Circumcision
by the American Academy of Pediatrics

What is Circumcision?

At birth, boys have skin that covers the end of the penis, called the foreskin. Circumcision surgically removes the foreskin, exposing the tip of the penis. Circumcision is usually performed by a doctor in the first few days of life. An infant must be stable and healthy to safely be circumcised.

Many parents choose to have their sons circumcised because "all the other men in the family were circumcised" or because they do not want their sons to feel "different." Others feel that circumcision is unnecessary and choose not to have it done. Some groups such as followers of the Jewish and Islamic faiths, practice circumcision for religious and cultural reasons. Since circumcision may be more risky if done later in life, parents may want to decide before or soon after their son is born if they want their son circumcised.

Scientific studies show some medical benefits of circumcision. However, these benefits are not sufficient for the American Academy of Pediatrics to recommend that all infant boys be circumcised. Parents may want their sons circumcised for religious, social, and cultural reasons. Since circumcision is not essential to a child's health, parents should choose what is best for their child by looking at the benefits and risks.

Research studies suggest that there may be some medical benefits to circumcision. These include the following:

• A slightly lower risk of urinary tract infections (UTIs). A circumcised infant boy has about a 1 in 1,000 chance of developing a UTI in the first year of life; an uncircumcised infant boy has about a 1 in 100 chance of developing a UTI in the first year of life.
• A lower risk of getting cancer of the penis. However, this type of cancer is very rare in both circumcised and uncircumcised males.
• A slightly lower risk of getting sexually transmitted diseases (STDs), including HIV, the AIDS virus.
• Prevention of foreskin infections.
• Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible.
• Easier genital hygiene.

The following are reasons why parents may choose NOT to have their son circumcised:

• Possible risks. As with any surgery, circumcision has some risks. Complications from circumcision are rare and usually minor. They may include bleeding, infection, cutting the foreskin too short or too long, and improper healing.
• The belief that the foreskin is necessary to protect the tip of the penis. When removed, the tip of the penis may become irritated and cause the opening of the penis to become too small. This can cause urination problems that may need to be surgically corrected.
• The belief that circumcision makes the tip of the penis less sensitive, causing a decrease in sexual pleasure later in life.
• Almost all uncircumcised boys can be taught proper hygiene that can lower their chances of getting infections, cancer of the penis, and sexually transmitted diseases.

Common Questions About Circumcision

Is circumcision painful?
When done without pain medicine, circumcision is painful. There are pain medicines available that are safe and effective. The American Academy of Pediatrics recommends that they be used to reduce pain from circumcision. Local anesthetics can be injected into the penis to lower pain and stress in infants. There are also topical creams that can help. Talk to your pediatrician about which pain medicine is best for your son. Problems with using pain medicine are rare and usually not serious.

What should I expect for my son after circumcision?
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. Petroleum jelly should be used to keep the bandage from sticking. Sometimes a plastic ring is used instead of a bandage. The plastic ring that is left on the tip of the penis usually drops off within 5 to 8 days. It takes about 1 week to 10 days for the penis to fully heal after circumcision.

Are there any problems that can happen after circumcision?
Problems after a circumcision are very rare. However, call your pediatrician right away if

• Your baby does not urinate normally within 6 to 8 hours after the circumcision.
• There is persistent bleeding.
• There is redness around the tip of the penis that gets worse after 3 to 5 days.

It is normal to have a little yellow discharge or coating around the head of the penis, but this should not last longer than a week.

What if I choose not to have my son circumcised?
If you choose not to have your son circumcised, talk to your pediatrician about how to keep your son's penis clean. When your son is old enough, he can learn how to keep his penis clean just as he will learn to keep other parts of his body clean.

The foreskin usually does not fully retract for several years and should never be forced. The uncircumcised penis is easy to keep clean by gently washing the genital area while bathing. You do not need to do any special cleansing, such as with cotton swabs or antiseptics.