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Brian A. Roelof, M.D. Circumcision is one of the oldest operations performed. It was probably originally devised to allow better hygiene as indoor hot running water and soap were not readily available. It also became part of religious ritual. Circumcision is now an extremely common operation performed in the United States. Currently, approximately 60% of our newborn males are circumcised. Forty percent are not circumcised. In West Michigan, the percentage of children circumcised is probably closer to 90-95%. In California, Texas, etc., the number of children circumcised is much less. Around the world, circumcision is not very common. The United States and Israel are the only two countries where circumcision is routinely done. The Europeans, Asians, South Americans, etc. do not perform routine circumcision. To circumcise or not to circumcise has been a very hotly debated subject. The American Academy of Pediatrics in the mid 1970's felt there was no medical indication for circumcision. In 1989, it modified that position. It has been shown that uncircumcised boys have more urinary tract infections than circumcised boys. Hygiene is generally easier in circumcised boys rather than in uncircumcised boys. There is probably no difference in the sexual function between a circumcised male and an uncircumcised male. If a child is not circumcised, it is natural for the foreskin (prepuce) to adhere to the head of the penis (glans penis). Over time, the foreskin will break away from the head of the penis and become fully retractile. The parents do not have to forcefully pull the foreskin back. This is a natural process and usually does not need our help. Many families feel there is a family, cultural or religious reason for having their boys circumcised. If the circumcision is done shortly after birth, it is usually performed by the pediatrician or gynecologist. Sometimes the children are too ill to be circumcised at birth or they have a hypospadias problem and are advised not to have a circumcision performed. Sometimes the parents change their minds after the baby is taken home. In the older infant, general anesthetic is necessary and the procedure is performed in an operating room at a hospital. The extra skin is removed by a scalpel or laser and then the skin edges are sewn together with small stitches that dissolve out on their own. The children do not usually have a great deal of pain afterwards. We often put a local anesthetic in the penis before the child wakes up to minimize their discomfort for several hours afterward. Most children only need Tylenol for discomfort at home. The complications of circumcision include excessive bleeding or infection. The skin can separate, there may be excessive or redundant skin remaining. It is possible to injure the penis or the urethra. We try to make a cosmetically pleasing circumcision, but at times, the circumcision may not look exactly like the parents expected. There are specific reasons when a circumcision should be performed. One reason is if the foreskin (prepuce) cannot be retracted because of a tight ring. Another reason would be if the child has reflux of urine from the bladder to the kidney or is having urinary tract infection to reduce the chance of a urinary tract infection. The decision to circumcise is usually an individual or family decision. I can only advise as to the facts and fiction. |
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