Over 30 years ago, on the information then available, most physicians in the U.S. felt circumcision was indicated and urged parents to have it done in the newborn period. Since then the medical evidence has swung the other way. Now, most men in the world are not circumcised, and probably about half of boys born in the US are circumcised. When your newborn son is in high school, he will likely know boys who are circumcised and boys who are not circumcised.
NORMAL (UNCIRCUMCISED) PENIS CARE
In a newborn, and beyond, the normal penis needs no special care. During routine bathing the penis and foreskin need to be washed with no special attention. The foreskin can be left alone, but if you want to retract it, do so as far as it goes very easily with no discomfort, which in a newborn and the first few years of life is usually not very far. Natural oils and shedding of dead skin sometimes form little white, cottage cheese-type secretions that may come out from under the foreskin in chunks. These lumps and the little pockets under the foreskin are normal and should cause no particular concern. With only a quick cleaning at bath and pretty much left alone, the uncircumcised natural penis will do fine. There is no need to have the foreskin pulled back by first grade, age ten, or any other arbitrary age.
For religious purposes, Muslims, Jews and some other groups have practiced circumcision for thousands of years. Circumcision became popular in the United States early in the 1900’s and by the end of World War II the vast majority of men were circumcised. However, old theories about less cancer in the circumcised male or his sex partner or better sensation have been disproved. There has been some evidence that circumcised men are less apt to catch sexually transmitted diseases if they have multiple sex partners. In a truly tropical zone uncircumcised men may have infections of the foreskin. There is no significant increased risk of foreskin infections in the United States. Some adolescents or grown men express regret they were circumcised; some wish they were and a few have it done later in life. The vast majority of men accept their parents’ decision about circumcision without second thought.
Circumcision in the first few weeks of life carries some risk. There is a small possibility of infection or significant bleeding. Though quite rare, these risks can lead to extended hospitalization or the use of medication. Also, though we use a local anesthetic, a circumcision causes some pain or discomfort and some babies may be fussy for a day or two afterwards. The least expensive time to do a circumcision is in the newborn period. The chance of a circumcision needing to be done later in life for medical reasons in the United States is less than 1/2 of 1 percent.
Most parents who decide to have a circumcision done do so for personal or religious reasons. Family pressure should not be an important factor in deciding to circumcise.
We will do a circumcision usually after the baby is at least 12 hours old and up to six weeks of age. It can be done in the hospital or in the clinic. In the hospital, in addition to our fee for doing the circumcision, there is a significant hospital charge for the use of their facilities, supplies and equipment. Medi-Cal and some insurances do not cover the cost of circumcision.
If a circumcision is to be done in our clinic, do not feed the baby for 2 hours before the procedure. The procedure takes about 15 minutes and we may ask you to stay after the circumcision in the clinic for another 15 minutes to be sure there is no significant immediate bleeding.
AFTER CIRCUMCISION CARE
After circumcision, the Vaseline gauze needs to be unwrapped and removed in an hour. The diaper may be kept lightly lubricated where the penis will rub with a little Vaseline or Neosporin ointment for the first day or two. No other special attention is necessary. Light bleeding leaving a spot in the diaper is fairly common in the first day. Also, a yellow-white membrane may form in patches over the head of the penis and around the cut edge. After about ten days the circumcision should look pretty well healed. The underside of the penis is usually the last to heal. If there is redness going down the shaft of the penis onto the abdomen, or if there is a rash with blisters or the baby’s behavior changes remarkably, let us know. There may be bruising at the base of the penis where the local anesthetic was given. You may give the baby 40 mg of acetaminophen (up to the first line on the infant dropper) every four hours if the baby seems uncomfortable.
After the circumcision is well healed, at bath time you should pull the foreskin back to completely expose the head of the penis, wash it off, and let go. This practice will prevent minor adhesions from forming.
ONE LAST THOUGHT
Baby boys, circumcised or not, grow up. How they do in life depends on many considerations, and whether they are left naturally uncircumcised, or circumcised, will likely not be a very important factor in the long run. We’d be happy to discuss these things further with you if you have questions or if other concerns about circumcisions should arise.