What Is Circumcision For Children?
Circumcision is a surgery to remove the skin covering the end of the penis. This skin is called the foreskin/prepuce. This surgery is most often done 1 or 2 days after a baby’s birth when it is done as a matter of routine as in Western nations, or for religious purposes as in the case of Jewish and Muslim faiths. Circumcision can also be done on older children. This can be more complex. An older child may need medicine (general anesthesia) to put them to sleep during the procedure.
Why Might A Child Need Circumcision?
In some cultures, circumcision is a religious practice or a tradition. It's most common in Jewish and Islamic faiths. Circumcision is often done 1 to 2 days after birth as a routine in some countries like the U.S, though as an elective procedure. It's helpful to decide before the baby is born.
It's important to learn about the benefits and risks of circumcision. According to the Indian Academy of Pediatrics (IAP):
Problems with the penis (such as irritation) can happen with or without circumcision.
There is no difference in health and cleanliness (hygiene) with or without circumcision, as long as a child can handle cleaning and care.
There is a higher risk of urinary tract infection (UTI) in uncircumcised children. This is more so in babies younger than 1 year old. But the risk for UTI in all children is less than 1%.
Newborn circumcision does give some protection from cancer of the penis later in life. But the overall risk of penile cancer is very low in developed countries.
Circumcised kids and adults have a lower risk for some sexually transmitted infections. This includes HIV.
The IAP has found that the health benefits of circumcision are greater than the risks. But the IAP also found that these benefits are not great enough to advise that all newborn babies be circumcised. Parents must decide what's best for their baby.
What Are The Risks Of Circumcision For A Child?
Circumcision as with any other surgical procedure has some risks. But the rate of untoward events is low. The most common risks are bleeding and infection.
The skin of the penis also becomes very sensitive after a circumcision. The area can get irritated from contact with the baby’s diaper or with the ammonia in urine. This can be treated by putting petroleum jelly/coconut oil or any other lubricant on the penis for a few days.
There may be other risks like prolonged bleeding if the child has a bleeding disorder. This depends on your baby’s pre existing health condition. It is best to talk about any concerns you have with the concerned surgeon before the surgery.
What Is A Partial Circumcision?
In a partial circumcision, only part of the foreskin is removed.
In many cases, only the topmost portion of the foreskin is removed, exposing the tip of the penis but leaving the bottom, or corona, of the penis head covered by the remaining foreskin tissue.
What Are The Benefits Of This Procedure?
Partial circumcision may be done instead of a full circumcision for various reasons. You may simply want to keep your foreskin for personal or aesthetic reasons (especially in case of Hindus, in a country like India), or you may feel uncomfortable removing the entire foreskin in your baby, especially if you’ve had it your whole life.
Partial circumcision may not always be an option. If the foreskin has become stuck due to the formation of scar tissue, one may need to have the entire foreskin removed. This is often a complication of phimosis, balanitis, or infections that occur underneath the foreskin.
Phimosis treatment
Partial circumcision is sometimes done to treat phimosis in young boys or adolescents when other treatments, such as steroid ointments or creams, haven’t worked.
How To Get A Child Ready For Circumcision?
Make sure the paediatric surgeon fully explains the procedure. Understand the pros and cons and risks involved. Ask if anesthetic is used for a circumcision. The American Academy of Paediatrics advises a local anesthetic. This helps reduce a baby’s pain during the procedure.
If your baby is premature(born early) or has other health problems, they may not be circumcised until they're ready to leave the hospital. If the baby has a physical problem with their penis like for example Hypospadias, they may not be circumcised. This is because the foreskin is used in a future surgery on the penis.
What Happens During Circumcision For A Child?
The procedure is usually done by an paediatric surgeon or a paediatric urologist in the hospital. When it's done for religious reasons, other people may do the surgery after the baby comes home from the hospital.
Circumcision is done only on healthy babies. The procedure is painful as it involves cutting off skin. So a local anesthetic agent like lignocaine is used. This numbs the area of the penis where the incision will be made. There are different types of anesthetic. A paediatric surgeon may also put a numbing cream on your child’s penis. Or they may inject small amounts of anesthetic around the penis. There are risks with any anesthetic agent, but these are considered safe. In addition to the anesthetic, your provider may give your baby a pacifier dipped in sugar water. This can help soothe them while the procedure is happening.
A circumcision can be done in several ways. The procedure usually takes about 15 minutes or less. The procedure goes like this:
· The paediatric surgeon will give the baby a local anesthetic.
· The surgeon then cleans the penis with an antiseptic like chlorhexidine or povidone iodine.
· The paediatric surgeon will gently loosen the foreskin from around the head of the penis, separating any adhesions, making a small slit in the foreskin.
· The surgeon may use one of the common methods to remove the foreskin.
These methods use devices that help protect the penis while removing the foreskin.
· The provider may attach a clamp (Mogen/Gomco) over the head of the penis.
Or he may place a plastic ring (Plastibell) over the head of the penis. This makes it easier to cut the foreskin.
·
The paediatric surgeon will then use surgical tools (surgical blade/scissors) to remove the foreskin. This exposes the glans head. The bleeding surfaces may be gently coagulated with electrocautery or stitches and the procedure is complete.
If clamps are used the bleeding is negligible. In case of plastibell, the bell head falls off on its own in a few days(10-12).
In conventional open circumcision or sleeve technique stitches are taken with absorbable suture material to control bleeding and ensure a good cosmetic appearance.
· The surgeon may place some petroleum jelly or ointment on the glans head of the penis and cover it with a loose gauze dressing. This is usually a day care procedure and the child doesn't need to stay back in the hospital.
What Is The Post Circumcision Care For A Child?
After the circumcision, parents need to care for the baby’s penis until it heals. This includes cleaning the area with plain/lukewarm water at least once a day. In the initial couple of days lukewarm baths are advised (Sitz baths). After a bowel movement the operated area would also need to be cleaned. Then let the area dry, and put petroleum jelly/medicated ointment as advised on it. This keeps the gauze dressing from sticking.
The parent may be asked to remove the dressing the next day. They may be asked to use a new dressing, and some petroleum jelly, each time they change diapers. When the gauze dressing is no longer needed, parents may be told to keep putting petroleum jelly on the end of the penis for a few more days. This helps prevent the penis from sticking to the diaper.
Some swelling on the penis is normal. It's also normal for the penis to develop a crust/scab. This will go away after a few days. The lukewarm baths also help with this. A small amount of bleeding may occur. But if it is copious, one might to consult the surgeon. If the penis keeps bleeding, apply firm pressure with a washcloth for a few minutes. Then look to see if the bleeding has stopped. If the bleeding continues, bring your child to the emergency room.
A baby’s penis usually fully heals from a circumcision in 1-2 weeks.
Schedule a visit to the paediatric surgeon if your baby has any of the following Red Flag Signs:
· Fever.
· Bleeding that just doesn't stop.
· No urine 6 to 8 hours after the procedure.
· Redness or swelling on the glans or stitch line, that doesn’t get better after 3 days, or gets worse.
· Yellow discharge or yellow coating on the penis after 7 days, that doesn't go away with gentle cleaning.