NEONATAL CIRCUMCISIONS

Summary

Boys are born with a hood of skin, called the foreskin that covers the head or glans of the penis. Circumcision is the surgical removal of the skin covering the head of the penis (the foreskin). Circumcision is a fairly common surgery for newborn boys (as well as older boys and men) in certain parts of the world, done for a variety of personal reasons. The removal of the foreskin of the penis does have some benefits including easier hygiene, prevention of balanitis, balanoposthitis and phimosis, and a decreased risk of urinary tract infections, STDs and penile cancer.

The decision to circumcise a newborn baby is entirely the parent's personal choice. In the United States, 85% of newborn male babies are circumcised. The WHO (World Health Organization) suggests that all male babies should be circumcised.

In this practice, the decision for a child to be circumcised may be for religious and cultural reasons, personal hygiene or preventive health care. The decision for a child to be circumcised is often based on whether or not the father of the child previously having been circumcised, but parents should discuss the benefits and risks of the procedure before making this decision.

Reasons:

• Personal preference
• Religious or cultural reasons

Procedure:

For newborns, circumcision is done within the first 10 days of life. The procedure is done with sterile equipment in the nursery and occasional in the procedure room. The groin area is cleaned, and an anaesthetic is given to numb the penis. Your baby will not feel any pain and will have no awareness or recollection of the procedure having been performed. A clamp is then used to seal off all the relevant blood vessels. The excess foreskin is clipped off, and the clamp is removed.

There should be no ongoing pain as the local anaesthetic lasts for 4-6 hours, and no pain medication is needed thereafter. The wound should heal within 3-5 days. There may be some swelling initially, and possibly a little bit of bruising related to the area of injection of local anaesthetic.

Should you have any other specific questions, these can be addressed prior to the procedure.

Recovery:

• After the operation, a small piece of gauze (surgical) is put directly on the wound and turns brown immediately.
• When first viewed, this may look like a scab; however, this will fall off during the course of a routine cleaning or bathing the baby.
• Each time that the nappy is changed (usually 2-3 hourly) the wound is gently cleaned with cotton wool balls and saline or sterile water.
• No surgical spirits are to be used on the wound when cleaning.
• Following gentle cleaning, a generous amount of unscented Vaseline should be applied to the tip of the penis to moisturize it and allow it not to stick to the nappy.
• The baby may be bathed the next day.
• No further follow-up is required unless there are specific concerns, and these can be relayed directly to Dr Kavin’s office, and a follow-up appointment will be scheduled.

Complications:
The risk of complication is 1:1000 circumcisions, either bleeding or local infection.

• Any acute complications the baby must be brought back to the hospital via the emergency department, and Dr Kavin will be informed immediately.
• Should there be a problem with bleeding then local pressure application should suffice to stop the bleeding (Once again, this is an extremely rare complication).