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Circumcision is one of the oldest operations known and the
most common performed in males in the United States. It has been
practiced as a religious rite for thousands of years.
If you know you are going to have a boy, it is a good idea to discuss
circumcision ahead of time with your physician. The decision to
circumcise or not is always best made by the parents, and it is important to
know and understand the risks or benefits of the procedure before
consenting.
Newborn circumcision consists of removal of the foreskin of the penis, usually
performed in the first few days of birth. Using a clamp (Gomco, Mogen
clamps, or plastibell), it is a safe surgical procedure if performed carefully
by a trained physician. More and more parents have concerns about
subjecting their baby to pain and stress. The procedure is usually
performed without anesthesia. The option to use local anesthesia should be
carefully considered because of the complications associated with its use.
The benefit of prophylactic neonatal circumcision remains controversial.
However, it has been shown that it reduces the incidence of urinary tract
infections, penile cancer, and sexually transmitted diseases.
Circumcision is not advised in a sick infant, a premature baby, or one with family
history of bleeding problems or congenital anomalies. Circumcision is
indicated in phimosis, paraphimosis, and balanoposthitis. Phimosis (derived
from Greek word for muzzling) occurs when the tip of the foreskin becomes
scarred and can no longer be retracted over the glans (head of) penis.
Paraphimosis is a condition in which the snugly fitting foreskin
with a partially scarred tip is retracted over the glans and becomes trapped
behind it. This is a medical emergency. Balanoposthitis is inflammation of the glans (balono) and the foreskin (posthe).
If your baby is circumcised, after the procedure a light dressing with
petroleum jelly is placed over the head of the penis. Usually the
dressing gets wet when the baby urinates and comes off. Do not try to pull
off the dressing if it is still dry, as it might bleed.
It is important to remember to keep this area as clean as possible. If
soiled, gently wash it with soap and water between diaper changes. The baby
is usually observed after the procedure at least four to six hours prior to
discharge from the hospital to ensure there is no excessive bleeding.
Initially the tip of the penis may look extremely red for the first few days
and you may notice a pale yellow secretion. This is a good indication that
it is healing normally. If the redness persists or there is swelling,
consult your physician. After the wound has healed, the penis should be bathed gently in normal manner.
To care for the uncircumcised penis, initially a gentle normal bathing
is required. Most newborn males have foreskins that cannot be retracted
over the glans. Do not try to force, fully retract, or cleanse with q-tips.
When the child is two to three years old, spontaneous separation of the
foreskin is usually complete. Gentle cleansing of the exposed part is
advisable at bath time. Once the foreskin can be removed easily in the bath
it should be pushed back gently, and the secretions should be cleaned
properly. This is the first step in developing a habit of careful penile
hygiene in young boys who must become responsible for washing themselves
adequately.
Mamatha Sundaresh is Attending Pediatrician in Primary Care, Maimonides Medical Center
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