Sunday, September 9, 2018

The Big Cut: Circumcision Information

What Is Circumcision?

Circumcision is the surgical removal of the foreskin from the penis.  In the United States, this procedure is routinely performed on males within the first few days of life for various religious, cultural, and aesthetic reasons. 

At birth, the foreskin is firmly adhered to the glans of the penis, like a fingernail is attached to its nail-bed.  The procedure requires that the foreskin be forcibly broken away from the glans.  After all of the adhesions are broken away, the foreskin is then surgically removed or a circumcision device is placed to cut off blood flow to the foreskin, causing it to become necrotic and to fall off in a few days.  If the procedure is done as an adult, the patient will be placed under general anesthesia and the foreskin will be surgically removed.  There is no need to break away any adhesions since most males have fully retractable foreskins by the time they reach sexual maturity.  

Risks VS Benefits

There are many risks to circumcision, the greatest of which are infection of the circumcision site, accidental damage to the penis, and post-operative hemorrhaging.  

Other side effects of circumcision include adhesions to the surgical site (which can cause irritation, discomfort, and pain) and urethral stenosis (a narrowing of the urethra causing urinary tract health issues and pain).  These types of issues typically require additional surgeries to be corrected.  

While there have been studies showing that circumcised males are at less risk for UTIs, phimosis, and for certain cancers none of these studies have shown significant improved outcomes.  The American Academy Of Pediatrics issued a statement that while the benefits of circumcision may outweigh the risks of the procedure, they do not recommend the routine circumcision of all infants as a preventative measure, while the American College of Obstetricians and Gynecologists published a statement that circumcision is an elective procedure and that parents should weigh the risks and benefits before making an informed decision about circumcising their sons.***
***American Academy Of Pediatrics Task Force On CircumcisionACOG Newborn Male Circumcision FAQ


It is very important that you keep your son's surgical site clean after his circumcision to prevent complications from infection.  The glans will appear to be very red, irritated, and is likely painful to the touch due to the forceable removal of the foreskin from the glans prior to the surgical removal of the tissue.  Any urine or stool will burn the skin of the glans until it has properly healed.  Using warm soapy water, wash the penis gently (do not use wipes or a washcloth).  Pat the area dry.  Apply vaseline liberally  all over the surgical site and penis.  It is important to make sure the skin on the shaft of the penis is not adhering to the surgical site.  Gently (but firmly) break away any forming adhesions at each diaper change.  

Other Considerations

Most insurance companies view routine circumcision as an elective and aesthetic procedure and as such do not cover the cost.  Depending on the area you live in and where you deliver, the cost of the procedure can run anywhere from $200 to $500.  

Intact Information

Intact Myths

Intact penises are dirty.

An intact penis is no dirtier than one that has been circumcised.  Proper cleaning of an intact penis is as simple as gentle SELF retraction in the shower and rinsing the glans with clean water (no soap needed).  After putting the foreskin back over the glans, wash the penis with mild soap and water - just like you would a circumcised one.  

It is harder to care for a newborn if they are intact.

Actually, it's easier.  There is no post operative care and no need to break adhesions to the surgical site routinely during diaper changes.  Remember two simple steps:  DO NOT RETRACT (not even a little) and wipe what you can see from base to tip, just like a finger.  

You need to retract your son to make sure he doesn't have issues as an adult.

This is very important:  IF INTACT, DON'T RETRACT.  Misinformed healthcare providers and outdated information still suggest that you should start retracting during diaper changes or when your child turns three years of age to prevent an issue called phimosis.  Phimosis is when the opening of the foreskin becomes to tight to allow for full or partial self-retraction to occur.  This can be very painful for adult males and can impact sexual pleasure and function.  We have now learned that most cases of phimosis are actually caused by forced retraction from care givers and health care providers.****  At birth, the foreskin is actually fused to the glans of the penis.  As your child grows, these adhesions gently break away on their own, allowing the foreskin to become retractable between the age of 6 through to the late teens.  Forced retraction causes damage and leads to the build up of scar tissue, which greatly reduces the natural stretch of the skin and tissues and can lead to phimosis.  
****It is important to note that even "a little" retraction from a care provider or parent is still considered forced retraction and can cause irritation, pain, and/or damage to the glans or foreskin.

Your son needs to look like his dad.

This is a common concern amongst circumcised men who are considering leaving their sons intact.  They worry that their son will question why their penises look different, or that it may somehow impact their son's body image or self-confidence.  However, these concerns are needless.  It is a simple enough thing to explain to your son that you chose to keep him intact while his father's parents chose to circumcise him and the difference in appearance will not impact potty training, self-confidence, or your son's body image.  

Your son will be bullied for having an intact penis.

This is known as the Locker Room Myth.  A study in 2015** showed that out of the 10% of boys who were teased about their penises in middle or high school (90% of boys were not teased about their penises at all), 83% were teased about penis size while only 17% were teased in relation to being intact or circumcised.  Finally, 97% of the boys polled who were intact reported that they were happy with their penis and would not change it's appearance.  
**Alexander, Cooper, Storm.  2015.  "Teasing In School Locker Rooms Regarding Penile Appearance" Journal Of Urology, 193:3, 983-988 

Intact Care

Intact care is SIMPLE!  Wipe any stool or urine off the exterior of the penis from base to tip, just as you would a finger.  Never retract, not even a little.  

If you are interested in more information about circumcision, why circumcision rates are so high in the United States, information about intact care, and functions of the foreskin I recommend watching the YouTube video Child Circumcision: An Elephant In The Hospital.

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