment at that stage is a minor operation called circumcision, in which the foreskin is surgically removed.
Is circumcision painful?
When done without pain medicine, circumcision is painful. There are pain medicines available that are safe and effective. It is recommended that they be used to reduce pain from circumcision. Local anaesthetics can be injected into the penis to lower pain and stress in infants. There are also topical creams that can help. Problems with using pain medicine are rare and usually not serious.
What to expect after the procedure?
After the circumcision, the tip of the penis may seem raw or yellowish. If there is a bandage, it should be changed with each diapering to reduce the risk of the penis becoming infected. The plastic ring that is left on the tip of the penis usually drops off within five to eight days. For both newborns and older children, circumcision is considered a very safe procedure with complete healing expected.
What are the health benefits?
Possible benefits of circumcision include:
- Circumcision prevents infection and inflammation of the foreskin. And it may decrease the risk of penile cancer.
- It might play a role in reducing the risk of sexually transmitted diseases. Practicing safe sex, however, is a far more important factor in preventing these diseases than whether a man is circumcised.
- Infants who are not circumcised may be more likely to develop urinary tract infections. These infections early in life may lead to kidney problems later in life. Infants who have kidney or bladder abnormalities are at higher risk of urinary tract infections, so circumcision may be advised for these babies.
- In rare circumstances problems can occur with the uncircumcised penis that may require circumcision at an older age. These problems include inflammation of the foreskin or adherence of the foreskin to the tip of the penis. Circumcision during infancy eliminates the possible need for the procedure at an older age.
- Circumcision makes it easy to keep the end of the penis clean. However, the shedding skin cells that naturally accumulate on the glans of an uncircumcised boy are not harmful. Do not try to force the foreskin back to clean the penis of an infant or young boy. Washing externally with mild soap and water is all that is necessary.
Like any minor surgery, circumcision poses some risk to the newborn:
- Circumcision may cause excessive bleeding or infection, but this is rare.
- Circumcision does cause pain. Local anaesthesia is frequently used. If you decide to have your son circumcised, you should to talk to your doctor about whether local anaesthesia will be used.
- Circumcision is a preventive measure but is by no means a guarantee that medical issues will not develop later in life at the tip of the penis.