What is circumcision?

Circumcision is the removal of the foreskin (the foreskin is the fold of skin that covers the glans/ head of the penis).

Circumcision, when done electively is a non-therapeutic procedure, meaning it is not medically necessary and is usually done for religious, cultural and social reasons. It is therefore not covered by OHIP.

It is important to be aware of all of the risks and benefits of circumcision prior to making a decision.

Risks of circumcision

Surgical complication is possible but occurs in only a small number of infants. This can include excessive bleeding or infection in the area, which occur 1 in 1000 times. Rarely, the area of the incision can heal as a fibrotic ring, which later needs to be released by a urologist. For every 1000 boys circumcised, less than 20 may experience a complication.

Benefits of circumcision

Risk of the infant developing a urinary tract infection (UTI) during the first year of life is slightly decreased. During the first year of life, 7 out of every 1000 uncircumcised boys will be admitted to the hospital with a UTI vs 2 in 1000 of circumcised boys.

There is a decreased chance of having to have a circumcision as an older boy. Certainly 10% of boys require a circumcision for medical reasons related to infections or problems with the foreskin later in life.

Very slight decrease in risk of developing penile cancer (this is a very rare cancer in men).

Circumcision prevents phimosis (the inability to retract the foreskin) and foreskin infections.

There is high quality evidence that circumcision prevents getting human immunodeficiency virus (HIV), HPV, and probably herpes simplex virus type 2 (HSV-2), and also some evidence that it may protect against trichomonas and chancroid infection, as well. Circumcision does not protect against infection from gonorrhea, chlamydia trachomatis, or syphilis.

The Canadian Pediatric Society has determined that the risks and benefits of circumcision are relatively equal and therefore do not recommend routinely circumcising all newborn males. (Reviewed July 9,2012 by the CPS, http://www.cps.ca/documents/position/circumcision)

Caring for an Uncircumcised Penis in Infancy

• An uncircumcised penis is easy to keep clean and requires no special care.

• Keep your baby’s penis clean by gently washing the area during his bath. This does not require any special products; in fact no soap is needed at all.

• Change diapers frequently to help keep the area clean.

• Do not try to pull back the foreskin. The foreskin is not usually fully retractable until age 3.5 years and sometimes not even until puberty.

Caring for an Uncircumcised Penis in an Older Child:

• When your son is older, it is normal for him to pull on his foreskin and this is not cause for concern; he will not hurt himself.

• When the foreskin does separate, old skin cells will shed and new ones will form to replace them. The dead skin cells look like white lumps and will work their way down the penis to the tip of the foreskin. If you see them under the skin you do not need to force them out, just wipe them away when they do come out.

• When the foreskin is fully retractable, teach your son to wash underneath it each day. Always pull the foreskin back over the head immediately after washing.

When to Seek Medical Advice for an Uncircumcised Child:

• The opening of the foreskin should allow for a normal urine stream. If you notice that the stream is weak or that your son appears to have difficulty or discomfort when urinating, speak to your child’s doctor.

• If the foreskin has swelling, redness, or discharge these could be signs of infection.

• If the foreskin is pulled back and gets stuck behind the head of the penis, seek medical attention immediately.

Care for the Circumcised Penis Immediately Post-surgery:

• Apply 1 tbsp of Vaseline to the 4x4 gauze and place over the penis, in order to prevent any tissue sticking to the diaper. Change the dressing every diaper change for two days. Thereafter, merely use a diaper normally without any further dressings.

• Bathe daily, immersing the penis in the water. Use soap or oil in the bath as per your usual routine. Allow the penis to be cleaned passively by being in the bath water. Do not directly touch the penis.

• A yellow crust over the incision site is normal and should not be removed (it will fall off on its own). By

7 days the penis should look basically normal, although some swelling where the cut is made may remain up to 2 weeks total.

• Many boys need one dose of acetaminophen (40 mg) if fussy 1-2 hours after the circumcision and occasionally a second dose is needed. By the next day, he will only be uncomfortable with diaper changes or when the penis head is touched. After a few days, only touching the penis head will bother him, as it is still like an open sore.

When to Seek Medical Advice for a Circumcised Child:

• Check the circumcision site at each diaper change. Expect some redness on the gauze the first few diaper changes. If you notice more than a few drops of blood flowing from anywhere on the penis, contact the doctor.

• If you notice any drainage, swelling, or fever this could be a sign of infection and you should contact the doctor.

• If your son does not urinate within four hours after the circumcision, contact the doctor.