Baby
SHOULD MY BABY BE CIRCUMSIZED?
By Mamatha Sundaresh, M.D.
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.
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About The Author
Mamatha Sundaresh is Attending Pediatrician in Primary Care at Maimonides Medical Center in New York.
