Circumcision

Circumcision is commonly performed in the newborn period. This is an elective procedure.

Should you circumcise your son?

This is up to the family. The American Academy of Pediatrics currently does not recommend it be done in all instances, but does endorse the procedure. Sometimes the decision is based on religion. Many parents want their son to look like his father or brother. If your baby is circumcised, the penis becomes very easy to clean for parents and ultimately for the child and adult, which helps reduce the risk of infection from bacteria. Circumcised infants have a lower risk of urinary tract infections in the first year of life. If your son is not circumcised the foreskin usually is able to be pulled back by the age of 3 - 6 years. This allows the skin to be pulled back and washed, initially by parents, then you teach your son to do the same with daily bathing. The foreskin should never be forcefully retracted, but you may gently retract the skin for general cleaning. If you decide to leave the foreskin alone, you should monitor your child for any signs or symptoms of penile discomfort or pain with urination.  If this occurs, please bring it to the attention of your pediatrician.

If you chose to not circumcise your son, please visit our Care of the Uncircumcised Penis page.

How common is circumcision?

circumcision rates

Source: CDC

As you can see, the rates of circumcsion vary by where you live. Rates are high in the Midwest, about 75%.

What are the risks of circumcision?

The most common risks associated with circumcision are bleeding and infection, but this only happens in 0.2 percent of cases, or about 1 in every 500 procedures. 

Risk of bleeding increases if a baby has a bleeding disorder or has not received a Vitamin K shot. We will ask about family history of bleeding disorders and ensure that your son has had the vitamin K prior to the procedure.

If your child is not stable, such as breathing or heart problems, it is best to wait to perform any unnecessary procedures.

Are there times a circumcision is NOT recommended?

If there is a concern that the penis did not form typically it is recommended to not do a circumcision in the newborn period. This might involve what looks like a "partial natural" circumcision, where the foreskin is shortened and the head of the penis is partially exposed. (Typically the foreskin completely covers the head of the penis at birth.) This often is associated with hypospadius, where the urethra (the hole that urine comes out of) is not at the tip of the penis. In this condition, the foreskin is sometimes used to move the urethra to the proper position when the boy is old enough, generally between 3 and 18 months of age. For more information on hypospadius, see CDC information on hypospadius.

Does a circumcision have to be done in a certain time frame?

Most circumcisions are done on newborns in the hospital. We want the baby to be feeding well and medically stable before the procedure. It is often done on the day of discharge, but may be done sooner if he is eating well. For religious reasons, some babies are circumcised on the 8th day of life. This is typically done at a home by a mohel but can be done in our office.

For babies who are not medically stable at birth; such as from breathing difficulties, infection or prematurity; they can be done when they are ready, generally in the first 3 months of life. 

If parents originally do not plan on a circumcision, but choose to do it later or if there are medical indications for the procedure at a later time, it is usually done under general anesthesia by a surgeon. After about 3 months of age we recommend this instead of doing it with local pain control.

How a circumcision is done

Our physicians do circumcisions with one of two procedures: a Mogen Clamp or a Plastibell. The type of procedure done depends on the training and experience of the physician. The final "look" of the penis with both procedures looks the same the following week. 

We use a local anesthetic called lidocaine to numb the area. This injection may sting initially and leave a bruise at the base of the penis. Babies can still feel the cold of the cleaning product we use to decrease risk of infection and they can still feel tugging, but the sharp pains of the procedure are lessened with the lidocaine. The foreskin is pulled away from the head of the penis (aka glans).

For the Mogen Clamp: The foreskin is pulled up and the clamp is placed over the glans, to protect it from being cut. The clamp puts pressure on the tissues to prevent bleeding. No stitches are needed unless there is excessive bleeding, which is a rare complication. The head of the penis will look open and raw during the healing process.

For the Plastibell: A plastic ring is inserted between the head of the penis and the foreskin and tied off. The ring is left in place until it falls off naturally, generally 3-7 days later.

How to care for a circumcised penis the first week

After a baby's circumcision, it takes about a week to heal regardless of method used.

The Plastibell must simply be left alone until the bell falls off.

After the Mogen Clamp it will look bright red and swollen initially, then less swollen. As it heals, yellow granulation tissue appears on the head of the penis. This is normal and NOT an infection.

We recommend putting petroleum jelly on the head of the penis during the healing process to keep it from sticking to the diaper. If stool gets to the area, simply rinse with water without rubbing the area much. Reapply petroleum jelly each diaper change. We suggest you do not use any creamy products or lotions on the healing penis, as they cause irritation.

It usually takes 3-7 days for the circumcision to heal. Once healed and there are no more red or yellow areas on the head of the penis, you can treat the penis like any other body part with cleaning.

How to care for a circumcised penis the first few years

The cells on the surface of the glans and inside the foreskin are discarded normally, like other cells of the body. Routine cleaning can prevent the accumulation of these cells. If these cells accumulate, they form a white cheesy substance called smegma. This is normal, but may become trapped if the foreskin and glans begin to fuse. The glans is the tip of the penis, the part that looks like a helmet. We call this fusion "penile adhesions". Adhesions usually do not cause any problems and no treatment is necessary. You might notice white pearly, cheesy, smegma coming out of the edge of the adhesion. This does not require treatment. If it becomes red and swollen, make an appointment with your doctor.

As boys build up baby fat, they tend to get a large fat pad at the base of the penis. The penis often hides in the fat pad. You should push down on the fat pad near the base of the penis to expose the penis for cleaning while bathing. If you notice that the skin starts to "stick" to the head of the penis (aka the glans), put petroleum jelly in the area several times per day to prevent more adhesions.

As your son becomes able, teach him to clean his own penis with normal bathing.

For more information, view our Male Infant Circumcision information.