Since times immemorial, circumcision has inspired plenty of heated debates and even wars! Its proponents and opponents are quite rabidly fanatic about their views. I do not propose to get into any controversy about this touchy subject.
Phimosis in simple terms means a tight foreskin that does not retract easily to reveal the urinary opening. In the normal newborn, the foreskin is firmly adherent to the underlying glans. As the child matures, there is a gradual separation of the foreskin from the glans by a process of shedding of cells (the so-called ‘white pearls’ or smegma). Separation is complete in 50% of boys by the age of three years, 95% by the age of five years, and by puberty, 99% of boys have a fully retractable foreskin (up to the junction of the body and the head of the penis).
In most children, this physiological phimosis does not cause problems, and they do not require circumcision unless requested for religious or for so-called “health” reasons.
DOES MY UNCIRCUMCISED BOY REQUIRE SPECIAL CARE?
Uncircumcised boys do not require special care. Learn how to take care of an uncircumcised boy.
Does my child require circumcision?
Your child may require circumcision if he has any of the following:
- Ballooning of the foreskin
- Redness
- Itching at the tip of the penis
- Pain while passing urine
- Urinary tract infection during infancy
Doctor, my infant cries just before passing urine. Does he have phimosis and does he require circumcision?
Most infants cry just before passing urine and afterward too! This is primarily to bring attention to themselves and a way of telling you to promptly alleviate an uncomfortable situation for them! Unless a child has any of the symptoms above, he does not require circumcision.
Is circumcision very painful?
Circumcision is an operation that is relatively more painful. The genital area is more sensitive and kids tend to be a little cranky and irritable especially when passing urine.
However, we give pain-killers in appropriate doses, so that your child is comfortable in the post-op period.
Can this operation be done under local anesthesia?
I prefer to perform circumcisions under general anesthesia, except in the newborn child (religious reasons). General anesthesia is very safe and the child is not subject to any significant extra risk.
The Operation
During circumcision, we remove the foreskin and then suture the residual penile skin to the junction of the head (glans) and the body of the penis.
POST-OPERATIVE CARE OF THE CIRCUMCISED CHILD
- In the immediate postoperative period, please follow the General postoperative instructions.
- The child will have a small sling-type dressing that hooks up the penis to the lower abdominal wall. This dressing will be removed by the nurse prior to the child going home.
- The child may have some difficulty in passing urine in the first 24-48 hours after surgery. He will experience pain while passing urine and may tend to hold his urine back. Even if the child does not pass urine until the morning after surgery it is OK. If the child does not pass urine beyond this, then please contact me
- Give sponge baths to the child in the first 48 hours after surgery. You should come in for a follow-up visit to me after 48 hours. After this child should sit in a sitz bath for ten minutes, thrice a day. The child can take a shower after that if desired. Apply soap to the rest of the body, but not to the genitals. This is to avoid frictional contact at the operated area. If the soapy solution falls on to the operated area it is OK.
Do protect your valuable flooring from stains by keeping a mat under the tub. The stains are very difficult to remove. - There is a variable amount of penile swelling, that slowly subsides over a period of time. It takes about a month for the penis to look completely normal.
- Oozing and encrustations are inevitable. Serous oozing (yellowish discharge) is to be expected and is not pus.
- Some amount of bleeding occurs in almost all children and subsides spontaneously. If there is persistent bleeding, then apply pressure over the bleeding point. If not controlled with pressure, either contact me or report to the hospital where your child has been operated.
- The child will also pass urine in a spray especially if there are encrustations at the tip. This will disappear once the area in front of the meatus is clean.
- Follow up: In general, I call the child back for inspection of the wound on the second and the seventh postoperative days.
- The foreskin will not grow back after some time. Do not worry! The skin on the head of penis develops more layers over time and becomes much less sensitive to routine touch. The sexual pleasure experienced is the same in both circumcised and uncircumcised males (data from men who were circumcised after they were sexually active).
If your child has been advised circumcision and you would like more information, please click here.