What is a circumcision?
A circumcision is a surgical procedure that removes the foreskin (the loose tissue) covering the glans of the penis. Circumcision may be performed for religious or cultural reasons, or for health reasons. Newborn circumcision is thought to diminish the risk for cancer of the penis and lower the risk for cancer of the cervix in sexual partners. It is also believed to decrease the risk of urinary tract infections and lower the risk of certain sexually transmitted diseases, including especially HIV.

Is a circumcision safe?

Circumcision is generally a safe surgical procedure if the following conditions are met:

• The circumcision is done with care;
• The circumcision is performed by a trained, experienced practitioner;
• The circumcision is done using strict aseptic (sterile) technique;
• The circumcision is done only on a healthy, stable infant; and
• There is no medical reason not to have circumcision performed (see below).

How is a circumcision done?

The circumcision may be done using surgical clamp techniques or a special disposable plastic device called a Plastibell. The results are equally good.

What is done after a circumcision?

At the first well-baby visit following hospital discharge, the penis should be carefully examined by the doctor and the parents given information concerning care.

Is a circumcision painful for a baby?

Newborns who have a circumcision without analgesia (for pain relief) respond in ways that strongly suggest that they do feel pain and experience stress. They show changes in heart rate, blood pressure, oxygen saturation and cortisol levels and behavioral changes. The behavioral changes include crying at the time as well as changes in sleep patterns and mother-child interactions that are temporary and disappear within 24 hours of the procedure.

How can the pain be reduced?

Analgesia has been found to be safe and effective in reducing the pain associated with circumcision, and should be provided if the procedure is performed. Analgesic methods include EMLA cream (a topical mixture of local anesthetics), the dorsal penile nerve block and the subcutaneous ring block.

What are the contraindications to circumcision (the reasons against doing it)?

Unstable or sick infant: Circumcision is contraindicated if the baby is unstable or sick. Circumcision is elective surgery and, as with other medically elective procedures, it should be delayed until the baby is well. Signs of stability include normal feeding, elimination, and maintenance of normal body temperature without an incubator or radiant warmer.

A period of observation after the infant's birth may allow for recognition of abnormalities or illnesses (eg, serious jaundice, infection, or manifest bleeding disorder) that should be addressed before this elective surgery.

Prematurity: It is usually best to wait until a premature infant meets the criteria for discharge from the hospital before performing circumcision.

Genital anomalies: Infants born with genital anomalies (including one called hypospadias) should not be circumcised. The foreskin may be needed for the surgical correction of the anomalies.

Bleeding problems: Whenever there is a family history of bleeding disorders, appropriate laboratory studies should be performed to make certain the baby himself has not inherited the bleeding disorder.

What is the chance of a complication from a circumcision?

Large-scale studies indicate that the rate of complications is low, ranging from 1 in 200 to 1 in 500. The most common complications are local infection and bleeding. Complications due to local anesthesia consist mainly of hematomas (bruises) and local skin necrosis (damage and loss).

Deaths attributable to newborn circumcision are rare. No deaths occurred, for example, in an analysis of 500,000 circumcisions in New York City or 175,000 circumcisions in US Army hospitals.

Circumcision, The Surgical Procedure At A Glance

• Newborn circumcision is a generally safe procedure, if it is done under proper circumstances.
• Circumcision should be done by a trained, experienced practitioner.
• Circumcision should not be done if an infant is sick or in unstable health.
• A premature infant should not have circumcision until the baby meets the criteria to be discharged from the hospital.
• Infants with genital anomalies (including hypospadias) should not be circumcised.
• Babies with a family history of bleeding should not be circumcised until tests are done to make sure the child does not have a bleeding problem.
• Infants, without pain relief, respond to the circumcision procedure with changes indicating pain.
• Local analgesia should be given to reduce this pain.

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