Circumcision is a surgical procedure to remove the foreskin from the head of the penis which is known as the glans penis. In some cultures, circumcision is done for religious beliefs or ceremonial traditions. It is an elective procedure, with the percentage of circumcised newborn boys varying among socioeconomic, racial and ethnic groups.
Female genital mutilation (FGM), which refers to circumcision in girls is strongly discouraged by the medical community. Parents are advised to refrain from such activities as there have been no medical grounds to support any benefit of circumcising girls.
Circumcision in male babies is also done for medical reasons. According to The American Academy of Pediatrics (AAP), the health benefits outweigh the risks, however, the benefits are not significant enough to recommend that all newborn baby boys be circumcised. It is rather recommended, that parents are educated well enough, given all the necessary information they need on benefits and risks for them to make informed decisions.
REASONS FOR CIRCUMCISION
Circumcision as stated above is an elective procedure and there are a few reasons why it is done. The most common reasons may be one or more of the following.
- For religious reasons and ceremonial traditions.
- To treat phimosis, which is a condition in which the foreskin of the penis cannot be pulled back past the glans. It may result is painful erections and also causes inflammation of the glans. However, in young children, it is normal for the foreskin to not be easily pulled back. This resolves by the age of seven for about 90% of cases and by age sixteen for 99% of cases.
- Circumcision can also be done in the treatment of refractory balanoposthitis which is inflammation of the glans penis and foreskin included.
- To treat chronic or recurrent urinary tract infections. There is an increased risk of urinary tract infection in males that are uncircumcised especially babies that are younger than 1 year of age. However, the risk of urinary tract infections in all males is less than 1 percent.
- Circumcision decreases the risk of certain sexually transmitted diseases like HIV. WHO recommends circumcision to be considered as part of a comprehensive HIV prevention program in areas that have high rates of HIV such as sub-Saharan Africa.
- It also decreases the risk of cancer caused by human papillomavirus.
CONTRAINDICATIONS FOR CIRCUMCISION
Circumcision is contraindicated in a few situations:
- In babies who have genital structure abnormalities such as a misplaced urethral opening e.g. hypospadias and epispadias, curvature of the head of the penis, etc. This is because the foreskin may be needed in reconstructive surgery.
- In premature infants and babies who are not in good health.
- In a child who is known to have or has a family history of bleeding disorders e.g. hemophilia. Blood must be checked for normal coagulation properties before circumcision is attempted.
Circumcision is usually performed by a medical practitioner in a hospital. It is performed on healthy babies as stated above. Local anesthesia is injected around the penis to reduce the pain and these anesthetics are considered generally safe.
Circumcision can be done using several methods; some may use a temporary clamp device and some may use a plastic bell that stays on the penis for a certain length of time.
In each method, the foreskin must be separated from the head of the penis (glans penis). A small slit will be made in the foreskin and a clamp placed on the foreskin. The clamp is left for a few minutes to stop the bleeding then the foreskin can then be cut and removed.
WHAT TO EXPECT AFTER CIRCUMCISION
Circumcision done by a qualified medical practitioner rarely has complications. The most common issues to arise are usually bleeding and an infection and proper care after the circumcision help to reduce the chances of these problems.
After the procedure, there may be a gauze dressing with antibiotic cream which can be removed after the first diaper change. The head of the penis may look very red and there may be small amounts of blood at first or yellow colored drainage later. These are all part of the normal healing process.
The penis must be cleaned with soap and water. The baby may be uncomfortable in the first few days due to pain, so suppository analgesics may be prescribed by a doctor and the mother is encouraged to breastfeed the child more. Circumcisions usually heal within one to two weeks.
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