How Is Circumcision Done?

What is circumcision?

Circumcision, the surgical removal of the foreskin of the penis, is usually performed with local anesthesia in newborns, but older children, adolescents and adults may require sedation.

Circumcision is the surgical removal of foreskin, a loose fold of skin that covers the head (glans) of the penis. The foreskin is detached from the glans penis and the excess skin is snipped off. Circumcision is usually performed with local anesthesia in newborn, but older children, adolescents and adults may require sedation.

Circumcision has its origins in religion and as a ritual for passage into manhood, but is also performed for hygienic purposes and certain medical reasons. The age for ritualistic circumcision differs with cultures, ranging from just days after birth to around puberty.

Circumcision is an ancient practice which likely originated in Egypt. Egyptian mummies and wall carvings show evidence of circumcision that can be dated to at least 6000 BCE. The practice may have spread with migration and also independently developed in different cultures. The Jewish faith worldwide still practices religious circumcision — perhaps the most well-known of groups who currently perform this rite.

Is circumcision good or bad?

Routine circumcision for the newborn is a controversial issue and has risks and benefits. The latest policy statement of the American Academy of Pediatrics states that the health benefits of neonatal circumcision outweigh the risks, but are not great enough to recommend routine universal neonatal circumcision.

Conflicting views prevail on the subject of elective circumcision. People who follow the practice consider circumcision hygienic and beneficial. Opposers contend that the foreskin protects the glans and circumcision also desensitizes the penis because the foreskin has specialized nerve endings that enhance sexual pleasure. No systematic scientific studies support this assumption, however.

Ethically, some feel neonatal circumcision violates a baby’s bodily integrity without consent, and so, ethically, should be left to the individual to decide.

Are most men circumcised?

A high percentage of American men are circumcised, though routine neonatal circumcision rates have declined in the recent decades, from 64.5% to 58.3% from 1979 through 2010, according to data from the National Hospital Discharge Survey.

Withdrawal of Medicaid funding in some states for neonatal circumcision may be one of the contributing reasons.

Globally, approximately 37.7% of men are estimated to be circumcised. Prevalence of circumcision is relatively low in much of Europe, parts of Asia, South Africa and South and Central America.

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Why do boys get circumcised?

Historically, circumcision was considered a miraculous cure for a gamut of ailments that ranged from a somewhat understandable bedwetting, to a bewildering array of conditions that included headaches and crossed eyes to epilepsy, paralysis and even clubfoot. Masturbation was a primary “ailment” that circumcision was thought to “cure.”

Circumcision can be a treatment procedure in conditions that include:

Urinary tract infections (UTIs): Circumcision is beneficial in infants who develop recurrent urinary tract infections and require frequent catheterization.
Phimosis: Phimosis is a condition in which the foreskin adheres to the glans and cannot retract. All boys are born with natural phimosis which usually resolves by the age of three. Acquired phimosis may result from poor hygiene, infections or repeated forceful retraction of the foreskin.
Paraphimosis: Paraphimosis is the inability to draw the retracted foreskin back to the normal position covering the glans. Paraphimosis is a urologic emergency requiring prompt treatment because it can cause edema and restrict blood supply to the penis.
Balanitis: Balanitis is an infection of the glans penis.
Posthitis: Posthitis is an infection of the foreskin.

Circumcision may not be performed in the following situations:

Premature babies
Abnormal curvature of the penis (chordee)
Hypospadias (urethral opening on the underside of the penis instead of at the tip)
Epispadias (urethral opening on the upper surface of the penis)
Concealed or buried penis
Micropenis (abnormally small penis)
Webbed penis (the scrotum is attached to the penis by a web of skin)
Ambiguous genitals
Bleeding disorders

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Is it worth getting circumcised?

Phimosis, without complications like urinary obstruction or blood in urine, may often be resolved without circumcision with daily cleaning and avoiding forced foreskin retraction. Local application of corticosteroids such as clobetasol or betamethasone cream for up to eight weeks is effective in separating loose adhesions between the foreskin and the glans.

There is, however, some evidence that elective circumcision has benefits that include the following:

Lower risk for UTIs. Uncircumcised male infants may have up to 20 times greater risk for developing a UTI, however, the absolute risk of UTIs remains low at 1%.
Lower risk for some sexually transmitted diseases such as syphilis, chancroid and human immunodeficiency virus (HIV) infection.
Prevention of acquired phimosis and paraphimosis.
Prevention of balanitis and posthitis.
Protection against penile cancer.
Lower risk for uterus cancer in female sex partners from human papillomavirus (HPV) infection.

How is circumcision done?

Circumcision in infancy is a relatively simple and safe procedure, but in adults, it becomes a little more complicated. Circumcision takes just about 10 minutes in a newborn, while it may take up to an hour for adults.

During circumcision the doctor

Cleans and numbs the penis with a local anesthetic cream and/or injection.
Separates the adhesions between the foreskin and the glans.
Places a clamping device on the penis. The three most common devices in use are:
- Gomco clamp
- Plastibell device
- Mogen clamp
Removes the excess foreskin.
Applies antibiotic cream and petroleum jelly on the penis and a gauze bandage over it.

Circumcision follow-up care

Newborn infants should only have sponge baths. Older patients may start bathing after a day.
Petroleum jelly and antibiotic cream must be applied after every diaper change or a bath.
Older boys and adult males should avoid swimming and strenuous activities for up to six weeks.

How painful is circumcision in adults?

The circumcision procedure itself is painless because the penis is numbed with local anesthesia during the procedure and adults may also receive sedation. The penis may be swollen and bruised for a couple of days and any post-procedural pain can be relieved with painkillers. The circumcision usually heals within a week. Most men can resume normal activities in two or three days.

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What are the complications from circumcision?

Circumcision is a relatively simple and safe procedure, but carries a few risks like any surgical procedure. Common risks include:

Pain
Bleeding
Infection
Irritation of the glans
Meatal stenosis (narrowing of the urethral opening)
Injury to the penis

Some isolated complications include the following:

Recurrent phimosis
Wound separation
Penile torsion (twisting of the penis)
Concealed penis
Unsatisfactory cosmetic result
Skin bridges (adhesions)
Urinary retention
Meatitis (inflammation of the urethral opening)
Chordee due to removal of excess skin
Inclusion cysts (cysts in the skin)
Retained Plastibell device

Other infection-related rare complications reported include:

Scalded skin syndrome
Necrotizing fasciitis
Sepsis
Meningitis
Urethral fistula
Penile necrosis
Amputation of a portion of the glans penis