Circumcision is a relatively simple procedure, usually performed on babies on the first or second day after birth. Circumcision can also be performed on older children and adults in an outpatient setting, but can be more complicated due to potential need for general anesthesia.

What is circumcision?

Circumcision is the surgical removal of the foreskin, which is the skin that covers the tip of the penis.

In some cultures, circumcision is a religious practice or a tradition, most common in Jewish and Islamic faiths. In the U.S., newborn circumcision is not required. It's an elective procedure, meaning you can choose to have your child circumcised or not.

Circumcised vs. Uncircumcised

It is important to learn about the benefits and risks of circumcision. The American Academy of Pediatrics (AAP) has found that the health benefits of circumcision are greater than the risks. But the AAP also found that these benefits are not great enough to advise that all newborn babies be circumcised. Parents must decide what's best for their baby.

According to the AAP:

• Problems with the penis (such as irritation) can happen with or without circumcision.
• There is no difference in health and cleanliness (hygiene) with or without circumcision, as long as a child can handle cleaning and care.

Circumcision Benefits

• There is a higher risk of urinary tract infection (UTI) in uncircumcised children. This is more so in babies younger than 1 year old. But the risk for UTI in all children is less than 1%.
• Newborn circumcision does give some protection from cancer of the penis later in life. But the overall risk of penile cancer is very low in developed countries, such as the U.S.
• Circumcised kids and adults have a lower risk for some sexually transmitted infections. This includes HIV.

Circumcision may be recommended if your child has phimosis, which is the inability to draw back the foreskin to expose the glans or head of the penis. Phimosis sometimes makes it difficult to perform proper hygiene in the area. In boys who suffer urinary tract infections, infections of the foreskin, or infections of the penis (balanitis), circumcision may help prevent recurrence of these problems.

Circumcision Risks

Circumcision has some risks. But the rate of problems is low. The most common risks are bleeding and infection.

The skin of the penis is also very sensitive after a circumcision. The area can get irritated from contact with the baby’s diaper or with the ammonia in urine. This can be treated by putting petroleum jelly on the penis for a few days.

There may be other risks. This depends on your baby’s health. Talk about any concerns you have with the physician before the surgery.

How to Prepare for a Circumcision

Because circumcision is often done one to two days after birth, you’ll want to make the decision well before your baby is born.

Make sure the doctor or surgeon fully explains the procedure. Ask if anesthetic will be used for a circumcision. The AAP advises using an anesthetic. This helps reduce the baby’s pain during the procedure.

If your baby is born early or has other health problems, they may not be circumcised until they're ready to leave the hospital. If your baby has a physical problem with their penis, they may not be circumcised. This is because the foreskin may be used in a future surgery on the penis.

What happens during the circumcision procedure?

The procedure is usually done by an obstetrician or pediatrician in the hospital. When it's done for religious reasons, other people may do the surgery after the baby comes home from the hospital.

Circumcision is done only on healthy babies. The procedure is painful, so the AAP advises using a local anesthetic which numbs the area of the penis where the incision will be made.

There are different types of anesthetics. A health care professional may put a numbing cream on your child’s penis, or inject small amounts of anesthetic around the penis. There are risks with any anesthetic, but these are considered safe. In addition to the anesthetic, your caregiver may give your baby a pacifier dipped in sugar water. This can help soothe them while the procedure is happening.

A circumcision can be done in several ways. The procedure usually takes about 15 minutes or less.

• Your baby is given a local anesthetic.
• The penis is cleaned with an antiseptic.
• The foreskin is loosened from around the head of the penis, making a small slit in the foreskin.
• A clamp or plastic ring may be attached over the head of the penis to make cutting the foreskin easier.
• Surgical devices are used to remove the foreskin, exposing the end of the penis (see below).
• Petroleum jelly or ointment may be placed on the head of the penis and covered with a loose gauze dressing or topical skin adhesive.

A number of devices have been developed to help perform circumcisions in babies, and the device used depends on the medical practitioner’s preference. However, in older children these devices are not always effective, so a “freehand technique” is often performed. In this operation, the excess foreskin is removed, and the cut edge is sewn with dissolvable stitches. The procedure takes less than an hour to perform.

What happens after the circumcision procedure?

After the circumcision, you will need to care for your baby’s penis until it heals. This includes cleaning the area with plain water at least once a day. You will also need to clean it if the area is dirty after a bowel movement. Then let the area dry, and put petroleum jelly on it. This keeps the gauze dressing from sticking.

You may be asked to remove the dressing the next day. Or you may be asked to use a new dressing, and some petroleum jelly, each time you change diapers. When the gauze dressing is no longer needed, you may be told to keep putting petroleum jelly on the end of the penis for a few more days to prevent the penis from sticking to the diaper.

Some swelling on the penis is normal. It is also normal for the penis to develop a crust. This will go away after a few days. A small amount of bleeding may occur. But if you see a blood stain on your baby’s diaper that's bigger than a quarter, call your physician right away. If the penis keeps bleeding, apply firm pressure with a washcloth for a few minutes. Then look to see if the bleeding has stopped. If the bleeding continues, bring your child to the emergency room.

If a plastic ring was used, it should fall off the penis in 10 to 12 days. Tell your doctor if this doesn’t happen.

A baby’s penis usually fully heals from a circumcision in seven to ten days.

Call your child’s doctor if your baby has any of the following:

• Fever
• Wound that doesn’t stop bleeding
• No urine six to eight hours after the procedure
• Redness or swelling that doesn’t get better after three days, or gets worse
• Yellow discharge or yellow coating on the penis after seven days

The baby’s penis usually fully heals from a circumcision in seven to ten days.